Title of Regulation: 18VAC115-50. Regulations Governing the Practice of Marriage and Family Therapy (amending 18VAC115-50-40, 18VAC115-50-60).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

November 13, 2008 - 1 p.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor, Richmond, VA

Public Comments: Public comments may be submitted until December 26, 2008.

Agency Contact: Evelyn B. Brown, Executive Director, Board of Counseling, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4488, FAX (804) 527-4435, or email evelyn.brown@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of Chapter 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code of Virginia. Section 54.1-2400 provides the Board of Counseling the authority to promulgate regulations to administer the regulatory system. The specific authorization to promulgate regulations establishing the qualifications for licensure as a marriage and family therapist is found in § 54.1-3505 of the Code of Virginia.

Purpose: The purpose of the action to amend regulations for the licensure of marriage and family therapists to require that at least 100 of the 200 hours of clinical supervision in a residency be provided by a licensed marriage and family therapist and to repeal the provision that allows a person holding a license as a professional counselor to be granted a license as a marriage and family therapist without further examination. The action is in response to a petition for rulemaking submitted by Dr. Arnold Woodruff, President of the Virginia Association for Marriage and Family Therapy. It was strongly supported by comment to the board from licensed MFT’s and others.

The purpose of the action is to ensure that persons who hold the marriage and family therapy license are specifically trained, experienced and tested in the unique theories and modalities for addressing the needs of their clients. While other mental health professionals can and do treat individuals and families, public health and safety is protected by the assurance that a person who holds a license as a marriage and family therapist is appropriately qualified in the specific application of theory and technique.

Substance: 18VAC115-50-60, which sets out the requirements for a residency in marriage and family therapy, is amended to specify that at least 100 of the required 200 hours of face-to-face supervision be provided by a person holding a license as a marriage and family therapist. The requirement would be similar to that for licensed professional counselors and would include a provision to allow the board to consider special requests in the event that the regulations create an undue burden in regard to geography or disability that limits the resident's access to qualified supervision.

In addition, 18VAC115-50-40 is amended to repeal subdivision 3 b, which allows a person holding a license as a licensed professional counselor to be licensed by endorsement without taking and passing the national examination in marriage and family therapy. Both changes would provide the consumer of mental health services with greater assurance about the training and competency of the practitioner who holds a license to provide marriage and family therapy.

Issues: The primary advantage to the public would be the assurance that persons who hold a license as a marriage and family therapist have had appropriate supervision in their residencies and have been tested on a national standard in the systemic theories and application relative to marriage and family therapy. There are no disadvantages to consumers of mental health services; persons who hold a license as a professional counselor will continue to be authorized to provide marriage and family counseling, and residents who have difficulty finding a licensed MFT to provide one-half of the required supervision will be able to request a hardship waiver.

There are no disadvantages to the agency or the Commonwealth. By specifying requirements for a supervisor, there will be less ambiguity in the regulation, which may encourage compliance. There are no other matters of interest.

The Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Counseling (Board) proposes to amend its Regulations Governing the Practice of Marriage and Family Therapy to specify that half of the required hours of face-to-face resident supervision be provided by a licensed marriage and family therapist. The Board also proposes to eliminate the regulatory provision that allows licensed professional counselors to also be licensed by endorsement as marriage and family therapists.

Result of Analysis. There is insufficient data to weigh the magnitude of costs versus benefits for this proposed regulation. Costs and benefits are discussed below.

Estimated Economic Impact. Currently, residents who are training to be marriage and family therapists must complete 4,000 hours of post graduate supervised clinical experience. Of those 4,000 hours, 200 must be under the face-to-face supervision of a licensed marriage and family therapist, professional counselor, clinical psychologist, clinical social worker or psychiatrist. The Board proposes to amend this provision so that 100 of the 200 hours of required face-to-face supervision must be performed by a licensed marriage and family therapist.

The Department of Health Professions (DHP) reports that this change is proposed to account for "distinctive differences in the therapy paradigms and systemic differences in theory and application with respect to marriage and family systems." The Board believes that, because of these differences, individuals who are working toward licensure in marriage and family therapy will be better prepared if they have a certain amount of dedicated supervision from individuals that are already licensed in the residents’ chosen field. To the extent that marriage and family therapists have a distinct knowledge base and skills set that they can pass on to future licensees, affected residents will benefit from this regulatory change.

DHP reports that the Board currently licenses approximately 830 marriage and family therapists, 2,940 professional counselors, 1,912 clinical psychologists and 4,409 clinical social workers. Since psychiatrists are licensed as medical doctors, and the Board of Medicine does not issue separate licenses for areas of specialization, DHP does not know the number of psychiatrists that practice in the Commonwealth. Given the much smaller pool of licensed marriage and family therapists, when compared to the pool of all types of professionals that can now offer supervision, residents will likely have a more difficult time finding an appropriate supervisor for the supervision hours that will now be restricted. DHP reports, however, that residents who cannot find an available licensed marriage and family therapist to provide the proposed supervision may apply to the Board for a waiver that would allow supervision by other acceptable Board licensed professionals. Currently this waiver program is Board policy but is not explicitly written into this regulation. Residents and others who are subject to this regulation would likely benefit from the clarity added if the Board were to explicitly write the waiver program into the regulatory language.

Currently regulation includes a provision that allows licensed professional counselors to also gain licensure as marriage and family therapists without have to meet separate education and examination requirements. The Board proposes to eliminate this provision. Once this amended regulation is promulgated, licensed professional counselors will have to have completed all course work required for licensure as a marriage and family therapist, and will have to take the marriage and family therapy exam, if they want to be licensed as marriage and family therapists.

DHP reports that, although there would be overlap with the requirements of the license they already hold, most licensed professional counselors would not have already completed all of the course work required for the dual licensure. Accordingly, licensed professional counselors would have to incur explicit costs for tuition, books and related school fees, as well as implicit costs for the time spent on the extra required education, if they want to also be licensed as marriage and family therapists. These costs could be small, if individual licensed professional counselors have already attained most of the required education, or they could be quite large, if individual licensed professional counselors have only taken a few of the required courses. DHP reports that there is no solid information that would indicate which of these cost paths is more likely. With this regulatory change, all licensed professional counselors who also wish to be licensed as marriage and family therapists would incur a fee of $224 for the marriage and family therapy examination and will also incur implicit cost for the time spent preparing for, and taking, this exam.

DHP reports that licensed professional counselors will not have to limit the scope of their practice on account of this proposed regulatory change. Licensed professional counselors who choose not to bear the extra costs that will be associated with licensure as a marriage and family therapist may be at a slight disadvantage in attracting new clients who have family related issues, but they will not face a regulatory bar to providing services for the clients they do attract.

Businesses and Entities Affected. These regulatory changes will mainly affect licensed professional counselors, who might wish to also be licensed as marriage and family therapists, and residents in marriage and family therapy programs. DHP reports that the Board currently licenses 2,940 professional counselors but has no data to indicate how many professional counselors have also been licensed by endorsement as marriage and family therapists. The number of individuals who are currently serving residencies in a marriage and family therapy program is also unknown. Other Board licensees will also be affected by these regulatory changes to the extent that they are no longer eligible to provide supervision for part of residents’ required supervised clinical hours.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. To the extent that this proposed regulation prescribes resident supervision, resident employment in offices of other Board licensed professionals will be limited.

Effects on the Use and Value of Private Property. Licensed professional counselors who choose not to bear the extra costs that will be associated with licensure as a marriage and family therapist may be at a slight disadvantage in attracting new clients who have family related issues. If this proposed regulation does adversely affect the number of clients that professional counselors can attract, these counselors may see their revenues decrease. This, in turn, may slightly lower the value of impacted counseling practices.

Small Businesses: Costs and Other Effects. Most licensed professional counselors in the Commonwealth are part of a practice that qualifies as a small business. These businesses will be affected by this proposed regulation only if the shift in requirements to gain an additional license in marriage and family therapy puts them at a disadvantage when attracting and retaining clients.

Small Businesses: Alternative Method that Minimizes Adverse Impact. There appear to be no alternative regulatory schemes that would both meet the Board’s goal of recognizing marriage and family therapy as a distinct profession and further minimize any adverse impact on affected small businesses.

Real Estate Development Costs. This regulatory action will likely have no affect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB’s best estimate of these economic impacts.

Agency's Response to the Department of Planning and Budget's Economic Impact Analysis: The Board of Counseling concurs with the analysis of the Department of Planning and Budget on proposed amended regulations for 18VAC115-50, Regulations Governing the Practice of Marriage and Family Therapists.

Summary:

The requirements for a residency in marriage and family therapy are amended to specify that at least 100 of the required 200 hours of face-to-face supervision must be provided by a person holding a license as a marriage and family therapist. The requirements for licensure by endorsement are amended to repeal the provision that allows a person holding a license as a licensed professional counselor to be licensed by endorsement without taking and passing the national examination in marriage and family therapy.

18VAC115-50-40. Application for licensure by endorsement.

A. Every applicant for licensure by endorsement shall submit in one package:

1. A completed application;

2. The application processing and initial licensure fee prescribed in 18VAC115-50-20; and

3. Documentation of licensure as follows:

a. Verification of all professional licenses or certificates ever held in any other jurisdiction. In order to qualify for endorsement the applicant shall have no unresolved action against a license or certificate. The board will consider history of disciplinary action on a case-by-case basis;

b. Documentation of a marriage and family therapy license obtained by standards specified in subsection B of this section; or.

c. If currently holding an unrestricted license as a professional counselor in Virginia, documentation of successful completion of the requirements set forth in 18VAC115-50-50, 18VAC115-50-55 and 18VAC115-50-60.

B. Every applicant for licensure by endorsement shall meet one of the following:

1. Educational requirements consistent with those specified in 18VAC115-50-50 and 18VAC115-50-55 and experience requirements consistent with those specified in 18VAC115-50-60; or

2. If an applicant does not have educational and experience credentials consistent with those required by this chapter, he shall provide:

a. Documentation of education and supervised experience that met the requirements of the jurisdiction in which he was initially licensed as verified by an official transcript and a certified copy of the original application materials; and

b. Evidence of clinical practice for five of the last six years immediately preceding his licensure application in Virginia.

3. In lieu of transcripts verifying education and documentation verifying supervised experience, the board may accept verification from the credentials registry of the American Association of State Counseling Boards or any other board-recognized entity.

18VAC115-50-60. Residency.

A. Registration.

1. Applicants who render counseling services shall:

a. With their supervisor, register their supervisory contract on the appropriate forms for board approval before starting to practice under supervision;

b. Have submitted an official transcript documenting a graduate degree as specified in 18VAC115-50-50 to include completion of the internship requirement specified in 18VAC115-50-55; and

c. Pay the registration fee.

2. After September 3, 2008, applicants who are beginning their residencies in exempt settings shall register supervision with the board to assure acceptability at the time of application.

B. Residency requirements.

1. The applicant shall have completed at least two years of supervised post-graduate degree experience, representing no fewer than 4,000 hours of supervised work experience, to include 200 hours of supervision with the supervisor in the practice of marriage and family therapy. Residents shall receive a minimum of one hour and a maximum of four hours of supervision for every 40 hours of supervised work experience. No more than 100 hours of the supervision may be acquired through group supervision, with the group consisting of no more than six residents. One hour of group supervision will be deemed equivalent to one hour of individual supervision.

2. Of the 4,000 hours stipulated, at least 2,000 hours must be acquired in direct client contact of which 1,000 hours shall be with couples or families or both.

3. The residency shall consist of practice in the core areas set forth in 18VAC115-50-55.

4. The residency shall begin after the completion of a master's degree in marriage and family therapy or a related discipline as set forth in 18VAC115-50-50.

5. A graduate-level internship completed in a program that meets the requirements set forth in 18VAC115-50-50 may count for no more than 600 of the required 4,000 hours of experience. The internship shall include 20 hours of individual on-site supervision, and 20 hours of individual or group off-site supervision. Internship hours shall not begin until completion of 30 semester hours toward the graduate degree.

6. A graduate-level degree internship completed in a COAMFTE-approved program or a CACREP-approved program in marriage and family counseling/therapy may count for no more than 900 of the required 4,000 hours of experience.

7. In order for a graduate level internship to be counted toward a residency, either the clinical or faculty supervisor shall be licensed as set forth in subsection C of this section.

8. Residents shall not call themselves marriage and family therapists, solicit clients, bill for services rendered or in any way represent themselves as marriage and family therapists. During the residency, they may use their names, the initials of their degree and the title "Resident in Marriage and Family Therapy." Clients shall be informed in writing of the resident's status, along with the name, address and telephone number of the resident's supervisor.

9. Residents shall not engage in practice under supervision in any areas for which they do not have appropriate education.

10. Residents who do not become candidates for licensure after five years of supervised training shall submit an explanation to the board stating reasons the residency should be allowed to continue.

C. Supervisory qualifications. A person who provides supervision for a resident in marriage and family therapy shall:

1. Hold an active, unrestricted license as a marriage and family therapist, professional counselor, clinical psychologist, clinical social worker or psychiatrist in the jurisdiction where the supervision is being provided;

2. Document two years post-licensure marriage and family therapy experience; and

3. Have received professional training in supervision, consisting of three credit hours or 4.0 quarter hours in graduate-level coursework in supervision or at least 20 hours of continuing education in supervision offered by a provider approved under 18VAC115-50-96. Persons who have provided supervision for a residency prior to September 3, 2008, shall complete such coursework or continuing education by September 3, 2010. At least one-half of the face-to-face supervision shall be rendered by a licensed marriage and family therapist.

D. Supervisory responsibilities.

1. The supervisor shall complete evaluation forms to be given to the resident at the end of each three-month period. The supervisor shall report the total hours of residency and evaluate the applicant's competency to the board.

2. Supervision by an individual whose relationship to the resident is deemed by the board to compromise the objectivity of the supervisor is prohibited.

3. The supervisor shall assume full responsibility for the clinical activities of residents as specified within the supervisory contract, for the duration of the residency.