No longer the alphabet soup of years ago, the number of California organizations that certify substance use disorder counselors has dropped from 14 to only three, and these groups agree—at last—on the need for and design of counselor licensure. The latest attempt to establish licensure, sponsored by California State Sen. Bob Weickowski, has three main characteristics: it is voluntary, it requires the certifying organizations to adopt a career ladder, and it requires a master’s degree for a license.
The three certifying organizations that are supporting the bill (SB 1101) are the California Consortium of Addiction Programs and Professionals (CCAPP), the California Association for Alcohol & Drug Educators (CAADE), and the California Association of DUI Treatment Programs.
Addiction Professional spoke to CCAPP chief executive Pete Nielsen and senior governmental affairs director Sherry Daley about the proposal. “Our goal is to make licensure in the state of California a reality for drug and alcohol counselors,” says Nielsen.
The need for licensure is tied to the Affordable Care Act (ACA), which has increased the number of insured people in the state, and to the Mental Health Parity and Addiction Equity Act, which increases the accessibility of substance use disorder (SUD) treatment. “There’s going to be more of a need for professionals doing alcohol and drug counseling,” says Nielsen.
“Right now, counselors in California are paraprofessionals,” says Daley. She characterizes the situation as the “Wild West,” in which counselors are certified, but at various levels, so that the public doesn’t know what it means to be an alcohol and drug counselor.
“This is a disease that needs to be treated, and not by laypeople,” Daley says.
Licensure: final rung
But that doesn’t mean that before being a counselor, someone has to have a complete education—that’s where the career ladder comes in.
“That’s what’s great about California—we haven’t decimated the career ladder,” says Daley. “People can still come out of recovery, register with the state, and start their education. They can move up to the first and second level of certification, and eventually they have the option to go to the license level.”
California’s approach is unique, Daley admits. “This values our recovery home movement that began here in California—it’s something you can work on throughout your career as a counselor, and then decide at some point whether you want to become licensed.”
Licensure represents the final rung on the career ladder for counselors. “I started out as a drug and alcohol counselor, and I was able to work my way up the ladder by being able to work,” says Nielsen. “Counselors first get a start at a lower level, and as they work and increase their skill set, their income increases, and going to school gets more affordable.”
CAADE is already working with colleges to provide the infrastructure to bring counselors up to the master’s level, which is required for licensure under the bill. “Everyone knows you have to have it,” Daley says of the master’s degree. “We have cleared an important philosophical hurdle in terms of whether you need it or not—yes, you need it. There’s a different attitude now.”
Timing is right
Licensure attempts for California counselors are not new, but circumstances are different now. “The biggest change this time around is that there are only three certifying organizations left, and all three are working together,” says Daley. “That’s huge for this field.”
The main reason for the consolidation was that the state added a $5,000 application fee for credentialing approvals, so some of the organizations decided it wasn’t worth the cost. “That got us down to four,” Daley says. A court case eliminated the Breining Institute, leaving three. “We are working well together,” she says. “There are uniform disciplinary guidelines.”
In addition to working together, there is the fact that the SUD treatment field is growing—not only because of the ACA and parity, but also because of a 1115 Medicaid waiver for California (the first state in the country to receive one for substance use treatment services) . The waiver, granted last September, expands SUD services paid for by Medicaid, including residential treatment for the first time.
The Medicaid waiver is being rolled out now, and it has become very clear that workforce needs are a critical issue. “This is creating pressure on building capacity, and capacity means qualified professional providing the service,” says Daley. “Timing is in our favor this time.”
Protecting public and profession
But with growth comes greed, and that’s why it’s essential to protect consumers and the profession. The focus on addiction, from the White House and just about everyone else, is making it impossible to ignore the need for licensing of counselors.
“One reason we want to make sure the bill happens is that there are issues now with practicing in the public sector without a license,” says Nielsen. “There are different bad actors out there using the guise of outpatient treatment in other states, and the fear is that will happen in California. We need to make sure that there are provisions in place not only for a licensed group of counselors, but some mandated certification for outpatient clinics, and also certification for sober living such as they did in Florida.”
Addiction carries enough stigma as it is, Nielsen says. “We want to make sure we protect the public and the profession. The bad actors make it look like treatment is a sham,” he says.
If it becomes law, the licensure bill will take effect in July 2017.