BILL ANALYSIS �
SB 570
Page 1
Date of Hearing: June 26, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
SB 570 (DeSaulnier) - As Amended: June 25, 2014
SENATE VOTE : Vote not relevant
SUBJECT : Advanced Alcohol and Drug Licensing Act.
SUMMARY : Establishes the Advanced Alcohol and Drug Counselor
Licensing Board (Board) within the Department of Consumer
Affairs (DCA) to carry out the Advanced Alcohol and Drug
Counselor Licensing Act, which regulates licensed alcohol and
drug counselors (AADC). Specifically, this bill :
1)Establishes the Board within DCA, consisting of five state
licensed advanced alcohol and drug counselors (LAADC) and six
public members to serve four-year terms, as specified.
2)Authorizes the Board to appoint an executive officer and
employ any clerical, technical, and other personnel as it
deems necessary to carry out the provisions of this bill, as
specified.
3)Requires the Board to keep an accurate record of all of its
proceedings and a record of all applicants for licensure and
all individuals to whom it has issued a license, and declares
that protection of the public shall be the highest priority
for the Board in exercising its licensing, regulatory, and
disciplinary functions.
4)Requires the Board to:
a) Adopt rules and regulations as necessary to administer
and enforce this bill according to the Administrative
Procedure Act;
b) Issue licenses and register interns seeking licensure
beginning January 1, 2017, as specified;
c) Take disciplinary action against licensees and
registered interns where appropriate, as specified, and
prohibits the Board from taking action against certified
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counselors and staff of licensed and certified facilities
who are not registered or licensed with the Board;
d) Establish continuing education requirements;
e) Establish procedures for the receipt, investigation, and
resolution of complaints;
f) Establish criteria to determine whether the curriculum
of an educational institution satisfies the requirements
imposed by this bill;
g) Establish parameters of unprofessional conduct that are
consistent with the uniform code of conduct adopted by the
California Coalition of Certifying Organizations, as
specified;
h) Establish reinstatement procedures for an expired or
revoked certificate or license;
i) Establish policies to implement and enforce clinical
supervision requirements for registered interns, as
specified;
j) Adopt one examination for administering to prospective
licensees which may be administered by the Board or by any
public or private entity selected by the Board;
aa) Maintain a database of licensees and registered interns,
including the individual's status, any public record of
discipline, and other information as the Board may require;
and,
bb) Establish an advisory committee, as specified, that
shall meet at least two times per year and make
recommendations to the Board concerning curriculum,
criminal background checks, unprofessional conduct, and
other matters. This advisory committee shall become
inoperative two years after the issuance of licenses.
5)Requires the Board to issue a registration for an advanced
alcohol and drug counselor intern (AADCI) who meets all of the
following requirements:
a) Possesses an earned master of arts, master of science,
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or doctoral degree in alcohol and drug counseling,
psychology, social work, counseling, marriage and family
therapy, counseling psychology, clinical psychology, or
other clinically focused major or an equivalent degree
recognized by the Board, from an institution of higher
learning accredited by the Western Association of Schools
and Colleges (WASC), the Bureau for Private Postsecondary
Education (BPPE), or state or regional accrediting agency
approved by the Board, as specified;
b) Completes 315 clock hours of alcohol and drug specific
education, as specified, approved by the Board from an
institution of higher learning accredited by WASC, BPPE, or
a state or regional accrediting agency approved by the
board;
c) Completes a supervised practicum of no less than 315
performance (experience) hours, including 45 hours of
classroom instruction and 255 hours of practical experience
performed at an agency approved by the practicum
instructor;
d) Submits to a state and federal level criminal offender
record information search and passes both background
checks, as specified;
e) Pays the required fees as set by the Board; and,
f) Completes the application for registration.
6)Authorizes the Board to accept any or all of the hours of
education specified as part of the education leading to a
person's earned master of arts, master of science, or doctoral
degree.
7)Requires the Board to issue an advanced alcohol and drug
counselor (LAADC) license to an existing drug and alcohol
counselor who applies between January 1, 2017, and June 30,
2018, if the individual meets either of the following set of
requirements:
a) Holds a current, valid, advanced alcohol and drug
counseling certification or clinical supervision
certification issued by a certifying organization
recognized by [DHCS] on or before January 1, 2017; submits
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to a state and federal level criminal offender record
information search and passes, as specified; provides a
letter from a certifying organization that confirms that
the applicant has documented a total of 10,000 hours of
experience in alcohol and drug abuse counseling or
supervised internship, as specified; pays the required
fees; and completes the application for a license; or,
b) A person who is licensed in the State of California who
practices alcohol and drug counseling and who provides
documentation to the Board that he or she meets the
following requirements on or before January 1, 2016:
i) Currently holds a valid license in the state to
practice marriage family therapy, psychology, social
work, professional counseling, or medicine and provides
documentation;
ii) Provides documentation to the board of 6,000 hours
of experience in providing alcohol and drug counseling
services directly to patients;
iii) Pays the required fees as set by the Board; and,
iv) Completes the application for a license.
8)Requires the Board to issue a LAADC license to individuals
meeting the following requirements:
a) Possesses an earned master of arts, master of science,
or doctoral degree in alcohol and drug counseling,
psychology, social work, counseling, marriage and family
therapy, counseling psychology, clinical psychology, or
other clinically focused major or an equivalent degree
recognized by the board, from an institution of higher
learning accredited by WASC or an equivalent accrediting
agency approved by the United States Department of
Education (USDOE);
b) Completes specified alcohol and drug specific
educational and experience requirements;
c) Submits documentation of 2,000 hours of work experience
as an alcohol and drug counselor, of which 1,500 hours may
be substituted by documenting certification in good
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standing as an alcohol and drug counselor as per
certification regulations of this state;
d) Receives a passing score on a nationally recognized exam
for licensure designated by the Board;
e) Submits to a state and federal level criminal offender
record information search and passes both background
checks, as specified;
f) Pays the required fees as set by the Board; and,
g) Completes the application for a license.
9)Authorizes the Board to accept education, supervised
experience, and work experience gained outside of California
toward the licensing requirements if it is substantially
equivalent to the requirements of this bill.
10)Authorizes the Board to issue a license to any person who, at
the time of application, meets all of the following
requirements:
a) Has held a valid active alcohol and drug counseling
license or certification issued by a board of alcohol and
drug counseling examiners or corresponding authority of any
state;
b) Passes the current applicable examination;
c) Pays the required fees;
d) Passes the required background check, as specified; and,
e) Is not subject to denial of licensure under this bill.
11)Authorizes the Board to limit, by regulation, the number of
registered interns that any one supervisor may supervise, the
number of registered interns that may be supervised in any
given program or setting, and the proportion of the workforce
in any given program or setting that may be comprised of
registered interns.
12)Exempts programs licensed or certified by [DHCS]from adhering
to the supervision provisions of this bill.
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13)Requires the Board to issue a license or intern registration
to each applicant meeting the requirements of this bill, which
permits the holder to engage in alcohol and drug counseling as
specified, entitles the holder to use the title of "licensed
advanced alcohol and drug counselor" or "advanced alcohol and
drug counselor intern," as applicable, and authorizes the
holder to hold himself or herself out as qualified to perform
the functions delineated by this part, subject to any
limitations relating to the level of the license or
registration or other conditions that may be imposed by the
Board.
14)Authorizes a licensee or registered intern to perform the
acts listed in this bill only for the purpose of treating
alcohol and drug addiction.
15)States that addiction counseling includes the professional
and ethical application of basic tasks and responsibilities,
including screening; initial intake; orientation; alcohol and
drug abuse counseling, including individual, group, and
significant others; case management; crisis intervention;
assessment; treatment planning; client education, referral,
reports and recordkeeping, and consultation with other
professionals with regard to client treatment or services and
communicating with other professionals to ensure
comprehensive, quality care for the client.
16)States that alcohol and drug counseling includes
understanding and application of the limits of the counselor's
own qualifications and scope of practice, including, but not
limited to, screening and, as indicated, referral to or
consultation with an appropriately licensed health
practitioner consistent with the client's needs. Every
licensee who operates an independent counseling practice shall
refer any client assessed as needing the services of another
licensed professional to that professional in a timely manner.
17)Exempts the following individuals from licensing
requirements, provided that the exemption does not preclude
the Board from considering any conduct in any setting in its
determination of fitness for registration or licensure or in
any disciplinary matter:
a) A person who engages in the practice of alcohol and drug
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counseling exclusively for any of the following:
i) In-custody services of the Department of Corrections
and Rehabilitation;
ii) As an employee or volunteer of the State of
California; or,
iii) As an employee or volunteer of an agency of the
government of the United States;
b) A person who is an unpaid member of a peer or self-help
group who performs peer group or self-help activities if
the person does not use a title stating or implying that he
or she is a licensed or certified alcohol and drug
counselor or registered intern;
c) A cleric or other religious leader who provides
spiritual advice and guidance to members of his or her
congregation or order, or to other persons, if it is free
of charge;
d) A director, officer, or staff member of a a live-in
alternative to incarceration rehabilitation program; and,
e) A director, officer, or staff member of an alcohol and
other drug abuse program or "DUI program", as specified.
18)Prohibits this bill from constricting, limiting, or
withdrawing the Medical Practice Act, the Nursing Practice
Act, the Psychology Licensing, the Licensed Marriage and
Family Therapist Act, the Clinical Social Worker Practice Act,
or the Licensed Professional Clinical Counselor Act. States
that this bill shall not be construed to mean that persons
exempted from this Act shall be required to be dually licensed
in order to provide alcohol and drug counseling services.
19)States that a person who has received a registration or
license under this part may use the title "advanced alcohol
and drug counselor intern" or "AADCI," or "licensed advanced
alcohol and drug counselor" or "LAADC," in accordance with the
type of registration or license possessed. Every person who
styles himself or herself or who holds himself or herself out
to be an AADCI or licensed advanced alcohol and drug
counselor, without holding a license or registration in good
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standing under this part, is guilty of a misdemeanor.
20)States that it is unlawful for a person to engage in the
practice of alcohol and drug counseling outside of a licensed
or certified alcohol and drug treatment facility, unless the
person holds a valid, unexpired, and unrevoked license or
registration as of January 1, 2017.
21)States that licenses shall be valid for two years after the
issue date.
22)Requires at least 60 hours of continuing education for
license renewal.
23)Requires a licensee to display his or her license in a
conspicuous place at the primary place of his or her business.
24)Prohibits an LAADC who conducts a private practice under a
fictitious business name from using a name that is false,
misleading, or deceptive, and shall inform the patient, prior
to the commencement of treatment, of the name and license
designation of the owner or owners of the practice.
25)Authorizes an LAADC to apply to the Board to request that his
or her license be placed on inactive status.
26)Requires a licensee to notify the Board in writing within 30
days of the following occurrences:
a) Any change of address;
b) Name change, giving both the old and the new names along
with a copy of the legal document authorizing the name
change, including, but not limited to, a court order or
marriage license; or,
c) Conviction of a misdemeanor or felony substantially
related to the practice of alcohol drug counseling.
27)Authorizes the Board to deny an application or revoke,
suspend, or impose conditions upon a license or the intern
registration for unprofessional conduct. Defines
"unprofessional conduct" to include the following:
a) Engaging in inappropriate social relationships, sexual
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relations, or soliciting sexual relations with a client or
with a former client within two years from the termination
date of the counseling relationship;
b) Engaging in a business relationship with clients,
patients, program participants, residents, or other persons
significant to them within one year from the termination of
the counseling relationship;
c) Unlawfully administering to himself or herself any
controlled substance, using dangerous drugs or devices, or
using any alcoholic beverage to the extent, or in a manner,
as to be dangerous or injurious to the person holding or
applying for intern registration or licensure or to any
other person or to the public; and,
d) Violating patient or client confidentiality except as
required or permitted by law, as specified.
28)Requires the Board to revoke a license or the registration of
an intern in accordance with the procedures set forth in the
adjudication provisions of the Administrative Procedure Act,
as specified.
29)Authorizes the Board to deny an application, or may revoke or
suspend a license or intern registration issued under this
part, for a denial of licensure, revocation, suspension,
restriction, or other disciplinary action imposed by another
state or territory of the United States, or by any other
governmental agency, on a license or registration to practice
alcohol and other drug counseling or other healing art. A
certified copy of the disciplinary action decision or judgment
shall be conclusive evidence of that action.
30)Authorizes the chairperson of the Board to temporarily
suspend a license or intern registration prior to a hearing
when, in the opinion of the chairperson, the action is
necessary to protect the public or a client from physical or
mental abuse, abandonment, or other substantial threat to
health or safety, as specified.
31)Establishes procedures to follow for criminal offender record
information searches.
32)Requires the Board to deny or revoke a person's license or
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registration if, at the time of the Board's determination, the
person meets one or more of the following criteria:
a) He or she has been convicted of five or more criminal
offenses within a 30-month period ending two years or less
prior to the date of the Board's determination;
b) He or she is required to register as a sex offender;
and,
c) He or she has been convicted of a violent felony within
three years prior to the date of the Board's determination.
33)Establishes procedures for the license or registration of an
individual on parole.
34)Prohibits the Board from denying or revoking a registration
or license solely on the basis of convictions stemming from
prior use of drugs or alcohol, provided the individual meets
the terms of rehabilitation established as specified.
35)Establishes parameters for filing an accusation.
36)Establishes the Advanced Alcohol and Drug Counselors License
Fund in the State Treasury, into which all fees and fines
collected by the Board shall be deposited.
37)Establishes licensure fees, as specified.
38)Requires that the startup funds to implement this bill to be
derived, as a loan, from the reserve of the fund, upon
appropriation by the Legislature, and the Board is not
required to implement this part until those funds are
appropriated.
39)Requires that the bill be liberally construed to achieve its
objectives.
40)Defines the following terms: "Advanced alcohol and drug
counselor intern" or "AADCI," "alcohol and drug counseling,"
"Advertise," "Board," "Clinical supervision," "Clock hour,"
"Department," "Director," "Independent counseling practice,"
"IC&RC," "Licensed advanced alcohol and drug counselor" or
"LAADC," and "Student."
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41)States that no reimbursement is required by this act because
the only costs that may be incurred by a local agency or
school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction.
EXISTING LAW :
1)Establishes the Medi-Cal program, administered by Department
of Health Care Services (DHCS), under which qualified
low-income individuals receive health care services. (Health
and Safety Code (HSC) Section 11750)
2)Establishes the Drug Medi-Cal (DMC) program, which provides
substance use disorder services to Medi-Cal recipients. (HSC
11750)
3)Allows DHCS to enter into contracts with counties for the
provision of DMC services. If a county declines to contract
with DHCS, existing law requires DHCS to contract for services
in the county to ensure beneficiary access. (HSC 11758.20)
4)Requires each county to fund the nonfederal share for DMC
services through realignment funds, as specified. (HSC
11758.10)
5)Requires providers of DMC services to obtain certification
from DHCS to provide those services. (HSC 11755)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of this bill . This bill establishes a board within
DCA to license AADCs in private practice, which are not
currently licensed by the state. This bill will provide a
single, comprehensive regulatory system that will enhance
consumer protection. This bill is sponsored by the California
Association of Alcoholism and Drug Abuse Counselors (CAADAC).
2)Author's statement . According to the author's office:
"There is currently no statutory authority for the Department
of Health Care Services (DHCS), or any other state agency, to
impose quality or consumer protection measures for AADCs
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working outside of licensed and certified facilities, putting
consumers at risk. The Affordable Care Act (ACA) requires
participating exchange members to maintain accreditation by
the National Committee for Quality Assurance (NCQA). The NCQA
requires behavioral health practitioners to be licensed in
order for a plan to maintain accreditation. Because California
is one of the minority of states without licensure for AADC,
patients are being referred to other licensed professionals
with little training or education in alcohol and drug
treatment. Others are being referred for expensive inpatient
treatment where early intervention in a private practice
setting would have been more appropriate and economic. Funding
for treatment via the ACA can be accessed for Californians if
AADCs were to be licensed.
"Counselors providing care in licensed alcohol and drug
treatment facilities are regulated by DHCS. DHCS is currently
forwarding new regulations using its existing authority to
certify and register AADCs via private certifying
organizations. These organizations must meet certain
criteria, including achieving a National Commission for
Certifying Agencies (NCCA) accreditation, to participate in
the certification process. These regulations apply only to
staff of licensed or certified facilities. There are no laws
protecting consumers outside of a facility and regulations
created and enforced by DHCS do not allow counselors to
provide service in a private practice setting under the ACA.
"Existing law does not require criminal background checks for
AADCs providing services outside of a licensed or certified
facility. These counselors have unsupervised contact with
clients. The State has a responsibility to protect all
vulnerable individuals from coming into direct contact with
people who could cause them physical or emotional harm while
receiving AADC services. Individuals suffering or recovering
from alcohol and other drug dependency are particularly
vulnerable.
"This bill would establish licensure and intern provisions
relating to alcohol and other drug (AOD) counselors to be
administered by the Department of Consumers Affairs (DCA).
The bill would authorize DCA to assess fees and establish the
Advanced Alcohol Drug Counselor License Fund for revenue and
expenditures relating to this bill. Additionally, this bill
would authorize DCA to require counselors to submit to
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fingerprinting and background checks, and to impose sanctions
for counselor misconduct."
3)Background on alcohol and drug counselor regulation .
California currently does not require licensure for AADCs.
DHCS requires certification for AADCs employed by certain
inpatient programs, but outpatient treatment programs -- where
70% of Californians seek treatment -- are not regulated by any
state agency, according to a 2008 report by the Little Hoover
Commission.
DHCS recognizes six agencies to provide certification, and
each program develops its own classroom curriculum, training,
supervisor and work experience requirements. Background
checks are not performed and there is no central repository of
counselor information, including disciplinary action taken to
suspend or revoke certification for misconduct. DHCS can
direct a certifying organization to take action against a
counselor for misconduct, but there is nothing to prevent a
counselor who has had certification suspended or revoked from
obtaining certification from another organization.
Approximately 36,000 registered or certified counselors work
in 2,534 private and publicly funded drug and alcohol programs
in California. With the implementation of the ACA, many
newly-insured people are expected to seek treatment. The
federal government and insurers, meanwhile, may impose greater
standards on providers. In combination, these developments are
likely to lead to greater scrutiny of California's system of
overseeing those who provide drug and alcohol treatment.
4)CSOOO Report. A 2013 report by the California Senate Office
of Oversight and Outcomes (CSOOO) extensively examined the
current process to become an AADC, and noted some of the
systemic flaws. "California is one of only two states among
the nation's 15 largest that makes no attempt to review
counselors' criminal backgrounds. Even within California, AAD
counselors are the only health-related profession not required
to undergo these checks. Among those who submit to screening
are acupuncturists, dental hygienists, optometrists, and
veterinarians.
"The ability to easily evade regulators represents a gaping
loophole in California's system. While the state's [six]
certifying organizations are required to check with their
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counterparts to see if a counselor has ever been revoked, the
regulation states that this must be done only upon
certification. Counselors can work for five years before they
must become certified.
"In 2004, Governor Gray Davis directed the California Department
of Alcohol and Drug Programs (DADP) to come up with
regulations for certifying counselors. [Current regulations
require 30% of staff providing alcohol and drug counseling in
any program must be certified by 2010, and counselors who work
in privately-run facilities that do not receive public funds
are exempt.]"
The CSOOO cross-checked lists of counselor names against
individuals who have been excluded from receiving Medicare and
Medi-Cal payments because of misconduct including fraud or
other criminal activity. CSOOO found several counselors who
were able to keep working despite having their registrations
or certifications revoked; they simply signed up with a
different certifying organization. The organizations are
supposed to check with their counterparts to make sure that an
applicant has not been ordered revoked by DHCS. However, the
regulation states that the check must be done only when the
organization certifies counselors, not when they register,
providing for a regulatory loophole. Regulations allow
counselors to work for five years without being certified,
meaning that a revoked counselor could go that long without
being detected. After five years, that same counselor might
be able to register with another of the certifying
organizations and keep working.
Counselors who failed to achieve certification within five
years would be revoked, unless the certifying organization
granted a two-year hardship extension.
5)Cost of substance abuse . According to the CSOOO report,
"Substance abuse is a key driver of California's most costly
problems. As many as two-thirds of all parents who enter the
state's $19-billion child welfare system are affected by
substance abuse, while an estimated 60,000 to 70,000 children
who are born each year in California have been exposed in the
womb to alcohol, tobacco or other drugs."
"California hospitals incur $1.3 billion in costs due to
alcohol-related incidents. Studies conducted by Kaiser
Permanente in California show that the health maintenance
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organization's members who sought substance abuse treatment
had medical costs more than four times that of other clients
prior to seeking treatment.
"Severe overcrowding in California's $10-billion prison system
has prompted federal judges to consider taking control of the
system away from the state. County jail policies in 20
counties are guided by court-imposed population caps, which
force sheriffs, every day, to release offenders early.
Approximately 80 percent of the offenders in these over-packed
prisons and jails are involved with substance abuse, and for
many, addiction is an integral part of their criminal
lifestyles?.
"In California, substance abuse treatment is a sound
investment. According to data collected by the state
Department of Alcohol and Drug Programs, Californians who
entered treatment in 2006 reduced their contact with the
criminal justice system by 57 percent, and the number who had
a job grew from 24,433 upon entering treatment to 30,198 upon
exiting treatment, a 24 percent increase in employment. Both
of these statistics illustrate positive results not only for
individuals and families, but also for public coffers.
"A long-term study conducted on northern California patients
in the addiction treatment system run by Kaiser Permanente,
the state's largest health maintenance organization, showed
that providing substance abuse treatment reduces the health
care costs of those struggling with addiction while adding
only minimal costs to the system. Medical care costs decreased
by $155 per month five years after admission to treatment for
the patients who sought help, while costs for a comparison
group remained stable. The study found that while the average
medical costs for those with substance abuse problems was four
times higher than the comparison group in the six months
before the study group was admitted to treatment, average
costs were only twice as high five years later, even with the
addition of the treatment costs."
Maximizing the effectiveness of treatment programs must begin
with confidence in the treatment provider, and the current
regulatory system for AADCs provides inconsistent consumer
protection.
6)Questions for the Committee . The Committee members may wish
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to consider the following issues:
a) Independent board within DCA . This bill establishes an
independent licensing board within DCA. The Board of
Behavioral Sciences currently licenses and regulates
Licensed Marriage and Family Therapists (MFTs), Licensed
Clinical Social Workers (LCSWs), and Licensed Professional
Clinical Counselors (LPCCS) - other allied health
professionals also trained in mental and social health
services. These licenses have similar work and experience
requirements and enforcement concerns.
However, BBS has expressed resistance to adding another
license to its regulation authority due to insufficient
resources. Licensing boards are required to be
self-sustaining, and receive no General Fund money. The
Committee may wish to consider whether it is appropriate to
have a completely separate board to administer a license
very similar to existing regulatory programs, or whether it
would be more efficient to create a committee within BBS
which could provide expert guidance while the BBS board
could continue to manage enforcement and discipline.
b) Master's level education and experience requirements .
This bill creates a license for mental health treatment of
a single diagnosis - alcohol and substance abuse - and
requires referral for other co-occurring disorders to other
qualified licensees, including MFTs, LCSWs, and LPCCs.
Those licenses require a master's level education and
experience similar to these requirements for an LAADC.
There is no uniform educational requirement for AADC
certification, and many certification bodies do not require
a bachelor's degree.
The Committee may wish to consider whether the educational
and experience requirements are commensurate with the level
of expertise needed for sufficient alcohol and drug
treatment, given the current levels required for other,
similar license types that are trained to handle a myriad
of other mental health issues, and the current standards
for certified AADCs.
c) CE hours . Current Continuing Education (CE)
requirements for MFTs, LCSWs, and LPCCs are 36 hours per
two year renewal cycle. This bill requires 60 hours every
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two years. The Committee may wish to consider whether 36
or fewer hours per two year cycle would be more appropriate
and feasible for licensees.
7)Committee amendments . The Committee recommends the following
technical amendments:
a) Change references from "the department" to "the
Department of Health Care Services" in the following
sections:
i) 4452.1(g);
ii) 4453.4 (m);
iii) 4453.1 (a)(1); a(2)(4)
b) Clarify what it means in 4452.1 (m) that "the advisory
committee shall become inoperative two years after the
issuance of licenses." Presumably the Board will continue
to issue licenses throughout its existence, so the author
may want to clarify that the committee shall become
inoperative two years after the Board's issuance of its
first license.
c) There have been concerns expressed with the lack of
standards for the use and training of MFT and LCSW interns,
so the committee recommends the following:
Replace "may" with "shall" in 4453.4(l) to read "The Board
shall limit, by regulation, the number of registered
interns that one supervisor may supervise, the number of
registered interns that may be supervised in a given
program or setting, and the proportion of the workforce in
a given program or setting that may be comprised of
registered interns."
d) 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 20% to 50% of those
with addiction problems. The following amendment has been
agreed upon by the author's office and other stakeholders
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to ensure that a referral is made to a provider able to
treat health concerns beyond alcohol and substance abuse.
This amendment will require a LAADC to refer a client to
another provider to assess any co-occurring needs within 14
days, and the LAADC may continue to see the client whether
the client decides to see the other provider or not.
Add the following language (sections i through vi) after
Section 4454.1:
i) Licensed alcoholism and drug abuse counselors
providing services in a private practice setting shall
refer all clients for an initial assessment to one of the
following professionals within 14 days of intake to
assess any co-occurring needs or disorders:
(1) A marriage and family therapist;
(2) A licensed clinical social worker;
(3) A licensed psychologist;
(4) A licensed physician and surgeon certified in
psychiatry by the American Board of Psychiatry and
Neurology;
(5) A licensed physician and surgeon who has
completed a residency but is not yet board certified
in psychiatry;
(6) A licensed professional clinical counselor;
or,
(7) Any other licensed professional approved by
the board.
ii) Referrals made pursuant to this subdivision shall be
documented in the client's chart.
iii) A professional receiving a referral under this
section shall, with the written consent of the client,
provide to the referring alcoholism and drug abuse
counselor a signed, written report that includes
assessment results and treatment and referral
recommendations. The referring alcoholism and drug abuse
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counselor shall place this report in the client's chart.
iv) A licensee shall, in an effective and safe fashion,
demonstrate the ability to refer patients in need of
services that go beyond the scope of practice of
alcoholism and drug abuse counseling. The licensee shall
maintain current referral information for the services he
or she is prohibited from providing.
v) During the course of the screening and intake
process, a licensed alcoholism and drug abuse counselor,
working within his or her scope of practice, shall
determine the level of care most appropriate for the
client and the need for integrated treatment in the
presence of medical, emotional, and behavioral
conditions. This determination shall be based on the
client's state of intoxication or withdrawal, the
presence of other conditions, relapse potential, the
nature of the recovery environment, and other client
issues, including, but not limited to, legal, financial,
or housing issues.
vi) If the licensed alcoholism and drug abuse counselor
properly refers a client as required in subdivision (a),
the counselor shall not be deemed to be practicing
illegally based solely on the client's refusal or failure
to follow up on the referral, and the counselor may
continue to see the client.
8)Arguments in support . The California Association of
Alcoholism and Drug Abuse Counselors writes, "By passing this
legislation you will be helping addicts and their loved ones
who are vulnerable to abusive and incompetent 'counselors' who
are able to 'practice' addictions counseling with no proof of
skills, knowledge or education. You will also put an end to
professionals who are banned from working in state licensed
facilities for harming clients or who may have had a license
revoked by one of California's licensing boards for sexually
abusing patients who turn to working under the guise of
'alcohol and drug counseling.' Consumers have no mechanism for
distinguishing legitimate counselors from those who have
previously abused clients and have no recourse should they
become victims of unscrupulous providers of addiction
treatment services."
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"SB 570 is a practical approach to adding this necessary
branch of disease treatment. It encourages workforce
development through a 'career ladder' approach; it firmly
defines the education requirements necessary for professional
practice; and it delineates scope of practices between
currently licensed professions. Through the collection of
licensure fees it does not impact the state budget and will
have enormous long term savings via reduced demand on publicly
funded programs."
9)Arguments in opposition . The National Association of Social
Workers, California Chapter writes, "Because this bill was
gutted and amended late in the process, we feel that many more
discussions need to take place in order to correct the
imperfections in the bill. We would like to see stronger
language regarding a referral for a mental health professional
for co-occurring disorders. We also believe that the
grandfathering provisions for certified Alcohol and Drug
Counselors may not be vigorous enough."
10)Related legislation : SB 1339 (Cannella) requires a county or
DHCS, before contracting with a DMC provider, to obtain
criminal background checks for the owner and key staff. SB
1339 is currently on the Assembly Floor.
AB 1967 (Pan) requires DHCS, when it commences or concludes an
investigation of a DMC provider, to notify counties that
contract with the provider. AB 1967 is currently in the
Senate Health Committee.
SB 1045 (Beall) decreases, from four to two, the minimum
number of participants in a group counseling session provided
by certain DMC providers and eliminates the maximum of 10
participants. SB 1045 is currently on the Assembly Floor.
11)Previous legislation . AB 2007 (Williams) of 2012 would have
established a licensing and certification system for AADCs to
be administered by the Department of Public Health. This bill
was held in Assembly Health Committee
SB 1203 (DeSaulnier) of 2010 would have instituted a licensing
and certification structure for AOD counselors by DADP. SB
1203 was held in the Assembly Rules Committee.
SB 707 (DeSaulnier) of 2009, which was substantially similar
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to SB 1203 of 2010, died on the Assembly Appropriations
Committee Suspense File.
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 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.
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.
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 AOD abuse
counselors. AB 2571 failed passage in the Assembly Health
Committee.
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.
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.
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.
REGISTERED SUPPORT / OPPOSITION :
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Support
California Association of Alcoholism and Drug Abuse Counselors
(sponsor)
California Association of Addiction Recovery Resources (sponsor)
2 Shine Again, Inc.
ACCESS
Alpha Project
Amity Vista Ranch
Associated Rehabilitation Program for Women, Inc.
Butte County Department of Behavioral Health Alcohol and Drug
Program
Central Valley Recovery Services, Inc.
Clean and Sober Recovery Services, Inc.
Community Recovery Resources
Day By Day
Gateway Corp., Inc.
Genesis Programs, Inc.
Healthy Partnerships, Inc.
Living Free Recovery
National Association on Alcohol, Drugs and Disability
New Heights
New Perspectives
New Start Life Coaching
Oceanside Malibu
Parisi House on the Hill
Research West Behavioral Health Services
Sacramento Native American Health Center
Sacramento Recovery House, Inc.
Soroptimist House of Hope, Inc.
The Ness Counseling Center, Inc.
WellSpace Health
Opposition
California Association of DUI Treatment Programs
California Association of Marriage and Family Therapists
California Psychiatric Association
California Psychological Association
National Association of Social Workers, California Chapter
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301
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