September 5, 2018
The Honorable Ralph Northam Dr. Daniel Carey
Governor of Virginia Secretary of Health and Human Resources
P.O. Box 1475 P.O. Box 1475
Richmond, VA 23218 Richmond, VA 23218
Dr. David E. Brown, Director Elaine J. Yeatts, Senior Policy Analyst
Virginia Department of Health Professions Virginia Department of Health Professions
9960 Mayland Drive, Suite 300 9960 Mayland Drive, Suite 300
Henrico, VA 23233-1463 Henrico, VA 23233-1463
Dear Honorable Northam, Dr. Brown, Dr. Carey, and Ms. Yeatts:
RE: Public Comment to Executive Order 17 (2014) to Review Regulations Governing Practice of Counseling, Practice of Marriage and Family Therapy and Licensure of Substance Abuse Professionals
As Chief Officer of Professional Practice, I am writing on behalf of the American Psychological Association (APA) to provide comment on the review of the current regulations regarding the practice of professional counseling and marriage and family therapy in Virginia. APA is the professional organization representing more than 115,700 members and associates engaged in the practice, research and teaching of psychology. APA works to advance psychology as a science and profession and as a means of promoting health, education, and human welfare. We work closely with our state psychological organizations, like the Virginia Academy of Clinical Psychologists (VACP), to further those goals at the state level.
It is our understanding that pursuant to the Virginia Executive Order 17 (2014) and Virginia Code Annotated §§ 2.2-4007.1 and 2.2-4017, the Virginia Board of Counseling is obligated to conduct a periodic review and small business impact review of those administrative regulations under its purview. The purpose of such review is to determine whether any regulation should be repealed, amended, or retained in its current form, considering the protection of public health, safety, and welfare, the performance of important governmental functions, and the potential economic impact on small businesses.
In this case, the review includes provisions governing the licensed practice of professional counseling and marriage and family therapy and licensing of substance abuse professionals.
APA would like to express strong concerns about two specific provisions subject to the Virginia Counseling Board’s oversight: (1) the elimination of psychologists, social workers, psychiatrists and substance abuse professionals from supervising trainees and (2) the continued recognition of licensure applicants who graduate from regionally accredited programs which may include programs accredited by the Counseling and Related Educational Programs (CACREP) or the Council on Rehabilitation Education (CORE).
The implementing regulations for professional counseling, marriage and family therapy and substance abuse treatment practitioners include provisions discontinuing the Board’s recognition of providers in other mental health disciplines – e.g., “school psychologists, clinical psychologists, clinical social workers, psychiatrists and clinical nurse specialists” – from serving as supervisors for trainees’ clinical training. [See 18 VAC 115-20-52(C)(3); 18 VAC 115-50-60(C)(3); 18 VAC 115-60-80(D)(1).] The language in all three of those provisions state that such psychologists et al who “have been approved to provide supervision may continue to do so until August 24, 2017.” Clearly, up until that date, psychologists, psychiatrists and social workers had been recognized as eligible supervisors for clinical training. There does not appear to be a clear rationale how that change serves to protect public health, safety, and welfare.
To the contrary, this change restricts the pool of eligible supervisors for trainees who must complete a 3,400-hour supervised residency. There is no rationale offered demonstrating that there is an ample supply of licensed LPCs and MFTs to serve as supervisors to justify eliminating other provider disciplines who have been eligible to supervise up until August 2017. Drastically limiting licensure applicants’ access to supervision runs counter to upholding protection of public health and welfare. There is no rationale for disqualifying otherwise eligible psychologists so long as a psychologist meets the supervisor qualifications outlined in the rules (namely, holding an active license in good standing where the supervision is provided and receives a certain number of hours in professional training or continuing education in supervision). In fact, the profession of counseling arose out of psychology – in particular, counseling psychology and some of the founders of the national counseling organization (American Counseling Association) were counseling psychologists. Therefore, psychologists who meet the supervisor qualifications should continue to be eligible to serve as supervisors.
We recognize the importance of maintaining the requirement in the rules that at least 100 hours of the required 3,400 supervised hours must be provided by a licensed professional counselor or a licensed marriage and family therapist to ensure that trainees receive some of their supervision from a licensed provider in their chosen discipline.
In addition, with health care moving towards integrated patient care using interprofessional teams, it would benefit trainees to be able to obtain supervision from various behavioral health provider disciplines. In fact, restricting supervision would impede a trainee from obtaining supervised clinical training in larger public and private clinical settings such as hospitals or even agency settings where trainees will routinely work in collaboration with other disciplines. To restrict the pool of eligible supervisors is a disservice to those trainees and ultimately to the patients and communities they will serve.
Therefore, we urge the board to repeal this particular provision from the rules governing professional counseling, marriage and family therapy and substance use treatment.
The administrative regulations for counseling, marriage and family therapy and substance use treatment practitioners outline the requirements for a graduate degree program. [See 18 VAC 115-20-49, 18 VAC 115-50-50, and 18 VAC 115-60-60.] Specifically, an eligible degree program must be housed in an accredited college or university, must provide a sequence of academic study preparing students for practice as documented by the institution, must be an identifiable training faculty as well as an identifiable body of students completing the sequence of study, and must have clear authority and primary responsibility for the core and specialty areas.
In addition, these administrative rule provisions state that programs approved by CACREP as well as CORE and COAMFTE are deemed as meeting the above-described requirements. But in no way does this state that only graduates from programs accredited by CACREP (or CORE or the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)) are eligible for licensure as professional counselors, marriage and family therapists or substance use treatment practitioners in Virginia. We strongly oppose changing this provision and urge that it be maintained so that the eligible workforce will not be restricted, protecting patients’ access to sufficient number of providers.
To do other than complying with the administrative regulations would result in an unfair obstacle for graduates from non-CACREP accredited programs who might otherwise qualify for licensure, diminishing the number of licensed counselors in Virginia. We do not understand why the Commonwealth would want to reduce the number of mental health providers at a time when the demand for mental health services far exceeds the number of available providers. The trend across the US is to focus on how to increase the behavioral health workforce supply to meet the growing patient demands. In this instance, Virginia has not adopted CACREP as the exclusive accreditation standard and therefore, all licensure applicants from otherwise eligible programs ought to be considered.
On behalf of the APA, we appreciate your diligent consideration of this important issue. We believe that the current restrictions in the administrative rules are not based on true public protection concerns. Rather, they seem to have a negative consequence in limiting clinical training options for supervised trainees especially in integrated care settings. This in turn is a disservice for the public. We also encourage the board to consider all qualified applicants for licensure including those from programs that aren’t CACREP accredited but otherwise meet the other regulatory requirements. Please feel free to contact us if we can be of any assistance as you consider these issues.
Sincerely,
Jared L. Skillings, PhD, ABPP
Chief of Professional Practice
American Psychological Association