NEWS FOR SOUTH DAKOTA COUNSELORS
The South Dakota Counseling Association is proud to announce the hiring of Marlys Schmidt to the position of Executive Director effective July 1, 2008
Marlys has over 25 years of leadership experience in professional organizations such as SDCA and SDSCA and as a school counselor in the Sioux Falls School District. In addition to her work and administrative experience, Marlys exhibits a strong commitment to the counseling profession, a dedicated work ethic, and a passion for working with people. She has a Bachelor of Arts in Elementary Education with Music and Psychology minor, Masters of Education in Guidance and Counseling, and an M.E.d. +48 with an emphasis on Counseling and Technology.
Access to Counseling in Department of Defense's TRICARE Health Services Program
Public Law 110-181 (originally H.R. 4986), "National Defense Authorization Act for Fiscal Year 2008"
Language is included in the legislation that requires a study of professional counselors' clinical qualifications and instructs the Department of Defense to issue regulations allowing LPCs to practice independently.
INFORMATION
In January, President Bush signed H.R. 4986, the National Defense Authorization Act for Fiscal Year 2008. The President vetoed the first proposed Defense Authorization due to a provision that would allow victims of terrorism to sue foreign governments; he did, however, approve the law after Congress removed the provision.
On January 16, 2008, the measure passed the House of Representatives by a vote of 369-46, and the Senate passed H.R. 4986 the next week by a vote of 91-3. The President signed the legislation on January 28, 2008.
The enacted legislation requires Department of Defense to issue regulations outlining training credentials that would allow LPCs to practice independently under the TRICARE program. This means that counselors who meet those criteria may be granted independent practice authority under TRICARE shortly.
The conference report also includes language instructing the Defense Department to contract with the Institute of Medicine or a similar organization to carry out a study of the training and licensure of mental health counselors. The ACA expects that the study, which is required to be completed by March 2009, will help to build a strong case for independent practice of professional counselors.
DOD expects that the regulations will not be issued for about 18 months and does not anticipate being able to meet the March 2009 deadline for the study. Nevertheless, the ACA and AMHCA are currently working with the offices of Senator Claire McCaskill (D-MO) and Senate Armed Services Committee Chairman Carl Levin (D-MI) to ensure that regulations are issued in a timely manner and that there is a strong and fair study.
BACKGROUND
Although counselors have been TRICARE providers for many years, they still lack independent practice authority under the program. Instead, service members must see their doctor first, who then must refer them to an LPC, and must supervise their treatment. Requiring physician referral and supervision is not only discriminatory against licensed professional counselors, but it provides an additional obstacle to care for a beneficiary population that is frequently hesitant to seek out mental health services. Service members continue to fear for their career advancement if they seek mental health treatment. The physician referral requirement also means mental health services are often overseen by a physician who has had no education, training, or experience in the use of therapy in treating mental and emotional disorders.
Many experienced counselors find themselves losing clinical supervisor positions to less experienced social workers and psychologists. Counselors in Department of Defense (DOD) clinics and hospitals are also often asked to provide services only under the direct supervision of another type of provider, or to have their clinical notes reviewed by a supervisor. Recently counselors in the DOD have been told that they will not be promoted unless they obtain another degree and that no more counselors will be hired to work in DOD facilities.
Representative Robin Hayes (R-NC) succeeded in getting his bill H.R. 1358 included as part of the broader defense spending authorization bills that passed by the House of Representatives for the past three years (Fiscal Year 2006, 2007, 2008). The Senate has failed to include similar provisions in its version of the Defense Authorization Act (DAA) each time.
The continued opposition of DOD and of Senate Armed Services Committee staff to letting licensed TRICARE mental health counselors practice independently is particularly surprising in the light of two reports. First, the RAND Corporation issued a report last year on the effects of a demonstration project testing independent practice authority for licensed TRICARE mental health counselors. The study concluded that TRICARE beneficiaries in the demonstration area had "greater odds of being able to 'usually or always' get an appointment as soon as desired." The report also noted that according to self-report survey data, "the demonstration resulted in improved ratings of mental health services." These outcomes were achieved without any significant increase in TRICARE costs or adverse effects on beneficiaries.
Second, the Government Accountability Office (GAO) recently issued a report ("Post-Traumatic Stress Disorder: DOD Needs to Identify the Factors Its Providers Use to Make Mental Health Evaluation Referrals for Servicemembers") faulting DOD for inadequate response to PTSD among servicemembers. GAO found that less than one in four servicemembers needing access to a mental health professional were referred by their general health care provider. In response to the critical report, DOD issued a statement saying that "numerous avenues to care" are available for servicemembers, and that "the absence of a referral does not preclude access to care." In fact, DOD is arguing that when it comes to licensed TRICARE mental health counselors, the absence of a referral does preclude access to care.
While the ACA and AMHCA were not able to gain total recognition of counselors this year, we were able to make significant progress. The organizations were able to garner the support of Senator Claire McCaskill of Missouri, who will be championing our cause and has promised to remain dedicated to passing the provision for as long as it may take. Moreover, Senator McCaskill was able to collect the signatures of sixteen other Senators from across the country on a letter in support of removing the restrictions that TRICARE currently places on counselors. Thanks to the efforts of Representative Hayes and Senator McCaskill, the final conference version of the Defense Authorization provides for a study of LPC qualifications and calls on the Department of Defense to issue regulations allowing counselors to practice independently.
STATISTICS / FINDINGS
• There is no justification for discriminating against licensed professional counselors based on their education and training. LPCs are licensed in 49 states and the District of Columbia. Counselors' education and training requirements are nearly identical to other master's level practitioners: typically, a licensed professional counselor possesses a master's or doctoral degree in counseling, completion of 3,000 hours of supervised clinical experience, passage of a national or state-recognized counseling exam, and adherence to a strict code of ethics. In addition to licensure, TRICARE requires its mental health service providers to have a minimum level of experience. TRICARE and DOD allow full, independent practice and reimbursement of all other master's-level providers with similar education and training requirements, including clinical social workers and marriage and family therapists.
• As a result of this policy, soldiers and their families are limited from accessing the 100,000 mental health counselors licensed nationwide. Allowing independent practice authority of counselors could help address staffing shortages and oppressive waiting lists for mental health services, especially in remote locations and underserved areas.
• Making beneficiaries see their physicians before they can see a mental health specialist adds an administrative obstacle, the additional cost of a doctor's visit, and a longer waiting period before a service member can receive therapy, further discouraging TRICARE beneficiaries from seeking treatment.
• Less than 10% of all service members who received mental health treatment after returning from OIF and OEF were referred through the screening program (JAMA).
• 35% of OIF veterans accessed mental health treatment after returning home and 12% were diagnosed with a mental health problem. (JAMA)
• Data from the Post Deployment Health Re-assessment indicate that 38% of Soldiers and 31% of Marines report psychological symptoms. Among members of the National Guard, the figure rises to 49%. (An Achievable Vision: Report of the DoD Task Force on Mental Health)
• 23.6% of female OIF veterans reported a mental health concern, versus 18.6% of male veterans. (JAMA)
• TRICARE covers both military personnel and their beneficiaries. According to Capt. Patricia Buss, deputy chief medical officer at Tricare Management Activity, "[c]hildren of active duty service members are potentially at a higher risk to develop mental health conditions common among children in the general population." (Children and Behavioral Health Care, TRICARE Provider News, Issue 5:2006, p. 3).
• Prolonged deployments and increased exposure to danger are raising suicide rates and rates of post-traumatic stress disorder among service members. Research from Walter Reed Army Institute of Research found depression, anxiety, and stress disorders rose sharply among troops sent to Iraq and Afghanistan (Combat Duty in Iraq and Afghanistan, Mental Health Problems and Barriersto Care, July, 2004).
• Mental illness is detracting from military readiness. Service members who are hospitalized for a mental illness are five times more likely to leave the military within six months than those hospitalized for physical illness. In 2001, thirteen percent of all military hospitalizations were attributed to mental disorders (American Journal of Psychiatry, September, 2002).
• Independent practice authority is an efficient way of increasing access; it is cost-free and saves time for the beneficiary, the physician,and the counselor.
FOR MORE INFORMATION
http://www.counseling.org/PublicPolicy/PositionPapers.aspx
Progress on Implementation of New Veterans Affairs Law
Law 109-461, the "Veterans Benefits, Healthcare, and Information Technology Act of 2006."
LATEST INFORMATION
The ACA has met with staff from the Department of Veterans Affairs (VA) and Congressional offices to begin the process of implementation. We have provided the VA with information for its current Occupational Study of professional counselors; the study will be used to determine how the VA can best utilize counselors' clinical expertise.
Upon completion of the study, which should take a couple of months, the VA will determine whether a new qualification standard (job description) needs to be written for LPCs or if an existing standard can be adapted; at that point the Office of Personnel Management can get involved in creating or adapting the standard.
The ACA supports the creation of a new qualification standard that will recognize LPCs as a separate profession with distinct abilities and not simply an extension of other mental health provider groups. While the process may seem long and cumbersome, it is important that it is thorough in order to ensure that LPCs are given responsibilities and a scope of practice indicative of their extensive training and experience. We hope to see LPC positions posted by the VA in the near future.
WHAT CAN YOU DO
Counselors are urged to check the ACA Public Policy website (at www.counseling.org/publicpolicy) for updated information regarding the regulatory process and implementation of S. 3421 by the Department of Veterans Affairs.
BACKGROUND
In the past, LPCs faced significant employment obstacles within the Veterans Health Administration (VHA) and its hospitals, clinics, and programs across the country. While some ACA members have found positions within the agency, either on a contract or full-time basis, there continue to be barriers to independent practice, advancement, and hiring.
While licensed clinical social workers were able to practice independently and serve as clinical supervisors in the VA, counselors found themselves struggling to achieve similar recognition. The VA remains the largest employer of clinical social workers in the country. According to the VHA, most supervisory positions at Department hospitals and clinics are filled by psychiatrists, psychologists, and social workers. Many VHA positions in mental health services are developed by social workers on staff, and therefore the agency is most likely to hire social workers first. While VHA says there is no formal policy excluding LPCs from being hired, some ACA members have found that the VA does not recognize their licensure, and therefore refuses to hire them or relegates them to non-clinical positions. The lack of recognition of licensed professional counselors by OPM exacerbates this problem.
On December 22, 2006, President Bush signed S. 3421, the "Veterans Benefits, Healthcare, and Information Technology Act of 2006" (now Public Law 109-461). Public Law 109-461 includes language establishing explicit recognition of licensed professional counselors as mental health specialists within health care programs operated by the Department of Veterans Affairs (VA). The bill also establishes explicit recognition of licensed marriage and family therapists.
Passage of this legislation follows years of work by ACA and the American Mental Health Counselors Association to gain recognition of licensed professional counselors within the VA. Although the VA has long employed rehabilitation counselors to provide readjustment counseling services to veterans, it had not recognized counselors as mental health specialists. Prior to this, the VA could not hire licensed professional counselors at the same pay grade as clinical social workers, nor could counselors apply for supervisory positions open to clinical social workers and others.
ACA would like to thank the Chairman (Sen. Larry Craig (R-ID)) and Ranking Member (Sen. Daniel Akaka (D-HI)) of the Senate VA Committee as well as Reps. Jerry Moran (R-KS) and Rep. Michael Michaud (D-ME) who introduced H.R. 5396. These members of Congress worked hard to ensure that the LPC provision was included in the final version of the bill.
FOR UPDATED INFORMATION
ACA Public Policy and Legislation website: http://www.counseling.org/publicpolicy