Monthly Archives: April 2013

ACA launches interest network for integrated care

By Heather Rudow April 30, 2013

Internet-group-chatThe American Counseling Association Governing Council recently approved two new interest networks: the Sexual Wellness in Counseling Interest Network and the Integrated Care Counseling Interest Network. ACA interest networks offer members a chance to join together to explore areas of common interest or concern.

Counseling Today spoke with Teresa Jacobson, a counselor who works with clients diagnosed as severely and persistently mentally ill and who is the facilitator of the new ACA Interest Network for Integrated Care.

Jacobson serves on two integrated care committees in her job at a community mental health agency and assists in the agency’s transition to a person-centered, health-focused facility.

Each of the 18 interest networks is free to join. For more information, email Holly Clubb at

How long did it take for the ACA Interest Network for Integrated Care to get off the ground? How long has it been in the minds of ACA members?

ACA’s Chief Professional Officer David Kaplan was kind enough to suggest I submit a petition for the interest network last fall after I was advocating for an ACA division for integrated care. The first signatures were obtained during a presentation on integrated care at the Kentucky Counseling Association’s annual meeting and completed while obtaining overwhelming support from faculty and peers. The petition was filed Nov. 1 and approved by the Governing Council in March.

I think there are many professionals already out there working in integrated care, but I was not convinced it was a priority within the professional organization since I had hit so many dead ends with inquiries. I was very glad Dr. Kaplan proved me wrong.

Why did you decide to get involved?

When I used to be a patient advocate, I was drawn to the needs of chronic pain patients due to my own experience, as well as the experiences of the hundreds of courageous clients I worked with. Because of this, I have been passionate about the need for mental health clinicians and physical health providers working side-by-side, providing a holistic approach to care by clinicians who can together connect the puzzle pieces of the mind and body. While [I was] a counselor trainee at my internship site, I proposed and co-led a chronic pain group, which worked towards instilling hope, understanding, and self-managing the mind and body connection.

I was inspired to research and write a manuscript specific to counseling chronic pain clients in an integrated care setting upon reading a piece in Counseling Today, “Reconnecting the head with the body,” in 2010 and was encouraged by my professor Gregory Hatchett to submit the manuscript for publication. 

After deciding I wanted to better understand how to specialize in integrated care, I emailed Russ Curtis, who had been quoted in the Counseling Today piece. He was kind enough to remain in contact with me, supporting each endeavor. Dr. Curtis teaches a course on integrated care in the counselor educator program at Western Carolina University, is well published on the matter of integrated care and, in fact, co-authored a book published last year: Integrated Care: Applying Theory to Practice. Dr. Curtis has committed to being a resource for the interest network.

For a couple years, I have been presenting and advocating through various means to gain the attention of counselors, graduate students and educators. My excitement paralleled the increasing national momentum for integrated care due to the passing of the Affordable Care Act. It became very clear to me [that] in many states counselors were not just lagging behind but indeed not at the table at all due to the inability for counselors to receive reimbursement for Medicare and, in some instances, not being able to bill commercial plans from primary care settings. 

At last year’s Southern Association for Counselor Education and Supervision (SACES) conference, I advocated to the Council for Accreditation of Counseling and Related Educational Programs (CACREP) to include education for integrated care in the CACREP standards for 2016. I was told no one had ever brought up the issue before. I contacted the National Board for Certified Counselors and ACA but did not have success in finding an audience interested in promoting integrated care for counselors. It became very clear that we needed a unified front to work towards overcoming obstacles so that we could properly serve all clients who can benefit from seeing counselors in integrated care settings.

When Dr. Kaplan asked for ideas from graduate students [during] the 2013 “For Graduate Students and New Professional Only” conference series, I shared with him why it was important ACA talked about opportunities in integrated care. Dr. Kaplan was warm and supportive and sparked the conversation that led to the development of the interest network. Dr. Rebecca Daniel-Burke’s enthusiasm as she announced the approval of the ACA Interest Network for Integrated Care while presenting “A New Opportunity: Getting a Job in Integrated Care” expressed that ACA is definitely on board.

What do you think the integrated care interest network offers that others don’t?

All interest networks have incredible value for the specialties they focus on.

The purpose of the ACA Interest Network for Integrated Care is to collaborate and share information regarding best practices for working in an integrated care setting. This interest network is relevant to professional counselors, counselor educators, new professionals [and] graduate students.

Multiple models of integrated care are in existence across the nation, with some states utilizing counselors and others not. Though the approach is not brand new, there is an urgency for states to join the momentum, not just because it means more money, but it just makes sense.

The interest network will house best practices for education, preparation and success towards working in an integrated care setting. As members of the ACA Interest Network for Integrated Care, we will together share best practices and ideas aiding all ACA members who desire to either work in an integrated care setting or more effectively counsel clients by connecting the mind with the body.

 Are there any additional thoughts you want to share?

Counselors are a natural fit to work side by side with physical health providers in an integrated care setting.

It is my hope that the ACA Interest Network for Integrated Care can open the door to more opportunities for both clients and professionals. If the interest network can gain the interest and collaboration of graduate students, new professionals, professional counselors, counselor educators and professional organizations such as CACREP and NBCC, then we are one step closer to overcoming obstacles such as portability, reciprocity, credentialing [and] regulatory issues, and [we] can maintain focus on best practices, education and a growing body of research. Eventually, the interest network hopes to become an ACA division, which would include the development of an integrated care journal for ACA members.

Future plans include the creation of a website for the ACA Interest Network for Integrated Care, which will host:

  • Best practices for counselors working in an integrated care setting
  • Links to instructional videos provided by integrated care counselor educator and author Russ Curtis
  • A newsletter for interest network members
  • A library of resources
  • Links to relevant conferences, workshops, webinars, trainings [and] certification programs, as well as higher education courses and programs
  • Spotlights on successful models of integrated care
  • Highlights of the barriers across the nation [that] require counselor advocacy



ACA responds to lockdown in Boston

April 19, 2013

acaCorpLogoACA recognizes how stressful sheltering-in-place is and wanted to provide you with guidelines developed by ACA and the American Red Cross that can help reduce anxiety for you, your clients and your students.

To access the sheltering-in-place guidelines, please click the following link:

Additional trauma resources to assist you and your clients are available on the ACA website at
ACA is thinking of you. Please let us know if there is any additional assistance we can provide.


Court hears challenge to gay therapy ban

Heather Rudow

800px-Bank_of_America_LA_Pride_2011A federal appeals court heard arguments Wednesday on whether a California law prohibiting licensed mental health professionals from practicing “reparative therapy” on gay and lesbian teenage clients violates the free speech rights of practitioners.

According to the Associated Press, the 9th U.S. Circuit Court of Appeals is considering two challenges to the ban on “sexual-orientation change” counseling of minors passed by the California legislature and signed into law by Gov. Jerry Brown last fall.

The ban was scheduled to take effect Jan. 1 but was put on hold pending resolution of the court cases, AP reports.

The current law states that therapists and counselors who treat minors with “methods designed to eliminate or reduce their same-sex attractions,” also known as reparative or conversion therapy, would be “engaging in unprofessional conduct and subject to discipline by state licensing boards.”

The appeals cases were brought by professionals who practice this therapy, two families who claim their teenage sons benefited from the therapy and a national association of Christian mental health counselors. All argue the ban infringes on their free speech, freedom of association and religious rights, and the counselors say it threatens their livelihoods.

The American Counseling Association issued a statement of opposition to reparative therapy during a Governing Council meeting in April 1999. The council adopted the position “opposing the promotion of ‘reparative therapy’ as a ‘cure’ for individuals who are homosexual.”

Last year, Robert L. Spitzer, a well-known psychiatrist who became notorious for his 2003 study supporting the use of reparative therapy as a means for “curing” homosexuality, retracted his claims, saying he owes the gay community an apology for what his study claimed.


    Heather Rudow is a staff writer for Counseling Today. Contact her at

Beyond the professional will: Are you prepared for the unexpected?

Berna G. Haberman April 17, 2013


(Photo:Wikimedia Commons)

(Photo:Wikimedia Commons)

You may be thinking “it” will never happen to me and stop reading here. But, yes, “it” can happen to you, so keep reading! Consider the following very real possible scenarios:

Vacation: You were a passenger on the Costa Concordia (January 2012). Disaster struck. Your body was lost at sea. Who will contact your clients? What will happen to your clients’ records? Who can release the records? Does another professional know where your records are kept?

Family Emergency: Monday morning your mom calls to say your dad has had a stroke. Can you come immediately? You buy a plane ticket, pack your bag and leave. You have 20 clients scheduled for next week. You do remember to take your client list. While under stress and anxiety, you now have to make 20 phone calls. Is there a better way?

Incapacity: You are in an accident or are suddenly ill and in a coma. Your family is under great pressure to make medical decisions for you. Your office phone keeps ringing. Do you have an emergency plan for a fellow professional to notify your clients that you will not be there?

These three example scenarios show why you need a professional plan of action for continuity of care and transfer of records.

How would you answer the following question? Are you aware that the ACA, AMHCA, NASW, AAMFT, APA and CRCC codes of ethics state that you need to have a plan of action for transfer of records in the event of your death, incapacity or when you are not able to be in contact with your office?

The following are excerpts from the respective codes of ethics.

ACA: Counselors need to prepare and disseminate to an identified colleague or “records custodian” a plan for the transfer of clients and client files in case of their incapacitation, death or termination of practice (ACA C.2.h.).

AMHCA: Counselors need to develop a plan in the event of their termination of practice, death or incapacitation by assigning a colleague or records custodian to handle transfer of their clients and files (AMHCA C.1.n.).

NASW: Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker’s termination of practice, incapacitation or death. (NASW 1.07 (o) Privacy and Confidentiality)

Social workers who anticipate the termination or interruption of services to clients should notify promptly and seek transfer, referral or continuation of services in relation to clients’ needs and preferences (NASW 1.16 Termination of Services)

AAMFT: Subsequent to the therapist moving from the area, closing a practice or upon the death of the therapist, a marriage and family therapist arranges for the storage, transfer or disposal of client records in a way that maintains confidentiality and safeguards the welfare of the clients. (AAMFT Principle 11 Confidentiality 2.5)

APA: Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that the psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability or retirement.

CRCC: Rehabilitation counselors prepare and disseminate, to identified colleagues or a records custodian, a plan for the transfer of clients and files in the case of their incapacitation, death or termination of practice. (CRCC A.8.d.)

After speaking with several individuals and conducting preliminary research, I discovered there are many articles on the “professional will,” but few if any on the topics of transfer of records and records custodians. A professional will is not sufficient to comply with the ethical standards. A professional will, if it is legal in your state, is probated after the individual has died. A professional will is not a plan of transfer.

I believe, based on the ethical codes cited earlier, that it is the obligation of every mental health professional to have a plan of transfer and a records custodian. This plan needs to be reviewed with each client to ensure that the client has been informed and has consented to this plan. I would suggest that you include this information as part of your client contract.

The following is not legal advice but rather suggestions for mental health professionals and/or their appointees to consider including as part of a plan of action should the therapist become unavailable, incapacitated or die. A caveat: Always consult a lawyer for legal advice; always refer to state or commonwealth and federal laws.

1) Appoint a records custodian. The following is an example of an agreement with a fellow professional.

I, Jan Jones of 1300 Stone Street, Framingham, MA, appoint Dana Smith, 1 Stowe Street, Natick, MA, 617-555-2013 to handle all emergencies related to my practice as a mental health professional. These emergencies may include vacations, illness, retirement, incapacity or death.

Dana Smith has access to my records and will act in accordance with the AMHCA and ACA codes of ethics, the laws of the Commonwealth of Massachusetts and the HIPAA regulations.

Counseling records must be kept for a minimum of seven years after the last date of service. I also direct Dana Smith to destroy my files by HIPAA-compliant standards after the seventh year from the last date of service. This can be completed on Dana Smith’s time schedule. All files should be destroyed within 10 years after my death or incapacity. If I have retired, I will personally destroy my files on this time schedule.

My files can be found in a locked cabinet in my office. The key is … And the code is …

Jan Jones___________________________ Date_____________

Dana Smith _________________________ Date_____________

The name and contact information of your records custodian needs to be shared with your clients, preferably in your client contract.

You may ask, “Can a spouse, partner, relative or friend serve as the custodian of records?” While the answer is technically yes, I would not recommend this. This might put an undue burden on the person. Also, the appointee needs to be aware of the HIPAA regulations and the codes of ethics that govern the transfer of records and confidentiality and the laws of the state or commonwealth.

2) I suggest that the mental health professional consult a lawyer to execute a Limited Power of Attorney and a Codicil to an existing will or write a new will including the information in the above agreement.

The Plan of Action for Continuity of Care and Transfer or Records includes additional information that may not be included in a will.

Professional documents: Malpractice insurance policy, copies of license/s, current certifications, NPI and CAQH number

Business records: Billing information, insurance panels, EAP panels

Client list: Up to date

3) Miscellaneous but important information.

Answering machine/voice mail: It may be disconcerting for past or potential clients and insurance companies to reach a disconnected number. I suggest you keep your present telephone number for six months and have your custodian of records record a message such as “Jan Jones is no longer accepting new clients. Please call Dana Smith at 617-555-2013 for additional information.”

Instructions for family and immediate associates: Family members and immediate associates need to be informed of your wishes and plans.

Letter to clients: You may wish to draft a letter to clients. Your custodian of records can send this letter as directed. I suggest that the letter reflect your personal view of counseling and the relationship you have to your clients. How do you want your clients to think about or remember you?

Disposal of records and retirement plan: This information can also be included in your personal action plan.

If this information is kept in a binder or file, then when your custodian of records needs to access it, there is a minimum amount of work and you and your family do not have to worry because you are in compliance with the respective codes of ethics governing mental health professionals.

Berna G. Haberman is the founder of the Massachusetts Mental Health Counselors Association and received the AMHCA Mental Health Counselor of the Year award in 1999. She has served on the AMHCA Board of Directors and the AMHCA Ethics Committee. She is in private practice in Framingham, Mass. For information on the book Beyond the Professional Will: The Mental Health Professionals’ Guide to Creating a Plan of Action for Continuity of Care and Transfer of Records, visit publisher Linda Lawless at and click on “Buy Books and CDs.” 

Winners of ACA ethics competition share passion for the subject

Heather Rudow April 16, 2013

COEThe winners of the American Counseling Association’s yearly ethics competition all agree that their reasons for participating go much deeper than the prize — they are each passionate about the subject in general and care about the substantial impact that ethics has on the counseling profession.

The ACA Graduate Student Ethics Competition, which has been open to master’s- and doctoral-level members of ACA for more than a decade, aims to educate student members on ethical issues and engage them by asking them to critically analyze a case, create an appropriate, ethical decision, and make a plan to respond to the situation.

“It gives them the opportunity to apply their knowledge in a practical and meaningful way,” says Erin Martz, director of ethics and professional standards for ACA.

Each entry is evaluated by members of the ACA Ethics Committee in a blind-review process.

First through third place winners of the competition receive gift certificates to the ACA bookstore, and their responses are submitted to VISTAS to be considered for publication.

“Next year,” Martz says, “we will be increasing the value of the first- through third-place awards to include conference registrations and higher dollar amounts for the bookstore gift cards.”

There were 63 submissions in this year’s competition, with 48 teams submitting on the master’s level and 15 on the doctoral level. The North Carolina State University (NCSU) team, consisting of Heather Warfield, Megan Tajlili, Stephen Kennedy and faculty member Stanley Baker, won for the doctoral level. Robin DuFresne, Jill Haar, Andrew Intagliata, Nicole Rybarczyk and faculty member Nick Piazza, hailing from the University of Toledo, won for the master’s level.

This year wasn’t the first time that the NCSU team entered the competition.

“Last year, our teammate Heather Warfield approached Stephen [Kennedy] and I about competing in the competition and we were pleased when we won third place,” recalls Tajlili, a second-year NCSU doctoral student. “This year, we felt prompted to enter because we wanted to come back and try some new approaches to the ethical case scenario and use a new ethical decision-making model based upon the information we gleaned by completing the process last year. Thankfully, it proved successful!”

Despite winning, Tajlili says she felt this year’s process to be more challenging in some respects.

“The case study was less cut-and-dry and had a lot of components, which all needed to be addressed,” Tajlili explains. “As a team, we spent a lot of time individually focusing on what the dilemmas were in the case and really had to think through our ethical decisions on an individual basis, as well as come together and have consensus in the group format. When we were all on the same page with how to proceed, we had to spend time finding justifications for our proposed actions, which took some research.”

Tajlili and her team members spent more of their time conceiving their plan than actually writing the paper, whereas last year they spent a majority of the time writing and less time thinking about the consequences and actions in the scenario.

“I think a major contributor to that was that Stephen [Kennedy] and I were supervising master’s students for the first time [during] the semester we were working on the competition,” Tajlili says. “So all of a sudden, the supervisory issues in the scenario seemed realistic, which elevated our thinking on the issue.”

Kennedy says the group researched ethical decision-making models upon entering the competition and selected ones that included a “significant number” of steps.

“Since the scenario that the American Counseling Association provided this year was complex, we quickly realized that we would need to consider a model that would enable us to evaluate multiple ethical dilemmas quickly,” explains Kennedy, a second-year doctoral student. “We also reviewed feedback from a presentation we led at the North Carolina Counseling Association’s conference, where participants told us that certain models were too complicated to integrate into their busy schedules as professional counselors. Our team selected the Tarvydas Integrative Decision-Making Model because it allows counselors to consider efficiently multiple dilemmas and contextual factors.”

The strategy proved successful.

Warfield is grateful that ACA holds the Graduate Student Ethics Competition because she says it gives students an opportunity to engage in the ethical decision-making process — one that they will eventually experience as professional counselors.

“The competition provides the framework for skill-building, advocacy and empowerment, and I would highly encourage students to submit an entry,” Warfield says. “This experience has given me a deeper connection to the work of the ACA Ethics Committee and has served as a bridge between my doctoral studies and my future professional plans.”

Warfeld notes that there is a robust pool of data suggesting that going through the process of grappling with ethical dilemmas leads to better overall ethical decision-making.

“Because of the rich diversity in the counseling profession, in counselor-training programs and among the clients served, it is critical to explore scenarios from a myriad of lenses,” she continues. “With the basic objective to not harm a client, ethical-decision making ought to be approached intentionally and with a degree of somber reflection. Professionals within the counseling community are in a position of power. As a result, a consistent exploration of ethical decision-making keeps at the forefront our responsibility to use our power in a healthy, non-exploitive manner.”

However, Warfield says she doesn’t think ethics is a popular subject among counseling students “because it seems the topic is often cloaked with negativity. Students are aware of ethical violations within the profession and may associate ethics with the behaviors in which they hope to never engage.”

Warfield believes ethical decision-making should be a strong component of every graduate training program.

“Small-group activities that focus on ethical dilemmas could provide a concrete opportunity for students to become familiar with the ACA Code of Ethics as well as relevant federal and state laws applicable to the dilemma,” Warfield suggests. “These types of activities may also increase the probability of future consultation and collaboration once students enter a professional setting. “

Members of the team from the University of Toledo say they are especially proud because they are the first master’s-level team from the university to compete, let alone win.

Andrew Intagliata says the team’s strategy was looking at the case study from a unique angle.

“For the competition, we decided to focus on the area that we felt was the least obvious ethical issue,” says Intagliata, a second-year master’s student in the school’s clinical mental health counseling program. “A number of aspects of the scenario were somewhat clear-cut in terms of what to do ethically, but we felt that one aspect in particular deserved a little more attention and explaining.”

Intagliata focused much of his time during the competition contemplating the role that ethics plays in the careers of counselors.

“We are expected to maintain a certain standard of excellence, and there are a number of rules by which we need to abide,” Intagliata says. “What stood out the most to me from this competition was just how much ethics can play a role in a single case and how it is important to remain focused on all aspects that may be problematic.”

Haar agrees, adding that the ACA Code of Ethics should be something constantly in the minds of students and counselors alike.

“I think it can be easy to forget that sometimes the choices we are faced with in the profession are not black and white,” Haar says. “We are all busy trying to see clients and balance so many needs and roles and requirements that, sometimes, in the pursuit of trying to help, there is the possibility of forgetting that sometimes the help you want to provide isn’t always the ethical help to provide. For me, the Code of Ethics is a knowledge base of best practices to help keep that impulse to help no matter what in check.”

Haar is now a practicing counselor at a community mental health agency and finds that ethics play a recurrent role in her professional life.

“I take steps to make sure that my decisions are informed by the code,” she says. “I keep a copy of the [Code of Ethics] on my office bookshelf, and I occasionally am asked to consult on ethical dilemmas when my peers experience them.”

It’s important to continually review and think about ethics, Haar says, because it “ensures that students and counselors are familiar with the code and are comfortable making ethical decisions.”

Intagliata thinks ethics should be on the forefront of counseling students’ minds but understands it isn’t as popular as it should be.

“As counselors, we all want to help our clients, and that is why I can see why people would get upset when there are all of these rules and restrictions by which we must abide,” Intagliata says. “While many of us would agree with a lot of the ethical standards set forth and the necessity of them, there are some cases we will encounter that will cause us some stress because of how gray the ethical situation is. Because of this, I think that ethics needs to be talked about on an ongoing basis by all counseling students, and bringing up vignettes and having open discussions in class about ethics might help to increase the popularity of an important subject.”

After participating in the competition, Intagliata says he is certain ethics will play more of a role in his counseling studies, as well as his professional life.

“I had a great experience with my teammates, including the discussion of issues and collaboration of writing the paper,” Intagliata says. “The ethics scenario we received really made me interested in all of the different layers that can exist with just one case. I have enjoyed past class discussions about ethics because they have prepared me for my internship, which then introduced me to even more ethical issues. It will be important for me to continue to monitor the ethics of my profession and keep up to date on cases that may be similar to ones that I [will] have in the future.”

   Heather Rudow is a staff writer for Counseling Today. Contact her at