Legislature(1997 - 1998)
03/20/1998 09:08 AM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= 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.
| Document Name | Date/Time | Subjects |
|---|