Legislature(1997 - 1998)
03/20/1998 09:08 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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.