Licensure and Practice in Marriage

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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 12234
• www.op.nysed.gov/mftlic.htm
• Email MHPBD_at_mail.nysed.gov
• 
  

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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

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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

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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

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Scope of practice defines allowed activities
 

Scope of other professions may overlap
Scope of other professions may overlap
Scope of other professions may not be related
  Scope of Practice is defined in Education Law
licensee may only perform those activities he/she
is competent to perform.
Scope of practice may encompass other
professions' scopes in their entirety

   Scope of other professions may overlap
Activities that do not require a license can be
performed by licensed or unlicensed persons
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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.

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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.

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Licensure Requirements

• Graduate Education
• Supervised Experience
• Examination

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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Qualified Supervisor

• Supervisor Qualifications in 79-10.3 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

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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.

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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

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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

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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)

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Professional Responsibility

• Education Law
• Regents Rules
• Unprofessional Conduct

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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.

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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

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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

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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

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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

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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.

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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.

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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

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Registration Licensure

• On-line registration
• Photo Identification
• On-line verification

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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

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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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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
1-800-567-7704 NYS Licensed Professional Photo
Identification Program Team
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(No Transcript)
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Frequently asked questions
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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
  investigatesprocedures 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

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

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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

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What if I dont 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

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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

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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

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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
• Commissioners 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 www.op.nysed.gov

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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 www.amftrb.org

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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

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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

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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

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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

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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

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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)