Keeping Up With The Counseling Profession: Current Issues on the National Level

David Kaplan ACA Chief Professional Officer Scott Barstow ACA Director of Public Policy & Legislation Janis Manalang ACA Doctoral Intern 2013 ACA Institute for Leadership Training

This year’s theme Closure

Counseling Professional Issues

THE ASSOCIATION FOR ASSESSMENT AND RESEARCH IN COUNSELING (AARC) The Association for Assessment in Counseling and Education (AACE) has become

The next CACREP standards revision has begun Slated for 2016

More evolutionary than revolutionary “Clarify, Simplify, and Unify”

One big change in draft #1 All entry-level programs, including career counseling, school counseling, and student affairs and college counseling be comprised of 60 credit hours by July 2020

Discrimination against LGBTQ clients Two high profile lawsuits settled

Ward v. Wilbanks Eastern Michigan University

Ward v. Wilbanks A practicum student referred rather than counsel a homosexual client. After due process, the student was dismissed from the counseling program. The student sued the university counseling faculty and officials alleging violation of her 1 st & 14 th amendment rights, including to practice her religious beliefs.

The Judge ruled against the student and for the EMU counseling program ACA has posted the decision at:

Judge’s Opinion University programs have the right to set standards. There is a “rational basis” to adopt the ACA Code of Ethics into a counselor preparation program. It is reasonable to use CACREP standards in a counselor preparation program.

However……

The case was appealed and sent back to District court ACA filed an amicus brief in support of the original decision

Depositions were taken for a January, 2013 trial

An out of court settlement was reached (12/11/12)

Augusta State University lawsuit Keeton v. Anderson-Wiley

The Judge ruled against the student and for the ASU counseling program

“This is not a case pitting Christianity against homosexuality”. Rather, the judge ruled, it is about a university enforcing reasonable standards - the ACA Code of Ethics.

An appeal was denied by the 11 th federal circuit court

And in February an appeal for the circuit court to revisit their decision was denied

Leaves all court rulings to date intact Graduate counseling programs have the right to set standards. There is a “rational basis” to adopt the ACA Code of Ethics into a counselor preparation program. It is reasonable to use CACREP standards in a counselor preparation program.

And…. It continues to be a major violation of the ACA Code of Ethics for a counselor to discriminate against clients on the basis of sexual orientation

State legislative bodies have gotten into the act….

It’s getting personal…language from Michigan SR 66 “Whereas, The American Counseling Association, a private organization that promulgates a code of ethics widely used by university counseling programs and state licensure boards in training for and regulating the counseling profession, has publicly supported universities that have punished or dismissed students for adhering to their sincere religious convictions…”

California recently banned reparative therapy for children

The Future of Counseling

20/20: A Vision for the Future of Counseling

The 20/20 consensus definition of counseling

Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

29 Organizational Endorsements ACA ACA MWR ACA NAR ACA SR ACA WR AACE AADA AASCB ACC ACCA ACEG ACES AGLBTIC AMCD AMHCA ARCA ASERVIC ASGW C-AHEAD CACREP CORE CRCC CSI IAAOC IAMFC NBCC NCDA NECA NRCA

The 20/20 Building Blocks to Portability Project

Building Blocks to Portability The task: Developing a consensus licensure title to recommend to all state licensing boards Developing a consensus scope of practice to recommend to all state licensing boards Developing consensus education requirements to recommend to all state licensing boards

The delegates reached consensus on the licensure title!

Licensed Professional Counselor

And the Scope of Practice!

Some Key Elements Individual, group, couples, & family counseling Promote mental health wellness, development across the lifespan, crisis intervention and the diagnosis and treatment of mental disorders Consultation and program evaluation Supervision Ability to practice independently

Two out of three ain’t bad!

Where does 20/20 go from here?

The DSM-5

DSM-5 - ACA and its members were heard - First time Licensed counselors eligible for participation in DSM field trials for the first time

DSM-5 Out in stores and online GET IT while its hot! Verdict still in for its validity and new content

DSM-5 Major Controversies - Vague wording has increased confusion (i.e. Mild Neurocognitive Disorder) - Intermittent Explosive Disorder lacks needed exclusions to rule out the many other common causes violent behavior

DSM-5 Major Controversies Autism as a spectrum -impossibly muddled, allowing for multiple interpretations that will lead to inherently inaccurate diagnosis -Criteria A-does not specify how many of its 3 are required

DSM-5 Major Controversies - Major Depressive Disorder has a foot note added that adds more confusion and no guidance to the clinicians as to when to diagnose MDD with mild depressive symptoms that occurred in reaction to bereavement or other losses -ADHD looses definition -- Disruptive Mood Dysregulation offers 4 different and inconsistent age range

DSM-5 Tools -ACA Webinars ( click on Continuing Education scroll to webinars *Currently have a series for understanding the changes in the new DSMwww.counseling.org -ACA creating a book to assist professionals to utilize DSM V to the fullest

2013 CPT code changes Dx evaluation goes from to minutes psychotherapy minute psychotherapy minutes psychotherapy ACA CPT update video is on our Private Practice Pointers page at: ers.aspx

New HIPPA Regulation Duty to warn According to Nancy Wheeler, ACA risk management consultant, counselors need to inform clients in consent forms about encrypted s

Alternative Counselor Education Credentialing

Masters in Counseling Accreditation Council (MCAC)

The ACA Code of Ethics Revision

Who is on the ERTF? Jeannette Baca Janelle Disney Perry Francis (Chair) Gary Goodnough Mary Hermann Shannon Hodges Lynn Linde Linda Shaw Shawn Spurgeon Richard Watts Michelle Wade Erin Martz (ACA staff) David Kaplan (ACA staff)

Timeline highlights Task force appointed Summer of 2011 Initial call for member input Fall 2011 Draft composed April Call for draft feedback May 2013 Draft revised based on input June-December 2013 Final draft presented to ACA Governing Council March 2014

ERTF Areas of Focus Social media The imposition of counselor personal values When is a client a client? Removing the end of life exemption Bartering Sliding scale Fee splitting

Legislative Issues

VA hiring of LPCs TRICARE certification of mental health counselors Medicare coverage of LPCs Federal education spending “Religious freedom of expression” legislation Major Issues We’re Following

VA (Non-)Hiring of LPMHCs April 2012 – VA Office of Inspector General report: For half of first-time patients, MH evals took about 50 days As of August 2012, total number of LPCs hired as mental health clinicians within the VA nationwide: 29 Number of VA LPMHC positions posted in 2012: 58 Number of VA social worker positions posted: 1,563

ACA Has… Written to VA Secretary Eric Shinseki, and met repeatedly with multiple VA staff Met with White House staff Met with members of Congress, and worked with them to draft letters to the VA Our goals: Our goals:   Gain cosponsors on S. 1155, legislation introduced by Senator Jon Tester (D-MT) to open up VA paid traineeships to counselors   Establish alternative eligibility criteria for LPCs w/o CACREP degrees   Have VA central office light a fire under local VA directors to hire more counselors

VA & counselors: What you can do Check if you’re curious about VA positions. If (surprise!) you find one not open to counselors, contact the HR person to ask that it be opened to counselors, and copy ushttp://USAJobs.gov Contact your Senators and Representative to ask that they 1) Cosponsor S (Senators only!), and 2) write to the VA to direct them to: – –Broaden the eligibility criteria for LPMHC positions, and instruct VA facilities to open more positions to counselors Share copies with/direct Q’s to Art Terrazas at

now through 2014 TRICARE requirements: now through 2014 Licensed counselors must: have a master's or higher-level degree “from a mental health counseling program of education and training* and either – Pass the NCE or NCMHCE (for CACREP-accredited degrees) OR – Pass the NCMHCE (for regionally-accredited degrees) have 2 years/3,000 hours of supervised clinical practice, "provided by a mental health counselor * For at least CACREP degrees, this is interpreted by DoD to mean only degrees with the title of “mental health counseling” or “clinical mental health counseling”

beginning 2015 TRICARE independent practice requirements: beginning 2015 Licensed counselors must: have a CACREP degree pass the NCMHCE same 2 years/3,000 hours of supervision as previous slide Independent practice only. Practice under physician referral and supervision will no longer be allowed.

TRICARE Mental Health Counselor Certification Requirements: Possible Barriers  Having a degree title other than “mental health counseling” or “clinical mental health counseling”  Not having passed the NCMCHE  Not having 2 years/3,000 hours of supervision under a licensed professional counselor (not psychologist, social worker, etc.)  Not having a CACREP-accredited degree

Comparing the federal standards AgencyMaster’s degree…ExamSupervision Dept of Veterans Affairs …in mental health counseling or related field from CACREP program, Ph.D. not recognized -- TRICARE (after 2014) …from a mental health counseling program of education and training accredited by CACREP NCMHCE2 years/3,000 hrs, 100 hrs face- to-face, meets AMHCA guidelines Army SAP…in counseling from a program accredited by CACREP NCMHCE-- Medicare bill (last year’s S. 604) In mental health counseling or a related field -- 2 years post- master’s

Q: Will Medicare require CACREP degrees?  The House and Senate have each passed Medicare coverage of LPCs/MFTs twice, without ever including CACREP requirement  HHS declined to require even regional accreditation of psychology degrees, said nothing about CSWE when writing regulations for psychologist/SW Medicare coverage  Starting 1/1/2014, Affordable Care Act (ACA) prohibits discrimination against state-licensed providers  HHS is incredibly busy implementing ACA, doesn’t have time to start second-guessing state licensure requirements  Requiring CACREP degrees would defeats the goal of expanding access to outpt. MH services, especially in rural and underserved areas A: Most likely not

Affordable Care Act – Provider Non-Discrimination Provision takes effect January 1, 2014 “Sec * Non-Discrimination in Health Care. (a) P ROVIDERS.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.” * of the Public Health Service Act

Medicare needs mental health providers! Licensed professional counselors Mental Health Professional Shortage Area (HPSA) Michigan

Our best hope: Our best hope: getting a lot of cosponsors on S. 562, to maximize our chance of being included in Senate Medicare physician payment reform package

Federal Spending

Sequestration is now “baked in”. Congress is supposed to take the lead in deciding where cuts happen within each agency over the next 9 years. House and Senate budgets are $91 billion apart on FY 2014 appropriations, and the House doesn’t seem to want to negotiate House Labor-HHS-Education spending proposal would be for ~19 percent less than last year’s funding level Debt ceiling expected to be hit in the fall, after “extraordinary measures” exhausted Federal Spending

“Discrimination is okay” Legislation  Michigan – SB 136: Lengthy bill allowing health care payers, facilities, purchasers, and providers to decline to cover/pay for/provide services that violate their “conscience”  Tennessee – SB 514: institutions of higher education shall not discipline or discriminate against counseling, social work, or psychology students for refusing to counsel clients based on “sincerely held religious beliefs”  Tennessee – SB 234: “Don’t Say Gay” bill  If similar legislation is brought up in your state, please let us know! ACA is firmly opposed to legislation like this, and we will gladly help fight religious discrimination legislation

How counselors can keep up with current national issues ACA Connect Read Counseling Today Read CT online Read ACA e-News Subscribe to the ACA blogs Subscribe to the ACA Government Relations Listserv

Visit the ACA Facebook page Follow ACA on Twitter Subscribe to counseling listservs (cesnet, counsgrads, icn, etc.) Use Google alerts Ask Scott or David

Let’s schmooze!

David Kaplan ACA Chief Professional Officer Scott Barstow ACA Director of Public Policy & Legislation Janis Manalang ACA Doctoral Intern 2013 ACA Institute for Leadership Training