Killeen Texas Daily Herald Story on TRICARE Counselors

A sincere thank you to military editor Rose Thayer for running the following piece in the Killeen Daily Herald today:

Off-post counselors await Tricare policy decision

There are so few news segments on the impending TRICARE disaster, so I appreciate her interest and efforts to warn the public.

I think I begin to see why there is so little interest in this big news story…  A causal reader who browses the above article could be forgiven for walking away thinking that this is no big deal.  After all, the Defense Health Agency is just trying to balance quality with accessibility, and only 29% of counselors are ineligible for the new TRICARE rules anyway, and even those 29% have an open-ended opportunity to grandfather into the new rules…

**NO**    **LETS TRY AGAIN**

If DHA and CACREP gave Ms. Thayer the statistics as stated knowing that they were for an article on TRICARE counseling, then they were extraordinarily misleading. Perhaps this is not how it came about.

We speculate — if these are the sorts of factoids given to reporters when they inquire on this topic, no wonder there is so little alarm over this issue.

How’s a well-meaning reporter to know that they have to take all the “facts” given to them with such a large dose of skepticism?

The DHA quote in the article talks about balancing quality versus accessibility.  This indirectly implies a lack of quality amongst CACREP unaffiliated counselors.  There have been no creditable studies showing that CACREP graduates perform better counseling.  Many quality schools – some of them ivy league – are not CACREP accredited .  In the northeast these non-CACREP programs include Harvard, Columbia, George Mason, Seton Hall, and (until recently) Johns Hopkins.

CACREP’s oft-repeated factoid about 640/650 programs being CACREP accredited is incredibly misleading.  This number includes school counseling and other counseling programs that **DO NOT QUALIFY FOR TRICARE**.  There are only 120 or 121 Clinical Mental Health Counseling Programs in the country that are CACREP-accredited.  These are the ONLY ones whose graduates will be qualified to serve Tricare beneficiaries.  Most accredited mental health programs are located in the South or North Central regions of the country.  All of New England has only EIGHT such programs.  The regulation will create “therapy deserts” where Tricare patients simply cannot find a qualifying mental health counselor.  Now it is the case that other similar professions (psychologists, social workers) can partially fill these service gaps, but this remains a ridiculous obstacle to veterans and their families getting the mental health care that they need.

There is a quote in this story that “the policy does allow for providers to be grandfathered in if they didn’t graduate from an accredited program.”  This is true as far as it goes…  If a counselor is lucky, he/she can take the NCMHCE exam before the end of the year to be grandfathered in.  However, this is problematic…  Some counselors have been told that they have to meet CACREP-like standards before they can sit for the NCMHCE exam (I’m told NBCC has very recently changed this).  Some regions are requiring counselors to sign a statement that they completed all of their hours of supervised practice prior to licensure under the supervision of a professional counselor or counselor educator (as opposed to a psychologist, social worker, or other licensed mental health professional).  Almost NO counselors who have been in the field more than a few years conducted their internships under another counselor – when the profession was new almost everyone had a psychologist or social worker as a supervisor.  So – hard as it is to believe – there is no grandfathering redress available for many counselors despite the show of such.  No, it does not make sense.  A psychologist makes for a fine training supervisor.

We are simply stunned by the following quote:

“According to CACREP, a random sample of licensed and nonlicensed counselors used in the 2010 National Counseling Examination job analysis study showed that 71 percent of counselors are CACREP graduates. Of the remaining participants, 17 percent indicated they graduated from a nonCACREP program and 12 percent reported they earned a degree before CACREP was formed in 1981.”

Please tell us that this material was not really given by CACREP as an answer to how the supply of counselors would be effected for TRICARE counseling?

Our best conservative estimates are that approaching 70% of counselors ARE NOT from CACREP programs:

~ In Mass there are roughly 5200 LMHCs (their version of professional counselors), estimated +/- 4% being from CACREP programs. Only two of 19 programs in Mass are CACREP accredited.

~ CACREP itself says over 640 approved programs exist.  Only 121 (about a fifth) are Clinical Mental Health Counseling programs that would meet the proposed regulations of TRICARE.

~ ACA did a study citing that only 13% of New York counselors would meet TRICARE requirements.  They cited this in a letter to Jonathan Woodson.

There is no way that 71% of counselors are CACREP graduates.  Not even including school counselors, who would not be paneled for TRICARE anyway.