BILL ANALYSIS                                                                                                                                                                                                    Ó







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        |Hearing Date:April 11, 2011        |Bill No:SB                         |
        |                                   |363                                |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                         Bill No:        SB 363Author:Emmerson
                    As Amended:March 21, 2011          Fiscal: Yes

        
        SUBJECT:  Marriage and family therapists.
        
        SUMMARY:  Allows marriage and family therapist trainees to continue 
        counseling clients while not enrolled in a practicum if the lapse in 
        enrollment is less than 45 days; limits the number of client-centered 
        advocacy hours for a marriage and family therapist intern to 500 
        hours; and allows professional clinical counselors to supervise 
        marriage and family therapist interns if they meet additional training 
        and education requirements to treat couples and families.

        Existing law:
        
        1) Licenses and regulates the practice of marriage and family 
           therapists (MFTs), licensed educational psychologists (LEPs), and 
           licensed clinical social workers (LCSWs) by the Board of Behavioral 
           Sciences (BBS) within the Department of Consumer Affairs.  
           Beginning 
        January 1, 2012, the BBS will additionally license professional 
           clinical counselors (LPCCs).

        2) Establishes education requirements for MFT licensure, including a 
           requirement for a practicum completed by an MFT intern that 
           involves certain types and hours of experience, and specifies that 
           not more than a combined total of 1,250 of experience may be gained 
           in the following:

           a)   Direct supervisor contact.

           b)   Professional enrichment activities, including workshops, 
             seminars, training sessions, conferences, or personal 





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             psychotherapy, as specified.

           c)   Client centered advocacy, generally defined as activities, 
             related to obtaining or providing services and supports for 
             clients.  (BPC § 4980.43)

        1) Authorizes MFT interns and trainees to perform counseling 
           activities and services in certain work settings; and requires that 
           a trainee or intern shall at all times be under the supervision of 
           a supervisor.

           a)   Requires the supervisor to be responsible for ensuring that 
             the counseling performed is consistent with the training and 
             experience of the person being supervised, requires the 
             supervisor to be responsible to the BBS for compliance with all 
             laws, rules, and regulations governing the practice of marriage 
             and family therapy.  (BPC § 4980.43)

           b)   Defines "supervisor" to include an MFT, LCSW, licensed 
             psychologist, or licensed physician certified in psychiatry.  
             (BPC § 4980.03)

        2) 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.  (BPC § 4980.42)

        3) Prohibits a LPCC from engaging in the assessment or treatment of 
           couples or families  unless the LPCC meets additional training and 
           education requirements beyond that required for licensure, 
           including:

           a)   Six semester units or nine quarter units in marriage and 
             family therapy or a specialization in marriage and family 
             therapy, as specified.

           b)   No less than 500 hours of documented supervised experience 
             working directly with couples, families or children.

           c)   A minimum of six hours of continuing education specific to 
             marriage and family therapy in each license renewal cycle.  (BPC 
             § 4999.20)

        This bill:

        1) Provides that an MFT trainee may also counsel clients while not 





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           enrolled in a practicum if the period of lapsed enrollment is less 
           than 45 calendar days.

        2) Recasts the provisions of No. 2, above, to instead provide that an 
           MFT intern practicum must involve certain types and hours of 
           experience, and specifies that not more than a combined total of 
           1,000 hours of experience may be gained  in the following:

           a)   Direct supervisor contact.

           b)   Professional enrichment activities, including workshops, 
             seminars, training sessions, conferences, or personal 
             psychotherapy, as specified.

           c)   Limits to 500 hours, the number of experience hours that may 
             be gained from client-centered advocacy, administering and 
             evaluating psychological tests, and writing clinical reports and 
             notes.

        1) Authorizes an LPCC to act as a supervisor of a MFT intern or 
           trainee if he or she meets the additional training and education 
           requirements required for a LPCC to counsel couples or families.

        2) Makes technical cleanup, and conforming changes.

        FISCAL EFFECT:  Unknown.  This bill has been keyed "fiscal" by 
        Legislative Counsel.


        

        COMMENTS:
        
        1. Purpose.  This bill is sponsored by the  Board of Behavioral 
           Sciences  (Sponsor) to clarify and amend supervision and experience 
           requirements for those seeking licensure as an MFT.  According to 
           the Sponsor, the bill contains three provisions.  First, allows an 
           MFT trainee to continue counseling clients while not enrolled in a 
           practicum if that lapse in enrollment is less than 45 days.  
           Second, limits the number of client-centered advocacy hours for an 
           MFT intern to 500 hours.  Third, allows LPCCs to supervise MFT 
           interns if they meet additional training and education requirements 
           to treat couples and families.

        2. Background.  Revisions made in the MFT law by  SB 33  (Correa, 
           Chapter 26, Statutes of 2009) require MFT trainees to be enrolled 





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           in a practicum course while counseling clients.  According to BBS, 
           a number of schools have voiced concern on how the practicum course 
           requirement would operate during intersession and summer break when 
           students may not be able to enroll in a practicum course.  This 
           could create continuity of care issues when the trainee goes on 
           summer break leaving the client with another practitioner or even 
           without care.  Additionally, there are barriers to licensure if the 
           trainee is not able to gain direct client hours due to not being 
           enrolled in practicum.  Therefore, allowing a trainee to continue 
           counseling clients while not enrolled in a practicum if that lapse 
           in enrollment is less than 45 days will help address these 
           concerns, according to the BBS.

        BBS further indicates that under current law, the number of 
           client-centered advocacy hours that a marriage and family therapist 
           intern can obtain is only limited by the amount of direct 
           supervisor contact hours acquired by the intern.  For example, if 
           an intern received the minimum number of direct supervisor contact 
           hours for 104 weeks, that individual could potentially receive 
           credit for 1,146 hours for client-centered advocacy.  The BBS 
           believes that the majority of the MFT intern's experience hours 
           should be gained through a variety of training activities other 
           than client-centered advocacy, therefore, the bill proposes to 
           limit the client centered advocacy allowed for an MFT intern to 500 
           hours.

        Currently, BBS states, licensed professional clinical counselors are 
           not allowed to supervise marriage and family therapist interns.  
           However, the law authorizes all other licensees of the BBS to 
           supervise these interns.  Therefore, the bill would authorize LPCCs 
           to supervise marriage and family therapist interns if they meet 
           additional training and education requirements to treat couples and 
           families.

        3. Related Legislation.   SB 33  (Correa, Chapter 26, Statutes of 2009) 
           updated and recast the educational curriculum requirements for MFTs 
           to require persons who begin graduate study after August 1, 2012, 
           to meet increased total unit requirements, increased practicum 
           hours for face-to-face counseling, integrates specified elements, 
           including public mental health practices, throughout the 
           curriculum, revised MFT educational requirements and revised 
           requirements for applicants licensed or educated outside of 
           California.

         SB 788  (Wyland, Chapter 619, Statutes of 2009) established the 
           licensing and regulation of professional clinical counselors in 





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           California.  Stated that LPCCs practice is a separate and distinct 
           profession from licensed marriage and family therapy (MFT) and 
           licensed clinical social work (LCSW).  Authorized BBS to begin 
           accepting applications for examination eligibility on January 1, 
           2012, and issue LPCC licenses to applicants who meet certain 
           education, experience and examination requirements.

         SB 146  (Wyland)   revises various provisions relating to the practice of 
           mental health professionals to also include the practice of 
           licensed professional clinical counselors, clinical counselor 
           trainees, and clinical counselor interns; makes technical updating 
           and conforming changes.  This measure is set for hearing in this 
           Committee on April 11, 2011.

         SB 704  (Negrete McLeod) revises and recasts examination requirements 
           for marriage and family therapists and interns and for licensed 
           clinical social workers and associate social workers; makes 
           technical cleanup and conforming changes.  This measure was 
           approved on Consent by this Committee on April 4, 2011.

        4. Arguments in Support.   American Association for Marriage and Family 
           Therapy  (AAMFT-CA) argues the bill ensures proper university 
           supervision for graduate MFT students who are seeking clients and 
           expands the pool of eligible supervisors for MFT interns and 
           trainees to include LPCCs who meet state requirements to assist and 
           treat couples and families.  

        AAMFT-CA further argues that the Board worked with graduate programs 
           over two years to revise the MFT curriculum.  Those changes, made 
           in SB 33 in 2009, did not increase the academic unit requirement 
           for practicum, but instead included a requirement that students 
           must be enrolled in a practicum course while seeing clients.  This 
           allowed practicum hours to be expanded without adding mandatory 
           units to the curriculum, and at the same time meeting the public- 
           protection need for trainees to receive adequate university 
           oversight of their work.  AAMFT-CA suggests that the bill's 45-day 
           allowance for academic breaks, ensures that client care is not 
           unduly impacted by breaks between academic terms, while maintaining 
           appropriate school oversight for trainees.

        AFMFT-CA argues that it is fully appropriate to require LPCCs to 
           complete specific coursework and supervised experience in order to 
           supervise MFT interns and trainees since MFT interns and trainees 
           under supervision are likely to be working with couples and 
           families.  To remove this requirement would allow LPCCs to 
           supervise an activity (assessing or treating couples or families) 





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           that the supervisor is legally prohibited from conducting, which 
           makes no sense according to AAMFT-CA.  Proponents further suggest 
           that adding a previously-unrecognized category of supervisors, 
           would expand the opportunities for MFT interns to receive 
           supervision, while ensuring that the supervisors are appropriately 
           qualified.

        5. Arguments in Opposition.  The  California Association for Licensed 
           Professional Clinical Counselors  (CALPCC) opposes this bill's 
           amendments which would require LPCCs who supervise MFT Interns to 
           meet additional training and education requirements.  CALPCC 
           believes the provision discriminates against LPCCs, since none of 
           the other professions are singled out with special requirements in 
           order to supervise MFTs, and suggests that if it is necessary for 
           supervisors to have specialized training, then the other 
           professions, which supervise MFTs, should meet the same 
           requirements.  CALPCC believes that the bill would make it even 
           more difficult for MFTs to find internships if LPCCs cannot 
           supervise them.  

        As an alternative, CALPCC suggests amendments to authorize a 
           supervisor to abide by his or her scope of competence instead of 
           requiring the additional education and training.  Specifically, the 
           amendment would do the following:

             On page 4, lines 10 through 12, strike out:  "(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." and insert: 
              

             (2) Abides by his or her scope of competence.

           California Association of Marriage and Family Therapists  (CAMFT) has 
          taken an oppose unless amended position on the bill, expressing 
          several concerns with the bill.  First CAMFT argues that the 
          requirement for a trainee to be enrolled in a practicum course to 
          counsel clients, does not address any public health, safety or 
          welfare issue, and states that since 1995, there has been no problem 
          with hours gained by MFT trainees apart from the practicum course so 
          long as the hours were obtained under the jurisdiction of their 
          schools.  

          CAMFT further disagrees with restricting to 45 days the period 
          during which MFT trainees may counsel clients while not enrolled in 
          a practicum, and argues that the 45-day time period is a random 





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          number.  Often, a summer recess is longer than 45 days, and the 
          proposed 45-day limit is disruptive to the needs of clients and 
          agencies where trainees work, places a hardship on trainees, and is 
          not based upon any identified problems.  Instead of placing a cap of 
          45 days, CAMFT suggests the law should allow trainees to gain hours 
          of experience outside of their practicum assignments, without a 
          45-day limitation, as long as there is sufficient oversight by their 
          schools for the services they are providing.

          CAMFT additionally opposes the limitations which would allow a LPCC 
          to supervise an MFT intern only if the supervisor meets additional 
          education and training requirements. CAMFT opposes the limitations, 
          especially for persons who will be "grand-parented" into the LPCC 
          profession.  CAMFT indicates it would be willing to accept those 
          limitations if they are applicable to those persons who begin 
          graduate study on or after January 1, 2012.


        SUPPORT AND OPPOSITION:
        
         Support  :  

        Board of Behavioral Sciences (Sponsor) 
        American Association for Marriage and Family Therapy

         Oppose Unless Amended  :  

        California Association for Licensed Professional Clinical 
        Counselors
        California Association of Marriage and Family Therapists (CAMFT)



        Consultant:G. V. Ayers