September 16, 2014
Invited Oral Testimony
House Select-Committee on Health Care Education and Training
My name is Jan Friese. I am the Executive Director of the Texas Counseling Association. TCA
represents almost 7500 professional counselors who work in a variety of settings across Texas.
Professional school counselors are regulated by the State Board for Educator Certification and are
required to have a minimum of two years classroom teaching experience, hold at least a master’s degree
and pass a rigorous state certification examination. Professional school counselors work with students at
the elementary, middle and high school level in private, public and charter schools. There are about
20,000 certified school counselors in Texas.
Licensed Professional Counselors are regulated by the Texas State Board of Examiners of
Professional Counselors and are required to hold at least a master’s degree, pass a rigorous licensing and
jurisprudence exam and complete 3,000 hours of post-graduate supervision. LPCs provide mental health
counseling, crisis response services, college counseling and career counseling – just to mention a few areas
of specialization. There are approximately 21,000 Licensed Professional Counselors in Texas.
TCA was asked to focus on three topics:

How will students who want to pursue careers in health and mental health services get the
guidance they need to make good and efficient choices;

How do we help students move more quickly through the educational pipeline; and

What strategies can we implement to quickly address the current and predicted mental health
workforce shortages?
The President of TCA asked me to testify because it would really take three different professional
counselors – a school counselor, a college counselor and a counselor in private practice – to address those
topics. She thought I might be able to testify more efficiently.
There is no doubt that the options facing our middle and high school students under the new
graduation plans can be daunting. The Comprehensive Developmental Guidance and Counseling Program
set forth in Chapter 33 of the Texas Education Code is the strategy to ensure that students and parents
receive the guidance they need to make good and efficient choices. Research has shown that students who
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attend schools that fully implement this program complete high school, perform better academically, are
less likely to get in trouble and are more likely to pursue postsecondary opportunities than students who do
not.
Texas has spent billions of dollars on initiatives to promote college and career readiness. One
strategy that has not been tried is lowering the student to school counselor ratio. It has been argued that
this solution is cost-prohibitive. Yet several school districts across the state are choosing to spend their
dollars to make this happen. Why? Because the cost of having students fail is much, much greater.
There are four components to the comprehensive, developmental guidance and counseling
program – classroom guidance, individual planning, responsive services and system support. Two are
especially germane to supporting students in their career choices – classroom guidance and individual
planning. Through classroom guidance, school counselors help teachers assess students’ interests and
career opportunities, among other things. Through individual planning, school counselors help students
select endorsements that align with their goals. Middle and High School counselors across Texas report that
their greatest need is more time for individual planning. According to TEA, when individual planning
requirements increase, the recommended student to counselor ratio is 300:1.
School counselors alone are not the panacea to improving student progress. Working through the
fourth component – system support – school counselors identify community resources to help students
stay on track. AdviseTexas a Coordinating Board program that provides near-peer, recent high school
graduates to work with high school students is a great example. The caution is that they should not replace
school counselors who have the training to provide responsive services to students in crisis, the ability to
teach students about their options, the experience to navigate the educational system, and the knowledge
to ensure that students are taking the classes they need.
Enrolling in postsecondary education, however, is just the first step toward a health career. Sadly,
many students who enroll in those programs leave long before they finish. According to the Chronicle of
Higher Education, in 2010 less than 25 percent of Texas university students graduated in four years and
about 13% of students enrolled in Texas community colleges completed their programs. Community
colleges are excellent gateways for those seeking careers in health care. The rigor of these programs,
however, can place enormous stress on students.
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In a survey released by the Association of University and College Counseling Center Directors in June
2013, seventy percent reported that the number of students presenting with severe psychological issues
has increased in the past year.
Yet, the student to counselor ratios on college campuses is outrageously high. It ranges from 716:1 on
campuses with less than 1500 students, to over 2700:1 on campuses with enrollments that exceed 35,000.
In Texas, we are seeing a disturbing trend – especially in community colleges – to replace licensed
mental health professionals with bachelor level academic advisors. These advisors are not prepared to
identify and develop appropriate treatment plans to address the psychological needs that our college
students are bringing to their campuses.
College counselors are uniquely qualified to help students identify and resolve issues of anxiety and
depression so that they can complete their studies and achieve their career goals. More than 65% of
college students report that counseling helped their academic performance.
Enacting rules to ensure that college counseling centers are appropriately staffed is another key
strategy to help students move quickly through the educational pipeline.
Finally, what strategies can we implement to quickly address the current and predicted mental health
workforce shortage?
The inability to find internship placements has had a chilling effect on the decision of LPC-Interns to
complete their training in Texas. That LPC-Interns are not authorized to bill Medicaid for the services they
provide under supervision has been repeatedly cited as an obstacle to their full-time entry into the
workforce.
LPC-interns have completed a graduate degree, passed the Texas license exams, and hold a temporary
license. Their preparation far exceeds that of Peer Specialists and is comparable to Provisionally Licensed
Psychologists both of whom are currently allowed to bill Medicaid.
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Including LPC-Interns will also create a pathway to help address the aging out of the current provider
groups. Working with Medicaid clients while under supervision, will increase the likelihood that these well
qualified mental health professionals will remain in the system as Medicaid providers.
TCA also recommends that reimbursement rates for behavioral services under Medicaid be increased
and that all providers receive the same rate for the same service.
Low Medicaid payment policies are a deterrent for participation. The current Medicaid reimbursement
rates are abysmally low for mental health professionals.
To make matters worse, LPCs, LCSWs and LMFTs are paid at only 70% of the Medicaid allowable rates
which equates to less than $10 an hour after office expenses. Not even the psychiatrists and psychologists
who are paid at 100% of the allowable rate recoup their costs.
Expanding opportunities for loan repayment programs for LPCs will also help attract these providers to
our shortage areas. Licensed Professional Counselors constitute the largest group of clinical mental health
providers in Texas. Strategies to help them recover the cost of their graduate training, expanding
internship opportunities and increasing reimbursement rates will provide significant incentives for them to
continue to deliver mental health services.
In summary, TCA requests that you consider strategies to:
 Reduce the student to counselor ratio in elementary, secondary and postsecondary institutions
 Require college counseling programs to use licensed mental health professionals as their core
providers
 Expand opportunities for LPC-Interns to complete their training in Texas by allowing them to bill
Medicaid
 Increase Medicaid reimbursement rates for all mental health providers
 Expand loan reimbursement programs to include all mental health professionals.
Thank you on behalf of the professional counselors in Texas and the students and clients they serve for the
opportunity to speak with you today.
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