AAMFT California Newsletter Winter 2013


Health Care Reform Update
BBS Regulations on Advertising and Discipline
Faculty Perceptions of Benefits and Barriers to COAMFTE Accreditation Survey Results
Client Simulation in MFT Training


Dear Reader,

Thank you. Our first issue of AAMFT-CA eNewsletter was a great success because of your interest and support that would not have been possible without member contributions or the keen eye and wonderful spirit of Associate Editors Steve Brown, PhD and Olivia Loewy, PhD. Bravo! Our second issue is very much an encore to the first. With articles of interest for all of our members, our newsletter is an exceptional tool that can take you into the future as a prepared professional. Should you wish to contribute to the future success of our newsletter or profession, forward your comment(s), idea(s), or article title(s) to me here.

Warm regards,

David Clark, MA
AAMFT-CA Communications Committee Chair & Editor
MFT Registered Intern

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Health Care Reform Update


Olivia Loewy, PhD

Current and anticipated changes in the delivery of mental healthcare nationally as well as in California will provide increased access to services. A provider shortage is predicted and AAMFT-CA Division is actively participating in policy meetings at the state level to ensure a role and opportunities for MFTs within the evolving systems of care. The brief overview that follows provides basic information about national healthcare reform as it pertains to mental health care.


In 2003, the President’s New Freedom Commission on Mental Health report presented a fundamental vision in the statement: “To achieve the promise of community living for everyone, new service delivery patterns and incentives must ensure that every American has easy and continuous access to the most current treatments and best support services.”

Research has since continued to surface that links primary health with mental health in multiple contexts, including cost effectiveness implications. Consider the following:

  • The Center for Disease Control, National Vital Statistics Report in 2009 stated that: “people with mental illness are nearly 2 times as likely as the general population to die prematurely (8.2 years younger) often of preventable of treatable causes (95.4% medical causes) and that behavioral health conditions lead to more deaths than HIV, traffic accidents and breast cancer combined”;
  • According to the National Survey on Drug Usage and Health (2008-2009), adults who had any mental illness, serious mental illness or major depressive episodes in the past year had increased rates of hypertension, asthma, diabetes, heart disease and stroke; and,
  • The World Health Organization stated that mental illnesses account for 15.4% of the total burden of disease, yet mental health expenditures in the U.S. account for only 6.2%.

The connection between primary health and behavioral health has become indisputable.  As such, the 2010 Affordable Care Act (ACA) includes the provision of behavioral health services in a solid and substantial position.  SAMSHA’s post-ACA Vision (2011) describes a nation that acts on the knowledge that:

  • Behavioral health is essential to health.
  • Prevention works.
  • Treatment is effective.
  • People recover.

Affordable Care Act

Among other changes that will be instituted at the national level, the ACA is intended to:

  • Extend care to millions of Americans in the coming years, including many who are presently uninsured.
  • Extend Medicare to cover many more individuals and provide reduced cost coverage to others, thereby helping many uninsured families receive coverage.
  • Require all individuals to be covered by health care and require many employers to provide it or pay financial penalties.
  • Prevent insurance companies from discriminating against those with pre-existing conditions and require insurance companies to rebate consumers if their costs do not adequately reflect the care received.
  • Reduce the overall cost of health care in time.

Additionally, the ACA decrees in law that funding must be provided for specific Essential Health Benefits (EHB). Mental Health and Substance Abuse services are included among the 10 categories of EHB defined under Section 1302 of the ACA. The implementation of ACA will permit utilization of the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 as it also applies to the newly defined Essential Health Benefits.

MFTs need to understand that the Essential Health Benefits include Behavioral Health, in which Mental Health and Substance Abuse are merged in the evolving systems of care and that knowledge of substance abuse will be an advantage in tomorrow’s marketplace. Similarly MFTs could benefit from education and training related to working with the seriously mentally ill (SMI) population, as new structures of care will make treatment more accessible for behavioral health conditions that meet the requirements for Medical Necessity.

Extended Care

Beyond immediate and acute services for the SMI population, of particular note for MFTs is incorporation of the perspective of mental health that extends to the community and preventative care.

The World Health Organization states: “Determinants of mental health include multiple social, psychological and biological factors that influence the level of mental health of a person throughout his or her life.” This implies that the whole person must be viewed within the context of mental health treatment.

Additionally, Ron Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) stated: “Most public clients require one or more social services – job supports, housing supports or social supports. Absent these supports, health care services are less effective. Hence, major efforts are underway in Washington D.C. to maintain funding for these services and to help policy makers understand how important they are to the success of health services. As we go forward, it is very likely that health homes will be expanded to include these services and that they will be reported as a part of the electronic medical record.”

The training that MFTs receive in working with the family, community, relationships and systems can be very relevant and applicable, depending on how (and whether) expanded care is included within the treatment continuum.

Extended services naturally bring up questions and concerns related to changes in payer policies. AAMFT continues to represent MFT concerns and will continue to convey information to you as information becomes available.

Health Benefits

Exchange Health Benefits Exchanges required by the ACA will increase the number of insured, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value. MFTs will be benefit from remaining informed about how the development of these Exchanges may affect future provider panels and reimbursement rates.

It is significant to note that the details of the related regulations, requirements and procedures are only now emerging from developmental stages. AAMFT-CA will continue to follow the progress and update our members about what we learn.

From national to state Health Care Reform

In a parallel process, California is planning for unique implementation of health care reform within our state. AAMFT-CA secured a place “at the table” to represent MFTs in policy and planning meetings at the state level. The next article provided to you will focus specifically on Healthcare Reform in California.

Image source: Courtesy of Olivia Loewy, PhD

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BBS Regulations on Advertising and Discipline


Benjamin E. Caldwell, PsyD

While many of the rules that govern MFTs in California are developed through legislation, the Board of Behavioral Sciences also has the ability to advance regulations that add clarity and detail to the laws. While legislative changes usually take effect January 1 of the following year, changes in regulation take effect more immediately. Two recent regulation packages put forward by the BBS will impact MFTs: One on advertising rules, and the other on the disciplinary process.

Advertising. The advertising changes are minor. Most importantly, even for licensees, the license number will now need to be included in every advertisement. In addition, a licensed MFT must give their title, though can provide either their fully spelled-out title “marriage and family therapist” or use the abbreviation MFT or LMFT in an ad. (Technically, LMFT had not been recognized in the past.) Previous law required licensees to either use their spelled-out title or their license number, but not both.

For MFT interns, the regulations appear to allow the abbreviation “MFT Registered Intern” in an ad, but because state law (California Business and Professions Code section 4980.44d) does not allow for this, interns may be safest continuing to use the fully spelled-out title “Marriage and family therapist registered intern.” One other noteworthy change is that the new regulations allow the BBS to issue fines to licensees and registrants who violate the advertising rules. Previously the BBS could only either order an advertiser to change their ads or move toward putting the license or BBS Regulations on Advertising and Discipline (Anchor here)  registration on probation. The advertising rule changes have been approved and take effect April 1, 2013.

Disciplinary process. Changes to the disciplinary process are more involved. Under the proposed regulations, failure to cooperate and participate in a board investigation would be, in and of itself, unprofessional conduct for which the BBS could take action against your license or registration. While several amendments have attempted to address due-process concerns, the regulations still would require therapists under investigation to provide most documentation within 15 days of the investigator’s initial request. The BBS’s stated motivation in developing these regulations was to speed up the investigation process, which according to the Board’s own web site currently takes an average of about two years from initial complaint to resolution. The disciplinary changes have not yet been approved by the state’s Office of Administrative Law, but if approved, the new rules would take effect as immediately as practicable for the BBS.

More information on both regulation packages is available at the BBS web site, on their Legislation and Regulation page (http://www.bbs.ca.gov/bd_activity/law_reg.shtml).

Benjamin E. Caldwell, PsyD chairs the AAMFT-California Division Legislative and Advocacy Committee. He can be reached at bcaldwell@alliant.edu

Image source: Courtesy of Ben Caldwell, PhD

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Faculty Perceptions of Benefits and Barriers to COAMFTE Accreditation Survey Results

Steve Brown, PHD, JD and Olivia Loewy, PhD

In many parts of the country, accreditation by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) is standard for all MFT programs. In California, however, a majority of our MFT programs are not accredited by this voluntary accrediting agency.

AAMFT-CA Division has established a strategic goal for aligning our MFTs with the national profession, which must begin with the educational process. In this context the steering committee of the AAMFT-CA Educators Collaborative decided to survey its members to help identify faculty members’ perceptions of the benefits and the barriers to COAMFTE accreditation. A task force was established with the following objectives:

  • Determine the impediments to COAMFTE accreditation as indicated by California graduate school programs.
  • Create a report of the findings.
  • If appropriate, submit recommendations to COAMFTE.

The 262 educators with emails on the California Educators Collaborative listserve were asked to follow a link to participate in the anonymous and confidential survey. A total of 65 (25%) surveys were returned. Of this number 28% were affiliated with COAMFTE Accredited programs, 71% were from faculty members at schools that were not COAMFTE accredited and 1% did not indicate their COAMFTE affiliation status. These responders represented 30 different programs.

Seven benefits were seen as significantly more valuable by faculty members in COAMFTE accredited programs than by faculty members in non-accredited programs:

  • A high-quality nationally recognized education
  • Helps in recruiting students
  • Assures that a program evaluates its own effectiveness
  • Assures that a program has been evaluated and approved by external expert reviewers
  • Portability of the degree
  • Helps in recruiting new faculty
  • COAMFTE Accreditation assists in receiving grants and fellowships

Faculty members at non-accredited programs perceived five areas as significantly larger barriers than did faculty at accredited programs:

  1. Lack of administrative support
  2. Lack of faculty support
  3. Paperwork considerations
  4. Accreditation is a low priority for our program
  5. Difficulty in obtaining placements that meet COAMFTE standards

Among the interesting comments were:

  • It seems relatively irrelevant in California for the effort required to obtain it.
  • Getting COAMFTE approved supervisors is a major barrier.
  • The primary and probably only barrier for our excellent program has always been that you have required at least three fulltime faculty members.
  • The standards don’t match California’s as well as other states; practicum training requirement is difficult to meet here.
  • COAMFTE is not well known in the state of California and is not valued.
  • The high standards will mean that we can accept fewer students and thus will limit our enrollment.
  • We are a Clinical Psychology program that meets MFT requirements in CA. We do not want to be exclusively an MFT program.
  • My university does not subscribe to the degree of focus on systems theory to the exclusion of many others.
  • We just don’t want it.

Brent Taylor; Dana Stone; Laura Steele; Mary Moline; Olivia Loewy and Steve Brown were the task force members who worked on this project. Educators Collaborative Steering Committee members Diane Gehart, Carmen Knudson-Martin, Ben Caldwell and Scott Woolley served in an Advisory capacity in relation to the work of the task force.

For more information, please contact Olivia or Steve 

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Client Simulation in MFT Training

Laura Steele, PhD

The journey to becoming a marriage and family therapist calls for training that focuses on the integration of therapeutic techniques along with an underlying theoretical understanding of how, and under what circumstances, to use them. Marriage and family therapy (MFT) programs are challenged with the task of preparing students to become therapists who are self-aware, conceptually sound, and ethically sensitive. Training in MFT not only involves the acquisition of knowledge gained, but the ability to demonstrate clinical skills. Academic programs must develop meaningful ways to integrate classroom knowledge with the practical skills required in the field.

The use of Client Simulation, simulated scenarios in which an individual is trained to play the role of a client, may be one way to bridge the gap between the classroom and the clinical training experience, and provide a way for supervisors and instructors to evaluate clinical competence. Client Simulation activities offer many instructional advantages, such as being able to expose every student to the same situation in a risk-free environment, directly link learning objectives and curriculum standards, and provide the opportunity for students to practice clinical skills. Simulated scenarios can be structured to allow students to demonstrate and practice the same clinical situation using alternative techniques and styles, enable faculty to evaluate students’ clinical performance, and provide meaningful feedback. As current trends in education continue to support student-centered learning, or outcome-based measures of assessment, the use of Client Simulation or standardized clients is one clinical training activity that places emphasis on “what the student can do.”

Client simulated scenarios provide the opportunity for the student to practice and demonstrate their clinical knowledge, skills, and professionalism. One way in which Client Simulation activities can be incorporated into graduate programs is to provide opportunities for students to complete several client simulations with simulated clients as a part of their clinical training. After the simulated session, students receive feedback from each simulation that will promote their growth and development as a therapist.

The idea of using standardized patients or simulated activities has evolved out of medical education in which an individual is carefully coached to simulate an actual patient so accurately that the simulation cannot be detected. The standardized patient presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well. Standardized patients in simulated scenarios have been widely accepted because they allow the student to have a more realistic experience, enhance learning while optimizing patient care and safety, and provide valuable training with minimal risk to the public. Similar simulation exercises may be used as a tool for demonstrating the therapeutic process.

While students are often sent into counseling sessions with limited practical experience, the Client Simulation activities may provide useful information to instructors on which teaching methods are ideal for teaching specific clinical skills before a student is introduced to an actual client. Instructors can place their time and energy into developing effective simulation exercises to incorporate into courses in conjunction with other teaching methods, such as lecture presentations and assigned readings. Since training programs cannot teach the therapist how to respond to every case, it is essential that students be trained to think for themselves and have a basic understanding of clinical skills.

Image source: Courtesy of Laura Steele, PhD

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