Presented by:

Rowena Gillo, LCSW Adrienne Shilton, MPPA Pacific Clinics California Institute for Mental Health

September 17, 2013

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Behavioral Health Career Pathway:Licensed Professional Clinical Counselor

LICENSURE HISTORY

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State of California . . .First state to license LCSWs (1945)*

First state to license LMFTs (1964)+

50th state to license LPCCs (2009)**

Sources: *Dyeson, T.B., Social Work Licensure: History and Definition, Home Health Care Management & Practice / August 2004 / Volume 16, Number 5, 408-411 +Esptein, J., The Living History of the MFT License, The Therapist / January-February 2013 https://www.camft.org **California Association for Licensed Professional Clinical Counselors www.calpcc.org

WHO ARE LPCCs?

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Licensed Professional Clinical Counselors (CA, KY, MN, NM, ND, OH)—Also named LPCs (Licensed Professional Counselors)—LCPCs (Licensed Clinical Professional Counselors) —LMHCs (Licensed Mental Health Counselors) —LPCMHs (Licensed Professional Counselor of Mental Health)

LPCCs:Are master's and doctoral-degreed mental health service providers, who are on par with LCSWs and LMFTs in California and with LPCs in the other 49 states Prevent, diagnose, and treat mental, emotional, and behavioral disorders and problemsCombine traditional psychotherapy with a practical, problem-solving approach that creates a dynamic and efficient path for change and problem resolution*

Nationwide, LPCCs: Are trained and have scope of competency to work with individuals, families, and groups, from children to

older adults. Make up a large percentage of the workforce employed in mental health centers, agencies, and organizations

Sources: American Counseling Association http://www.counseling.org/PublicPolicy/WhoAreLPCs.pdf *American Mental Health Counselors Association http://www.amhca.org/about/facts.aspx University of San Diego http://www.sandiego.edu/soles/academics/ma-counseling-clinical-mental-health

WHAT DO LPCCs DO?

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Nationwide, LPCCs:Practice independently in a variety of settings that include (but are not limited to) hospitals, community-based mental health organizations, colleges and universitiesProvide mental/behavioral health and substance abuse services to millions of Americans Provide a diverse spectrum of services, from life adjustment, career counseling, to substance abuse and serious & persistent mental illnesses. ——Work with veterans, active duty military personnel and their families —Are covered by managed care organizations and health plans

Sources: American Counseling Association http://www.counseling.org/PublicPolicy/WhoAreLPCs.pdf California Association for Licensed Professional Clinical Counselors www.calpcc.org

Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations

HOW ARE LPCCs USED?

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Nationwide, LPCCs have been utilized as:

Addiction Therapist Advanced Clinical Specialist Assessment & Referral Clinician Behavioral Care Coordinator Behavioral Health Coach Children’s Behavior Specialist Children’s Social Skills Worker Clinical Director Clinical Supervisor Counselor Educator Mental Health Practitioner Inpatient Behavioral Care Manager Licensed Therapist Psychotherapist Senior Case Manager School Counselor School & Family Mental Health Therapist

Offering a full range of services, including:* Assessment and diagnosis Psychotherapy Treatment planning and utilization review Brief and solution-focused therapy Alcoholism and substance abuse treatment Psychoeducational and prevention programs Crisis management

Sources: Indeed Job Search Engine http://www.indeed.com/jobs?q=Licsw+Lpcc&start=30 Career Builder http://www.careerbuilder.com *American Mental Health Counselors Association http://www.amhca.org/about/facts.aspx

CURRENT STATE: 2013 Master-LevelMental Health Professional Counts

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According to the American Counseling Association:

LPC/LPCCs: 126,378 nationwide300 licensed in CA (as of 3/19/13)

LMFTs: 58,007 nationwide Over 33,000 licensed in CA

LCSWs: 224,593 nationwideOver 19,000 licensed in CA

Source: American Counseling Association – Office of Public Policy and Legislation - 2013

COUNSELOR LICENSURE LAW: IMPLEMENTATION OF SB 788

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Oct 2009: Governor Schwarzenegger signed SB 788 into LawLegislation amended the CA Business & Professions CodeBoard of Behavioral Sciences identified as the regulatory agency

responsible for the licensure of counselors*

Jan 2010: SB 788 became law

Jul 2011: Applications became available from the BBS Grandparenting Path (application deadline 12/31/2011): non-BBS-licensed

counselors and currently licensed LMFTs and LCSWs in CA Traditional Path: for LPCs from other states, PCC Intern registration

Feb 2012: First LPCC licenses were issued

Sources: California Association for Licensed Professional Clinical Counselors www.calpcc.org *The National Certified Counselor / Volume 25, Number 3 / Fall 2009

LPCCs & PCCIs ARE MEDI-CAL PROVIDERS

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Dec 18, 2012: California LPCCs and PCC Interns were approved as providers of Medi-Cal servicesWill provide services within their scope under state law through the

county mental health systems

Will abide by procedures and processes parallel to those currently used for LMFTs, MFTIs, LCSWs and ASWs

Source: The California State Plan Amendment (SPA) developed by California’s Department of Health Care Services (DHCS) and approved by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services

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Council for Accreditation of Counseling and Related Educational Programs (CACREP): A specialized accrediting body recognized by the Council for Higher Education Accreditation (CHEA)

CACREP grants accredited status to graduate-level programs in the professional counseling field.

The CACREP scope of accreditation includes the following program areas: Addiction Counseling Career Counseling Clinical Mental Health Counseling Marriage, Couple, and Family Counseling School Counseling Student Affairs and College Counseling Counselor Education and Supervision

Federal Law: LPCCs must graduate from CACREP-accredited mental health counseling training programs in order to provide counseling services at the Department of Defense (DoD) and VA programs, and those services reimbursed by Tricare (Health care insurance program for military beneficiaries: active duty, retired, families)*

Sources: Council for Accreditation of Counseling and Related Educational Programs (CACREP) http://www.cacrep.org *Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations

CACREP’SSCOPE OF ACCREDITATION

HOW ARE LPCCs QUALIFIED?

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According to the American Counseling Association (2011): “LPCC education and training standards for licensure are on par with those of the other two master’s level mental health

providers (clinical social workers and marriage and family therapists)”

California requirements for LPCCs: Possession of a 60-unit master’s or doctoral degree in counseling, or a closely related degree, from a regionally

accredited or “approved” institution of higher education that includes certain core content areas

Completion of a minimum of 3,000 hours of post-master’s supervised clinical experience, performed over two years, and continuing education hours for renewal

Passage of a California Law & Ethics Exam (taken during first year of internship)

Passage of the National Clinical Mental Health Counselor Examination (NCMHCE) (taken after supervision requirements have been met)

Adherence to a strict Code of Ethics and recognized standards of practice, as regulated by California’s Board of Behavioral Sciences

Sources: Business and Professions Code, Chapter 16, Licensed Professional Clinical http://www.leginfo.ca.gov Board of Behavioral Sciences http://www.bbs.ca.gov American Counseling Association http://www.counseling.org/PublicPolicy/WhoAreLPCs.pdf California Association for Licensed Professional Clinical Counselors www.calpcc.org

LPCC EDUCATION REQUIREMENTS

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For individuals beginning graduate study ON or AFTER August 1, 2012:A qualifying master’s or doctoral degree that includes: 60 semester-units (or 90 quarter-units) in counseling or psychotherapy from

an accredited or approved university with: 13 core content areas: At least 3 semester-units (or 4 ½ quarter-units)

o 3 of 13 areas may be completed post-degree, but all must be completed before intern registration

Supervised practicum/fieldwork: 6 semester-units (or 9 quarter-units) with a minimum of 280 hours of face-to-face supervised clinical experience counseling individuals, families, or groups

Sources: Business & Profession Code 4999.33 Board of Behavioral Sciences http://www.bbs.ca.gov California Association for Licensed Professional Clinical Counselors www.calpcc.org

2012 LPCC CORE CONTENT AREAS

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10 of the 13 Core Content areas must be included in the degree and all must be completed before education can be approved:

1. Counseling and psychotherapeutic theories and techniques2. Human growth and development across the lifespan3. Career development theories and techniques4. Group counseling theories and techniques5. Assessment, appraisal, and testing of individuals6. Multicultural counseling theories and techniques7. Principles of the diagnostic process8. Research and evaluation9. Professional orientation, ethics, and laws in counseling10. Psychopharmacology11. Addictions counseling12. Crisis or trauma counseling13. Advanced counseling and psychotherapeutic theories and techniques

Sources: Business & Profession Code 4999.33 Board of Behavioral Sciences http://www.bbs.ca.gov California Association for Licensed Professional Clinical Counselors www.calpcc.org

LPCC EDUCATION REQUIREMENTS (CONT’D)

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The 60 graduate semester units (or 90 graduate quarter units) of instruction shall, in addition to meeting the 13 core content areas, include instruction in all of the following:

(1) The understanding of human behavior within the social context of socioeconomic status and other contextual issues affecting social position

(2) The understanding of human behavior within the social context of a representative variety of the cultures found within California

(3) Cultural competency and sensitivity, including a familiarity with the racial, cultural, linguistic, and ethnic backgrounds of persons living in California

(4) An understanding of the effects of socioeconomic status on treatment and available resources (5) Multicultural development and cross-cultural interaction, including experiences of race, ethnicity, class, spirituality, sexual

orientation, gender, and disability and their incorporation into the psychotherapeutic process (6) Case management, systems of care for the severely mentally ill, public and private services for the severely mentally ill,

community resources for victims of abuse, disaster and trauma response, advocacy for the severely mentally ill, and collaborative treatment

(7) Human sexuality, including the study of the physiological, psychological, and social cultural variables associated with sexual behavior, gender identity, and the assessment and treatment of psychosexual dysfunction

(8) Spousal or partner abuse assessment, detection, intervention strategies, and same-gender abuse dynamics (9) Child abuse assessment and reporting (10) Aging and long-term care, including biological, social, cognitive, and psychological aspects of aging. This coursework shall

include instruction on the assessment and reporting of, as well as treatment related to, elder and dependent adult abuse and neglect.

Sources: Business & Profession Code 4999.33 Board of Behavioral Sciences http://www.bbs.ca.gov

LPCC EDUCATION REQUIREMENTS (CONT’D)

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Within the 60 graduate semester units (or 90 graduate quarter units) of instruction: 15 semester units or 22.5 quarter units of advanced coursework to develop knowledge of specific treatment

issues or special populations

A degree program that qualifies for licensure under B & P Code 4999.33 shall do all of the following:

(1) Integrate the principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments

(2) Integrate an understanding of various cultures and the social and psychological implications of socioeconomic position

(3) Provide the opportunity for students to meet with various consumers and family members of consumers of mental health services to enhance understanding of their experience of mental illness, treatment, and recovery.

Sources: Business & Profession Code 4999.33 Board of Behavioral Sciences http://www.bbs.ca.gov

LPCCs SUPERVISION REQUIREMENTS

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Supervised experience requires: Completion of education requirements Registration with the BBS 3,000 post-degree hours of supervised clinical mental health experience, with an

approved supervisor, over a period of not less than two years (104 weeks) and no more than six years to include:

Not less than 1,750 hours of direct counseling At least one hour of individual or two hours of group supervision each week that

counseling takes place Not less than 150 hours of clinical experience in a hospital or community health

setting Not more than 1,250 hours of supervisor contact, test administration, writing

progress notes, attending training sessions, client centered advocacy, etc.

Sources: Business & Profession Code 4999.42, 45, 46, 47, 48 Board of Behavioral Sciences http://www.bbs.ca.gov California Association for Licensed Professional Clinical Counselors www.calpcc.org

WHO CAN SUPERVISE PCC INTERNS?

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An approved supervisor must have:2 years of clinical experience in CA as a LPCC, LMFT, LCSW,

licensed clinical psychologist or licensed physician certified in psychiatry

Received professional training in supervision

Not provided therapeutic services to the trainee or intern

A current and valid license that is not under suspension or probation

Source: California Association for Licensed Professional Clinical Counselors www.calpcc.org

LPCCs SCOPE OF PRACTICE IN CALIFORNIA

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California Business & Professions Code 4999.20. (a) (1):"Professional clinical counseling" means the application of

counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues, including personal growth, adjustment to disability, crisis intervention, and psychosocial and environmental problems.

Professional clinical counseling includes conducting assessments for the purpose of establishing counseling goals and objectives to empower individuals to deal adequately with life situations, reduce stress, experience growth, change behavior, and make well-informed, rational decisions.

LPCCs SCOPE OF PRACTICE IN CALIFORNIA

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California Business & Professions Code 4999.20. (a) (2):"Professional clinical counseling" is focused exclusively on

the application of counseling interventions and psychotherapeutic techniques for the purposes of improving mental health, and is not intended to capture other, nonclinical forms of counseling for the purposes of licensure. For purposes of this paragraph, "nonclinical" means nonmental health.

LPCCs SCOPE TRANSLATED:

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California Business & Professions Code 4999.20. (a) (1):

Application of counseling interventions and psychotherapeutic techniques to improve mental health

California Business & Professions Code 4999.20. (a) (2):

The license is not intended to capture other, non-clinical, non-mental health forms of counseling

Source: California Association for Licensed Professional Clinical Counselors www.calpcc.org

WHAT DOES THE SCOPE NOT INCLUDE?FOR CA LPCCs

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California Business & Professions Code 4999.20. (a) (3):

The assessment or treatment of couples or families, or the supervision of MFT interns, unless the LPCC has:

6 semester-units (or 9 quarter-units) focused on MFT OR

A named specialization in MFT AND

500 hours supervised experience working with couples, families or children AND

6 hours of CEUs in MFT in each renewal cycle

WHAT ELSE DOES THE SCOPE NOT INCLUDE?FOR CA LPCCs

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California Business & Professions Code 4999.20. (a) (3):

Projective techniques in the assessment of personality

Individually administered IQ tests

Neuropsychological testing

Utilization of a battery of 3 or more tests to determine presence of psychosis, dementia, amnesia, cognitive impairment or criminal behavior

COURTESY OF A CALIFORNIA UNIVERSITY (ANNONYMITY PREFERRED): Recruitment and Retention of Diverse StudentsThe Counseling Program and the Clinical Mental Health specialization have made specific efforts to attract, enroll, and retain a diverse student population. In the 2012-2013 academic year, 43% of the students enrolled in the CMHC program were classified by the Registrar’s office as minority representatives. The gender and race/ethnic distribution of students and graduates across the 2010-2012 cohorts is presented in the table below:

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Counseling M.A.

CMHC Total

Male FemaleHispanic/Latino 1 8 9Black/African- American 1 1

Asian 2 5 7

Hawaiian/ Pacific Islander

White 6 17 23Multiracial (two or more races) 4 4Unknown 5 5American Indian or AK Native

0

Nonresident Alien 1

Total Students 9 40 49

Table : Gender and Race/Ethnic Distribution of 2010-2012 CMHC Cohort

FUTURE NEED

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According to a 2012 Health Benefits Exchange Briefing by Dale Jarvis, it is not unreasonable to assume that an additional 200,000 to 300,000 uninsured individuals in the safety net needing behavioral health services will obtain coverage beginning in 2014 and present for care.

Although progress has been made with the support of MHSA funding to support workforce development, many challenges remain.

Our behavioral health system is not ready to meet the needs of an additional 200,000 behavioral health consumers in a culturally/ linguistically competent and recovery-oriented manner.

Additional efforts are needed to ensure that behavioral health providers reflect the cultural and linguistic profiles of the communities they serve, the entire workforce is trained in the provision of recovery-oriented care.

FUTURE NEED (CONT’D)

Dale Jarvis also predicts a need for 3,866 to 5,205 additional behavioral health clinicians by 2019.

Employers are not necessarily looking for a specific occupation; but rather seeking specific functions in their workforce; e.g., those individuals who can truly understand the mission and values of the public mental health system.

LPCCs bring essential functions to the public mental health workforce that will be needed to address the mental health demands of the newly insured.

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TARGET GROUPS

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• Career hotline workers• Case managers/MH workers/Individuals with lived experiences• Career Counselors at High Schools and Colleges• Deaf and Hard of Hearing community• Jr. High/High Schools & Community College Students• LPCCs from other states• Undergraduates: Social work, Sociology, Psychology, Human Services, Education• Psychology clubs @ college campuses• Substance abuse counselors• Those working within inpatient systems • Underserved ethnic groups• Under-represented groups• Veterans • Older students• Online Universities

HEARTFUL THANKS TO ALL OUR SOURCES CONSULTED: Subject Matter Experts

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Dean Porter, Executive Director Kim Madsen, Executive Officer California Association for LPCC Board of Behavioral Sciences

Leah Brew, Ph.D., LPCC Susan Mandel, Ph.D., President/CEO California State University, Fullerton Pacific Clinics

Janee Booth-Gragg, Ph.D., LMFT David Miller, LMFT, LPCC University of Redlands Fresno County Behavioral Health

Rhonda Chabran, LCSW Marianne Ruffolo, MBA Pacific Clinics San Bernardino County Behavioral Health

Carla Cross, LMFT David Schoelen, LCSW Ventura County Behavioral Health Riverside County Behavioral Health

Rita Downs, M.Ed., MPA Roman Shain, Ph.D., LMFT, LPCC CalMHSA Regional Contract Specialist San Fernando Valley Community MH Center

Beth Jenks, Ph.D. Sheree Summers, LMFT Pacific Clinics Riverside County Behavioral Health

Karen Lee, LMFT Laura Williams, M.S., MBA, SSGB, CHC Pacific Clinics Butte County Behavioral Health

Susan Zgliczynski, Ph.D., LPCC University of San Diego

SOURCES CONSULTED: Literature Review

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American Counseling Association http://www.counseling.org/PublicPolicy/WhoAreLPCs.pdf American Mental Health Counselors Association http://www.amhca.org/about/facts.aspx

Board of Behavioral Sciences http://www.bbs.ca.gov/pdf/publications/pcci_faq.pdf Business and Professions Code, Chapter 16, Licensed Professional Clinical Counselors http://www.leginfo.ca.gov

California Association for Licensed Professional Clinical Counselors (CALPCC) www.calpcc.org California State University of Fullerton / College of Health & Human Development http://hhd.fullerton.edu/counsel/degree.htm#MFT%20Licensure%20Preparation

Career Builder http://www.careerbuilder.com Council for Accreditation of Counseling and Related Educational Programs (CACREP) http://www.cacrep.org Counselor License Resources http://www.counselor-license.com/states/california-counselor-license.html

Dyeson, T.B., Social Work Licensure: History and Definition, Home Health Care Management & Practice / August 2004 / Volume 16, Number 5, 408-411

http://www.sagepub.com/jimenezstudy/articles/Dyeson.pdf

Esptein, J., The Living History of the MFT License, The Therapist / January-February 2013 https://www.camft.org

Federal Register / Vol. 76, No. 248 / Tuesday, December 27, 2011 / Rules and Regulations http://www.gpo.gov/fdsys/pkg/FR-2011-12-27/pdf/2011-33109.pdf

Indeed Job Search Engine http://www.indeed.com/jobs?q=Licsw+Lpcc&start=30

The National Certified Counselor / Volume 25, Number 3 / Fall 2009 http://www.nbcc.org/Assets/Newsletter/Issues/fall09.pdf

University of Redlands / Masters of Arts in Clinical Mental Health Counseling http://www.redlands.edu/academics/school-of-education/11789.aspx University of San Diego / Masters of Arts in Counseling http://www.sandiego.edu/soles/academics/ma-counseling-clinical-mental-health/

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LACK OF CLARITY AND DELINEATION: LPCC ROLE AND SCOPE

Barrier Recommendation- LPCC is a new state licensed profession, therefore not familiar to CA’s public health care system and diverse community-based MH/Behavioral Health providers.

- Lack of clarity and understanding in LPCCs professional role, scope of practice, scope of competency, and supervisory capability.EX: Employers do not know if LPCCs are professionally comparable in education, training and scope with LCSWs and LMFTsEX: “Counselor” term perceived as “below” other licensed professionals

- Collaboration between key groups that have the ability to educate, communicate, and disseminate information about LPCCs on a statewide level (e.g., BBS, CMHDA, CCCMHA, CiMH, OSHPD, CALPCC)- Campaign to educate workforce providers and payors about LPCC- Use of multi-media approach to educate and communicate to the public and diverse communities about LPCCs professional role, scopes of practice and competency, and supervisory capability

County DMHs and MH contract providers would like to employ LPCCs but hesitant to do so due to lack of clarity and understanding in LPCCs professional role, restriction in scope, and supervisory capability.

EX1: Myth about LPCCs not within scope of practice to treat childrenEX2: Myth that LPCCs training and scope is not paralleled with LMFTs

- Public/community education on LPCCs (role, scope, supervisory capabilities) via a multi-media approach- Collaboration with County DMHs and MH providers in educating the local communities on LPCCs

Most County DMHs do not have LPCC job classifications/descriptions within their system. Lengthy and multi-layered approval process to develop new job classification/description.

-Update job descriptions to include LPCCs as qualified for certain common jobs and work functions-Develop regional county ad hoc committee that includes HR staff to develop standardize LPCC job classification/description- Share classifications statewide that have been developed in counties (e.g., some counties have generic therapist classifications that do not require changes to include LPCCs)

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RESTRICTION IN SCOPE OF PRACTICE

Barrier Recommendation- Restriction in Scope of Practice, that requires LPCCs to have additional education and training (6-semester units, 500 supervised hours, CEUs), to see couples and families is not commensurate with the LPCC Scope of Competency. This restriction devalues the rigorous LPCC requirements in California, which exceed or are on par with LPCCs in the other 49 states, and are on par with LMFTs and LCSWs in California.

- California is the only state that has this Scope restriction for LPCCs. California psychologists, LCSWs and LMFTs do not have this restriction in Scope.

- Counties and CBOs (community-based organizations) are hesitant to develop job descriptions or to hire LPCCs or PCC interns, as neither employers nor the regulatory body is prepared to monitor this additional education and training. The restriction thereby inadvertently undermines LPCCs unique contribution to the MH/Behavioral health sectors.

- The Scope restriction may discourage potential students to pursue a career as a LPCC, which may negatively impact employment recruitment efforts; perpetuate lack of workforce diversity; and prolong the shortage of qualified trained mental health professionals in the public MH/Behavioral health field.

-Remove restriction in the LPCC Scope of Practice, that requires additional education requirements to see couples and families, and recognize the rigor of the LPCC preparation.

- Ensure parity in Scope among the master's-level licensed disciplines in California, so counties can feel free to hire LPCCs and PCCIs.

- Model after the other 49 states’ LPCC Scope requirements. The other 49 states do not have any Scope restrictions placed on LPCCs.

- Enhance collaboration among the licensed disciplines in California, and with their state/national affiliated associations.

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RESTRICTION IN SUPERVISORY CAPABILITY

Barrier RecommendationRestriction in supervisory capability: (1)Only LMFTs and LPCCs (if LPCC has met the 3 additional education and training requirements) can supervise PCC interns for the additional supervised 500 specifically working with couples, families and children. May create hardship for employers who do not have LMFTs or LPCCs in their organizations to provide required supervision. May discourage employers to hire LPCCs.

(2)MFT interns can be supervised by LCSWs and Licensed Psychologists without restrictions (i.e., neither discipline is required to take the additional education requirements).

(3)MFT interns can be supervised by LPCCs, only if the LPCC has met the additional education and training requirements. No other state has laws or regulations that require additional education and training for LPCCs to supervise MFT Interns. May discourage employers to hire LPCCs.

(4) Due to newness of licensure, LPCCs are not yet able to supervise PCC interns (e.g., requires two years of the license to supervise). Unclear to the MH/Behavioral health providers as to who can supervise PCC interns

- Remove restriction in LPCC supervision capability, which will encourage employers to hire LPCCs. Will enhance the diversity of perspectives and training within the psychotherapy and counseling fields

- CA to model after the other 49 states in LPCC supervisory capability. The other 49 states do not require additional education and training for LPCCs to supervise MFT interns.

- Enhance collaboration among the licensed disciplines and their state/national affiliated associations.

- Use multi-media approach in educating the community about licensed professionals who can supervise PCC interns

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LIMITED PRACTICUM AND INTERNSHIP SITES

Barrier Recommendation-Limited pre-degree practicum and post-degree internship sites for PCC interns

- Lack of knowledge of PCC programs by DMH and CBOs

- Outreach to county DMHs and community-based providers, and provide information/education on LPCCs and the benefits of having practicum students and PCC interns in their organizations/agencies

- Enhance collaboration between academic institutions, DMH and CBOs to create community-based practicum and internship sites for PCC interns

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COST OF EDUCATION

Barrier RecommendationCOST OF EDUCATION IS NOT AFFORDABLE TO MANYIn state applicants: Increased education requirement of 60-units is costly (e.g., 3 unit course costs range $560-$3,600). May significantly impact applicant’s decision to go into the LPCC career pathway.

Out of state applicants: - Experienced LPCs with degrees granted before the 2012 requirements must take the long list of additional courses; college credit course in psychopharmacology; take 90 CEU hours, plus pass the CA Law & Ethics Exam and the NCMHCE (unless already taken in their state).

- Education cost for out-of-state applicants is approximately $2,324 (costs may vary, includes: BBS & National Exam fees; CE and college courses; national & state exam study guides). May significantly impact out of state LPCs’ decision to work in California. - California may become deprived of the diversity of qualified and experienced licensed counselors from other states.

Develop financial incentive programs for LPCC students, such as educational scholarships, stipends, and loan forgiveness & repayment programsEX: MHSA funded stipends provided for MFT students within MFT Consortium and MSW students within the CalSWEC Consortium

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CROSSCUTTING: BBS REGULATORY AND RESOURCE CHALLENGES

Barrier RecommendationLack of needed resources (e.g., staffing) at BBS has delayed SB 788 Implementation- According to BBS, evaluation of applications for registration as a LPCC intern and out of state applicants takes approximately “up to 60 days”- BBS anticipates that the initial evaluation of all grandfather LPCC applications will be completed no later than December 2013

Add staff to support BBS’s efforts to expedite applications

Lack of needed resources at BBS has delayed curricula approval process, subsequently delaying universities’ ability to implement LPCC counseling training programs

Add staff to support BBS’s efforts to expedite curricula approval process

NOTE: Recent communication with BBS indicates that, to date, the Board has completed its review of the schools with LPCC programs. List of schools with LPCC programs: http://www.bbs.ca.gov/lpcc_program/lpcc_schools.shtml

Regulatory challenge: to identify and track those who have met the required 500 hours supervised experience working with couples, families or children

Add staff to support BBS’s efforts to identify and track LPCC licensure requirement

Out of state applicants: how to determine most effective/efficient way to integrate CA degree requirements (e.g., CE vs. going through formal education process)

Add staff to support BBS’s efforts in this area

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LIMITED CACREP PROGRAM ACCREDITATION

Barrier RecommendationOnly some Counseling Training Programs in CA are CACREP-accredited (most CSU programs are; most private university programs are not): may impact number of LPCCs who can work at DoD and VA programs, unless LPCC graduated from a CACREP-accredited counseling program. Adds to statewide workforce shortage of qualified MH professionals, particularly in working with Vets, those on active duty, and their families.

- Encourage more university counseling programs to become CACREP-accredited- Provide financial incentives to students who attend CACREP-accredited counselor training programs.

Online (often private) universities who offer counseling training programs that are CACREP-accredited are often more expensive than traditional state universities. Increased tuition can be an added hardship on the potential student, who may decide to go into another (non-MH/BH) educational and career pathway.

Develop scholarships, stipends and loan forgiveness/repayment targeted to LPCCs

NOTE: There are no alternative accreditation bodies for LPCC programs specific to California, only nationally via CACREP. California Business & Professions Code Section 4999.12 (b) and (c): For purposes of this chapter, the following terms have the following meanings: (b) "Accredited" means a school, college, or university accredited by the Western Association of Schools and Colleges, or its equivalent regional accrediting association. (c) "Approved" means a school, college, or university that possessed unconditional approval by the Bureau for Private Postsecondary Education at the time of the applicant's graduation from the school, college, or university.

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CALIFORNIA HAS NO DOCTORAL PROGRAM IN COUNSELOR EDUCATION

Barrier Recommendation-CAPREP accreditation requires full-time instructors to have doctoral degrees in Counselor Education.-California has no doctoral programs in Counselor Education.

Collaborate with the UC, CSU and private universities, to develop doctoral programs to prepare counselor educators

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TOP 4 LPCC PATHWAY BARRIERS & RECOMMENDATIONS ADDRESS MHSA CORE VALUES & WET GOALS

Barriers Recommendations Supports MHSA Core Values* and WET Goals**

(Sources: *CA BBS and **OSHPD)

(1) New state licensed profession: Lack of clarity and understanding of LPCC Scope and Role

Collaboration between key groups on statewide level and campaign to educate workforce providers and payors about LPCC

MHSA CORE VALUES: (1) Develop a diverse, culturally sensitive and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. (2) Outreach to underserved and unserved populationsWET GOALS: (1) Increase the quality and success of educating and training the public mental health workforce in the expressed values of the Act (2) Increase the partnership and collaboration of all entities involved in public mental health workforce education and training

(2) Restriction in Scope of Practice & Supervisory Capability

Remove restrictions in Scope of Practice & Supervisory Capability. CA to model after 49 states that do not have Scope and Supervisory Capability restrictions. Collaboration among the licensed disciplines

MHSA CORE VALUES: (1) Develop a diverse, culturally sensitive and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. (2) Promote wellness, recovery and resilience (LPCCs are formally trained in principles of MH recovery-oriented care)WET GOALS: (1) Develop sufficient qualified individuals for the public mental health workforce (2) Increase the quality and success of educating and training the public mental health workforce in the expressed values of the Act (3) Increase the partnership and collaboration of all entities involved in public mental health workforce education and training

(3) Limited Pre-degree practicum & Post-degree internship sites for PCC Interns

Collaboration between academic institutions, DMH and CBOs to create community-based practicum/internship sites, and educate staff about benefits of PCC interns

MHSA CORE VALUES: Develop a diverse, culturally sensitive and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. WET GOALS: (1) Increase the quality and success of educating and training the public mental health workforce in the expressed values of the Act (2) Increase the partnership and collaboration of all entities involved in public mental health workforce education and training(3) Develop sufficient qualified individuals for the public mental health workforce

(4) Cost of Education not affordable Develop financial incentive programs for LPCC graduates. Create employment commitment incentives for LPCC graduates to work in public behavioral health similar to other MHSA WET stipend programs (MSW, MFT)

MHSA CORE VALUES: Develop a diverse, culturally sensitive and competent workforce in order to increase the availability and quality of mental health services and supports for individuals from every cultural group. WET GOALS: (1) Develop sufficient qualified individuals for the public mental health workforce(2) Increase the quality and success of educating and training the public mental health workforce in the expressed values of the Act

Coordinated Health Workforce Pathway

Target Groups: • Career hotlines workers Case managers/MH workers/Lived

Experience• Deaf/HoH community Jr. High/H.S. & Comm College Students• LPCCs from other states Undergraduates: SW, Soc, Psych,

Education• Psychology clubs @ college campuses• Substance abuse counselors• Those working within Inpatient systems • Underserved ethnic groups• Under represented groups• Veterans • Older Students• Online Universities

Target Groups: • Career hotlines workers Case managers/MH workers/Lived

Experience• Deaf/HoH community Jr. High/H.S. & Comm College Students• LPCCs from other states Undergraduates: SW, Soc, Psych,

Education• Psychology clubs @ college campuses• Substance abuse counselors• Those working within Inpatient systems • Underserved ethnic groups• Under represented groups• Veterans • Older Students• Online Universities

Quality, Diverse Health

Workforce

Pre-Training Health Professions Education Workforce

Career Awareness

Assessment

Academic Preparation & Entry Support

Financial & Logistic Feasibility

Health Professions Training Program Access

Training Program Retention

Internships Hiring & Orientation

K-12 Education

Cultural Sensitivity and Responsiveness

Retention & Advancement

Financing & Support Systems

Lack of doctoral programs in Counselor Education

Limited pre-degree

practicum & post-degree

internship sites

Adapted from the coordinated health career pathway developed by Jeff Oxendine.

Lack of information or awareness about

LPCCs as a career choice

Lack of clarity of LPCC role and scope.

Cost of education not affordable, for In-state

& Out-of-state applicants

Lack of financial

incentives

New state licensed

profession

Restriction in Scope of Practice

& Supervisory Capability

Limited CACREP Accreditation. LPCC must graduate from CACREP accredited

school to work in DoD and VA programs

ACTION PLAN: NEXT STEPS

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Begin public/community education campaign on LPCCs

1. Provide LPCC Career Pathway presentation to:• California Mental Health Directors Association (CMHDA)• CMHDA Medi-Cal Policy• California Council of Community Mental Health Agencies (CCCMHA)

2. Q & A Forum: California Institute for Mental Health (CiMH) Hot Topic Webinar

3. Information sessions: Invite CALPCC Executive Director to speak at DMH and CBO management staff meetings to educate, communicate, and disseminate information about LPCCs

4. Survey DMH and CBOs regarding LPCC recruitment and hiring, or barriers to recruit/hire LPCCs. Sample questions may include:

- Are you hiring LPCCs?- If yes, are there any barriers you have encountered and how have you overcome them?- If not, please list the barriers for your county/organization- If you are interested in hiring LPCCs but have not yet, please list what material or information would be

helpful for your county/organization

THANK YOU!

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