Credentialing Determination Request Instructions
REQUIRMENT:
Credentialing forms and unofficial transcripts (if applicable) are required from applicants
who are applying for a position at the Health Department that require the following:
QMHA
QMHP
LMP
CADC
Qualified Mental Health Associate
Qualified Mental Health Professional
Licensed Medical Professional (Behavioral Health)
Certified Alcohol & Drug Counselor (I, II, III)
PURPOSE:
Credentialing forms are used to determine credentialing qualifications.
COMPLETING THE FORM:
The top portion of the form requires your name, the date that you are completing the
form, the classification that you are applying for and the credentialing status that you
are applying for. You do not need to indicate the name of the supervisor if you do not
know it.
Education
If you have a degree, list the name(s) of the college or university that you earned
your degree(s) at, the major/minor, degree earned, and the month/year that the
degree was awarded.
If you have education that did not result in a degree being awarded, indicate the
college or university, major/minor, but leave the degree earned and date(s)
columns blank.
If you are currently working on a degree, indicate the college or university,
major/minor, leave the degree earned column blank and indicate the date that it is
anticipated that the degree will be awarded.
Licenses / Certifications
If you have a license or certification that is relevant to the credentialing that you
are applying for, indicate if the license or certification is current or not, the type
of license (e.g. CADC, LCSW, LPC, RN) and the expiration date of the license.
You do not need to indicate licenses or certifications such as CPR, AED, drivers
license, etc., that are not relevant to the position.
Experience
You should document any experience that you may have that is relevant to the
position and credentialing status that you are applying for. Indicate the name of
the position or title, the employer or location, the start and end dates and the
hours per week that you worked while gaining the experience.
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Competencies
The next sections of the form is for you to list any training, education and/or
experience that you have in specific areas, which are required competencies of
each credential. These are the competencies that prior employers will be rating if
we call for references. If you are a successful candidate, we will use this
information in determining if you have the required competencies for the
credentialing status that you are applying for. There may be additional practical
exams or interview questions that will also help us determine competencies.
Applicant Signature
When you have completed the Credentialing Determination Request form, finish
up by signing and dating the form.
COMPLETED FORMS:
Submit the completed Credentialing Determination Request with your application.
TRANSCRIPTS:
Submit copies of your transcript (do not submit official transcripts) with your application.
If you are chosen to fill the position that you are applying for, you will be required to
submit the official transcript within 30 days from the date of hire.
QMHA – Submit copies of transcript that indicate that you have earned a
Bachelor’s degree in a behavioral health field (see below). If you do not have
a degree in a behavioral health field, you must indicate a minimum of 3 years of
relevant training, education and/or experience.
QMHP – Submit copies of transcript that indicate that you have earned a
Master’s degree in a behavioral health field (see below). You do not need to
submit transcript for your Bachelor’s degree.)
LICENSES / CERTIFICATIONS:
If you have a license or certification that will be considered for determining credentialing,
submit it with your application.
QMHP – If you have a license such as a LCSW that requires a Master’s degree,
or have a Registered Nursing license, you should submit a copy of the license
with your application and credentialing form. If you have such a license, you do
not need to submit a copy of your Master’s degree transcripts.
CADC (I, II, III) – If you are applying for a position that requires a CADC you
must submit a copy of your certification with your application and credentialing
form.
TRAINING:
You do not need to attach proof of training that is listed on your credentialing form. If
you are a successful candidate, we may request proof prior to making a job offer.
QUESTIONS: If you have questions regarding the completion of the Credentialing
Determination Request or the documents that may need to be attached, please contact
Karri Tinney at (503) 373-3776.
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Behavioral Health Credentialing Definitions and
Qualifications
Qualified Mental Health Associate
An individual must meet the following minimum qualifications to be
credentialed as a Qualified Mental Health Associate (QMHA):
"Qualified Mental Health Associate" or "QMHA" means a person
delivering services under the direct supervision of a Qualified Mental
Health Professional (QMHP) and meeting the following minimum
qualifications as documented by the provider:
(a)
A bachelor's degree in a behavioral sciences field; or
(b)
A combination of at least three year's relevant work, education,
training or experience;
AND
(c)
Has the competencies necessary to:
(1)
Demonstrate
effectively;
the
ability
to
communicate
(2)
Understand mental health assessment, treatment
and service terminology and apply each of these
concepts;
(3)
Implement skills development strategies and
identify, implement and coordinate the services
and supports identified in an Individual Service
and Support Plan (ISSP).
Calculation of education, training and experience will be determined
using the following formulas:
Coursework: 13 credits = 1 year
Coursework in behavioral science, i.e., psychology, counseling
Training:
450 hours = 1 year
Relevant training in behavioral health science areas
Experience: 2080 hours = 1 year
Relevant experience in behavioral health field (Experience
working with Individuals with Developmental Disabilities and in
Alcohol & Drug field may count as half depending on actual work
duties)
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Qualified Mental Health Professional
An individual must meet the following minimum qualifications to be
credentialed as a Qualified Mental Health Professional (QMHP):
"Qualified Mental Health Professional" or "QMHP" means a Licensed
Medical Practitioner (LMP) or any other person meeting one or more
of the following minimum qualifications as authorized by the LMHA
or designee:
(a)
Bachelor’s degree in nursing and licensed by the State of
Oregon;
(b)
Bachelor’s degree in occupational therapy and licensed by the
State of Oregon;
(c)
Graduate degree in psychology;
(d)
Graduate degree in social work;
(e)
Graduate degree in recreational, art, or music therapy; or
(f)
Graduate degree in a behavioral science field.
AND
(g)
Has the competencies necessary to:
(1)
Demonstrate the ability to conduct an assessment,
including identifying precipitating events, gathering
histories of mental and physical health, alcohol and
other drug use, past mental health services and criminal
justice contacts, assessing family, cultural, social and
work relationships, and conducting a mental status
examination, complete a five-axis DSM diagnosis,
write and supervise the implementation of an Individual
Service and Support Plan (ISSP) and provide
individual, family or group therapy within the scope of
their training.
*Marion County Health Department direct service personnel with QMHP
status prior to April 2, 1996 who do not meet the revised QMHP criteria
outlined in the revised OAR, Medicaid Payment for Rehabilitative
Mental Health Services Rule, effective April 2, 1996, have been
grandfathered under the current QMHP definitions.
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Licensed Medical Practitioner
An individual must meet the following minimum qualifications to be
credentialed as a Licensed Medical Practitioner (LMP):
"Licensed Medical Practitioner" or "LMP" means a person who meets the
following minimum qualifications as documented by the Local Mental Health
Authority (LMHA) or designee:
(a)
Physician licensed to practice in the State of Oregon; or
(b)
Nurse Practitioner licensed to practice in the State of Oregon;
or
(c)
Physician's Assistant licensed to practice in the State of Oregon
AND
(d)
Whose training, experience and competence demonstrate the
ability to conduct a mental health assessment and provide
medication management.
For ICTS and ITS providers, LMP means a board-certified or board-eligible
child and adolescent psychiatrist licensed to practice in the State of Oregon.
Pending CADC
An individual must meet the following minimum qualifications to be
credentialed as a Pending CADC:
(a)
Completion of all educational requirements for entry-level
certification of a certifying body accepted by the state of
Oregon (ACCBO, NAADAC or the Northwest Indian Alcohol
and Drug Specialist Certification Board) at the time of hire. At
the time of hire, the supervisor will formulate a plan for the
employee to complete the necessary contact and supervision
hours to obtain certification within 6 months from the date of
hire.
(b)
The employee will obtain CADC 1 within 1 year from date of hire.
CADC I
An individual must show proof of CADC I certification through the Addiction Counselor
Certification Board of Oregon (ACCBO).
CADC II
An individual must show proof of CADC II certification through the Addiction
Counselor Certification Board of Oregon (ACCBO).
CADC III
An individual must show proof of CADC III certification through the Addiction
Counselor Certification Board of Oregon (ACCBO).
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