BILL ANALYSIS ---------------------------------------------------------- |Hearing Date: April 30, 2001 |Bill No:SB | | |537 | ---------------------------------------------------------- SENATE COMMITTEE ON BUSINESS AND PROFESSIONS Senator Liz Figueroa, Chair Bill No: SB 537Author:Vasconcellos As Amended:April 3, 2001 Fiscal: Yes SUBJECT: Alcohol and drug abuse counselors. SUMMARY: Creates state licensing and regulation for persons who provide alcohol and drug dependency counseling services for compensation by a new Board of Alcohol and Drug Abuse Counselors within the Department of Consumer Affairs. Existing law: 1)Provides for the licensing and regulation of by various healing arts practitioners, including those who provide counseling-related services, such as psychologists licensed by the Board of Psychology, and social workers and marriage and family therapists licensed by the Board of Behavioral Science. 2)Provides for the licensing and regulation of narcotic treatment programs (NTPs) by the California Department of Alcohol and Drug Programs (DADP). 3)Does not require the licensing or regulation of persons who provide alcohol and drug dependency-counseling services for compensation. This bill: 1)Licensing Board . Creates within the Department of Consumer Affairs, the California Board of Alcohol and Drug Abuse Counselors (Board), composed of nine members as follows: SB 537 Page 2 (a) Eight licensees: two of whom are to be voting members of the National Association of Alcoholism and Drug Abuse Counselors, two of whom are to be alcohol and drug abuse counseling educators, two others of whom are to have a background in social model recovery programming, and the remaining two licensees are not specified to have any other particular background. (b) One consumer of alcohol or drug abuse counseling services who is not a licensee or employed in the alcohol or drug abuse counseling field. 2)Registration and licensing authority . Provide for the registration and licensing by the Board of persons who render alcohol and drug dependency counseling services, or related services , for compensation, to an individual, group, organization, corporation, institution, or the general public. 3)Registration and Licensing categories and qualifications . Specifies one category of registration and three categories of licensing, and specifies the criteria required for issuance of a registration or a license as follows: (a) Registration - if the applicant is a California resident, at least 18 years old, has completed a professional ethics and orientation class, and has signed a code of ethics approved by the Board. (b) Licensed Addiction Counselor I : if the applicant is a California resident, at least 18 years old, has graduated from high school or possesses a general education development equivalent (GED), has at least 2080 hours of experience working with chemically dependent persons in a supervised setting, and has completed 90 hours of classroom education or training in a Board approved curriculum; OR has current certification as a Certified Addiction Specialist by the California Association of Addiction Recovery Resources; OR has certification as a Certified Addiction Specialist by the California Association of Addiction Recovery Resources (c) Licensed Addiction Counselor II : if the applicant is a California resident, at least 18 years old, has a high school degree or a general education development SB 537 Page 3 equivalent, has completed 315 hours of classroom instruction in a Board-approved curriculum, has 4000 hours of experience working with chemically dependent persons in a clinically supervised setting, has completed 300 hours of field work in a clinically supervised setting, has submitted two letters of reference from licensees, and has passed a Board-approved oral and written exam; OR has current certification as an alcohol and drug abuse counselor by the National Association of Alcoholism and Drug Abuse Counselors, the California Association of Alcoholism and Drug Abuse Counselors, the International Certification and Reciprocity Consortium, or by the California Association of Alcohol and Drug Educators; (d) Licensed Addiction Practitioner : if the applicant meets all of the requirements for licensing as a Licensed Addiction Counselor II (Item(c) above) and has a master's or doctorate degree in alcohol and drug counseling or a related human services field from a Board-approved college; OR who meets all of the requirements for licensing as a Licensed Addiction Counselor II (Item (c) above) and who has a bachelors degree in addiction counseling or a related human services field, and five years of counseling experience. 4)Grandfather licensing clauses . Limits the duration of the alternate "grandfather" provisions for license qualification for a Licensed Addiction Counselor I or II and a Licensed Addiction Practitioner (i.e., the "OR " alternative qualifications in paragraphs (c), (d) and (e) above) to one year, until January 1, 2003. 5)Provisional Licenses . Authorizes the Board to issue a five (5) year "provisional license" for a Licensed Addiction Practitioner to an applicant who meets all of the licensing criteria for a Licensed Addiction Counselor II and who is currently enrolled in a bachelor's or master's degree program that satisfies the requirements for licensing as a Licensed Addiction Practitioner. Allows one five (5) year renewal of a five (5) year provisional license (thereby allowing 10 years of provisional licensure), and terminates the Board's authority to issue provisional licenses in four years, on January 1, 2006. SB 537 Page 4 6)Authorized Licensed Practices . (a) Authorizes a Licensed Addiction Counselor I or II to perform screening, intake, orientation, assessment, treatment planning, treatment, case management, substance abuse, dependence crisis intervention, client education, referral activities, recordkeeping, and consultation with other healing arts professionals and in connection with alcohol or drug abuse counseling, either while under the supervision of a Licensed Addiction Practitioner or other licensed medical or mental health professional, or while employed in an alcohol or drug treatment program licensed or certified by the state, a Department of Corrections facility, or a hospital or clinic licensed by the State Department of Health Services. (b) Authorizes a Licensed Addiction Practitioner to perform all of the above functions without any supervision in any setting and to supervise, direct or instruct others who provide alcohol and drug abuse treatment services. 7)Title protection . Makes it a misdemeanor for an unlicensed person to use license titles or related initials, or practice or attempt to practice alcohol and drug abuse counseling. Exempts from these prohibitions: (a) persons who are licensed to perform alcohol and drug abuse counseling who does not use a license title or representation that he or she is licensed, (b) members of peer or self-help groups who do not use a license title or representation, or (c) a student enrolled in an accredited school of alcohol and drug abuse counseling providing services under qualified supervision. 8)Fees and repealer . Requires the Board to assess an unspecified fee for registration and license issuance and renewal, and provides an unspecified date for repeal of all of the bill's licensing provisions. FISCAL EFFECT: Unknown. Legislative Counsel has keyed this as a fiscal bill. COMMENTS: 1.Purpose. This bill is sponsored by the California Association of Alcoholism and Drug Abuse Counselors (CAADAC) to provide for the licensure of alcoholism and SB 537 Page 5 drug abuse counselors at three tiers or levels to reflect the training, experience and educational level of counselors employed in a wide range of settings, and to provide for registration for new counselors entering the field. The purpose of the new proposed state regulation is to assure that persons who are counseling alcoholics and drug addicts are competent and ethical. 2.Background. Current California law provides for the licensing and regulation of alcoholism or drug abuse recovery or treatment program, including narcotic treatment programs, by the Department of Alcohol and Drug Programs (ADP). However, state law does not mandate any specific education or training to assure the minimum competency or ethical behavior of persons who are providing alcoholism or drug abuse counseling or treatment within those programs. There appear to be a number of private professional certifying organizations, including but not limited to this bill's sponsor, who have established their own educational, training, and experience standards for counselors. Materials provided by the CAADAC indicate that there are approximately 1300 persons with valid certification by CAADAC. Further, the sponsor states that it has certified over 2500 people over the past 20 years, many of who continue to work without maintaining a current certification. Last year the voters passed Proposition 36 which provides, effective July 1, 2001, that: (1) a person convicted of a nonviolent drug possession offense shall receive probation with completion of a drug treatment program as a condition of probation; and, (2) a person's parole may not be suspended or revoked for commission of a nonviolent drug possession offense, or for violating a drug-related condition of parole, and that an additional condition of parole for those offenses or violations shall be completion of a drug treatment program. As a result of the passage of Prop. 36, it is anticipated that there will be an increased demand for drug treatment programs and counselors. According to the sponsor, there have been over 200 new applications for drug program certification/licensure since the passage of Prop. 36, without a corresponding increase in the number of SB 537 Page 6 certified counselors. According to the sponsor, there are about 20 other states that currently have some form of state licensure for alcohol and drug abuse counselors. The education, training and experience requirements in those states vary from no educational requirement, to a high school diploma or up to a master's degree; to no minimum number of educational hours up to 270 hours; and from 880 hours of supervised experience up to 6,000 hours, or 18 months of training. 3.Arguments in Support. The author and sponsor argue, that except for criminal penalties for sexual exploitation of clients, there are no controls or regulations placed on alcohol and drug abuse counselors to assure that they are competent or ethical. They argue that the lack of standards in the treatment of addicts borders on discrimination, in that no other life-threatening disease is treated by lay persons whose only qualification is that they have had the disease (were addicts.) The expectation that recovering addicts, who are the primary source of new counselors, are unable to become educated and tested for competency has resulted in the current shortage of treatment providers according to proponents. The lack of a "career ladder" and the scourge of abusive counselors who are allowed to continue "treating" clients are believed to have made the profession one in which the pay is traditionally slightly higher than minimum wage. This is said to lead counselors to pursue licensure by other licensing boards or to move into administrative or teaching positions to obtain better salaries, thereby draining the talent from the profession and reducing its capacity to serve the needs of the addicted. The proponents believe that the bill would create a career path that will lead to an increase counselors, both in the short term and the long term. The proponents argue that it is difficult to quantify consumer harm because, unlike other medical conditions, when poor treatment is received, the client is unaware and inherently vulnerable to accepting responsibility for failed treatment outcomes. Proponents also state that in cases of abuse, particularly of women, the victims are reluctant to speak out since their word as an addict is SB 537 Page 7 likely to be discounted. It is argued that private certification and the threat of revoking professional credentials is ineffective because there are many certify organizations and treatment programs for counselors to circulate through, without being confronted with any repercussions from their incompetent or unethical actions. According to the author, the inadequacy of the current law has been exacerbated by the passage of Prop 36 and the influx of $150 million in new funding each year for drug treatment that will generate a great potential for fraud and abuse. Because a drug abuse treatment program can consist of a single individual of unproven qualifications, it is argued that the potential of referring addicts to unqualified persons is a grave one. According to the author, the Department of Alcohol and Drug Programs has conducted meetings on this subject for over 10 years - but efforts to establish minimum counselor requirements have been thwarted by the economic stakeholders of the industry (the drug programs). 4.Arguments in Opposition. The California Association of Marriage and Family Therapists (CAMFT) opposes the bill unless it is amended to specify a "scope of practice" that clearly delineates the limited services that may be provided by alcohol and drug abuse counselors. CAMFT believes that the bill should make it clear that it is outside the scope of practice for such counselors to diagnose and treat mental, emotional or nervous disorders, and that the proposed licensing act specifically should exempt persons who are appropriately licensed, certified, or registered as physicians, psychologists, marriage and family therapists, and clinical social workers. The California Psychological Association (CPA) opposes the bill stating that it would allow "counselors" with minimal education to work with critically ill drug and alcohol abusers. The CPA notes that a substantial portion of drug and alcohol addicted individuals also suffer from co-occurring mental illness that can compound the difficulties in treating the patient. The SB 537 Page 8 psychologists argue that there are no requirements in the bill that the proposed new counselor licensees have training to recognize these types of conditions, nor does the bill prevent undereducated counselors from treating these more clinically complicated cases via the authority for counselors to provide "related services." The California Organization of Methadone Providers (COMP), and organization composed of narcotic treatment programs (NTPs) licensed by the State Department of Alcohol and Drug Programs (DADP), also opposes the bill stating that it does not believe the licensure of counselors will improve the quality of care that patients receive in state treatment programs. COMP states that opiate addiction is significantly different from others kinds of addictions and that counselors in state licensed NTPs work with physicians and licensed nurses to provide fairly specialized counseling services. COMP points out that its experience in other states, which require alcohol and drug counselor licensure, is that most counselors do not receive specialized training in opiate counseling. In those situations the methadone clinics have had to provide counselors with that specialized training and sometimes instruct counselors to forget the inapplicable alcohol abuse training emphasized by most licensure training programs. At a minimum, COMP believes that the bill's licensure requirements should not apply to NTPs that are licensed and regulated by the state. The California Society for Clinical Social Work opposes the bill arguing that it would exclude professionals who are already licensed to treat these addiction problems and who have proven themselves to be the most effective in doing that counseling. The California Coalition of Addiction Certifying and Credentialing Organizations (CCACCO), the California Association of Addiction Recovery Resources (CAARR), and the California Association for Alcohol/Drug Educators (CAADE) are also all opposed to this bill. These three organizations state that for the past six years they have been working together with other organizations, including the sponsor, which are interested in advancing the concept of certification of persons who work in the SB 537 Page 9 alcohol and drug program field. These opponents have been working to try and reach some consensus on legislation that would establish minimum standards for workers and meet the needs of a diverse client population, assure public safety, establish a career ladder, honor the hard work and dedication of workers, meet the needs of employers and be inclusionary of a very diverse work force. To that end, these organizations have developed their own working draft language for establishing standards for alcohol and drug counselor personnel. They believe that their proposal is a better approach than that being put forward in the bill, and would like to see it amended into the bill as a substitute. One aspect that is different is that their alternative would leave out private practice provisions to be addressed separately. 5.Regulatory Request Questionnaire Provided by Sponsor. Pursuant to Government Code 9148 et seq., the author or sponsor of a proposal to create a new registration program to regulate a profession must provide a plan for the establishment and operation of the new program and/or justification for regulating the particular profession. The sponsor has been working to fulfill this requirement by providing responses to a "Regulatory Request Questionnaire" ("sunrise questionnaire") provided by the Business and Professions Committee. Only a partial draft of responses to that questionnaire was completed prior to this analysis. 6.Issues, Questions and Concerns. As is most often the case, this proposal for new state licensing is being proposed by the occupational group who would be regulated, and not by the consumers of the occupation's services. This always raises some skepticism that the proposed licensing scheme is self-serving rather than necessary to protect the consuming public - in this case alcohol and drug addicts. This is particularly true when the standards being promoted for state licensure appear to be the same as those which proponents already have met to obtain private certification. The intent of the author and the sponsor to assure competent and ethical drug counseling service to the public is laudable. However, it seems that the evidence SB 537 Page 10 of the existence of a problem is largely theoretical, subjective or anecdotal. There appears to be a significant lack of consensus among the various private professional organizations that are involved in alcohol and drug abuse counseling regarding what form of state regulation is warranted, and what the particular educational and training standards should be. The current proposal seems to have adopted the standards of one of the many private certifying organizations and simply placed them in proposed statutes. The estimate as to the potential number of licensees seems to be indefinite. The proposed licensing Board is weighted heavily towards licensee representation (8 licensees to 1 "public" member), and even towards one particular private organization - contrary to the Legislature's trend in recent years to expand the representation of the public on state occupational licensing Boards. There does not appear to be a clearly defined scope of practice related to the education and training and activities of the proposed licensees. As such the potential for overlap with other state licensed professions seems likely to occur and create confusion. The criteria for licensure seems to be rather vague and appears to be leaving it up to the proposed Board to determine. Unlike virtually all state occupational licensing schemes, no examination is required to test the basic skills and abilities necessary for the performance of the profession's services. The grandfather and provisional licensing provisions while accommodating to those currently performing alcohol and drug counseling services, appear to undercut the assurance that licensed practitioners will have the minimum education and training that is being proposed as needed to perform with minimum competency. It seems that, as with other professions that are licensed by the state, it would make sense to have an independent expert assess the available information to determine the need for licensure, and to perform an occupational analysis to determine the basic core knowledge, skills and abilities that are necessary to perform competently in this profession. Having that study and analysis performed would seem to provide a better basis for determining the need and degree of state regulation that SB 537 Page 11 is warranted. Since the proposed licensing Board would be placed in the Department of Consumer Affairs, having the department's Office of Examination Resources perform the study and analysis would seem to be one viable option. SUPPORT AND OPPOSITION: Support: Boyle Heights Family Recovery Center (Los Angeles) California Association of the Alcoholism and Drug Abuse Counselors (CAADAC - sponsor) California Narcotic Officers' Association California Paramedical and Technical College (Long Beach) California Society of Addiction Medicine (San Francisco) College for the Advanced Study of Addictive Disorders (Sacramento) Cornerstone of Southern California (Tustin) Crutcher's Serenity House (Deer Park) Fred Brown Recovery Services (San Pedro) Living Proof Recovery Center (Monrovia) National Council on Alcoholism and Drug Dependence of the San Fernando Valley Nevada County Substance Abuse Treatment and Recovery Programs Owens Valley Career Development Center, Vocational Education Program Manager of the St. Joseph's Hospital Chemical Dependence Tibur Cio Vasquez Health Center (East S.F. Bay) Tierra Miguel Foundation (San Diego) One alcohol/drug counselor Opposition: California Association of Marriage and Family Therapists California Society for Clinical Social Work California Psychological Association California Organization of Methadone Providers (COMP) California Coalition of Addiction Certifying and Credentialing Organizations (CCACCO - Oppose unless Amended) SB 537 Page 12 California Association of Addiction Recovery Resources (CAARR - Oppose unless Amended) California Association for Alcohol/Drug Educators (CAADE - Oppose unless Amended) Consultant: Jay J. DeFuria