BILL ANALYSIS �
AB 2007
Page 1
Date of Hearing: April 10, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2007 (Williams) - As Amended: March 29, 2012
SUBJECT : Alcohol and drug abuse counselors.
SUMMARY : Establishes a licensing and certification (L&C) system
for alcohol and drug abuse counselors to be administered by the
Department of Public Health (DPH). Specifically, this bill :
1)General Provisions .
a) Creates the following three counselor classifications,
as defined, and includes various other definitions for
purposes of this bill:
i) Certified Alcohol and Drug Counselor (CADC) means a
person certified by DPH to practice alcohol and other
drug counseling;
ii) Licensed Alcohol and Drug Counselor (LADC) means any
person licensed by DPH to practice alcohol and other drug
counseling who may provide clinical supervision and
maintain an independent practice; and,
iii) Registrant means a person registered with a
counselor preparation and testing organization (CPTO) who
is working towards counselor certification or licensure.
b) Prohibits the provisions of this bill from being
construed to constrict, limit, or withdraw the Medical
Practice Act, Nursing Practice Act, Psychology Licensing
Act, Marriage and Family Therapist Act, Clinical Social
Work Practice Act, or substance abuse professionals defined
by the U.S. Department of Transportation.
c) Exempts the requirements of this bill from applying to
employees or volunteers of the U.S. Armed Forces,
volunteers of peer or self-help groups, clerics or other
religious leaders, employees of the California Department
of Corrections and Rehabilitation, and specified healing
arts practitioners who provide alcohol and other drug abuse
counseling services in the course of their profession.
2)Administration .
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a) Creates, within DPH, a seven-member Committee on
Counselor Preparation and Testing (Committee) to meet a
minimum of four times per year to review and issue
recommendations relating to DPH's implementation of this
bill, including proposed regulations; counselor education
and examination issues; code of conduct and ethics issues;
disciplinary actions; and, reciprocity provisions with
other states. Prescribes various requirements for the
composition and terms of the Committee's membership.
b) Assigns numerous duties to the Committee, including the
following:
i) Review and make recommendations on the viability of
CPTOs, including specific actions DPH should take if it
finds that a CPTO has not met one or more of the
qualifications or requirements specified in this bill;
and,
ii) Create separate processes by which a CPTO is
required to submit a request for certification,
licensure, or license and certificate renewal to DPH for
applicants who have been registrants and who meet all the
requirements for certification; applicants who have been
CADCs and who meet all the requirements for licensure;
and, applicants who meet all the requirements for renewal
of their license or certificate, as specified. DPH must
adopt regulations to implement this provision by January
1, 2014, after seeking recommendations from the
Committee.
c) Imposes various minimum requirements on a CPTO,
including requirements related to accreditation and
maintenance of an electronic database of all persons
affiliated with the CPTO through registration,
certification, and licensure.
d) Requires DPH, in order to administer and enforce the new
counselor L&C system, to do all of the following:
i) Adopt rules and regulations, in accordance with the
Administrative Procedure Act (APA), as necessary to
administer and enforce the new program;
ii) Beginning on January 1, 2014, issue licenses and
certificates to persons who meet the qualifications of
the bill and subsequent regulations;
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iii) Take specified disciplinary action against
counselors as appropriate;
iv) Adopt regulations by January 1, 2014, for the
receipt, investigation, and resolution of complaints made
by or against registrants and certified and licensed
counselors;
v) Maintain a public database of registrants and
certified and licensed counselors, including the person's
status, any public record of discipline, and other
information as DPH may adopt by regulation. DPH must
also maintain on its Internet Website a current listing
of all registrants and counselors against whom a
finalized disciplinary action has been taken, including
the specific disciplinary action ordered; and,
vi) Take specified disciplinary action against CPTOs.
3)Counselor L&C .
a) Requires DPH, commencing January 1, 2014, and until the
disposition of all complete applications actually received
by DPH prior to January 1, 2015, to issue a CADC
certification, within 30 business days, to a qualified
person who DPH determines was certified as a counselor on
or before December 31, 2013, if specified requirements are
met.
b) Requires DPH, commencing January 1, 2015, to issue a
CADC certification within 30 business days to a person if
DPH receives documentation from a CPTO that the person has
met specified education, work experience and training
requirements; has submitted and passed state and federal
level criminal background checks; and, has completed the
application for a certificate and paid the required fees.
c) Requires DPH, commencing January 1, 2014, and until the
disposition of all complete applications actually received
by DPH prior to January 1, 2015, to issue a LADC license
within 30 business days to a qualified person who DPH
determines was certified as a counselor on or before
December 31, 2013, if specified requirements are met.
d) Requires DPH, commencing January 1, 2015, to issue a
LADC license within 30 business days to a person who
possesses specified graduate or doctoral level education,
meets specified hours of education in clinical supervision
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techniques; has submitted and passed state and federal
criminal background checks; and, has completed the
application for a license and paid the required fees.
e) Specifies the curriculum for educational qualifications
and the criteria for testing, work experience, and clinical
supervision, required for counselor L&C.
f) Establishes and defines the scope of practice of alcohol
and drug counseling and makes it unlawful to engage in the
practice of alcohol and drug counseling without holding a
valid certificate or license.
g) Specifies that a LADC who operates an independent
counseling practice must refer any client assessed as
needing additional services not within his or her scope of
practice to another licensed professional, as appropriate.
h) Authorizes DPH to deny, revoke, suspend, or impose
conditions upon a license or certification for
unprofessional conduct, as defined, and provides a process
for CADCs and LADCs to appeal adverse decisions of the
department.
i) Provides that licenses or certificates expire within two
years after the issue date and specifies renewal
procedures.
j) Requires a counselor to display his or her license or
certificate in a prominent place.
aa) Allows a license to be placed on an inactive status.
bb) Requires a CADC or LADC to provide written notice to DPH
within 30 days of a name change or a change of address.
cc) Permits education and work experience gained outside
California to be accepted toward the counselor L&C
requirements if it is substantially equivalent to the
requirements of this bill and prescribes various
reciprocity requirements for DPH to issue a license or
certification to a person from another state.
4)Fiscal provisions .
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a) Establishes the Alcohol and Other Drug Counselor License
Fund in the State Treasury.
b) Requires all fees collected under this bill to be
deposited in the fund and available for appropriation by
the Legislature.
c) Directs DPH, in consultation with the Committee, to
establish fees relating to counselor L&C and requires the
fees to be established in accordance with the APA.
d) Requires DPH to assess each CPTO $5,000 every two years
for the purposes of reviewing CPTOs and enforcing
regulations related to CPTO compliance.
e) Requires DPH to assess each CPTO a one-time $25 fee for
each individual who either received a license or a
certificate pursuant to this bill and who registers with,
is certified by, or applies for licensure through, the CPTO
between January 1, 2014, and December 31, 2014, inclusive,
for purposes of implementing this bill.
f) Provides that this bill shall not establish or limit the
fees charged for education, examinations, or application
preparation or submission.
g) Requires the fees collected pursuant to this bill to
cover the full cost of, and in no way exceed the reasonable
cost of, administering and implementing this bill.
EXISTING LAW :
1)Establishes the Department of Drug and Alcohol Programs (DADP)
as the lead state agency for alcohol and drug programs and
requires DADP to prepare a master plan to eliminate drug and
alcohol abuse in California. Directs DADP to cooperate
closely with individuals and organizations concerned with
alleviating problems related to inappropriate alcohol and drug
use.
2)Requires all adult alcoholism or drug abuse recovery or
treatment facilities to be licensed by DADP.
3)Grants DADP the sole authority in state government to
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establish appropriate minimum qualifications, including
education, skills, life experience and training for licensees,
designated administrators and staff.
4)Requires all alcohol and drug abuse programs to register with
the county drug and alcohol program administrator in order to
coordinate efforts in the county. Provides that registration
does not constitute approval or endorsement by the county or
by DADP.
5)Establishes, in state regulations, nine counselor
organizations, approved by DADP, to register and certify
alcohol and drug counselors who provide counseling services in
an alcohol or drug program, defined as a program that is
subject to state licensing, receives state funding, or is
granted voluntary certification.
6)Allows, in state regulations, currently employed counselors
five years, dating from 2005, to become certified and requires
the certification to be based on specific addiction counseling
competencies, including understanding addiction, knowledge of
treatment methods, and professional readiness.
7)Require, in state regulations, at least 30% of counselors in
licensed facilities to be in compliance with certification
requirements by 2010, and all other noncertified counseling
staff to be registered with a certifying organization.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, developing a
L&C category for substance abuse counselors will increase the
pool of trained and licensed counselors by creating a
disease-specific class of professionals qualified to address
the specific needs of addicts. The author asserts that,
despite documentation demonstrating the abuse of patients
receiving care within licensed and certified facilities that
fall under the regulation of DADP, there is currently no
central governmental agency where a patient can file a
grievance, report ethics violations, or seek redress for
abusive treatment. The author maintains that L&C would give
patients, employers and referring agents, such as the courts,
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probation and counties, the ability to choose counselors with
a given set of competencies and a grievance procedure to
address abuses if they arise. The author notes that placing
oversight responsibility within DPH is consistent with the
Governor's 2012-13 Budget proposal to eliminate DADP and
reassign some of its responsibilities, including current
counselor certification to DPH. Lastly, the author states
that creating a license for alcohol and drug abuse counselors
will help protect patients during a vulnerable stage in their
life and while professionalizing substance abuse counselors
throughout California.
2)BACKGROUND . Alcohol and other drug dependency is a treatable
condition, but no one treatment modality is successful with
all persons who exhibit chemical dependency problems. Due to
the fact that individual problems, needs and resources vary
greatly, a variety of treatment strategies must be available.
Treatments for chemical dependency vary because there are
multiple perspectives about the condition itself.
Most treatments focus on helping people discontinue their
alcohol or other drug intake, followed by life training and/or
social support in order to help them resist a return to
substance use. Since chemical dependency involves multiple
factors which encourage a person to continue using, they must
all be addressed in order to successfully prevent a relapse.
An example of this kind of treatment is detoxification,
followed by a combination of supportive therapy, attendance at
self-help groups, and ongoing development of coping
mechanisms.
The number of people seeking treatment who have co-occurring
mental health disorders has steadily increased in recent
years, although it is not clear if the reason is improved
diagnosis of mental disorders or a change in the population.
It is estimated that individuals with co-occurring disorders
now comprise roughly 20 to 50% of those with addiction
problems. In sponsoring a prior counselor certification bill,
SB 707 (DeSaulnier) of 2009, DADP noted that, if counselors
were better qualified, they would be better prepared to
accurately identify these co-occurring disorders earlier,
treat the addiction and make appropriate referrals to treat
the co-occurring mental health disorder.
Alcohol and other drug counselors work very closely with program
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participants, patients and residents, and provide critical
services including assessments, counseling, treatment planning
and case management. Counselors are not currently required to
be certified or to have a minimum amount of education or
experience. Most treatment programs use or employ a mixture
of counselors, who have some formal education or personal
experience with alcoholism, drug addiction, and recovery.
3)CURRENT COUNSELOR CERTIFICATION REGULATIONS . In April 2005,
DADP adopted counselor certification regulations that only
apply to individuals providing counseling services in an
alcohol and other drug program licensed by DADP. To meet DADP
certification requirements, individuals must be certified by
one of the nine certifying entities approved in the DADP
regulations. In order for a certifying organization to issue
counselor certification, its requirements must meet minimum
standards that have been established by DADP. These standards
require the certifying entity to, among other things, require
individuals to complete at least 155 hours of formal classroom
education, as defined; document at least 160 hours of
supervised alcohol or other drug program counseling and 2,080
or more hours of work experience; and obtain a score of at
least 70% on an approved exam. DADP certification is valid
for two years and a counselor is required to complete 40 hours
of continuing education every two years for renewal.
4)OTHER COUNSELING PROFESSIONS . Many other licensed
professionals provide alcoholism and drug abuse counseling
either in a medical setting or in private practice. These
include marriage and family therapists and licensed clinical
social workers, who are licensed by the Board of Behavior
Sciences (BBS); psychologists, who are licensed by the Board
of Psychology; and, physicians and surgeons, including
psychiatrists, who are licensed and regulated by the Medical
Board of California. All of these professional boards are
overseen by the Department of Consumer Affairs (DCA).
According to technical assistance obtained from BBS, BBS is
between 12-18 months behind in implementing the last licensure
that it received which was Licensed Professional Clinical
Counselors, a new category of mental health professionals,
because it only received five of the 12 staff members
requested for implementation. BBS notes that it does not
certify any of its professions and would not be prepared to
take on the certification responsibility required in this
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bill. BBS also states that substance abuse counselors are a
very narrowly tailored profession that does not resemble any
of the other professions they currently license and oversee.
Lastly, BBS points out that DCA, is currently undergoing
significant changes to its information technology systems and,
as a result, implementation of any additional licensure
categories would be delayed until at least 2015.
Currently, because there are no laws specifically regulating
the practice of alcoholism and drug abuse counseling, as long
as the individual performing alcoholism and drug abuse
counseling does not encroach on the scope of practice of
another licensed professional by, for example, performing
psychotherapy, anyone can provide alcoholism and drug abuse
counseling in a private setting. This bill attempts to set
uniform standards for substance abuse counselors in both
public and private settings.
5)REGULATION IN OTHER STATES . According to the sponsor, 26
states require licensure for alcohol and drug counselors. In
a survey done by the sponsor of 51 certification and/or
licensure boards, which included all 50 states and the U.S.
Navy's certification program, 55% require state certification,
licensure or both; 41% of the states have voluntary
certification. Regardless of whether licensure/certification
is mandatory or voluntary, 24% of the states require over 300
hours of education (up to and including a degree); while 68%
require a minimum of 270 hours of specific alcohol and other
drug education. Six percent of the states require an
equivalent to 300 hours of education. California currently
requires 155 hours of formal alcohol and other drug-specific
education.
6)PROPOSED ELIMINATION OF DADP . One of the Governor's 2012-13
Budget proposals is to eliminate DADP and shift its programs
and functions to other departments. Specifically, the
Administration has proposed moving DADP's responsibility to
approve counselor certification via the nine certification
organizations to DPH and shifting DADP's authority to license
alcohol and drug treatment facilities to the Department of
Social Services. According to the Administration, co-locating
substance use disorder services with other health programs is
a step toward integrating services to create a continuum of
care; and, transferring DADP's programs to other state
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departments will better align the programs' mission with that
of the receiving departments. The author notes that this bill
is consistent with the Administration's proposal to move
DADP's current role in counselor certification to DPH.
7)PRIOR LEGISLATION .
a) SB 1203 (DeSaulnier) of 2010 would have instituted a L&C
structure for alcohol and other drug counselors by DADP.
SB 1203 was held in the Assembly Rules Committee.
b) SB 707 (DeSaulnier) of 2009, which was substantially
similar to SB 1203, died on the Assembly Appropriations
Committee Suspense File.
c) AB 239 (DeSaulnier) of 2008 would have established two
categories of licensed alcoholism and drug abuse counselors
for persons licensed to practice alcoholism and drug abuse
counseling under clinical supervision, and persons licensed
to conduct an independent practice of alcoholism and drug
abuse counseling, and to provide supervision to other
counselors, both to be overseen by BBS. AB 239 did not
address counselors working in licensed treatment facilities
who would have remained under the jurisdiction of DADP and
subject to the existing certification process. AB 239 was
vetoed by Governor Arnold Schwarzenegger who stated, in his
veto message, that he was directing DADP to work to craft a
uniform standard for all alcohol and drug counselors
whether in private practice or in facilities.
d) AB 1367 (DeSaulnier) of 2007 would have provided for the
licensing, registration and regulation of Alcoholism and
Drug Abuse Counselors, as defined, by BBS. AB 1367 died on
Assembly Appropriations Committee Suspense File.
e) AB 2571 (Longville) of 2004 would have created the Board
of Alcohol and Other Drugs of Abuse Professionals in DCA
and established requirements for licensure of alcohol and
other drugs of abuse counselors. AB 2571 failed passage in
the Assembly Health Committee.
f) AB 1100 (Longville) of 2003 would have enacted the
Alcohol and Drug Abuse Counselors Licensing Law, to be
administered by BBS. AB 1100 was held in the Assembly
Business and Professions Committee.
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g) SB 1716 (Vasconcellos) of 2002 would have required BBS
to license and regulate alcohol and drug abuse counselors.
SB 1716 was held in the Assembly Business and Professions
Committee.
h) SB 537 (Vasconcellos) of 2001 would have required DCA to
initiate a comprehensive review of the need for licensing
substance abuse counselors. SB 537 was vetoed by Governor
Gray Davis due to cost concerns. In his veto message, the
Governor directed DADP to require counselors in drug and
alcohol treatment facilities to be certified for quality
assurance purposes.
8)SUPPORT . The California Association of Alcoholism & Drug
Abuse Counselors (CAADAC), the sponsor of this bill, writes
that creating a L&C category for substance abuse counselors
raises the level of care provided to addicts seeking treatment
in both the public and private sectors. CAADAC asserts that a
licensure category for these professionals will prepare
California's workforce to meet the expanded need for substance
use disorder treatment for persons receiving coverage under
the federal Affordable Care Act in 2014. CAADAC also states
that placing the regulation of the alcohol and drug counselor
profession under DPH makes sense because the professions that
are already licensed there, such as nurses and genetic
counselors, are disease-oriented and substance abuse
counselors treat the disease of addiction. The California
Association of Addiction Recovery Resources, which is one of
the nine certifying entities approved to ensure the competency
of alcohol and drug abuse counselors, writes in support that
this bill, while still a work in progress, ensures that
Californians in treatment programs have access to the very
best and most professional treatment staff in the nation by
delineating the responsibilities of CPTOs, identifying the
responsibilities of DPH as the state agency overseeing
counselors and CPTOs, delineating the requirements to become a
CADC or LADC, and, creating a uniform code of conduct. The
International Certification & Reciprocity Consortium states in
support that licensure offers the public a basis upon which to
choose a professional and provides properly trained and
educated professionals to improve the quality of the workforce
and lead to better treatment outcomes. CRC Health Group, Inc.
supports this bill as a good beginning toward raising the bar
for professionalizing substance abuse counselors and requests
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amendments to allow an additional year to phase in the L&C
system; make changes to background check requirements to
enable existing counselors with criminal histories to receive
their grandfathered status; and, narrowly define the
activities that must be performed by CADCs and LADCs.
9)OPPOSITION . Mental Health Systems, Inc., an employer of
substance abuse counselors, opposes this bill because it
presumes that the counselor L&C will be located at DPH and
that the current certification process needs only minor
modifications rather than a major revamping.
10)OPPOSE UNLESS AMENDED . The California Psychiatric
Association (CPA) opposes this bill unless it is amended to
confer the responsibilities for counselor L&C on DCA instead
of DPH. CPA argues DPH does not have the mission or expertise
to regulate the counselor profession competently and prefers
that the oversight functions be placed under DCA because it
oversees other behavioral disciplines and can provide coherent
regulation.
11)TECHNICAL AMENDMENTS .
a) On page 7, line 9, delete "Public Safety" insert "Health
".
b) On page 10, line 36, delete "certificate" and insert
"certification".
c) On page 11, line 9, delete "certificate" and insert
"certification".
d) On page 12, line 30, delete "and" and insert "or".
e) On page 28, line 18, delete "certificate" and insert
"certification".
12)POLICY COMMENTS .
a) Appropriate oversight . Given the lack of agreement in
the substance abuse counseling field over which state
agency should administer an L&C system and the interest in
consumer protection, should this profession be subject to a
"sunrise review" process to provide an occupational
analysis of counselors' skills, abilities, and competencies
prior to moving forward with licensure?
b) Role of DPH . Rather than require DPH to assume new
licensure responsibilities for substance abuse counselors,
should this bill instead require DPH to investigate
complaints concerning misconduct and maintain a registry
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that include a counselor's certification status and any
proposed or completed disciplinary actions, similar to what
DPH is required to do for other professions under its
jurisdiction, such as certified nursing assistants and home
health aides? Additionally, as the Legislature has yet to
act on the Governor's proposal to eliminate DADP and
transfer its current counselor certifying functions to DPH,
it is unclear if, or when, DPH would be prepared to take on
additional licensure responsibilities, including the
promulgating of implementing regulations, as required by
this bill.
c) Ongoing stakeholder negotiations . This bill will be
further amended to reflect the results of ongoing
negotiations with stakeholders regarding requirements for
the Committee, conditions for grandfathering existing
counselors, and revising the activities relating to the
scope of practice provisions to reflect the different
levels of staff that may be working in a treatment program.
The Committee may wish to ask the author to bring the bill
back to be heard again if the bill changes significantly.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Alcoholism & Drug Abuse Counselors
(Sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Association of Addiction Recovery Resources
Community Recovery Resources
CRC Health Group, Inc.
International Certification & Reciprocity Consortium
Stepping Stone of San Diego
Opposition
California Psychiatric Association (unless amended)
Mental Health Systems, Inc.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097
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