Monthly Archives: December 2012

Binge eating disorder to be recognized in the DSM-V

Heather Rudow December 11, 2012

(Photo: Flickr/46137)

As the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is set to be released in May, counselors are preparing for the changes that will come along with it, including the inclusion of binge eating disorder as a mental illness.

Binge eating disorder had previously been listed as “under review” because symptoms can sometimes be similar to mood disorders such as depression and anxiety.

The disorder is identified by “a sense of lack of control over eating during the episode” with the individual also exhibiting three or more of the following:

  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed or very guilty afterward.

However, Eric Cowan, a professor in the Department of Counseling and Graduate Psychology at James Madison University, has reservations about the new classification.

“Binge eating has long been recognized by clinicians as a compensatory symptom and one possible manifestation of any number of underlying disorders,” says Cowan, a member of the American Counseling Association who co-wrote a Knowledge Share article about bulimia in the December issue of Counseling Today. “However, I think that making binge eating a discrete diagnosable disorder will create a problem for some clinicians.”

Cowan says he is concerned that there will be too much overlap between individuals whose disordered eating could be considered a mental illness and those who tend to display what he calls “problematic eating” behaviors but are otherwise normal.

“This is especially true,” Cowan points out, “in that our culture’s relationship with food, both physically and emotionally, could be considered disordered. In other words, because the criteria for binge eating disorder are behaviorally based and a person either meets the criteria or not without regard to other contextual and relevant factors, it could pathologize behaviors that in the past we have considered as within the range of the ordinary. We don’t have this issue with other eating disorders. Both anorexia and bulimia have associated behaviors and symptoms that are clearly disordered, such as the severely altered perception of one’s own body or purging behaviors. Binge eating disorder, on the other hand, is somewhere on the continuum of eating behaviors that includes mere habitual overindulgence.

With the DSM-IV, says Cowan, if counselors judge that their client’s binge eating is a “significant factor in the client’s presentation, they could classify it as [an] Eating Disorder [Not Otherwise Specified]. The binge eating might occur with other eating behaviors that did not meet the criteria for anorexia or bulimia. With binge eating now a [concrete] disorder, counselors will now have to parse out these symptoms. It is possible that binge eating disorder could be the client’s only diagnosis, regardless of whether it reflects the most salient aspects of the client’s presentation or pathology.”

As with all diagnoses, Cowan warns that there is now a danger of losing information, as counselors must fit clients’ symptoms into narrower categories.

Clients may also be impacted by the change in that more of them will fit the criteria for a mental disorder, he adds.

“In reclassifying these behaviors as pathology,” Cowan continues, “we are not merely diagnosing, we are also communicating, both with other mental health professionals [and also with clients] about how they should think about themselves.”

Some practitioners contend that adding binge eating disorder to the DSM will allow clients to receive treatment with insurance coverage and allow mental health professionals to seek insurance reimbursement. But Cowan disagrees.

“I don’t think that not having binge eating disorder in the DSM-IV hindered mental health professionals from getting insurance reimbursement,” he says. “Almost always, significantly disordered eating is a symptom of underlying problems of thought or affect that are themselves discrete diagnosable disorders for which insurance reimbursement is accepted. Not to mention that binge eating could always be classified as Eating Disorder NOS.”

But what strikes Cowan most about classifying binge eating as a mental illness in the DSM, he says, is “that these symptoms are invariably a manifestation of a more fundamental disorder of self. The binge eating behaviors stand in for underlying processes involving affect regulation, self esteem and so on. Though the DSM system does not intend to address causation, the myriad ways in which these self disorders can manifest must make us cautious about reifying any one configuration of symptoms and assuming that because we have named it we have also better understood it. All normal behaviors that are taken to an extreme can be classified as pathological. We have to be careful about where, for the sake of helping our clients, we draw the line on the continuum.”

 Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Online gambling addictions up, despite absence from DSM

Heather Rudow December 5, 2012

(Photo: Wikimedia Commons)

The number of online gamblers who exhibit problem gambling behaviors has increased dramatically in the past decade, according to reports. However, online gambling addiction did not find its way into the soon-to-be published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and future editions don’t seem to have plans to feature it any time soon — which troubles some addictions counselors and problem gambling specialists.

Julie Hynes, the problem gambling prevention coordinator at Lane County Public Health in Eugene, Ore., believes the reason online gambling has yet to be recognized by DSM-V is because it is still a relatively new problem on the radar of mental health professionals. InterCasino, the first online casino, launched in 1996.

What Hynes says she finds more controversial, however, is actually the classification of problem gambling itself in the DSM-IV.

“Many experts do not consider problem/pathological gambling as an impulse control disorder as it is currently classified,” Hynes says. “Many consider problem gambling to be a behavioral addiction.”

Proposed drafts of the DSM-V would categorize problem gambling as a behavioral addiction instead.

Pathological gambling was officially recognized as a disorder in 1980 when it was included in the DSM-III. The DSM-V, set to publish in May 2013, includes “Munchausen by Internet” and has Internet addiction listed under the category for “future study.”

Hynes is not a member of the American Counseling Association, but she delivered the keynote speech on online gambling at the Midwest Leadership Institute and Nebraska Counseling Association Annual Conference in October.

Doyle Daiss, an alcohol and drug counselor and current president of the Nebraska Counseling Association, believes online gambling addiction should be included as a part of the pathological gambling diagnosis in the DSM.

“I am hopeful that future research will focus on online gambling issues to identify what, if any, differences exist between traditional and online gambling addictions, as well as different interventions that can create a best clinical practice guideline when addressing online gambling behaviors,” says Daiss, a member of ACA.

Daiss has personally noticed an increase in online gambling behavior among his clients over the past five years. “Gambling behavior is an area that has largely been under-assessed during the pretreatment assessment, in my opinion, and yet it is often present in clients whose presenting problems are not gambling in nature.”

Because of this increased awareness of gambling being a possible secondary issue to mental health and substance abuse problems, Daiss began screening for it more earnestly and has found it to be present in many of his clients and in situations that he might previously have missed.

Hynes says gambling addictions in the U.S. have increased substantially due to the increase in online gambling sites.

“In the mid-1990s, there were only about 15 online gambling sites,” she notes. “Today, there are over 2,600 sites and, despite its illegality in the United States until 2012, over $4 billion a year has been spent on online gambling by Americans [according to 2011 statistics by the American Gaming Association]. It is expected that with the recent legalization of online gambling in the U.S., the amount of money spent will rise significantly — global revenue for online gambling in 2010 was $30 billion.”

Hynes has found online gambling to be most prevalent among the young adult population — especially among college students. She cites their tech savviness, newfound freedom from their families and “access to discretionary money” as key factors.

“I’ve seen and heard from many youth and young adults who’ve grown up with online gambling around them, whether it’s seeing ads for online sports books, playing at  ‘free’ online casinos or other ways of engaging, online gambling has become an ingrained part of the Internet culture,” Hynes says. “I’ve talked with kids who play with their parents’ credit cards, often even together, as it’s seen as a way to bond. All too often, parents don’t even realize that online gambling can be very risky.”

Daiss echoes Hynes’ observation. “I have personally noticed online gambling becoming more prevalent among males, 21 to 30, who are also struggling with mental health or substance abuse issues in which isolation is an issue,” Daiss says.  “Those individuals with whom I have worked have isolated themselves in their house with their computer and initially begin participating in online gambling in which token money is utilized. Within a short period of time, however, they begin utilizing sites in which real money is exchanged via a credit or debit card.”

Hynes says counselors often stereotype gambling addicts based upon general risk factors, which can be problematic.

“We need to remember that there are people from all walks of life that can and do develop addictions to electronic forms of gambling,” she says. “For example, the mom who stays at home might escape from her stress with some online games, and she develops a gambling problem. The disabled veteran who finds that gambling online gives him an outlet and connection to the outside world, and he finds himself borrowing money and against his mortgage payments to gamble.  And so on.  Counselors should be aware that gambling addiction can move quickly and can easily be hidden behind other addictions. Counselors need to screen for pathological gambling in their assessments and throughout the therapeutic process —particularly if there are warning signs [such as] suicidal ideation, mentions of debt, bankruptcy, relationship problems, etc.”

Daiss agrees, saying he believes that gambling behaviors as a whole often go undetected and that addictive gambling behaviors go undiagnosed due to counselors’ personal assumptions or lack of knowledge.

“Good, bad or indifferent, gambling is a prevalent activity in our culture that in recent times has experienced a perception that it is a legitimate form of entertainment,” he says. “Because of this ‘legitimacy,’ I believe counselors may be inclined to overlook online gambling behavior or may fail to educate themselves in the process of online gambling behavior. If the symptoms are missed, the addiction is allowed to continue toward the inevitable outcome that ruins lives.”

 In one specific instance, the wife of a client Daiss treated made note of the manner in which her husband’s online gambling was done “right under her nose. She stated her husband would spend extended episodes of time on the computer gambling,” Daiss recalls, “but she was unaware of it because each time she approached him on the computer he would minimize the window of gambling and maximize a ‘legitimate’ window. She did not find out until several months later — when he was unable to pick up the mail ahead of her to secure the credit card bills — what was actually occurring.”

Hynes says that there are a multitude of side effects from gambling, impacting both the gambler and those close to them:

  •  Suicide attempts and ideation: This is one of the most harmful effects of problem gambling in general. In Oregon, almost half (48 percent) of all problem gamblers entering into treatment reported suicidal ideation within six months of entering treatment; 9 percent actually attempted suicide. (Oregon Health Authority, 2012)
  • Increased withdrawal from family, friends and usual interests as greater amounts of time are spent gambling.
  • Mood changes and swings: The gambler can be excited about wins, dejected and/or angry after losses and exhausted from hours of being engaged in gambling.
  • Debt: The average problem gambler in Oregon owes $30,000 in gambling-related debts. (Oregon Health Authority, 2012)
  • Criminal behavior: It could be crimes of theft but often is “white collar” crime, i.e., writing bad checks, embezzling from employers, etc.
  • Concurrent addictions: Problem gamblers have high rates of co-occurrence with other mental health and addictions issues.

Daiss believes the harmful effects of online gambling are similar to other addictions, “inasmuch as the person becomes preoccupied with the behavior and begins to lose control over the activity and how much is spent,” he says. “Those with whom I have worked state that they did not begin experiencing financial problems immediately due to the nature in which credit cards can be repaid, thus the financial amount that is repaid is a fraction of that which is actually borrowed. Within a short period of time, however, they begin applying for and receiving new credit cards, causing a financial  ‘house of cards.’ Eventually, the financial burden impacts their life and their family’s life, as monies set aside for staples in life have to be used to repay credit cards. Unfortunately, the addiction remains in place and becomes secondary to the financial turmoil, so the cycle continues. Before ‘rock bottom’ eventually occurs, the addict and their family are tens, if not hundreds, of thousands of dollars in debt, with no legal way to repay it.”

Hynes says online gambling and electronic gambling, however, differ from other kinds of gambling because of the time it takes to become addicted.

“Where ‘analog’ problem gambling [such as] sports bets, horse track betting, etc. often takes years from onset to [become] pathological behavior,” she says, “electronic gambling addiction has the tendency to develop rapidly.”

Hynes attributes this to a variety of factors, including:

  • Easy access.
  •  The isolative, anonymous nature of the medium and the ability for individuals to hide their behavior.
  • Rapid rate of play (e.g., casino card games have an average rate of play of about 30 hands per hour, compared to online poker, which can average 60 to 80 hands per hour, and many players play more than one hand at a time).
  • Decreased perception of the value of cash (i.e., players are forgetting that they are spending real money).

“The above factors can all too easily create a perfect storm for addiction,” Hynes continues. “Add in other risk factors, such as ADHD or concurrent substance addiction, and [it] is easy to see how electronic gambling can be highly addictive and very difficult to manage.”

In the clients Daiss treats — primarily people suffering from drug and alcohol addiction — who eventually disclose having an online gambling addiction, many “[indicate] that the primary difference is how the gambling can occur from the safety of the home,” he says, “thereby allowing them to participate in gambling behavior without requiring them to enter the traditional gambling world of casinos or other public venues. Again, this is a lucrative element to those individuals who are struggling with mental health and substance abuse issues in which public interaction is problematic.”

Daiss believes the best approach for professional counselors in helping clients with a gambling addiction is to ensure that pretreatment assessments include a gambling screening instrument and that they continue to screen for gambling behaviors throughout the treatment session. “Once an online or traditional gambling addiction is identified, the best approach is for that therapist to make a referral to a qualified counselor,” he says, if they don’t already specialize in that area.

Hynes says counselors “can and should” screen for problem gambling with a two-question test called the Lie/Bet Questionnaire for Screening Pathological Gamblers. Visit preventionlane.org/lie-bet for more information and to download the screening tool. Hynes says it is also important for counselors to get connected with problem gambling resources and specialists in their region.

“If counselors are unsure about resources, they might start with contacting the National Council on Problem Gambling for information about local resources,” she says. “The council’s website, ncpgambling.org, provides a ‘counselor search’ resource for all states. While there are many similarities between problem gambling and other addiction and mental health disorders, there are also distinct differences in problem gambling that are important to address. Access to money is one example.”

Additionally, the National Council on Problem Gambling operates a 24-hour helpline, 800.522.4700, and Gamblers Anonymous (gamblersanonymous.org) provides information about problem gambling and locations of groups around the country.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Staff and counselors come together at a Pennsylvania middle school to combat bullying

Stuart Shore December 3, 2012

This is the fourth in a series of school counselor advocacy stories that will run online as a counterpart to the school advocacy stories running in Counseling Today’s Counselor, Educator, Advocate column. To read the first post in this series, click here. To read the second post in this series, click here. To read the third post in this series, click here.

The following story was submitted by professional school counselor Stuart Shore of Bala Cynwyd Middle School in Pennsylvania, regarding the department’s involvement in the school’s anti-bullying program:

Stories about bullying in schools have been making headlines across the country for a number of years.  The results from an anonymous student survey detailing the rates of bullying incidents in our school prompted our building to implement Olweus last year.  Olweus is a school-wide program in which teachers, administration, support staff, counselors and students work together to reduce all forms of bullying behavior.  Through Olweus, the school counselors play a critical role within our school by providing key leadership, working directly with students and parents, communicating with staff and tracking data.  Our department tracks and records all of the bullying referrals made by staff and students.  More importantly, we follow-up with students and parents after an on-the-spot intervention made by the staff member who witnessed bullying or had it reported to them.  We follow-up with all students involved in a bullying incident, including the bully, the target and the bystanders.  The purpose of meeting with the bullies is to identify and label their behavior as bullying, help them understand the impact they are having on other students around them and problem-solve with them to avoid future bullying behavior.  The objective in meeting with the target is to offer support and acknowledge that they were bullied.  Further, we assure them that we will have to intervene to stop the bullying and schedule up a follow-up meeting to make certain they are not bullied anymore.  The school counselors also talk with bystanders to better understand how they felt about witnessing bullying.  We encourage bystanders to take an active stand against the bullying by being an ally to the target.  In addition, we contact parents to keep them informed about the bullying situations that involve their children and to partner with the family to resolve the problem.

These efforts are truly a staff collaboration and there are several facets to the program that were created by other staff members including small-group class meeting lesson plans, staff t-shirts, positive notice cards that are mailed home when a student is witnessed to be an ally, and the preparation for the all school assembly last year.  The school counselors shared in this planning and serve on the 12-person Olweus Committee, which was largely responsible for the implementation of the program and training of all staff.    The School Counseling Advisory Council reviewed various social-emotional school curriculums over a two year period which impacted the school to adopt Olweus.   Our department also created a comprehensive guide to Olweus that all parents receive.  We are encouraged by the preliminary data collected last year, especially in regard to the decreasing number of bullying incidents and repeat bully offender over the course of the year.

Counselor uses personal experiences to become advocate for parents’ role in their child’s mental health

Heather Rudow December 2, 2012

A series of personal and professional experiences led Kevin McClure down a path he didn’t initially envision for himself. Working as a professional counselor and being a father to multiple children with mental health and behavioral problems has turned McClure, a member of the American Counseling Association, into an advocate and mentor for two certifications gaining popularity across the country: the Certified Family Partnership Professional (CFPP) and the Parent Support Provider (PSP).

CFPPs are “individuals trained to incorporate their unique life experiences gained through parenting a child whose emotional and/or behavioral challenges required accessing resources, services and supports from multiple child-serving systems as they progressed toward achievement of the family’s goals,” according to the Illinois Mental Health Collaborative, an organization offering CFPP certification to Illinois residents.

Those who are certified as PSPs are also required to use their personal “lived experiences” navigating youth service systems — whether clinical systems, educational systems, justice systems or medical systems — on behalf of a child with mental health issues.

PSP certification is currently offered in 18 states and the District of Columbia. According to the Certification Commission for Family Support, PSPs have four functions:

  • To promote high standards and level of competence of peer support services in order to promote wellness and resiliency of children, youth and emerging adults, including but not limited to: family-to-family, parent-to-parent, youth-to-youth, and peer-to-peer services and programs.
  • To provide a formal testing, certification and recertification process in the professional field of peer support.
  • To promote ethical practice in the professional field of peer support by providing a process for the administration of ethics and disciplinary enforcement.
  • To encourage, promote and assist in the development of quality instructional programs to improve the professional field of peer support.

As the father of four daughters, three of whom have mental, emotional and behavioral challenges, McClure is the perfect candidate for these certifications. The three oldest — ages 6, 8 and 9 — are in process of adoption from foster care.

“All three have been diagnosed with ADHD and take medications [now] after a long trial of behavior modification,” says McClure, who is also a member of the Illinois Counseling Association. “The oldest also has developmental delay from her premature birth, and recently we’ve learned of some trauma before she came to us. … After consulting with her primary care physician, we are initiating a psychiatric evaluation, and I fear that her genetic predisposition for bipolar [disorder] has begun to emerge through frequent and unregulated severe mood swings and aggression, none of which has been significantly improved through individual and family counseling.”

McClure’s youngest, a little older than a year, is his biological daughter.

Even though McClure has been living with children who have emotional, mental health and behavioral problems for the past five years, it was only recently that he became aware that he could take their well-being into his own hands through PSP and CFPP certification.

Before becoming a licensed professional counselor, McClure completed his graduate internship at an outpatient private practice. The experience allowed him to administer a variety of community needs, such as providing services for youth and families, helping children adjust to life post-divorce, pediatric and adult bipolar management, LGBTQ lifestyle concerns, and PTSD treatment for first responders, medical personnel, educators and youth.

“Within my caseload of individual children and youth therapeutic work,” McClure recalls, “I was continually drawn to the family systems paradigm of therapeutic recovery.”

After becoming licensed in the spring of 2008, McClure says he chose to branch outside the four walls of his counseling office and “consult with private and public schools [that] thirsted for innovative social and emotional health approaches for their emotionally struggling students and staff.”

While maintaining a limited private practice caseload, McClure received multiple referral calls from families who wanted to utilize Medicaid benefits for their children with mental health and behavioral problems but weren’t able to. He decided to further research the subject.

But what he learned made his “stomach turn,” McClure says. “Families reported to me that the single contractee for children’s mental health services for a three-county area [in Illinois] had been creating a waiting list up to eight months for non-crisis services over the past several years. I later learned that this agency was unable to serve the needs due to a lack of funding and [children’s mental health] providers available to go beyond the needs of post-hospitalized youth, [something] not uncommon across Illinois or the nation.”

McClure notes that after five years of investigating, the American Psychological Association concluded in 2007 that there was “substantial and alarming evidence that the current workforce lacks adequate support to function effectively and is largely unable to deliver care of proven effectiveness. There is equally compelling evidence of an anemic pipeline of new recruits to meet the complex behavioral health needs of the growing and increasingly diverse population. … The improvement of care and the transformation of systems of care depend entirely on a workforce that is adequate in size and effectively trained and supported.”

Soon after this revelation, McClure took a family advocacy counseling position connected with the Illinois Children’s Mental Health Partnership and Illinois Violence Prevention Authority. His new job provided even more information regarding the definition and the implementation of the “family-driven care” model in his profession.

According to The Substance Abuse and Mental Health Services Administration, family-driven care means “families have a primary decision-making role in the care of their own children, as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation.”
This care includes:

  • Choosing supports, services and providers.
  • Setting goals.
  • Designing and implementing programs.
  • Monitoring outcomes.
  • Determining the effectiveness of all efforts to promote the mental health and well-being of children and youth.

In addition, he was able to listen better as a practitioner to the voice of the parents.

“While I had been connected to several divisions of ACA during the previous years,” McClure says, “it became evident that the ‘family voice’ within counseling had yet to be truly heard and valued within a national professional counseling organization.”

Then, in what McClure calls a “rare moment of self-reflection,” he realized that despite all the strides he had made in his career, none of his professional preparation had included the voice of a parent’s experience navigating the sometimes-convoluted byways of the children’s mental health system. “My inner-voice [was telling] me that the parent’s experience and point of view, while of course clouded with their own needs and experiences, was an invaluable tool in supporting the health and well-being of the youth in treatment.”

This he knew from experience. “I was one of ‘them’ — a parent of children with mental health needs.”

“I had categorized and detached my experiences as a parent of children with mental health needs at a conscious level from that of my professional role,” McClure continues. “While I had watched these two roles parallel each other for the past five years, I hadn’t truly actualized that the passionate compassion for family voice was coming from lived experience. Over the past five years, my wife and I had embarked on the journey of foster care to ‘modern-day family,’ including the difficulties of children with multiple medical and mental health needs. The personal, belief-altering experiences of these moments of navigating youth service systems on behalf of my daughters was more influential in who I am today than my formal and professional education.”

He says that being on this side of the perspective was traumatizing for him. “Colleagues from my own community were unable to relate to me when treating my children,” he recalls. “Preschool teachers were uncompromising when asked to attend to sensory needs, doctors seconded-guessed my parental intuition, therapists condescended to my answer of, ‘We’ve tried that.’ My spiritual community supports were lost when told that, ‘We’ll pray for you,’ no longer was helpful.”

But, McClure and his family found hope when connecting with parents who were going through similar situations. “There was hope, encouragement, feelings of not being alone [and] reciprocity,” he says.

McClure used his newfound confidence and newly acquired children’s mental health skills to ask providers to acknowledge his rights as a father in order to drive the care his daughters needed.

All of his years of learning and advocacy came to a head about a year ago, when he became aware of the PSP and CFPP certifications.

Earlier this spring, McClure completed certification at both the national and state level for the founding CFPP class in Illinois, and he has been working with a team to build the curriculum for future parents. He has also achieved his national PSP certification and is looking forward to supporting both certifying organizations and continuing to educate and mentor other parents in the future.

McClure believes this population of clinical supports who are also trained as CFPPs and PSPs could “be part of the stop-gap in the dearth of [children’s mental health] providers by increasing engagement of families in their child’s therapy as well as ongoing support outside of and between the clinical sessions.”

McClure believes ACA members “must begin to value other ‘experts’ in their offices and communities to further the professional care of that same community.”

Additionally, fellow members who have experience navigating the youth service system should consider certification, he says.

“I see this new professional role as potentially able to help fill the current and future possible black hole of timely and competent [children’s mental health] services,” he says. “Certified and supervised parents with ‘lived experience’ might be the missing element of improved treatment outcomes, shortened treatment duration, exponentially expanded promotion and prevention services, and, most critical of all for future improvements in our field, early identification. As funding through public and third-party providers continues to be strangled, this group of professionals just might keep ‘our’ profession alive and growing into the future.”

Had McClure been certified before adopting his daughters, he is certain things would have been different for his family. “I’m sure that having the certification before foster care would have given myself and my family better awareness of additional local and national resources for our needs, as well as the confidence to better challenge the systems who took guardianship of their three little lives to better meet their needs.”

“I also believe,” McClure continues, “that I would have been in contact with other caregivers — biological, foster, adoptive, parent-by-choice, grandparents, etc. — with similar needs much sooner and would have had a context by which to accept their warmth and support for my own needs. Spending time with and hearing supportive encouragement from those who have walked in your shoes has had a much greater impact on my personal determination and dedication to my children with mental health concerns.”

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

ACA asks TRICARE to clarify, adjust counselor certification

Scott Barstow & Jessica Eagle December 1, 2012

Counselors across the country are trying to become certified under new requirements for participation in TRICARE, the health care program operated by the Department of Defense (DoD) for active-duty military personnel, dependents and retirees. In some cases, the process appears to be working, but many counselors are running into problems. This is bad news both for counselors and for TRICARE beneficiaries, who need better access to mental health services.

DoD’s rules state that during a transition period lasting through the end of 2014, counselors can become certified for TRICARE if they have a counseling degree from a regionally accredited program, pass the National Clinical Mental Health Counselor Examination (NCMHCE), are licensed and meet supervision requirements. (During the transition period, counselors with a degree from a program accredited by the Council for Accreditation of Counseling and Related Educational Programs can be certified if they have passed either the NCMHCE or the National Counselor Examination.) Beginning Jan. 1, 2015, counselors will only be certified for TRICARE participation if they have a counseling degree from a CACREP-accredited program, pass the NCMHCE and meet supervision requirements.

Many counselors are having problems with the supervision requirements. TRICARE is requiring two years/3,000 hours of post-master’s supervised experience, obtained from a licensed professional counselor. Because counseling is a relatively young mental health profession, many state licensure laws recognize supervision hours conducted under the supervision of a psychologist, psychiatrist or clinical social worker. Consequently, many counselors would not meet the supervision requirements as specified in DoD’s interim final rule.

More problematic than the supervision requirements, however, is that some counselors are being told they will not be certified now if they do not meet the
2015 requirements (degree from a CACREP-accredited program and passage of the NCMHCE) because TRICARE won’t recognize them after the transition period ends.

The American Counseling Association has written the DoD asking that it clarify to TRICARE contractors and administrators that counselors meeting the transition period requirements will continue to be recognized as providers in 2015 and beyond. In addition, the letter asks that TRICARE allow counselors to become certified if they meet the education criteria by the end of 2014 but complete the examination and supervision requirements later. ACA’s letter, which is posted at counseling.org/publicpolicy, also encourages TRICARE to recognize all supervision hours accepted by the individual counselor’s state licensure board.

If you have questions, comments or information about TRICARE certification of counselors, contact Scott Barstow with ACA at sbarstow@counseling.org or 800.347.6647 ext. 234.

ACA stepping up coalition work on education issues

ACA has increased its participation in coalition efforts supporting education funding and improved student outcomes. In October, ACA attended the Committee for Education Funding (CEF) Gala, where speakers including Education Secretary Arne Duncan addressed a packed room of educators and education interest group representatives. CEF presented Rep. Todd Platts (R-Pa.), Rep. Chris Van Hollen (D-Md.), Sen. Dick Durbin (D-Ill.) and Sen. Olympia Snowe (R-Maine) with awards recognizing their dedicated work to improve education funding and policies at the federal level.

Since 2010, ACA has been a partner and supporter of the College Board National Office for School Counselor Advocacy (NOSCA) “Own the Turf” campaign. NOSCA recently released its second national survey, which takes the pulse of the school counseling profession. The first national survey in 2011, “Counseling at a Crossroads,” found that school counselors were at a point at which they could either become central to student academic achievement in schools or remain on the sidelines as new education efforts ramped up. The 2012 national survey, “True North: Charting the Course to College and Career Readiness,” provides powerful evidence that school counselors and their administrators know how to plot the course of their students’ college and career success. However, significant barriers stand in the way of real progress. The survey identifies barriers such as a lack of focus, training, accountability and resources for counselors, but says that school districts, university programs, public policy and professional organizations can help to overcome these barriers. To read the report, go to counseling.org/publicpolicy. If you have any thoughts on the survey, or input for ACA’s School Counseling Task Force, email Jessica Eagle in ACA’s public policy office at jeagle@counseling.org.

Finally, ACA has joined the America’s Promise Alliance, founded by Gen. Colin Powell. The alliance is the nation’s largest partnership of businesses, nonprofits and other organizations dedicated to 1) ensuring that children get the support they need to succeed, 2) slashing high school dropout rates and 3) helping students graduate ready for college and the 21st-century workforce. Alliance members agree to support “Five Promises” for young people: caring adults, safe places, a healthy start, effective education and opportunities to help others. School counselors are a critical component of this work, and ACA will be promoting school counseling’s role to its partners in the America’s Promise Alliance. In February, ACA will attend the alliance’s Grad Nation Summit, which will focus on successful local, state and national education initiatives.