Alain Montgomery, JD, Staff Attorney
The Therapist
March/April 2017

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Introduction
For an MFT Registered Intern, the value of working in a private practice setting can be a rewarding, enriching, and invaluable experience. Also, becoming a supervisor may also provide the opportunity for a licensee to grow his or her practice. It is critical, however, for both the supervisor and the registered intern to be aware of each party’s responsibilities with regard to the legal and ethical requirements that pertain to supervision. Cultivating a successful collaborative relationship takes time, attention, and patience from both parties involved. This article will discuss the general and nuanced aspects of the supervisor’s obligations and issues to consider when hiring a registered intern in a private psychotherapy practice.

Establishing a Strong Relationship at the Outset
In order to maximize the supervision experience for both the supervisor and the registered intern, it is important to establish goals and objectives at the outset of the supervision relationship. Therefore, it is important to spend some time at the beginning of the relationship to review expectations, employment issues that govern the nature of a supervision relationship in a private practice setting, and to get an overall sense of one another to determine whether or not the relationship is a good fit for each person.

Supervisor Qualifications
The Board of Behavioral Science’s (BBS) Responsibility Statement for Supervisors of a Marriage and Family Therapist Trainee or Intern outlines the legal requirements which pertain to the supervisor’s qualifications and must be signed by the supervisor upon commencement of supervision.

Only licensed mental health professionals can supervise registered interns in a private practice setting. Licensed mental health professionals include any of the following: Licensed Marriage and Family Therapists (LMFTs); Licensed Clinical Social Workers (LCSWs); Licensed Professional Clinical Counselors (LPCCs) (must have met education and experience requirements that allow the LPCC to treat couples and families); Licensed Psychologists; Licensed Physicians certified in Psychiatry by the American Board of Psychiatry and Neurology. Additionally, the supervisor must meet all of the following:

1. Maintain a current valid California license;
2. Have held that license for at least two (2) years prior to the commencement of supervision;
3. Have practiced psychotherapy or directly supervised trainees, interns, or associate clinical social workers who perform psychotherapy as part of their clinical practice for at least two (2) years within the last five (5) years.
4. Complete a minimum of six (6) hours of supervision training or course work within sixty (60) days of commencement of supervision and every two (2) year renewal period thereafter.

Psychologists and psychiatrists are exempt from the six-hour training requirement. However, a psychologist who acts as a supervisor for a registered intern must be licensed through the Board of Psychology. Likewise, a psychiatrist must be certified in psychiatry by the American Board of Psychiatry and Neurology.¹

The supervisor’s failure to take the required coursework will not result in the loss of hours for the intern. However, a supervisor’s failure to renew his or her license—or failure to maintain a license with the appropriate regulatory board—will result in a loss of hours to the supervisee.

While the six (6) hours of supervision training can be taken through a continuing education provider, CAMFT also offers a CAMFT Certified Supervisor Program which is a multifaceted program that offers coursework, supervision experience, and supervision mentorship. For more information about the CAMFT Certified Supervisor program visit: www.camft.org.

It should be noted that the BBS has sponsored legislation in 2017 that would alter many of these requirements starting in 2018. Check with CAMFT if you are looking to supervise or are supervising in 2018 and beyond.

Intern Qualifications
Only those who have been issued an intern registration number may work in a private practice. Interns issued a subsequent registration may NOT work in a private practice setting.² Registered interns must receive one unit of supervision for the first 10 hours of counseling experience performed in any week in each setting. Interns must receive one additional unit of supervision during any week in which more than 10 hours of psychotherapy or counseling are performed in each setting. Group supervision can be broken into one-hour sessions, as long as both increments (full two hours) are provided in the same week as the experience being claimed. “One unit” of supervision = one (1) hour of individual OR two (2) hours of group.

Relevant BBS Forms
As discussed above, prior to the commencement of any counseling or supervision, the supervisor shall sign under penalty of perjury the “Responsibility Statement for Supervisors of a Marriage and Family Therapist Trainee or Intern” which attest that the supervisor is qualified and has satisfied the foregoing requirements. The law requires that interns maintain a weekly log of all hours of experience gained towards licensure (“LMFT Weekly Summary of Experience Hours—Option 1 or Option 2”) and requires that the supervisor sign the log on a weekly basis. While the weekly logs are not required to be submitted as part of a registered intern’s application for licensure, the applicant is required to retain the logs and submit the logs to the BBS in the event that the summary of hours forms are necessary to verify hours of experience.³ Upon termination of the intern’s employment, the supervisor shall provide the intern with the “Licensed Marriage and Family Therapist In-State Verification—Option 1 or Option 2” form, so the intern can submit that form with his or her “Application for Licensure and Examination.”

For more information about the distinction between having the BBS calculate hours of experience either under Option 1 or Option 2, please visit the BBS website for more information. Also, you can consult CAMFT’s article, “SB 620: A Change in the Landscape of Gaining LMFT Hours,” by Cathy Atkins, JD.

Supervisor’s Responsibilities
Supervisors are required to consider their responsibilities as defined in the LMFT statutes and regulations, which include taking responsibility for, and control of, the quality of services being provided. Among other responsibilities, supervisors are required to do all of the following:

• Ensure that the extent, kind and quality of counseling performed by the intern is consistent with the education, training and experience of the person being supervised.
• Review client/patient records and monitor and evaluate assessment, diagnosis and treatment decisions of the intern.
• Monitor and evaluate the ability of the intern to provide services at the site(s) where he or she will be practicing and to the particular clientele being served.
• Ensure compliance with all laws and regulations governing the practice of marriage and family therapy.⁴
• More specifically, the supervisor may consider taking time to have discussions and conversations with his or her intern about the following subject matters:
• The scope of practice and scope of competence for MFTs
• Standards of care for MFTs
• Advertising and related disclosures
• Consent to treatment/minors and consent to treatment (if applicable to the interns scope of practice)
• Confidentiality and selected exceptions such as permitted and mandated reporting responsibilities Psychotherapist-patient privilege
• A patient’s rights to access clinical records
• Patient termination issues /p>
• Dual relationships/conflicts of interest

Clinical supervision is an invaluable part of the professional development of an intern to become a licensed mental health professional. Therefore, ensuring that an intern understands both the legal and ethical standards which pertain to the practice of marriage and family therapy is key.

LABOR AND EMPLOYMENT ISSUES

Obtain an EIN
Before hiring an employee, you need to get an employment identification number (EIN) from the U.S. Internal Revenue Service. The EIN is often referred to as an Employer Tax ID. The EIN is necessary for reporting taxes and other documents to the IRS. In addition, the EIN is necessary when reporting information about your employees to state agencies. You can apply for an EIN online at IRS.gov

Obtain Workers Compensation Coverage for Employees
Any business with employees is required to carry workers’ compensation insurance coverage through a commercial carrier or through their state’s Workers Compensation Program, even if the business has only one employee. This would include supervisors who employ MFT interns in their practice. When an employee is injured due to work, employers in California are required to pay for workers’ compensation benefits. Employees cannot pay for, or offset the cost of, workers’ compensation insurance. Failure to provide workers compensation insurance could be costly. The best way to find a suitable insurance carrier is to shop around for a broker who understands what will best meet your needs. The Division of Labor Standards Enforcement has the authority to issue a stop order (prohibits the employer from using employee labor until coverage is obtained) if it discovers that an employer is operating without appropriate workers’ compensation coverage. If the order is not followed, imprisonment or fines, or both, may be imposed.

Where the Intern May Lawfully Work
Interns may only perform services at the place where their employers regularly conduct business. However, an intern may perform services at other locations, as long as the services are performed under the direction and control of his/her employer/supervisor.⁵ For example, an intern may render services to a patient at the patient’s home; as well as other locations such as school campuses, churches, non-profits, or health care clinics. It is not permissible for a supervisor to rent a separate space out of which he or she does not work solely for the purpose of allowing the intern to render services to patients. Likewise, it is not permissible for the intern to independently rent his or her own space as a place to render services to his or her patients. As per, California Business and Professions Code, Section 4980.45(a), a licensed professional in private practice may supervise or employ, at any one time, no more than a total of three individuals registered as a Marriage and Family Registered Intern.

Hire a Payroll Company/Professional
In a private practice, registered interns may only perform services as employees (IRS Form W-2) or as volunteers, and not as independent contractors (IRS Form 1099). An applicant for licensure who has been hired and paid on an independent contractor basis will have their hours denied by the BBS. If employed, the applicant is required to provide the BBS with copies of the corresponding W-2 tax forms for each year of experience claimed when applying for the license. If a volunteer, the applicant is required to provide the BBS with a letter from his or her employer verifying the intern’s employment as a volunteer when applying for the license.⁶

Therefore, a licensee who is considering employing an intern in his or her private practice may want to consult with tax and/ or payroll professional to evaluate whether hiring an employee is sustainable for his or her practice and to help set up records for withholding state and federal taxes, and to obtain workers compensation.

While an intern should maintain and pay for his or her own malpractice coverage, it is unlawful for an intern to have a proprietary interest in their supervisor’s/employer’s businesses. For example, a supervisor cannot require an intern to lease or rent space, pay for furnishings, equipment or supplies, pay advertising costs, or in any other way pay for the obligations of their employers. ⁷ Also, to California Labor Code Section 221, an employer may not require an employee to pay for anything that is of benefit to the employer, which arguably includes supervision. ⁸ Therefore, it is CAMFT’s recommendation that employers not require employed and volunteer interns to pay for supervision. For mor information about California labor laws relevant to employing interns please refer to CAMFT articles, “Labor Board Sets Precedent for California Internships” and New Laws Affecting Employers Employees Volunteers,” by Ann Tran-Lien, JD Managing Director Legal Affairs.

Intern Agreement
It is recommended that the supervisor and the intern memorialize their employment agreement in writing and review employment policies prescribed in the supervisor’s employee handbook. Among the issues may be discussed include, but are not limited to, compensation and benefits, employee responsibilities, and termination of the employ relationship. CAMFT has a sample “Intern Agreement” form available on CAMFT website in its “Legal Forms” section.

Employee Statement Acknowledging Requirement to Report Child Abuse
Prior to commencing his or her employment, a mandated reporter, as a prerequisite to employment, shall sign a statement on a form provided to him or her by his or her employer attesting that he or she is knowledgeable for the provisions of the Child Abuse and Neglect and Reporting Act (CANRA) and will comply with those provisions. The statement shall inform the employee that he or she is a mandated reporter and inform the employer of his or her reporting obligations and of his or her confidentiality rights. Also, the employer shall provide a copy of CANRA Sections 11165.7, 11166, and 11167 to the employee.⁹ A sample acknowledgement form from the CANRA statement can be found on the CAMFT website under “Resources” at camft.org

Forms and Advertisement
Any forms utilized by the intern in rendering services should be those of the supervisor’s. For example, the Informed Consent, Disclosure Statement and Agreement for Services, Patient Intake Forms, and Authorization to Exchange Confidential Information documents should reflect the supervisor’s name, professional title, license number and address or include the supervisor’s standard or traditional letterhead. However, the intern can reflect him or herself as the “treating provider” when providing the patient with an invoice or a “superbill.”

It is important to ensure that interns working in a private practice comply with BBS Advertising guidelines. Under BBS regulations, any advertisement by, or on behalf of, a Marriage and Family Therapist Registered Intern shall include the following:

1. A professional title such as “Marriage and Family Therapist Registered Intern,” or in the alternative, “MFT Registered Intern;”¹⁰
2. The intern’s registration number
3. The name of the intern’s employer; and
4. That he or she is supervised by a licensed person¹¹

For sample advertising formats for BBS Interns, visit the BBS website. Also, for more information about the topic of advertising read CAMFT article, “Ten Advertising Mistakes Made by Therapists,” by Ann Tran-Lien, JD Managing Director Legal Affairs.

Alternative Supervision
In the event that a supervisor goes on vacation, takes a leave of absence, or is indisposed, alternate supervision may be arranged. The alternate supervising licensee must also be qualified under the licensing regulations.

Recordkeeping
Employers are the custodian of records and are responsible for ensuring that an adult patient’s health care service record is retained for a minimum of seven years from the date therapy is terminated. If the patient is a minor, the record is to be retained for a minimum of seven years the date the patient reaches the age of 18 years of age and applies to records of a patient whose therapy terminated on or after January 1, 2015.¹² The law, as well as CAMFT ethical standards, requires that records be maintained in a manner that is consistent with sound clinical judgment, the standards of the profession, and the nature of the services being rendered.¹³ Therefore, it is important to review record keeping practices with the intern. For information on record keeping, read CAMFT article, “On Writing Progress Notes,” by Michael Griffin, JD, CAMFT Staff Attorney.

Upon termination of the employment relationship, the records of the patients who were treated by the intern remain with the supervisor/employer as the custodian of those records.

Insurance Billing
California’s Freedom of Choice laws do not mandate that services rendered by interns and trainees be reimbursed, so it is unlikely that insurance companies will reimburse for services rendered by unlicensed professionals.¹⁴ If a claim form is submitted, it should clearly indicate that the intern or trainee was the provider of services and both the supervisor and the intern or trainee should sign the claim form. A cover letter may also be attached to the claim form clearly pointing out the fact that the services were provided by the intern who is registered or trainee and under supervision. It is recommended that clients be informed that their insurance plans may not provide reimbursement for the services provided by the intern or trainee. Generally, therapists who are individually contracted with an insurance plan are the only providers that may render services to clients insured by that particular plan. The therapist will, generally, not be able to delegate the contracted services out to his or her Intern. On the other hand, a corporation or agency may engage in contracts with insurance plans where their employees are allowed to provide services pursuant to the contract. In these circumstances, it may be possible for interns or trainees working at the corporation or agency to provide services and the corporation or agency be reimbursed for the intern’s or trainee’s services. Check with the client’s insurance plan for more information regarding billing for interns’ or trainees’ services. For further reading on this topic, see Michael Griffin’s article, “On Ethics: Avoiding Problems with Fees, Payment Agreements and Health Insurance.”

Terminating the Employment Relationship
Terminating an employment relationship can arise for a number of reasons and can be initiated by either the supervisor or intern. A supervisor is required to give at least one (1) week’s prior written notice to an intern of the supervisor’s intent not to sign for any further hours of experience. A supervisor is required to sign for hours of experience obtained in good faith where such supervisor actually provided the required supervision.

Conclusion
Just like any other professional relationship, the relationship between an MFT supervisor and intern is one of mentorship meant to enhance supervisees’ skills, competence and confidence, to provide a reflective space and emotional support, to provide assistance with professional development, to ensure that services to clients is safe, ethical and competent, and to ensure compliance with legal and ethical standards and practices. Therefore, it is necessary for both parties to understand the legal and technical aspects for forming and maintaining a professional supervision relationship. Consider utilizing the following to make sure you have covered all of your bases when hiring an intern as an employee in your private practice:

CHECKLIST FOR SUPERVISORS WHO HIRE INTERNS IN PRIVATE PRACTICE

Am I Qualified to Supervise?

• Have I possessed a current and valid California license for at least two years?
• Have I completed a six (6) hour supervision training course?
• Have I practiced psychotherapy–or directly supervised interns—in two of the past five years immediately preceding the commencement of supervision?

Labor and Employment Issues:

• Have I obtained an EIN Number?
• Have I obtained Workers Compensation Insurance to cover my intern(s)/ employee(s)?
• Have I consulted with a payroll company to ensure I have provided the intern(s)/ employee(s) with the correct IRS forms for withholding taxes on or before the date of employment?
• Am I familiar with the labor laws regarding sick leave that may apply to my intern(s) employee(s)?
• Do I have an intern agreement which explains the scope of the employment, compensation, and termination?
• Have I thoroughly reviewed my employee manual/handbook/policies with the intern(s)?
• Have I provided the intern(s) with the “Employee Statement Acknowledging Requirement to Report Child Abuse” and a copy of CANRA?
• Have I reviewed the policies and procedures prescribed in my employee handbook with the intern(s)?

Have I Reviewed the Relevant BBS Forms?

• Have I read, signed, and do I understand my responsibilities as a supervisor as indicated on the “Responsibility Statement for Supervisors of a Marriage and Family Therapist Trainee or Intern?”
• Am I prepared to sign the interns “LMFT Weekly Summary of Experience Hours” on a weekly basis at supervision?

Other Considerations?

• Have I reviewed the standards for record keeping with the intern(s)?
• Have I made sure the intern is advertising in compliance with the BBS statutes and regulations?

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Alain Montgomery, is a paralegal for CAMFT. Alain is available to answer member calls regarding ethical and licensure issues.

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Endnotes

¹  B&P Code section 4980.03; Title 16, CCR section 1833.1
²  B&P Code sections 4980.43 and 4984.01; Title 16 CCR section 1833
³  CCR Section 1833 (e)
⁴  B&P Code section 4980.43; Title 16, CCR sections 1833 and 1833.1
⁵  B & P Code Section 4980.43 (4) (g) and (j)
⁶  B&P Code Section 4980.43(c)(1)
⁷  B & P Code Section 4980.43 (j)
⁸  Cal. Labor Code Section 221
⁹  California Penal Code 1116.5(a)
¹⁰  The title of Marriage and Family Therapist Registered Intern will change to Associate MFT as of January 1, 2018 per BBS-sponsored SB1478.. For more information, visit the BBS website at www.bbs.ca.gov.
¹¹  B & P Code, Section 4980.44
¹²  B & P Code, Section 4980.49
¹³  B& B Code, Section 4982
^{14 13} Cal. Health & Saf. Code § 1373; Cal. Ins. Code §§ 10176, 10176.7, 10177, 10177.8

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This article is not intended to serve as legal advice and is offered for educational purposes only. The information provided should not be used as a substitute for independent legal advice and it is not intended to address every situation that could potentially arise. Please be aware that laws, regulations and technical standards change over time. As a result, it is important to verify and update any reference or information that is provided in this article.

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