How Marriage and Family Therapists Can Support Victims of Crime in California by Working with the California Victim Compensation Board

Alain Montgomery, JD
Staff Attorney
The Therapist
July/August 2023

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What is the California Victim Compensation Board (CalVCB)?
The California Victim Compensation Board (CalVCB) was established in 1965 as the nation’s first victim compensation program. Since its creation, the program has served as a model for victim services across the country and around the globe. Each year, CalVCB helps tens of thousands of Californians recover from the pain and injuries caused by violent crime. CalVCB compensates victims for crime-related expenses to help them restore and move on with their lives. This article will discuss the primary components of the CalVCB program and explain how MFTs in California can play a key role in helping victims of crime heal.

Who Does CalVCB Serve?
The mandate of CalVCB is to help individuals who are injured by acts of domestic violence, child abuse, elder abuse, sexual and physical assault, homicide, human trafficking, robbery, and vehicular manslaughter, in addition to other crimes. CalVCB helps victims of crimes that occur in California and provides assistance to California residents who are victimized by crime in another state or country. Children under the age of 18 who witness a violent crime and suffer emotional injuries as a result of being in close proximity to the crime may also qualify for an array of benefits under the CalVCB program. Not only are direct victims entitled to compensation, but assistance is also available to the survivors of crime victims who have died, persons who were legally dependent upon a victim for financial support, and members of a victim’s family, such as parents, grandparents, siblings, spouses, children or grandchildren.

What Costs and Expenses Does CalVCB Cover?
CalVCB provides up to $70,000 in reimbursement of expenses as a payer of last resort to cover necessary medical and dental care, mental health services, income loss, funeral expenses, relocation costs, crime scene clean-up, medical equipment, home or vehicle modifications, and residential security. As a payer of last resort, CalVCB reimburses claimants for crime-related expenses when other sources, such as private and public health insurance (i.e. Medi-Cal, Blue Shield, etc.), auto insurance, homeowners insurance, workers’ compensation, and settlements from civil law suits are not available or are exhausted. The insurance provider must be billed prior to submitting expenses to CalVCB for reimbursement. CalVCB works with insurance companies to determine how much of a claimant’s bill can be considered for payment, which may include co-pays, deductibles and share-of-cost payments. If CalVCB reimburses a victim for losses but another source of funding becomes available to the victim because of the same qualifying incident, CalVCB is entitled to reimbursement.

CalVCB cannot pay any expenses incurred while a person is incarcerated, on parole, probation, or post-release community supervision for a violent felony, or on behalf of registered sex offenders. Also, CalVCB will not pay for treatment that is unrelated to the crime, missed appointments, treatment related to child custody issues, and other administrative charges.

MFTs and AMFTs Are Eligible CalVCB Providers Under the CalVCB program, licensed Marriage and Family Therapists (LMFTs) and Registered Associate Marriage and Family Therapists (AMFTs) are eligible to provide mental health care services to CalVCB claimants.¹ CalVCB may pay for services provided by a registered associate as long as the associate’s licensed supervisor bills for those services.

Becoming a CalVCB Authorized Provider
One must become an authorized CalVCB provider before CalVCB can issue reimbursement. Providers can apply through the CalVCB “Provider Portal” to submit the required information and documentation. To become an authorized provider, a completed W-9 must be submitted with information that matches the provider’s IRS records. At the end of the year, CalVCB will send a 1099 to any authorized provider who has received payment over $600. The provider portal also allows CalVCB providers to check the status of existing bills for reimbursement on behalf of crime victims and view their current payment status.

Billing Procedures for Mental Health Services
CalVCB has a strict set of billing and documentation guidelines that must be followed by all service providers. CalVCB typically issues payment within 30–90 days from receipt of a bill. To ensure timely payment, providers need to be familiar with the following billing and CalVCB-specific forms and guidelines:

Centers for Medicare & Medicaid Services (CMS) CMS 1500 Form
Providers are required to submit their mental health bills on a Centers for Medicare & Medicaid Services (CMS) CMS 1500 form for each CalVCB claimant. The CMS 1500 must be completed entirely with each date of service listed individually. If the treating therapist is a registered associate with the Board of Behavioral Sciences, their licensed supervisor must sign the CMS 1500 form.

CalVCB Mental Health Billing Intake Form (MHBI)
In addition to the CMS 1500 form, providers must complete, sign, and submit a CalVCB “Mental Health Billing Intake Form” (MHBI). The MBHI allows CalVCB to verify that treatment is a direct result of the qualifying crime and that no other reimbursement sources are available. The MHBI must be submitted along with the first CMS 1500 form for each claimant. Failure to correctly complete the form may lead to the bill being returned and result in a delay of payment. Bills must be submitted within 90 days of each date of service provided. If bills are not submitted within 90 days of each date of service, reimbursement will be denied.

CalVCB Treatment Plan Form (TP)
The CalVCB Treatment Plan Form (TP) describes the crime for which mental health sessions are being provided, identifies the claimant’s diagnosis as described in the most recently published version of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), a description of the claimant’s presenting symptoms, behaviors that are the focus of treatment, a description of the means by which progress will be measured, and a declaration signed under penalty of perjury of the percentage of the treatment that is necessary as a direct result of the qualifying crime, among other things. The TP must be completed in its entirety and kept in the claimant’s file. A provider is required to submit the TP to CalVCB prior to the beginning of the claimant’s fourth (4th) treatment session upon request by CalVCB, when the treatment is less than 100% related to the qualifying crime, there was a delay in treatment of three years or break in treatment over one year, if the treatment is for a Post- Crime Primary Caretaker, or if the claimant was three years old or younger when treatment began. If the TP is not submitted to CalVCB when requested, the bills may be denied until the document is submitted.

CalVCB Additional Treatment Plan Form (ATP)
Reimbursement for additional mental health sessions for a victim beyond the initial session limit may be approved if an ATP and TP are submitted and the documentation meets specific criteria. The ATP must not be completed until the claimant is within eight (8) sessions from reaching their authorized session limit. The ATP must be submitted within 90 days after the date the bill for sessions that exhaust the initial authorized session limit is submitted to CalVCB. If the ATP is not submitted within the 90-day timeframe, bills for all dates of service that exceed the authorized session limit will be returned and will not be considered for payment.

Critical Reminder Re: CalVCB Billing
CalVCB may request documents and/or files to verify that mental health treatment is necessary as a direct result of the crime for which an application was filed. Failure to complete and/ or submit billing forms and documentation in a timely manner could result in denial of reimbursement or repayment to CalVCB. Providers have 10 business days to submit items requested; failure to do so will result in denial of reimbursement for services. Several things can cause a delay in reimbursement including other available sources of payment, a problem with the eligibility of the claim, or difficulty verifying some of the information. CalVCB offers authorized providers the opportunity to receive information on billing and documentation guidelines as well as the opportunity to ask questions about documentation requirements through its Mental Health Provider Forums.

MFTs in California Are Prepared to Serve CALVCB Recipients
MFTs are uniquely trained to address a broad range of matters and life events that may arise within relationships and within a variety of cultures. This includes treating the effects of trauma and abuse. The support MFTs can offer victims of tragedy can facilitate the resilience, healing, and rehabilitation vital to the victims themselves, their families, and their communities.

Working With Victims of Trauma
Victims of crime may often experience trauma as a direct result of the incident. Trauma can have different meanings and take on different manifestations and presentations for each individual. Exposure to traumatic events is linked to a wide range of detrimental social, economic, physical, and behavioral outcomes that impact a person’s long-term well-being. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”² Examples of trauma include, but are not limited to, experiencing or observing physical, sexual, and emotional abuse or experiencing or witnessing violence.

There are a number of evidence-based clinical practices and treatment models for working with individuals who have experienced trauma. While many providers are exposed to trauma work through their education and training, not all providers are trauma-informed. Ethical practice is paramount. Providers of trauma-based services must be competent in their skills and abilities. The California Business and Professions Code defines the scope of competence for a marriage and family therapist as something that is established by one’s education, training, or experience. It is a form of unprofessional conduct to act beyond the scope of one’s competence.³ This point is reiterated in the California Code of Regulations, which partially states that unprofessional conduct includes, but is not limited to, presenting oneself as capable of performing professional services beyond one’s field or fields of competence as established by one’s education, training, and experience.⁴

The CAMFT Code of Ethics encourages marriage and family therapists to treat and advise on issues that are within their level of competence and to ensure the competence of their work through education, training, consultation, experience, and/or supervision.5 Additionally, supervisors of pre-licensed providers must not allow their students, employees, or supervisees to present themselves as exceeding their pre-licensed status or to provide professional services beyond their scope of competence.6 Trauma-informed therapists make sure they remain current in the research and best practices related to working with clients who have experienced trauma.

The Cultural Context of Trauma and Cultural Humility
Race, ethnicity, gender, sexuality, and sexual identity—among other variables—affect how a person experiences, makes meaning of, responds to, and eventually heals from trauma. A trauma-informed care approach acknowledges that trauma is not experienced independently from social and cultural factors. Trauma-informed care can be enhanced by adopting an attitude of cultural humility.⁷

Cultural humility is the understanding that clients are rooted in a cultural context and identity shaped by their environments, customs, and shared norms. Cultural humility is about learning how a client’s culture may instill in them a unique set of resources that might contribute to their healing journey.⁸ Cultural humility requires “having an interpersonal stance that is other-oriented rather than selffocused, characterized by respect and lack of superiority toward an individual’s cultural background and experience.⁹” In clinical care, cultural humility can serve as a guiding concept for the practice of trauma-informed care in centering and empowering patients on their journey of healing.

The concept of cultural humility is a value that CAMFT endeavors to inspire in its membership. CAMFT’s Social Policy Statement on Racism, Racial Trauma, and Access to Mental Health Care for BIPOC (June 2021) encourages all therapists to continuously strive towards cultural humility and culturally responsive mental health care. CAMFT’s Social Policy Statement on Culturally Responsive Training, Service Provision, and Clinical Supervision for Marriage and Family Therapists (June 2021) encourages marriage and family therapists to remain committed to lifelong learning, engagement, and self-reflection. The statement summarizes certain aspects of cultural competency in therapeutic practice:

1. Awareness of one’s assumptions, values, and biases and the ways these aspects of our own identities influence therapeutic and supervisory relationships. Therapists must attend to issues of power, privilege, and oppression in the context of clients’ environments outside of the therapy room in addition to the ways in which these constructs influence the therapy process in the room.
2. Knowledge and understanding of our own worldviews and values as well as the worldviews and values of diverse clients, trainees, and colleagues. It is important for MFTs to understand the shared experiences and uniqueness each client and/or family brings to the therapy context.
3. Developing skills inclusive of relevant and values-based assessment, diagnostic, prevention, and intervention strategies and techniques that align with the values and worldviews of our clients. This includes ensuring access to culturally responsive, evidence-based practices for clients.

Conclusion
People who survive a tragedy and trauma rarely remain the same. As MFTs, you are equipped to help victims of crime who have experienced trauma cultivate the resilience they need—for some, this must be won again and again, day after day. Your skills can help these clients rediscover their own strength and find the means to develop new faculties. Working with CalVCB can create the opportunity for you to do that for many Californians.

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Alain Montgomery, JD, is a staff attorney at CAMFT. Alain is available to answer member calls regarding legal, ethical, and licensure issues.

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Endnotes

¹ Cal. Code of Reg., tit. 2, § 649.29 and California Government Code 13957

² U.S. Department of Health And Human Services, Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment, Trauma-Informed Care in Behavioral Health Services Treatment Improvement Protocol, Series 57, Part 3 (https://store.samhsa.gov/sites/default/files/d7/priv/sma14- 4816_litreview.pdf).

³ Cal. Bus. and Prof. Code, Section 4982(s)

⁴ CCR, Section 1845 (a)

⁵ 5.11 SCOPE OF COMPETENCE: Marriage and family therapists take care to provide proper diagnoses of psychological disorders or conditions and do not assess, test, diagnose, treat, or advise on issues beyond the level of their competence as determined by their education, training, and experience. While developing new areas of practice, marriage and family therapists take steps to ensure the competence of their work through education, training, consultation, and/or supervision.

⁶ 7.4 COMPETENCE OF SUPERVISEES: Marriage and family therapists assure that the extent, quality and kind of supervision provided is consistent with the education, training, and experience level of the supervisee. Marriage and family therapists do not permit their students, employees, or supervisees to perform or to hold themselves out beyond their pre-licensed status or to perform professional services beyond their scope of competence.

⁷ Noshene Ranjbar,M.D., Matt Erb,PT, Othman Mohammad, M.D.,Francisco A. Moreno,M.D., Trauma-Informed Care and Cultural Humility in the Mental Health Care of People From Minoritized Communities, 2020.

⁸ Id.

⁹ Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally iverse clients. Journal of Counseling Psychology, 60(3), 353–366.

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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.