Legislature(1997 - 1998)

03/20/1998 09:08 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
                                                                               
           SB 331 - PROFESSIONAL COUNSELOR LICENSING                           
                                                                               
CHAIRMAN WILKEN announced a committee substitute (version F) had               
been prepared for SB 331.  SENATOR GREEN moved to adopt version F              
as the working document of the committee.  There being no                      
objection, the motion carried.                                                 
                                                                               
BETH HAGEVIG, staff to Senator Wilken, sponsor of the measure,                 
explained the changes in the committee substitute as follows.  On              
page 7, line 23, the word "appraisal" was changed to the word                  
"diagnosis."  The Alaska Psychologists Association (APA) suggested             
the word appraisal be used, but it was changed to diagnosis on the             
advice of Catherine Reardon, who felt it should be used to reflect             
the fact that counselors actually diagnose clients.  On line 24,               
the phrase "other than through the use of projective techniques"               
was added as a courtesy to the APA and because the sponsor's staff             
is of the opinion that no professional counselors practice                     
projective techniques.  On page 29, the word "appraisal" was                   
changed to "evaluation" before the word "techniques" at the                    
suggestion of the APA.  On page 8, Section 2 was added by the                  
Legislative Council.  That section adds the Board of Licensed                  
Professional Counselors to the applicability of AS 08.01, which is             
standard procedure for all boards.  Section 4, beginning on line               
27, is also a standard provision for all boards and provides for a             
sunset date.                                                                   
                                                                               
Number 244                                                                     
                                                                               
CHAIRMAN WILKEN said when the committee reviewed this bill at a                
previous meeting, there was discussion about merging this board                
with the board of marriage and family therapists.  He noted it is              
not appropriate to do so at this time and it is a proposal best                
left to the professional groups to work out.  He asked Ms. Hagevig             
if the groups she worked with on SB 331 agree with the bill's                  
content.                                                                       
                                                                               
MS. HAGEVIG said they do and, although not all of the issues have              
been hammered out, the groups have made progress.                              
                                                                               
Number 256                                                                     
                                                                               
MR. ALAN MOROTTI, representing both the Alaska School Counselors'              
Association and the University of Alaska Fairbanks Guidance and                
Counseling Program, addressed his comments to the letter sent to               
Senator Wilken, dated March 20, from Dr. Lane of the APA.  In that             
letter, Dr. Lane expressed concern that SB 331 does not require                
counselors to meet stringent educational requirements similar to               
those required for a psychological associate license.  Mr. Morotti             
explained APA's regulations address seven areas of study. Those                
seven areas correspond to the eight areas of study put forward by              
the Council for the Accreditation of Counseling and Educationally              
Related Programs (CACERP), which is the accrediting arm of the                 
American Counseling Association.  CSSB 331 specifically requires               
counselors to have completed 60 semester hours plus 3,000 hours of             
supervised experience after the master's degree.  He believed those            
requirements meet all of the criteria for a psychological associate            
license.  Mr. Morotti argued that counselors work with clients                 
moving through transitional issues and clients who need long term              
supportive care for some type of mental illness and psychologists              
perform many of the same duties; the line is not as clear between              
the two professions as psychologists like to make out.  Regarding              
the involvement in the practice of diagnosis and evaluation, Mr.               
Morotti stated no one mental health profession has the exclusive               
ability to do that.  He pointed out Dr. Lane is assuming that a                
master's level trained counselor is not of the same level and                  
ability to diagnose and evaluate clients as psychological                      
associates, which flies in the face of reason, especially when 44              
other states have licensure requirements for counselors.  He                   
believes if Alaska is going to bring the counseling profession in              
line with the rest of the nation, it is to the benefit of                      
counselors and consumers to require standards and licensure                    
requirements.                                                                  
                                                                               
Number 333                                                                     
                                                                               
MR. ROBERT POUND, representing the American Counseling Association             
of Alaska (ACAA), made the following remarks.  SB 331 appears to               
have equivalent educational requirements to other bills pertaining             
to mental health professions.  Many people support this bill                   
because of the high cost of supervision which, at present, can only            
be done by licensed psychologists or psychological associates.                 
Many counselors who received licenses from other states were                   
supervised by licensed psychiatrists, psychologists, and social                
workers.  Mr. Pound said he completed an internship, which included            
diagnosis and treatment of clients, and he completed 2,000 hours of            
supervised experience and then took the national board                         
certification test in order to obtain licensed professional                    
certification in the State of Colorado ten years ago. He then                  
practiced in Colorado yet he still cannot be certified under                   
Alaska's system.  Many people in the counseling profession have                
backgrounds and experience that they cannot get credit for,                    
including extensive hospital experience with patients with serious             
psychopathology which provides an excellent training ground for                
observation, diagnosis and treatment on a daily basis.  Steps                  
required for the psychological associate license are not                       
necessarily higher than those for other programs that many                     
counselors who were trained in other states completed.  The                    
psychological associate licensing steps require applicants to jump             
more hurdles and they serve to decrease the number of qualified                
professionals and increase the cost of licensing.  Mr. Pound                   
thought this whole approach questions the integrity of the other               
master's level licensed professionals, including licensed clinical             
social workers and marriage and family therapists.  A large number             
of individuals in Alaska, who do not have insurance, and are low               
income and/or homeless, need treatment and are served by agency                
staff.  They are not served by psychologists and are referred to               
agencies because of their monetary status.  Agency staff diagnose              
and treat those types of people on a daily basis.  Mr. Pound                   
concluded by saying that the information presented demonstrates                
that SB 331 requires that licensed professional counselors be                  
adequately trained and it protects consumers against practice by               
unqualified people.                                                            
                                                                               
Number 398                                                                     
                                                                               
DR. ROBERT LANE, President-elect of the APA, stated that although              
some psychologists are opposed to any sort of licensing for                    
master's level practitioners, that is not the APA's position.  The             
APA would like to see appropriate licensing requirements and                   
appropriate scopes of practice be established.  In general, APA                
believes most counseling programs prepare people to deliver                    
services within what is considered the normal range of human                   
development and human problems as opposed to mental disorders                  
listed in the DSM IV.  The delivery of services by most master's               
level people in agencies around the state is often supervised by               
licensed clinical social workers or licensed psychologists and is              
typically done as an independent practice.  He commented his letter            
to Senator Wilken contained proposed language to put appropriate               
limits on the scope of practice for licensed professional                      
counselors.  The APA is looking to this legislation to provide                 
appropriate scopes of practice, appropriate accountability, and to             
serve the public in the best way possible.                                     
                                                                               
CHAIRMAN WILKEN informed Dr. Lane that the committee received a                
letter from Pamela Watts, President of the ACAA, in response to the            
proposals in his letter and that she would be testifying shortly.              
                                                                               
Number 427                                                                     
                                                                               
MR. BAILEY REICHARD, staff at Southcentral Counseling, commented               
that the level of training required for counselors is adequate,                
that counselors are currently diagnosing and treating clients, and             
they are making recommendations to psychologists and psychiatrists.            
Psychologists and psychiatrists rely on counselors to assess and               
diagnose clients because they do not have the time.  Counselors                
undergo internships and most have years of experience assessing and            
diagnosing clients. He agreed with Mr. Pound that it is time to                
give counselors their due.  Counselors are not competing with                  
psychologists for clients; counselors often work with clients who              
cannot afford psychologists' fees.                                             
                                                                               
CATHRYN SIMON, a member of the American Counselors' Association of             
Alaska, and a nationally certified counselor, made the following               
statements.  She was a certified mental health counselor in the                
State of Washington for three years before moving to Alaska.  She              
pointed out SB 331 is the equivalent of Washington State's                     
counselor certification law.  This bill will be advantageous to                
consumers because it helps them to identify counselors who have met            
state and national standards, and it establishes a grievance                   
procedure and a means of recourse when they have been victims of               
unethical practices.  Second, it gives clients more options for                
meeting their mental health needs.  The increase in the type and               
number of licensed professionals translates to lower costs to                  
consumers without compromising the standard of care.  Third, the               
bill will increase the availability of services to consumers,                  
particularly for rural populations that have had poor access to                
services.  From the viewpoint of a professional counselor, MS.                 
SIMON said she is in favor of SB 331 because it allows counselors              
to perform the job they were trained to do and can already do in               
other states.  She noted the point was made that counselors are                
usually not in private practice.  However, in other states that                
have counselor licensure, master's level counselors do go into                 
private practice and can serve the populations they are trained to.            
She stated she does not support individuals administering tests or             
making diagnoses when they have not been properly trained, but the             
professional code of ethics prohibits counselors from doing so,                
and counselors are trained in those areas.  Her position is that               
all professionals who are properly trained to administer and                   
interpret tests, and to diagnose and treat mental illnesses, should            
be allowed to do so regardless of their titles or the discipline to            
which they belong.  SB 331 is a right to work issue for                        
professional counselors.  She urged committee members to support               
the legislation.                                                               
                                                                               
CHAIRMAN WILKEN welcomed Senators Leman and Ellis.                             
                                                                               
Number 504                                                                     
                                                                               
MS. PAMELA WATTS, President of the ACAA, stated that previous                  
speakers addressed most areas of concern with SB 331.  She                     
indicated her letter to Senator Wilken, dated March 20, 1998,                  
contains a list of the general core areas of study that counseling             
programs cover and she believes that list should cover Dr. Lane's              
concern about the lack of specificity in the licensure bill.  she              
pointed out that although the specific course work is not listed in            
the bill, that is the case with the social workers' licensing                  
requirements.  A national examination will be required for                     
licensure of professional counselors; to take that examination,                
individuals must graduate from a CACREP approved school.  In                   
addition, every behavioral health professional receives on-the-job             
training to become skilled in his/her specific area of expertise               
during the 3,000 hour internship.  Social workers, counselors and              
psychologists often fine tune their areas of specialty during                  
internships.                                                                   
                                                                               
MS. WATTS said the other area of concern expressed by Dr. Lane was             
the broad definition of counseling and APA's belief that the                   
diagnosis and treatment of mental disorders should remain in the               
purview of licensed psychologists or psychological associates.  Ms.            
Watts referred to other language in the bill, and said marriage and            
family therapists are able to diagnose and treat mental and                    
emotional disorders that are referenced in the standard diagnostic             
nomenclature, and social workers are able to use techniques of                 
applied psychotherapy of a non-medical nature to assist and                    
diagnose the treatment of mental and emotional conditions.                     
Counselors are not asking for any provisions different than those              
provided to similarly educated and qualified behavioral health                 
professionals.                                                                 
                                                                               
MS. WATTS said she spoke with Sheila Clarson of the APA earlier                
this week who acknowledged that there is a diversity of opinion                
among psychologists in the state about whether or not they support             
counselor licensure.  She noted the social workers board chose to              
leave it up to individuals within that discipline to respond either            
in support or in opposition to SB 331.  Ms. Watts maintained the               
ACAA has addressed the concerns of the APA and she asked committee             
members to move the bill out of committee.                                     
                                                                               
Number 551                                                                     
                                                                               
CHAIRMAN WILKEN asked Dr. Lane if he had a copy of Ms. Watts'                  
letter.  DR. LANE said the letter was just handed to him so he had             
not had time to review it.                                                     
                                                                               
CHAIRMAN WILKEN informed Dr. Lane he planned to move the                       
legislation on to the Senate Judiciary Committee today where Dr.               
Lane could develop a response to Ms. Watts' letter, if he so                   
desired.                                                                       
                                                                               
Number 556                                                                     
                                                                               
CATHERINE REARDON, director of the Division of Occupational                    
Licensing, stated this is a difficult type of legislation to deal              
with because there are knowledgeable professionals who differ in               
their opinions about the training and scopes of practice that                  
should be permitted.  This difference is reflected in the boards of            
marriage and family therapists, psychological examiners, and social            
workers.  The issues are further complicated by the fact that the              
scopes of practice for the three behavioral health professions                 
already overlap.  She stated her view on allowing professional                 
counselors to diagnose is that if the Legislature intends to permit            
professional counselors to diagnose clients, that it be stated in              
the bill to enable her to enforce the law.  She thought it makes               
sense that licensed counselors would be diagnosing clients.  She               
pointed out the reason diagnosis is a contentious issue is that                
professionals must be able to assess the problem to fix it and also            
because unless licensed professionals can identify a diagnosis for             
insurance companies, billing and reimbursements are not possible.              
                                                                               
TAPE 98-25, SIDE B                                                             
Number 574                                                                     
                                                                               
MS. REARDON informed committee members the licensed counselors                 
would have to cover the costs of establishing and maintaining a                
board.  She did believe the license fee will be expensive because              
her best estimate is that 250 people will choose to be licensed.               
She said it is hard to know because SB 331 creates a title                     
restriction, not a practice restriction.  If 250 people choose to              
become licensed, the license fee will probably cost $400 to $700               
for a two-year license.  The fee will depend on operating costs,               
especially related to investigations, because it is not as easy to             
point to what is competent or incompetent counseling practice as it            
is in professions such as accountacy.                                          
                                                                               
Number 556                                                                     
                                                                               
CHAIRMAN WILKEN questioned whether the other three boards have a               
definition of "diagnosis" in statute.                                          
                                                                               
MS. REARDON said no.  The marriage and family therapist legislation            
just says it means the diagnosis and treatments.  The clinical                 
social workers board legislation cross references social work                  
principles and methods which refers to "assisting in the diagnosis             
and treatment."  The psychology board language says diagnosis,                 
prevention, treatment and amelioration of psychological problems.              
MS. REARDON said professionals in these fields often refer to the              
DSM IV, which is a commonly used diagnostic manual, and is accepted            
by insurance companies.  The DSM IV lists a series of                          
characteristics of different mental illnesses but it does not                  
contain different levels of seriousness.                                       
                                                                               
CHAIRMAN WILKEN asked Ms. Watts how many counselors she thought                
would become licensed.                                                         
                                                                               
MS. WATTS estimated that there are 600 counselors in the State of              
Alaska and she agreed that probably 250 to 300 of them would become            
licensed.  She thought that as time goes on, and the University                
system becomes more aligned with national standards both in the                
fields of psychology, counseling, and social work, more and more               
people will become licensed in the state.                                      
                                                                               
Number 528                                                                     
                                                                               
CHAIRMAN WILKEN asked Ms. Reardon if she thought the people of                 
Alaska or the counselors would be better served by this                        
legislation.                                                                   
                                                                               
MS. REARDON replied SB 331 will certainly be beneficial to the                 
development of the counseling profession.  She thought it will help            
in terms of providing access to a different type of behavioral                 
health treatment and more providers will be available, as long as              
people do not do things they are not trained to do.  She noted                 
family and marriage therapists are diagnosing right now so this                
legislation will not create a new problem that does not already                
have the potential to exist.                                                   
                                                                               
MS. WATTS added that in answer to whether or not consumers will be             
better protected, she truly believes they will because this bill               
will require more accountability for people who are already                    
providing counseling services.  She believes one part of the bill              
that will cover that problem is the limitation of practice                     
regulating individuals who might be tempted to practice beyond                 
their scope of expertise.                                                      
                                                                               
There being no further testimony on CSSB 331(HES), SENATOR LEMAN               
moved the bill from committee with individual recommendations.                 
There being no objection, the motion carried.                                  
                                                                               
The committee took a brief at-ease.                                            

Document Name Date/Time Subjects