BILL NUMBER: SB 363 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 21, 2011
INTRODUCED BY Senator Emmerson
FEBRUARY 15, 2011
An act to amend Sections 4980.36 and 4980.42
4980.01, 4980.03, 4980.36, 4980.42, and 4980.43 of the
Business and Professions Code, relating to marriage and family
therapists.
LEGISLATIVE COUNSEL'S DIGEST
SB 363, as amended, Emmerson. Marriage and family therapists.
Existing law provides for the licensing and regulation of marriage
and family therapists by the Board of Behavioral Sciences. Existing
law specifies the education required for licensure, which includes a
requirement for a practicum that involves direct client contact
and hours of experience relating to client centered advocacy, as
defined . Existing law authorizes trainees to perform
activities and services in certain work settings provided that these
constitute part of the trainee's supervised course of study and the
person is designated as a trainee. Existing law also authorizes
trainees to gain hours of experience outside the required practicum
under certain conditions, but requires trainees who gain experience
outside the required practicum to be enrolled in a practicum in order
to counsel clients.
This bill would provide that trainees may also counsel clients
while not enrolled in a practicum if the period of lapsed enrollment
is less than 45 calendar days. The bill would reduce the maximum
number of hours that may be gained by engaging in client centered
advocacy, as specified.
Existing law requires an applicant for licensure as a marriage and
family therapist to complete a specified number of hours of
supervised experience. For those purposes, existing law requires the
supervision of a marriage and family therapy intern or trainee by a
supervisor, defined as, among other things, a person who has been
licensed for at least 2 years as a marriage and family therapist,
licensed clinical social worker, licensed psychologist, or licensed
physician certified in psychiatry.
This bill would authorize a licensed professional clinical
counselor to act as a supervisor of a marriage and family therapy
intern or trainee if he or she meets additional training and
education requirements, as specified.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4980.01 of the
Business and Professions Code is amended to read:
4980.01. (a) Nothing in this chapter shall be construed to
constrict, limit, or withdraw the Medical Practice Act, the Social
Work Licensing Law, the Nursing Practice Act, the Licensed
Professional Clinical Counselor Act, or the Psychology
Licensing Act.
(b) This chapter shall not apply to any priest, rabbi, or minister
of the gospel of any religious denomination when performing
counseling services as part of his or her pastoral or professional
duties, or to any person who is admitted to practice law in the
state, or who is licensed to practice medicine, when providing
counseling services as part of his or her professional practice.
(c) (1) This chapter shall not apply to an employee working in any
of the following settings if his or her work is performed solely
under the supervision of the employer:
(A) A governmental entity.
(B) A school, college, or university.
(C) An institution that is both nonprofit and charitable.
(2) This chapter shall not apply to a volunteer working in any of
the settings described in paragraph (1) if his or her work is
performed solely under the supervision of the entity, school, or
institution.
(d) A marriage and family therapist licensed under this chapter is
a licentiate for purposes of paragraph (2) of subdivision (a) of
Section 805, and thus is a health care practitioner subject to the
provisions of Section 2290.5 pursuant to subdivision (b) of that
section.
(e) Notwithstanding subdivisions (b) and (c), all persons
registered as interns or licensed under this chapter shall not be
exempt from this chapter or the jurisdiction of the board.
SEC. 2. Section 4980.03 of the Business
and Professions Code is amended to read:
4980.03. (a) "Board," as used in this chapter, means the Board of
Behavioral Sciences.
(b) "Intern," as used in this chapter, means an unlicensed person
who has earned his or her master's or doctor's degree qualifying him
or her for licensure and is registered with the board.
(c) "Trainee," as used in this chapter, means an unlicensed person
who is currently enrolled in a master's or doctor's degree program,
as specified in Sections 4980.36 and 4980.37, that is designed to
qualify him or her for licensure under this chapter, and who has
completed no less than 12 semester units or 18 quarter units of
coursework in any qualifying degree program.
(d) "Applicant," as used in this chapter, means an unlicensed
person who has completed a master's or doctoral degree program, as
specified in Sections 4980.36 and 4980.37, and whose application for
registration as an intern is pending, or an unlicensed person who has
completed the requirements for licensure as specified in this
chapter, is no longer registered with the board as an intern, and is
currently in the examination process.
(e) "Advertise," as used in this chapter, includes, but is not
limited to, any public communication, as defined in subdivision (a)
of Section 651, the issuance of any card, sign, or device to any
person, or the causing, permitting, or allowing of any sign or
marking on, or in, any building or structure, or in any newspaper or
magazine or in any directory, or any printed matter whatsoever, with
or without any limiting qualification. Signs within religious
buildings or notices in church bulletins mailed to a congregation
shall not be construed as advertising within the meaning of this
chapter.
(f) "Experience," as used in this chapter, means experience in
interpersonal relationships, psychotherapy, marriage and family
therapy, and professional enrichment activities that satisfies the
requirement for licensure as a marriage and family therapist pursuant
to Section 4980.40.
(g) "Supervisor," as used in this chapter, means an individual who
meets all of the following requirements:
(1) Has been licensed by a state regulatory agency for at least
two years as a marriage and family therapist, licensed clinical
social worker, licensed professional clinical counselor,
licensed psychologist, or licensed physician certified in psychiatry
by the American Board of Psychiatry and Neurology.
(2) If a licensed professional clinical counselor, the individual
shall meet the additional training and education requirements
specified in paragraph (3) of subdivision (a) of Section 4999.20.
(2)
(3) Has not provided therapeutic services to the
trainee or intern.
(3)
(4) Has a current and valid license that is not under
suspension or probation.
(4)
(5) Complies with supervision requirements established
by this chapter and by board regulations.
(h) "Client centered advocacy," as used in this chapter, includes,
but is not limited to, researching, identifying, and accessing
resources, or other activities, related to obtaining or providing
services and supports for clients or groups of clients receiving
psychotherapy or counseling services.
SECTION 1. SEC. 3. Section 4980.36
of the Business and Professions Code is amended to read:
4980.36. (a) This section shall apply to the following:
(1) 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.
(2) Applicants for licensure or registration who begin graduate
study before August 1, 2012, and who graduate from a degree program
that meets the requirements of this section.
(3) Applicants for licensure or registration who begin graduate
study on or after August 1, 2012.
(b) To qualify for a license or registration, applicants shall
possess a doctor's or master's degree meeting the requirements of
this section in marriage, family, and child counseling, marriage and
family therapy, psychology, clinical psychology, counseling
psychology, or counseling with an emphasis in either marriage,
family, and child counseling or marriage and family therapy, obtained
from a school, college, or university approved by the Bureau for
Private Postsecondary and Vocational Education or accredited by
either the Commission on the Accreditation of Marriage and Family
Therapy Education or a regional accrediting agency recognized by the
United States Department of Education. The board has the authority to
make the final determination as to whether a degree meets all
requirements, including, but not limited to, course requirements,
regardless of accreditation or approval.
(c) A doctor's or master's degree program that qualifies for
licensure or registration shall do the following:
(1) Integrate all of the following throughout its curriculum:
(A) Marriage and family therapy principles.
(B) The principles of mental health recovery-oriented care and
methods of service delivery in recovery-oriented practice
environments, among others.
(C) An understanding of various cultures and the social and
psychological implications of socioeconomic position, and an
understanding of how poverty and social stress impact an individual's
mental health and recovery.
(2) Allow for innovation and individuality in the education of
marriage and family therapists.
(3) Encourage students to develop the personal qualities that are
intimately related to effective practice, including, but not limited
to, integrity, sensitivity, flexibility, insight, compassion, and
personal presence.
(4) Permit an emphasis or specialization that may address any one
or more of the unique and complex array of human problems, symptoms,
and needs of Californians served by marriage and family therapists.
(5) Provide students with the opportunity to meet with various
consumers and family members of consumers of mental health services
to enhance understanding of their experience of mental illness,
treatment, and recovery.
(d) The degree described in subdivision (b) shall contain no less
than 60 semester or 90 quarter units of instruction that includes,
but is not limited to, the following requirements:
(1) Both of the following:
(A) No less than 12 semester or 18 quarter units of coursework in
theories, principles, and methods of a variety of psychotherapeutic
orientations directly related to marriage and family therapy and
marital and family systems approaches to treatment and how these
theories can be applied therapeutically with individuals, couples,
families, adults, including elder adults, children, adolescents, and
groups to improve, restore, or maintain healthy relationships.
(B) Practicum that involves direct client contact, as follows:
(i) A minimum of six semester or nine quarter units of practicum
in a supervised clinical placement that provides supervised fieldwork
experience.
(ii) A minimum of 225 hours of face-to-face experience counseling
individuals, couples, families, or groups. Up to 75 of those hours
may be gained performing client centered advocacy, as defined in
Section 4980.03.
(iii) A student must be enrolled in a practicum course while
counseling clients, except as specified in subdivision (c) of Section
4980.42.
(iv) The practicum shall provide training in all of the following
areas:
(I) Applied use of theory and psychotherapeutic techniques.
(II) Assessment, diagnosis, and prognosis.
(III) Treatment of individuals and premarital, couple, family, and
child relationships, including trauma and abuse, dysfunctions,
healthy functioning, health promotion, illness prevention, and
working with families.
(IV) Professional writing, including documentation of services,
treatment plans, and progress notes.
(V) How to connect people with resources that deliver the quality
of services and support needed in the community.
(v) Educational institutions are encouraged to design the
practicum required by this subparagraph to include marriage and
family therapy experience in low-income and multicultural mental
health settings.
(2) Instruction in all of the following:
(A) Diagnosis, assessment, prognosis, and treatment of mental
disorders, including severe mental disorders, evidence-based
practices, psychological testing, psychopharmacology, and promising
mental health practices that are evaluated in peer reviewed
literature.
(B) Developmental issues from infancy to old age, including
instruction in all of the following areas:
(i) The effects of developmental issues on individuals, couples,
and family relationships.
(ii) The psychological, psychotherapeutic, and health implications
of developmental issues and their effects.
(iii) Aging and its biological, social, cognitive, and
psychological aspects.
(iv) A variety of cultural understandings of human development.
(v) The understanding of human behavior within the social context
of socioeconomic status and other contextual issues affecting social
position.
(vi) The understanding of human behavior within the social context
of a representative variety of the cultures found within California.
(vii) The understanding of the impact that personal and social
insecurity, social stress, low educational levels, inadequate
housing, and malnutrition have on human development.
(C) The broad range of matters and life events that may arise
within marriage and family relationships and within a variety of
California cultures, including instruction in all of the following:
(i) Child and adult abuse assessment and reporting.
(ii) Spousal or partner abuse assessment, detection, intervention
strategies, and same-gender abuse dynamics.
(iii) Cultural factors relevant to abuse of partners and family
members.
(iv) Childbirth, child rearing, parenting, and stepparenting.
(v) Marriage, divorce, and blended families.
(vi) Long-term care.
(vii) End of life and grief.
(viii) Poverty and deprivation.
(ix) Financial and social stress.
(x) Effects of trauma.
(xi) The psychological, psychotherapeutic, community, and health
implications of the matters and life events described in clauses (i)
to (x), inclusive.
(D) Cultural competency and sensitivity, including a familiarity
with the racial, cultural, linguistic, and ethnic backgrounds of
persons living in California.
(E) Multicultural development and cross-cultural interaction,
including experiences of race, ethnicity, class, spirituality, sexual
orientation, gender, and disability, and their incorporation into
the psychotherapeutic process.
(F) The effects of socioeconomic status on treatment and available
resources.
(G) Resilience, including the personal and community qualities
that enable persons to cope with adversity, trauma, tragedy, threats,
or other stresses.
(H) Human sexuality, including the study of physiological,
psychological, and social cultural variables associated with sexual
behavior and gender identity, and the assessment and treatment of
psychosexual dysfunction.
(I) Substance use disorders, co-occurring disorders, and
addiction, including, but not limited to, instruction in all of the
following:
(i) The definition of substance use disorders, co-occurring
disorders, and addiction. For purposes of this subparagraph,
"co-occurring disorders" means a mental illness and substance abuse
diagnosis occurring simultaneously in an individual.
(ii) Medical aspects of substance use disorders and co-occurring
disorders.
(iii) The effects of psychoactive drug use.
(iv) Current theories of the etiology of substance abuse and
addiction.
(v) The role of persons and systems that support or compound
substance abuse and addiction.
(vi) Major approaches to identification, evaluation, and treatment
of substance use disorders, co-occurring disorders, and addiction,
including, but not limited to, best practices.
(vii) Legal aspects of substance abuse.
(viii) Populations at risk with regard to substance use disorders
and co-occurring disorders.
(ix) Community resources offering screening, assessment,
treatment, and followup for the affected person and family.
(x) Recognition of substance use disorders, co-occurring
disorders, and addiction, and appropriate referral.
(xi) The prevention of substance use disorders and addiction.
(J) California law and professional ethics for marriage and family
therapists, including instruction in all of the following areas of
study:
(i) Contemporary professional ethics and statutory, regulatory,
and decisional laws that delineate the scope of practice of marriage
and family therapy.
(ii) The therapeutic, clinical, and practical considerations
involved in the legal and ethical practice of marriage and family
therapy, including, but not limited to, family law.
(iii) The current legal patterns and trends in the mental health
professions.
(iv) The psychotherapist-patient privilege, confidentiality, the
patient dangerous to self or others, and the treatment of minors with
and without parental consent.
(v) A recognition and exploration of the relationship between a
practitioner's sense of self and human values and his or her
professional behavior and ethics.
(vi) Differences in legal and ethical standards for different
types of work settings.
(vii) Licensing law and licensing process.
(e) The degree described in subdivision (b) shall, in addition to
meeting the requirements of subdivision (d), include instruction in
case management, systems of care for the severely mentally ill,
public and private services and supports available for the severely
mentally ill, community resources for persons with mental illness and
for victims of abuse, disaster and trauma response, advocacy for the
severely mentally ill, and collaborative treatment. This instruction
may be provided either in credit level coursework or through
extension programs offered by the degree-granting institution.
(f) The changes made to law by this section are intended to
improve the educational qualifications for licensure in order to
better prepare future licentiates for practice, and are not intended
to expand or restrict the scope of practice for marriage and family
therapists.
SEC. 2. SEC. 4. Section 4980.42 of
the Business and Professions Code is amended to read:
4980.42. (a) Trainees performing services in any work setting
specified in subdivision (e) of Section 4980.43 may perform those
activities and services as a trainee, provided that the activities
and services constitute part of the trainee's supervised course of
study and that the person is designated by the title "trainee."
(b) Trainees may gain hours of experience outside the required
practicum but must be enrolled in a practicum course to counsel
clients, as set forth on subparagraph (iii) of paragraph (B)
in clause (iii) of subparagraph (B) of
paragraph (1) of subdivision (d) of Section 4980.36, except as
provided in subdivision (c).
(c) Trainees may counsel clients while not enrolled in a practicum
course if the period of lapsed enrollment is less than 45 calendar
days.
(d) All hours of experience gained pursuant to subdivisions (b)
and (c) shall be subject to the requirements of subdivision (b) and
to the other requirements of this chapter.
(e) On and after January 1, 1995, all hours of experience gained
as a trainee shall be coordinated between the school and the site
where the hours are being accrued. The school shall approve each site
and shall have a written agreement with each site that details each
party's responsibilities, including the methods by which supervision
shall be provided. The agreement shall provide for regular progress
reports and evaluations of the student's performance at the site. If
an applicant has gained hours of experience while enrolled in an
institution other than the one that confers the qualifying degree, it
shall be the applicant's responsibility to provide to the board
satisfactory evidence that those hours of trainee experience were
gained in compliance with this section.
SEC. 5. Section 4980.43 of the Business
and Professions Code is amended to read:
4980.43. (a) Prior to applying for licensure examinations, each
applicant shall complete experience that shall comply with the
following:
(1) A minimum of 3,000 hours completed during a period of at least
104 weeks.
(2) Not more than 40 hours in any seven consecutive days.
(3) Not less than 1,700 hours of supervised experience completed
subsequent to the granting of the qualifying master's or doctoral
degree.
(4) Not more than 1,300 hours of supervised experience obtained
prior to completing a master's or doctoral degree.
The applicant shall not be credited with more than 750 hours of
counseling and direct supervisor contact prior to completing the
master's or doctoral degree.
(5) No hours of experience may be gained prior to completing
either 12 semester units or 18 quarter units of graduate instruction
and becoming a trainee except for personal psychotherapy.
(6) No hours of experience may be gained more than six years prior
to the date the application for examination eligibility was filed,
except that up to 500 hours of clinical experience gained in the
supervised practicum required by subdivision (c) of Section 4980.37
and subparagraph (B) of paragraph (1) of subdivision (d) of Section
4980.36 shall be exempt from this six-year requirement.
(7) Not more than a combined total of 1,250
1,000 hours of experience in the following:
(A) Direct supervisor contact.
(B) Professional enrichment activities. For purposes of this
chapter, "professional enrichment activities" include the following:
(i) Workshops, seminars, training sessions, or conferences
directly related to marriage and family therapy attended by the
applicant that are approved by the applicant's supervisor. An
applicant shall have no more than 250 hours of verified attendance at
these workshops, seminars, training sessions, or conferences.
(ii) Participation by the applicant in personal psychotherapy,
which includes group, marital or conjoint, family, or individual
psychotherapy by an appropriately licensed professional. An applicant
shall have no more than 100 hours of participation in personal
psychotherapy. The applicant shall be credited with three hours of
experience for each hour of personal psychotherapy.
(C) Client centered advocacy.
(8) Not more than 500 hours of experience providing group therapy
or group counseling.
(9) Not more than 250 hours of experience
(9) For all hours gained on or after January 1, 2012, not more
than 500 hours of experience in the following:
(A) Experience administering and
evaluating psychological tests, writing clinical reports, writing
progress notes, or writing process notes.
(B) Client centered advocacy.
(10) Not less than 500 total hours of experience in diagnosing and
treating couples, families, and children. For up to 150 hours of
treating couples and families in conjoint therapy, the applicant
shall be credited with two hours of experience for each hour of
therapy provided.
(11) Not more than 375 hours of experience providing personal
psychotherapy, crisis counseling, or other counseling services via
telemedicine in accordance with Section 2290.5.
(12) It is anticipated and encouraged that hours of experience
will include working with elders and dependent adults who have
physical or mental limitations that restrict their ability to carry
out normal activities or protect their rights.
This subdivision shall only apply to hours gained on and after
January 1, 2010.
(b) All applicants, trainees, and registrants shall 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 shall be responsible to the board
for compliance with all laws, rules, and regulations governing the
practice of marriage and family therapy. Supervised experience shall
be gained by interns and trainees either as an employee or as a
volunteer. The requirements of this chapter regarding gaining hours
of experience and supervision are applicable equally to employees and
volunteers. Experience shall not be gained by interns or trainees as
an independent contractor.
(1) If employed, an intern shall provide the board with copies of
the corresponding W-2 tax forms for each year of experience claimed
upon application for licensure.
(2) If volunteering, an intern shall provide the board with a
letter from his or her employer verifying the intern's employment as
a volunteer upon application for licensure.
(c) Supervision shall include at least one hour of direct
supervisor contact in each week for which experience is credited in
each work setting, as specified:
(1) A trainee shall receive an average of at least one hour of
direct supervisor contact for every five hours of client contact in
each setting.
(2) An individual supervised after being granted a qualifying
degree shall receive at least one additional hour of direct
supervisor contact for every week in which more than 10 hours of
client contact is gained in each setting. No more than five hours of
supervision, whether individual or group, shall be credited during
any single week.
(3) For purposes of this section, "one hour of direct supervisor
contact" means one hour per week of face-to-face contact on an
individual basis or two hours per week of face-to-face contact in a
group.
(4) Direct supervisor contact shall occur within the same week as
the hours claimed.
(5) Direct supervisor contact provided in a group shall be
provided in a group of not more than eight supervisees and in
segments lasting no less than one continuous hour.
(6) Notwithstanding paragraph (3), an intern working in a
governmental entity, a school, a college, or a university, or an
institution that is both nonprofit and charitable may obtain the
required weekly direct supervisor contact via two-way, real-time
videoconferencing. The supervisor shall be responsible for ensuring
that client confidentiality is upheld.
(7) All experience gained by a trainee shall be monitored by the
supervisor as specified by regulation.
(d) (1) A trainee may be credited with supervised experience
completed in any setting that meets all of the following:
(A) Lawfully and regularly provides mental health counseling or
psychotherapy.
(B) Provides oversight to ensure that the trainee's work at the
setting meets the experience and supervision requirements set forth
in this chapter and is within the scope of practice for the
profession as defined in Section 4980.02.
(C) Is not a private practice owned by a licensed marriage and
family therapist, a licensed psychologist, a licensed clinical social
worker, a licensed physician and surgeon, or a professional
corporation of any of those licensed professions.
(2) Experience may be gained by the trainee solely as part of the
position for which the trainee volunteers or is employed.
(e) (1) An intern may be credited with supervised experience
completed in any setting that meets both of the following:
(A) Lawfully and regularly provides mental health counseling or
psychotherapy.
(B) Provides oversight to ensure that the intern's work at the
setting meets the experience and supervision requirements set forth
in this chapter and is within the scope of practice for the
profession as defined in Section 4980.02.
(2) An applicant shall not be employed or volunteer in a private
practice, as defined in subparagraph (C) of paragraph (1) of
subdivision (d), until registered as an intern.
(3) While an intern may be either a paid employee or a volunteer,
employers are encouraged to provide fair remuneration to interns.
(4) Except for periods of time during a supervisor's vacation or
sick leave, an intern who is employed or volunteering in private
practice shall be under the direct supervision of a licensee that has
satisfied the requirements of subdivision (g) of Section 4980.03.
The supervising licensee shall either be employed by and practice at
the same site as the intern's employer, or shall be an owner or
shareholder of the private practice. Alternative supervision may be
arranged during a supervisor's vacation or sick leave if the
supervision meets the requirements of this section.
(5) Experience may be gained by the intern solely as part of the
position for which the intern volunteers or is employed.
(f) Except as provided in subdivision (g), all persons shall
register with the board as an intern in order to be credited for
postdegree hours of
supervised experience gained toward licensure.
(g) Except when employed in a private practice setting, all
postdegree hours of experience shall be credited toward licensure so
long as the applicant applies for the intern registration within 90
days of the granting of the qualifying master's or doctoral degree
and is thereafter granted the intern registration by the board.
(h) Trainees, interns, and applicants shall not receive any
remuneration from patients or clients, and shall only be paid by
their employers.
(i) Trainees, interns, and applicants shall only perform services
at the place where their employers regularly conduct business, which
may include performing services at other locations, so long as the
services are performed under the direction and control of their
employer and supervisor, and in compliance with the laws and
regulations pertaining to supervision. Trainees and interns shall
have no proprietary interest in their employers' businesses and shall
not lease or rent space, pay for furnishings, equipment or supplies,
or in any other way pay for the obligations of their employers.
(j) Trainees, interns, or applicants who provide volunteered
services or other services, and who receive no more than a total,
from all work settings, of five hundred dollars ($500) per month as
reimbursement for expenses actually incurred by those trainees,
interns, or applicants for services rendered in any lawful work
setting other than a private practice shall be considered an employee
and not an independent contractor. The board may audit applicants
who receive reimbursement for expenses, and the applicants shall have
the burden of demonstrating that the payments received were for
reimbursement of expenses actually incurred.
(k) Each educational institution preparing applicants for
licensure pursuant to this chapter shall consider requiring, and
shall encourage, its students to undergo individual, marital or
conjoint, family, or group counseling or psychotherapy, as
appropriate. Each supervisor shall consider, advise, and encourage
his or her interns and trainees regarding the advisability of
undertaking individual, marital or conjoint, family, or group
counseling or psychotherapy, as appropriate. Insofar as it is deemed
appropriate and is desired by the applicant, the educational
institution and supervisors are encouraged to assist the applicant in
locating that counseling or psychotherapy at a reasonable cost.