Mental Health Act - Sunset Coalition Minutes
November 13, 2009
Meeting Held at 709 Clarkson in Denver, CO
Chaired by Leanne Clark (NASWCO)
BEGINNING DISCUSSION:
Discussion was initiated by Bill (CCA) about his view of the need to be apprised of history around language in different sections in the current law. It was noted that Mickey Maroon, Sandra Holman, & Jean Greenburg (NASWCO) had good background and had been involved in two prior sunset reviews on the Mental Health Practice Act.
Bill mentioned that he thought we should have an understanding of the original intention of the statute and we should try to address the statute within the context of original legislative intent. There are some provisions that seem to be exceptions to other parts of the law.
Mickey described how the original law was written by the professional groups originally years ago. It was a "for practice act." And it is very much a public protection law now and that the Social Work group is committed to keeping that as such.
Len (CPA) referenced how the law has been piecemealed along the way.
Leanne suggested that what we are trying to do is to catch those pieces that are a throw back and need clarification. Mickey shared how the law had evolved out of a provision for only one governing regulatory board into one with multiple boards and so there are pieces that seem to not fit.
Leanne noted that Tami Parker (Graduate Intern at NASWCO) would be incorporating all the changes we arrive at in the coalition into a draft revised version of the statute in order to track the progress of our meetings.
There was a brief discussion we had as to whether we should consider changing the title of the Act to minimize any confusion as to what function DORA is regulating and what practice is being protected, specifically psychotherapy vs. the professional practice of the various groups.
Jeff (for Mendez & Associates - SACC and LMFT’s and CAFCA - Colorado Association of Family and Children’s Agencies) stated that the addiction counselors are flushing out their changes but would not have much to offer for change.
ADDRESSING PART 2 OF THE STATUTE:
206.5 Re: Provisional Licensure Issue
Jeff had no specific language but indicated that this paragraph needed to be reenacted. He discussed how a new provisional level of licensure was needed by the state (Departments of Health Care and Finance and Human Services) when a rule was made by the state to comply with Medicaid reimbursement requirements, stating that a counselor or mental health worker could not work in a residential facility unless licensed. So the statute was amended recently (in 2006?) to include provisional licensure as a mental health practitioner. This was done to assure that the residential treatment facilities licensed under DHS would be reimbursed through Medicaid. This section repeals next Spring.
Jeff noted that provisional licensure has evolved into a sort of stepping stone to licensure for approximately 110 of the 333 mental health staff in these facilities.
It was agreed upon by the Coalition members that the general consensus is that there is no Coalition members will need to see/read the official language that is being proposed by the CAFCA officially agreeing to support this proposal as a Coalition. Jeff agreed to provide the Coalition with this language once it is written.
CONSIDERATION OF SUBMISSIONS BY THE GROUPS:
Submissions/Recommendations were received by the following groups: Social Work, Licensed Professional Counselors, & Unlicensed Psychotherapy.
12-43-201 Definition of Psychotherapist and Psychotherapy
Greg raised the issue of interfacing the replacement for the removal of "psychotherapist" and offered the Unlicensed Psychotherapy group’s suggestion, the overarching term "mental health professional" be used as it is elsewhere in other Colorado law.
Discussion from Ken and Leanne addressed the public’s assumption of "mental health professional" assumes such a person has a graduate degree. Leanne noted that the Social Work group is approaching the change by including the whole list of the providers in the references across the board.
Leanne reported that the Social Work group was looking at services "within the scope" of each profession would be the language they would to use to replace "psychotherapy" in other sections of the law.
12-43-209 consultation with a physician (SW group)
(see changes in Social Work group’s proposal)
Discussion was held on paragraph (209) and making changes to it included many considerations and inquiry about the history of this paragraph. Mickey will look into the history of this and report back.
Later a suggestion was made regarding 12-43-209 and physician relationship that proposed changes might be done by Rule instead of Statute change.
Jennifer Miles also suggested that she could go through DORA’s Sunset report on the Medical Practice Act that was just released to see what policy trends might be indicated in that document that might affect the Mental Health Act Sunset process.
It was agreed upon that this discussion will be carried over to the next Coalition meeting on December 11, 2009.
12-43-214 (b) and (c) (LPC’s & SW) See Proposals.
A motion to accept these recommendations was approved by consensus.
12-43-214 (d) (Licensed Professional Counselors Group)
Discussion was led by Ken about the need to clarify the exceptions in (d) to the client confidentiality privilege (see proposal).
Len mentioned that the psychologists are seeking to address changes to the rules regarding mandatory disclosure when the visit is not originally to a mental health professional, but to a medical service provider and intervention by the mental health professional is appropriate, the mental health professional should not be required to provide a disclosure form for the purpose of short term or brief intervention. It was mentioned that it is very likely that the Psychology Group will be pursuing rule changes regarding mandatory disclosure requirements.
No consensus was reached on this.
It was agreed upon by Coalition members that each group will discuss the above suggestion with their internal committees & discussion on this issue will continue at the start of the December 11, 2009 meeting.
12-43-222(1) (g) (see SW & Unlicensed Psychotherapist Groups' Proposals)
Len suggested striking the language "has acted" and leave "has failed to act in a manner that does not meet the generally accepted..."
Greg referenced the Unlicensed Psychotherapy Group’s recommendations that the generally accepted standards should be referenced through the national and state professional associations’ codes of discipline or standards. See Proposal.
Len also suggested that the law should specifically reference national codes of ethics such as APA, NASW, etc.
It was agreed upon that the language should state "... shall include the national codes of standards & conduct," or something similar to this, and to NOT call them codes of "ethics" as that would allow for an opportunity for DORA & the Boards to deal directly with the ethics of each profession instead of strictly with practice standards.
Next meeting Psychology, Licensed Professional Counselors, and the Unlicensed Psychotherapy Groups will present their recommended changes to the Statute. Please submit a written copy of the recommended changes to Leanne one week before the next meeting which is December 11, 2009. (It was noted that the Unlicensed Psychotherapy group has already submitted those recommendations)
January 8, 2010 meeting will involve the presentation of recommendations by the Marriage and Family Therapists and Addiction Counselors Groups.
It was also agreed that each professional group would take the suggestions made today back to their internal committees for consideration and that any alterations to agreed upon changes be discussed at the beginning of the next Coalition meeting on December 11, 2009.
Meetings will be held on the second Friday of each month from 1:00-3:00pm at 709 Clarkson Street in Denver, CO.
