WSR 06-10-083

PROPOSED RULES

DEPARTMENT OF HEALTH


[ Filed May 3, 2006, 10:02 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 01-22-068 and 06-07-192.

Title of Rule and Other Identifying Information: WAC 246-809-110 Definitions, 246-809-130 Supervised postgraduate experience, 246-809-134 Approved supervisor, 246-809-210 Definitions, 246-809-230 Supervised postgraduate experience, 246-809-234 Approved supervisor, 246-809-310 Definitions, 246-809-320 Education requirements and supervised postgraduate experience, and 246-809-334 Approved supervisor standards and responsibilities for licensed marriage and family therapists, licensed mental health counselors, and licensed social workers.

Hearing Location(s): Department of Health, Point Plaza East, Room 139, 310 Israel Road S.E., Tumwater, WA 98501, on June 8, 2006, at 10:00 a.m.

Date of Intended Adoption: June 8, 2006.

Submit Written Comments to: Holly Rawnsley, P.O. Box 47869, Olympia, WA 98504-7869, e-mail http://www3.doh.wa.gov/policyreview/, fax (360) 236-4909, by June 22, 2006.

Assistance for Persons with Disabilities: Contact Holly Rawnsley by June 1, 2006, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposal amends WAC 246-809-130, 246-809-230, and 246-809-320 and creates new sections WAC 246-809-110, 246-809-134, 246-809-210, 246-809-234, 246-809-310, and 246-809-334.

The purpose of this proposal is to clearly define the terms that apply to licensure for marriage and family therapists, mental health counselors, and social workers. The proposal also identifies the requirements for postgraduate experience and the requirements necessary to become an approved supervisor.

Reasons Supporting Proposal: The proposal updates the rules to reflect changes to the licensed counselor laws. The proposal provides additional clarification regarding postgraduate education requirements and the approved supervisor requirements.

Statutory Authority for Adoption: RCW 18.225.040 and [18.225.]090.

Statute Being Implemented: Chapter 18.225 RCW.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Holly Rawnsley, Department of Health, P.O. Box 47869, Olympia, WA 98504-7869, (360) 236-4912.

A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

1. Briefly describe the proposed rule: Chapter 18.19 RCW was amended to eliminate certification of marriage and family therapists (MFTs), mental health counselors (MHCs) and social workers (SWs). New chapter 18.225 RCW was created for licensing of those counselors. The statute mandates that licensed counselors have a number of supervised postgraduate hours prior to being issued a license. However, the statute does not define who will provide the supervision or the requirements to be an approved supervisor.

The proposed rules do the following:

1. They clearly define terms that apply to licensure of MFTs, MHCs and SWs;

2. They identify the requirements for postgraduate experience;

3. They identify the requirements necessary to become an approved supervisor.

2. Is a small business economic impact statement (SBEIS) required for this rule? Yes, portions of this rule require an SBEIS. However, department of health (department) has reviewed this proposal and has determined that no SBEIS is required for the following portions of the rule.

The proposed rules will allow an equally qualified licensed mental health practitioner to supervise mental health applicants.

An SBEIS is not required because the rule does not impose more than minor costs on affected businesses. Instead, this portion of the rule provides additional resources for applicants.


3. Which industries are affected by this rule?


SIC Industry Code and Title # of Businesses # of Employees Average # of Employees for Smallest Businesses Average # of Employees for 10% of Largest Businesses
8051 Skilled nursing facilities 281 26,407 15 144
8063 Psychiatric hospitals 6 3,177 0 147
8221 Colleges and universities 124 43,952 31 3,454
8322 Individual and family services 1,261 29,061 31 181
8399 Social services, not elsewhere classified 372 3,400 4 36

4. What are the costs of complying with this rule for small businesses (those with fifty or fewer employees) and for the largest 10% of businesses affected? The rules require approved supervisors to complete a minimum of fifteen clock hours of training in clinical supervision prior to beginning to supervise prospective licensees. The elements of the fifteen hour training course include ethical, legal and philosophical issues relating to supervision. The cost of obtaining individual supervision by an applicant from an approved supervisor ranges from $65 to $125 an hour. An applicant may also choose to obtain group supervision which may range from $100 to $150 an hour, split among the group of supervisees. The cost to supervisees would be approximately the same as it was under the old certification rules.

Requiring fifteen hours of training in supervision is a new cost that was not previously required for approved supervisors for certification. This change will increase the cost to be an approved supervisor for licensure applicants. However, the fees that supervisors charge prospective applicants for supervision would more than offset the cost of the training for approved supervisors.

The cost of a two day training course in supervision ranges from $200 to $250. The cost of a two day continuing education (CE) course on supervision would be the same, approximately $200 to $250 or, if the employer pays through an agency grant, the CE course would be no cost to the supervisor. The cost of fifteen hours of supervision would depend on who provides this service, a licensed counselor or licensed psychiatrist. The range for a licensed counselor supervisor is $125 to $150 an hour. The range for a licensed psychiatrist may reach $175 an hour. Group supervision costs range from $200 to $250 an hour, split among the group.

The Washington state mental health counselors, marriage and family therapists, and social workers advisory committee was created by the legislature to provide the department of health with expertise and assisted in the accurate assessment of the costs of the proposed rules.

5. Does the rule impose a disproportionate impact on small businesses? If individual supervisors pay for the costs of their individual supervision training, then small businesses would not be disproportionately affected. However, if we assume that employers pay for the costs of supervision, the supervisor training requirement cost is disproportionate to small businesses as the following table shows. This analysis was based on the assumption that small businesses employ one supervisor and large businesses employ two supervisors to supervise prospective applicants for licensure who are employed by the business.

SIC Industry Code and Title Average # of Employees for Smallest Businesses Average # of Employees for 10% of Largest Businesses Costs of

Rule Change

Small Businesses

Costs of

Rule Change

Large

Businesses

Average Cost

Per Employees

Small Businesses

Average Cost

Per Employees

Large

Businesses

8051 Skilled nursing facilities 15 144 $250 $500 16.67 3.47
8063 Psychiatric hospitals 0 147 $250 $500 3.40
8221 Colleges and universities 31 3,454 $250 $500 8.06 0.14
8322 Individual and family services 31 181 $250 $500 8.06 2.76
8399 Social services, not elsewhere classified 4 36 $250 $500 62.50 13.89

6. If the rule imposes a disproportionate impact on small businesses, what efforts were taken to reduce that impact (or why is it not "legal and feasible" to do so) by: Parts of the proposed rule impose a disproportionate impact to small businesses. In order to mitigate the impact of these costs, the department focused on reducing costs associated with the following parts of the rule.

The proposed rules allow a person to be an approved supervisor if they have not been the licensure candidate's therapist for the past two years. The rules on certification did not specify a length of time and limited the pool of potential approved supervisors to only those who had never been the licensure candidate's therapist. By specifying a length of time, which is less than the original certification rule, this may increase the pool of potential supervisors.

The SW proposed rules do not include a limit on the number of supervisees an approved supervisor may meet with at one time. The MHC and MFT rules include a limit of two supervisees to one supervisor for "individual or one-on-one" supervision. The MFT rules also include a limit of six supervisees to one supervisor for "group" supervision. The previous general certification definition rules included a limit of two supervisees to one supervisor for all categories of approved supervisors.

The proposed rules require that the supervisor must hold a license without restrictions that has been in good standing for at least two years in all categories. The previous certification rules required three years of employment as a licensed counselor for all categories.

The proposed rules require twenty-five hours of supervision experience rather than one year of supervision experience required by the certification rules for all categories of licensed counselors.

The advisory committee considered including language making the approved supervisors legally responsible (liable) for the actions of supervisees but decided to exclude that provision in these rules.

Although the rule causes a disproportionate impact to small businesses, the benefit to the public outweighs the cost.

7. How are small businesses involved in the development of this rule? Many social service agencies are small businesses. They have been regularly informed of the rule development and invited to participate in the rule-making process through the distribution of advisory committee meeting agendas and minutes.

A copy of the statement may be obtained by contacting Holly Rawnsley, P.O. Box 47869, Olympia, WA 98504-7869, phone (360) 236-4912, fax (360) 236-4909, e-mail Holly.Rawnsley@doh.wa.gov.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Holly Rawnsley, P.O. Box 47869, Olympia, WA 98504-7869, phone (360) 236-4912, fax (360) 236-4909, e-mail Holly.Rawnsley@doh.wa.gov.

May 2, 2006

Mary C. Selecky

Secretary

OTS-8748.3


NEW SECTION
WAC 246-809-110   Definitions.   The following terms apply to the licensure of marriage and family therapists.

(1) "Approved educational program" means:

(a) Any college or university accredited by a national or regional accrediting body recognized by the Commission on Recognition of Postsecondary Accreditation or its successor; or

(b) A program accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), at the time the applicant completed the required education.

(2) "Approved supervisor" means a licensed marriage and family therapist, or an equally qualified licensed mental health practitioner.

(3) "Equally qualified licensed mental health practitioner" means a licensed mental health counselor, licensed clinical social worker, licensed psychologist, licensed physician practicing as a psychiatrist, or licensed psychiatric nurse practitioner, who has completed:

(a) Three hundred clock hours in graduate or postgraduate marriage and family education, or continuing education in marriage and family therapy or supervision by an approved marriage and family therapist supervisor in marriage and family therapy or any combination of these; and

(b) Five years of clinical practice that includes the equivalent of one year of clinical practice working with couples and families.

(4) "Group supervision" means face-to-face supervision with an approved supervisor, involving one supervisor and no more than six licensure candidates.

(5) "Licensure candidate" means an individual that is accruing supervised clinical experience required for licensure.

(6) "One-on-one supervision" means face-to-face supervision with an approved supervisor, involving one supervisor and no more than two licensure candidates.

(7) "Supervised experience requirement" means experience that is obtained under an approved supervisor who meets the requirements described in WAC 246-809-134.

(8) "Supervision of supervision" means supervision by an approved supervisor for the purpose of training and qualifying a license holder to act as an approved supervisor for purposes of chapter 18.225 RCW and WAC 246-809-134.

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AMENDATORY SECTION(Amending WSR 01-17-113, filed 8/22/01, effective 9/22/01)

WAC 246-809-130   Supervised postgraduate experience.   The ((following are)) experience requirements for the marriage and family therapist applicant's practice area((:

(1))) include successful completion of a supervised experience requirement. The experience requirement consists of a minimum of two calendar years of full-time marriage and family therapy. Of the total supervision, one hundred hours must be with a licensed marriage and family therapist with at least five years' clinical experience; the other one hundred hours may be with an equally qualified licensed mental health practitioner. Total experience requirements include:

(((a))) (1) A minimum of three thousand hours of experience, one thousand hours of which must be direct client contact; at least five hundred hours must be gained in diagnosing and treating couples and families; plus

(((b))) (2) At least two hundred hours of qualified supervision with ((a)) an approved supervisor. At least one hundred of the two hundred hours must be one-on-one supervision, and the remaining hours may be in one-on-one or group supervision.

(((2))) (3) Applicants who have completed a master's program accredited by the Commission on Accreditation for Marriage and Family Therapy education of the American Association for Marriage and Family Therapy may be credited with five hundred hours of direct client contact and one hundred hours of formal meetings with an approved supervisor.

[Statutory Authority: 2001 c 251, RCW 43.70.250. 01-17-113, 246-809-130, filed 8/22/01, effective 9/22/01.]


NEW SECTION
WAC 246-809-134   Approved supervisor.   (1) The approved supervisor shall hold a license without restrictions that has been in good standing for at least two years.

(2) The approved supervisor shall not be a blood or legal relative or cohabitant of the licensure candidate, licensure candidate's peer, or someone who has acted as the licensure candidate's therapist within the past two years.

(3) The approved supervisor, prior to the commencement of any supervision, shall provide the licensure candidate a declaration, on a form provided by the department, that the supervisor has met the requirements of WAC 246-809-134 and qualifies as an approved supervisor.

(4) The approved supervisor shall have completed the following:

(a) A minimum of fifteen clock hours of training in clinical supervision obtained through:

(i) A supervision course; or

(ii) Continuing education credits on supervision; or

(iii) Supervision of supervision; or

(iv) Any combination of these; and

(b) Twenty-five hours of experience in supervision of clinical practice; or

(c) An American Association of Marriage and Family Therapy (AAMFT) approved supervisor is considered to have met the qualifications above.

(5) The approved supervisor shall attest to having thorough knowledge of the supervisee's practice activities including:

(a) Practice setting;

(b) Recordkeeping;

(c) Financial management;

(d) Ethics of clinical practice; and

(e) A backup plan for coverage.

(6) Applicants whose supervised postgraduate experience began prior to the effective date of these rules are exempt from the requirements of subsection (4) of this section.

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NEW SECTION
WAC 246-809-210   Definitions.   The following definitions apply to the licensure of mental health counselors.

(1) "Approved educational program" means any college or university accredited by an accreditation body recognized by the Council for Higher Education Accreditation (CHEA) or its successor, at the time the applicant completed the required education.

(2) "Approved setting" includes facilities, agencies or private practice where an applicant works with individuals, families, couples or groups under the supervision of an approved supervisor.

(3) "Approved supervisor" means a qualified licensed mental health counselor or equally qualified licensed mental health practitioner who has been licensed without restrictions for at least two years.

(4) "Equally qualified licensed mental health practitioner" means a licensed marriage and family therapist, licensed clinical social worker, licensed psychologist, licensed physician practicing as a psychiatrist, or licensed psychiatric nurse practitioner.

(5) "Group supervision" means face-to-face supervision with an approved supervisor, involving one supervisor and no more than six licensure candidates.

(6) "Immediate supervision" means a meeting with an approved supervisor, involving one supervisor and no more than two licensure candidates.

(7) "Licensure candidate" means an individual that is accruing supervised clinical experience required for licensure.

(8) "Supervision of supervision" means supervision by an approved supervisor for the purpose of training and qualifying a licensee to act as an approved supervisor for purposes of chapter 18.225 RCW and WAC 246-809-234.

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AMENDATORY SECTION(Amending WSR 01-17-113, filed 8/22/01, effective 9/22/01)

WAC 246-809-230   Supervised postgraduate experience.   The ((following are)) experience requirements for the mental health applicant's practice area((:)) include successful completion of a supervised experience requirement. The experience requirement consists of a minimum of thirty-six months full-time counseling or three thousand hours of postgraduate mental health counseling under the supervision of a qualified licensed mental health counselor or equally qualified licensed mental health practitioner in an approved setting. The three thousand hours of required experience includes a minimum of one hundred hours spent in immediate supervision with the qualified licensed mental health counselor or equally qualified licensed mental health practitioner, and includes a minimum of one thousand two hundred hours of direct counseling with individuals, couples, families, or groups.

[Statutory Authority: 2001 c 251, RCW 43.70.250. 01-17-113, 246-809-230, filed 8/22/01, effective 9/22/01.]


NEW SECTION
WAC 246-809-234   Approved supervisor.   (1) The approved supervisor shall hold a license without restrictions that has been in good standing for at least two years.

(2) The approved supervisor shall not be a blood or legal relative or cohabitant of the licensure candidate, licensure candidate's peer, or someone who has acted as the licensure candidate's therapist within the past two years.

(3) The approved supervisor, prior to the commencement of any supervision, shall provide the licensure candidate a declaration, on a form provided by the department, that the supervisor has met the requirements of WAC 246-809-234 and qualifies as an approved supervisor.

(4) The approved supervisor shall have completed the following:

(a) A minimum of fifteen clock hours of training in clinical supervision obtained through:

(i) A supervision course; or

(ii) Continuing education credits on supervision; or

(iii) Supervision of supervision; and

(b) Twenty-five hours of experience in supervision of clinical practice.

(5) The approved supervisor shall have full knowledge of the licensure candidate's practice activities including:

(a) Recordkeeping;

(b) Financial management;

(c) Ethics of clinical practice; and

(d) The licensure candidate's backup plan for coverage in times when the licensure candidate is not available to their clients.

(6) Applicants whose supervised postgraduate experience began prior to the effective date of these rules are exempt from the requirements of subsection (4) of this section.

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NEW SECTION
WAC 246-809-310   Definitions.   The following definitions apply to the licensure of independent clinical and advanced social workers.

(1) "Approved educational program" means a master's or doctoral educational program in social work accredited by the Council on Social Work Education.

(2) "Approved supervisor" means a licensed independent clinical social worker (LICSW), licensed advanced social worker (LASW)(for LASWs only), or an equally qualified licensed mental health practitioner.

(3) "Equally qualified licensed mental health practitioner" means a licensed mental health counselor, licensed marriage and family therapist, licensed psychologist, licensed physician practicing as a psychiatrist, or licensed psychiatric nurse practitioner.

(4) "Group supervision" means face-to-face supervision with an approved supervisor, involving one supervisor and no more than six licensure candidates.

(5) "Licensure candidate" means an individual that is accruing supervised clinical experience required for licensure.

(6) "Nationally recognized standards" means the Educational Policy and Accreditation Standards, revised October 2004 published by the Council on Social Work Education revised October 2004 or any future revisions.

(7) "One-on-one supervision" means face-to-face supervision with an approved supervisor, involving one supervisor and no more than two licensure candidates.

(8) "Supervision of supervision" means supervision by an approved supervisor for the purpose of training and qualifying a licensee to become an approved supervisor for purposes of chapter 18.225 RCW and WAC 246-809-334.

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AMENDATORY SECTION(Amending WSR 01-17-113, filed 8/22/01, effective 9/22/01)

WAC 246-809-320   Education requirements and supervised postgraduate experience.   ((The following are education and experience requirements for the applicant's practice area:

(1) Licensed advanced social worker.

(a) Graduation from a master's or doctoral social work educational program accredited by the council on social work education and approved by the secretary based upon nationally recognized standards; and

(b) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of three thousand two hundred hours with ninety hours of supervision by a licensed independent clinical social worker or a licensed advanced social worker who has been licensed or certified for at least two years. Of those hours, fifty hours must include direct supervision by a licensed advanced social worker or licensed independent clinical social worker; the other forty hours may be with an equally qualified licensed mental health practitioner. Forty hours must be in one-to-one supervision and fifty hours may be in one-to-one supervision or group supervision. Distance supervision is limited to forty supervision hours. Eight hundred hours must be in direct client contact.

(2) Licensed independent clinical social worker.

(a) Graduation from a master's or doctorate level social work educational program accredited by the council on social work education and approved by the secretary based upon nationally recognized standards; and

(b) Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of four thousand hours of experience, of which one thousand hours must be direct client contact, over a three-year period supervised by a licensed independent clinical social worker, with supervision of at least one hundred thirty hours by a licensed mental health practitioner. Of the total supervision, seventy hours must be with an independent clinical social worker; the other sixty hours may be with an equally qualified licensed mental health practitioner. Sixty hours must be in one-to-one supervision and seventy hours may be in one-to-one supervision or group supervision. Distance supervision is limited to sixty supervision hours.)) (1) The following are the education requirements for the social worker applicant's practice area:

(a) Licensed advanced social worker. Graduation from a master's or doctoral social work educational program accredited by the Council on Social Work Education and approved by the secretary based upon nationally recognized standards.

(b) Licensed independent clinical social worker. Graduation from a master's or doctorate level social work educational program accredited by the Council on Social Work Education and approved by the secretary based upon nationally recognized standards.

(2) The following are the supervised postgraduate experience requirements for the social worker applicant's practice area:

(a) Licensed advanced social worker. Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of three thousand two hundred hours with ninety hours of supervision by a licensed independent clinical social worker or a licensed advanced social worker who has been licensed or certified for at least two years. Of those hours, fifty hours must include direct supervision by a licensed advanced social worker or licensed independent clinical social worker; the other forty hours may be with an equally qualified licensed mental health practitioner. Forty hours must be in one-to-one supervision and fifty hours may be in one-to-one supervision or group supervision. Distance supervision is limited to forty supervision hours. Eight hundred hours must be in direct client contact.

(b) Licensed independent clinical social worker. Successful completion of a supervised experience requirement. The experience requirement consists of a minimum of four thousand hours of experience, of which one thousand hours must be direct client contact, over a three-year period supervised by a licensed independent clinical social worker, with supervision of at least one hundred thirty hours by a licensed mental health practitioner. Of the total supervision, seventy hours must be with an independent clinical social worker; the other sixty hours may be with an equally qualified licensed mental health practitioner. Sixty hours must be in one-to-one supervision and seventy hours may be in one-to-one supervision or group supervision. Distance supervision is limited to sixty supervision hours.

[Statutory Authority: 2001 c 251, RCW 43.70.250. 01-17-113, 246-809-320, filed 8/22/01, effective 9/22/01.]


NEW SECTION
WAC 246-809-334   Approved supervisor standards and responsibilities.   (1) The approved supervisor must hold a license without restrictions that has been in good standing for at least two years.

(2) The approved supervisor shall not be a blood or legal relative or cohabitant of the licensure candidate, licensure candidate's peer, or someone who has acted as the licensure candidate's therapist within the past two years.

(3) The approved supervisor, prior to the commencement of any supervision, shall provide the licensure candidate a declaration, on a form provided by the department, that the supervisor has met the requirements of WAC 246-809-334 and qualifies as an approved supervisor.

(4) The approved supervisor shall have completed the following:

(a) A minimum of fifteen clock hours of training in clinical supervision obtained through:

(i) A supervision course; or

(ii) Continuing education credits on supervision; or

(iii) Supervision of supervision; and

(b) Twenty-five hours of experience in supervision of clinical practice; or

(c) Has had two years of clinical experience postlicensure (LASWs only) or five years of clinical experience postcertification or licensure (for LICSWs only).

(5) The approved supervisor shall attest to having thorough knowledge of the licensure candidate's practice activities including:

(a) Specific practice setting;

(b) Recordkeeping;

(c) Financial management;

(d) Ethics of clinical practice; and

(e) The licensure candidate's backup plan for coverage in times when he/she is not available to their clients.

(6) Licensure candidates whose supervised postgraduate experience began prior to the effective date of these rules are exempt from the requirements of subsection (4) of this section.

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Washington State Code Reviser's Office