BILL ANALYSIS
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|Hearing Date:June 22, 2009 |Bill No:AB |
| |1113 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 1113Author:Bonnie Lowenthal
As Amended:May 14, 2009 Fiscal:Yes
SUBJECT: Prisoners: professional mental health providers: marriage
and family therapists.
SUMMARY: Allows a marriage and family therapist intern to gain
qualifying experience for licensure as a marriage and family therapist
while working in a state correctional facility.
Existing law, the Penal Code:
1)Requires any person employed or under contract to provide mental health
diagnostic or treatment or other mental health services in the state
correctional system to be a physician and surgeon, psychologist, or
other health professional (includes a marriage and family therapist,
or licensed clinical social worker) licensed to practice in the
state, except as specified (Penal Code (PC) 5068.5).
2)Provides that the aforementioned license requirement may be waived in
order for a person to gain qualifying experience for licensure as a
psychologist or clinical social worker while working within a state
correctional system (PC 5068.5(c)).
Existing law, the Business and Professions Code:
1)Licenses and regulates marriage and family therapists (MFTs), marriage
and family therapy interns (MFT Interns), licensed clinical social
workers (LCSWs) and associate social workers (ASWs) by the Board of
Behavioral Sciences (Board) within the Department of Consumer
Affairs (DCA).
2)Provides that a person who wishes to gain experience toward licensure as
an LCSW shall register with the Board as an ASW prior to obtaining
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that experience. The ASW shall gain experience under the
supervision of a LCSW, licensed psychologist, MFT or psychiatrist,
as specified.
3)Provides that a person who wishes to gain experience toward licensure as
an MFT shall register with the Board as an MFT Intern prior to
obtaining that experience. The MFT Intern shall gain experience
under the supervision of an, MFT, LCSW, licensed psychologist or
psychiatrist, as specified.
This bill:
1) Adds a person gaining qualifying experience for licensure as an
MFT (i.e., an MFT Intern) to the list of those for whom the license
requirement may be waived.
2) Specifies that an MFT Intern is limited to working within his
or her scope of practice.
3) Makes technical and clarifying changes.
FISCAL EFFECT: The Assembly Appropriations Committee analysis, dated
April 29, 2009, cites no direct fiscal impact to the California
Department of Corrections and Rehabilitation (CDCR) to continue
oversight of clinical training in prisons.
COMMENTS:
1.Purpose. This bill is sponsored by California Association of
Marriage and Family Therapists (Sponsor) to allow MFT Interns
working in correctional facilities to gain qualifying experience for
licensure as an MFT. The Sponsor states that the bill would not
compel CDCR to use any particular discipline and merely provides for
greater choice among a greater array of possible mental health
professionals.
2.Background. The Business and Professions Code provides for the
licensing and regulation of more than 28,000 MFTs, 10,000 MFT
interns, 16,000 LCSWs, and 7,200 ASWs by the Board. In order to
qualify for MFT licensure, an individual must have at least a
master's level degree and 3,000 hours of supervised experience as a
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MFT Intern over a period of at least 104 weeks, and consisting of
specified types of activities. The experience must be gained under
the supervision, as specified, of an MFT, LCSW, licensed
psychologist or psychiatrist.
The Penal Code requires a person employed or under contract to provide
diagnostic, treatment, or other mental health services or to
supervise or provide consultation on those services in the State
correctional system to be licensed as a physician and surgeon,
psychologist or as an "other health professional" (which includes
LCSW, and MFT licensees). An exemption from the requirement to hold
a license provides for persons gaining qualifying experience in
order to become licensed as a psychologist, or LCSW.
By including persons gaining experience for licensure as an MFT to
those who may have the license requirement waived, this measure
would allow an MFT Intern to be employed in the state correctional
system and in that employment gain qualifying supervised experience
toward becoming licensed as an MFT.
3.Related Legislation. AB 2652 (Anderson) was introduced last year
(2008) and was nearly identical to this bill. That bill was held in
Assembly Appropriations Committee.
AB 1975 (Romero, Chapter 356, Statutes of 2000) waived the license
requirement to practice in the state correctional system for
clinical social workers gaining qualifying experience for licensure.
4.Mental Health Services in the State Correctional System. According
to the Sponsor, the CDCR is suffering from a severe shortage of
mental health clinician applicants to fill its vacancies in mental
health programs throughout the state. The Sponsor indicates that
the CDCR needs to increase its candidate pool with the appropriate
and viable candidates to hire in order to decrease its vacancy rate,
which currently stands at 1,100 positions. If these positions
cannot be filled, the mental health needs of the persons
incarcerated are not met, which will deter rehabilitation and likely
lead to repeated offenses when their periods of incarceration have
been completed, according to the Sponsor.
The Sponsor states, "Marriage and family therapists currently provide
mental health services in state facilities, except in correctional
facilities. CDCR recognizes the nearly identical training and
qualifications of MFTs and Clinical Social Workers and would like to
be able to use MFTs to help address the current shortage of mental
health professionals serving in the correctional system. In 2000,
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AB 1975 (Romero) waived the licensure requirement for clinical
social workers. This waiver should equally apply with equal force
to MFTs, whose training and education are comparable to that of
LCSWs. MFT interns have completed masters' level degrees and are
registered with the Board of Behavioral Sciences."
CDCR has employed social workers for decades within various program
areas. In the development of the Mental Health Services Delivery
System in the mid 1990s, the number of social workers (among other
mental health clinicians) employed within CDCR was increased due to
the recognition of the significant percentage of seriously mentally
ill inmates within the prison system.
With the burgeoning inmate population increasing the number of
mentally ill inmates in the system, the mental health program has
proportionately increased its clinical position numbers as well.
Concurrently, CDCR is under court order to improve services to its
mentally ill inmates. Part of the order requires CDCR to decrease
its clinicians' vacancy rate. Due to several factors, including low
pay, poor working conditions and lack of appropriate candidates, the
vacancy rate for these clinical positions is high.
Currently, the CDCR does not have a specific employment classification
that includes MFTs. The CDCR has proposed establishing a new class
known as the Mental Health Therapist, Correctional Facility, for
which an MFT licensee would qualify. This proposal is currently
pending before the California State Personnel Board. The State
Personnel Board has authorized CDCR to use another employment
classification (New Programs Consultant) until September 15, 2009,
pending the establishment of the new Mental Health Therapist
classification.
5.Requirement for Only Working Within the MFT Scope of Practice. The
wide range of mental health services found in the state correctional
system may very well go beyond the skills, training and expertise
which an MFT is qualified to perform. Therefore, this bill
clarifies that a person gaining experience for licensure as an MFT,
as provided by the bill, is limited to working only within the MFT
scope of practice.
Concerns that an MFT Intern would practice outside of that scope of
practice are met by the existing requirement in the B&P Code that a
MFT Intern must be at all times under the supervision of a
supervisor who shall be responsible for ensuring that the extent,
kind, and quality of counseling performed is consistent with the
training and experience of the person being supervised, and who
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shall be responsible to the Board for compliance with all laws,
rules, and regulations governing the practice of marriage and family
therapy.
6.Arguments in Support. The Sponsor of this measure, the California
Association of Marriage and Family Therapists, states: "MFT Interns
have education and experience requirements substantially equivalent
to clinical social work associates and are equally capable of
providing the mental health services necessary within correctional
settings. Permitting MFT interns to be employed within the CDCR
would help reduce the mental health professional shortage currently
at issue."
The Board of Behavioral Sciences states that marriage and family
therapy interns may already gain qualifying experience for licensure
in other settings when those services are provided under the
supervision of a qualified mental health practitioner pursuant to
the Marriage and Family Therapy Act. Therefore, this bill proposes
a practice already acceptable to the Board and merely makes it
possible for CDCR to allow interns to provide services within its
facilities.
The California Psychiatric Association indicates that the bill would
take a small but significant step toward meeting the crisis in
providing constitutionally adequate mental health care to
California's prison inmates.
7.Arguments in Opposition. The California Psychological Association
(CPA) states in opposition, "With nearly 20% of the prison
population in the mental health program designed for individuals
with severe mental illness, the CDCR needs trained clinicians who
possess the training and skill sets to assist these individuals.
CPA does not believe that the skills, training, and education of an
MFT make for a good fit within the prison system.
"The scope of practice for an MFT is to assist individuals to have
healthier interpersonal relationships within their families. This
bill, in effect, is requesting a significant scope of expansion for
MFTs to work with individuals with severe mental illness without any
increase in training and educational standards to accommodate the
expansion.
"CPA is also concerned that the training of these individuals will not
be effective as there will not be a position for an MFT in CDCR once
they are licensed. There is currently no state-approved position
for an MFT in state service . . . Training an individual in a
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position in a Department for a job that will not exist is a poor use
of state resources."
American Federation of State, County, and Municipal Employees, Local
2620 (AFSCME) writes in opposition, "It is not in the best interest
of the public or for prisoners to receive mental health treatment
from MFTs who do not have the appropriate educational background or
training to work with this highly volatile population who generally
have multiple diagnoses, including drug addiction." AFSCME further
states that MFTs are best suited to work with the general population
and trained to deal with marriage and family issues, not the wide
variety of severe mental health issues inmates have in California
prisons.
8.Policy issue: Can MFTs Work in the State Correctional System? The
Sponsor indicates that currently MFTs do not work in state
correctional facilities because there is no civil service
classification that includes MFTs. As described above, the law
already authorizes a licensed "health professional" to practice in
the state correctional system. Regardless of the status of this
bill, the new state classification for Mental Health Therapist,
Correctional Facility, which is currently being considered by the
State Personnel Board, includes licensed MFTs. That classification
would establish the specific mechanism under which MFTs may be
employed under the provisions of the existing Penal Code Section
5068.5(a) as "other health professional" in the state correctional
system.
However, even though the new civil service classification would
provide the mechanism for a licensed MFT to be employed in the
correctional system, this measure is still needed to authorize an
MFT Intern (who is by definition, an unlicensed person gaining
experience to meet the qualifications for an MFT license) to be
employed in a state correctional facility.
SUPPORT AND OPPOSITION:
Support:
California Association of Marriage and Family Therapists (Sponsor)
American Association for Marriage and Family Therapy, California
Division
Board of Behavioral Sciences
California Council of Community Mental Health Agencies
California Psychiatric Association
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Mental Health Association in California
Opposition:
American Federation of State, County, and Municipal Employees,
Local 2620
California Psychological Association
Consultant:G. V. Ayers