Provision of Mental Health Counseling Services Under TRICARE (2010) / Chapter Skim
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3 Requirements Related to the Practice of Counseling
3 Requirements Related to the Practice of Counseling
Pages 91-148
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From page 91... ...
Box 3.1 at the end of the chapter contains a compilation of the abbreviations and acronyms used to denote the accrediting bodies, professional associations, certifications, and examinations referenced below. Little has been published on the licensing, credentialing, and privileging of counselors; for that reason, the chapter provides detailed information on these topics.
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From page 92... ...
In the 1950s, the psychology profession was establishing the doctoral level as the requirement for professional status, and counseling psychology was developing as a specialty within psychology. Historical events were leading to the rapid development of school counseling programs and vocational-rehabilitation counseling.
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From page 93... ...
The dynamics of the creation of the specialty of counseling psychology, the decision in the psychology profession to recognize professionals only at the doctoral level, the emergence of school counseling, and the funding of vocational-rehabilitation counseling programs led to the creation of counseling as a separate master's degree–level profession. The origins of the profession were in the convergence of several disparate forces rather than in a single event.
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; and for psychiatry, the Liaison Committee on Medical Education (LCME, 2008) and the Accreditation Council for Graduate Medical Education (ACGME, 2007)
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REQUIREMEnTS RELATED To THE PRACTICE oF CoUnSELInG TABLE 3.1 Comparison of Preparation Requirements for the Mental Health Professions Profession and Graduate Summary of Required Courses and Required Supervised Education Required Field Experience Counseling Graduate coursework required in professional identity; 48–60 graduate credits social, cultural diversity; human growth, development; required for master's career development; helping relationships; group work; degree assessment; research, program evaluation; specialty (mental health counseling, community counseling, school counseling, career counseling, marriage and family counseling and therapy, college counseling, gerontologic counseling, student affairs) 100-hour practicum, 600-hour internship required Pastoral Counseling Field of pastoral counseling does not accredit academic preparation programs; people may become certified as pastoral counselors by American Association of Pastoral Counselors, but academic preparation programs not accredited Marriage and Family Graduate coursework required that covers 128 Therapy competencies in six domains: admission to treatment; Minimum number of clinical assessment, diagnosis; treatment planning, case graduate credits not management; therapeutic interventions; legal issues, specified ethics, standards; research, program evaluation Number of hours of practicum, internship not specified Social Work Coursework required in professional social worker 60 graduate credits identity; ethical principles; critical thinking; diversity, required for master's difference; advancing human rights, social and economic degree justice; research-informed practice, practice-informed research; human behavior, social environment; policy practice; contexts that shape practice; engaging, assessing, intervening, evaluating individuals, families, groups, organizations, communities Minimum of 900 hours of field experience required continued
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MEnTAL HEALTH CoUnSELInG SERVICES UnDER TRICARE TABLE 3.1 Continued Profession and Graduate Summary of Required Courses and Required Supervised Education Required Field Experience Nursing Graduate nursing coursework in research; policy, Minimum number of organization, financing of health care; ethics; professional graduate credits not role development; theoretical foundations of nursing specified practice; human diversity, social issues; health promotion, disease prevention; advanced health, physical assessment; advanced physiology, pathophysiology; advanced pharmacology; psychiatric nursing Minimum of 500 hours of direct clinical practice (Additional requirements are placed on persons practicing in psychiatric nurse specialties) Psychology Graduate coursework required in biological aspects of 3 full-time years of behavior; cognitive, affective aspects of behavior; social graduate study required aspects of behavior; history, systems of psychology; for doctoral degree psychological measurement; research methodology; techniques of data analysis; individual differences in behavior; human development; dysfunctional behavior or psychopathology; professional standards, ethics; theories, methods of assessment, diagnosis; effective intervention; consultation, supervision; evaluating efficacy of interventions; cultural, individual diversity; attitudes essential for life-long learning, scholarly inquiry, professional problem solving 1 full-time year of residency required
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REQUIREMEnTS RELATED To THE PRACTICE oF CoUnSELInG TABLE 3.1 Continued Profession and Graduate Summary of Required Courses and Required Supervised Education Required Field Experience Psychiatry MD requires coursework in anatomy; biochemistry; 130 weeks required for genetics; physiology; microbiology, immunology; medical degree (usually pathology; pharmacology, therapeutics; preventive 4 years) medicine; scientific method; accurate observation of biomedical phenomena; critical analysis of data; organ systems; preventive, acute, chronic, continuing, rehabilitative, end-of-life care; clinical experiences in primary care, family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, surgery in outpatient, inpatient settings; multidisciplinary content, such as emergency medicine, geriatrics; disciplines that support general medical practice, such as diagnostic imaging, clinical pathology; clinical, translational research, including how such research is conducted, evaluated, explained to patients, applied to patient care; communication skills as related to physician responsibilities, including communication with patients, families, colleagues, other health professionals; addressing medical consequences of common societal problems, for example, providing instruction in diagnosis, prevention, appropriate reporting, treatment of people for violence, abuse; how people of diverse cultures, belief systems perceive health, illness and respond to various symptoms, diseases, treatments; sex, cultural biases; medical ethics, human values Psychiatry residency curriculum must include patient care; medical knowledge; practice-based patient learning, improvement; interpersonal, communication skills; professionalism; systems-based practice; research; required topics include supervised practice in providing psychiatric services to diverse populations 48-month residency in psychiatry is required, which includes 12-month internship in primary-care clinical setting SOURCE: Adapted from Remley and Herlihy (2010)
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From page 98... ...
accredit counselor educational programs: CACREP, which provides accreditation in a variety of counseling specialties other than rehabilitation counseling, and the Council on Rehabilitation Education (CORE) , which accredits only rehabilitation counselor educational programs.
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From page 99... ...
. The profession has moved toward a more consolidated view of how elements of the specialties are related to one another, and the 2009 CACREP accreditation standards consolidated the two specialties most closely related to the practice of mental health counseling -- Community Counseling and Mental Health Counseling -- into the singular category of Clinical Mental Health Counseling (CACREP, 2009a)
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. Number and types of programs As of August 2009, CACREP accredited 569 master's and doctoral level counseling programs in 239 institutions in the following fields: 164 in Community Counseling; 55 in Counselor Education and Supervision; 19 in College Counseling; 9 in Career Counseling; 2 in Gerontologic Counseling; 32 in Marital, Couple, and Family Counseling and Therapy; 63 in Mental Health Counseling; 22 in Student Affairs; 2 in Student Affairs Practice in Higher Education with emphasis on College Counseling; and 201 in School Counseling (CACREP, 2009c)
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From page 101... ...
) have identified the same eight categories of core knowledge for professional counselors: professional identity, social and cultural diversity, human growth and development, career development, helping relationships, group work, assessment, and research and program evaluation (Chronister et al., 2009)
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Private practice as an employment setting occurs at lower rates: 10% of college counselors, 11% of community counselors, 8% of school counselors, and 12% of mental health counselors (Schweiger et al., 2008)
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. ACCREDITATION OF COuNSELOR EDuCATIONAL INSTITuTIONS Voluntary accreditation in higher education is a collegial process of self-assessment and peer review for improvement of academic quality and public accountability of institutions and programs.
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From page 104... ...
Those for Clinical Mental Health Counseling were established in 2009 and reflect a transition period for programs that were previously accredited in Community Counseling, which required 48 graduate semester hours. As of July 1, 2009, 54 graduate semester credit hours or 81 quarter credit hours were required.
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Diversity and Advocacy • Understands how living in a multicultural society affects clients who are seeking clinical mental health counseling services.
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• Demonstrates skill in conducting an intake interview, a men tal status evaluation, a biopsychosocial history, a mental health history, and a psychological assessment for treatment planning and caseload management. • Screens for addiction, aggression, and danger to self and/or others, as well as co-occurring mental disorders.
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The Annapolis Coalition on the Behavioral Health Workforce has observed that graduate education and training for all mental health professionals lack specificity in a number of knowledge and competence elements that are essential for professional contemporary mental health practice (Hoge et al., 2002)
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• The program has institutional approval for courses and degrees offered. • The program has a person designated as coordinator, or the equivalent, who is a Certified Rehabilitation Counselor.
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• Establish in collaboration with the consumer, individual counseling goals and objectives. • Assist the consumer with crisis resolution.
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Educational and Clinical-Experience Requirements The 2008 CORE program standards require a minimum of 48 semester hours for RCE programs, but if the state in which the program exists requires 60 semester hours for licensure, the program must identify and provide the additional 12 semester hours required for licensure (CORE, 2008b)
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From page 111... ...
There is no requirement for students to have experience with specific mental health diagnostic categories. The academic preparation for a Rehabilitation Counselor does not, in the committee's view, support diagnostic and treatment ability in mental health associated with specific psychopathologic conditions unless additional coursework and clinical experiences are obtained, as would be the case when rehabilitation counselors become licensed as mental health counselors in states that require such additional courses and postgraduate clinical practice.
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From page 112... ...
The first tier is licensure in one's discipline in the state in which one practices, the second is credentialing, and the third is the granting of appropriate clinical privileges to diagnose mental health disorders or treat those who are experiencing them. Credentialing and privileging are considered critical elements in ensuring the delivery of high-quality mental health care because they involve verification of completed licensure requirements and assessment of a provider's competence to deliver high-quality care to beneficiaries.
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Satisfactorily practiced the discipline as determined by the results of professional staff monitoring and evaluation of the quality and appropriateness of patient care. LICENSINg Overview All states, the District of Columbia, Puerto Rico, and Guam license mental health counselors.
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. Most states do not require that people graduate from counseling programs that specialize in mental health to become licensed as mental health counselors.
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• 1,000 hours for mental health– counseling specialty (including 360 direct service hours in mental health setting) Commission on Master's in Rehabilitation 700 hours (including 2 Rehabilitation Counseling 280 hours of Education direct service to people who have disabilities)
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and the National Clinical Mental Health Counselor Examination (NCMHCE) -- both administered by NBCC -- and the Certified Rehabilitation Counselor Examination (CRCE)
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. and the District of Columbia accept any of the three examinations for licensure, as of late 2009.3 Some states also allow additional or alternative examinations; others require additional examinations created by state licensing boards.
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The National Clinical Mental Health Counseling Examination The NCMHCE is designed specifically for counselors who work in mental health. It is administered by NBCC.
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It should be noted that the primary and secondary clinical features could lead to confusion if the DSM-IV is used for diagnosing purposes. Furthermore, although the content of the examination appears to be comprehensive, the use of such terms as coordinate and function as a member of a multidisciplinary team/network in the activities outline (NBCC, 2009c)
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Clinical Diagnosis and Treatment Planning • Integrate client assessment and • Formulate DSM-IV classification (axes observational data with clinical I–V) judgment to formulate differential • Formulate ICD--CM classification diagnosis • Develop treatment plan in • Coordinate treatment plan with collaboration with client other service providers • Establish goals that are relevant to • Monitor client progress toward goal diagnosis and client's needs attainment • Establish intervention strategies related to treatment objectives continued
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From page 121... ...
The examination does seem to be aligned with the standard for an accredited academic program under CACREP. Given those caveats, the NCMHCE's focus on clinical mental health counseling and on the evaluation of candidates' ability to apply knowledge to patient care led the committee to conclude that the examination is a more relevant test of the ability of counselors to serve In the mental health field, psychotherapy is generally defined as a practice that aims 4 to remediate conflicts or symptoms related to psychopathology while facilitating growth.
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The Certified Rehabilitation Counselor Examination The CRCE is administered by CRCC (CRCC, 2009b)
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. The licensure mechanism is structured in such a manner that licensure boards adjudicate complaints brought to them and do not attempt to monitor the practices of behavioral health professionals to ensure the quality of care for clients.
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. The profession of licensed mental health counseling has followed the same general pattern as the other behavioral health disciplines.
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Boundaries of Competence Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population.
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Supervisor Preparation Prior to offering clinical supervision services, counselors are trained in supervision methods and techniques. Counselors who offer clinical supervision services regularly pursue continuing education activities including both counseling and supervision topics and skills.
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A complete list of continuing education and license renewal requirements is provided in Appendix G CERTIFICATION BY STANDARDS ASSOCIATIONS Licensure and certification are viewed as complementary mechanisms; certification is thought to help in standardizing licensure requirements across states in that national certification examinations are often used as prerequisites for licensure.
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credential are based on the CACREP accreditation standards and include a master's degree in a counseling-related field from a regionally accredited institution, 48 semester hours of graduate study in the practice of counseling and closely related fields, and a counseling course in each of eight content categories. The categories are human growth and development, social and cultural foundations, helping relationships, group work, career and lifestyle development, appraisal, research and program evaluation, and professional orientation and ethics.
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certification was launched in 1979 under the National Academy for Certified Clinical Mental Health Counselors (NACCMHC) , an organization formed by the American Mental Health Counselors Association.
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CRCC requires that counselors renew their certification every 5 years by documenting the accrual of at least 100 clock hours of continuing education or by reexamination. Certificants are also obliged to conform to the commission's Code of Professional Ethics for Rehabilitation Counselors as overseen by an ethics committee.
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From page 131... ...
states that clinical psychologists, certified clinical social workers, certified psychiatric nurse specialists, certified marriage and family therapists, pastoral counselors, and mental health counselors must be licensed or certified by the jurisdiction where they wish to practice. For jurisdictions that do not offer licensure or certification, providers must be "certified by or eligible for full clinical membership in the appropriate national professional association that sets standards for the specific profession." For counselors, the TRICARE Policy Manual (6010.54-M, Chapter 11, Section 3.10)
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From page 132... ...
Credentialing and Privileging in TRICARE TRICARE Direct-Care System Overview Credentialing and privileging requirements in the directcare system are outlined in the appropriate service regulations or instructions, specifically Army Regulation 40-68; Navy BUMEDINST 6320.66E; and Air Force Instruction 44-119. The policies apply not only to active-duty people and others employed by each service but to other providers (e.g., volunteers and members of other services)
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From page 133... ...
Section 4-4 of Regulation 40–68 provides a "not all inclusive" list of the professional disciplines requiring license, certification, or registration to practice in the Army. The list specifically mentions clinical psychologists, clinical social workers, counseling psychologists, physicians, psychological associates, substance-abuse counselors, and "behavioral health practitioners." Guidance regarding the scope of practice and other specific professional requirements for privileged providers is in Section 7.
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From page 134... ...
." Section 7-6c states that practitioners will "practice within the guidelines of their respective State licensing boards as LPCs (or equivalent) or, if offered by their State, a license for master's-level psychology graduates such as psychological associate or licensed mental health provider." Specific clinical privileges are "granted based upon training, experience, and competency." Five general privileges are delineated: 1.
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, BUMEDINST 6320.66E, states that "Chief, BUMED shall: Establish, in coordination with chiefs of the appropriate corps and the specialty leaders, standardized clinical privilege sheets, which prescribe both core and supplemental privileges reflecting the currently recognized scope of care for each health care specialty." Section 10d adds: Professionals who practice substance-abuse rehabilitation have educational and licens 6 ing requirements similar to those of behavioral health practitioners.
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From page 136... ...
of BUMEDINST 6320.66E contains clinical-privilege sheets for the allied-health professions and outlines the educational requirements for each specialty. Clinical psychologists, clinical social workers, and marriage and family therapists are all addressed, but behavioral health practitioners and mental health counselors are not mentioned on this list or elsewhere in the instruction.
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From page 137... ...
, a DOD-mandated Web-based secure credentials and riskmanagement application used in the provider credentialing and privileging process, and it lists the categories of providers that according to DOD must be included in CCQAS. The list is similar to that of allied health professions included in Appendix G of Navy BUMEDINST 6320.66E in that it lists clinical psychologists, marriage and family therapists, and social workers; but it also mentions mental health counselors (to include certified alcohol and drug-abuse counselors)
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From page 138... ...
MHN/HealthNet did not engage in case-specific or treatment-specific privileging but did ask providers to identify subjects of specific expertise in client subpopulations (children and adolescents, for example) , in diagnosis, and in treatment modalities (such as dialectical behavioral therapy)
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From page 139... ...
and URAC.7 All contracted providers must be credentialed and, for most managed-care behavioral health organizations (MBHOs) , must be licensed.
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Most behavioral health diagnoses and treatments do not have recognized designations of competency that are consistent and reliable, such as board certifications or subspecialty fellowships that are accredited. Complex conditions, such as eating disorders and traumatic brain injury, that require expertise do not have recognized certifications or accredited fellowships.
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From page 141... ...
Patient-safety data collection and review is ongoing for complaints and sentinel events reported to the MBHO. The MBHO must investigate, review, and resolve all complaints and sentinel events typically within 30 days.
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From page 142... ...
If there are complaints and sentinel events regarding the quality of service of specific providers, MBHOs review patient-safety trends at the time of recredentialing or each time an event is reported. During the investigation of a complaint or sentinel event, whatever scope-of-practice issues arise are addressed.
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From page 143... ...
REQUIREMEnTS RELATED To THE PRACTICE oF CoUnSELInG BOx 3.1 Abbreviations and Acronyms Accrediting bodies and professional associations ACA American Counseling Association ACGME Accreditation Council for Graduate Medical Education AMHCA American Mental Health Counselors Association APA American Psychological Association APA CoA APA Commission on Accreditation CACREP Council for Accreditation of Counseling and Related Educational Programs CARF Commission on Accreditation of Rehabilitation Facilities CCNE Commission on Collegiate Nursing Education CHEA Council on Higher Education Accreditation CORE Council on Rehabilitation Education CRCC Commission on Rehabilitation Counselor Certification CSWE Council on Social Work Education LCME Liaison Committee on Medical Education NACCMHC National Academy for Certified Clinical Mental Health Counselors NBCC National Board for Certified Counselors NCCA National Commission for Certifying Agencies NCQA National Committee for Quality Assurance formerly, the Joint Commission on Accreditation of The Joint Healthcare organizations (JCAHo) Commission the current name of the organization originally URAC incorporated as the "Utilization Review Accreditation Commission" Certifications in the field of counseling CCMHC Certified Clinical Mental Health Counselor CRC Certified Rehabilitation Counselor NCC National Certified Counselor Counseling examinations CRCE Certified Rehabilitation Counselor Examination NCE National Counselor Examination NCMHCE National Clinical Mental Health Counselor Examination
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From page 144... ...
2008. Licensure requirements for professional counselors: A state-by-state report.
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From page 145... ...
2009. Qualifications of professionals providing mental health counseling services under TRICARE.
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2009c. Clinical mental health counselors modified*
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2009. Presentation to the Committee on the Qualifications of Professionals Providing Mental Health Counseling Services Under TRICARE, July 7.
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