camft.org | BBS Update August 2010

Following are some of the highlights, as well as concerns, resulting from the July 28th, 2010 Meeting of the Board of Behavioral Sciences.

AAMFT/AAMFT-CA Push for Examination of LMFTs Seeking LPCC Grand-Parenting
At its July Meeting, the BBS reversed its unanimous decision (11 to 0) to not require an examination for LMFTs and LCSWs who wish to grand-parent into the LPCC profession. This action was taken following discussion in a closed session based on a written request for reconsideration from AAMFT and AAMFT-CA. The business of the BBS must be conducted in public session, with limited exceptions.

We reported in the last issue of The Therapist that the BBS contracted with Applied Measurement Services, LLC (AMS), to determine if sufficient differences exist between the LMFT/LCSW and LPCC practices to warrant an additional examination for those wanting to be grand-parented into the LPCC license. If differences between the practices were found to exist, an examination on the differences would have to be developed for those who wish to be dually licensed and grand-parented as LPCCs. The determination of whether or not there are differences was referred to as a “gap analysis,” and a test, if needed, was referred to as a “gap examination.” This review was required by the legislation enacting licensure for LPCCs (SB788—2009), which was negotiated by the parties on opposite sides of the grand-parenting issue. CAMFT, the social work organizations, the counselor coalition, and the BBS were in favor of grand-parenting without examination for LMFTs and LCSWs, since LMFTs and LCSWs may do in practice everything LPCCs may do. AAMFT and AAMFT-CA, together with the California Psychological Association, have been opposed to grand-parenting of LMFTs and they have pushed for there to be an examination, as a pre-condition to licensure as an LPCC.

At the BBS meeting in early May, the Board adopted the recommendation of Applied Measurement Services that no examination should be required for LMFTs and LCSWs as a pre-condition to being grand-parented. The issues were fully discussed in the public meeting, the report of AMS was distributed to the public, and Tracy Montez, Ph.D., presented her findings and recommendations. Within a few days of this vote, AAMFT-CA wrote to the Board (the letter was signed by Olivia Loewy, PhD, Executive Director, and Ben Caldwell, PhD, Central Liaison), asking for a meeting with the Board, and arguing that an examination had to be given to those LMFTs and LCSWs who wish to seek licensure as LPCCs. We were unaware of the letter and the request for a meeting. We are unaware, at this time, of how many meetings may have taken place, or between whom. At the Board’s meeting on July 28th, the Board first went into closed session (it appears without proper authority, which would be a violation of law) to discuss this issue once again.

BBS meetings and actions are to occur in open (public) sessions, and only certain meetings or actions are permitted to occur in closed sessions. One exception, which was relied upon by the BBS to close the meeting for this matter, is for the Board to prepare, grade, approve, or administer examinations [Government Code section 11126(c)(1)]. In this case, they were not preparing an examination, nor were they grading examinations, approving examinations, or administering examinations. They were determining whether or not to change the prior position they had taken in public to not administer an examination—a topic that must be addressed in an open session. They were also determining whether the law required the BBS to administer an examination, a topic that must be discussed in public.

The AAMFT-CA letter to the Board stated that Dr. Montez did find that there are identifiable differences between the LMFT, LCSW, and LPCC professions. They concluded that to not give an examination was not an option available to the Board. While we agree that there are differences between the professions, the differences concern the education, the philosophy of practice, the theoretical underpinnings of the professions, and the manner in which experience is acquired. All professionals are, of course, required to work within their respective scopes of competency. The licensing examinations are based upon occupational analyses (the actual practice of the particular licensee). The law called for an examination if any differences exist between the practices of LMFTs/LCSWs and LPCCs, which are the services that the public receives. When one dissects the three disciplines and their scopes of practice, the end result is that the three professions work with the same types of clients providing the same types of mental health services, but from different yet similar frameworks.

Dr. Montez (principal of AMS) was asked about the differences between the professions as she perceived them to be. Her response identified three areas: 1. Career Counseling (a non-regulated activity—in other words, an activity that can be performed by anyone without a license and not considered mental health treatment), 2. Psychological Assessment (an area where LMFTs are required to have had coursework, may gain experience, and are permitted to do as part of their practices), and 3. Research (which, of course, most LMFTs have had or have engaged in as part of their education or as they pursue their careers). Thus, we once again question what are the differences between the practices of the three professions who deliver mental health counseling and treatment? In these discussions, we have yet to hear clear and valid reasons why AAMFT-CA opposes grand-parenting of LMFTs. We can only speculate that it is driven by fear of loss of identity and possibly members. What does AAMFT-CA believe LPCCs can do in their practices that LMFTs cannot do?

On July 28th the BBS voted (five to three) to move forward with an examination on the supposed gap between the professions in spite of their unanimous vote in support of no examination at its prior meeting. My perception and belief was that some Board members had made up their minds on the issue outside of the public part of the Board Meeting (when the Board discussed this issue in closed session) and apparently as a result of being lobbied. At any rate, it appears that Board members had made up their minds without the benefit of stakeholder/public input.

With regard to the exam that the Board now plans to develop, it essentially indicated that it will construct an examination at a low level of difficulty. The Board’s counsel essentially advised them that whichever direction they might choose to go—exam or no exam—that if legal action was pursued against them (e.g., by a writ), that it would be defensible. A closed meeting on a public matter is not defensible. It constitutes a violation of the Bagley-Keene Open Meeting Act. This Act provides for misdemeanor penalties against individual members of a licensing board if the member attends a meeting in violation of the Act with the intent to deprive the public of information to which the member knows or has reason to know the public is entitled to receive.

We are now in the process of deciding our next course of action with regard to what has occurred. We may pursue the matter in one or more ways—legislatively, by legal action, or in some other manner that might expose what may have been inappropriate and unlawful conduct and actions on the part of the Board.

Trainee Hours of Experience in Jeopardy
Currently there is a conflict in law with regard to trainee hours of experience gained outside of the practicum requirement. With the changes brought about by SB 33 (2009), the required hours of experience to be gained in practicum increased from 150 to 225 (of which 75 may be in client centered advocacy). A provision was added to this section of law [Business and Professions Code section 4980.36(d)(1)(B)(iii)] that states “A student must be enrolled in a practicum course while counseling clients.” It is our belief that this latter change was inadvertent. It is the BBS’s position that this change was intentional. Our logic for it being inadvertent is that there is another section of law [Business and Professions Code section 4980.40] that has been in existence since 1995 that says that hours may be gained outside of the practicum requirement, as long as certain conditions are met. This section says that “...Trainees may gain hours outside of the required practicum...coordinated between the school and the site...school shall approve each site...have a written agreement with each site...provide for regular progress reports and evaluations...” If the change had been intentional, this conflicting section would have been removed from law. It was not. Further, had the intent been to limit the hours a trainee may gain, the total hours that one can gain as a trainee (1,300 hours), would likewise have been curtailed by SB 33, and these hours remain the same. The reason I believe they would have been reduced is the fact that few, if any, educational programs require 750 hours of face to face client contact and supervision as a part of a practicum. If one could not gain this number of hours in a practicum, there would be no reason to allow in law this number of hours as a trainee. Additionally, I am not aware that anyone has expressed a problem with hours gained by trainees outside of practicum. Such hours come under the jurisdiction and responsibility of the school. Granted some schools do not allow trainees to gain hours outside of practicum, but some schools do and these schools have created mechanisms for trainees to gain these additional hours that can count toward licensure. Finally, none of the legislative analyses of the bill express any intent to restrict trainee hours to those gained as a part of the practicum course.

The BBS, as of their meetings in May and July, is willing to fix a portion of this problem, but not the whole problem, and they are unwilling to keep the law as it has been since 1995. The BBS’s fix would only allow trainees to continue to accrue hours up to 45 days during breaks between practicum courses, but would not permit the break to be as long as a typical summer recess. Consequently, if trainees are gaining their hours and working with clients, they would have to quit working in these settings during a longer summer recess or when no longer in practicum, or continue to work with the knowledge that the hours would not count toward their licenses. The BBS’s position not only disrupts the services employers are attempting to provide to the public, it also provides a serious hardship for the clients who will suddenly feel abandoned by the trainees who have been working with them.

The BBS would have to pursue this change legislatively, which can only occur next year or they could leave the conflict in law. We believe it is a bad idea to leave the conflict in law as it would create unnecessary confusion and misunderstandings. Further, we believe the law should be changed to be consistent and that trainees should be able to count hours outside of their practicums as long as the school takes the prescribed responsibility for the hours they accrue.

Regularly BBS measures are covered in “Committee” bills. Committee bills generally must be non-controversial. This issue is, of course, controversial, thus the matter is an unlikely candidate for a Committee bill. CAMFT is in opposition to what the Board has proposed and trusts that some schools, agencies, and trainees may likewise be opposed. Thus, if the BBS addresses this matter, it will occur next year. If the BBS chooses to not address the issue, we will likely address it by sponsoring legislation next year. The matter will be further discussed by a BBS committee.

Some may ask, what about those who are in the pipeline, persons now acquiring their hours of experience as trainees, can they continue to get hours outside of their practicum assignments? Trainees who began graduate study before August 1, 2012 will not likely be affected until at least August 1, 2012. BBS Counsel takes the position that the more recently passed law would be the law that would be applicable and would be followed as it would trump previously passed law even though it remains a part of law. This conclusion is arguable, in our opinion. The BBS is also of the opinion that the more recently passed law would be applicable to all persons who are meeting the new educational requirements that were brought about by SB 33 (2009).

This section of law is rather confusing as to who it is applicable to, thus anyone with questions should call CAMFT for more specificity. Meanwhile, we will be working to preserve prior law, effective in 1995, which permits trainees to gain hours of experience outside of their practicum courses.

Examinations
The BBS continues to work on a way to bifurcate the existing examination structure by requiring a law and ethics examination while an intern and then requiring a single clinical examination following the gaining of all of the hours of experience. Because the details of this proposed change are complex, the examination committee is continuing to work on the particulars. The Committee will be working on the details of this change throughout this year and it is likely that legislation will be forthcoming next year. At the same time, BBS staff continues to tinker with the operation of the new examination format. This change in exam structure came from recommendations from an Examination Committee that met throughout 2009. The major benefit to this bifurcation is that it shortens the time an applicant is in the exam process following the completion of the hours of experience. Another benefit is that it puts the BBS in line to subsequently adopt the use of national examinations, if they are determined to be comparable with state-developed examinations. Additionally, from the BBS’s perspective, it provides greater assurance that interns are “safe” to practice with the public.

Some of the details, however, became complex, convoluted, and problematic. BBS staff initially proposed that the Law and Ethics Examination would be required to be passed during the first three years one is an intern. This exam is proposed to be given up to three times each year. They would have required that if the intern did not pass the Law and Ethics Examination before the end of his or her third year of registration, the registration number would be cancelled. Before the registration number would be re-issued, the individual would have to successfully complete the Examination. We, as well as others, were finally, after much deliberation, able to persuade the Board to allow the full six years one is a registered intern to pass the law and ethics examination.

Registrants who do not pass the Law and Ethics Examination within the first year of registration will be required to complete a 12-hour course in law and ethics in order to be eligible to take the Examination in the next year of registration.

Persons currently in the examination process would be required to complete the Law and Ethics Examination and the New Standard Examination would replace the Clinical Vignette Examination.

The framework of the New Standard Examination, given there would be a separate Law and Ethics Examination, would be a practice-oriented and vignette-based examination with some law and ethics questions integrated into it.

Again, to accomplish this change in examination structure and administration, legislation will have to be pursued and that cannot be accomplished until next year.

Regulations to Implement the LPCC Licensing Law
The BBS is moving forward with regulations to implement the LPCC licensing law. These regulations are largely patterned after existing regulations that pertain to marriage and family therapists and clinical social workers. These regulations also address the continuing education requirements for licensed educational psychologists and various amendments are included to correct technical issues with regard to existing regulations.

Proposed Change in Acceptable Degree Titles for MFT Licensure
The BBS approved adding to the acceptable degree titles to become licensed marriage and family therapists, degrees in “Couples and Family Therapy.” Such a change can only be pursued by legislation, which will occur in 2011.

Use of National Examination for Clinical Social Workers
The BBS approved moving toward the use of the National Examination for licensure as clinical social workers. The BBS moved from this examination a number of years ago due to excessively high pass rates on the national examination. Based upon the review and analysis of Dr. Tracy Montez of Applied Measurement Services, the National Examination now includes in its development a larger California component, more thoroughly covers the necessary content, and is now more discerning as a measurement of competence to practice the clinical social work profession in California. NASW-CA has sought legislation this year to push the BBS into making a change to the National Examination. Their reasoning, an issue that also exists for MFTs, is the ability of licentiates to be able to access federal loan reimbursement monies.

Reappointments to BBS
Elise Froistad, a LMFT and Renee Lonner, a LCSW were reappointed by the Governor to the BBS. Renee is the current Chair of the BBS.


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