11 Licensure and Practice in Marriage & Family Therapy David Hamilton, Ph.D. LMSW Executive Secretary State Board for Mental Health Practitioners NYS Education Department Office of the Professions 89 Washington Ave., Albany, NY

22 Licensed Professions 48 professions established under Title VIII of the Education Law Requirements for licensure Defined scope of practice Restriction on use of title and practice to those licensed or authorized Penalties for illegal practice or unprofessional conduct by licensees

33 History of Psychotherapy Regulation  Title protection for “licensed psychologists” in 1956  Title protection for “certified social workers” in 1965  Insurance reimbursement for psychiatrists, psychologists and CSW  Practice of psychotherapy was not restricted to any profession

44 Practice defined & restricted under NYS Education law Only those licensed or under limited permit can practice professions and use titles Exemptions for students under appropriate supervision, certain occupations and professions allow performance of activities defined in law but not the use of the protected title Exemptions until 1/1/2010 for individuals in programs regulated, funded, operated or approved by OMH, OMRDD, OASAS, OCFS, local social service or mental hygiene districts

55 Scope of practice defines allowed activities Scope of Practice is defined in Education Law; licensee may only perform those activities he/she is competent to perform. Scope of other professions may overlap Scope of other professions may not be related Scope of practice may encompass other professions' scopes in their entirety Activities that do not require a license can be performed by licensed or unlicensed persons

6 Practice of marriage and family therapy defined in law (a) the assessment and treatment of nervous and mental disorders, whether affective, cognitive or behavioral, which results in dysfunctional interpersonal family relationships including, but not limited to familial relationships, marital/couple relationships, parent-child relationships, pre-marital and other personal relationships; (b) the use of mental health counseling, psychotherapy and therapeutic techniques to evaluate and treat marital, relational, and family systems, and individuals in relationship to these systems; (c) the use of mental health counseling and psychotherapeutic techniques to treat mental, emotional and behavioral disorders and ailments within the context of marital, relational and family systems to prevent and ameliorate dysfunction; and (d) the use of assessment instruments and mental health counseling and psychotherapy to identify and evaluate dysfunctions and disorders for purposes of providing appropriate marriage and family therapy services.

7 Exempt professions may practice marriage and family therapy Nothing contained in this article shall be construed to: Apply to the practice, conduct, activities, services or use of any title by any person licensed or otherwise authorized to practice medicine, psychology, social work, nursing, or to practice as a physician assistant or nurse practitioner within this state; provided, however, that no physician, physician's assistant, registered professional nurse, nurse practitioner, psychologist, licensed master social worker, or licensed clinical social worker may use the titles "licensed mental health counselor", "licensed marriage and family therapist", "licensed creative arts therapist", or "licensed psychoanalyst", unless licensed under this article. Prohibit or limit an occupational therapist from performing work consistent with article 156 of Title VIII.

Licensure Requirements Graduate Education Supervised Experience Examination

99 Licensed Marriage and Family Therapist Education acceptable to the Department MFT degree from registered program Other degree acceptable to Department File application and fee ($345) At least 21 and of good moral character Child abuse course work or exemption 1,500 client contact hours of supervised experience in MFT acceptable to SED Pass the AMFTRB Examination

10 Application Process Submit application (Form 1) and $345 School verifies education in MFT (Form 2) Individual eval if not qualifying program SED approves Edn Eligible for exam Interview with qualified employers Moral character review by OPD Receive job offer & submit permit application & $70 SED reviews Valid for one year Register with PES & pass examination Submit experience Board reviews Meet all requirements License issued & 3 year registration

11 Acceptable Education 45-semester hours with course content and 300 client contact hour internship defined in law Masters or doctoral degree in MFT registered by SED as leading to licensure Equivalent degree in MFT acceptable to the Department Masters or other degree in related profession determined by SED as equivalent to MFT licensure program

12 Acceptable MFT experience 1,500 client contact hours in practice of marriage and family therapy All experience must be submitted by supervisor on Form 4B May include supervised client contact hours completed as part of licensure-qualifying MFT degree Only post-degree client contact hours for graduates of equivalent programs, as determined by the Department

13 Limited Permits Allow supervised practice under a qualified supervisor in acceptable setting Supervision must be consistent with experience requirements for licensure MFT permit to meet exam & supervised experience, 1 year and 1-year renewal. Meet education, application & moral character requirements to qualify Cease practice when permit expires

14 Requirements for permit Application (Form 1) and fee ($345) for licensure Acceptable moral character Education (Form 2) approved License-qualifying Form 2 from school Other program evaluated by SED Permit application (Form 5) and fee ($70) before starting practice

15 Acceptable experience The practice of marriage and family therapy is defined in the Education Law as: the evaluation, assessment, amelioration, treatment, modification, or adjustment to a disability, problem, or disorder of behavior, character, development, emotion, personality or relationships by the use of verbal or behavioral methods with individuals, couples, families or groups in private practice, group, or organized settings; and the use of assessment instruments and mental health counseling and psychotherapy to identify, evaluate and treat dysfunctions and disorders for purposes of providing appropriate mental health counseling services. The State Board for Mental Health Practitioners recently clarified that only direct face-to-face therapy with clients is applicable toward the required 1,500 supervised hours. No other activities (e.g., record-keeping, advocacy, case management or supervision) are acceptable experience.

16 Supervision of MFT Permit Holder Supervisor is legally and professionally responsible for assessment, diagnosis and treatment of each patient seen by the permit holder For purpose of improving skills and to assure ongoing review of patient treatment Supervision must be in-person sessions of at least one-hour per week or two hours every other week with a qualified supervisor No more than 5 permit holders under a qualified supervisor to ensure public safety

17 Supervision of practice Supervisor is responsible for assigning tasks to supervisee Supervisee must be competent by education, training or licensure Cannot delegate tasks restricted to licensee to unlicensed person Supervisor is legally and professionally responsible for services provided Assess client to ensure appropriate evaluation or diagnosis and treatment

18 Qualified Supervisor Supervisor Qualifications in of Regulations: The supervisor shall have completed a master's or higher degree program in marriage and family therapy, in the subject of the field in which the supervisor is licensed as prescribed in subparagraph (iii) of this paragraph, or in another field related to the field of marriage and family therapy as determined by the department. The supervisor shall have engaged in the practice of marriage and family therapy for three years or the part-time equivalent. For purposes of this subparagraph, practice on a full-time basis shall mean 960 clock hours in the practice of marriage and family therapy, earned over a 52-week period; The supervisor shall be licensed and registered in New York State to practice marriage and family therapy, medicine, as a physician assistant, psychology, licensed clinical social work, or as a registered professional nurse or nurse practitioner, pursuant to Articles 163, 131, 131-b, 139, 153, or 154 of the Education Law, respectively; or be an individual with equivalent qualifications as determined by the department;

19 Purpose of supervision Supervision of the experience shall consist of contact between the applicant and supervisor during which: the applicant apprises the supervisor of the assessment and treatment of each client; the applicant's cases are discussed with the supervisor; the supervisor provides the applicant with oversight and guidance in the application of marriage and family therapy theories, techniques and supervisory processes to assist the applicant in developing skills necessary to practice marriage and family therapy, which emphasizes the treatment of relational, systemic dynamics in therapy and focuses on special training and techniques required for treating more than one person in therapy; and the supervisor provides an average of one hour per week or two hours every other week of in-person individual or group supervision.

20 Supervision in legal setting Sole practitioner (LMFT) Professional entity (foreign or domestic) Professional corporation Professional limited liability partnership Professional limited liability corporation Authorized under State law (OMH, DOH) General business corporation (“Inc.”) is not an acceptable entity Consent of the Education Commissioner

21 Approval for the exam Eligibility determined by jurisdiction Approved application for licensure (Form 1 & fee) and approved education (Form 2) Register and pay fee ($245) to PES for exam Schedule test administration through Prometric ($75 fee) for test window: 1/12--2/7/09; 5/18--6/13/09; 9/14/09--10/10/09 4-hour test window, computer based examination 200 items Multiple choice items with four options Notification of pass/fail & equated score

22 Exam tests five domains Practice of marriage and family therapy (22.5%) Assessing, hypothesizing and diagnosing (22.5%) Designing and conducting treatment (32.5%) Evaluating ongoing process and terminating treatment (7.5%) Maintaining ethical, legal and professional standards (15%)

Professional Responsibility Education Law Regents Rules Unprofessional Conduct

24 Education Law Defines Professional Misconduct Obtaining license fraudulently Practicing fraudulently, beyond authorized scope, with gross incompetence, with gross negligence Practice while ability is impaired by alcohol, drugs, physical or mental disability Convicted of crime or misconduct in New York State, another jurisdiction or federal law.

25 Education Law Defines Professional Misconduct Permitting, aiding or abetting an unlicensed person to provide professional services Practicing the profession while license is suspended, or willfully failing to register or notify department of any change in name or mailing address Committing unprofessional conduct as defined in Regents Rules or Regulations

26 Regents Rules Define Unprofessional Conduct Exercising undue influence on the patient, including sale of appliances, goods or drugs to exploit the client for financial gain Directly or indirectly offering, giving, soliciting, or receiving any fee for the referral of a patient Fee splitting for professional service, rent, etc. Moral unfitness to practice the profession Revealing identifiable information Practicing beyond the scope or without supervision when required

27 Regents Rules Define Unprofessional Conduct Delegating professional responsibility to person not competent to practice Advertising that is not in public interest: False, fraudulent, deceptive, misleading Guarantees any service or outcome Claims professional service that cannot be substantiated Claims professional superiority Offers bonus or inducement other than discount in established fee

28 Unprofessional conduct in health profession Part 29.2 Willfully harassing, abusing or intimidating a patient Failing to maintain patient record & provide access per Public Health Law Using “doctor” without the degree Failing to provide appropriate supervision Guaranteeing satisfaction or cure Claiming special or secret treatment Failure to wear name badge with professional title in a clinic or public setting

29 Law and Regents Rules prohibit certain activities Mental health licensees are prohibited from: prescribing or administering drugs as defined in this chapter as a treatment, therapy, or professional service in the practice of his or her profession; or using invasive procedures as a treatment, therapy, or professional service in the practice of his or her profession. For purposes of this subdivision, "invasive procedure" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or other means. Invasive procedure includes surgery, lasers, ionizing radiation, therapeutic ultrasound, or electroconvulsive therapy.

30 Physician consultation It shall be deemed practicing outside the boundaries of his or her professional competence for a person licensed pursuant to this article, in the case of treatment of any serious mental illness, to provide any mental health service for such illness on a continuous and sustained basis without a medical evaluation of the illness by, and consultation with, a physician regarding such illness. Such medical evaluation and consultation shall be to determine and advise whether any medical care is indicated for such illness. For purposes of this section, "serious mental illness" means schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, panic disorder, obsessive-compulsive disorder, attention-deficit hyperactivity disorder and autism.

31 Licensure affects business entities and corporations Professions are practiced by licensed individuals not by corporations Professional entities include P.C., PLLC, PLLP, but not “Inc.” Entities may only provide services in profession in which member(s) licensed All members of entity must be licensed PLLP and PLLC owners restricted to same licensed profession

Registration & Licensure On-line registration Photo Identification On-line verification

33 Licensed Practice License valid for life unless revoked, annulled or suspended by Regents Must register to practice the profession Practice within scope and competence Practice in legal setting or entity Comply with laws, rules and regulations Professional or criminal actions may result in professional discipline

34 Practice and registration Licensed for life but must be registered to practice Triennial registration, adjusted to birth month in second registration period Option to become “inactive” without fee by notifying SED Return to practice requires an application and fee for registration Registration notice mailed 4 months prior to end of registration period--complete on-line or by mail Must notify SED of name or address change within 30 days No requirement for continuing education for registration in marriage and family therapy; could only be added by change in law

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36 Picture IDs *Available upon re-registration or on request. *Cost: $20 *There must be a “match” between DMV and SED files in order to issue the ID card. For information call: NYS Licensed Professional Photo Identification Program Team

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38 Frequently asked questions

39 What is “Acceptable Moral Character”? Applicant must meet moral character requirement for limited permit or license. Applicant is required to answer questions about past convictions of state or federal crimes or professional discipline in another profession or jurisdiction The Department reviews this information and investigates—procedures in Regents Rules The process for determining good moral character begins after all other licensure requirements have been met Bias toward rehabilitation but each case is considered on its own merits

Exams scored after test window Pass point set for each “form” of exam Score equated based on laws Score report shows areas needing improvement

41 Can I meet experience without a limited permit? In order to gain legal experience, the applicant must hold a limited permit or other authorization, as defined in statute Law defines exempt setting until 1/1/2010 as program that is regulated, funded, approved or regulated by certain state or local government entities

42 What if I don’t have a permit or exemption? Effective January 1, 2006 the practice of marriage and family therapy is restricted to those licensed or authorized Experience without authorization is not acceptable for licensure Practice without permit or exemption is a felony and moral character question Supervisor may face charges of unprofessional conduct for delegating to unlicensed person

43 Question: Approximately how long should it take to gain the 1500 hours? Must meet requirement in legal manner No more than 2 years under limited permit Requires 15 hours/week for 100 weeks

44 Question: What are the differences in the new requirements and will the people who have began their student career based on the older requirements be able to use the old one or must they meet new requirements to be licensed? All applicants must meet requirements in place at time of application

45 Where can I find information about practice? Education Law defines qualifications for licensure and practice of marriage and family therapy Public Health Law establishes requirements for record keeping and access to records by patients Commissioner’s Regulations clarify the requirements for licensure and practice Education Law and Regents Rules define unprofessional conduct in the practice of the licensed professions Visit OP on the web:

46 Is there reciprocity? Requirements for licensure are established by each jurisdiction, including education and experience Requirements in California are different from most jurisdictions, including specific course content and qualifying degrees AMFTRB examination is used in all jurisdictions, except California, which uses state-specific examination Practice of marriage and family is defined by each jurisdiction as is reimbursement Specialty credentials (e.g. clinical AAMFT membership or designation as AAMFT supervisor) do not substitute for licensure or other requirements in state law Information available at

47 Professional Demand How do you think the current economic situation will affect the profession of marriage and family therapy as a whole? Enrollment in graduate schools increases during economic downturns Recognition of profession grows with addition of education and licensure

48 What is confidential? Statute does not establish privileged communication for the marriage and family therapist Communications must be confidential Records must be maintained in accordance with State and Federal laws Licensee responsible for explaining limits of confidentiality at outset

49 Can I get paid by insurers? No provisions in Education Law to establish third-party reimbursement for marriage and family therapist Provisions of Insurance Law for LCSW are not applicable to other professions (“R” provision) State Insurance and Health Departments regulate MCO/Insurers

50 Can I establish a practice? Licensee can establish a sole proprietor or professional entity under the Education and Business Corporations law Employee of entity authorized to provide services restricted to individuals licensed under Title VIII General business corporations or “S” corporations are not authorized May not include non-licensee owner or members Title must reflect licensed profession

51 What can I call myself? MFT Intern or MFT Student under supervision MFT Permit holder or MFT Permittee Licensed Marriage & Family Therapist Licensed Marriage Therapist Licensed Family Therapist

52 Are there record- keeping requirements? May be charged with misconduct for “failing to maintain a record for each patient which accurately reflects the evaluation and treatment of the patient. Unless otherwise provided by law, all patient records must be retained for at least six years. Obstetrical records and records of minor patients must be retained for at least six years, and until one year after the minor patient reaches the age of 21 years ” (Regents Rules 29.2b)