Keeping Up With The
Counseling
Profession: Current
Issues on the
National Level
www.counseling.org/kaplan
David Kaplan
ACA Chief Professional Officer
dkaplan@counseling.org
Janis Manalang
ACA Doctoral Intern
jmanalang@counseling.org
2013 ACES Conference
Things we might talk about
• Professional Identity
• Counselor Education Accreditation
• Practice Issues
• Legal and Ethical Issue
• Public Policy & Legislation
Things we might talk about
• Professional Identity
• Counselor Education
Accreditation
• Practice Issues
• Legal and Ethical Issue
• Public Policy & Legislation
Dr. William Glasser
1925-2013
Professional
Identity
The Association for Assessment in
Counseling and Education (AACE)
has become
THE ASSOCIATION FOR ASSESSMENT
AND RESEARCH IN COUNSELING
(AARC)
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 was to develop:
• A consensus licensure title to recommend to all
state licensing boards
• A consensus scope of practice to recommend to
all state licensing boards
• 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
What about the licensure
education requirements?
TWO OUT OF THREE
AIN’T BAD!
Where does 20/20 go
from here?
Counselor Education
Accreditation
The next CACREP
standards revision has
begun
Slated for 2016
Draft # 2 public comment period
ends 1/10/14
Review the draft and give feedback at:
http://www.cacrep.org/template/page.cfm?id=141
More evolutionary than
revolutionary
“Clarify, Simplify, and Unify”
Three significant proposals
• By July 2020, all entry-level
programs, including:
– career counseling
– school counseling
– postsecondary counseling
be comprised of 60 credit hours
• Clinical Rehabilitation
Counseling added as a specialty
• Student Affairs and College
Counseling specialty becomes
Postsecondary Counseling
Important accreditation news
CORE has become a corporate
affiliate of CACREP
CORE will jointly implement the new
CACREP Clinical Rehabilitation Counseling
specialty
The Goal
To provide a unified structure for
counselor preparation
Alternative
Counselor
Education
Credentialing
Masters in
Counseling
Accreditation
Council (MCAC)
Initial MCAC programs
• U of Albany (mental health counseling)
• U of Massachusetts, Boston (mental
health counseling & school counseling)
Psychology
& counselor education
accreditation
THE COUNSELING PSYCHOLOGIST
VOL. 41, NO. 5, JULY 2013
Articles
• Quality of Master’s Education: A Concern for
Counseling Psychology?
• Looking to the Future – The role of Master’s
Programs in Counseling Psychology
• Integrating Master’s Education in Counseling
Psychology for Quality, Viability, and Value
Added
• Legitimizing and Reclaiming Master’s
Training and Education in Counseling
Psychology: An Urgent Concern
Contributing to the
ambivalent relationship of
counseling psychology to
masters training…
-Jackson & Scheel, p.676
In some situations, the
master’s training programs
were developed …to help
fund the doctoral training
program.
-Palmer, p.703
In some cases, master’s
programs help pay the bills for
doctoral education…in difficult
economic times, counseling
psychology doctoral programs
without master’s programs
may be easier to cut
-Jackson & Scheel, p. 687 &
688
To maintain CACREP accreditation
when budget cuts are required,
deans and other
administrators…may prioritize
master’s over doctoral programs
since master’s training is less
expensive than doctoral training.
-Jackson & Scheel, p.682
…such developments do
threaten counseling
psychology programs…
-Jackson & Scheel, p.682
The new MCAC accreditation
standards may serve to promote
a new direction for counseling
master’s education…consistent
with core values and
contributions of counseling
psychology
-Jackson & Scheel, p. 681
It is questionable…whether
we [counseling psychology]
will be able to avert eventual
professional annihilation…as
a profession we are
experiencing THE RECKONING
-Palmer, p. 701 & 704
Practice Issues
The DSM-5
DSM-5
•Out in stores and online
GET IT while its hot!
DSM-5
- How do we teach the
new DSM?
DSM-5
- DSM-5 combines Axis I, II, and III
- “The multiaxial distinction among Axis I, Axis II, and
Axis III disorders does not imply that there are
fundamental differences in their conceptualization,
that mental disorders are unrelated to physical or
biological factors or processes, or that general
medical conditions are unrelated to behavioral or
psychosocial factors or processes” (APA, 2000)
- Primary Diagnosis
- The most acute condition that requires the most
intensive skilled services
DSM-5
- Contributing psychosocial and environmental
factors or other reasons for visits (replaces DSMIV Axis IV)
- Over 130V codes (use Z codes after October 1, 2014)
- The V codes can be used when it is more specific to
the care being rendered than a psychiatric diagnosis
- The DSM-5 includes separate measures of
symptom severity and disability for individual
disorders (replaces DSM-IV Axis 5)
- World Health Organization Disability Assessment
Schedule (WHODAS 2.0)
DSM-5
- 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
• Substance Use Disorders
– Abuse and Dependence combined into Use
– Read and follow the Recording Procedures and
Coding Notes!
– Criteria
• Threshold = 2 of 11 symptoms
–
–
–
–
Impaired control (criteria 1-4)
Social impairment (criteria 5-7)
Risky use (criteria 8-9)
Pharmacological criteria (criteria 10-11)
DSM-5
• Substance Use Disorders
–Removed
• Polysubstance-Related Disorder
• Specifier for a physiological subtype
–Changed
• On agonist therapy to On
maintenance therapy
DSM-5
• Disruptive Mood Dysregulation Disorder
– Temper/anger outbursts occur three or
more times per week
– Manifest verbally or behaviorally, such as in the form of verbal rages, or
physical aggression towards people or property
– Grossly out of proportion in intensity or duration to the situation or
provocation and inconsistent with the child’s developmental level
– Hallmark symptom is “very severe, non-episodic irritability” (DSM-5, p. 157)
• Criterion present for at least 12 months and symptoms
have not been absent for less than 3 months at a time
– “persistent, frequent, extreme”
DSM-5
• Disruptive Mood Dysregulation Disorder,
con’t
• Age 6 years or older, onset before 10 years of age;
prior to age 18
• Mutually exclusive with bipolar, intermittent
explosive, PTSD, and oppositional defiant disorders –
and it trumps ODD (15%)
– But it can coexist with attention-deficit/hyperactivity,
conduct disorder, substance use disorder, major depression –
“clear-cut changes”
DSM-5 Tools
- ACA Webinars ( www.counseling.org) click
on Continuing Education scroll to webinars
- ACA creating a book to assist professionals
to utilize DSM V to the fullest
New HIPPA Regulation
• Duty to warn (technology use)
• According to Nancy Wheeler, ACA risk
management consultant, counselors need
to inform clients in consent forms about
encrypted emails
• “covered entity”
• Updating NPP(Notice of Privacy Practices)
Legal & Ethical
Issues
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 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
•
•
•
•
•
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
• Fee splitting
Public Policy &
Legislation
Major PP&L Issues
• Affordable Care Act
• VA hiring of Counselors
• TRICARE independent practice
• Medicare
The Other ACA – a lot to like
• Exchange plans must cover both mental
health and substance – use disorders.
• Coverage must be generally comparable
with coverage for medical care.
• Co-pays for mental health care abolished.
VA (Non-)Hiring of LPMHCs
www.usajobs.gov
• Number of VA social worker
positions posted in 2012: 1,563
• Number of VA LPMHC positions
posted in 2012: 58
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
Goals
• 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
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
Practice under physician referral and supervision will
no longer be allowed.
Medicare
The Current Strategy: getting
included in the Senate Medicare
physician payment reform
package
For updates on legislative
issues go to the ACA website
at www.counseling.org
and click on the public policy
tab
Let’s schmooze!
Keeping Up With The
Counseling
Profession: Current
Issues on the
National Level
www.counseling.org/kaplan