Dan Alan Corley.

Generic professional and technical knowledge skills and abilities needed by mental health counselors / online

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garded because the professions will attempt in time to gain control
over accountability as well (Cohen, 1977).

Others (Hogan, 1978b; Shimberg, 1976; Shimberg & Roederer,
1978) are not as systematic as Cohen in their identification of
professional benefits from licensure. Some of the advantages mentioned
are obvious even to the casual observer. The statutory regulation is
a symbol of respectability and demonstrates that the profession is
well established. This lessens the difficulty of attracting high-
caliber recruits and helps define the field more clearly. It also
controls the number and geographic distribution of practitioners
(Hogan, 1978b). Some licensing boards use their power to erect
barriers to restrict entry into the field, control the availability
and cost of services, and restrict competitive bidding (Shimberg &
Roederer, 1978).

HEW Licensure Studies

The growing public interest in the health care system and man-
power credentialing influenced the enactment of Public Law 91-519,
an amendment to the Public Health Service Act on November 2, 1970.
In that law Sec. 799A provided for the Secretary of Health to prepaire
and submit to Congress a report identifying the major problems
associated with licensure, certification, and other qualifications
for practice or employment of health personnel (DHEW, 1971). The
first of the health manpower reports (DHEW, 1971) was an overview of
the state of professional credentialing and presented many of the



27



concerns about licensure mentioned earlier. In addition, it covered
probl ens encountered for licensure with career and geographic
mobility, foreign graduates, and demonstrating and maintaining
proficiency. The report recontnended a moratorium for two years on
the enactment of legislation that would establish new health per-
sonnel categories, adoption and use of national examinations for
licensure, development of proficiency examinations, and the investiga-
tion of national certification and institutional licensure as alterna-
tives to the present system. A follow-up report provided greater
detail and justification for the 1971 recommendations, reported on
activity in the states, and urged continuance of the moratorium on
legislative activity while alternative credential ing methods were
being explored. Two reports followed; one reported that construction
of a system of national level certification of health providers was
feasible and should be undertaken (Sweezy, 1974). The other explored
institution licensure as an alternative and it was found lacking due
to political difficulties that would prevent initiation of an adequate
system (Storrer et al., 1976).

The Subcommittee for Health Manpower Credentialing (SMC, 1976)
prepared a final report with recommendations on the studies. How-
ever, the report when previewed by officials in various states did
not meet with total approval. In recognition of political pressure,
one recommendation was dropped, and wording was altered slightly in
a subsequently drafted and published version of the final report
(SMC, 1977).



28



The HEW studies had been founded on the premise that the only
reason for licensure was to protect the public from significant
harm to health and to safety (DHEW, 1971). The studies found that
licensure failed in this purpose, and, instead of making quality
health care more available, it served to enhance the professions
and harm the public (DHEW, 1977). Cohen (1977), articulating this
failure, pointed out that licensure, having concentrated on creating
restrictive (usually irrelevant) criteria for initial entry into a
profession, has virtually ignored the maintainence of competence
in those licensed. It has neither served to advance the development
of performance standards nor the development of competency assessment.
Reiff (1974) saw licensure as a self-serving device that professions
use to control knowledge as a commodity which if made available would
benefit the public.

Board compositions and board practices bear much of the responsi-
bility for criticism of licensure. Boards are almost always made
from recommended candidates from state professional organizations and
are thus tied to the politics within the state association rather
than selected on the basis of being the best qualified for board
service (Matarazzo, 1977). Board practices have been identified as
having contributed to poor distribution of practitioners and
specialists in the states (Cohen, 1977). Cohen (1973b) also identifies
several reasons that Boards do not act in accordance with the dis-
ciplinary powers and responsibilities that are entrusted to them.
The reasons are



29



1. revoking a license means depriving a colleague of a means
of livelihood and an entire way of life;

2. law suits against Boards result in about a 50 percent
reinstatement of revoked licenses;

3. boards must often assume roles of investigators, prosecutors,
juries, judges, and executioners in proceedings which creates great
opportunity for the misuse of power and threatens the accused's right
of due process;

4. general ambiguity and lack of precision in statutory
provisions delimiting the groups for board sanctions; and

5. the role in assuring minimal quality has been limited to
initial entry (Cohen, 1973b).

Virtually e^ery writer addressing the area of professional regula-
tion recommends some kind of reform and many are specific as to the
reforms needed. Cohen (1973b) addresses two general areas of reform
concern: (1) the rigidity of licensure that impedes geographic and
career mobility or the use of trained assistants and (2) the extent
to which licensure is a meaningful indicator or measurer of competence.
More specifically, Cohen and Mi ike (1974) suggested expanded
responsibilities for boards which included (a) assuring initial
competence, (b) assuring continued competence, (c) formulating and
imposing discipline on errant practitioners, (d) determining specialty
and geographic distribution of those licensed, and (e) providing for
interprofessional coordination of new patterns of manpower utiliza-
tion. More recently, Cohen (1977) has called for the application of
more pervasive social controls on health manpower including competency



30



based licensure examinations founded on national standards, prof esr
sional standards review organizations, continued competency
requirements for reli censure, and possible adoption of manpower
as a public utility with requirements for service in unserved
areas for third-party remibursement eligibility.

Perhaps the most powerful recommendation for change in health
manpower credential ing came out of the HEW studies. The final report
quoted here (SMC, 1977) offered six recommendations which in onei form
or another have been adopted and acted upon by various agencies.
They are

1. A broadly representative national (non-Federal) certification
commission should be established to perform the following functions
for allied health occupations:

a. Develop and continually evaluate criteria and policies
for the purpose of recognizing certification organiza-
tions and monitoring their adherence to the criteria.

b. Participate in the development of national standards as
proposed in recommendation 2.

c. Provide consultations and technical assistance to
certification organizations.

2. National standards for the credential ing of selected health
occupations should be developed and continually evaluated. Profes-
sional organizations, other elements in the private sector, and state
governments should play a significant role in this process. The
standards thus developed should be utilized for the various purposes
for which standards are required, including professional certification,
licensure, private sector and civil service employment, and third-
party reimbursement.



31



3. States should entertain proposals to license additional
categories of health personnel with caution and deliberation. Before
enacting any legislation that would license additional categories of
health manpower, states should consider the following factors:

a. In what way will the unregulated practice clearly
endanger the health, safety, and welfare of the
public, and is the potential for harm easily
recognizable and not remote or dependent on tenuous
argument?

b.. How will the public benefit by an assurance of
initial and continuing professional competence?

c. Can the public be adequately protected by means
other than licensure?

d. Why is licensure the most appropriate form of
regulation?

e. How will the newly licensed category impact upon
the statutory and administrative authority and
scopes of practice of previously licensed cate-
gories in the States?

4. States should take new steps to strengthen the accountability
and effectiveness of licensure boards that will allow them to play an
active role in assuring high quality health services. These include

a. Allocate increased funding, staffing, legal assistance
and other resources.

b. Assign high priority to disciplinary procedures and
responsibilities.



32



c. Adopt relevant national examinations and standards.

d. Expand membership on boards to include effective
representation of consumers and other functionally-
related health professions.

e. Establish appropriate linkages with the various
health licensing boards and between such boards and
other governmental health agencies responsible for
planning, development, and monitoring of health man-
power and services.

f. Develop a data capacity that is relevant to the formu-
lation of health manpower policy.

5. Certification organizations, licensure boards, and professional
associations should take steps to recognize and promote the widespread
adoption of effective competency measures to determine the qualifica-
tions of health personnel. Special attention should be given to the
further development of proficiency and equivalency measures for appro-
priate categories of health manpower.

6. Certification organizations, licensure boards, and profes-
sional associations should adopt requirements and procedures that will
assure the continued competence of health personnel. Additional
studies of the best mechanisms to assure continued competence should
be supported on a high-priority basis by professional associations,
the proposed national certification commission, state agencies, and
the Gederal Government (SMC, 1977, p. 7-16).

As mentioned earlier, a preliminary report was drafted and revised
prior to the final report. The recommendation that was delineated in



33



the final report is important to understanding the mood or inten-
tions of the federal bureaucracy. The recommendation was

Where personnel standards are deemed appropriate for
reimbursement under Federal health care financing programs,
such reimbursement should be limited to those services
rendered by health professionals who are either: (1)
licensed by state board who have adopted national standards
or (2) are approved by the proposed national certification
council. (SMC, 1976, p. 8).

The HEW studies have had great influence on the recent development
in manpower credential ing. In 1976, a steering coimiittee met to
create the National Commission for Health Certifying Agencies and was
attended by approximately 70 professional organizations and agencies
(Messina, 1980). The purpose of the commission had been outlined in
the HEW recommendations. Initially the Commission created guidelines
that would create competency- based certification with national per-
formance standards and mechanisms to assist organizations with meeting
those guidelines (NCHCA, 1977).

State Actions

With the National Commission established, one major area of the
HEW recommendations was started. The other major area was the reform
of licensure laws and processes. The most significant advance in
licensure reform has been the creation of Sunset Laws which call for
the automatic termination of government agencies or licensure boards
after a designated number of years unless reinstated by passage of new
legislation (Adams, 1976). Shimberg (1976) relates six questions
that are in the Florida Sunset Law (Chapter 76-168) which are
intended to help in the assessment of need for licensure and which
advocate parsimony:



34



(1) Would the absence of regulation significantly hann or
endanger the public health, safety, or welfare?

(2) Is there a reasonable relationship between the exercise
of the State's police power and the protection of the public health,
safety, or welfare?

(3) Is there another less restrictive method of regulation avail-
able which could adequately protect the public?

(4) Does the regulation have the effect of directly or indirectly
increasing the costs of any goods or services involved, and, if so,

to what degree?

(5) Is the increase in cost more harmful to the public than the
harm which could result from the absence of regulation?

(6) Are all facets of the regulatory process designed solely for
the purpose of, and have as their primary effect, the protection of the
public? (Shimberg, 1976, p. 144)

To assist state legislators in considering licensing, the Council of
State Governments published a booklet expanding the above questions
(Shimberg & Roederer, 1978). Sunset legislation has passed or is
being considered by over 30 states.

Recent Development in Counselor Credential ing

Accountability was a major concern to the counseling profession
during the seventies. Beymer (1971) advised counselors of the
dangers of ignoring quality in counselors. He predicted a malpractice
suit within the decade on a charge of negligence. The suit occurred
only three years later (Tarasoff v. Regents of California, 1975).
Brammer and Springer (1971) introduced a four-tiered system for



35



counselor credential ing in Washington which emphasized performance
standards rather than accumulation of credits, degrees, and experience.
Beymer (1971) also emphasized performance standards as the direction
for professional growth.

It was evident that counseling was growing in other ways as
well. Counselor education was a popular major and with a decline of
positions in public schools a greater proportion of students sought
positions outside of the schools (Forster, 1977). This may have been
evidence of Scott's (1971) assumption that novices look to their pred-
ecessors for guidance. His study of 1964 counselor educators showed
that 44.3 percent were members of APA and many were licensed
psychologists (Scott, 1971). It is no wonder that counseling is
perceived as developing under the wing of psychology (Forster, 1978).
Finally, the move away from schools was recognized in a Position
Statement on Counselor Licensure saying that members were increasingly
seeking positions in community agencies and private practices (APGA,
1974).

This movement out of schools by counselors was not sudden but
did not go undetected or unimpeded by organized psychology. A bill
was introduced into the New York legislature creating a hierarchy
of mental health workers with doctorates in clinical psychology at
the top. It was an attempt to control what was seen as widespread
quackery, and malpractice (Policing, 1973). However, the bill
ultimately failed with opposition from workers in specialized areas
of service objecting to forced supervision by clinical psychologists
(Riegelman, 1973). The attempted bill, however, introduced a logic



36



which was advocated at a national level. The Standard for Providers
of Psychological Services stated that providers who do not meet
the qualification of a provider as set in the standards shall be
supervised by a qualified psychologist. The interpretation accompany-
ing, the statement made it clear that a service provider with a
master's degree, associates, assistants, and clerks must be super-
vised by a qualified psychologist (APA Task Force on Standards for
Service Facilities, 1975).

This stand was further advanced by a new president of the
Psychotherapy Division of APA. His first address called for Division
29 to stand against APA recognizing as full members of APA those
master's degreed professionals giving no reasons having to do with
competence but identifying the negative effect such recognition would
have on the receipt of third-party payments (Zimet, 1976). Zimet
denied that psychology is interested in containing competition, but
was worried about the balance of power in the profession if APA were
to recognize potentially 40,000 master's members citing that APGA was
70 percent master's degreed membership. Division 17, traditionally
close in goals to those of counselors, formulated a position statement
in 1977 with the American Association of State Psychology Boards which
identified counseling psychology as a specialty area distinguished
from related disciplines such as counseling and guidance, counselor
education, and counseling (Asher, 1979). Psychologists generally felt
that counselors are unqualified in mental health and need supervision
(Goodyear & Derner, 1978). Positions such as these led counselors
to perceive the need for licensure initially as an issue forced by
psychologists (Gazda, 1977).



37



Counselors were introduced to the professional issues developing
in licensure by Sweeney and Sturdevant (1974) in their discussion of
the difficulty counselors were having in being licensed as psycholo-
gists. They suggested that licensure was an issue demanding the
attention of the profession and listed some alternative strategies
for achieving legal equality with psychologists including the
development of counselor licensure. Cottingham and Swanson (1976)
detained further difficulties in counselor licensure and articulated the
need for legal definition showing how this need was reflected in court
cases and state statute and national legislation. Mackin (1976)
warned counselors that licensure was a method by which the profession
could determine its own definition and avoid being defined by the
government. Counselors were provided a demonstration of how, without
action on credential ing, the profession could easily become completely
subordinate to psychology (Lindenberg, 1975). The basis for licensure
concerns were identified by Cottingham and Warner (1978) as follows:

1. litigation by examining boards in psychology on counselors
who were said to be practicing psychology.

2. a move toward supervision of all mental health workers
including counselors by psychologists.

3. Veteran's Administration requirement of state licensing for
psychology positions.

4. the need to define counseling.

5. failure of counselors to implement professional standards.

6. lack of national visibility of counselors.



30



The Cottingham and Warner (1978) article was part of a second wave
of counseling literature on licensure which identified needs for
licensure as a function of professional growth rather than as a
threat from psychology. An APGA Position Statement on Counselor
Licensure advanced three reasons for involvement in licensure develop-
ment:

1. APGA has a responsibility to consumers and society to insure
that people who hold themselves out to the public as professional
counselors are qualified to hold that title and to provide services
for a fee.

2. Membership has an obligation to strive toward effective
means of implementing the profession's recognized standards of
preparation and practice.

3. APGA has a responsibility to promote cooperative relationships
among related professions as equal partners in service to the public
(APGA, 1974).

Forster (1977) focused on the relation of credential ing to the
development and independence of the profession. He espoused that
credential ing must be based on a shared meaning of what a counselor
is and does and that there must be evidence or experience that
indicates effectiveness and value of what counselors do. Later,
Forster (1978) discussed the use of credential ing in defining counsel-
ing to remedy the profession's lack of identity. Rutledge (1973) saw
the need to set high standards for specialty counselors and Gianforte
(1976) suggested that credentialing meet the need for an introduction
to negotiations for third-party reimbursements.



39



APGA having committed itself to licensure (APGA, 1974) started
to take concrete steps toward licensure development. The APGA
Licensure Commission (1977) developed a licensure action packet with
a model bill to serve as a guide to states considering licensing.
The APGA Special Committee for Credentialing (1977) recommended con-
tinued pursuit of counselor licensing in its final report by saying
that the key to improvement in most areas of credentialing lies in
developing and implementing professional preparation standards.
American School Counselor Associated trained licensure consultants
for the various regions and AGES developed a proposal for national
registry of Professional Counselors (Cottingham & Warner, 1978).
Warnath (1978) wrote about some of the political realities counselors
must consider when seeking licensing laws including compromises,
grandfathering, and exclusions ini bills and hiring lobbyists. States
were becoming involved with news of success in licensing attempts in
Virginia and Alabama (APGA, 1979; Harris, 1977).

Return to Definition and Standards

The licensure efforts forced a return to the core elements of
the profession - definition and standards. Several authors have
written of the need for a definition of counseling for legislative
purposes (Asher, 1979; Brammer & Springer, 1971; Cottingham &
Swanson, 1976). Lack of adequate definitions in mental health was
recognized by Combs (1953) and has gone relatively unchanged (Hogan,
1978b). This need for definition may have been most effectively
advanced by a report of a study of the effects of the deregulation
of psychology in Florida. The report cites definitions used by



■ , ■40^ ;

professions that are broad and vague and allow a professional to do
virtually anything in the context of licensed practice (Staff of
the Senate Committee on Governmental Operations, 1979). Vague
definitions were not limiting enough to be definable in courts and
were among the reasons that Boards cannot take definitive action
against errant practitioners (Hogan, 1978b).

Forster (1977) recognized the difficulty of the growing counseling
profession's need for a definition that is flexible and open while
competing with other social service professions in a political climate
that encourages and may even demand fixed definitions and practices.
He advanced an area of identity for a definition of counseling as the
facilitation of human development. He stated that counseling more than
any discipline has focused its efforts on human development and adjust-
ment. Forster (1978) also used this idea of counseling to accentuate
its difference from psychology. He claimed that there are three
major distinctions: (1) psychology emphasizes the doctoral degree
while counseling emphasizes a two year master's program; (2)
psychologists work with psychopathology while counselors work with
normal populations; and (3) psychologists are involved in reorganiza-
tion of personality while counselors work with the personality's
existing strengths and weaknesses rather than restructuring the
personality. He suggested that counseling adopt a positive theoreti-
cal base such as Blocker's Developmental Counseling.

Equal to the need for definition is the need for cpmmonly accepted
and applied standards of practice and preparation. Authors have
written about the importance of standards relative to credentialing
efforts (Cottingham & Warner, 1978; Forster, 1977) and some have



41



recognized that the standards should be practice related competencies
(Beymer, 1971; Carroll, Halligan, & Griggs, 1977; Rutl edge, 1973).
Arbuckle (1977) speaking of practice standards, stated that if
licensure is to have meaning it must be directly related to the
professional function of the person being licensed, and that if
competencies can be determined, licensure should be based on the
evaluation of them. Stripling (1978) seeking to influence the
foundation of counseling, stated that at the heart of professional
development are standards of preparation and that, through involvement
in standards of preparation and accreditation, counselors can gain
more visibility for the profession and play a more responsible role
in providing quality counseling and guidance services.

Alternatives to Licensing

Some counselors have been continually dubious of whether licensing


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Online LibraryDan Alan CorleyGeneric professional and technical knowledge skills and abilities needed by mental health counselors / → online text (page 3 of 19)