BILL ANALYSIS
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|Hearing Date:April 27, 2009 |Bill No:SB |
| |788 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 788Author:Wyland and Steinberg
As Amended:April 1, 2009 Fiscal: Yes
SUBJECT: Licensed professional clinical counselors.
SUMMARY: Provides for the licensing and regulation of
professional clinical counselors by the Board of Behavioral
Sciences.
Existing law:
1)Licenses and regulates the practice of psychotherapy preformed by
more than 28,000 marriage and family therapists (MFTs), 1,700
licensed educational psychologists (LEPs), and 16,000 licensed
clinical social workers (LCSWs) by the Board of Behavioral
Sciences (Board) within the Department of Consumer Affairs.
2)Provides for an 11 member Board, made up of:
a) 5 professional members (all Governor appointees)
consisting of: 2 LCSW licensees, 1 LEP licensee, and 2 MFT
licensees
b) 6 public members consisting of: 4 Governor appointees, 1
Senate Committee on Rules appointee, and 1 Assembly Speaker
appointee.
3)Defines a psychotherapist as a physician and surgeon specializing in
psychiatry or practicing psychotherapy, a psychologist, a
clinical social worker, a marriage and family therapist, a
psychological assistant, a marriage and family therapist
registered intern or trainee, or an associate clinical social
worker.
4)Establishes the following general requirements for licensure of
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psychotherapists:
a) A graduate degree from an accredited school in a related
clinical field.
b) Extensive hours of supervised experience gained over a
specified number of years.
c) Registration with the Board while gaining the supervised
experience.
d) Standard and Clinical Vignette licensing examinations.
5)Defines the practice of marriage and family therapy as service
performed with individuals, couples, or groups wherein
interpersonal relationships are examined for the purpose of
achieving more adequate, satisfying, and productive marriage and
family adjustments.
6)Defines the practice of clinical social work as service in which a
special knowledge of social resources, human capabilities, and
the part that unconscious motivation plays in determining
behavior, and service that is directed at helping people achieve
more adequate, satisfying, and productive social adjustments.
7)The Child Abuse and Neglect Reporting Act, requires a mandated
reporter to report whenever he or she has knowledge of or
observes a child whom the mandated reporter knows or reasonably
suspects has been the victim of child abuse or neglect. The Act
identifies numerous categories of mandated reporters, and
includes: a physician, surgeon, psychiatrist, psychologist,
dentist, resident, intern, podiatrist, chiropractor, licensed
nurse, dental hygienist, optometrist, marriage, family and child
counselor, clinical social worker, or any other person who is
currently licensed under Division 2 (commencing with Section
500) of the Business and Professions Code.
This bill:
1) Creates the Licensed Professional Clinical Counselors Act
(Act) that provides for the licensing and regulation of licensed
professional clinical counselors (LPCCs), as defined, by the
Board.
2) Revises the membership of the Board to add 4 members
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appointed by the Governor, consisting of: 2 LPCC's licensees,
and 2 public members.
3) Defines professional clinical counseling as the application
of counseling interventions and psychotherapeutic techniques to
identify and remediate behavioral, cognitive, mental, and
emotional issues, including personal growth, adjustment to
disability, crisis intervention, and psychosocial and
environmental problems. Professional clinical counseling
includes conducting assessments for the purpose of establishing
treatment goals and objectives to empower individuals to deal
adequately with life situations, reduce stress, experience
growth, and make well-informed, rational decisions.
4) Requires LPCCs to refer clients to other licensed mental
health professionals when they identify issues beyond their own
scope of education, training, and experience.
5) Prohibits the practice or advertising professional clinical
counseling services without a license from the Board, and
excludes from the Act:
a) Persons, not otherwise licensed to perform counseling
services, who do not use the title "licensed professional
clinical counselor" or do not represent themselves as
licensed to practice professional clinical counseling.
b) The Medical Practice Act, the Clinical Social Worker
Practice Act, the Nursing Practice Act, the Psychology
Licensing Law, or Marriage and Family Therapy licensing laws.
c) Any priest, rabbi, or religious minister who performs
counseling services as part of his or her pastoral or
professional duties.
d) Any attorney in this state or person licensed to practice
medicine, who provides services as part of his or her
professional practice.
e) An employee of a governmental entity, school, college,
university, or nonprofit charitable institution, practicing
under the supervision of the entity, school, or organization,
and as a part of that employment.
6) Makes any violation of the Act a misdemeanor (crime)
punishable by imprisonment up to six months, or by a fine of up
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to $2,500, or both.
7) Specifies educational and experience requirements for
applicant qualification, including a master's or doctor's degree
that is counseling or psychotherapy in content, as specified,
from an accredited or state approved school.
8) Provides that the Board shall make the final determination
as to whether a degree meets all requirements, including, but
not limited to, course requirements, regardless of
accreditation.
9) Authorizes the Board to issue an LPCC license to any person
who meets the following requirements:
a) Holds a master or doctoral degree in counseling, as
specified in item # 7) above.
b) Completes 3,000 hours of supervised experience in the
practice of professional clinical counseling.
c) Passes the examinations approved by the Board.
d) Meets other regulatory requirements, including:
i. Not having committed acts or crimes that are grounds
for denial.
ii. Not having been convicted of a crime involving
sexual abuse of children.
iii. Passing a fingerprint check through the Department
of Justice.
10)Authorizes the Board to issue an LPCC license to any person
who has a valid license for at least 2 years as a professional
clinical counselor, or an equivalent title, in another
jurisdiction of the United States, if the education and
supervised experience requirements are substantially equivalent
to those required in the Act; the applicant has passed the
Board-approved examinations, and pays the required fees.
11)Requires the Board to evaluate various national examinations
to determine whether they meet the prevailing standards for
licensing and certification tests in California.
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12)Permits the Board, under a grandparenting provision, to issue
an LPCC license to any person who applies for a license between
January 1, 2011 and June 30, 2011, and who meets specified
education, coursework, experience and examination (including a
California jurisprudence examination) requirements.
a) Provides that a license issued under the grandparenting
provision is valid for six years and must be renewed
annually, and requires that in order to renew the license
after the six-year period, the applicant must have passed the
examination approved by the Board.
b) Authorizes an individual who meets certain coursework
requirements, and who is currently licensed as an MFT or a
LCSW to obtain a LPCC license under the grandparenting
provision. Those who are licensed in this manner are not
required to pass the examination required in # a) above.
13)Requires the Board to accept applications for LPCC intern
registration beginning January 1, 2011.
14)Requires the Board to accept applications for LPCC licensure
beginning January 1, 2012.
15)Requires the Board to deposit all revenue received under the
Act into the Behavioral Sciences Fund (Fund).
16)Provides that the Board shall not implement the provisions of
this bill until funds have been appropriated from the Fund, as a
loan, by the Legislature.
FISCAL EFFECT: Unknown. This bill is keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1)Purpose. This bill is sponsored by the California Coalition
for Counselor Licensure (Sponsor) which is comprised of the
following 9 state and national counseling organizations:
California Association for Counselor Education and
Supervision (CACES)
California Association of School Counselors (CASC)
California Career Development Association (CCDA)
California Counseling Association (CCA)
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California Mental Health Counselors Association (CAMHCA)
California Rehabilitation Association-North, Inc. (CRA-North,
Inc.)
California Rehabilitation Counseling Association (CRCA)
Northern California Art Therapy Association (NorCATA)
Southern California Chapter of American Dance Therapy
Association (SCCADTA)
The Sponsor has identified a number of workforce issues that
they believe licensure of LPCs would address. They cite the
2003 California Workforce Initiative report The Mental Health
Workforce: Who's Meeting California Needs which states that
unlicensed providers are meeting much of the mental health needs
of Californians, and the problem is obtaining third-party
reimbursement. The study points out that the state will need an
additional 13,000 to 20,000 mental health professionals by the
year 2010.
The Sponsor explains that there is a shortage of mental health
providers in rural areas to treat Medi-Cal beneficiaries, and
the shortage could increase due to the passage of Proposition
63, which potentially will double the number of clients served.
Proposition 63, the Mental Health Services Act (MHSA), passed in
2004, expands mental health care for children and adults through
a 1% tax on taxable personal income over $1 million.
News articles have reported that some counties are receiving
money from MHSA, far beyond what was projected, yet the counties
are finding it hard to recruit qualified staff. According to
the Sponsor, "In terms of sheer numbers, the MFTs and LCSWs can
fill the positions; however, they are not filling those
positions currently. LPCCs curricula prepare them to readily
adapt to the needs of the public mental health system under the
principles of MHSA."
Background provided by the Author's office states that
master-level counselors are employed in 36 county mental health
departments throughout the state, yet, without a license, there
are limits to the services they can provide and the county
cannot receive reimbursement unless the counselor is licensed.
According to the Sponsor, every other state licenses
professional counselors in some form, leaving California as the
only state without licensure.
2)Federal Legislation. In 2006, the President signed the
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Veterans Benefits, Health Care, and Information Technology Act.
Among other things, the bill recognized, for the first time,
licensed professional counselors as mental health specialists
within health care programs operated by the Department of
Veterans Affairs (VA). Previously, licensed professional
counselors had a limited role as mental health providers. The
change in recognition was intended to bring more and better
access to mental health services for persons in the VA system,
which has faced a shortage of mental health providers.
3)Hurricane Katrina Assistance. In 2005, the American Counseling
Association received a large federal grant to help facilitate
the immediate deployment of licensed professional counselors to
Louisiana to provide mental health services for hurricane
survivors. Volunteers participating in the effort were required
to hold a state license as a professional counselor. According
to the Sponsor, federal grant guidelines did not allow any
exemptions from this requirement. Therefore, none of
California's thousands of mental health counselors qualified
(unless they were licensed in another state). The professional
counselors deployed provided mental health services to
individuals, families and children affected by the devastating
effects of Hurricane Katrina. They helped clients cope with
crisis (including suicidal ideation and substance abuse), post
traumatic stress disorder (PTSD) symptoms, grief and loss, as
well as assessing the need for both immediate and long-term
intervention.
4)Similar Legislation. Last year AB 1486 (Calderon), was almost
identical to this bill. It would have established, the
licensing and regulation of licensed professional counselors
(LPCs) by the Board. That measure was a two-year bill which was
originally heard in this Committee on July 9, 2007, at which
time it failed passage 1-5. Upon being granted reconsideration,
the bill was again before the Committee on June 9, 2008 for
testimony only, and after being significantly amended to address
the many concerns of the Chair and other Committee members, the
bill was approved by the Committee on June 16, 2008 on a 5-4
vote. Ultimately the bill failed passage 7-8 in the Senate
Appropriations Committee.
AB 894 (La Suer, 2005) similarly provided for the licensing and
regulation of professional counselors by the Board. AB 894 was
held in the Assembly Appropriations Committee.
5)Sunrise Hearing: Subject heard by the Joint Committee in 2006.
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The issues presented in this bill were part of "Sunrise Review"
by the Joint Committee on Boards, Commissions, and Consumer
Protection (Joint Committee) in 2006. It is significant to note
that the recommendation before the Joint Committee, as follows,
" It has not been clearly established that there is sufficient
consumer protection justification for this proposal and that
this proposal meets the threshold for licensure (the potential
for serious injury or death, or severe financial harm) " did not
receive sufficient votes to be approved by the Joint Committee.
Therefore, the proposal went forward without a support or oppose
recommendation from the Joint Committee regarding the licensure
and regulation of professional counselors.
6)Scope of Practice. Discussions regarding this bill often focus
on the scope of practice proposed for LPCCs. Indeed, a great
deal of the debate over last year's AB 1486 (Calderon) centered
on the scope of practice, and concern that the bill would
authorize LPCCs to practice psychotherapy and mental health
counseling. It should be noted that the bill currently contains
strong psychotherapeutic education content. Section 4999.32
specifies that the 48 graduate semester units necessary to
obtain the license must include: (1) a minimum of 3 semester
units in each of the nine core areas, 5 of which contain strong
psychotherapeutic content, (2) a minimum of 6 semester units of
supervised practicum or field study experience that includes
specified areas, which contain a strong psychotherapeutic
content. In addition, this bill mirrors the increased
coursework proposed in SB 33 (Correa) to further include
psychopharmacology.
(SB 33 passed this Committee on April 20, 2009, with a 9-0 vote,
and updates and recasts the educational curriculum requirements
for MFTs who begin graduate study after August 1, 2012. The
measure increases the total unit requirements, practicum
face-to-face counseling hours, and public mental health
education.)
According to the Sponsors: "The scope of practice is founded on
the premise that licensed professional clinical counselors must
first meet the requirements for the general practice of
professional counseling and then they may develop a specialty
that is narrowly focused, requiring advanced knowledge in a
particular area. It is not intended that the State would
regulate counseling specialties."
7)Would LPCCs be Mandated Reporters? Concern has been expressed
about the April 1, 2009 amendments which removed the reference
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to Penal Code 11165.7 from the bill. That section lists the
categories of persons who are mandated reporters under the Child
Abuse and Neglect Reporting Act. As stated above under Existing
law item
# 7), that Act requires a mandated reporter to report whenever he
or she has knowledge of or observes a child whom the mandated
reporter knows or reasonably suspects has been the victim of
child abuse or neglect. As introduced, the bill would have
specifically added LPCCs to the list of mandated reporters.
However, it should be noted that whether or not LPCCs are
specifically named, they fall within the umbrella of Section
11165.7 (a) (21) which names as a mandated reporter: "A
physician, surgeon, psychiatrist, psychologist, dentist,
resident, intern, podiatrist, chiropractor, licensed nurse,
dental hygienist, optometrist, marriage, family and child
counselor, clinical social worker, or any other person who is
currently licensed under Division 2 (commencing with Section
500) of the Business and Professions Code ."
8)Arguments in Support. The Sponsor of the bill, California
Coalition for Counselor Licensure , makes the case that LPCC
licensure is needed in California for the following reasons:
To protect consumers of counseling services. Without the
title protection and definition established in law, anyone
can claim to be a "professional counselor." Licensure
assures consumers that their counselor has met specified
standards and that a mechanism exists to enforce these
standards.
To address mental health workforce shortages and their
impact on the implementation of Prop 63. There is a
documented shortage of mental health practitioners in
California. In a survey by the Sponsors, two thirds of the
respondents said that they would be interested, or were open
to, working in the county or state mental health system, if
they were licensed and if there were jobs. Enacting LPCC
licensure would be a step to help meet the needs of the
mental health system in the coming years, according to the
Sponsors
To provide more access for the underserved, those in rural
areas, the culturally diverse, and the aging population of
California. LPCCs would be particularly well positioned to
meet the needs of a rapidly increasing culturally diverse
population in California. Professional counselors develop
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expertise in areas, such as gerontology and rehabilitation,
where there is the greatest need among our diverse and aging
population. More than 50% of counseling graduate students
are people of color. Professional counselors are already
employed in mental health centers in rural and isolated
counties, but they are underutilized because they are not
licensed.
To enable California to participate in federally funded
programs. Without LPCC licensure, California is unable to
take advantage of federal programs that benefit consumers and
counselors, according to the Sponsor. Because LPCs are
included as providers for the Department of Veterans Affairs,
they could serve veterans' mental health needs in
California's 10 veterans' hospitals and 50 outpatient
clinics. The federal aid facilitating deployment of LPCs to
Louisiana to provide mental health services to hurricane
victims in 2005 could not be utilized by California's
qualified, but unlicensed, counselors.
To allow portability for licensed counselors coming to
California. Counselor licensure exists in 48 other states.
California and Nevada are the only states that do not
recognize LPCs. There is a disincentive for graduates to
stay in California and practice, and for qualified LPCs in
other states to move to California, where there is no license
available.
To achieve parity and equity among California counseling
professionals. The Sponsor argues that marriage and family
therapists are licensed, but there are thousands of
master's-degreed professional counselors in California who
should also be licensed. Other states generally license four
mental health professions: psychologists, clinical social
workers, professional counselors and marriage and family
therapists.
According to the American Association of State Counseling Boards
(AASCB) and the National Board for Certified Counselors , states
have been licensing professional counselors for 30 years and
over 100,000 masters and doctoral-degreed professional
counselors are licensed to practice independently in 49 states.
AASCB states, "SB 788 closely follows the requirements used by
other states for licensure of professional counselors.
Requirements include a master's or doctoral degree, two years
post-degree supervision, passage of two nationally recognized
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examinations, a jurisprudence exam and ongoing oversight by the
existing Board of Behavioral Sciences."
The California Psychiatric Association , representing over 3,300
psychiatrists in California, states that under SB 788 licensed
professional clinical counselors will be uniquely suited to
engage in collaborative work with psychiatrists (and other
mental health professionals) in community mental health
programs, state institutions such as prisons, state hospitals,
veterans facilities, and programs for the autistic and
developmentally disabled. LPCCs can provide badly needed
clinical services to help meet those needs and insure that
patients receive the care that they deserve, according to the
Association.
Pointing out that SB 788 emphasizes the obligation of LPCCs to
refer "when they identify issues beyond the scope of their
education, training, supervision and experience," the
Association states: "These educational requirements and
training experiences will tend to put LPCCs in direct contact
with psychiatrists. As they learn from and are supervised by
psychiatrists, a foundation for future collaboration will be
established. This is good for patients."
1)Arguments in Opposition. The California Psychological
Association (CPA) has an Oppose Unless Amended position and
believes that without significant amendments, the bill could
cause great harm to consumers. CPA states that it is concerned
about provisions in the bill related to the broad scope of
practice (including mental health practice) and the inadequate
preparation for that scope of practice.
CPA argues that "the proposed scope of practice for this master's
level training can be interpreted to be as broad as
doctoral-level psychologist's, including diagnosis,
psychological testing, and treatment of psychopathology. Yet
the license relies upon a counseling curriculum oriented toward
helping well populations make well-informed decisions in areas
such as vocational planning or career change, and how to deal
adequately with life situations. The counseling curriculum does
not prepare counselors for the treatment of serious mental
disorders or for the specialized practice of psychotherapy."
CPA also argues that the bill contains overly lenient
grandparenting provisions for MFTs and LCSWs who would merely
have to show verification of core coursework to become a
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licensed LPCC. CPA states: "They might not even have to pass
ONE examination in counseling curriculum, which is vital for
practice as a mental health professional practicing in a
distinctly different profession. The justification for
excluding the MFTs and LCSWs from taking the examination is that
the education and training are so similar, and it would be a
redundant and unnecessary step. If that is, indeed, the case,
then there is no need for an additional mental health
professional license."
The American Association for Marriage and Family
Therapy?California Division (AAMFT) has significant concerns
with the bill, as they did with AB 1486.
AAMFT believes this bill risks harming the public by reducing the
public mental health workforce, contending that many counselors
already work in the public mental health system in
license-exempt settings. "The creation of a counseling license
that allows these clinicians to practice independently will
eviscerate the public mental health workforce. The public
system will suffer a loss of practitioners without any increase
in skills."
AAMFT argues this bill does nothing to enhance the quality of
mental health services in California, and states that a 2006
Board of Behavioral Sciences analysis found no evidence that
professional counselors would improve accessibility in rural
areas or to Medi-Cal patients, and states that "since then, no
evidence challenging these conclusions has been presented."
AAMFT indicates that the bill creates an umbrella license for
those who may not have adequate training or experience, stating
that the license encompasses a diffuse group of clinical and
vocational specialties, and gives them all the right to practice
psychotherapy.
AAMFT further states that the bill grandparents in those who may
not be qualified for the much broader scope of practice embraced
under the LPCC license. AAMFT believes that if the scope of
practice is distinct from other licenses, then grandparenting
without even an exam is highly inappropriate. Furthermore, it
is argued that by including LPCCs in the definition of
"psychotherapist" counselors from other states whose experience
is in rehabilitation or career counseling would have their scope
of practice unduly broadened.
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The American Federation of State, County, and Municipal Employees
(AFSCME) Local 2620, AFL-CIO argues that the bill is redundant,
unnecessary, and confusing for consumers, and suggests that the
existing licensed professions of psychiatry, psychology, social
workers and MFTs are already trained and qualified to carry out
the functions that this new license seeks to perform.
NOTE : Double-referral to Public Safety Committee second.
SUPPORT AND OPPOSITION:
Support:
California Coalition for Counselor Licensure (Sponsor)
American Association of State Counseling Boards
American Counseling Association
American Dance Therapy Association
American Mental Health Counselors Association
American Rehabilitation Counseling Association
California Counseling Association
California Mental Health Counselors Association
California Psychiatric Association
California Registry of Professional Counselors and
Paraprofessionals
California Rehabilitation Association
California Rehabilitation Counseling Association
California State Rural Health Association
Commission on Rehabilitation Counselor Certification
National Board for Certified Counselors
National Career Development Association
Northern California Art Therapy Association
Southern California Chapter of the American Dance Therapy
Association (SCCADTA)
University of Phoenix
Western Association for Counselor Education and Supervision
Numerous Individuals
Opposition:
American Association for Marriage and Family Therapy (AAMFT)
California Division
American Federation of State, County, and Municipal Employees
(AFSCME) Local 2620, AFL-CIO
Oppose Unless Amended :
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California Psychological Association
Consultant:G. V. Ayers