Category Archives: Personal Testimonials

Letters Needed to Expand TRICARE Eligibility

The House and Senate will meet in conference shortly to work out differences to their versions of the National Defense Authorization Act.

We need language in The Special Rule adopted in H.R. 1735 would allow qualified mental health counselors who hold masters or doctoral degrees in counseling from institutions accredited by other than CACREP to receive TRICARE reimbursement for services provided to veterans and their families through 2027.

This language is not currently in the Senate version.

Letters sent to the following email address will distribute your letter to all the legislative directors serving the Congressmen and Senators involved in this process:

tricarecounseling@concernedcounselors.org

This is not a discussion list – it only exists for a short time in order to email the right Congressional senior staff.

Please consider using elements of the following modified letter which is written to a group rather than to individual members of Congress.

Letter to all legislative directors and their Senators and Congressmen

We strongly recommend that you modify this letter or write your own to include specific examples of how you have served military members, families, and veterans.  Personalize your story.

You are more than welcome to write individual members – please see our last post for the list of names and contacts, as well as an individual member letter format.

Thanks

Counseling Students Who Will Never Get to Help TRICARE Clients

Another piece of great reporting by Crystal Price at KFOX in El Paso, TX.  She interviews an intern/student therapist about how — after all her work — she is never going to be able to help military children on TRICARE if the new regulations stand.  Ms. Price also interviews a school official for his comments.

Transcript available at: http://ow.ly/zd3WY

The CACREP Party line about current licensed counselors being able to grandfather into TRICARE if they take an exam is repeated in this story.  While that is true, its also the case that counselors must have received all of their supervision from a counselor or counselor educator (not a psychologist, a social worker, or other licensed mental health professional).  Most older counselors came up through school when supervisors from other professions were needed due to few fully trained counselors.  This renders the “grandfathering” options of TRICARE about useless for many of us.

This news segment does utilize a much more likely statistic for how many CACREP-trained counselors there actually are in this country.  Ms. Price AVOIDS using the following frankly embarrassing nugget that we are told is currently being passed around by CACREP in response to inquiries:

CACREP, which was formed in 1981, accredits the majority of post-graduate counseling programs in the country – over 650 graduate counseling programs at more than 290 institutions.  A random sample of licensed and non-licensed counselors used in the 2010 National Counseling Examination (NCE) job analysis study showed that 71% of counselors are CACREP graduates.  Of the remaining participants, 17% indicated that they graduated from a non-CACREP program and 12% reported to have earned their degree before CACREP was formed in 1981.

This quote is just so wrong in so many ways, most of them discussed here.

The Florida CACREP and Grandfathering Trap

The state of Florida requires that Licensed Mental Health Counselors have a master’s degree in mental health counseling from a CACREP accredited program (option 1(a) in their regulations) or that they present closely equivalent credentials (option 1(b) in their regulations). The board’s website goes to some pains to point out that even CACREP accredited degrees in community counseling are not good enough to satisfy the CACREP option 1(a).  The state requires some coursework – such as human sexuality and substance abuse – not offered in all degree programs.

Melanie, a Licensed Mental Health Counselor in New York for the past five years, found this out the hard way. She recently received a rejection letter:

I officially just received my license rejection notice from the state of Florida citing that I needed to take 3 additional graduate courses…  I graduated from my counseling program in 2003, so regardless if it was CACREP or not, educational programs tend to change and evolve over time.  When states decide to adopt a CACREP only policy or even just educational requirements WITHOUT putting a grandfathering clause into place for existing licensed counselors, none of us are protected unless you just don’t move.  Ever.  This appears to me to be either gross negligence on part of the lawmakers and corresponding advocacy/lobbying groups or just general discrimination.

Melanie is hopeful that she can appeal the decision. In the meantime she is falling into a common trap. Counselors face an array of obstacles in moving state-to-state:

  • The possibility of CACREP certification requirements invalidating their educational degrees.
  • Ever increasing coursework requirements that make it cost prohibitive to reach compliance.
  • The difficulty of finding a university willing to let you drop in for just a few classes.
  • The bewildering frustration that meaningful grandfathering opportunities rarely exist.

CACREP states that they are in favor of grandfathering CACREP-unaffiliated counselors into licensing eligibility for a period of seven years. However, support for grandfathering in their obscure position paper on their website is useless unless grandfathering is promoted in all the PR and lobbying efforts under way to promote CACREP at the state and national levels. This seems unlikely as long as CACREP-unaffiliated counselors are being wrongly portrayed as inferior in training.

The Florida example also illustrates the frustration of “alternative” licensing options to CACREP that are anything but.  The CACREP alternative section of the Florida regulations asks for:

The equivalent of at least 1,000 hours of university-sponsored supervised clinical practicum, internship, or field experience as required in the standards for CACREP accredited mental health counseling programs.

The problem here is that this “alternative” requirement to CACREP is TOO EXACTLY like CACREP (as we suspect are many of the section’s requirements).

For example, let’s take Maryland’s requirement for full licensure.  Maryland requires 3000 hours of face-to-face supervised counseling experience, up to 1000 hours of which may be accrued prior to graduation.  So let’s say that you completed an 800 hour internship as part of your graduate program.  You won’t qualify for the Florida license.  More to the point, the shortfall is all but unrepairable.  How the heck would a licensed counselor in another state seeking to move to Florida return to a graduate school just to complete additional supervised practicum?  How awkward would this be for a 10-year seasoned counselor even if it could be arranged?  Furthermore, it’s possible that were we to go read the cited internship regulations of CACREP there would be further requirements – perhaps such as no psychologists or social workers for supervisors?

Now in this particular example, it certainly IS better to have 1000 hours internship/practicum rather than 800 hours.  But it’s a trivial training difference for someone who has been in the field more than a few years.

Stepping away from Florida for just a moment, we also have a situation where CACREP-unaffiliated counselors can take the National Clinical Mental Health Counseling Examination (NCMHCE) from NBCC as part of their process to certify for TRICARE before the “grandfathering” period expires at the end of 2014.  We have many reports of counselors not being allowed to take this exam as part of their CACREP alternative credentials for TRICARE because… they don’t have coursework matching CACREP.

We must be on-guard against “alternative” credentials or “grandfathering” options that are de facto CACREP-only since there is no reasonable way for a CACREP-unaffiliated counselor to overcome the barriers.

State reciprocity of licensing is another goal that we should be aiming for. The argument is made that such reciprocity is one of the aims of national certification standards. However,the implementation of such national standards requires a long lead-in period and flexibility for equally desirable alternative training and certification methods.

Melanie goes on to state:

The last time I spoke to a representative at the Florida Board, I was told by the very nice man I spoke to that he hears these stories all the time from very seasoned counselors. It made me realize how much worse it would be if I had been practicing for 30 years and facing this. Nonetheless I believe we need to unite around this issue.

Melanie makes a good point about how difficult (or impossible) it would be for veteran counselors. Although Florida is not all about retirement, lots of retirees do move there. Does this mean counselors will no longer get to retire to Florida if they need to keep working a bit to make ends meet?

The elderly are the folks least likely to seek counseling. If they do, are they really all going to want counseling from 25-year-olds? CACREP-only language strongly favors new counselors. Older counselors are the professionals least likely to have CACREP certified graduate school backgrounds — and seasoned counselors are arguably the professionals with enough life experience to handle seniors more effectively.