Title: An act relating to modifying credentialing standards for counselors.

Brief Description: Modifying credentialing standards for counselors.

Sponsors: Representatives Barlow, Morrell, Moeller, Conway, Simpson and Kenney; by request of Governor Gregoire.

Brief History:

Health Care & Wellness: 1/28/08, 2/4/08 [DPS].

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 13 members: Representatives Cody, Chair; Morrell, Vice Chair; Hinkle, Ranking Minority Member; Alexander, Assistant Ranking Minority Member; Barlow, Campbell, Condotta, DeBolt, Green, Moeller, Pedersen, Schual-Berke and Seaquist.

Staff: Chris Blake (786-7392).

Background:

The Department of Health (Department) regulates several different categories of behavioral health professionals. These include registered counselors, hypnotherapists, psychologists, chemical dependency professionals, mental health counselors, marriage and family therapists, and social workers. Registration as a counselor or hypnotherapist requires that an individual submit an application and a fee of $40 and obtain a background check. Certification as a chemical dependency professional requires that an individual have at least an associate's degree, pass an examination, and meet specified experience requirements. Licensing as a psychologist, mental health counselor, marriage and family therapist, or social worker requires that an individual hold a graduate degree, pass an examination, and meet specified experience requirements.

In 2006 at the direction of the Governor, the Department conducted a review of the registered counselor profession to determine the appropriate level of regulation for the profession. The final report included recommendations to eliminate the profession of registered counselors and create several pre-licensure credentials, an agency-affiliated counselor credential, and a private practice counselor credential. The report also made recommendations regarding the scope of practice, disclosure statements, and public education campaigns. Two bills, HB 1494 and HB 1993, were introduced in the 2007 legislative session which addressed many of the recommendations in the Department's report. Neither bill passed the Legislature.

The 2007-09 operating budget directed the Department to convene another work group to develop recommendations regarding the need to regulate registered counselors. The work group report was due by November 15, 2007. The report included several recommendations pertaining to the creation of new pre-licensure credentials, an agency-affiliated counselor credential, and a private practice counselor credential similar to the 2006 report. A survey of registered counselors conducted at the direction of the work group found that about 35 percent of registered counselors are using the credential to work toward obtaining the experience requirements of another type of license, 30 percent work in a state-regulated agency, and 28 percent practice in a private practice setting.

Summary of Substitute Bill:

The health profession of registered counselors is divided into seven new categories of fully-credentialed and pre-credential status health professions. To continue to practice counseling, all registered counselors must obtain another health profession credential by July 1, 2010, when the registered counselor credential is eliminated.

Agency-Affiliated and Certified Counselors
Practice Requirements
Agency-affiliated counselors are registered health professionals who engage in counseling and are employed by an agency or facility that operates under state regulations. Applicants for registration as an agency-affiliated counselor must provide documentation of their employment with an agency or an offer of employment with an agency.

Certified counselors are certified health professionals authorized to engage in private practice counseling. "Private practice counseling" includes screening a client's level of functional impairment and recognizing mental or physical disorders or functioning levels that require the client to seek diagnosis and treatment from an appropriate health care provider. The term also includes counseling and guiding clients in adjusting life situations, developing new skills, and making desired changes through specific counseling methods and established practice standards. Certified counselors may not provide counseling or guidance services to clients with a global assessment of functioning score of 60 or less.

Applicants for a certificate to conduct private practice counseling as a certified counselor must apply prior to July 1, 2010, and:

• be a currently registered counselor in good standing;
• have been a registered counselor for at least five years;
• have completed courses in risk assessment, ethics, screening and referral, Washington law, and other subjects identified by the Secretary of Health (Secretary) and pass an examination in these subjects; and
• have a written supervision agreement with an approved supervisor.

After July 1, 2010, the Secretary shall not issue any initial certified counselor credentials. The only individuals who may receive a renewal certified counselor credential are those who were certified prior to July 1, 2010, without interruption.

In addition to the Secretary's present authority relating to registered counselors, the Secretary is authorized to establish requirements for certified counselors related to education equivalency, examinations, supervision, consultation, and continuing education.

Disclosure Statements
Certified counselors must provide disclosure statements to clients similar to the disclosures currently provided by registered counselors with additional information requirements. The disclosures must also include referral resources, a statement regarding the supervisory arrangement of the agency-affiliated counselor or certified counselor, and a statement that they are not credentialed to diagnose or treat mental disorders or to conduct psychotherapy. Clients are not responsible for any charges prior to the receipt of the disclosure statement.

Advisory Committee
The Washington State Certified Counselors and the Hypnotherapist Advisory Committee (Committee) is established. The Committee is comprised of two certified counselors, two hypnotherapists, and three members of the public. Members shall be appointed by the Secretary.

Associates and Trainees
Associate licenses are created for individuals pursuing a license as a social worker, mental health counselor, or marriage and family therapist. Associates must have a graduate degree and be working toward meeting the supervised experience requirements as required for a full license. Associates may not practice independently for a fee. Associates may only practice under approved supervision. An associate license may be renewed up to four times.

A chemical dependency professional trainee credential is created for individuals working toward the education and experience requirements for certification as a chemical dependency professional. To obtain a trainee credential, an individual must submit a declaration to the Secretary that he or she is enrolled in an approved education program and pursuing the experience requirements for full certification. Trainees must practice under levels of supervision determined by rule, except that the first 50 hours of client contact must be under direct supervision. A trainee credential may be renewed up to four times.

Other
One must be registered with the Department to practice hypnotherapy for a fee.

Peer counselors are exempt from credentialing requirements.

Substitute Bill Compared to Original Bill:

The substitute bill prohibits the issuance of any initial certified counselor credentials after July 1, 2010. The Secretary of Health may only issue renewal certified counselor credentials for those who held the credential prior to July 1, 2010 without interruption.

When conducting screening of a client's condition, certified counselors must recognize the client's level of functioning by using the global assessment of functioning. Certified counselors may not counsel clients with a global assessment of functioning score that is below 60.
      
Certified counselors are required to have supervisory agreements rather than consultation arrangements.
   
"Psychotherapy" is defined as the practice of counseling using diagnosis of serious mental disorders according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
         
Peer counselors are exempt from the credentialing requirements.

Removes agency-affiliated counselors from disclosure statement requirements. The Secretary of Health must consult with other agencies that regulate facilities where agency-affiliated counselors work when establishing continuing education requirements. Agency-affiliated counselor are removed as members of the advisory committee. The size of the advisory committee is reduced from nine to seven.

Appropriation: None.

Fiscal Note: Available.

Effective Date of Substitute Bill: This bill takes effect 90 days after adjournment of session in which bill is passed except for sections 1, 2, 6 through 8, relating to the establishment of credentials for agency-affiliated counselor and certified counselor, and 10 through 18, relating to the establishment of pre-licensure credentials for mental health counselors, marriage and family therapists, social workers, and chemical dependency professionals, which take effect July 1, 2009.

Staff Summary of Public Testimony:

(In support) This bill promotes public safety. This bill is built from the work of the Registered Counselor Work Group. This bill will include education and supervisory requirements which do not currently exist for those who conduct counseling. The inclusion of agency-affiliated counselors is helpful. There are many types of counseling that certified counselors can do without diagnosing or treating a client. This bill should be passed in its current form.

(In support with amendments) Registered counselors are not asking for an increase in their scope of practice, only to maintain the current practice that they are engaged in with increased standards. The bill needs to define "psychotherapy." There needs to be clarification that there is a scope of practice that counselors can perform. Counselors have successfully served clients with mild to moderate disorders for 20 years. There should be an amendment to specify that certified counselors are only prohibited from counseling those clients with "serious" mental disorders. There is no evidence that supports the curtailment of counseling services due to a lack of quality. The global assessment of functioning should be used to determine what a client's level of functioning is.

(Opposed) The scope of practice in the bill is not what it appears to be. This bill will put people out of business. This bill is not fair. The bill should clarify the definition of psychotherapy.

Persons Testifying: (In support) Representative Barlow, prime sponsor; Ann Christian, Washington Community Mental Health Council; Christina Hulet, Office of the Governor; Mary Selecky, Department of Health; Adrian R. Magnuson-Whyte, Washington Mental Health Counselors Association; Lucy Homans, Washington State Psychological Association; and Laura Groshong, Washington State Society for Clinical Social Work.

(In support with amendments) Terne Gibbs, Miriam Dyak, and Kate Abbott, Washington Professional Counselors Association.

(Opposed) Roger Libby; and Diane Hillaire.

Persons Signed In To Testify But Not Testifying: None.