BILL ANALYSIS                                                                                                                                                                                                    �



                                                                AB 2198
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        ASSEMBLY THIRD READING
        AB 2198 (Levine)
        As Amended  April 21, 2014
        Majority vote 

         BUSINESS & PROFESSIONS        10-0                  APPROPRIATIONS  
        15-1                
         
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        |Ayes:|Bonilla, Bocanegra,       |Ayes:|Gatto, Bigelow,           |
        |     |Campos, Gordon, Hagman,   |     |Bocanegra, Bradford, Ian  |
        |     |Holden, Maienschein,      |     |Calderon, Campos, Eggman, |
        |     |Mullin, Ting, Wilk        |     |Gomez, Holden, Linder,    |
        |     |                          |     |Pan, Quirk,               |
        |     |                          |     |Ridley-Thomas, Wagner,    |
        |     |                          |     |Weber                     |
        |-----+--------------------------+-----+--------------------------|
        |     |                          |     |                          |
        |     |                          |Nays:|Jones                     |
        |     |                          |     |                          |
         ----------------------------------------------------------------- 
         SUMMARY  :  Requires Psychologists, Licensed Marriage and Family  
        Therapists (LMFTs), Licensed Education Psychologists (LEPs),  
        Licensed Clinical Social Workers (LCSWs), and Licensed Professional  
        Clinical Counselors (LPCCs) to complete either 15 or more hours of  
        coursework during a degree program, or six or more hours of  
        continuing education (CE) coursework as part of license renewal, in  
        suicide assessment, management and treatment, depending on the  
        professional's date of graduation.  Specifically,  this bill  :  

        For Psychologists:

        1)Requires an applicant for licensure as a psychologist, who began  
          graduate study on or after January 1, 2016, to complete as a  
          condition of licensure, a minimum of 15 contact hours of  
          coursework in suicide assessment, treatment, and management and  
          prohibits the Board of Psychology (BOP) from issuing a license to  
          a psychologist applicant until the applicant has met the specified  
          educational requirements.

        2)Requires a licensed psychologist, who began graduate study prior  
          to January 1, 2016, to complete a six-hour CE course in best  
          practices for suicide assessment, treatment, and management during  
          his or her first renewal period, as specified, and submit  








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          acceptable evidence to BOP of the person's satisfactory completion  
          of that course, and prohibits BOP from issuing a license to a  
          psychologist until the applicant has met the specified educational  
          requirements.

        3)Permits CE courses taken in suicide assessment, treatment and  
          management, to be applied to the 36 hours of approved continuing  
          education required, as specified.

        4)Delays the implementation of the CE requirement until January 1,  
          2016.

        For Licensed Marriage and Family Therapists:

        5)Requires a qualified applicant for licensure as a marriage and  
          family therapist, who began graduate study on or after January 1,  
          2016, to complete, as a condition of licensure, a minimum of 15  
          contact hours of coursework in suicide assessment, treatment, and  
          management.

        6)Requires a LMFT, who began graduate study prior to January 1,  
          2016, to complete a six-hour CE course in best practices for  
          suicide assessment, treatment, and management during his or her  
          first renewal period, as specified, and submit acceptable evidence  
          to California Board of Behavioral Sciences (BBS) of the person's  
          satisfactory completion of that course.

        7)Permits CE courses taken in suicide assessment, treatment, and  
          management, to be applied to the 36 hours of approved CE required,  
          as specified.

        8)Delays the implementation of the CE requirement until January 1,  
          2016.

        For Licensed Educational Psychologists:

        9)Requires an applicant for licensure as an educational  
          psychologist, who began graduate study on or after January 1,  
          2016, to complete as a condition of licensure, a minimum of 15  
          contact hours of coursework in suicide assessment, treatment, and  
          management and prohibits BBS from issuing a license to an  
          educational psychologist until the applicant has met the specified  
          educational requirements.









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        10)Requires a LEP, who began graduate study prior to January 1,  
          2016, to complete a six-hour CE course in best practices for  
          suicide assessment, treatment, and management during his or her  
          first renewal period, as specified, and submit acceptable evidence  
          to BBS of the person's satisfactory completion of that course.

        11)Permits CE courses taken in suicide assessment, treatment, and  
          management, to be applied to the 36 hours of approved CE required,  
          as specified.

        12)Delays the implementation of the CE requirement until January 1,  
          2016.

        For Licensed Clinical Social Workers:

        13)Requires an applicant for licensure as a clinical social worker,  
          who began graduate study on or after January 1, 2016, to complete  
          as a condition of licensure, a minimum of 15 contact hours of  
          coursework in suicide assessment, treatment, and management and  
          prohibits BBS from issuing a license to a social worker until the  
          applicant has met the specified educational requirements.

        14)Requires a LCSW, who began graduate study prior to January 1,  
          2016, to complete a six-hour CE course in best practices for  
          suicide assessment, treatment, and management during his or her  
          first renewal period, as specified, and submit acceptable evidence  
          to BBS of the person's satisfactory completion of that course.

        15)Permits CE courses taken in suicide assessment, treatment, and  
          management, to be applied to the 36 hours of approved continuing  
          education required, as specified.

        16)Delays the implementation of the CE requirement until January 1,  
          2016.



        For Licensed Professional Clinical Counselors:

        17)Requires a qualified applicant for licensure as a professional  
          clinical counselor, who began graduate study on or after January  
          1, 2016, to complete, as a condition of licensure, a minimum of 15  
          contact hours of coursework in suicide assessment, treatment, and  
          management.








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        18)Requires a LPCC, who began graduate study prior to January 1,  
          2016, to complete a six-hour CE course in best practices for  
          suicide assessment, treatment, and management during his or her  
          first renewal period, as specified, and submit  acceptable  
          evidence to BBS of the person's satisfactory completion of that  
          course.

        19)Permits CE courses taken in suicide assessment, treatment, and  
          management, to be applied to the 36 hours of approved CE required,  
          as specified.

        20)Delays the implementation of the CE requirement until January 1,  
          2016.

         FISCAL EFFECT  :  According to the Assembly Appropriations Committee,  
        "Minor and absorbable workload and costs to the [BBS] and the [BOP]  
        for verifying an applicant has completed required coursework."

         COMMENTS  :   

        1)Purpose of this bill.  This bill will require psychologists,  
          LMFTs, LEPs, LCSWs and LPCCs to complete either 15 or more hours  
          of coursework, or six or more hours of continuing education,  
          related to suicide assessment, treatment, and management,  
          depending on the date in which the individual began their graduate  
          degree program.  The aim is to ensure that mental health  
          professionals have adequate training to deal with potentially  
          suicidal individuals.  This bill is author sponsored.  

        2)Author's statement.  According to the author, "Studies estimate  
          that 40% of people who die by suicide have had contact with mental  
          health services within a year of their death.  There is no  
          requirement on the books that mental health professionals have  
          training in suicide assessment, treatment and management.  Most  
          people would assume that if [patients need] help with suicide  
          prevention that they should [seek] a mental health professional  
          who has experience with suicide assessment, treatment and  
          management.  This bill is necessary to ensure that mental health  
          professionals receive the appropriate training in suicide  
          assessment, treatment and management, thereby protecting public  
          health."

        3)Suicide prevention.  According to information provided by the  








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          Centers for Disease Control and Prevention, in 2009 suicide ranked  
          as the 10th leading cause of death of person's ages 10 years and  
          older, accounting for over 36,000 deaths.  In 2012, the National  
          Action Alliance for Suicide Prevention released the 2012 National  
          Strategy for Suicide Prevention (National Strategy).  The National  
          Strategy outlines strategic directions with 13 goals and 60  
          objectives that are meant to work together in a coordinated format  
          to help prevent suicide.  Goal number seven of the National  
          Strategy is to, "Provide training to community and clinical  
          service providers on the prevention of suicide and related  
          behaviors," including, but not limited to, professions such as  
          first responders, adult and child protective service  
          professionals, and health care providers, including behavioral  
          health care professionals.  The objective of the goal is to  
          "provide training to mental health and substance abuse providers  
          on the recognition, assessment, and management of at-risk  
          behavior, and the delivery of effective clinical care for people  
          with suicide risk."  The objective states that mental health and  
          substance abuse providers should have the essential foundations of  
          attitudes, knowledge and clinical prevention skills to address and  
          reduce suicide risk.  In addition, it calls for all education and  
          training programs, including undergraduate, graduate and CE, to  
          adopt core education and training guidelines addressing the  
          prevention of suicide-related behaviors.  

          This bill aims to ensure that education for mental health  
          providers include coursework in suicide assessment, treatment and  
          management by requiring coursework in this subject area be  
          completed either during a degree program or through CE, depending  
          upon the beginning date of their graduate degree program.  In  
          order to provide schools with an opportunity to revise their  
          curricula if necessary, this bill authorizes licensees who  
          completed graduate study before January 1, 2016, to obtain the  
          needed coursework through CE, as approved by BOP or BBS.  For  
          individuals who begin graduate study after 2016, they will be  
          required to complete the coursework during a degree program.   

        4)Need for additional training.  According to the report, Preventing  
          Suicide through Improved Training in Suicide Risk Assessment and  
          Care: An American Association of Suicidology Task Force Unabridged  
          Report Addressing Serious Gaps in Mental Health Training,  
          one-third of people who die from suicide have had previous contact  
          with a mental health services within one year of their death and  
          20% have had mental health contact within the last month of their  








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          life.  The report concludes that despite the prevalence of patient  
          suicidal behavior and deaths from suicide, the mental health  
          disciplines have been, at best, inconsistent in training mental  
          health professionals in the evaluation and management of suicidal  
          patients.  

        5)Training standards for mental health professionals.  Training and  
          educational standards for mental health professionals vary  
          depending on the profession.  Psychologists, LMFTS, LCSWs, LEPs,  
          and LPCCs are required to meet different educational elements  
          which are determined by each board and are based on each  
          professions educational needs and standards.  In addition, CE is  
          often required to maintain an active license, and CE requirements  
          may be set forth in statute and specified in more detail through  
          regulations issued by BOP or BBS.  However, each of these  
          regulatory bodies has unique CE requirements and oversight.  

        6)Psychologists.  Psychologists are regulated by BOP and are not  
          under the jurisdiction of BBS as are the other mental health  
          professions (LMFTs, LEPs, LCSWs, and LPCCs).  Psychologists are  
          required to possess an earned doctorate degree in psychology from  
          an approved or accredited educational institution.  In addition,  
          applicants must complete specified coursework in spousal or  
          partner abuse assessment, detection and intervention, and training  
          in the detection and treatment of alcohol and other chemical  
          substances dependency.  All psychologists seeking licensure  
          renewal must obtain training in the subject of laws and ethics  
          before they apply to the practice of psychology in California.   
          Additionally, psychologists are required to take a specified  
          one-time, CE course in spousal or partner abuse assessment,  
          detection and intervention strategies, and a one-time three hour  
          CE course in aging and long-term care, or show proof to the board  
          of its equivalent in teaching or practicing experience.  A  
          psychologist may request an exemption from CE requirements if they  
          meet specified criteria.  

        7)Licensed Marriage and Family Therapists.  Under current law, LMFTs  
          are required to complete very specific coursework in numerous  
          subject areas in order to satisfy licensing requirements which  
          include:  the principals of mental health recovery-oriented care;  
          methods of service delivery in recovery-oriented practice  
          environments, among others; and specific instruction in diagnosis,  
          assessment and prognosis and treatment of mental disorders.  
          However, there is no specific requirement for a course to include  








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          suicide assessment.  The BBS indicates that this training may  
          already be included in several degree programs, but is currently  
          not mandatory.  LMFTs must complete several one-time CE  
          requirements for a total of 36 hours of CE every license renewal  
          period.  However, no CE requirements are currently specified in  
          this subject matter.  

        8)Licensed Education Psychologists.  In order to qualify to be a  
          LEP, applicants must possess, at minimum, a master's degree in  
          psychology, educational psychology, school psychology, counseling  
          and guidance, or a degree deemed equivalent by BBS.  Applicants  
          must complete three years of full time experience, or the  
          equivalent, working as a school psychologist.  While LEPs are  
          required to obtain specified degrees and relevant experience  
          related to psychology, they are currently not required to take  
          coursework in specified subjects such as suicide assessment.   
          However, according to BBS, they may obtain coursework in suicide  
          assessment, treatment and management as part of an established  
          curriculum from an approved degree program.  In addition, LEPs are  
          required to obtain 36 hours of CE in subject areas such as the  
          aspects of the discipline that are fundamental to the  
          understanding or the practice of educational psychology.   

        9)Licensed Clinical Social Workers.  LCSWs typically diagnose and  
          treat mental and behavioral health issues.  To be licensed, a  
          person must graduate from an accredited master's degree program,  
          register with the BBS as an Academy of Certified Social Workers,  
          and complete additional required coursework including:  alcoholism  
          and other chemical dependency; spousal or partner abuse  
          assessment, detection and intervention; human sexuality and child  
          abuse assessment and reporting, as specified, in addition to  
          obtaining 3,200 hours of supervised work experience, and  
          successfully pass specified exams.  Currently, there is no  
          specific course requirement for suicide assessment, treatment, and  
          management, as prescribed by this bill; however, some individuals  
          may receive it during their degree program.

        10)Licensed Professional Clinical Counselors.  In order to obtain  
          licensure as an LPCC, an applicant who began graduate study on or  
          after August 1, 2012, is required to obtain a master's or doctoral  
          degree from an accredited or approved institution, which covers  
          counseling or psychotherapy in context, and includes supervised  
          practicum in specified content areas.  In addition, an applicant  
          must obtain a minimum of 3,000 post-degree hours of experience  








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          supervised by a LPCC, LMFT, LCSW, psychologist or licensed  
          physician and surgeon who is certified in psychiatry by the  
          American Board of Psychiatry and Neurology.  Of the 3,000 hours  
          required, not less than 1,750 hours must involve direct counseling  
          with individuals or groups in a clinical mental health counseling  
          setting and 150 hours in a hospital or community mental health  
          setting.  In addition, an applicant must receive a passing score  
          on the National Clinical Mental Health Counselor Examination and  
          the California Law and Ethics Exam, which are taken upon  
          completion of the supervised hours.  Currently, there is no  
          specific course requirement for suicide assessment, treatment, and  
          management, as prescribed by this bill; however, some individuals  
          may receive it during their degree program.  


         Analysis Prepared by  :    Elissa Silva / B., P. & C.P. / (916)  
        319-3301


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