IMHCA’s IBBS meeting notes from 12/9/2021

The following are notes from Courtney Ackerson, IMHCA past president and member of the IMHCA legislative committee, from the Iowa Board of Behavioral Sciences (IBBS) meeting on 12/9/2021 as an observer and member of the public. These are her own notes from the IBBS meeting which is not affiliated with IMHCA. These notes are not official from the IBBS in any way. Any feedback regarding the accuracy of these notes can be submitted to [email protected]. IMHCA feels that the IBBS meeting information is pertinent to our practice and our members. These notes contain helpful tips and rule clarification. This meeting specifically has discussion of the proposed rule changes and public comment regarding supervision rules of temporary licensed individuals. This would be pertinent to current students, professors, those working toward their temporary license, and current or future supervisors in the field (LMFT, LMHC, and LISW). New Joint Rules are here: https://idph.iowa.gov/Portals/1/userfiles/90/NoticeJointRules_1.pdf

The boards are requesting public comment by February 1, 2022. Delivery instructions are at the link above.

MEETING INFORMATION

This electronic meeting is being held in accordance with Iowa Code section 21.8.

Date and Time: December 9, 2021 – 9:00 a.m. Location: Electronically via Zoom Public Access

Current Board Members: Kevin Allemagne, Marital and Family Therapist; Natalia Indrasari, Marital and Family Therapist; Kerry Lust, Public Member; Echo Kent, Marital and Family Therapist; Amy Mooney, Mental Health Counselor; Cody Samec, Mental Health Counselor; Laura Wilcke, Behavior Analyst; Blake Stephenson, Behavior Analyst; David Wolter, Public Member; Ramona Wink, Mental Health Counselor

MEETING AGENDA with notes:

  1. Call to Order
    1. Roll Call, Introductions:
      1. BOARD members present
        1. New Board Member: Ramona Wink – Representing LMHC, first meeting. Was not at the last meeting and cannot approve minutes.
        2. Cody Samec – September appointed to the board, LMHC
        3. Blake Stephenson – BCBA
        4. David Walter – public member
        5. Kerry Lust – public member
        6. Amy Mooney – LMHC board
        7. Natalia Indrasari – LMFT
        8. Echo Kent – LMFT
        9. Kevin Allemagne – LMFT and has social work background. Serving as interim Chair until one is appointed. No mention of appointment for Chair in the meeting.
      2. Assist the board
        1. Tony Alden – Bureau of Professional Licensure
        2. Steven – bureau chief of professional licensure
        3. Laura Steffensmeier – AG’s office – Assistant Attorney General
        4. Beth – Compliance administraton
      3.  Guests:
          1. Vicky Winterc… Didn’t catch who she was.
          2. Jennifer Becker – here to observe, LMHC serves on the IMHCA legislative committee
          3. Emily Piper – Lobbyist for IMHCA and the LMFTs in the state on behalf of AMFT.
          4. Sandra Conlin – Tanager Place Lobbyist
          5. Courtney Ackerson – IMHCA past president and IMHCA legislative committee
          6. Joan Tamra – TLMHC – Waiver applicant
          7. Larry Jackson – TLMHC- license applicant
    2. Announcements: none
    3. Approval of minutes. Echo abstains. Ramona abstains.
    1. No information was shared about these minutes. These were not available to the public prior to approval. These will be posted at some point after this meeting when they were approved and voted on.
      1. Feedback was given in the previous meeting from the public and a request has been made to post tentative minutes prior to their approval for public review. This has not yet been address, but the feedback was noted
      2. There was no discussion of any changes or amendments.
      3. Approval of Open Session Minutes Bureau of Professional Licensure 321 E. 12th St., Des Moines, IA 50319 515-281-0254 Online Services: https://ibplicense.iowa.gov Bureau Homepage: www.idph.iowa.gov/licensure September 9, 2021

 

  1. Reports
    1. Board Executive Report – Tony
      1. 2024 CACREP draft standards. Looking for feedback from the IBBS. This is shared with the board only in their shared drive.
    2. AAG Report – Laura
      1. IA supreme court case – Issued in October. Someone (I didn’t get a name) v. Iowa board of medicine. Regarding the public notice of hearing and charges documents. These are not to include the investigative information any longer. Redacting facts until the conclusion of the case. All the facts will be in the final board order. This document will be public, but not until the conclusion of the case. The combined agreements will not fall into this rule. Only when sending it to a hearing.

 

  1. Waiver Requests

REMINDER for IMHCA members: 645—31.19(154D) Temporary licensees. A temporary licensee shall engage only in the practice of marital and family therapy or mental health counseling as part of an agency or group practice with oversight over the temporary licensee. The agency or group practice shall have at least one independently licensed mental health provider. A temporary licensee shall not practice as a solo practitioner or solely with other temporary licensees. [ARC 5010C, IAB 3/25/20, effective 4/29/20]

Tony educated new board members on the decision-making areas for consideration of waivers. Some things I learned from this process:

  • Points of decision-making for waivers include, but are not limited to, the following: (1) the relation to current law and rules and if there are any in direct opposition to granting the waiver outside of the scope of the IBBS interpretation, (2) impact on the general public and safety concerns, (3) the hardship that the person is in due to the rule or the denial of the waiver.
  • A waiver, if granted, may excuse the petitioner from the requirements of a rule in its entirety or in part, or may modify the requirements of a rule, for a period of time or permanently.
  • The process for seeking a waiver from an administrative rule and the standards under which the petition will be evaluated are described in IAC 645 Chapter 18.
  • The boards are not allowed to waive or alter a statutory duty or requirement. The burden of persuasion rests with the petitioner to demonstrate by clear and convincing evidence that the board should exercise its discretion to grant a waiver from board rule.
  1. Request to waive 645 IAC 31.7(1)(f) regarding supervision plans—Joan Tamara:
    1. facts of the case were that Joan was not aware that her supervision hours prior to the exam were able to be counted in her total supervision hours. She was asking to be able to count these hours even though there was no supervision plan in place or approved.
    2. Reminders of the need to know and understand Iowa Administrative code as you are emerging in the field because you are responsible for you licensure and the rules around it.
    3. Waiver denied, some of the discussion points were:
      1. (a) This was not a hardship to the person requesting because still able to practice and work toward her full licensure
      2. (b) there is a risk to the public in counting these previous supervision experience outside of the accepted plan, as they are not sure that these experiences fit the requirements outlined by IAC.
      3. (c) Provider should not be operating in a private practice prior to full licensure.
      4. (d) IAC is clear in the expectations of supervision and practice. It is the person who holds the license that is responsible for following the rules that govern the license.
  2. Request for alternate supervisor approval – Angela Erickson (not discussed)
  3. Discussion of authorizing administrative approval for alternate supervisor requests. (not discussed)
  4. Request to waiver 645 IAC 31.3(1)(c) regarding exam requirements for full licensure – Jessica Bedard (not discussed)

 

  1. Application Review

a. Larry Jackson Jr. – supervision review – spoke to summarize his case for the board. Answered questions and was asked to be very clear on what hours count towards supervision.

Learning point for members: It is important that the documents waiver requests submit are consistent, clear and concise. Ensure that when you are submitting documentation to the board for review, they are able to discern the facts of your situation.

b. Sarah Jones – Appeal of CCE education evaluation (not discussed)

 

  1. Administrative Rules: Proposed Notice of Intended Action to promulgate joint supervision rule changes between the Board of Social Work and the Board of Behavioral Science (implementing HF891) brief summary of changes based on a sub-committee in response to the public comment that was due at the end of October:

> > > 1.  Maintains the requirement of 3000 hours of practice.
> > > 2.  Increases the direct client contact hours from 1500 to 2000 hours.
> > > 3.  Allows a supervisee to be supervised by up to four supervisors at a time.
> > > 4.  Allows a supervisor to determine how many persons can be effectively supervised.

Current rule proposal sent with agenda. https://idph.iowa.gov/Portals/1/userfiles/90/NoticeJointRules.pdf

Discussion in the meeting:

  • The public comments will not be shared publicly.
  • Will be discussed in this meeting and summarized.
  • No report on how many letters/comments were received.
  • 4000 Hours of supervised clinical experience was too much according to public comment, so the board decreased it to 3000 which was the original requirement for LMFT/LMHC.
  • The committee of both boards could not come to a consensus on the number of individual supervision hours. It will be a decrease for LMFT/LMHC. New proposed rule set it as at least 110 hours of direct supervision equitably distributed throughout the supervised clinical experience, including at least 24 hours of live or recorded direct observation of client interaction. A maximum of 50 hours of direct supervision may be obtained through group supervision. Original rule had it at 200 hours of supervision with 100 allowed to be group supervision. This change would mean approximately a little more than one hour of supervision per week.
  • Previous rule wasn’t clear if it is live or recorded at 24 hours out of the 110 for, so this was clarified in new proposed rules.
  • Ratios of supervisors to supervisees was strongly opposed in public comment and this was addressed by removing it and (1) allowing a supervised to be supervised by up to four supervisors and (2) allowing a supervisor to determine how many persons can be effectively supervised.
  • 4 supervisors at one time would cover individual, group, and two expertise areas, which was a concern brought up in public comment.
  • Courtney Ackerson, IMHCA past president brought up that overall, the new proposed rules increase the administrative burden to licensees and agencies. They also increase the requirements of the licensure. IMHCA was not noting an opinion, but merely pointing out an observation and making sure the board was aware of this. The board noted that they were aware and felt this was needed change in some areas and required change in some areas due to the law and combining rules.
  • The IBBS noted that they are seeing more and more issues with supervision. They were not able to report on complaint numbers/topic areas because they do not track and trend this data. They did note that is concerning to public safety that supervision has been an increased concern for some time. Two members of the board spoke about this increase in complaints and concerns.
  • It will be approximately 6 months before new rule would be effective if after public comment again, there is no need to re-write.
  • The IBBS and social work boards need to sort out when this new rule would start and how to grandfather people in. It is likely that if someone has an approved supervision plan already reviewed and approved by the IBBS, then the rules would not apply. Anyone making a new plan would have to consider these new rules. Not clear on how they would maintain two sets of rules for these situations through the timeline of approved supervision plans. Also discussed the options of proration for those who have started hours when rule is in effect.
  • The new proposed rules were voted on and passed and will go out for public comment next. (UPDATE – They are out for public comment here.) Public comment on rules is open until February 1, 2022.

 

  1. Public Comment:

No Public comment outside of the agenda Items. Members of the public wishing to address the Board may do so at this time. The Board Chair retains the discretion to determine the amount of time allowed for public comment. Anyone who has submitted material for an agenda item will be given an opportunity to address the Board during the particular agenda item.

 

Courtney left the virtual meeting. The following is from the IBBS agenda.

________________________________________________________________________________

  1. Closed Session Agenda -Scheduled for 10:30, but the board was running a bit late.

Motion to go into closed session pursuant to Iowa Code section 21.5(1)(a), to review or discuss records which are required or authorized by state or federal law to be kept confidential, pursuant to Iowa Code section 21.5(1)(d), to discuss whether to initiate licensee disciplinary investigations or proceedings, and pursuant to Iowa Code section 21.5(1)(f), to discuss the decision to be rendered in a contested case conducted according to the provisions of 17A.3

a. Review closed session minutes [21.5(1)(a)] i. September 9, 2021

b. Complaints and investigative information [21.5(1)(d)]

c. Combined Statement of Charges, Settlement Agreement, and Final Orders [21.5(1)(d) and 21.5(1)(f)] i. Case 19-0237 ii. Case 19-0137

d. Settlement Agreement and Final Order [21.5(1)(f)] i. Case21-0014

e. Request for release from probation 14-0361 – Michelle Johnson [21.5(1)(f)]

f. Return to Open Session

g. Vote on any items discussed in closed session requiring final action

    9. Future Board Meetings:

03/10/2022 – Board Meeting (Conference Call)

06/09/2022 – Board Meeting (Conference Call)

09/08/2022 – Board Meeting (Conference Call)

12/08/2022 – Board Meeting (Conference Call)

 

Members of the public wishing to have an item added to the next meeting agenda should submit the agenda item at least 3 weeks in advance of the scheduled Board meeting. Inclusion of items on the agenda is at the discretion of the Board Chair. a. March 10, 2022 11.

 

The following is a more detailed list of changes that will occur in proposed rules and was not discussed in the meeting, but is here for the membership to review:

  1. Maintains the requirement of 3000 hours of practice.
  2. Increases the direct client contact hours from 1500 to 2000 hours for LMFT/LMHC. This also increases the percentage of hours that need to be direct client contact.
  3. Allows a supervised to be supervised by up to four supervisors at the same time, this is not over the life of the supervision. Additional regulation which previously was not regulated in IAC for LMFT/LMHC.
  4. Allows a supervisor to determine how many persons can be effectively supervised. Additional regulation and was not regulated by IAC previously for LMFT/LMHC
  5. The supervised clinical experience must consist of at least 110 hours of direct supervision equitably distributed throughout the supervised clinical experience. Addition to LMHC/LMFT rules.
  6. Including at least 24 hours of live or recorded direct observation of client interaction. Addition for LMHC/LMFT rules.
  7. A maximum of 50 hours of direct supervision may be obtained through group supervision. Decreased from 100 hours.
  8. Direct supervision can occur in-person or using video conferencing. Removing the ability to use phone conferencing. Previous rule allowed for up to 50% of all supervision hours to be completed by telephone.
  9. The supervised clinical experience must consist of at least 110 hours of direct supervision are complete. Decrease from 200 hours of supervision for LMHC/LMFT. This is a change though the IBBS reported in the meeting today that there is an increased need for supervision standards. Many people are not getting adequate supervision from their experience on the board. This is not documented anywhere in meeting minutes or with the board. This has been suggested to be documented from public comment in meetings in the past.
  10. 110 hours of direct supervision equitably distributed throughout the supervised clinical experience. Addition to rule for LMHC/LMFT. IAC used to say: The supervisee must: (1) Meet with the supervisor a minimum of four hours per month to insure equitable distribution. We are losing the requirement for monthly supervision. No definition of “equitable distribution.” Addition for LMHC/LMFT rules.
  11. After the 110 hours of supervision are completed, ongoing direct supervision must continue to occur for the remainder of the supervised clinical experience (until the person is fully licensed, though rule does not clarify that).
  12. Content. The supervised clinical experience must involve performing psychosocial assessments, diagnostic practice using the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and providing treatment, including the establishment of treatment goals, psychosocial therapy using evidence-based therapeutic modalities, and differential treatment planning. The supervised clinical experience must prepare the supervisee for independent practice and must include training on practice management, ethical standards, legal and regulatory requirements, documentation, coordination of care, and self-care.
    1. This adds clarification and simplification as a REPLACEMENT for 31.7(1) the supervisee requirements (4) to have the background, training, and experience that are appropriate to the functions performed; (5) Have supervision that is clearly distinguishable from personal counseling and is contracted in order to serve professional/vocational goals. This is also REPLACING 31.7(2) To meet the requirements of the supervised clinical experience under item b.“the supervisor shall” (6) Provide training that is appropriate to the functions to be performed; and (7) Ensure that therapeutic work is completed under the professional supervision of a supervisor; and (8) Not supervise any mental health counselor or permit the supervisee to engage in any therapy that the supervisor cannot perform competently.
  13. Supervision report. When supervision is complete, or when a supervisor ceases providing supervision to the supervisee, the supervisee must ensure a completed supervision report using the current form published by the Board is submitted to the Board. If the supervisor reports that the supervisee is not adequately prepared for independent licensure, or reports violations of the Board’s rules or applicable ethical code, the Board may require the supervisee to complete additional supervision or training as deemed appropriate prior to licensure. Addition to LMHC/LMFT to indicate details of the final supervision form as well as what will happen if a supervisor does not feel that the temporarily licensed individual is not prepared for independent licensure. The board will have a clear administrative task in addressing this issue.
  14. A supervisor must be knowledgeable in the applicable ethical code and licensing rules governing the supervisee. Additional language, though this was always an expectation according to ethical standards from ACA and AMHCA.

New rules do not address:

  • part-time employment. Previous rule: a. The supervisee must: (3) Compute part-time employment on a prorated basis for the supervised professional experience. Not needed because the new rule indicates that the 110 hours have to be evenly distributed. This change would mean one hour of supervision per month.
  • The limits on individual supervision and group supervision are lifted. The previous rule states (6) Have individual supervision that shall be in person with no more than one supervisor to two supervisees; (7) Have group supervision that may be completed with up to ten supervisees and a supervisor. Missing standards from rules.
  • The following items that are not allowed in clinical supervision are completely removed: (8) Not participate in the following activities which are deemed unacceptable for clinical supervision: 1. Peer supervision, i.e., supervision by a person of equivalent, but not superior, qualifications, status, and experience. 2. Supervision, by current or former family members, or any other person, in which the nature of the personal relationship prevents, or makes difficult, the establishment of a professional relationship. 3. Administrative supervision, e.g., clinical practice performed under administrative rather than clinical supervision of an institutional director or executive. 4. A primarily didactic process wherein techniques or procedures are taught in a group setting, classroom, workshop, or seminar. 5. Consultation, staff development, or orientation to a field or program, or role-playing of family interrelationships as a substitute for current clinical practice in an appropriate clinical situation. Missing standards from rules.

NEW PROPOSED RULES posted to the public with the agenda for the 12/9/2021 IBBS meeting and passed by the Iowa Social Work Board:

 

 

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