IMHCA Response to the IAC Pre-notice (10/25/2021)
October 25, 2021
RE: Pre-Notice for Rule Changes for IAC 645-31 due to 2021 Iowa Acts, House File 891
Bureau of Professional Licensure
321 E. 12th Street
Des Moines, IA 50319-0075
Dear Mr. Alden and the Iowa Board of Behavioral Science,
The Iowa Mental Health Counselors Association would like to express their comments and concerns for the changes proposed in the pre-notice rule changes for IAC 645-31. After overall review of the pre-notice, the board would like to urge the IBBS to indicate a reasoning for each new standard. Reasoning would be beneficial for historical purposes as well as ensuring: (1) the integrity of the license and (2) compatibility with other state and federal regulations for mental health providers.
These changes come at a time when Iowa has the potential to join with other states in the counseling compact and it is imperative that we ensure rule changes are within the scope of that counseling compact for the positive impact this would have on ensuring access to care for all Iowans. This counseling compact would allow professional counselors licensed and residing in a compact member state to practice in other compact member states without need for multiple licenses as long as licenses are similar and have similar standards. Although this is hopeful for our profession and the good of Iowa’s mental health, changes of these types indicated in the pre-notice may affect our ability to participate or may be subsequently changed again when the compact is in place. If standards of practice and other state rules are not considered, Iowa may miss out on the opportunity to participate. Some of the proposed changes to IAC will not only impair our ability to participate in reciprocity and portability of our license, but they would also increase administrative burden to licensed individuals and agencies as well as establish barriers to obtaining a full license.
The Iowa Mental Health Counselors Association has the following questions, comments, and concerns:
- Standard: Raising the minimum number of hours for supervised clinical work and direct client contact.
- Response: This would increase the burden on those working towards full licensure in a time where we have a provider shortage in the state exacerbated by the pandemic. Is there a reason for this increase when the standard of practice set by the American Mental Health Counselors Association (AMHCA) Standards for the Practice of Clinical Mental Health Counseling (Revised 2021) is 3000 hours of supervised clinical practice post-degree over a period of at least two years? This is a significant increase in the amount of hours required for supervision and has the potential to lengthen the time it takes to become fully licensed. Is there any data for why this new standard should be higher such as complaints to the board or issues with the clinical experience?
- We understand that this standard has been discussed with the sub-committee tasked with adjusting IAC to fit House File 891 and look forward to the next possible update to the requirements. IMHCA wanted to ensure they commented on the pre-notice as it currently stands.
- Standard: The supervised clinical experience must consist of at least 110 hours of direct supervision equitably distributed throughout the supervised clinical experience.
- Response: This has been decreased in the new rules. According to their published standards, AMHCA recommends a ratio of one hour of supervision for every 20 hours of on-site work hours with a combination of individual, triadic and group supervision. The Iowa Mental Health Counselors Association would like to know how 110 hours was determined and if there is a standard used for the establishment of this number of hours when other criteria for supervision have been increasing to accommodate issues reported to the board. It would seem 150 hours would be more of a compromise between IBBS and Iowa Social Work standards as well as be closer to the recommendation from AMHCA standards.
- Standard: Additional changes in the pre-notice include a standard of at least 24 hours of direct observation of client interaction.
- Response: This standard has potential concern for the privacy of clients. Practitioners have been evaluated in this capacity in their school training and practicums. This is the more appropriate setting for this process. Is there a reason for this additional administrative and in-practice burden for licensees and providers? This is seemingly an intrusive practice and has potential for violation of client confidentiality where it may not be needed. Is there a less intrusive method for achieving this goal such as recording and transcribing a session rather than a direct observation? Will the IBBS be creating the standardized form for this process so that it is not an additional administrative or legal burden for agencies supporting temporarily licensed individuals?
- Standard: Direct supervision can occur in-person or using video conferencing.
- Response: The new rules have removed the option for supervision by phone. Is there a reason that this increased standard has been introduced to the rules? Have there been issues with supervision by phone in the past?
- Standard: Number of supervisees. A supervisor can supervise a maximum of six supervisees at any given time.
- Response: IMHCA is strongly opposed to this new standard. This places a significant burden on those agencies and temporarily licensed individuals. With the changes our license has seen in supervisor standards over past years, there are practices in place to accommodate supervision expectations that have not previously been in place. One example of this is the IBBS setting a standard for supervision training. We have not yet seen the positive effects of this requirement and we anticipate more qualified and prepared supervisors to decrease the likelihood of complaints with the supervision process. These proposed IAC changes have placed a greater administrative burden on agencies across Iowa. In some agencies there are manager/director positions who have a main job of supervision. There are also specialists for supervision that have honed skills and acquired training specific to this area. To limit their capacity to supervise and therefore increasing the number of supervisors in the agency or throughout the field would be an undue costly burden for already taxed providers. This financial burden comes at a time when agencies are struggling to keep fully staffed. If they aren’t able financially to hire/promote additional supervisors, they will take less temporarily licensed individuals and the state will have a difficult time keeping mental health professionals in the state, or even in the profession, if they cannot get the experience needed. Iowa needs practitioners to serve its residents. We were allowing 10 individuals in group supervision at the same time and not limiting the number of supervisees a supervisor can oversee currently. If there are themes of concerns with this, perhaps we could utilize training across the state as well as the professional organizations to shape the course of supervision in the state rather than setting an IAC standard that may not fit well with all practices. Additionally, the state has just place standards on supervision training and would benefit from seeing the results of this training requirement over the next few years.
The Iowa Mental Health Counselors Association hopes that you will consider these comments, questions, and concerns in the deliberation of standards to meet the requirements for House File 891. We appreciate your dedication to the profession and continued work to ensure the safety of the public in regards to the behavioral sciences.
The Iowa Mental Health Counselors Association