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

Transcription

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

2 David Kaplan ACA Chief Professional Officer Scott Barstow ACA Director of Public Policy & Legislation Janis Manalang ACA Doctoral Intern 2013 AASCB Conference

3

4 This year s theme

5 íel Código Ética de ACA ya se ha traducido en español! The ACA Code of Ethics has now been translated into Spanish!

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

7 The next CACREP standards revision has begun Slated for 2016

8 More evolutionary than revolutionary Clarify, Simplify, and Unify

9 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

10 CACREP is soliciting feedback on the first draft until January 15 at

11 Discrimination against LGBTQ clients Two high profile lawsuits settled

12 Ward v. Wilbanks Eastern Michigan University

13 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.

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

15 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.

16 However

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

18 Depositions were taken for a January, 2013 trial

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

20 Augusta State University lawsuit Keeton v. Anderson-Wiley

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

22 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.

23 An appeal was denied by the 11 th federal circuit court

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

25 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.

26 State legislative bodies have gotten into the act.

27 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

28 California recently banned reparative therapy for children

29 The Future of Counseling

30 20/20: A Vision for the Future of Counseling

31 The 20/20 consensus definition of counseling

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

33 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

34 The 20/20 Building Blocks to Portability Project

35 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

36 We have a licensure title!

37 Licensed Professional Counselor

38 The DSM-5

39 DSM-5 Little APA has been working on the DSM-5 revision for a decade. The little APA Board of Trustees approved the final draft 12/12. Publication now slated for May 2013.

40 ACA has sent three DSM-5 letters June 11, November 8, April 16,

41 And received a response letter from the American Psychiatric Association DSM-5_response_11-11.pdf

42 Licensed counselors eligible for participation in DSM field trials for the first time

43 Some DSM-5 apparent changes

44 The multiaxial system will be replaced by dimensional assessments

45 Autism becomes a spectrum

46 Extending dx Disruptive Mood Dysregulation Disorder Bereavement becomes part of Major Depressive Disorder Minor Neurocognitive Disorder Binge Eating Disorder

47 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:

48 ASCA National Model Revision For highlights visit the ASCA website at: +a+model+school+counselor%3f&utm_campaign=model+sc+ &utm_medium=

49 ACA Feedback to ASCA The ASCA model has been instrumental in advancing school counseling programs. Serving diverse, underserved, and high needs populations have not been sufficiently addressed. ACA does not agree with the statement that working with one student at a time in a therapeutic, clinical mode is an inappropriate activity.

50 Alternative Counselor Education Credentialing

51 Masters in Counseling Accreditation Council (MCAC)

52 The ACA Code of Ethics Revision

53 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)

54 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

55 ERTF Areas of Focus The imposition of counselor religious values When is a client a client? Social media Bartering Sliding scale Fee splitting

56 Legislative Issues

57 Big Issues You Should Know About VA hiring of LPCs TriCare certification of mental health counselors Medicare coverage of LPCs Affordable Care Act developments Religious freedom of expression legislation

58 VA Hiring of LPMHCs is it really happening? September 2010 LPMHC standard released April 2012 VA Office of Inspector General report: For half of first-time patients, MH evals took about 50 days April 24, 2012 VA Press release: VA adding family therapists and mental health counselors to workforce Number of VA LPMHC positions posted in 2012: 58 Number of VA social worker positions posted: 1,563

59 VA & counselors going forward ACA is talking to staff within the Administration and in Congress about the need for concrete action by the VA to bring more counselors into the VA system, and for alternative routes to eligibility for LPMHC positions for counselors from non-cacrep programs ACA and its members have worked to generate letters from members of Congress to the VA on this issue, including from Rep. Michael Michaud (D-ME), Rep. Walter Jones (R-NC), and Senators Barbara Mikulski and Ben Cardin (both D-MD)

60 Rep. Michaud letter to the VA Michaud ( ME-show ), from Maine, is ranking minority member of the Health Subcmte of the House VA Committee, past recipient of the ACA Federal Legislative Service Award ACA drafted letter with Michaud s staff Michaud letter to VA Secty Shinseki, sent June 26, expresses concern over VA s failing to take advantage of licensed professional mental health counselors and MFTs asks VA what actions it has taken to accelerate the hiring of LPMHCs/MFTs, what it s doing to address misunderstandings and misinformation at the facility level asks VA why LPMHC/MFT interns are ineligible for the same financial stipends given to psychologists and LCSWs

61 VA & counselors going forward ACA is talking to staff within the Administration and in Congress about the need for concrete action by the VA to bring more counselors into the VA system, and for alternative routes to eligibility for LPMHC positions for counselors from non-cacrep programs Counselors can help! If a VA mental health clinician position is posted on USAJOBS as not open to counselors Contact the HR person to ask that it be opened to counselors Contact your Senators and Representative to ask that they contact the VA facility to ask why counselors aren t being made eligible for the position and copy us! Art Terrazas is our lead on VA issues aterrazas@counseling.org

62 TRICARE independent practice 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 who is licensed for independent practice in mental health counseling in the jurisdiction where practicing and must be conducted in a manner that is consistent with the guidelines for supervision of AMHCA

63 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.

64 TRICARE certification We encourage counselors to apply for certification now, before transition period ends DoD may modify the requirements, but isn t saying if/when this would happen ACA has asked DoD to extend transition period, recognize all state-recognized supervision hours, and allow counselors from non-cacrep programs to meet the exam and supervision hours requirements after 1/1/2015

65 Comparing the federal standards Agency Master s degree Exam Supervision 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 NCMHCE 2 years/3,000 hrs, 100 hrs face-to-face, meets AMHCA guidelines Army SAP Medicare bill (last year s S. 604) in counseling from a program accredited by CACREP In mental health counseling or a related field NCMHCE years postmaster s

66 What the debate on Medicare coverage of counselors is about these days It s not about policy: The legislation has been passed twice in both the Senate and House over the past 9 years

67 Medicare coverage of counselors can save money! Tx costs for Medicare beneficiaries with both diabetes/chf and depression are about ~50% higher than w/o depression Across 8 common medical conditions, elderly Medicare beneficiaries with comorbid depressive syndrome were 2 X as likely to use the ER as those w/o depression 32% of Medicare spending (0.32 X $575b = $184b) is on people with diabetes, and depression/dysthymia occur in ~12% of patients with diabetes. Medicare spends $22-$30 billion a year on beneficiaries w/diabetes and depressive disorder Even a 2% reduction in spending---just on beneficiaries with diabetes and depression---would save >$2 billion over 5 years, twenty times the $0.1b cost of covering LPCs & MFTs

68 There will be a Medicare legislation train in 2013 The Medicare sustainable growth rate (SGR) formula is still in effect, and will cut physician payments by ~27% starting January 1, 2014 Congress will do something this year to deal with this, and if they include enough $$ s to do more than just fix MD payment rates, we want on the train

69 Affordable Care Act Provider nondiscrimination provision All health insurance plans must cover mental health and substance abuse services, at parity with general health care services 32 million more people with health insurance Insurance reforms: no lifetime/annual dollar limits; no coverage rescissions; no preexisting condition exclusions; guaranteed acceptance and renewal; appeals processes required Emphasis on preventive services including depression screenings

70 Affordable Care Act Provider Non-Discrimination Provision takes effect January 1, 2014 Sec * Non-Discrimination in Health Care. (a) PROVIDERS. 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

71 Affordable Care Act Proposed rule on Essential Health Benefits Beginning 2014, All non-grandfathered health plans must cover mental health and substance use disorder services, including behavioral health treatment, in compliance with MHPAEA States must defray costs associated with state-mandated benefits beyond those in the state s benchmark plan, BUT [S]tate rules related to provider types, cost-sharing, or reimbursement methods would not fall under our interpretation of state-required benefits. Even though plans must comply with those state requirements, there would be no federal obligation for states to defray the costs associated with those requirements.

72 Religious discrimination is okay laws Michigan legislature considered legislation in 2012 (SB 975) to allow health care providers, facilities, and payers to decline to provide services that violate their conscience Arizona has two laws on the books, nothing heard yet on their effect on counselor graduate program CACREP accreditation or counselor licensure. Ironically, Arizona s counselor licensure law requires adherence to the ACA Code of Ethics. 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

73 Arizona s free exercise of religion laws 2011 HB 2565: Prohibits schools from disciplining a student in a counseling, SW, or psychology program because the student refuses to counsel a client about goals that conflict with the student s sincerely held religious belief 2012 SB 1365: Prohibits denial, suspension, or revocation of a person s license or certification for: Declining to provide any service that violates the person s sincerely held religious beliefs Expressing sincerely held religious beliefs in any context, as long as services provided otherwise meet the current standard of care or practice for the profession Providing faith-based services that otherwise meet the current standard of care or practice for the profession Making business-related decisions in accordance with sincerely held religious beliefs, including employment decisions, client selection decisions, and financial decisions

74 How leaders can keep up with current national issues Read Counseling Today Read CT online Read ACA e-news Subscribe to the ACA blogs Subscribe to the ACA Government Relations Listserv

75 How leaders can keep up continued Visit the ACA Facebook page Follow ACA on Twitter Subscribe to counseling listservs (cesnet, counsgrads, icn, etc.) Use Google alerts Ask Scott or David

76 Any questions? Scott: ext ext. 397 Powerpoint posted at:

77 Let s schmooze!

78 David Kaplan ACA Chief Professional Officer Scott Barstow ACA Director of Public Policy & Legislation Janis Manalang ACA Doctoral Intern 2013 AASCB Conference