BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 788
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          Date of Hearing:   July 7, 2009

                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
                                 Mary Hayashi, Chair
                     SB 788 (Wyland) - As Amended:  June 22, 2009

           SENATE VOTE  :   36-1
           
          SUBJECT  :   Licensed professional clinical counselors.

           SUMMARY  :   Establishes the Licensed Professional Clinical  
          Counselor Act which provides for the licensing and regulation of  
          professional clinical counselors (LPCCs) by the Board of  
          Behavioral Sciences (BBS).  Specifically,  this bill  :

          1)Increases the number of members comprising the BBS from 11 to  
            15 by adding two additional state licensed LPCCs and two  
            additional public members, commencing January 1, 2012.

          2)Increases from four to six public members and from five to  
            seven licensed members of BBS to be appointed by the Governor.

          3)States legislative intent recognizing that LPCCs practice a  
            separate and distinct profession from licensed marriage and  
            family therapists (MFTs) and licensed clinical social workers  
            (LCSWs), and as such the Legislature recognizes the need to  
            appropriately test MFTs and LCSWs seeking to become LPCCs on  
            the difference in practice between the professions.

          4)Requires BBS to:

             a)   Communicate information about its activities, the  
               requirements and qualifications for licensure, and the  
               practice of professional clinical counseling to the  
               relevant education institutions, supervisors, professional  
               associations, applicants, clinical counselor trainees,  
               interns and the public; and,

             b)   Develop polices and procedures to assist educational  
               institutions in meeting the educational qualifications for  
               those seeking licensure as a LPCC, as specified.

          5)Establishes the following guidelines for LPCC scope of  
            practice:









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             a)   Defines "professional clinical counseling" as the  
               application of counseling interventions and  
               psychotherapeutic techniques to identify and remediate  
               cognitive, mental and emotional issues, including personal  
               growth, adjustment to disability, crisis intervention, and  
               psychosocial and environmental problems.  Includes  
               conducting assessments for the purpose of establishing  
               counseling goals and objectives to empower individuals to  
               adequately deal with life situations, reduce stress,  
               experience growth, change behavior and make well informed,  
               rational decisions;

             b)   States that professional clinical counseling is focused  
               exclusively on the application of counseling interventions  
               and psychotherapeutic techniques for the purpose of  
               improving mental health and is not intended to capture  
               other, nonclinical forms of counseling for the purposes of  
               licensure;

             c)   States that professional clinical counseling does not  
               induce the assessment or treatment of couples or families  
               unless the LPCC has completed additional training and  
               education beyond the minimum training and education  
               required for licensure, as specified; and,

             d)   Requires LPCCs to refer clients to other licensed health  
               care professionals when they identify issues beyond their  
               own scope of education, training, and experience.

          6)Prohibits persons from holding themselves out to the public by  
            any title or description of services as an LPCC unless they  
            are otherwise licensed to provide professional clinical  
            counseling services.

          7)Requires that applicants for licensure or registration who  
            begin graduate study before August 1, 2012, and complete that  
            study on or before December 31, 2018 adhere to the following  
            requirements:

             a)   Possess a master's or doctoral degree in counseling or  
               psychotherapy containing no fewer than 48 graduate semester  
               or 72 graduate quarter units of instruction, as specified;

             b)   Take the equivalent of at least three semester units of  
               graduate study in the following core content areas:  








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               counseling and psychotherapeutic theories and techniques;  
               human growth and development across the lifespan; career  
               development theories and techniques; group counseling  
               theories and techniques; assessment, appraisal, and testing  
               of individuals; multicultural counseling theories and  
               techniques; principles of the diagnostic process; research  
               and evaluation; professional orientation, ethics, and law  
               in counseling, as specified;

             c)   A minimum of 12 semester units or 18 quarter units of  
               advanced coursework to develop knowledge of specific  
               treatment issues, special populations, application of  
               counseling constructs, assessment and treatment planning,  
               clinical interventions, therapeutic relationships,  
               psychopathology, or other clinical topics;

             d)   A minimum of six semester units or nine quarter units of  
               supervised practicum or field study experience in a  
               clinical setting, as specified, including  a minimum of 150  
               hours of face-to-face supervised clinical experience  
               counseling individuals, families, or groups, as specified;  
               and,

             e)   Specifies that in addition to the degree requirements,  
               an applicant shall complete the following coursework or  
               training prior to registration as an intern: a minimum of  
               15 contact hours of instruction in alcoholism and other  
               chemical substance abuse dependency; a minimum of 10  
               contact hours of training or coursework in human sexuality;  
               two semester unit or three quarter unit survey course in  
               psychopharmacology; a minimum of 15 contact hours of  
               instruction in spousal or partner abuse assessment,  
               detection, and intervention strategies; a minimum of seven  
               contact hours of training or coursework in child abuse  
               assessment and reporting; a minimum of 18 contact hours of  
               instruction in California law and professional ethics for  
               LPCCs; a minimum of 10 contact hours of instruction in  
               aging and long-term care; and a minimum of 15 contact hours  
               of instruction in crisis or trauma counseling, as  
               specified.

          8)Requires that applicants for licensure or registration who  
            begin graduate study before August 1, 2012, and do not  
            complete that study on or before December 31, 2018; begin  
            graduate study before August 1, 2012 and who graduate from a  








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            degree program meeting the requirements of this bill; and  
            applicants for licensure or registration who begin graduate  
            study on or after August 1, 2012, adhere to the following  
            requirements:

             a)   Possess a master's or doctoral degree in counseling or  
               psychotherapy that contains no fewer than 60 graduate  
               semester or 90 graduate quarter units of instruction  
               including at least three semester units or four and  
               one-half quarter units of graduate study in all of the  
               following core content areas: counseling and  
               psychotherapeutic theories and techniques; human growth and  
               development across the lifespan; career development  
               theories and techniques; group counseling theories and  
               techniques; assessment, appraisal, and testing of  
               individuals; multicultural counseling theories and  
               techniques; principles of diagnostic process; research and  
               evaluation; professional orientation, ethics, and law in  
               counseling; psychopharmacology; addictions counseling;  
               crisis or trauma counseling; and advanced counseling and  
               psychotherapeutic theories and techniques, as specified;

             b)   Take 15 semester units or 22.5 quarter units of advanced  
               coursework and experience to develop knowledge of specific  
               treatment issues or special populations; and,

             c)   Take no fewer than six semester units or nine quarter  
               units of supervised practicum or field study experience in  
               a clinical setting that provides a range of professional  
               clinical counseling experience, including a minimum of 280  
               hours of face-to-face supervised clinical experience  
               counseling individuals, families or groups.

          9)Authorizes BBS to make the final determination as to whether a  
            degree meets all requirements, including, but not limited to,  
            course requirements, regardless of accreditation.

          10)Requires each educational institution preparing applicants to  
            qualify for licensure to notify each of its students by means  
            of public document or otherwise in writing that its degree  
            program is designed to meet the requirements of this bill and  
            to certify to BBS that it has done so.

          11)Requires each applicant for licensure to complete a minimum  
            of 3,000 post-degree hours of supervised clinical mental  








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            health experience, as specified.

          12)Authorizes BBS to begin accepting applications for licensure  
            on January 1, 2012 and issue a LPCC license to any person  
            meeting the following requirements:

             a)   He or she has received a master's or doctoral degree, as  
               specified;

             b)   He or she has completed of 3,000 hours of supervised  
               experience in the practice of professional clinical  
               counseling, as specified; and,

             c)   He or she provides evidence of a passing score on the  
               examinations designated by BBS.

          13)Prohibits BBS from issuing a license to any person who has  
            been convicted of a crime involving sexual abuse of children  
            or who is required to register as a sex offender, as  
            specified.

          14)Requires BBS to direct applicants to electronically submit to  
            the Department of Justice fingerprint images, as specified.

          15)Requires BBS to offer licensing examinations at least twice a  
            year, as specified, and specifies that the examinations shall  
            measure knowledge and abilities demonstrably important to the  
            safe, effective practice of the profession, as specified.

          16)Establishes grandfathering provisions for persons who submit  
            an application for licensure between January 1, 2011 and June  
            30th, 2011, who meet one of the following sets of criteria:

             a)   He or she meets the following requirements:

               i)     Has a master's or doctoral degree in counseling or  
                 psychotherapy, which includes coursework in core content  
                 areas, as specified;

               ii)    Has at least two years, full-time or the equivalent  
                 of post-degree counseling experience that includes at  
                 least 1,700 hours of experience in a clinical setting, as  
                 specified; and,

               iii)   Has a passing score on the following examinations:  








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                 The National Counselor Examination for Licensure and  
                 Certification or the Certified Rehabilitation Counselor  
                 Examination; the National Clinical Mental Health  
                 Counselor Examination; and a California jurisprudence and  
                 ethics examination, when developed by BBS.

             b)   He or she is currently licensed as a MFT in the state of  
               California, meets the coursework requirements as specified,  
               and passes the examinations listed above; or,

             c)   He or she is currently licensed as a LCSW in the state  
               of California, meets the coursework requirements as  
               specified, and passes the examinations listed above.

          17)Requires BBS and the Office of Professional Examination  
            Services to jointly develop an examination on the differences,  
            if any exist, between the practice of professional clinical  
            counseling and the practice of marriage and family therapy;  
            and the practice of professional clinical counseling and the  
            practice of clinical social work.

          18)Establishes provisions for persons seeking licensure who are  
            licensed outside of California, which includes having a  
            passing score for the jurisprudence and ethics exam, having a  
            license in good standing with another state, and having  
            education and experience substantially equivalent to the  
            requirements for licensure in California, as specified.

          19)Prohibits BBS from renewing any LPCC license unless the  
            applicant has completed approved continuing education, as  
            determined by BBS.

          20)Authorizes BBS to refuse to issue any registration or  
            license, or suspend or revoke the registration or license of  
            any intern or LPCC if that person has been found guilty of  
            unprofessional conduct, as specified.

          21)Establishes the following fee structure for licensure,  
            licensure renewal and examinations for LPCCs and interns:

             a)   The fee for the application for an initial license shall  
               not exceed $180.

             b)   The fee for the jurisprudence and ethics examination  
               shall not exceed $100.








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             c)   The fee for the written examination shall not exceed  
               $250.

             d)   The fee for the issuance of an initial license shall not  
               exceed $200.

             e)   The fee for annual renewal of licenses shall not exceed  
               $150.

             f)   The fee for annual renewal of an intern registration  
               shall not exceed $100; and,

             g)   The fee for two-year renewal of licenses shall not  
               exceed $200.

          22)Requires BBS to report each month to the Controller the  
            amount and source of all revenue received pursuant to this  
            bill and at the same time deposit the entire amount thereof in  
            the State Treasury for credit to the Behavioral Sciences Fund.

          23)Includes in the definition of "psychotherapist" a LPCC,  
            intern, and clinical counselor trainee, as specified.

          24)Includes in the definition of "licentiate" a LPCC.

          25)Makes conforming and technical changes.

           EXISTING LAW  :

          1)Licenses and regulates the practice of psychotherapy performed  
            by MFTs, licensed educational psychologists (LEPs), and LCSWs  
            by BBS within the Department of Consumer Affairs.

          2)Provides for an 11 member BBS, made up of:

        a)   Five professional members appointed by the Governor  
               consisting of:  2 LCSW licensees, 1 LEP licensee, and 2 MFT  
               licensees; and,

        b)   Six public members consisting of:  4 gubernatorial  
               appointees, 1 Senate appointee, and 1 Assembly appointee.

          3)Defines a psychotherapist as a physician and surgeon  
            specializing in psychiatry or practicing psychotherapy, a  








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            psychologist, a LCSW, a MFT, a psychological assistant, a MFT  
            registered intern or trainee, or an associate clinical social  
            worker.

          4)Establishes the following general requirements for licensure  
            of 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 BBS while gaining the supervised  
                   experience; and,

            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  
            of the Business and Professions Code.

           FISCAL EFFECT  :   Unknown









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           COMMENTS  :   

           Purpose of this bill  .  According to the author's office, "49  
          states currently recognize LPCCs, yet California is the only  
          remaining state not to recognize this profession, whose numbers  
          exceed 100,000 nationally.

          "This bill will not only allow out-of-state licensed counselors  
          who have moved to California to practice, but also allow the  
          counseling tracks in our CSU and private universities, to lead  
          to licensure beyond the one category California offers of  
          marriage and family therapy.  Consumer protection is of utmost  
          concern, as consumers who want to seek out a counselor for  
          issues not related to marriage and family, could then seek out a  
          licensed professional which they cannot currently do.  With  
          recognition of the 'LPCC' California would benefit from federal  
          funding which includes the LPCC, including funding from  
          Veteran's Affairs for Rehabilitation Counselors to serve  
          veterans and their families, and Federally Qualified Health  
          Clinic funding as well."

           Background  .  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; California  
          Career Development Association; California Counseling  
          Association; California Mental Health Counselors Association;  
          California Rehabilitation Association-North, Inc.; California  
          Rehabilitation Counseling Association; Northern California Art  
          Therapy Association; and, the Southern California Chapter of  
          American Dance Therapy Association.
           
          The 2003 California Workforce Initiative report, The Mental  
          Health Workforce: Who's Meeting California Needs, points out  
          that the state will need an additional 13,000 to 20,000 mental  
          health professionals by the year 2010.  The sponsor believes  
          licensing of LPCCs would address this deficiency.
           
          The sponsor explains that there is a particular shortage of  
          mental health providers in rural areas available to treat  
          Medi-Cal beneficiaries.  This shortage could increase due to the  
          passage of Proposition 63, the Mental Health Services Act  
          (MHSA), passed in 2004, which expands mental health care for  
          children and adults through a 1% tax on taxable personal income  








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          over $1 million.
           
          News articles have reported that some counties are receiving  
          money from MHSA, but 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 currently employed in 36 county  
          mental health departments throughout the state.  Without a  
          license, there are limits to the services they can provide and  
          the reimbursements counties can receive unless the counselor is  
          licensed.

           Federal Legislation  .   In 2006, the President signed the  
          Veterans Benefits, Health Care, and Information Technology Act.   
           This Act recognized LPCCs as mental health specialists within  
          health care programs operated by the Department of Veterans  
          Affairs (VA) to bring increased access to mental health services  
          for persons in the VA system. 

           Hurricane Katrina Assistance  .   In 2005, the American Counseling  
          Association received a large federal grant to help facilitate  
          the immediate deployment of LPCCs 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, so none of California's thousands of mental health  
          counselors qualified unless they were licensed in another state.  
           

           Sunrise Hearing:  Subject heard by the Joint Committee in 2006  .   
          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.  The Joint Committee  
          recommended, "It has not been clearly established that there is  
          sufficient consumer protection justification for this proposal  
          [the licensure of LPCCs] and that this proposal meets the  
          threshold for licensure [the potential for serious injury or  
          death, or severe financial harm]."  The proposal did not receive  
          sufficient votes to be approved by the Joint Committee and went  








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          forward without a support or oppose recommendation from the  
          Joint Committee.


           Previous legislation  .

          AB 1486 (Calderon) of 2008 would have provided for the licensure  
          or registration and regulation of licensed professional  
          counselors by BBS.  This bill was held in the Senate  
          Appropriations Committee.
           
          AB 894 (La Suer) of 2005 would require professional counselors  
          be licensed and regulated by BBS, and prohibits a person from  
                    practicing or advertising the performance of professional  
          counseling services without a license issued by BBS.  This bill  
          was held in the Assembly Appropriations Committee.

           REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          American Art Therapy Association
          American Association of State Counseling Boards
          American Counseling Association
          American Mental Health Counselors Association
          Associates for Relational Therapy
          California Association for School Counselors
          California Career Development Association
          California Chapters of the American Red Cross
          California Coalition for Counselor Licensure
          California Counseling Association
          California Mental Health Counselors Association
          California Primary Care Association
          California Psychiatric Association
          California Registry of Professional Counselors and  
          Paraprofessionals
          California Rehabilitation Association
          California Rehabilitation Counseling Association
          California State Rural Health Association
          Center for Independent Living - Fresno
          Coast Rehabilitation Services, Inc.
          Commission on Rehabilitation Counselor Certification
          Department of the Navy
          Department of Veterans Affairs
          Loma Linda University








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          Mountain Health & Community Services, Inc.
          National Board for Certified Counselors
          Northern California Art Therapy Association
          San Diego Regional Center
          Santa Ynez Valley People Helping People
          Southern California Chapter of the American Dance Therapy  
          Association
          Survivors of Torture International
          The Effort
          Western Association for Counselor Education and Supervision
          Several individuals
           
            Opposition 
          
          None on file.

           Analysis Prepared by  :    Rebecca May / B. & P. / (916) 319-3301