The Future of Clinical Mental Health Counseling: Putting “Health” back into Licensed Professional

CounselorBy

Stephen A. Giunta, Ph.D., LMHC, CCMHCPresident (2014-2015) American Mental Health Counselors

Association

The Affordable Care Act:The move from provider centered to community centered

Hospitals are becoming insurance companies Patient Centered Medical Homes (PCMH)Accountable Care Organizations (ACO)

A system of integrated medicine in which patients wellness is promoted by addressing the myriad of mental health issues…Compression Morbidity (sudden death in overtime; $0.00 Vs. 90% of

all cost over an individual’s lifetime) is the only way to pay for the continuing increased costs to Medicare.

Palliative Care Maryland’s uncompensated Behavioral Health costs were cut in half after

expanded ACA’s Medicare/Medicaid

Why the Need for “Health”?

Definition of Behavioral Medicine

• Behavioral Medicine is the interdisciplinary field concerned with the development and the integration of behavioral, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation.

(Definition is provided by Society of Behavioral Medicine on their website at: http://www.sbm.org/about )

Excerpts from “Introduction to Behavioral Medicine for Mental Health Counselors” by Dr. James Messina

Improve effectiveness of medical interventionsHelp reduce overutilization of the health care systemReduce the overall costs of care

Key StrategiesLifestyle Change (prevent drug abuse, increase

physical activity, stop smoking)Training (stress management, pain management,

priority setting)Social Support (group education, caretaker support)

Behavioral Interventions Can:

Prevent diseases related to high risk behaviors and substance abuseLower blood pressure Improve weight managementDecrease painDecrease complications of pregnancyEnhance immune response Increase compliance with treatment – medication plansReduce anxiety and improve emotion regulation Improve sleep Improve strength, endurance, and mobility Improve quality of life

http://coping.us/behavioralmedicine/integratedprimarycaretools.html Tools for learning about Behavioral Medicine (screening instruments,

guides, powerpoints, fact sheets, etc)

Examples of Positive Outcomes:

The Thirtieth Annual Rosalynn CarterSymposium on Mental Health Policyat The Carter Center in Atlanta Georgia.

The theme this year:Celebrating the Past and Shaping the future.

Hot off the Press: ACA providers need to be Medicare & Medicaid providers; we are not included; Congress is a mess; and our profession sucks at teamwork

The Carter Center gets a lot of credit for...The Paul Wellstone and Pete Domenici Mental Health

Parity and Addiction Equity Act of 2008 (MHPAEA) A federal law that prevents group health plans

and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

The Affordable Care Act. MHPAEA (parity) was a necessary first step before

the Affordable Care Act could be implemented.

Rosalynn Carter Symposium on Mental Health Policy

Each year AMHCA, ACA, AAMFT and every large organization/association in the country is

invited to the event to discuss mental health public policy.

The Three AmigosPresident, President-Elect & Past

President

The Georgia Mental Health Consumer NetworkThe Director of Public and Community Psychiatry & Clinical

Professor of Psychiatry and Public Health at the University of Illinois at Chicago

The Vice president of Consumer and Family Affairs for OptumHealth (United Health Care)

A senior advisor for the World Health OrganizationDean of the Medical College of Georgia, past president of the

American Association of Chairs of Departments of Psychiatry and a chair of various NIMH committees

The former Surgeon General of The United States and former Director of the CDC

Senior advisors and department heads within SAMHSAThe Director of the Department of Health in Ohio (formerly Mass.

and Conn.)President and CEO of Mental Health America

Folks that do not seem to know who we are and/or don’t seem to care enough to mention

our profession:

Besides Medicare & Medicaid… VHA TRICARE Challenges to our scope of practice

Georgia – assessment & DX/TXWeak licensure laws

ChicagoLeverage in the insurance/EAP marketplaceConsumer/Legislator awareness: What’s an LPC?

“There are known knowns… But there are also unknown unknowns. There are things we don't know we don't know.”

- Donald Rumsfeld

Not Just an Issue of ACA & the M&Ms

Membership Look like our competition (Psychology & Social

Work)A single title (not 32)A single scope of practice A single accrediting body

“It is not the strongest of the species that survives, nor the most intelligent, it is the one most responsive (adaptable) to change.”

- Charles Darwin

If we are to have a future we might want to consider the following:

In 1975, AMHCA argued for the title Mental Health Counselor and 60 hour degrees.

In 1990, Fong suggested that the counseling profession was generating “confusing and wasteful duplicate structures.” (p. 106) and stated “…the scope of counseling and mental health counseling is the same; the terms are synonymous and, thus, the proper name for the entire profession of counseling is mental health counseling.” (p. 107). Fong further argued that while some specialties are named for the environment in which intervention occurs (e.g., school counseling, community counseling) and others for the main concern addressed (e.g., vocational counseling, marriage and family counseling), all encompass the same core and are a form of mental health counseling. (Mental health counseling: The essence of professional counseling. Counselor Education and Supervision, 30, 106–113).

A Single Title (not 32)

It is imperative that our professional identity be a clear statement that “Health” is our focus and we perform “Clinical” work in Behavioral Medical settings.

Says who? The latest edition of the AMHCA bylaws refers to LPCs/LMHCs as CMHCs. The US Department of Labor and the Institute of Medicine (IOM) and, as a

consequence, the VA and TriCare refer to LPCs/LMHCs as CMHCs and/or LPMHCs. It is reasonable to presume that when/if we become Medicare providers they will

refer to us as CMHCs and/or LPMHC. In fact, referencing “health” in the title is a qualifier that Medicare will likely demand before our profession can be defined by them as health care providers.

While a consensus was not reached for education requirements in the 20/20 process, CACREP accredited mental health counseling or clinical mental health counseling programs received the most support. In turn, the IOM only recognizes CACREP mental health counseling or clinical mental health counseling programs

2016 CACREP Standards flattens DX/TX across programs. Will it work or make the situation worse?

A Single Title (not 32)

Marjorie Hansen Shaevitz Become a fan Author, Speaker, Founder, www.adMISSIONPOSSIBLE.comSo You Want to Be a Counselor/Therapist? Let Me Tell You the Different WaysPosted: 03/17/2015 3:50 pm EDT Updated: 03/17/2015 3:59 pm EDT

You know, some individuals are born with a natural talent for helping others. They are the ones from an early age to whom people are drawn…Somewhere down the line, many of these youngsters decide they want to be mental health professionals when they grow up. But the $64 million question is which one?...

CAREER AREASThe list of career areas includes 1. Psychiatrist, 2. Psychologist, 3. Counselor: a. Social Worker, b. Marriage and Family Therapist, c. Licensed Mental Health Counselor, d. Licensed Professional Counselor, e. School Counselor and many others. How do you decide?

Huffington Post

Council for Accreditation of Counseling and Related Educational Programs (CACREP) – vs – Master’s in Psychology and Counseling Accreditation Council (MPCAC)

IOM – VHA, TRICARE, Army, etc. The M&Ms? AMHCA and NBCC have argued for CACREP with a 7

year transition period. ACA remains silent. MPCAC: false argument and an example of “overfitting”

(a stat term for mistaking noise for a signal).Professions are, by definition, exclusive not inclusive.

A Single Accrediting Body

Arguably, and Ironically, the only thing that came out of the 20/20 effort with substance. And yet…

With respect to scope of practice, AMHCA supports the 20/20 Committee’s consensus that includes the March 3rd addendum circulated by the 20/20 facilitator, Dr. Kurt Kraus. However, AMHCA will continue to articulate the need to modify the definition dependent upon the individual needs of any particular state. For example, AMHCA argues that the reference in the definition to the administration of assessments, tests and appraisals may be strengthened in a number of states if it included verbiage noting that CMHCs can also offer interpretations of the results of assessments, tests and appraisals (“…administration and interpretation of assessments, tests and appraisals…”). In turn, the recent addition of “physical disorders” may be more clearly articulated by referring specifically to “co-occurring disorders” and/or “integrated services” within the scope of practice definition.

A Single Scope of Practice

The Delphi method is a one-person-one-vote method when the person is defined as an expert. Each round of votes narrows down the options based on throwing out the extremes on both ends.

The ACA divisions (e.g., ACES and IAMFC) carry an overwhelming majority of the votes.

The representative of AMHCA (7,100 national members plus state chapter members) is no more impactful (has no more votes) than the Association of Humanistic Counseling with 340 members, ACES with 2,750 members or the half dozen employees of CACREP.

The American Association of Christian Counselors, an association as large as ACA had zero votes. AAMFT was not invited either.

ACA gave a vote to each of their four regions multiplying their vote by a factor of four, in addition to the duplication between divisions.

ASCA pulled out from the discussion and AMHCA discounted the process.

20/20: A Vision for the Future of Counseling

General Roadblocks to Any Action It is just short of absurd to suggest that each state would willingly defer to

an outside entity in an effort to secure a standardize title, scope of practice and/or educational requirements, when those states risk unintended consequences (i.e., attacks by psychologists) if they open their licensure law to make changes.

Some states, like Florida (an LMHC state), already have a excellent scope of practice and viable title. Why would they be motivated to act?

One need only look at the mess in education caused by the Common Core Standards to realize that each state thinks they are “special” and in need of special tweaks to any national standard. ACA’s 20/20’s Scope of Practice is ripe for state by state tweaks.

Who will organize, lead and pay for the state by state standardization? More to the point, who will defend the profession against legislative adversaries?

Is Portability a search for the Holy Grail?

What have the National Counselor Organizations done to address putting

“Health” back into Clinical Mental Health Counseling: Kobayashi Maru

American Counseling Association American Association of State Counseling Boards

(AASCB) Individual States/Regions

Advances: Portability, etc.

NCC credential Documentation of a minimum of 60 semester (or 90 quarter) hours of

graduate-level academic credit in counseling from a regionally accredited university, or equivalent entry for 48-hour master’s degrees .

100 hours of counseling supervision, spanning at least 24 months from the date the applicant's graduate degree (master’s or higher) in counseling, or with a major study in counseling, was conferred.

3,000 hours of clinical client contact, spanning at least 24 months from the date the applicant's graduate degree (master’s or higher) in counseling, or with a major study in counseling, was conferred.

A taped clinical session (after the application and examination are complete and approved), OR documentation of two additional years of clinical supervision. (This requirement is waived for CACREP Mental Health Counselor graduates.)

A passing score on the National Clinical Mental Health Counseling Examination (NCMHCE).

Personal Solution: The CCMHC

Educate the other mental health professions (particularly psychiatrists)

Educate your legislatorsBecome experts in integrated health careJoin AMHCA and whichever state organization that

holds the resources (and inclination) to effectively represent you at the state capital.

Recruit! Recruit! Recruit!

Additional Solutions?

My wife, a school teacher, pays $627.80 a year in union dues as a member of Pinellas Classroom Teachers Association (1.56 percent of her annual income).

As a member of ACA, ACES, FCA, FACES, AMHCA, FMHCA, SMHCA, NBCC and CSI last year I paid $674.00 (.8 percent of my annual income).

It is time to stop looking for the key under the light and recruit.

“We are either AT the table or we are ON the table.”- FMHCA lobbyst

Membership

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Questions