BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                    SB 33|
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                              UNFINISHED BUSINESS


          Bill No:  SB 33
          Author:   Correa (D)
          Amended:  6/8/09
          Vote:     21

           
           SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE  :  9-0,  
            4/20/09
          AYES:  Negrete McLeod, Aanestad, Corbett, Correa, Florez,  
            Oropeza, Romero, Walters, Yee
          NO VOTE RECORDED:  Wyland

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           SENATE FLOOR  :  36-0, 5/11/09
          AYES:  Aanestad, Alquist, Ashburn, Benoit, Cogdill,  
            Corbett, Correa, Cox, Denham, DeSaulnier, Ducheny,  
            Dutton, Florez, Hancock, Harman, Hollingsworth, Huff,  
            Kehoe, Leno, Liu, Lowenthal, Maldonado, Negrete McLeod,  
            Oropeza, Padilla, Pavley, Romero, Runner, Steinberg,  
            Strickland, Walters, Wiggins, Wolk, Wright, Wyland, Yee
          NO VOTE RECORDED:  Calderon, Cedillo, Simitian, Vacancy

           ASSEMBLY FLOOR  :  74-0, 7/9/09 (Consent) - See last page for  
            vote


           SUBJECT  :    Marriage and family therapy:  licensure and  
          registration

           SOURCE  :     Board of Behavioral Sciences


                                                           CONTINUED





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           DIGEST  :    This bill updates and recasts the educational  
          curriculum requirements for marriage and family therapists  
          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  
          marriage and family therapist educational requirements on  
          January 1, 2019, revises requirements for applicants  
          licensed or educated outside of California, and makes  
          technical and conforming changes.

           Assembly Amendments  added language related to elder adults  
          to clarify that this population is included in the  
          curriculum requirements for marriage and family therapists  
          (MFTs).  In addition, the amendment added language to allow  
          MFT interns to gain unlimited supervision via  
          videoconferencing, and made other technical changes.

           ANALYSIS  :    

          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,  
             16,000 licensed clinical social workers, and 7,200  
             associate social workers by the Board of Behavioral  
             Sciences (Board) within the Department of Consumer  
             Affairs.

          2. Specifies certain educational requirements necessary to  
             obtain an MFT license.

          3. Requires each applicant, prior to making application for  
             the licensing examination, to complete specific  
             supervised experience requirements.

          4. Establishes certain requirements for persons who  
             obtained education or experience outside of California.

          This bill:

          1. Recasts the required curriculum to obtain an MFT license  







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             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:

                (1)      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.

                (2)      Require training in the applied use of  
                   theory and psychotherapeutic techniques, working  
                   with families, adults (including elder adults),  
                   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:  

                (1)      Recovery oriented care and related methods  
                   of service delivery.

                (2)      Greater emphasis on understanding various  
                   cultures.

                (3)      Greater understanding of the impact of  
                   socioeconomic position.







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                (4)      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:

                (1)      Case management.

                (2)      Working with the severely mentally ill.

                (3)      Collaborative treatment.

                (4)      Disaster and trauma response.

             G.    Requires degree program content to include  
                instruction in:

                (1)      Evidence based practices.

                (2)      End of life and grief.

                (3)      Behavioral addiction, substance abuse,  
                   co-occurring mental and substance abuse disorders.

                (4)      Human sexuality and psychosexual  
                   dysfunction.

                (5)      Differences in legal and ethical standards  
                   for different types of work settings.

                (6)      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  







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                requirements:

                (1)      48 semester units (72 quarter units).

                (2)      Six semester units of practicum (nine  
                   quarter units).

                (3)      150 hours in practicum providing  
                   face-to-face counseling.

                (4)      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.

             C.    The applicant completes credit level coursework in  
                the following areas:

                (1)      Recovery oriented care. 

                (2)      Understanding various California cultures  
                   and the social and psychological implications of  
                   socioeconomic position.

                (3)      Structured meetings with consumers and  
                   family members.

                (4)      Behavioral addiction.

                (5)      Co-occurring mental health and substance  
                   abuse disorders.

                (6)      California law and ethics.

          4. 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.

          5. Permits applicants for an MFT license to count  
             experience for performing "client centered advocacy"  
             activities toward licensure.







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          6. Permits MFT interns to gain a portion of the required  
             supervision via teleconferencing.

          7. Requires applicants for MFT licensure to verify that  
             supervised experience was gained as an employee or  
             volunteer and not as an independent contractor.

          8. Makes conforming and clarifying changes. 

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  7/9/09)

          Board of Behavioral Sciences (source)
          American Association for Marriage and Family Therapy,  
          California Division
          California Association of Marriage and Family Therapists
          California Coalition for Counselor Licensure
          California Communities United Institute
          California Southern University
          Education Management Corporation
          University of Phoenix

           OPPOSITION  :    (Verified  7/9/09)

          American Federation of State, County, and Municipal  
            Employees (AFSCME) Local 2620, AFL-CIO
          Capitol Resource Family Impact

           ARGUMENTS IN SUPPORT  :    This bill is sponsored by the  
          Board of Behavioral Sciences who states that MFT  
          educational requirements 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 (Proposition 63) enacted in  
          2004, is transforming mental health services in California  







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          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.

           ARGUMENTS IN OPPOSITION  :    Capitol Resource Family Impact  
          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  







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          their marriages or families is too ambiguous and is  
          unnecessary in many situations, according to Capitol  
          Resource Family Impact, 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."

          AFSCME Local 2620 states in opposition:  "[W]hile we  
          support MFTs improving their education and training  
          requirements, the requirements as spelled out in SB 33 do  
          not support marriage and family treatment, but more closely  
          resemble those of Social Workers and Psychologists.  The  
          MFT license was instituted to specifically train therapists  
          in the treatment of family and relationship issues and the  
          integrity of this purpose should be maintained.  This is an  
          important function that MFTs provide and an essential piece  
          to the overall functioning of the community.  This function  
          should not be diluted to providing treatment that can and  
          should be provided by Social Workers and Psychologists.   
          AFSCME Local 2620 support MFTs adding courses to their  
          curriculum related to multiculturalism and socioeconomic  
          impact of treatment if those courses clearly specify their  
          relationship to marriage and family treatment.  Since SB 33  
          does not specify this, we fear that rather that [sic]  
          providing the community with well trained MFTs, it would  
          result in poorly trained Social Workers."  
           

           ASSEMBLY FLOOR  : 
          AYES:  Adams, Ammiano, Anderson, Arambula, Beall, Bill  
            Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,  
            Brownley, Buchanan, Caballero, Carter, Chesbro, Conway,  
            Cook, Coto, Davis, De La Torre, De Leon, DeVore,  
            Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,  
            Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,  
            Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,  
            Huffman, Jeffries, Knight, Lieu, Logue, Bonnie Lowenthal,  
            Ma, Mendoza, Miller, Monning, Nestande, Niello, Nielsen,  
            John A. Perez, V. Manuel Perez, Portantino, Ruskin,  
            Salas, Saldana, Silva, Skinner, Smyth, Solorio, Audra  
            Strickland, Swanson, Torlakson, Torres, Torrico, Tran,  
            Villines, Yamada, Bass
          NO VOTE RECORDED:  Charles Calderon, Duvall, Jones,  







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            Krekorian, Nava, Vacancy


          JJA:mw  7/10/09   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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