Credentialing, Certification, and Licensure in Professional Counseling, Exams of Psychology

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Intro To Mental Health Final Exam

Questions And Answers.

Wilkerson, Smith, and Wimberly (2019) identified recent trends in complaints resulting in licensure board disciplinary actions 2010-2014: - -Failure to obtain required continuing education (16.8%) -Nonsexual dual relationships (12.5) -Sexual relationships with clients (9%) -Misrepresentation of credentials (6.7%) -Improper supervisory practices (4%) -Breach of privacy (2.4%) Liability claim report, 2nd edition 2019 - \Closed claims from (2013-2017): -Sexual romantic relationships with clients (32%) -Failure to practice within boundaries of competence (17.5%) -Sexual romantic relationships with supervisees (7.5%) -Dual relationships (5.9%) -Sexual romantic relationships with former (4.4%) -Breaching confidentiality (4.4%) Time past before intimate relationship can be held: - \Psychologist- no relationship for two years Counselors- 5 years Social work- never Hallmarks of a profession? - \1) professional membership organization

2. code of ethics
3. certification and licensure
4. accreditation
5. research into effectiveness of service delivery accreditation: - \pursued by educational institution to show compliance with high professional, educational and/or training standards developed by an independent professional review board institutional accreditation - \involves a general review of operational and curricular practices at an entire university, college, or school specialized accreditation -

\focuses on a particular program or field of study, such as counseling, teacher education, or medicine CACREP follows a process of program review and approval that features six steps: - \1) self-study and application

2. initial review
3. on-site visit
4. team report
5. institutional response
6. accreditation decision CACREP accreditation decisions include: - \a) full 8 year accreditation b) 2 year provisional accreditation (minor deficiencies to address in a follow up report, or c) denial of accreditation revisions process is completed every 8 years CACREP three general components of the curricular model: - \sets the national standards for training clinical mental health counselors common core curriculum standards for specialization professional practice experience common core curriculum: - \knowledge and skills that are foundational to all graduate counseling students regardless of specialization standards for specialization: - \knowledge, skills, and practices that are expected of students preparing to go into a specific area of specialization professional practice experience: - \courses that provide opportunity to apply theory and develop counseling skills while working under supervision common core courses: 8 areas - - professional orientation and ethical practice -social and cultural diversity

• human growth and development
• career development
• counseling and helping relationships -group work -assessment -research and program evaluation Courses for CMH Specialization: 6 areas -

(60 total semester credit hours required)

• foundations
• counseling, prevention, and intervention -diversity and advocacy -assessment -research and evaluation -diagnosis clinical experiences requirements: - - practicum -internship
• credentialing -registry
• certification practicum: - -minimum of 100 clock hours -of these hours, 40 hours must be direct contact hours with individuals and groups
• supervision: an average of 1 hour of individual/triadic supervision and 1.5 hours of group supervision per week Internship: - (Began after successful completion of practicum)
• minimum of 600 clock hours
• of these hours, 240 hours must be direct contact hours -supervision: an average of 1 hour per week of individual/triadic supervision (typically with site supervisor); an average of 1.5 hours per week of group supervision (typically with faculty supervisor) credentialing: - \the process by which individuals are identified as part of a professional group after they have completed academic requirements. three types: -registry -certification -licensure registry: - \a list of members of a professional group. being listed on a registry is the simplest and least restrictive method of credentialing, as professionals simply provide information and pay a small fee in order to be listed certification: - \the process by which an indivudal demonstrates their competency in meeting or exceeding standards of quality that have been set forth by the profession itself (national board of certified counselors (NBCC or CRCC)

• national certified counselor (NCC)
• certified clinical mental health counselor (CCMHC)
• Master Addiction Counselor (MAC)
• certified rehabilitation counselor International Registry of counselor education programs (IRCEP) - \CACREP developed a system that recognizes counseling programs from diverse nations that adhere to culturally appropriate accreditation standards without professional counseling organizations there wouldn't be any - -licensure -guidelines for ethical practice -third party reimbursement from health insurance true score theory: - \any observed score (X)= the true score (T) + the error score (E) standard error of measurement communicates how much an observed score varies from the true score Qualified Mental Health Provider (QMHP): - \to work in mental health in va you must have this title.
• entry level position, impacts your practicum/internship and residency placement National Counselor certification: - \administered by the NBCC
• administers 2 examinations that are used for national certification and state licensure: National counselor examination (NCE) and National Clinical Mental Health counseling examination (NCMHCE)
• states use one or both of these exams as part of the licensure process in VA is the NCMHCE
• exams can be taken towards the end of a master's program if in an approved CAREP program, or after graduation National Counselor examination (NCE) - - counselors who wish to become nationally certified voluntarily submit their credentials to determine if they have met preset, specific standards required to become a national certified counselor (NCC) (basically a general practice certification)
• 220 item written test of the knowledge, skills, and abilities necessary for providing professional counseling services. examinees have 3 hours and 45 minutes to complete the multiple-choice test
• NCC requirements include specific educational coursework, documented experience, endorsements by qualified professionals, and a passing score on the NCE. National Clinical mental health counseling examination (NCMHCE) -

-assesses applicants on the following counseling domains: professional practice and ethics; intake, assessment and diagnosis, clinical focus, treatment planning, counseling skills and interventions, and core counseling attributes

• a major difference between the NCMHCE and the NCC is the format: it uses 10 case vignettes, that assess the examinees' ability to identify, analyze, diagnose, and develop treatment plans with -it is administered at specified locations throughout the US
• you are allowed to retake the test 3 times in a two-year period (fee for registration) counselor preparation comprehensive examination (CPCE) - \used as a program evaluation tool by more than 100 counselor education programs in US colleges and universities
• when a professional counselor becomes a NCC, the counselor can pursue national certification in a specialty area NBCC enforces the NBCC code of ethics, which sets standards for ethical behavior of all NCCs commission on rehabilitation counselor certification (CRCC): - -issues the CRC credential
• not affiliated with the NBCC
• to obtain national certification, applicants must take the certification examination. beyond this, applicants by choose one of six different paths for the remainder of the certification process State licensure: - \the process by which individual state legislatures regulate either the title, practice, or both, of an occupational group
• licensure is another level of state credentialing procedures and the most prestigious
• licensure laws exist in every state -laws vary by state -differs from certification in that t is governmentally sanctioned and not trade sanctioned licensure laws may be written as practice acts or title acts: practice acts: prohibit the practice of professional counseling without first obtaining licensure title acts: restrict the use of a professional title to those individuals' granted licensure by their appropriate state credentialing agency state licensure: general requirements - - a master's degree in counseling form an accredited institution
• a certain number of semester hours of graduate study (usually 60)
• specific coursework within the semester hours (usually aligning with CACREP educational standards) -between 2000 and 4500 hours of supervised experience (depending on the state), usually within a specific time frame
• pass a comprehensive examination on the practice of counseling

current LPC residency requirements in VA - - a 3400 hour supervised residency in counseling practice with various populations, clinical problems, and theoretical approaches -2000 hours of face-to-face client contact must be documented within the 3400 our residency. graduate internship hours in excess of 600 hours, may count for up to an additional 300 hours towards the total residency requirements

• a minimum of 200 hours of supervisory sessions, occurring at a minimum of 1 our and a maximum of 4 ours of supervision per 40 hours of work experience, during the period of the residency -you must complete your residency in no less than 21 months and no more than 4 years Portability: - \the ability of professionals to move their licensed status from state to state -due to different state standards and procedures for licensure, currently, the counseling profession does not have a portability agreement for licensed professional counselors Reciprocity agreements with partner states: - \states with similar licensing requirements agree to accept each others licenses so long as the appropriate fees are paid in the new state American association of state counseling boards (AASCB) - \maintains responsibility for the licensure and certification of counselors in the United states
• establishes licensure, creates common standards, develops national portability of licensure, and serves as a useful clearinghouse for tracking and documenting unethical counselors from state to state the American Counseling Association (ACA) - -ACA speaks to and for professional counselors across all settings and specialties -it is the worlds larges organization for counselors with over 51,000 members
• provides numerous resources for counselors, including publications, websites, continued education, webinars, and blogs it is suggested that all counselors become a member of at least tree associations: - -ACA -One division of ACA -their state branch functions of the ethical code - -to safe guard the welfare of the client and society -define ethical conduct in a profession: to inform and educate members -define standards of practice: important in legal actions -create a means by which members are held accountable for actions - protecting public -offer a way to promote professional growth, best practice criminal law: -

\sets for the legal rules for what the federal and state governments consider to be illegal and sets forth punishments for violations civil law proceedings: - \response of court system to controversies between two or more people federal regulations: - \procedures sometimes put into place to which licensed mental health professionals must adhere peer control mechanisms: - \implemented by professional groups who seek to monitor and exert control over members of their group

• ethical practice committee of the ACCA est. 1953, first draft of ethics was reviewed by members in 1950 and adopted in 1961 -ACA Code revision task force -generally speaking, the ethical code upholds professional standards of conduct that are higher than legal standards ethical standards: - \are normally developed by professional associations to guide the behavior of a specific group of professionals they help to : -educate members about sound ethical conduct -provide mechanism of accountability -improve professional practice best practice guidelines: - \are not ethics, but do recommend practice standards that professional counselors should strive to uphold laws: - \are more prescriptive than ethical stnadards, have been incorporated into code, and carry greater sanctions or penalities for failure to comply -when ethics and laws appear to be in conflict with each other, the professional counselor must attempt to resolve conflict in a responsible manner
• counselor will often follow the legal course of action if there is no harm to the client subpoena: - \a legal document, (in most cases) the client an attorney is representing believes that the counselor may have some information that will be helpful to the case
• do not automatically comply with the subpoena without discussing it first with the client/client's attorney/your own attorney -obtain signed informed consent from the client if he or she wishes information to be released. if he or she does nor, request the attorney file a motion to quash- which allows the counselor to not to comply with the subpoena

-maintain record of everything court order: - \permits the release of confidential informatin, but does not mandate its release; a court order allows professional counselors to use their judgement regarding whether to relase confidential information

• if the the release of confidential information is damaging to the client, the counselor should not release the requested materials -if both a subpoena and a court order are received, the counselor must release the information with or without the clients consent
• failure to do so may result in the counselor being held in contempt of court I.1.c. Conflicts between ethics and laws - - if ethical responsibilities conflict with law, regulations, or other governing legal authority, counselors make known their commitment to the ACA code of ethics and take steps to resolve the conflict -if the conflict cannot be resolved b such means, counselors may adhere to the requirements of law, regulations, or other governing authority professional competence: counselors should - - maintain professional growth continuing education -maintain accurate knowledge and expertise in areas of responsibility -accurately represent the credentials -provide only those services for which qualified and trained the standard of practice: - \will be used in any liability proceeding to determine if the professional counselors performance was within accepted practice -when a professional counselor is faced with any legal action, the first thing the counselor should do is call a lawyer and then let counselor supervisor, if there is one, know -never attempt to reason with the client or contact the clients lawyer without advice of counsel liability, negligence, and malpractice -if a professional counselor fails to exercise "due care" in fulfilling their professional responsibilities, they can be found quality of civil liability; the counselor committed a wrong against an individual -negligence may be found if the wrong committed results in an injury or damages -malpractice is the area of tort law that concerns professional conduct for a counselor to be held liable in tort for malpractice, four conditions have to be met: - \1) a duty was owed to the client by the counselor

2. the counselor breached that duty
3. there is a causal link between the breach and the clients injury
4. the client suffered a damage or injury

Informed consent: - \clients rights to be clearly informed regarding the nature of their counseling and make autonomous decisions regarding it

• clients should be informed during entire process professional disclosure statement -clients must understand the concepts, procedures, and implications conveyed. they must give consent for treatment and make a voluntary, autonomous decision youth and informed consent: - \generally the law states youth are unable to provide consent if under the age of 18. some states have expectations where minor deemed "especially mature" -HIPAA: a minor who chooses to enter mental health treatment and give consent on their own will be considered "the patient" and can maintain all of the rights given to adult patients Minor consent laws: - \allow certain minors to seek treatment for certain conditions without parental consent or notification, usually involving substance use, mental health, and some reproductive health areas
• based on federal regulation -vary by state
• counselors should be prepared for upset or angry parents who do not understand that their children can seek treatment in these areas without parental consent confidentiality: - \the ethical responsibility to safeguard client-related information gained through the professional relationship and disclose it only when fully informed clients give consent to do so -seperates the counseling relationship from other relationships where information is shared -belongs to the client -students under 18 yrs have an ethical right to confidentiality, but the legal rights belong to their parent or gaurdian -most states protect counselor-client confidentiality -place where law and ethics may collide privileged communication: - \the legal obligation to protect clients against forced disclosure in legal proceedings of information conveyed in the context of the professional relationship -all states have a psychotherapist-client privilidge law -for the protection of the client -client can waive this privilege (no confidentiality responsibilities to the therapist in a court of law) limits to confidentiality: - -duty to warn

-subordinates -treatment teams -consultation -groups and families -third party payers -minors -contagious, life-threatening diseases -court-ordered disclosure protection of clients or others from harm: - - confidentiality must be breached when a risk of harm to clients or others exists, but decision to do so requires compelling evidence -protecting clients who pose a danger to themselves: conduct a risk or lethality assessment -clients who pose a danger to others -end of life issues -clients with communicable diseases whose behavior poses a danger to others

• must confirm medical diagnosis with a medical provider before taking action child abuse: - \physical or mental injury, sexual abuse or exploitation, negligent treatment, or maltreatment of a child younger than age 18 or the age specified by the child protection law of the state in question, by a person who is responsible for the child's welfare is harmed or threatened -the keeping children and families safe act (2003) federal law pertaining to child abuse -must report suspected abuse or neglect generally within 24-72 ours of first "having reason to suspect"
• required to call CPS, oral and written report -no liability for reporting child abuse, serious penalties for failure to report when dealing with a potentially suicidal client, the professional counselor should: - -conduct a lethality assessment -determine the seriousness of the threat -based on the seriousness of the threat, decide whether the duty to warn is applicable privileged communication cannot apply to : - -group counseling -couples counseling -family therapy -child and adolescent therapy confidentiality should still be protected in these areas outside of a court of law (have members sign a confidentiality contract) Dual relationships: - \a specific type of bourndary issue that occurs when a counselro assumes two or more roles concurrently or sequentially with a person seeking help

-failure to manage and maintain boundaries represents the majority of claims (49.8%) (32% claims sexual/romantic interactions) Colston v. Bureau of professional and occupational affairs (PA) - - the counselor realized that her client was developing romantic feelings toward her. prior to referring him to another counselor, she continued counseling him and returned his texts, attended his mothers funeral, and sent inappropriate pictures to him. -the board indefinitely suspended her license -court affirmed the boards actions state Bd. v. Mathews-glover (Ct. of Civil appeals, oklahoma) - - the counselor engaged in a romantic relationship with a former client over two years after termination

• the statute governing LPCs provides that counselors cannot engage in sexual or romantic relationships with clients for five years after the termination of the counseling relationship -the counselor asserted that the five year ban violated her rights, though she supported a shorter time limit -the board revoked her license (could reapply in five years) -court found this harsh bu upheld the action Dept of licensing v Duncan, Ct. of appeals, michigan - -an LPC with a PHD in counseling also worked as a life coach, though he was not certified as a life coach, had no training in life coaching, and didn't belong to any life coaching professional organizations -the life coaching contract that he and his client signed indicated that they were not engaging in therapeutic services
• did refer to himself as Dr. and included his counseling credentials in his signature -respondent had been drinking one night and wen tot clients house where he states they "engaged in consensual sexual activity" -client reported that he had sexually assaulted her -court considered the coaching services the respondent provided to the client to fall into the states definition of counseling -court affirmed boards determination NBCC has constructed best practice guidelines for the practice of internet counseling, including: - -use of code words or numbers to verify the identity of the client -orient the client with procedures for contacting the counselor when off-line and how often emails will be checked by the counselor -acknowledge the possibility of internet failure and discuss alternative modes of communication, if that failure occurs -discuss potential misunderstandings due to lack of visual cues -identify free public access points to the internet within the community for accessing internet counseling or web-based assessment

-take security precautions and inform clients of encryption methods and potential hazards of unsecured online communication -discuss how long data of sessions will be preserved and release of information via other electronic sources Family Educational Rights and Privacy Act (FERPA): - -often referred to as the Buckley amendment -applies to all school districts, pre-k -12 schools, and postsecondary institutions that receive federal funding through the US department of education (nonpublic schools that do not accept federal funding are exempt from this law) -schools or systems annually send a notice to parents or guardians regarding their right to review their children's records and to file a complaint if they disagree with anything in the record -specifies that personally identifiable information can be disclosed without informed consent -only individuals "with a legitimate educational interest" can access a students record -the school must make whatever information is needed available to the schools law enforcement unit educational records: - \the record of a student -only exceptions are personal notes, reports to CPS for abuse or neglect, and in some states reports from law enforcement agencies regarding students arrests for reportable offenses -the inspection, dissemination, and access to student educational records must be in accordance with FERPA of 1974 protection of pupil rights amendment (PPRA) of 1978 (hatch amendment) - -established certain requirements when surveys are given to students in prek- schools; it doesn't apply to post secondary schools because students can consent on their own -if the survey is funded with federal money, informed consent must be obtained for all participating students -requires informed parental consent before the student undergoes any psychological, psychiatric, or medical examination, testing, or treatment, or any school program designed to affect the personal values or behavior of the student

• also gives parents the right to review instructional materials in experimental programs no child left behind (NCLB) of 2001 - -requires that schools and contractors make instructional materials available for review by the parents of participating students if those materials will be used in any department of education -funded survey, analysis, or evaluation -parents also have the right to inspect any instrument used to collect personal information that will be used in selling or marketing -parents have the right to not grant permission or to opt their child out of participating in any activity involving specific topics

CFR 42, part 2 - \confidentiality of alcohol and drug abuse patient record

• restricts the disclosure of records or their information concerning any patient in a federally assisted alcohol or drug program, except under certain specified conditions (medical emergencies, immediate threats to health or safety, child abuse, or court orders) intent: to ensure that an alcohol or drug abuse patient is not made more vulnerable by reason of the availability of their patient record than an individual wo has an alcohol or drug problem and who does not seek treatment (1970's) Wheeler and Bertrham (2008) identify four purposes of client records: - -clinical management -legal implications for client -protection of health info -risk management The health insurance portability and accountability act (HIPAA) of 1996 - \required that the US department of health and human services (HHS) adopt national standards for the privacy of individually identifiable health information, outlined patients rights, and established cirteria for access to health records
• health records in schools that are under FERPA are specifically excluded from HIPAA Psychotherapy notes: - \have special status under HIPAA -includes observations that therapists wish to record for their own use and could include details of the content and process of psychotherapy beyond the more standard documentation typically included in general medical records -disclosure of psychotherapy notes requires special designation in the release of waiver form signed by the patient. a signed waiver authorizing the release of medical records does not include psychotherapy notes, unless specific mention is made of that category working notes: - \refers to those impressions, hypothesis, and half-formed ideas that counsleor may jot down to assist in formulateing more comprehensive reports or recommendations later -due to the speculative and impressionistic nature of such working notes, they may not have meaning or utility to anyone except the person who made them forensic reports: - \involve data collected and reports written specifically for use in legal contexts and may not fall under the penumbra of HIPAA ACA code of ethics: - \preamble, purpose statement, and eight sections: -the counseling relationship -confidentiality, privileged communication, and privacy

-professional responsibility -relationships with other professionals -evaluation, assessment, and interpretation -supervision, training, and teaching -research and publication -resolving ethical issues AMHCA code of ethics: - \consists of preamble and guidance in the following sections: -commitment to clients -commitment to other professonals -commitment to stuents, supervisees, and employee relationships -commitment to the profession -commitment to the public -resolution of ethical problems scope of practice- - \outlines those professional roles and tasks that the person licensed under the law can legally perform

• from a legal perspective: practicing within the areas of competency as identified by the state law foundational principles of ethical codes - \autonomy: the clients capacity and right to self-direct and be an informed consumer of the service nonmaleficence- refers to the avoidance of doing intentional or unintentional harm beneficence-involves promoting good for others justice- fairness and equality of treatment fidelity-practice of honoring commitments and keeping promises veracity-honesty and genuineness ethical decision making model: - \1) identify the problem

2. apply the ACA code of ethics
3. determine the nature and dimensions of the dilemma
4. generate potential course of action
5. consider the potential consequencces of all options and choose a course of action
6. evaluate the selected course of action
7. implement the course of action