California advocates eschew career ladder in favor of broader system reform | Addiction Professional Magazine Skip to content Skip to navigation

California advocates eschew career ladder in favor of broader system reform

August 14, 2017
by Alison Knopf, Contributing Writer
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A California state Assembly bill that had been touted as “career ladder” legislation for addiction counselors passed by a 70-4 vote at the end of May, but bill author Reggie Jones-Sawyer pulled the legislation as it was headed to the state Senate. This came as good news to the California Consortium of Addiction Programs and Professionals (CCAPP), which was firmly opposed to AB 700. CCAPP actually considered the legislation to be a “counselor demotion” bill.

“It was a good idea to have a career path,” CCAPP CEO Pete Nielsen tells Addiction Professional. “But they tried to move too far too fast, and were trying to create a career path without any infrastructure, because there wasn’t any money.”

The career path would have had a hollow meaning, says CCAPP, because the state's treatment system wasn’t going to be given any more money. Costs for the career ladder would have come out of an already underfunded system and out of counselor’s pockets, according to the association.

CCAPP and other groups are now backing the California Comprehensive Addiction Recovery Act (C-CARA), a comprehensive initiative that would make addiction treatment available on demand for anyone in the state who needs it. A package of bills, the initiative also would focus on addressing ethical problems in the industry, including patient brokering, insurance abuses, and flagging counselor competency.

Competency, with funding

CCAPP knows that it doesn’t help treatment centers—or patients—to have counselors in the field who are not competent.

“Our ultimate goal is to have a career ladder with licensure at the top,” says Nielsen, noting that this is the way it works in most states. “But it needs to be where individuals not only acquire education and experience as they progress, but they get wages to match that.” This means the public system, which in California is administered on a county-by-county basis, needs to have sufficient funding.

“There are some drug and alcohol programs in California that only get 38 dollars from the county per bed for residential [treatment]. You can’t even get a Motel 6 for that,” says Nielsen.

These programs can’t afford to pay their staff very much, which means their employees are mainly entry-level, or are stuck in a position and unable to move up no matter how much education and experience they get, says Nielsen. “If they do move up, they move out of the industry altogether,” he says.

CCAPP's goal, says Nielsen, is to increase per-bed reimbursement. Under the state’s 1115 Medicaid waiver from the federal Centers for Medicare and Medicaid Services (CMS), California developed an organized delivery system, in which state Medi-Cal dollars are distributed to the counties. However, not all 57 counties participate in the waiver.

So typically, most of the money for the public system comes from the federal Substance Abuse Prevention and Treatment (SAPT) block grant, said Nielsen. The SAPT block grant is typically used for recovery housing, he says. “We can’t use Medicaid dollars for room and board.”

Problems with AB 700

Lack of money was at the crux of the provider community's problems with AB 700. “If someone is only making $15 an hour but they have a master’s degree, that’s not going to work very well,” says Nielsen. “It may work in the foster care system where counselors make more money once they get the degree.”

Without licensure at the top, a career path is not worth much, says Nielsen. “It doesn’t support individuals going through the system, and it doesn’t expand the workforce,” he says.

Under AB 700, all counselors without degrees, regardless of their years of service or skill and accomplishment, would have been relegated to the bottom of the career ladder. This includes all presently credentialed counselors, who would have lost their jobs if they didn’t have degrees. Bill opponents say the legislation would have led to a downward spiral in pay for experienced counselors—with the degreed but less experienced counselors taking their place.

A legitimate career ladder means you can start in the business on the bottom without full education, gain education as you gain experience, and be rewarded if you are good at your job and obtain the degree.

Many treatment programs are using therapists who are trained and licensed, but not in substance use disorders, says Nielsen. “There should be competency,” he says. “This population is a very difficult population to work with. And if you don’t have special knowledge and skills and abilities, you may be doing that population a disservice and causing further harm.”

Taking a broad view

In the future, it’s essential that counselors and treatment programs collaborate on legislation that benefits patients and the field as a whole, says Nielsen. “We’re taking on the patient brokering issue, hoping to get rid of it,” he says. “Our whole goal is to upgrade addiction treatment in California, so that people don’t have to be on a waiting list.”

Finally, Nielsen favors the county payment system, saying it has potential to be one of the best in the country. “I think the insurance system needs a lot of work,” he says. “It’s very cumbersome for providers and patients, especially in the addictions space. Then you have the fraud that does exist, which makes it worse—we have become penalized because of the bad actors.” In California, providers saw the fraud that was taking place and went to the legislature about it, he says.

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I applaud CCAPP's efforts on many levels, especially the fight against patient brokering and fee-splitting. Counselors definitely need to be paid better, and I hope they echo CAADE's call to the State demanding that decent salaries be built into all contracts.

On the other hand, I find their opposition to AB 700 rather disingenuous. When the bill passes no one will lose their job, be forced to go back to school or be "demoted". Why on earth would they just make this stuff up? CCAPP says they want a career ladder, but when offered a chance to propose amendments to AB 700 they refused and simply started a campaign to scare their members into opposing the bill.
Of course we all want a license, but all previous attempts to get one were shot down because of absurd provisions that would have allowed people with GEDs to get a license. All other human service professions require a Master's degree, and we were all a laughingstock in Sacramento. I value my 37 years in addiction treatment, but that alone shouldn't give me a license or even make me a CADC 16, or the like.
CCAPP standards were developed long before HIV, Co-Occurring Disorders, MAT, evidence-based standards, cultural competency, ASAM standards, etc. AB 700 encourages...but does not require....counselors to further their education. What's wrong with that?

Dear Readers,

Although it is CCAPP’s sincere desire to keep the alcohol drug treatment field united, I must correct several misstatements made in the previous post. The post asserts that AB 700 would not “demote” anyone. Readers can reference the legislation here: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB700 Section 11834.77 clearly states that counselors without degrees are sent to the bottom level. It also clearly states that only counselors who are licensed by another board can work in private practice. If the bill had passed, all non-degreed counselors, regardless of the years of service, amount of AOD specific education, or successful national competency test, would be sent to the bottom of the career ladder.

As for the comments about CCAPP’s approach to working with sponsors of the bill, some corrections are necessary here too. Last year, CCAPP introduced licensure legislation that was supported by all three certifying organizations. We spent months of painstaking work to draft a bill all could agree on. EVERY word of that legislation was voted on by all three groups. Nothing was put in the bill unless a unanimous vote occurred. The result was a bill that required a Master’s degree for licensure for future counselors, and a FAIR grandparent for the thousands of competent counselors who are currently in the field. The comment that our licensure bill only required a “high school degree” is utterly false. The grandparent clause had requirements for education, experience, and passing a national competency exam given to master’s level applicants. The grandparent provision would have retained competent counselors, who should not have to give up their careers to go back to school to meet new requirements, and would have encouraged new entrants to the profession to continue up the career ladder and achieve master’s degrees.

By contrast, the sponsors of the bill drafted their bill in secret with zero input from CCAPP. When it was introduced it would have prohibited group and individual counseling by ANYONE without a bachelor’s or master’s degree. Note that this would have occurred on January 1, 2018. Imagine the impact that would have had on treatment. Clearly the drafters of the bill had no concern for the careers and lives that would be impacted by cutting the available AOD counselors in California by one half.

Rather than oppose the bill at the outset, the CCAPP Board opted to work with the sponsors to improve the bill. Our concerns were sent to them in March. Subsequently, they were sent to the author on April 19. You can see proof of this here: https://www.ccapp.us/site_media/media/attachments/flatpages_flatpage/26/AB%20700%20Oppose%20Unless%20Amended%204_19_2017.pdf The letter clearly provides pages of suggested amendments sent as early as April. CCAPP continued to work for amending the bill until the absolute limit of legislative deadlines to do so. We even suggested that it be made a “two-year” bill to extend negotiations. sponsors of the bill refused.

CCAPP is committed to working with the sponsors of AB 700 to create a comprehensive career path that does not have a negative impact on the profession or the individuals it serves. CCAPP is confident that the only way to move forward is together for the betterment of the addiction treatment industry and the individuals that suffer from the disease of addiction.

Yes, please read the bill. Please. You will see it is nothing like CCAPP describes it.

Let's not confuse apples and oranges. Nobody gets demoted. The uniform certifications will level the playing field by clearly indicating what levels of education people have. This does not denigrate or demote anyone. I currently have a "IV" in my certification; would llikely be a "III" in the new formulation. Am I being demoted? Is my education or experience any less? Will I lose my job? Should my feelings be hurt? Uh, none of these.
Experience is a good thing; I 'm proud to have lots of it. But that alone can't be a determinant for my spot on the career ladder. As long as we try to equate education and experience we are doomed to be the laughingstock of human service professions.
There is no law against private practice for anybody, regardless of education. Tommorrow I could open up "Jack's House of Aromatherapy and Addiction Treatment" and nothing would stop me. But if I want to use a credential accredited by the State as a measure of competency I better have some education to back that up. Good, sincere people can disagree about what that level of education that should require, but when it comes to private practice the consensus of the human services professions is a Master's degree. Like the MFTs did we can start with some liberal grandfathering, but we have to set a high standard for those who want to go out there with little or no accountability in what they do. Talk about self-will run riot....
I stand by my comments about CCAPP not providing specific amendments for discussion: I was in the room when the question was asked. Instead we got a plea to postpone the bill. Please...we can be flexible and work things out; moving the start date to 2019 is a reasonable request for example. Grandfathering can be worked out. But this nonsense about demotions, job losses, school closings, etc is not the way to do it. .

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