BILL ANALYSIS Ó ----------------------------------------------------------------------- |Hearing Date:April 11, 2011 |Bill No:SB | | |363 | ----------------------------------------------------------------------- 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 SB 363 Page 2 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 SB 363 Page 3 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 SB 363 Page 4 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 SB 363 Page 5 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) SB 363 Page 6 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 SB 363 Page 7 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