BILL ANALYSIS                                                                                                                                                                                                    Ó







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        |Hearing Date:April 23, 2012        |Bill No:SB                         |
        |                                   |1238                               |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                          Bill No:        SB 1238Author:Price
                    As Introduced:     February 23, 2012 Fiscal:Yes

        
        SUBJECT:  Professions:  Board of Psychology:  Board of Behavioral 
        Sciences.
        
        SUMMARY:  Extends until January 1, 2017, the provisions establishing 
        the California Board of Psychology (BOP), the Board of Behavioral 
        Sciences (BBS), and extends the term of the executive officers of the 
        BOP and BBS.

        Existing law:
        
       1)Licenses and regulates psychologists by the BOP within the Department 
          of Consumer Affairs (DCA), and makes the BOP inoperative and 
          repealed on January 1, 2013.  (Business and Professions Code (BPC) § 
          2920)

       2)Authorizes the BOP to employ an executive officer and makes that 
          authority inoperative and repealed on January 1, 2013.  (BCP § 2933)

       3)Provides that protection of the public shall be the highest priority 
          for the BOP in exercising its licensing, regulatory, and 
          disciplinary functions, and whenever the protection of the public is 
          inconsistent with other interests sought to be promoted, the 
          protection of the public shall be paramount.  (BPC §2920.1)

       4)Authorizes BBS, under the DCA, to license and regulate educational 
          psychologists, social workers, marriage and family therapists and 
          licensed professional clinical counselors, and makes the BBS 
          inoperative and repealed on January 1, 2013.  (BPC § 4990).  

       5)Authorizes the BBS to employ an executive officer and makes that 





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          authority inoperative and repealed on January 1, 2013.  (BPC § 
          4990.04)

       6)Provides that protection of the public shall be the highest priority 
          for the BBS in exercising its licensing, regulatory, and 
          disciplinary functions, and whenever the protection of the public is 
          inconsistent with other interests sought to be promoted, the 
          protection of the public shall be paramount.  (BPC § 4990.16)


        This bill:

        1)Extends until January 1, 2017, the provisions establishing the BOP. 

        2)Extends until January 1, 2017, the term of the executive officer of 
          the BOP.

        3)Extends until January 1, 2017, the provisions establishing the BBS. 

        4)Extends until January 1, 2017, the term of the executive officer of 
          the BBS.


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

        


        COMMENTS:
        
       1.Purpose.  The  Author  is the Sponsor of this measure.  According to 
          the Author, in 2012, this Committee conducted oversight hearings to 
          review 7 regulatory boards within the DCA:  the Acupuncture Board, 
          the Board of Podiatric Medicine, the Physician Assistant Committee, 
          the Board of Pharmacy, the Court Reporters Board, the Board of 
          Behavioral Sciences and the Board of Psychology.  The Committee 
          began its review of these licensing agencies in March and conducted 
          two days of hearings.  This bill, and the accompanying sunset bills, 
          is intended to implement legislative changes as recommended in the 
          Committee's Background/Issue Papers for all of the agencies reviewed 
          by the Committee this year.

           This bill is one of the four "sunset bills" authored by the Chair 
           of this Committee.  According to the Author, this bill is necessary 
           to extend the sunset date of the BOP and the BBS in order to 





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           continue the regulation of psychologists, educational 
           psychologists, social workers, marriage and family therapists and 
           licensed professional clinical counselors in California.  The 
           continued regulation will help to ensure that the BOP and BBS's 
           mission of protecting the public is in place for an additional four 
           years.

       2.Background of the BOP.  The BOP in the DCA is responsible for 
          implementation and enforcement of the Psychology Licensing Law; the 
          laws and regulations related to the licensure, practice and 
          discipline of those who are engaged in the practice of psychology in 
          California in order to protect the public.  Only licensed 
          psychologists can practice psychology independently in the private 
          sector in California.

           The Board's mission statement is as follows:

             "The Board of Psychology protects and advocates for Californians 
             by promoting the highest professional standards through its 
             licensing, regulation, legislation, enforcement, continuing 
             education, and outreach programs."

           The Board regulates the field of psychology in three categories:

            a)   Psychologists  .  Practices psychology independently in any 
             private or public setting.  The license must be renewed every two 
             years, and licensees must complete 36 hours of continuing 
             education for renewal.  Requires a doctoral degree in psychology, 
             educational psychology, or in education with a field of 
             specialization in counseling psychology or educational 
             psychology; to complete 3,000 hours of qualifying supervised 
             professional experience, 1,500 of which must be accrued 
             post-doctorate; pass the Examination for Professional Practice in 
             Psychology (EPPP) and the California Psychology Supplemental 
             Examination (CPSE); complete coursework in human sexuality, child 
             abuse, substance abuse, spousal abuse, and aging and long-term 
             care.

            b)   Registered psychologist  .  A 30 month, non-renewable 
             registration to work and train under supervision in non-profit 
             agencies that receive government funding.  Requires a doctoral 
             degree in psychology, and 1,500 hours of qualifying supervised 
             experience for registration.

            c)   Psychological assistant.   An annually renewed registration 
             (for up to six years) to work and train while supervised by a 





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             qualified licensed psychologist in a private setting.  Intended 
             to be a method by which an unlicensed person can perform limited 
             psychological functions to accrue hours of supervised 
             professional experience.  Requires a qualifying master's degree 
             in psychology, with no experience required for registration.

       3.Prior Review of the BOP.  The Board was last reviewed by the former 
          Joint Committee on Boards, Commissions and Consumer Protection 
          (Joint Committee) seven years ago (2004-2005).  During the previous 
          Review, the Joint Committee raised several issues and 
          recommendations regarding the Board.  In November 2011, the Board 
          submitted its required Sunset Review Report to the Committee.  In 
          this report, the Board described actions that have been taken since 
          the Board's prior review to address the recommendations of the Joint 
          Committee.  The following are some of the more important 
          programmatic and operational changes and enhancements which the 
          Board has taken and other important policy decisions or regulatory 
          changes it has adopted, as well as some highlighted accomplishments:

               Recommended Changes Enacted by SB 229 (Figueroa, Chapter 658, 
             Statutes of 2005).  The 10 final recommendations made by the 
             Joint Committee in 2005 were embodied in SB 299 legislation 
             authored by the Joint Committee Chair, Senator Liz Figueroa.  The 
             changes included:  extend the Board's sunset date; establish the 
             title "registered psychologist" and increase the amount of time 
             one can work as a registered psychologist from 24 months to 30 
             months; add postdoctoral placements overseen by the American 
             Psychological Association (APA), the Association of Psychology 
             Postdoctoral and Internship Centers (APPIC) and the California 
             Psychology Internship Council (CAPIC) as acceptable post-doctoral 
             placement programs; delete the obsolete term "certified" with 
             regard to the regulation of psychology and include Canadian 
             licensed psychologists; provide that the Board makes the final 
             determination as to whether a degree from an accredited 
             university, college, or professional school meets the 
             requirements for licensure; make corrections to refer to "Ethical 
             Principles and Code of Conduct" rather than "code of ethics;" 
             refer to the "supplemental licensing examination" and reflect the 
             Board's use of computer-administered examinations; accurately 
             refers to the term of an initial license; add "retirement" to the 
             list of reasons to place a license on inactive status.

               Posting Information About Non-Licensees Convicted of 
             Unlicensed Practice on the Board's Website.  The Board believes 
             that the disclosure of a citation and fine, or conviction for 
             unlicensed practice, would be very relevant and important to the 





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             public.  However, it is problematic for the Board's current IT 
             system to allow the posting of such information in a similar 
             place as the license verification function.  According to the 
             Board, it has aggressively sought out those in unlicensed 
             practice through their advertising, websites and publications.  
             The Board states that it is currently involved with the 
             Department and IT regarding changes to its Website to disclose 
             actions taken regarding unlicensed practice.

               Board Authority to Order Restitution to Consumers Who Have 
             Been Harmed by Licensees.  During the 2004 sunset review, DCA 
             recommended that all Boards examine their authority to order 
             restitution to consumers and develop policies to execute our 
             authority.  The Board now has the authority to order restitution, 
             as reflected in its disciplinary guidelines.  Restitution is a 
             standard term in any case involving Medi-Cal or insurance fraud.  
             Failure to pay restitution when ordered is considered a violation 
             of probation.  The Board also uses restitution as part of the 
             stipulation process.

               New Executive Officer.  Robert Kahane was appointed by the 
             Board in March of 2006.

               Headquarter Relocation.  In March 2008, the Board moved from 
             the Howe Avenue complex to its current location on Evergreen 
             Street in Sacramento.

               Strategic Planning.  The Board has conducted a number of 
             strategic planning sessions.  In 2009, the Board began using a 
             two-year model for its Strategic Plan.  The Board is currently 
             using a 2011-2013 plan.

               Probation.  Approximately 51% of the Board's disciplinary 
             actions result in probation.  The average term of probation is 
             three to five years.  The Board monitors approximately 60 
             licensees on probation per year.  Since the last sunset review, 
             there has been a 400% increase in the number of probationers that 
             the Board must monitor.  Probationers must be adequately 
             monitored to ensure compliance with the terms and conditions of 
             the disciplinary order.  The Board has taken a proactive approach 
             in implementing new procedures to reduce the strain on staffing 
             resources and improve consumer protection.  In July 2010, the 
             Board entered into the DCA master contract with Phamatech, Inc. 
             for drug testing services.  Phamatech services give the Board 
             drug test results within 24 hours, and access to experts in the 
             interpretation of test results.  The Board has further 





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             implemented a requirement for an annual face to face meeting with 
             all probationers, resulting in fewer probation violations which 
             represents a cost savings for the Board.

       1.Background of the BBS.  The BBS licenses and regulates licensed 
          clinical social workers (LCSW), licensed marriage and family 
          therapists (LMFT), licensed educational psychologists (LEP), and 
          licensed professional clinical counselors (LPCC).   Additionally, 
          the Board registers associate social workers (ASW), marriage and 
          family therapist interns (MFT Interns), professional clinical 
          counselor interns (PCC Interns), and continuing education providers.

           The BBS's mission is to protect Californians by promoting consumer 
           awareness, advocating for improved mental health services, and 
           setting, communicating, and enforcing standards.  In order to 
           accomplish its mission, the BBS develops and administers licensure 
           examinations, investigates consumer complaints and criminal 
           convictions, responds to emerging changes and trends in the mental 
           health profession legislatively or through regulations, and creates 
           publications for consumers, students, and licensees.

           The BBS's statutes and regulations require a license before an 
           individual may engage in the practice of licensed clinical social 
           work, licensed marriage and family therapy, licensed educational 
           psychology, and licensed professional clinical counseling.  These 
           statutes and regulations set forth the requirements for 
           registration and licensure and provide the BBS the authority to 
           discipline a registrant or licensee.

           Effective January 1, 2010, a fourth mental health profession, LPCC, 
           was added to the Board's jurisdiction.  Today, the BBS is 
           responsible for the regulatory oversight of nearly 77,000 
           licensees.  Current law provides for thirteen board members; six 
           licensees and seven public members.  Eleven members are appointed 
           by the Governor, one public member is appointed by the Speaker of 
           the Assembly, and one public member is appointed by the Senate 
           Rules Committee.  In 2010, a public member was added to the BBS and 
           in 2012, a LPCC member was added to the BBS increasing the board 
           composition to thirteen members, however, it is still a public 
           majority board.

       2.Prior Review of the BBS.  The BBS was last reviewed by the Joint 
          Committee seven years ago (2004-2005).  During the previous Sunset 
          Review, the Joint Committee raised several issues regarding the BBS. 
           The following are actions which the BBS took since the last Sunset 
          Review to address these issues.





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               Continuing Education Through Self-Study.  The Joint Committee 
             questioned whether the Board should allow licensees to fulfill 
             all 36 hours of Continuing Education (CE) through only 
             self-study.  The Joint Committee pointed out that licensees may 
             obtain all 36 hours of CE by visiting internet sites, accessed 
             remotely from their home or other location, and that the licensee 
             need only certify to the BBS that they have done this, without 
             any further proof, and the BBS does not audit the licensee 
             certifications.  The Joint Committee raised two potential 
             problems:

             a)     There may exist a potential for licensees to abuse this 
               method of fulfilling CE. 

             b)     In a profession so heavily dependent on human interaction, 
               is it entirely appropriate 
               that licensees be permitted to fulfill all of their CE 
               requirements without interaction with others?

             The BBS conducted a random survey of licensees who renewed their 
             licenses between October 1, 2004, and April 1, 2005, and found 
             that of the 554 responses, only two percent (2%) completed the 
             entire required CE through online courses.  The BBS concluded 
             that the survey indicated that the Board's licensees favor 
             traditional, classroom style courses, but that online courses 
             remain a useful alternative.   According to BBS, the Board is 
             currently in the process of reviewing its continuing education 
             program.

               Restitution.  The Joint Committee questioned whether the Board 
             should have the authority to order restitution to consumers who 
             have been seriously harmed by licensees.  The Joint Committee 
             raised the issue of whether the Board's authority should include 
             the ability to request restitution in appropriate cases or in 
             cases where there is reason to believe restitution would be 
             substantial, or when such an award would serve the interest of 
             justice in a particular case.

           BBS stated that it did not have specific legislative authority to 
             require restitution for consumers.  However, it may consider 
             seeking restitution when negotiating a stipulated agreement.  
             Historically, BBS indicates that it has placed more importance on 
             consumer safety and protection, and on imposing discipline that 
             either helps correct the problem through probation monitoring and 
             remedial education, supervised practice, or in cases involving 





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             the most serious misconduct, removes the individual from the 
             profession by revoking their license or registration. 

           According to BBS, the intangible nature of the services provided by 
             Board licensees and registrants makes it difficult if not 
             impossible to determine the monetary value of those services.  
             The BBS recognizes there are other avenues, such as civil or 
             malpractice actions, available to consumers who seek financial 
             compensation from licensees who have provided services that are 
             inappropriate or harmful.

               Non-licensee Notices on Website. The Joint Committee 
             questioned whether the public would benefit by being able to 
             learn from the Board's website of non-licensees who have been 
             convicted of the unlicensed practice of psychology.  The Joint 
             Committee recommended the BBS should work with the DCA to 
             determine an appropriate and efficient way to post information 
             about non-licensees who engage in unlicensed practice.

           According to BBS, the current online license verification feature 
             was programmed by the DCA's Office of Information Services, and 
             extracts public data from the BBS's licensing records and 
             enforcement actions from its enforcement tracking system, 
             allowing the information to be accessed on the BBS website.  The 
             BBS states the program requires a license or registration number 
             to be present, and does not have the ability to extract 
             unlicensed records from the enforcement tracking system.

           According to BBS, since 2004, the DCA and the Board have initiated 
             educational campaigns urging consumers to verify a practitioner's 
             license prior to engaging in services.  These efforts focus on 
             the requirement of licensure for the service offered.  The BBS 
             believes the addition of information to the BBS's website about 
             individuals not licensed with the BBS would cause confusion.

               Reorganization.  Since the last Sunset Review in 2004, the BBS 
             restructured its organization to meet its operational needs more 
             efficiently.  Following an evaluation of the BBS's operational 
             needs and desire to improve efficiency, the BBS added a manager 
             position in 2005 to provide oversight of the daily activities of 
             all the BBS's programs.  This allowed the EO and AEO to primarily 
             focus on policy decisions, changes in mental health affecting the 
             BBS's licensees and registrants, and implementing the direction 
             of the board members.

           A steady growth in licensees and registrants and the addition of 





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             the Licensed Professional Clinical Counselor program in 2011, 
             resulted in a 38% increase in total staffing since 2005.  Three 
             separate units were created grouping similar or related 
             activities together.  The Licensing and Examination, Enforcement, 
             and Administration units each are under the direction and 
             supervision of a Staff Services Manager.

               Relocation.  In 2005 the BBS relocated from R Street in 
             Sacramento to its current location at North Market Boulevard.

               Change in Leadership.  Prior to 2010, the BBS consisted of 
             eleven board members.  The addition of the LPCC program increased 
             the composition of the Board to twelve members in 2010 (by adding 
             a public member), and to its current makeup of thirteen members 
             by adding a LPCC to the Board.  Since November 2004, the BBS has 
             had two executive officers.  The previous incumbent served from 
             November 2004 to November 2009.  The current Executive Officer, 
             Kim Madsen, was appointed in January 2010.

               Strategic Plan.  The BBS revised its Strategic Plan in 2007, 
             adopting its current mission statement to protect Californians by 
             promoting consumer awareness, advocating for improved mental 
             health services, and setting, communicating, and enforcing 
             standards.  The Strategic Plan was updated in 2009 to further 
             define the BBS's goals with the inclusion of performance 
             measures.  In 2010, the Strategic Plan was revised to reflect the 
             core functions of the BBS with the primary goal to become a model 
             state agency and enhance consumer protection.

        6.Current Issues and Problems Identified for BBS.  The following are 
          some of the major unresolved issues pertaining to the BBS, or areas 
          of concern presented to the Committee for consideration, along with 
          background information concerning the particular issue.  
          Recommendations were made by Committee staff regarding the 
          particular issues or problem areas which needed to be addressed.  
          The BBS has 30 days to submit a response to the issues raised at the 
          Sunset Review informational hearings on April 19, 2012.

            a)   Issue  :  New license category.  
            
           Background :  Effective January 1, 2010, a fourth mental health 
             profession, Licensed Professional Clinical Counselor, was added 
             to the Board's jurisdiction.   Today, the Board is responsible 
             for the regulatory oversight of nearly 77,000 licensees.  Current 
             law provides for twelve board members; five licensees and seven 
             public members.  Ten members are appointed by the Governor, one 





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             public member is appointed by the Speaker of the Assembly, and 
                                  one public member is appointed by the Senate Rules Committee.  In 
             2012, a LPCC member appointed by the Governor will be added, 
             increasing the board composition to thirteen members.

           Considering that the LPCC is the newest license category, the 
             Committee desires to know if the Board has fully implemented this 
             new licensing category.  What is the current status of training 
             programs for LPCC candidates?  What is the current status of 
             newly licensed Professional Clinical Counselors?  Have there been 
             any challenges in this process?  Is any legislation needed to 
             assist the Board in overseeing the training and/or licensing 
             process for LPCCs?

            Recommendation.  The BBS should provide an update to the Committee 
             on the current status of the LPCC category including information 
             about training programs, licensed LPCCs and any challenges to 
             implementing this new license category.  The BBS should also 
             indicate if any legislation needs to be proposed in order to help 
             the BBS more effectively oversee this facet of the profession and 
             serve the professional interests of licensees.

            b)   Issue  :  Does the BBS have adequate authority to oversee the 
             course content of continuing education providers?  

            Background  :  The BBS requires each licensee to complete 36 hours of 
             continuing education (CE) every two years, in or relevant to, the 
             licensee's field of practice in order renew the license.  CE 
             courses must be obtained from either:

                i.        An accredited or state-approved school. 

                ii.       A professional association, licensed health 
                  facility, governmental entity, educational institution, 
                  individual, or other organization approved by the BBS.

             CE course content must be applicable to the practice of the 
             particular profession, must be related to direct or indirect 
             patient care and must incorporate one or more of the following 
             elements related to the licensed discipline:  

                i.        Elements fundamental to the understanding and 
                  practice of the profession.

                ii.       Elements in which significant recent developments 
                  have occurred.





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                iii.      Elements of other disciplines that enhance the 
                  understanding or the practice of the discipline of the 
                  licensee.

             BBS regulations outline the requirements for CE Provider 
             (Provider) approval by the Board.  In order to be approved by the 
             Board, a Provider must meet the Board's course content and 
             instructor qualification.  Provider approval must be renewed 
             every two years.  A Provider must apply for renewal by submitting 
             the appropriate form and paying the required $200 fee.  A 
             Provider with an expired approval is prohibited from presenting 
             courses for credit to BBS licensees, and licensees are unable to 
             use CE courses from a Provider whose approval has expired in 
             order to meet the CE requirement.  Provider approvals that are 
             not renewed within one year after expiration may not be renewed 
             and will be cancelled.  Cancelled providers will need to apply 
             for a new provider number by submitting the Continuing Education 
             Provider Application and application fee.  For FY 2010/2011, the 
             BBS indicates there were 2,528 approved providers and 185 
             delinquent approvals.

             Current law outlines broad course content requirements for CE 
             courses, and requires the Provider to ensure that course content 
             and instructor qualifications criteria are met.  The BBS may 
             revoke or deny a provider application for good cause, including:  
             a criminal conviction, failure to comply with the licensing law, 
             or making a misrepresentation of fact in information submitted to 
             the BBS.

             Though the BBS does not have explicit authority to review course 
             content, the Board may audit provider records to ensure 
             compliance with the CE requirements, including the requirement 
             that a Provider ensure that the course content and instructors 
             teaching courses meet the specified criteria.  The law gives the 
             Board authority to revoke or deny a Provider based on not 
             ensuring quality of content, however, it does not allow the Board 
             to approve or deny specific courses offered by a Provider.  
             Language expressly permitting the review of course content and 
             instructor qualification relates only to an initial Provider 
             approval application.  This review of coursework content and 
             instructor qualification does not extend to renewal or 
             maintenance of a Provider's approval.

             A recent case illustrates need for the BBS to review its process 
             for approving CE Providers, and make appropriate changes to its 





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             procedures, or recommend legislative changes to its CE 
             requirements.  In July of 2011, the BBS began receiving 
             complaints from the public regarding the BBS approved CE 
             Provider, the National Association of Research and Therapy of 
             Homosexuality (NARTH).  The BBS received hundreds of emails from 
             individuals protesting the approval of an organization that 
             offers "reparative" or "conversion" therapy for individuals that 
             have unwanted homosexual tendencies.  NARTH was approved by the 
             Board as a CE Provider in 1998.  As of November 1, 2010 NARTH had 
             not renewed its Provider Approval and is currently unable to 
             provide CE courses to the BBS licensees for credit.  Since that 
             time NARTH's approval remained expired for more than one year and 
             can no longer be renewed, and has been cancelled by the BBS.  In 
             order to become a CE Provider, NARTH would have to apply for a 
             new Provider authorization from the BBS.

             One of the primary factors in this issue is that NARTH has 
             advocated the use of "reparative" or "conversion" therapy.  
             Conversion therapy (also called reparative therapy or 
             reorientation therapy) is a type of sexual orientation change 
             effort that attempts to change the sexual orientation of a person 
             from homosexual or bisexual to heterosexual.  The American 
             Psychological Association defines conversion therapy as "therapy 
             aimed at changing sexual orientation."  The American Psychiatric 
             Association states that conversion therapy is a type of 
             psychiatric treatment "based upon the assumption that 
             homosexuality per se is a mental disorder or based upon the a 
             priori assumption that a patient should change his/her sexual 
             homosexual orientation."  Both the American Psychiatric 
             Association and the American Psychological Association have 
             rejected the concept of conversion therapy for therapists.

             However, the approval of an organization advocating conversion 
             therapy, such as NARTH, by the BBS drew the attention of the 
             public and a number of Legislators.  Since that time, BBS staff 
             has met with Legislative staff to discuss the provider approval 
             process and deficiencies in the process.  Concern has been 
             expressed over the approval of NARTH and the provider approval 
             process.  

             The BBS states in its November Sunset Report that at its October 
             13, 2011, Policy and Advocacy Committee (BBS-PAC) meeting, 
             committee members discussed needed changes to the regulations 
             that set forth requirements for Providers.  Additionally, BBS-PAC 
             members discussed the possible need to transition to a continuing 
             competency model for licensure renewal.  The BBS-PAC recommended 





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             that the BBS create a Continuing Education sub-committee to 
             conduct meetings with stakeholders, professional associations, 
             and experts in continuing competence programs to determine the 
             best possible solutions in moving forward with a restructure of 
             the continuing education program.

              Recommendation  :  The BBS should report to the Committee its 
             current assessment of changes that may need to be made to the 
             requirements for CE Providers, and advise the Committee on any 
             legislative changes that should be made.  The BBS should further 
             work with the stakeholders in the profession and in the 
             Legislature to make the appropriate procedural, regulatory or 
             legislative changes to its CE program.

            a)   Issue  :  Why is staff turnover rate so high?

            Background  :  Historically, the BBS has had very little staff 
             turnover.  Currently, the BBS has authorization for 43.3 staff 
             positions and 3.3 blanket positions.  The Governor's Hiring 
             Freeze (Executive Order B-3-11) and the past Executive Orders for 
             the Furlough Programs were adversely impacted the Board's 
             recruitment efforts and operations.  The BBS currently has eight 
             vacancies and has initiated recruitment efforts to fill the 
             following positions:  1 Staff Services Manager I, 1 Special 
             Investigator, 1 Associate Governmental Program Analyst, and 5 
             Office Technicians.  Recruitment efforts were not successful 
             under the recent hiring freeze constraints.  The majority of the 
             vacancies are in the BBS's licensing and cashiering unit.  The 
             time of the year when the BBS sees an increase in the application 
             volume has recently passed.  Consequently, as a result of the 
             ongoing vacancies, the BBS's processing times increased.

             The BBS was legislatively mandated to license and regulate a new 
             mental health profession, Licensed Professional Clinical 
             Counselor, established by Senate Bill 788 (Wyland, Chapter 619, 
             Statues of 2009), starting January 1, 2010.  The Board staff 
             faced challenges implementing this new licensing program with the 
             existing vacancies and significant delays in filling positions 
             specifically created for the LPCC licensing program.

             The Committee understands the impact that the recent hiring 
             freeze has had on the BBS.  However, it would be helpful to 
             explain why so many vacancies exist.  Has a survey of departing 
             staff been conducted to ascertain why they left?  What are the 
             efforts to fix the problems that led to the vacancies?  What are 
             the plans to hire new staff and what are the impediments to 





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             accomplishing this task?

              Recommendation  :  The BBS should report the current status of 
             vacancies and newly hired staff to the Committee.  The BBS should 
             review the nature of the remaining vacancies and report to the 
             Committee its plan to fill the vacancies.
              
           b)   Issue  :  Webcasting meetings. 

              Background  :  In 2010 two BBS committee meetings were available 
             via webcast.  The Committee is concerned about the BBS's lack of 
             use of technology in order to make the content of the BBS 
             meetings more available to the public.  Webcasting is an 
             important tool that can allow for remote members of the public 
             and/or those who are disabled to stay apprised of the activities 
             of the Board as well as well as trends in the professions.  

              Recommendation  :  The BBS should utilize webcasting at future 
             Board meetings in order to allow the public the best access to 
             meeting content and to stay apprised of the activities of the BBS 
             and trends in the professions.
              
         7. Current Issues and Problems Identified for BOP.  The following are 
          some of the major unresolved issues pertaining to the BOP, or areas 
          of concern presented to the Committee for consideration, along with 
          background information concerning the particular issue.  
          Recommendations were made by Committee staff regarding the 
          particular issues or problem areas which needed to be addressed.  
          The BOP has 30 days to submit a response to the issues raised at the 
          Sunset Review informational hearings on April 19, 2012.

            a)   Issue  .  Will the BOP be able to fill vacant positions?

            Background  :  As with other regulatory boards, the Board of 
             Psychology has been working within the limitations of the current 
             fiscal emergency and the resulting Executive Orders.  As a 
             result, the BOP has experienced a number of vacancies and 
             encountered considerable difficulty in filling the vacancies due 
             to the hiring limitations.  As a small board without any 
             redundant positions, all vacancies directly affect the 
             productivity and timeliness of the BOP's processes as the 
             workload resulting from these vacancies must be absorbed by 
             remaining staff.

           Effective January 2011, the BOP received additional budget approval 
             through the DCA's Consumer Protection Enforcement Initiative 





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             (CPEI) to hire 2 investigators, 2 medical consultants, and one 
             limited term analyst, bringing its staffing level to 19.5 
             authorized positions.  The BOP has worked with DCA Office of 
             Human Resources (OHR) to fill these CPEI positions.  Although 
             these positions were funded in January 2011, the BOP had been 
             unable to fill them due to the hiring freeze implemented in 
             August 2010.  

           Though the BOP continues to improve its timeliness, vacancies 
             reduce the amount of progress that can be made.  At the time of 
             its November 2011 Report, 41% of the BOP's allotted positions (or 
             8 positions), including the positions that were granted as a 
             result of the CPEI, were vacant.  Also, because of the 
             classification level of some of these positions, the BOP 
             indicated that it has received disappointingly low interest from 
             potential candidates to fill those positions.

            Recommendation  :  The BOP should inform the Committee of its current 
             staffing levels.  Are there current staff vacancies?  What are 
             the current challenges to fill vacant positions?  What has been 
             the effect of the staff vacancies on the BOP's operations?

            b)   Issue  .  Are regulatory or legislative changes needed regarding 
             telehealth or the online practice of psychology?

            Background  :  The BOP states in its Report that the issue of the 
             practice of psychology by alternative methods such as telephone 
             and online psychotherapy has recently moved to the forefront of 
             issues facing the profession of psychology.  The BOP states that 
             California, along with many other states and provinces, are 
             beginning to look seriously into this topic and how it affects 
             consumers.

           The BOP acknowledges that there are many issues regarding providing 
             psychological services electronically across state lines, such as 
             the location of the recipient of the services and the location of 
             the provider; however, there are many other issues regarding the 
             provision of psychological services electronically within 
             California that the BOP needs to address first.  These issues 
             include, but are not limited to, safety, security, informed 
             consent, and ethical practice.

           The BOP has considered conducting a symposium and inviting various 
             individuals and organizations knowledgeable about telehealth, 
             including the Association of State and Provincial Psychology 
             Boards (ASPPB) which is currently developing guidelines that 





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             could be useful for all psychology licensing jurisdictions.  The 
             California Psychological Association (CPA) has offered to partner 
             with the BOP in this endeavor.  The BOP is aware of the urgency 
             of this issue, as there are licensees who are currently 
             practicing telehealth, and the BOP will be determining if 
             regulations regarding this issue are necessary to protect 
             consumers of psychological services in California.

           According to the BOP, whether legislation or some basic regulations 
             are needed is yet to be determined.  There are many similar 
             discussions in other jurisdictions regarding telehealth.  Since 
             this delivery of mental health services will encompass much more 
             than our state, the BOP states that efforts must be made to 
             ensure that consumers are not harmed if receiving services from 
             another jurisdiction.  Working with the other jurisdictions 
             (boards) in assessing what is needed for the best practice in 
             teleheath will also benefit the California consumer when they 
             leave the state.  Telehealth would allow the continuation of 
             therapy without interruption due to proximity to the 
             practitioner.

            Recommendation  :  The BOP should update the Committee on its 
             evaluation of whether regulations or legislation are needed 
             regarding telehealth or the online practice of psychology.

            c)   Issue  .  Are there regulatory or legislative changes which 
             should be made regarding unaccredited schools?

            Background  :  The BOP states that California is the only state which 
             allows students from unaccredited schools to sit for psychology 
             licensing examinations.  All other states require students to be 
             from accredited institutions, accredited by either a regional or 
             national accrediting body.  This leaves California as an outlier 
             in the profession, and stands as an impediment to the BOP 
             entering into any reciprocity agreements with other states.

           The BOP indicates that the lack of reciprocity with other states is 
             a barrier to full participation by California-licensed 
             psychologists in national issues.  The BOP also would like all 
             psychologists and students in California to be included in 
             national organizations, able to be accepted into internship 
             placement programs and have the ability to become licensed in 
             other states.  These limitations are among many which those 
             practitioners from California, who attended an unaccredited 
             school, will be subject to.






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           According to the BOP, it is currently monitoring statistics and 
             passing rates.  The BOP has recently sent out letters to all 
             national organizations questioning their reasoning regarding the 
             limitations they have set for those who have not attended 
             accredited institutions.  With the re-establishment of the Bureau 
             for Private Postsecondary Education (BPPE), the BOP is hopeful 
             that these unaccredited institutions, while having their students 
             continue to apply for licensure, will be held accountable within 
             the new regulations, to the minimum standard of notifying those 
             students, prior to attending, of the limitations of their 
             graduation and degree from a non-accredited program.

           BPC § 2914 of the requires each applicant for licensure to possess 
             a doctoral degree in psychology, educational psychology, or in 
             education with a field of specialization in counseling psychology 
             or educational psychology from a regionally accredited 
             educational institution in the United States or Canada, or from 
             an educational institution in California that is approved by the 
             BPPE.  It provides that applicants for licensure trained in an 
             educational institution outside the United States or Canada shall 
             demonstrate to the satisfaction of the BOP that he or she 
             possesses a doctorate degree in psychology that is equivalent to 
             a degree earned from a regionally accredited university in the 
             United States or Canada.

           There are currently 6 schools approved by the BPPE that meet the 
             educational criteria to qualify for licensure.  The BOP has no 
             authority over school approvals or their operation and 
             curriculum.  The BOP feels very strongly about full disclosure in 
             regards to the restrictions an unaccredited degree program in 
             psychology has on California students in regards to mobility and 
             membership in various professional organizations and programs 
             within the profession.  AB 611 (Gordon, Chapter 103, Statutes of 
             2011) set forth certain disclosure requirements pertaining to 
             accreditation status, licensure, and related limitations for 
             unaccredited doctoral programs.

            Recommendation  :  The BOP should inform the Committee of its current 
             efforts regarding the issue of unaccredited schools.  To what 
             extent are California students being harmed by this issue?  Is 
             there a way for the BOP to better inform potential students of 
             the differences between attending an accredited versus an 
             unaccredited school and to keep a list of both?  Are there 
             regulatory or legislative changes that need to be made regarding 
             unaccredited schools?  What can be done to enhance the ability of 
             California's licensed psychologists to have reciprocity with 





                                                                        SB 1238
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             other states?

            d)   Issue  .  What is the status of the BOP's efforts to ensure the 
             continued competency of its licensees?

            Background  :  The BOP requires each licensee to complete 36 hours of 
             continuing education for each two-year license renewal.  The BOP 
             reports that it averages a 92% compliance rate of licensee 
             compliance with the continuing education requirements, and that 
             most noncompliance issues deal deficiencies in submitting the 
             proper documentation of the completed continuing education 
             courses.

           The BOP additionally states that it has also discussed continued 
             professional development/competency for licensed psychologists.  
             The BOP states that continued competency has been an issue on the 
             agenda for the BOP's Committee on Contemporary and Emerging 
             Issues for the past several board meetings.  The Committee has 
             been looking at how licensees can demonstrate competency beyond 
             continuing education.  In 2011, the Committee on Contemporary and 
             Emerging Issues recommended referring this topic to the BOP's 
             Continuing Education Committee.  The BOP stated that the 
             Committee would  review models regarding continued professional 
             development/competency created by the Association of State and 
             Provincial Psychology Boards and the American Psychological 
             Association at the November 2011 board meeting.  The BOP states 
             that it is also planning to partner with the California 
                                    Psychological Association to address this developing issue.

            Recommendation  :  The BOP should discuss with the Committee its 
             efforts to date to address continuing competency, and what it 
             expects to accomplish in near future regarding this issue.

            e)   Issue  :  What is the status of pending regulations?

            Background  :  The BOP has reviewed and implemented a number of 
             rulemaking changes since the previous sunset review.  The two 
             regulatory packages noted above were "pending" at the time the 
             Sunset Report was submitted to the Committee.  The BOP should 
             update the Committee about the status of these two regulatory 
             proposals, especially the regulations which would streamline and 
             augment the BOP's enforcement processes.

           This regulatory proposal is in response to the DCA's request to 
             implement regulations to enhance the BOP's mandate of consumer 
             protection.  The DCA launched the Consumer Protection Enforcement 





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             Initiative (CPEI) to overhaul the enforcement processes used by 
             healing arts boards within the Department, in order to reduce the 
             average enforcement completion timeline from 36 months to between 
             12 and 18 months.  The regulations implement certain elements 
             that were reflected in SB 1111 (Negrete McLeod) from 2010, and SB 
             1441 (Ridley-Thomas, Chapter 548, Statutes of 2008).  The former 
             DCA Director encouraged the boards in the Department to develop 
             regulatory changes, as needed, to implement the changes that 
             could be adopted through the regulatory process.

           The regulations would make the following changes to enhance the 
             BOP's mandate of consumer protection:
           
               i.       Delegate authority to the executive officer to approve 
                 settlement agreements for revocation, surrender, or interim 
                 suspension of a license or registration.

               ii.      Delegate authority to the executive officer to order 
                 an applicant or licensee to submit to a physical or mental 
                 examination if it appears the person may be unable to safely 
                 perform licensed duties and functions due to physical or 
                 mental illness.  

               iii.     Clarify the authority of the executive officer to deny 
                 an application if the applicant is unable to safely practice, 
                 based on the review of the evaluation report.  

               iv.      Prohibit "gag clauses" in civil settlement agreements 
                 that forbid a party from contacting, cooperating with, or 
                 filing a complaint with the BOP, or that require a person to 
                 withdraw a complaint filed with the BOP.  

               v.       Define as unprofessional conduct failure to provide 
                 the BOP with copies of documents within 15 days of receipt of 
                 a request. 

               vi.      Define as unprofessional conduct the failure to 
                 cooperate and participate in any BOP investigation pending 
                 against a licensee or registrant.

              Recommendation  :  The BOP should inform the Committee of the 
             current status of the proposed regulations relating to delegation 
             of functions to the executive officer and regarding 
             unprofessional conduct for licensees.

        7.Related Legislation.  In the current legislative session, other 





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          sunset review bills to be presented before the BPED Committee 
          include:

           SB 1236  which deals with the Board of Podiatric Medicine and the 
          Physician Assistant Board.

           SB 1237  which deals with the Board of Pharmacy and the Court 
          Reporters Board. 

           SB 1239  which deals with the Acupuncture Board.


        SUPPORT AND OPPOSITION:
        
         Support:  

        Board of Behavioral Sciences
        Board of Psychology
        Alameda County Psychological Association
        California Psychological Association- Independent Practice Division
        Contra Costa Psychological Association
        Los Angeles County Psychological Association
        Marin County Psychological Association
        Monterey Bay Psychological Association
        Redwood Psychological Association
        Sacramento Valley Psychological Association
        San Joaquin Valley Psychological Association
        San Mateo County Psychological Association

         Opposition:  None on file as of April 18, 2012


        Consultant:Le Ondra Clark