Scott, Condos announce reforms to address Vermont’s substance use disorder workforce crisis

-A A +A

Scott, Condos announce reforms to address Vermont’s substance use disorder workforce crisis

Mon, 10/16/2017 - 3:54pm -- tim

Vermont Business Magazine In a move to reduce the red tape and allow for more substance use professionals across the state, Governor Phil Scott, Secretary of State Jim Condos and Director of Professional Regulation Colin Benjamin on Monday announced reforms to the administrative rules governing Apprentice Addiction Professionals (AAPs), Alcohol and Drug Counselors (ADCs) and Licensed Alcohol and Drug Counselors (LADCs).

The “strike-and-rewrite” replacement brings the administrative rules for these professions from 30 pages to 10, eliminating red tape and introducing efficiency, while maintaining high professional standards. Areas of focus include carefully defined core competencies, more relevant and inclusive degree and continuing education requirements, and compatibility with prevailing national standards.

“The opioid epidemic is one of the most serious challenges we face, and I appreciate the hard work of this group to assess and respond to the workforce needs of our treatment community with the sense of urgency this public health crisis deserves,” said Gov. Scott. “In just five months, a dedicated group of experts and professionals from the public, private and nonprofit sectors worked together to take an important step in addressing our substance use disorder workforce crisis, and they accomplished it in a way that makes Vermont an even more attractive and accessible place to work and live for the professionals we badly need.”

Reforms also focused on increasing efficiency of the program for both licensees and administrators. A key achievement was identifying and addressing a bottleneck for applicants under the existing clinical supervision policy.

“The challenge in this case was to maintain the high, statutory standards set out by the General Assembly while eliminating unnecessary barriers to entry,” said Director Benjamin. “By engaging with the brightest people in the field, we identified 12 core challenges providers are facing, and addressed each of those obstacles with this emergency rule filing.”

These reforms are the result of work by the Governor’s Opioid Coordination Council, created by Gov. Scott under Executive Order 02-17, the Office of Professional Regulation (OPR), and numerous providers, physicians and treatment professionals from throughout Vermont.

Changes were guided by feedback from professionals who participated in the Governor’s Summit on Vermont’s Substance Use Disorder Workforce. The Summit, held in partnership with the Vermont State Colleges System in April, focused on the workforce needs of the provider community.  

Improving licensing processes across professions has been a focus of Sec. Condos for several years, and following the April Summit he directed OPR to work with the Opioid Coordination Council and its partners to address the regulatory and licensing challenges of these professionals.

“The emergency rule changes we’ve filed demonstrate the enormous potential we realize when those in state government work together – and in partnership with the private sector and our colleges and universities – to improve processes and services to the people of Vermont,” said Sec. Condos. “This is what good government looks like, and I thank everyone for their contributions to this initiative.”

On Wednesday, October 4, the rules were filed with the Legislative Committee on Administrative Rules (LCAR) for emergency adoption. This approach cut the adoption timeline from almost ten months to a matter of days. They will be in place for 120-days while undergoing the standard proposed rule filing with the Interagency Committee on Administrative Rules (ICAR) and LCAR for permanent adoption.

Regulatory Reforms Responsive to the SUD Workforce Crisis:

Licensed Alcohol & Drug Counselors

In response to Executive Order No. 02-17 and the Governor’s call to review existing State mental health and drug and alcohol addiction laws and regulations, the Office of Professional Regulation has completed a strike-and-rewrite replacement of its administrative rules for Apprentice Addiction Professionals (AAPs), Alcohol & Drug Counselors (ADCs), and Licensed Alcohol and Drug Counselors (LADCs). These rules will be filed with the Legislative Committee on Administrative Rules for emergency adoption, cutting the adoption timeline from almost ten months to a matter of days.

The challenge in this case is to maintain high, statutory standards of competence while eliminating unnecessary barriers to entry arising from idiosyncratic degree requirements and excessively prescriptive educational mandates. This is accomplished by carefully defining core competencies for the top-level credential: a master’s or greater, 270 hours of SUD-specific training, 2,000 hours of supervised clinical practice, examination, and continuing education—and allowing applicants from diverse educational and professional backgrounds to progress toward that credential by showing the required qualifications through appropriate proxies, such as documented time as an SUD treatment provider in a similar context, or under cover of a different license, or in a foreign jurisdiction. We also identified a training bottleneck at supervision. We responded by opening eligibility to act as a clinical supervisor to the full range of professionals qualified to provide addiction-related psychotherapy.

Continuity

  • AAPs were limited to two renewals, effectively removing from the workforce any who lacked the means or the time to progress, as well as those who liked working in their current roles. The emergency rules allow AAPs to remain so indefinitely, if matriculated in SUD-related training.

Consistency

  • ADCs and LADCs were required to demonstrate 300 hours of SUD-specific education, requiring many applicants qualified in other states to return to educational programs for additional training before serving Vermonters. The emergency rules conform to the national standard, 270 hours, facilitating reciprocal recognition and practitioner mobility.

Efficiency

  • AAPs and ADCs are now deemed to be on the roster of non-licensed, non-certified psychotherapists. This halves the fees and paperwork required to remain credentialed.
  • An independent clinical social worker, psychologist, marriage and family therapist, or clinical mental health counselor, licensed and in good standing in Vermont or a foreign jurisdiction, with at least one year of full-time addiction counseling experience and the core SUD competencies, may now test directly into a Vermont LADC license.
  • Clear, structured supervision paperwork is to be provided by the Office, relieving the burden on clinical supervisors to document rule compliance, and relieving the burden on LADC advisors when reviewing applications.
  • Thirty pages of administrative regulations have been trimmed to ten pages.

Degrees

  • 48-credit-hour MS degrees were denied recognition in favor of 60-hour MS degrees. The emergency rules open the field to those with 48-credit-hour degrees if they complete appropriate supplemental training, salvaging the significant value in the earned degree.

Core Competencies

  • Idiosyncratic SUD competencies set out seventeen subcategories of mandatory education, each with a required hourly minimum not necessarily enforced by any other state. Few people, no matter how qualified, met these without undertaking additional education, often in topics irrelevant to their practice contexts.
  • The emergency rules harmonize SUD-competency requirements, embracing New Hampshire’s model of defining four public-health-critical competencies that must be demonstrated by all applicants, then allowing applicants to determine their own training ratios within other recognized categories.
  • Applicants who specialized in counseling psychology at the baccalaureate level were not advantaged under the old rules by comparison to applicants who studied accounting. The emergency rules allow applicants to demonstrate SUD-specific counseling training earned throughout their academic careers.
  • U.S. Service Members are afforded recognition of relevant military training, pursuant to 3 V.S.A. § 123(g).

Supervision

  • Clinical supervision presented a devastating bottleneck for applicants, who could be supervised only by LADCs with multiple years of experience.

o The emergency rules capitalize on the deep experience of licensed independent clinical social workers, licensed clinical mental health counselors, board-certified physicians, psychologists, and licensed marriage and family therapists. Practitioners licensed in these fields, who demonstrate SUD core competencies and one year of SUD-counseling experience, may now serve as supervisors, and upon successful examination, may cross-qualify for the LADC license themselves.

o The emergency rules recognize a much broader range of qualifying supervision, at a direct-supervision ratio of 1:40, rather than 1:20, allowing provider agencies the flexibility to meet real-world demands, and allowing the state’s most experienced practitioners to spend more time with patients, and less time signing supervision forms.

o Group supervision of as many as six unlicensed persons is permitted, as is supervision by videoconference.

o Applicants may have multiple supervisors and may interrupt clinical supervision, for example, for pregnancy, illness, or military service, without losing supervision credit.

o LADCs or LADC equivalents with five years’ full-time addiction-counseling practice in a foreign jurisdiction are presumed to have satisfied the supervised-clinical-practice hours required in Vermont, knocking down a major barrier to efficient interstate reciprocity and mobility.

Continuing Education

  • A complex and prescriptive continuing-education regime is replaced with a relevance test.
  • Addiction Technology Transfer Center Network (ATTC) and National Association for Alcoholism and Drug Abuse Counselors (NAADAC) programs are presumptively approved, eliminating unnecessary approval paperwork.
  • Designated agencies may provide as much as 30 of the 40 biennial continuing-education hours required of licensees, encouraging in-service training and allowing licensees to maintain their credentials at lower cost. As a condition of recognition, agency continuing-education training is opened to private practitioners and others, and agencies may charge reasonable fees to recover costs.
Click here to view a summary of the changes made.
Click here to view the full emergency rule

Source: Governor 10.16.2017