BILL ANALYSIS
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|Hearing Date:April 20, 2009 |Bill No:SB |
| |33 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 33 Author:Correa
As Amended:February 10, 2009 Fiscal:Yes
SUBJECT: Marriage and family therapy: licensure and
registration.
SUMMARY: Updates and recasts the educational curriculum
requirements for marriage and family therapists (MFTs) to require
persons who begin graduate study after August 1, 2012 to meet
increased total unit requirements; increased practicum hours for
face-to-face counseling; integrates specified elements, including
public mental health practices, throughout the curriculum; repeals
current MFT educational requirements on January 1, 2019; revises
requirements for applicants licensed or educated outside of
California; and makes technical and conforming changes.
Existing law:
1)Provides for the licensing and regulation of more than 28,000
marriage and family therapists (MFTs), 10,000 MFT interns, 1,700
licensed educational psychologists (LEPs), 16,000 licensed
clinical social workers (LCSWs), and 7,200 associate social
workers (ASW) by the Board of Behavioral Sciences (Board) within
the Department of Consumer Affairs (DCA).
2)Specifies certain educational requirements necessary to obtain
an MFT license , to generally include the following:
a) A specified doctor's or master's degree from an accredited
or state-approved school.
b) An integrated course of study consisting of a minimum
48-semester or 72- quarter units of instruction.
c) 12-semester or 18-quarter units of marriage, family, and
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child counseling and related approaches to treatment.
d) Six-semester or nine-quarter units of practicum including
150 hours of face-to-face counseling experience.
e) Specifies the number of hours or units required for
certain courses.
f) Permits certain coursework, such as child abuse assessment
and reporting, to be taken outside of the degree program and
prior to licensure (not prior to registration as an intern).
g) Requires specific content to be integrated throughout the
program, including:
i) Diagnosis, assessment, prognosis, and treatment of
mental disorders.
ii) The broad range of matters that may arise within
marriage and family relationships.
iii) The application of marriage and family relationship
counseling principles and methods.
iv) Development of personal qualities intimately related
to the counseling situation.
v) A variety of psychotherapeutic techniques and
modalities.
vi) Cross-cultural mores and values.
h) Requires the following specific course content:
i) A variety of MFT-related psychotherapeutic techniques
and modalities.
ii) Developmental issues.
iii) Treatment of children.
iv) Aging and long-term care.
v) Alcoholism and substance abuse.
vi) Spousal and partner abuse assessment, detection, and
intervention.
vii) Psychological testing.
viii) Psychopharmacology.
3)Requires each applicant, prior to making application for the
licensing examination, to complete specific supervised
experience requirements, which includes:
a) 3,000 hours of supervised experience over a period of at
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least 104 weeks, composed of the following activities:
i) Counseling and direct supervisor contact (not more
than 750 hours).
ii)Professional enrichment activities, including workshops,
seminars, training sessions, or conferences (not more than
250 hours).
iii)Personal psychotherapy (not more than 100 hours).
iv)Group therapy or group counseling (not more than 500
hours).
v) Administering and evaluating psychological tests,
writing clinical reports, writing progress or process notes
(not more than 250 hours).
vi)Telephone or crisis counseling (not more than 250 hours).
vii)Couples, family, and children (not less than 500 hours).
viii)Telemedicine counseling (not more than 125 hours).
b) Supervision must be provided weekly and consists of one
hour of individual, direct supervisor contact, or two hours
in a group.
c) Of the 3,000 hours, 1,300 may be gained during the degree
program as a trainee, and 1,700 must be gained post-degree as
an intern.
d) Interns and trainees are prohibited from working as an
independent contractor and from accepting payments directly
from clients.
4)Establishes certain requirements for persons who obtained
education or experience outside of California as follows:
a) Applicants licensed for at least two years in another
state as an MFT and whose education and experience is
substantially equivalent to California requirements, shall be
issued a license after passing the Board's licensing
examinations and completing additional coursework or
training.
b) Applicants not licensed in another state as a MFT or who
have been licensed for less than two years, must meet the
following:
i) Experience must be substantially equivalent to
California requirements.
ii) The applicant must register as an intern and gain 250
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hours of supervised experience in California.
iii) Education must meet core requirements and the
applicant must make up for any deficiencies in coursework
and content.
iv) The applicant must complete additional coursework or
training.
v) The applicant must pass the Board's licensing
examinations.
This bill:
1)Recasts the required curriculum to obtain an MFT license for
persons who begin graduate study after August 1, 2012, and makes
various changes including:
a) Increases the graduate degree's total unit requirement
from 48 to 60 semester units (72 to 90 quarter units).
b) Specifies fewer requirements for specific hours or units
for particular coursework within the curriculum requirements,
thereby allowing for flexibility and innovation in curriculum
design.
c) Revises the required practicum to:
i) Increase the face-to-face counseling hours from 150 to
225 hours, and provide that 75 of those hours may be gained
performing client centered advocacy, as defined.
ii) Require training in the applied use of theory and
psychotherapeutic techniques, working with families,
documentation skills, and how to find and use resources.
d) Recasts certain coursework requirements, such as
California law and ethics and child abuse assessment and
reporting, which are currently required prior to licensure
(and permitted to be taken outside of the degree program) to
instead be completed within the degree program and thus,
prior to registration as an intern.
e) Requires various elements to be integrated throughout the
curriculum, including:
i) Recovery oriented care and related methods of service
delivery.
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ii) Greater emphasis on understanding various cultures.
iii) Greater understanding of the impact of socioeconomic
position.
iv) Provide students the opportunity to meet with
consumers and family members.
f) Adds instruction in areas needed for practice in a public
mental health environment which may be provided in credit
level coursework or through extension programs, including the
following:
i) Case management.
ii) Working with the severely mentally ill.
iii) Collaborative treatment.
iv) Disaster and trauma response.
g) Requires degree program content to include instruction in:
i) Evidence based practices.
ii) End of life and grief.
iii) Behavioral addiction, substance abuse, co-occurring
mental and substance abuse disorders.
iv) Human sexuality and psychosexual dysfunction.
v) Differences in legal and ethical standards for
different types of work settings.
vi) Licensing law and licensing process.
2)Repeals the current MFT educational requirements January 1,
2019.
3)Revises the requirements for persons who earned a degree outside
of California effective January 1, 2014, including accepting
education as substantially equivalent that meets the following:
a) The degree meets the following minimum requirements:
i) 48 semester units (72 quarter units).
ii) 6 semester units of practicum (9 quarter units).
iii) 150 hours in practicum providing face-to-face
counseling.
iv) 12 semester units (18 quarter units) of marriage,
family, and child counseling and related approaches to
treatment.
b) The applicant must remediate any deficiencies in content
and units.
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c) The applicant completes credit level coursework in the
following areas:
i) Recovery oriented care.
ii) Understanding various California cultures and the
social and psychological implications of socioeconomic
position.
iii) Structured meetings with consumers and family members.
iv) Behavioral addiction.
v) Co-occurring mental health and substance abuse
disorders.
vi) California law and ethics.
5)Effective January 1, 2014, no longer requires an applicant
licensed as an MFT for less than two years in another state to
complete 250 hours of experience in California as an intern
prior to applying for licensure.
6)Permits applicants for an MFT license to count experience for
performing "client centered advocacy" activities toward
licensure.
7)Permits MFT interns to gain a portion of the required
supervision via teleconferencing.
8)Requires applicants for MFT licensure to verify that supervised
experience was gained as an employee or volunteer and not as an
independent contractor.
9)Makes conforming and clarifying changes.
FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Note : Last Year's SB 1218 (Correa). This bill is a
reintroduction of last year's SB 1218 by the same Author which
was one of an unprecedented number of bills that were vetoed by
the Governor citing the delay in passing the Budget. That bill
passed this Committee on an 8-0 vote.
2.Purpose. This bill is sponsored by the Board of Behavioral
Sciences (Board) who states that MFT educational requirements
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have not been substantively changed since 1988. However the
practice has evolved over the past 20 years, and the Board
states that there is a growing body of evidenced-based and
best-practices in treatment. Employment opportunities are
increasing for MFTs and work settings are shifting from private
practice to the public sector according to the Board.
The Board further states that the voter-approved California Mental
Health Services Act (MHSA, Proposition 63) enacted in 2004, is
transforming mental health services in California in a number of
ways. This includes placing greater attention on serious mental
illness, reducing adverse impacts resulting from untreated
mental illness, expanding successful innovative services,
emphasizing culturally and linguistically competent approaches,
and involving people with mental illness in the system as
stakeholders with an equal voice. These new services are guided
by a promise to do "whatever it takes" to help people fully
recover from mental illness, and are typically referred to as
"recovery oriented care." The Board indicates that this
transformation demands that those employed in public mental
health, including MFTs, must have a different perspective and be
able to provide different approaches to treatment. The proposed
changes to the educational requirements make it necessary that
the Board's requirements for applicants who completed their
education outside of California also change for consistency with
those new requirements.
According to the Board, permitting applicants to count
experience for performing client centered advocacy is important
because this is a central part of practice in public settings
and helps the practitioner provide recovery oriented care.
The Board believes that permitting a portion of the required
supervision to take place via teleconferencing is important for
persons who are practicing in a rural area, who may not have
constant access to a supervisor, and for persons who are
practicing in a specialty area who may not have access to a
supervisor who is an expert in that area.
The Board points out a flaw in the current law which currently
prohibits MFT interns and trainees from working as independent
contractors but has no way to verify that it is not occurring.
Requiring the applicant to verify employment or service as a
volunteer will provide the Board with this verification and will
help to protect interns and trainees from unlawful employment
practices.
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3.Board Committee Meetings Regarding Curriculum Changes. The
Board states this measure is the result of the work of the
Board's MFT Education Committee which met 7 times, beginning in
July 2006. Charged with reviewing the current curriculum
requirements and determining their appropriateness for today's
MFT practice, the Committee reviewed different studies of
competencies necessary for MFT practice as well as workforce
data in order to determine ways in which the profession has
evolved. The Committee involved a number and variety of
stakeholders throughout this process and benefited greatly from
the participation and feedback from more than 138 people
involved in the meetings. Stakeholders involved included
schools, agencies, consumers, and students.
4.Arguments in Support. Representing more than 30,000 members,
the California Association of Marriage and Family Therapists
(CAMFT) argues that consumer protection is best assured when
education for a profession keeps pace with the evolving demands
of a profession, and believes that the bill will again assure
that MFTs are being trained to effectively practice. CAMFT
states that while MFTs are well-trained clinically, the typical
education content prepares the MFT to work in the private
sector; however there is an increasing need for mental health
professionals in the public and community sector, and MFTs are
filling many of these positions.
The American Association for Marriage and Family Therapy,
California Division (AAMFT) states that the bill responds to the
critical provider shortage within public mental health by
requiring all MFT training programs to incorporate education on
the public system, including recovery-oriented mental health
care, inclusion of consumers and family members, and advocacy
for the severely mentally ill. AAMFT affirms that California
would be the first state in the country to require such training
for MFTs working in the public system. AAMFT further states
that the Board developed the bill in collaboration with
California's MFT degree programs in an inclusive process
designed to ensure committed implementation.
5.Arguments in Opposition. Capitol Resource Family Impact (CRFI)
argues that requiring MFT students to study "multicultural
development and cross-cultural interaction" is unnecessary for
becoming an effective and empathetic counselor. Cultural
training required simply to counsel people about their marriages
or families is too ambiguous and is unnecessary in many
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situations, according to CRFI, who also states: "Furthermore,
it is not the legislature's [sic.] place to determine the
curriculum of private graduate institutions. By requiring
licensed therapists to take certain courses, this law
effectively controls their curriculum."
SUPPORT AND OPPOSITION:
Support:
Board of Behavioral Sciences (Sponsor)
American Association for Marriage and Family Therapy, California
Division
California Association of Marriage and Family Therapists
University of Phoenix
Opposition:
Capitol Resource Family Impact
Consultant:G. V. Ayers