Several types of health providers are licensed to perform behavioral health services, including psychologists, substance use disorder professionals, advanced social workers, independent clinical social workers, mental health counselors, and marriage and family therapists.
Psychologists.
A psychologist is authorized to observe, evaluate, interpret, and modify human behavior by the application of psychological principles, methods, and procedures for the purposes of preventing or eliminating symptomatic or maladaptive behavior and promoting mental and behavioral health.
To be a licensed psychologist, a person must hold a doctoral degree in psychology, have at least two years of supervised experience, pass an examination, and be of good moral character.
Substance Use Disorder Professionals.
A substance use disorder professional is authorized to employ the core competencies of substance use disorder counseling to assist or attempt to assist individuals with substance use disorder in their recovery.
To be a certified substance use disorder professional, a person must complete an educational program, an apprenticeship program, or alternative training. The person must also pass an examination and complete an experience requirement that establishes fewer hours of experience for applicants with higher levels of education.
Advanced Social Workers.
An advanced social worker is authorized to apply social work theory and methods, including emotional and biopsychosocial assessment, psychotherapy under the supervision of another mental health professional, case management, consultation, advocacy, counseling, and community organization.
To be an advanced social worker, a person must graduate from a master's or doctorate level social work educational program accredited by the Council on Social Work Education, pass an examination, and complete at least 3,200 hours of supervised experience. The supervised experience hours must include at least 90 hours of direct supervision by a independent clinical social worker, an advanced social worker, or an equally qualified mental health professional. At least 50 of the 90 hours must be supervised by a licensed advanced social worker or independent clinical social worker.
Independent Clinical Social Workers.
An independent clinical social worker is authorized to perform the same services as an advanced social worker. In addition, the independent clinical social worker may diagnose and treat emotional and mental disorders based on knowledge of human development, the causation and treatment of psychopathology, and psychotherapeutic treatment practices.
To be an independent clinical social worker, a person must graduate from a master's or doctorate level social work educational program accredited by the Council on Social Work Education, pass an examination, and complete at least 4,000 hours of supervised experience over a period of at least three years. At least 130 of the 4,000 hours must be supervised by a licensed mental health practitioner. At least 70 of the 130 hours must be under the supervision of an independent clinical social worker.
Mental Health Counselors.
A mental health counselor is authorized to apply principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups, and organizations, for the purpose of treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes the assessment, diagnosis, and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health.
To be licensed as a mental health counselor, an applicant must graduate from a master's or doctoral program in mental health counseling or a related discipline, pass an examination, and complete a supervised experience requirement of at least 36 months or 3,000 hours.
Marriage and Family Therapists.
A marriage and family therapist is authorized to diagnose and treat mental and emotional disorders within the context of relationships, including marriage and family systems.
To be licensed as a marriage and family therapist, a person must graduate from a master's or doctoral program in marriage and family therapy or equivalent allied field, pass an examination, and complete a supervised experience requirement consisting of two calendar years of full-time marriage and family therapy totaling at least 3,000 hours.
Provisional Licenses.
The Department of Health grants probationary licenses to applicants from other states who seek a credential in Washington as a psychologist, substance use disorder professional, advanced social worker, independent clinical social worker, mental health counselor, or marriage and family therapist. A person with a probationary license may only practice in a behavioral health agency.
Examination of Licensure Requirements.
The Department of Health (DOH), in consultation with the Workforce Training and Education Coordinating Board and the Examining Board of Psychology (EBP), must examine licensure requirements for psychologists, substance use disorder professionals, advanced social workers, independent clinical social workers, mental health counselors, and marriage and family therapists. The DOH must identify changes to statutes and rules that would remove barriers to entering and remaining in the workforce and streamline and shorten the credentialing process.
The requirements that the DOH must examine include examinations, continuing education, administrative requirements for license application and renewal, English language proficiency, supervised experience, supervisor requirements, and the costs of completing required experience. The DOH must consider the following:
By November 1, 2023, the DOH must provide to the Legislature a progress report and recommendations to remove licensing barriers and improve credentialing timeframes. By November 1, 2024, the DOH must provide a final report to the Legislature on actions and recommendations to remove licensing barriers and improve credentialing timeframes.
By July 1, 2024, the DOH and the EBP must adopt emergency rules to implement the recommendations. The DOH and EBP must adopt permanent rules by July 1, 2025.
Clinical Supervision Programs.
Subject to appropriated funds, by October 1, 2023, the DOH must develop a program to facilitate placement of associates with clinical supervision services. The program must include a database of license holders with the required qualifications who are willing to serve as approved supervisors and agencies or facilities that offer supervision services through their facilities to associates seeking to satisfy supervised experience requirements.
The DOH must establish, by rule, minimum qualifications for supervisors and facilities and minimum supervision standards. The DOH may not include in the database any person or facility not meeting the minimum qualifications. The DOH must periodically audit the list to remove persons or facilities not meeting the qualifications or standards.
Subject to appropriated funds, by July 1, 2024, the DOH must establish a stipend program to defray out-of-pocket expenses incurred by associates completing supervised experience requirements. Expenses eligible for defrayment include costs incurred in order to obtain supervised experience, such as fees or charges imposed by the individual or entity providing supervision and any other expenses the DOH deems appropriate. The DOH must consider defraying out-of-pocket expenses associated with unpaid internships that are part of an applicant's educational program. Associates must document their out-of-pocket expenses in a manner specified by the DOH.
Licensing Requirements.
Changes are made to the licensing requirements for advanced social workers, independent clinical social workers, mental health counselors, and marriage and family therapists.
In addition, the following changes are made to licensing requirements for the professions:
Provisional Licenses.
The requirement that probationary licensees practice in a behavioral health agency is eliminated.
The Senate amendment:
(In support) This bill will help address the behavioral health workforce crisis. The Department of Health (DOH) is working on this, but has not made sufficient strides. In the meantime, people are continuing to struggle to access behavioral health services. Part of the solution is getting qualified people into the workforce as quickly as possible.
This bill will directly address workforce barriers, expand practice settings for probationary licenses, reduce supervised hour requirements for social workers, allow pre graduation hours to count toward postgraduate experience requirements, require the creation of recommendations that must be adopted in rule, require the DOH to act as a clearinghouse to connect associates with supervision, and provides a stipend program to offset costs. This is an emergency. We must act now.
(Opposed) None.
(Other) Workforce shortages create access problems for people. The reasons for the shortages are multiple and complex. Behavioral health professions are unique in that there is no centrally planned system for postgraduate experience. Applicants must coordinate their own supervision, which is unfunded. Licensing should not cause unnecessary barriers. People need to get credentialed quickly. The timelines for the rulemaking are problematic.
Allowing pre graduation experience to count toward postgraduation requirements is problematic. It may prevent Washington from aligning with national standards and prevent membership in interstate compacts. Inadequate training and incompetent practice can endanger the public. Curriculum loopholes in behavioral health credentials should be closed. States are aligning their credit hour requirements and Washington should be in compliance.
The clearinghouse and stipend provisions will be helpful. Sometimes supervisors do not meet minimum requirements. The clearinghouse will help with verifying qualifications and increase public safety. The stipend should be expanded to include student interns.
Federally qualified health centers (FQHCs) should be able to employ agency-affiliated counselors, who are workforce multipliers. Not being able to do this causes FQHCs to hire applicants below their scope of practice. Families dealing with trauma will run if they are not engaged every day. Federally qualified health centers are operating at half speed and agency affiliated counselors will help fill this gap.
(In support) These policies will set the state up for a future interstate compact that could allow social workers to work across state borders. In the past few years, there have been occasions where therapist positions were posted and unfilled for over nine months. The funding, training, and supervisory opportunities exist for these professions, but there is a lack of actual providers and a great need for the services they provide. The supervision registry and financial support structure in the bill are important to help grow this workforce in our communities.
(Opposed) None.
(Other) The bill overall is key to addressing severe workforce shortages. Work is needed to review licensing requirements and remove barriers, and this work is best done by the Department of Health with consultation from the Workforce Training and Education Coordinating Board.