Keeping Up With
The Counseling
Profession:
Current Issues on
the National Level
David Kaplan
ACA Chief Professional Officer
dkaplan@counseling.org
Scott Barstow
ACA Director of Public Policy & Legislation
sbarstow@counseling.org
Janis Manalang
ACA Doctoral Intern
jmanalang@counseling.org
2013 ACA Institute for Leadership Training
www.counseling.org/institute
This year’s theme
Closure
Counseling
Professional
Issues
The Association for Assessment in
Counseling and Education (AACE)
has become
THE ASSOCIATION FOR ASSESSMENT
AND RESEARCH IN COUNSELING
(AARC)
The next CACREP
standards revision has
begun
Slated for 2016
More evolutionary than
revolutionary
“Clarify, Simplify, and Unify”
One big change in draft #1
All entry-level programs, including career
counseling, school counseling, and
student affairs and college counseling be
comprised of 60 credit hours by July 2020
Discrimination against
LGBTQ clients
Two high profile
lawsuits settled
Ward v. Wilbanks
Eastern Michigan
University
Ward v. Wilbanks
• A practicum student referred rather than counsel a
homosexual client.
• After due process, the student was dismissed from
the counseling program.
• The student sued the university counseling faculty
and officials alleging violation of her 1st & 14th
amendment rights, including to practice her
religious beliefs.
The Judge ruled against the
student and for the EMU
counseling program
ACA has posted the decision at:
www.counseling.org/kaplan/EMU.pdf
Judge’s Opinion
• University programs have the right to set
standards.
• There is a “rational basis” to adopt the
ACA Code of Ethics into a counselor
preparation program.
• It is reasonable to use CACREP standards
in a counselor preparation program.
However……
The case was appealed and
sent back to District court
ACA filed an amicus brief in support of
the original decision
www.counseling.org/resources/pdfs/EMUamicusbrief.pdf
Depositions were
taken for
a January, 2013 trial
An out of court
settlement
was reached
(12/11/12)
Augusta State
University lawsuit
Keeton v. Anderson-Wiley
The Judge ruled against
the student and for the
ASU counseling program
“This is not a case pitting
Christianity against
homosexuality”.
Rather, the judge ruled, it is
about a university enforcing
reasonable standards - the
ACA Code of Ethics.
An appeal was denied
th
by the 11 federal circuit
court
And in February an
appeal
for the circuit court to
revisit their decision was
denied
Leaves all court
rulings to date intact
• Graduate counseling programs have the right to
set standards.
• There is a “rational basis” to adopt the ACA
Code of Ethics into a counselor preparation
program.
• It is reasonable to use CACREP standards in a
counselor preparation program.
And….
It continues to be a major violation of
the ACA Code of Ethics for a counselor to
discriminate against clients on the basis
of sexual orientation
State legislative
bodies have gotten
into the act….
It’s getting
personal…language from
Michigan SR 66
“Whereas, The American Counseling Association, a
private organization that promulgates a code of ethics
widely used by university counseling programs and state
licensure boards in training for and regulating the
counseling profession, has publicly supported universities
that have punished or dismissed students for adhering to
their sincere religious convictions…”
California recently
banned reparative
therapy for children
The Future of
Counseling
20/20:
A Vision for the
Future of Counseling
http://www.counseling.org/20-20
The 20/20 consensus
definition of
counseling
http://www.counseling.org/20-20/definition.aspx
Counseling is a professional
relationship that empowers
diverse individuals, families,
and groups to accomplish
mental health, wellness,
education,
and career goals.
29 Organizational
Endorsements
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ACA
ACA MWR
ACA NAR
ACA SR
ACA WR
AACE
AADA
AASCB
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ACC
ACCA
ACEG
ACES
AGLBTIC
AMCD
AMHCA
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ARCA
ASERVIC
ASGW
C-AHEAD
CACREP
CORE
CRCC
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CSI
IAAOC
IAMFC
NBCC
NCDA
NECA
NRCA
The 20/20 Building
Blocks
to Portability Project
Building Blocks to
Portability
The task:
• Developing a consensus licensure title to
recommend to all state licensing boards
• Developing a consensus scope of practice to
recommend to all state licensing boards
• Developing consensus education requirements
to recommend to all state licensing boards
The delegates
reached consensus
on the
licensure title!
Licensed Professional
Counselor
And the Scope of
Practice!
Some Key Elements
• Individual, group, couples, & family counseling
• Promote mental health wellness, development
across the lifespan, crisis intervention and the
diagnosis and treatment of mental disorders
• Consultation and program evaluation
• Supervision
• Ability to practice independently
Two out of three ain’t bad!
Where does 20/20 go
from here?
The DSM-5
DSM-5
- ACA and its members were heard
- First time Licensed counselors
eligible for participation in DSM
field trials for the first time
DSM-5
• Out in stores and online GET IT
while its hot!
• Verdict still in for its validity and
new content
DSM-5 Major Controversies
- Vague wording has increased confusion
(i.e. Mild Neurocognitive Disorder)
- Intermittent Explosive Disorder lacks
needed exclusions to rule out the many other
common causes violent behavior
DSM-5 Major Controversies
Autism as a spectrum
-impossibly muddled, allowing for
multiple interpretations that will lead to
inherently inaccurate diagnosis
-Criteria A-does not specify how many of
its 3 are required
DSM-5 Major Controversies
- Major Depressive Disorder has a foot note
added that adds more confusion and no guidance
to the clinicians as to when to diagnose MDD with
mild depressive symptoms that occurred in
reaction to bereavement or other losses
- ADHD looses definition
- - Disruptive Mood Dysregulation offers 4
different and inconsistent age range
DSM-5 Tools
- ACA Webinars ( www.counseling.org) click
on Continuing Education scroll to webinars
*Currently have a series for understanding
the changes in the new DSM
- ACA creating a book to assist professionals
to utilize DSM V to the fullest
2013 CPT code
changes
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Dx evaluation goes from 90801 to 90791
90832 - 30 minutes psychotherapy
90834 - 45 minute psychotherapy
90837 - 60 minutes psychotherapy
• ACA CPT update video is on our Private Practice Pointers
page at:
http://www.counseling.org/Counselors/PrivatePracticePoint
ers.aspx
New HIPPA Regulation
• Duty to warn
• According to Nancy Wheeler, ACA risk
management consultant, counselors
need to inform clients in consent forms
about encrypted emails
Alternative
Counselor
Education
Credentialing
Masters in
Counseling
Accreditation
Council (MCAC)
The ACA Code of
Ethics Revision
Who
is
on
the
ERTF?
• Jeannette Baca
• Janelle Disney
• Perry Francis
(Chair)
• Gary
Goodnough
• Mary Hermann
• Shannon
Hodges
• Lynn Linde
•
•
•
•
•
Linda Shaw
Shawn Spurgeon
Richard Watts
Michelle Wade
Erin Martz (ACA
staff)
• David Kaplan (ACA
staff)
Timeline highlights
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Task force appointed Summer of 2011
Initial call for member input Fall 2011
Draft composed April 2012-2013
Call for draft feedback May 2013
Draft revised based on input June-December
2013
• Final draft presented to ACA Governing
Council March 2014
ERTF Areas of Focus
• Social media
• The imposition of counselor
personal values
• When is a client a client?
• Removing the end of life exemption
• Bartering
• Sliding scale
• Fee splitting
Legislative Issues
Major Issues We’re Following
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VA hiring of LPCs
TRICARE certification of mental health
counselors
Medicare coverage of LPCs
Federal education spending
“Religious freedom of expression”
legislation
VA (Non-)Hiring of LPMHCs

April 2012 – VA Office of Inspector General report: For half
of first-time patients, MH evals took about 50 days
http://www.va.gov/oig/pubs/VAOIG-12-00900-168.pdf

As of August 2012, total number of LPCs hired as mental
health clinicians within the VA nationwide: 29

Number of VA LPMHC positions posted in 2012: 58
Number of VA social worker positions posted: 1,563
ACA Has…
Written to VA Secretary Eric Shinseki , and met repeatedly
with multiple VA staff
 Met with White House staff
 Met with members of Congress, and worked with them to
draft letters to the VA
 Our goals:
Gain cosponsors on S. 1155, legislation introduced by
Senator Jon Tester (D-MT) to open up VA paid
traineeships to counselors
Establish alternative eligibility criteria for LPCs w/o
CACREP degrees
Have VA central office light a fire under local VA
directors to hire more counselors

VA & counselors: What you can do

Check http://USAJobs.gov if you’re curious about VA
positions. If (surprise!) you find one not open to
counselors, contact the HR person to ask that it be
opened to counselors, and copy us
Contact your Senators and Representative to ask that
they 1) Cosponsor S. 1155 (Senators only!), and 2)
write to the VA to direct them to:
– Broaden the eligibility criteria for LPMHC positions,
and instruct VA facilities to open more positions to
counselors
 Share copies with/direct Q’s to Art Terrazas at
aterrazas@counseling.org

TRICARE requirements: now through 2014
Licensed counselors must:
• have a master's or higher-level degree “from a mental health
counseling program of education and training* and either
– Pass the NCE or NCMHCE (for CACREP-accredited degrees)
OR
– Pass the NCMHCE (for regionally-accredited degrees)
• have 2 years/3,000 hours of supervised clinical practice,
"provided by a mental health counselor
* For at least CACREP degrees, this is interpreted by
DoD to mean only degrees with the title of “mental
health counseling” or “clinical mental health
counseling”
TRICARE independent practice
requirements: beginning 2015
Licensed counselors must:
 have a CACREP degree
 pass the NCMHCE
 same 2 years/3,000 hours of supervision as
previous slide
Independent practice only.
Practice under physician referral and supervision
will no longer be allowed.
TRICARE Mental Health Counselor Certification
Requirements: Possible Barriers
 Having a degree title other than “mental health
counseling” or “clinical mental health counseling”
 Not having passed the NCMCHE
 Not having 2 years/3,000 hours of supervision
under a licensed professional counselor (not
psychologist, social worker, etc.)
 Not having a CACREP-accredited degree
Comparing the federal standards
Agency
Master’s degree…
Exam
Supervision
Dept of
Veterans
Affairs
…in mental health counseling or
related field from CACREP program,
Ph.D. not recognized
--
--
TRICARE (after
2014)
…from a mental health counseling
program of education and training
accredited by CACREP
NCMHCE
2 years/3,000
hrs, 100 hrs faceto-face, meets
AMHCA
guidelines
Army SAP
…in counseling from a program
accredited by CACREP
NCMHCE
--
Medicare bill
(last year’s S.
604)
In mental health counseling or a
related field
--
2 years postmaster’s
Q: Will Medicare require CACREP degrees?
A: Most likely not
 The House and Senate have each passed Medicare coverage of
LPCs/MFTs twice, without ever including CACREP requirement
 HHS declined to require even regional accreditation of
psychology degrees, said nothing about CSWE when writing
regulations for psychologist/SW Medicare coverage
 Starting 1/1/2014, Affordable Care Act (ACA) prohibits
discrimination against state-licensed providers
 HHS is incredibly busy implementing ACA, doesn’t have time
to start second-guessing state licensure requirements
 Requiring CACREP degrees would defeats the goal of
expanding access to outpt. MH services,
especially in rural and underserved areas
Affordable Care Act –
Provider Non-Discrimination Provision
takes effect January 1, 2014
“Sec. 2706.* Non-Discrimination in Health Care.
(a) PROVIDERS.—A group health plan and a health insurance issuer offering
group or individual health insurance coverage shall not discriminate with
respect to participation under the plan or coverage against any health
care provider who is acting within the scope of that provider’s license or
certification under applicable State law. This section shall not require that
a group health plan or health insurance issuer contract with any health
care provider willing to abide by the terms and conditions for
participation established by the plan or issuer. Nothing in this section
shall be construed as preventing a group health plan, a health insurance
issuer, or the Secretary from establishing varying reimbursement rates
based on quality or performance measures.”
* of
the Public Health Service Act
Michigan
Medicare
needs
mental
health
providers!
Licensed professional
counselors
Mental Health
Professional Shortage
Area (HPSA)
Our best hope: getting a lot of cosponsors on S. 562, to
maximize our chance of being included in Senate
Medicare physician payment reform package
Federal Spending
Federal Spending
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Sequestration is now “baked in”. Congress is supposed
to take the lead in deciding where cuts happen within
each agency over the next 9 years.
House and Senate budgets are $91 billion apart on FY
2014 appropriations, and the House doesn’t seem to
want to negotiate
House Labor-HHS-Education spending proposal would
be for ~19 percent less than last year’s funding level
Debt ceiling expected to be hit in the fall, after
“extraordinary measures” exhausted
“Discrimination is okay” Legislation
 Michigan – SB 136: Lengthy bill allowing health care payers,
facilities, purchasers, and providers to decline to cover/pay
for/provide services that violate their “conscience”
 Tennessee – SB 514: institutions of higher education shall
not discipline or discriminate against counseling, social
work, or psychology students for refusing to counsel clients
based on “sincerely held religious beliefs”
 Tennessee – SB 234: “Don’t Say Gay” bill
 If similar legislation is brought up in your state, please let us
know! ACA is firmly opposed to legislation like this, and we
will gladly help fight religious discrimination legislation
How counselors can keep up with
current national issues
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ACA Connect
Read Counseling Today
Read CT online www.ct.counseling.org
Read ACA e-News
Subscribe to the ACA blogs www.my.counseling.org
Subscribe to the ACA Government Relations
Listserv www.counseling.org/PublicPolicy
• Visit the ACA Facebook page
• Follow ACA on Twitter
https://twitter.com/#!/CounselingViews
• Subscribe to counseling listservs (cesnet,
counsgrads, icn, etc.)
• Use Google alerts
• Ask Scott or David
Let’s schmooze!
David Kaplan
ACA Chief Professional Officer
dkaplan@counseling.org
Scott Barstow
ACA Director of Public Policy & Legislation
sbarstow@counseling.org
Janis Manalang
ACA Doctoral Intern
jmanalang@counseling.org
2013 ACA Institute for Leadership Training
www.counseling.org/institute