The regulation that Residents in Counseling may  not "directly bill for services" is an antiquated concept and places a tremendous strain on both residents and supervisors.

It's often difficult for a master's level graduate to find a job in our field because of: a lack of job openings (due to increasingly diminished funding for public mental health treatment), low paying jobs that don't provide a living wage (let alone repayment of student debt), or limited opportunities to contract in an established private practice.  So, unable to find a job after months of searching, some graduates turn to the only option left, even if it isn't their first choice, of starting a private practice.  Unfortunately they are often stopped in the process because they can't find a supervisor who will take client payments.

But supervisors took client payments in the past, so what's changed?  Why are supervisors more reluctant to take their residents' client payments?  The possibilities are: 1. Depositing someone else's income into their account increases their own income (even though all the payment is returned to the resident); 2. Split payments, which were typical in the past (splitting the client payment between supervisor and resident) would not increase the supervisor's income, but were deemed illegal and no longer an option; 3. In the past a supervisor could accept the residents' client payments by check and simply endorse the check and return it to the resident, but with new technology based banking that's no longer an easy option; 4. It's extremely time-consuming to take residents' multiple client payments and electronically transfer the funds back to the resident especially if a supervisor has more than one resident in private practice; and 5. Many supervisors don't understand or are afraid of the process.

So this regulation is incredibly unnecessary when the entire amount of the client payment must be given to the resident in it's entirety.  It's likely that clients don't understand this behind the scenes process and may be confused by why their payment goes to the supervisor when it's the resident that provided the counseling.  What message does this send to clients about the value of the resident's work?

It's understandable that the intent of the regulation was to assure that clients understood that the resident in counseling is not an independently practicing clinician and is under supervision during residency.  However, this requirement is incredibly redundant when residents must have their supervisor's name and information on everything they give to a client (practice forms, business cards, advertising, etc.) as well as verbally inform their clients they are under supervision and by whom.  Doing that already makes it crystal clear that a resident is NOT working independently and whether or not a resident takes payment seems superfluous.  It would be more important to spend the energy to  confirm that a resident is, in fact, informing their clients they are in a residency under supervision. 

Becoming licensed as an LPC is already a lengthy, costly, and time-consuming process.  Let's support our residents and their supervisors by removing this truly unnecessary impediment for both.

I agree with Sharon Watson. Denying Residents' ability to accept payment is unnecessary and burdensome on the both the Resident and the supervisor responsible for accepting payments. Please consider allowing Residents to accept payments.

I am in favor of removing the restriction regarding residents directly accepting payment from clients per all of the reasoning Sharon Watson provided in her comments. This restriction creates an unnecessary burden on residents and supervisors. It leads to discrepancies in how residents are handling billing, which creates inconsistencies and confusion in the field. As long as residents are following the regulations that state they must not represent themselves as sole practitioners and must inform clients of their status as a resident/use the title "Resident in Counseling," billing methods should not be regulated.

I STRONGLY believe that it is necessary for Residents in Counseling be able to accept payments directly. It reflects on our reliability to our clients as well as our professionalism. 

While a resident it can be hard enough to find a job to fulfill the needed hours, the choices often end up being employed below training level, at a low pay rate. It can also be difficult to find a local supervisor who is willing to accept payment on behalf of their resident. Additionally society has moved from making payment for services by using cash/checks to primarily using credit/debit/online payment services. When a resident has to go through one of these and requires the payment go to the supervisor first it becomes a financial tangle that can be difficult to navigate for many. I feel that residents would benefit from being able to bill for their own services as long as all forms, documents, websites, etc clearly display the Resident in Counseling status and contact name/information of the supervisor.

I am in favor of removing the restriction regarding residents directly accepting payment for their services, in agreement with Sharon Watson and many other commenters here.  I fully support the idea of residents needing to make it clear to their clients that they are working under clinical supervision and are not practicing independently, and residents are required to communicate this to the public in a number of ways.  But residents not being able to directly accept payment for their services is an unnecessary hurtle that makes things more complicated for residents and supervisors and does not increase public safety, and in fact often confuses the public.  The amount of increased administrative difficulty that this regulation imposes is not proportional to the amount of benefit that it intends to provide to the public, and in fact seems to confuse the public rather than benefit it.  Let’s remove this unnecessary impediment in order to streamline things for residents, supervisors, and clients alike.

In favor of removing the restriction and allowing residents to Bill for services provided

In favor of residents billing directly for services.

NOT in favor of this petition. As a long time LPC Supervisor I do not believe it is in the best Interest of Residents to permit them to receive direct payment from clients for counseling services as learning the aspects of having a business is a different skill set. I would rather allow Residents to focus on strengthening their counseling skills - an already complex set of tasks.

I am not in favor of this unless the Board also develops detailed guidelines for Residents and Supervisors. In theory then, new Residents could have their own practice which requires more skill sets than the ones they need to really focus on and learn. Allowing them to bill directly also does not mean that insurance companies will agree. We continue to fight to get paid by Medicare and the VA. This would continue to muddy waters.

In favor of residents accepting payment. Not all clinicians accept insurance and this makes running a business and being self-sufficient possible. 

I am in favor of amending the current regulations preventing residents from accepting direct payment from clients. 

Many states already allow provisionally licensed clinicians this role and has not created any harm to the system of obtaining complete licensure. In fact it increases clinicians drive and ability to gain more clients. 

This is also a positive acknowledgement of the current economic needs of residents. Times have changes and clinicians are unable to make ends meet by such restrictions. 

As a current resident who is navigating the process towards licensure, I am in favor of accepting payments for counseling services. Unlicensed counselors are working towards developing the skills for counseling and some are also interested in learning the private practice side as well. This opportunity to manage money helps residents to learn the business part of counseling as well for private practice. I’m grateful that my supervisor continues to educate me regarding the additional skill sets and would appreciate the board’s approval of allowing me to manage the money for the services that I provide as I work towards my licensure. Lastly, I am aware of colleagues in the field in other states who accept money and have not seen how that ability has challenged their abilities to learn the counseling skills while managing the income piece as well. I’m grateful for this dialogue and the opportunity to consider making this change, thanks for your consideration. 

While allowing residents to charge for services enhances credibility it may send message to clients of level of skill they do not possess as residents. It would encourage more people to stick with the process, however. If working in an agency they would be reimbursed for their services. As a private practitioner it might cut into my client pool. Perhaps setting rates across the  board would work more equitably.

Clinica

I am a supervisor and an LPC. I, too, am concerned about the impact that changing the rule could have on the public. There are already cases in which the public is not being informed when a resident is not licensed and is under supervision. This misleads the public and hurts the profession as a whole. 
As LPCs, we have a responsibility to maintain professional standards, and while allowing residents to accept payments in their name would make it easier for residents, it would destroy the checks and balances already built into the system.

I understand the inconvenience of not having the ability to directly accept payments.  However, much more is at stake.  It is important to recognize and understand the purpose of this rule. 

This rule is in place to ensure that the Resident in no way represents him or herself as an independent practitioner.  This rule requires that some overarching entity provide protection against such a misrepresentation by requiring all payments to go through that entity.  This rule is in place to protect the public from inexperienced clinicians who might attempt to practice independently. As stated by a previous respondent, this change would enable Residents with little experience to practice independently in any  setting including private practice.  Absent intensive and frequent, quality supervision, this change would be ripe for abuse.   

Second, our profession should not differ from related professions in our rigor for preparing  our Residents for independent practice..  No one wants to see an MD open a practice while still in Resdency .  The same holds true for other health professions.  We should not differ in our application of professional rigor to ensure our Residents are fully qualified before enabling them to work on their own.  This change would likely stigmatize our profession in Virginia since it essentially would permit Residents to practice independently before their training in complete.  No other profession allows this.

This rule was created for a purpose-  protection of the public and our profession.  This change would put both at risk.

I am firmly in favor of residents accepting direct payment from clients as long as they are and reporting those direct payments to their supervisors, attesting to the accuracy of those direct payments, and agreeing to not holding their supervisors responsible for any conflict between themselves and their clients with regard to those payments. 

Not in favor.  Very little experience; no direct supervision.  Do not agree that Residents should be allowed to have their own private practice.

I am in favor of removing the requirement that residents not be allowed to accept payments.  As a supervisor of an agency with several employees and no reception staff, disallowing residents to take payments significantly inhibits my abilities to employ residents. 

In favor of Residents, while under supervision, to bill and collect directly.

In favor

I am in favor of allowing residents to be able to bill directly for services because I believe this would allow for Resident's in Counseling to gain more experience and open more opportunities for them to practice. There are currently few opportunities and most of them are community based work with QMHP's. I believe that the more opportunities residents have to provide services while under supervision while allow them to gain valuable experiences while still protecting their clients. Most counselor's are not able to get outpatient therapy experience while in their residency which makes it a more difficult transition once they are licensed. Allowing resident's to develop competency in different areas is to allow them more ways to gain experiences while under supervision. I think it should be allowed and then be up to the supervisor to monitor the resident's training and progress. 

I am in favor of the change as Sharon Watson and many others have identified the multiple merits of allowing for this change to occur. 

The whole purpose of a residency is to be mentored and trained.  It's a long process but necessary one.  If residents are allowed charge clients directly, what's the difference between a residency and a private practice? Let's do one thing at a time please.

I am in favor of allowing residents to bill and collect payments for their services through their established businesses (LLCs).  There are some residents who are quite capable of establishing a private counseling practice.  It is, therefore, incumbent on supervisors to assess whether they are prepared to supervise a particular resident wanting to start a private practice. 

Like all residents, those who establish a private practice are still required to inform clients "in writing of the resident's status and the supervisor's name, professional address, and phone number."  They are not allowed to ". . . represent themselves as independent, autonomous practitioners or professional counselors.  During the residency, residents shall use their names and the initials of their degree, and the title "Resident in Counseling" in all written communications."

However, requiring the supervisor to collect payments on behalf of the resident's business not only creates a redundant exercise in creative accounting, but it puts an undue legal responsibility for the resident's business on the supervisor.  This only serves to discourage supervisors from accepting any responsibility for helping those very capable residents.

I am in favor of lifting this restriction on Residents and allowing them to receive direct payments for their services. There are many reasons for this.  The most compelling reason in my opinion, is the barriers it would remove, allowing opportunity for Residents to both complete necessary requirements of their Residency and make a reasonable living at the same time.

I am in favor of residents taking payment directly from clients with the understanding that they are already under supervision of a licensed clinician. However, I do believe that the board should have guidelines that specify the scope of this happening under direct supervision. The board has gone to great lengths to clarify in writing the restriction of residents taking payment; therefore, if the rule was changed I can only imagine that there would be clarification and guidelines for the allowance of such practice.

I have been a supervisor for many years as both an LMFT and an LPC in three states. Virginia has always been the standard bearer as one of my colleagues has stated. As a supervisor, I consciously choose to take enormous risk to my license by directly supervising Residents in my practice. Allowing a Resident to take direct payment will only increase malpractice risk to both Supervisor and Resident. A Resident will be able to “Hang a Shingle” and operate independently by receiving direct client payment and I believe many will do just this and be very excited about it and be too young in the profession to clearly comprehend the risk involved. I often receive phone calls from graduating Interns planning on opening their own business in Residency to which I gently help them understand the regulations and the protection provided for them through the regulations. I urge the VA Board of Counseling to NOT APPROVE this petition.

The Residency period is for learning and increasing therapeutic skills and should not be a time for learning how to run a private practice on your own with a minimum of one hour of supervision per 40 hours. As a colleague has stated, no other profession allows for a Resident to accept direct payment as this one act clearly identifies the Resident as an independent practitioner to the public and creates confusion and one might even go so far as to say is deceptive.

Regarding the accounting of Resident’s Client payment records: There are so many software systems that automatically do all of the accounting for you and will determine exactly how much a Resident is due within any time frame a supervisor would create. Accounting should not be an issue in this discussion rather this discussion should focus of increased malpractice risk for both Resident and Supervisor. As a Supervisor who directly hires Residents, my malpractice insurance for each Resident is astronomically high due to the risk. The malpractice insurance will only increase with the approval of this petition. If this happens, the existing shortage of Supervisors in VA will also increase. Supervision of Residents is a method of giving back to the field of counseling, so why would a supervisor want to increase risk?

In summary, The process of becoming a fully licensed counselor is in place for a reason: To do no harm and protect the public specifically our Clients. I understand the desire for this petition to pass. However, the increased risk to both Residents, Supervisors and our Clients does not warrant its approval. 

Due to increased malpractice risk for both Resident and Supervisor. 

I do not support this

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unnecessary requirement that complicates the provision of supervision and doesn't confirm either the skill level of a resident or that they are under supervision.

I am writing to address previous responses, correct some misinformation, and add additional support for allowing residents to take direct payment from their clients.  I have been in the field for 30 years, licensed as an LPC for 25 years, and supervised residents for over 20 years in Virginia in exempt and non-exempt settings.  I have been a provider of the 20-hour Clinical Supervision Training required for becoming a supervisor and have trained many supervisors over the years.  Here are my points:

1.  In Virginia a resident is allowed to have a private practice if they are under Board approved supervision with a Board approved supervisor and if they identify themselves as a Resident in Counseling under supervision and by whom.  This petition is not about whether or not a resident can have a private practice.  Suggesting to a graduate that they can't or shouldn't have a private practice is giving misinformation.

2.  There are not enough jobs available, including working in an established practice, so for many graduates there is no alternative but to start a private practice, even if they would rather not do so.  In terms of one response that suggested Virginia should do something about the job opportunities, I agree that it would be great to have more funding for mental health, but that's a future goal and shouldn't be a determining factor in making a decision about residents' ability to take direct payment now.

3.  I require my residents to carry their own malpractice insurance.  My malpractice coverage doesn't change with additional residents, so it's possible that the increased malpractice costs discussed in previous responses are for taking on employees (residents or interns) and not for those residents who are contractors or simply rent space in a practice.

4.  The risk to a supervisor (i.e. vicarious liability) is the same whether or not the resident takes direct client payment.  That's why a supervisor does due diligence in choosing who to supervise.

5.  Accounting isn't an issue if your residents are your employees or if payment goes through the front desk of a practice.  But because in Virginia a resident's supervisor is not required to be on-site and virtual supervision is allowed, the issue is for supervisors who are not supervising residents within their own practice. They must therefore set up bank accounts to accept client payments and then transfer the entire amount back to the resident.  The gyrations of having payment pass through the supervisor is unnecessary when both the resident and supervisor are following the regulations by identifying that the resident is under supervision.  And why shouldn't the payment go to the resident - they are the one providing the service?  I believe it's more confusing to clients to be told they must pay a supervisor and not the counselor with whom they have made the therapeutic alliance.  And in response to the idea that withholding a resident's client earnings in order to be sure they report their hours is holding their earnings as ransom and a misuse of a supervisor's current requirement to take client payments.

6.  I suspect the shortage of supervisors is more due to the unwillingness to take on the time-consuming process of making multiple bank transfers to send client payments back to their residents (giving them the income they earned) rather than concerns about increased risk having a resident in private practice.

7.  I believe there is a confusion between payment and competency.  Payment for services is a mechanical issue and has nothing to do with counselor competency.  In fact, some graduates seeking supervision may have already taken the licensing exam and be an NCC.

8.  How are graduates to get experience if they don't see clients?  It puts residents in a Catch 22 situation if they can't get a job without experience but can't get experience without getting a job.  The purpose of being supervised is to allow graduates to identify themselves as residents, practice, and be supervised so they can learn the skills to be a good therapist.

9.  There is concern expressed that a resident in private practice may lack skills, but that's why they are under supervision.  It's important to note that in some exempt settings graduates are practicing as counselors without Board approved supervision, may have a supervisor who isn't even licensed, are required to see the next client who walks in the door whether or not they have expertise in the client's issues, and are often in very intense and difficult situations with typically seriously mentally ill clients.  The supervisor of a resident in private practice on the other hand can guide the resident in taking only those clients within the resident's skill set and who can be appropriately managed in the private sector.

10.  The suggestion that the regulations are there to protect residents and supervisors is a misunderstanding.  The regulations are taken directly from Virginia law and are meant to protect the public.

11.  Regarding Virginia being the standard bearer in the profession: yes, indeed, Virginia was the first state to license counselors but there are other states with equivalent requirements and in fact some with stricter requirements.  This is an opportunity for Virginia to again be in the forefront by taking into consideration the changing technological landscape and take advantage of the opportunities this brings.  Paper checks made out to the supervisor and signed back over to the resident are a thing of the past now with instantaneous payments and cash transfers.  Dictating that a resident not take direct client payment doesn't make our regulations better, it just keeps us from adapting to the present.

12.  Regarding the statement that no other profession allows residents to take payment is actually incorrect regarding our own profession because in some states residents are allowed to take payment. In my research, of the 18 states that have responded to date, 5 allow residents to take client payment, 7 report it's not regulated or not addressed at all (which means the resident can take payment).  It's important to note that the Virginia Board doesn't regulate insurance reimbursement for residents because it's outside their purview.  Which begs the question of why they regulate another form of payment.

13.  The implication that allowing residents to take client payments in their private practice will make graduates more willing to break the law by practicing without a supervisor or license is inappropriate.  If a graduate is practicing outside of the regulations, that is what should be policed and reported.  The bottom line is, if you see something, say something.  If you see someone practicing illegally, report it.  That's how we protect the public.  The public isn't protected by not allowing a resident, who is practicing according to the regulations, take direct client payment.  It's unconscionable to penalize residents adhering to the regulations because of individuals who might not be. 

14. In response to changing this regulation meaning there would be no difference between a residency and a private practice is a misunderstanding.  The answer is they can be one in the same. A residency can be done in a supervisor's practice, in a private company, in an exempting setting, or while running a private practice.

In summary, I hope this addresses some of the concerns voiced by some and supports all of those in favor of changing this regulation.