Annual Meeting 2018

1. Annual Meeting 2018 Mobility of LMFT Licenses

2. AMFTRB Perspective on Mobility • AMFTRB looks at the larger systemic picture which includes the Federal level, State issues and concerns, as well as global changes. • AMFTRB is ever cognizant that each state has complete autonomy in the decisions related to their licensure process. • Our goal has been to help states respond to or be aware of Federal views and actions associated with mobility. • AMFTRB sees mobility as a means by which to increase access of care to the public which falls under the mission to protect the public for state boards.

3. Brief History of Mobility • LMFTs are now looking at the need to be licensed in multiple states in order to provide teletherapy services. • Yet, the process of licensure mobility continues to be a challenge for both states and licensed clinicians.

4. 2009 Model for Endorsement • In 2009, AMFTRB recommended a Model for Endorsement for states to accept the policy of licensing already licensed individuals from other states • if the applicant had been licensed and in good standing for 5 years, • completed a criminal background check, taken and passed the MFT National Examination, • and taken and passed a state jurisprudence exam, workshop, or training for the state in which they were seeking an additional license. • This policy has been developed and accepted by many states and has been working well. In fact, the American Counseling Association has also accepted the 5-year policy.

5. What have other Boards done? • The Federation of State Medical Boards (FSMB) has been working toward licensure portability and multi-state practice for over 20 years (Robin, 2014). • Medical Licensure Compact was adopted by 22 states (IMLC, 2017). • Physical Therapy Compact has 13 states. • Nurse Licensure Compact was adopted by 26 states.

6. What have other Mental Health Organizations done? • American Counseling Association (ACA) developed the ACA Licensure Portability Model. • This model calls for a standardization of state requirements that would, “allow licensed counselors to move from state to state with a maximum of ease” (ACA, 2017).

7. What have other organizations done? • “National Counselor Licensure Endorsement Process” • American Association of State Counseling Boards • the Association of Counselor Education and Supervision • the American Mental Health Counselors Association • and the National Board for Certified Counselors (NBCC)

8. National Counselor Licensure Endorsement Process • Any counselor licensed at the highest level of licensure for independent practice available in his or her state may obtain licensure in any other state or territory of the United States if all of the following criteria are met: • The licensee has engaged in ethical practice, with no disciplinary sanctions, for at least 5 years from the date of application for licensure endorsement. • The licensee has possessed the highest level of counselor licensure for independent practice for at least 3 years from the date of application for licensure endorsement. • The licensee has completed a jurisprudence or equivalent exam if required by the state regulatory body.

9. Continued • The licensee complies with ONE of the following: • a. Meets all academic, exam, and post-graduate supervised experience standards as adopted by the state counseling licensure board. • b. Holds the National Certified Counselor (NCC) credential, in good standing, as issued by the National Board for Certified Counselors (NBCC). • c. Holds a graduate-level degree from a program accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP). • (AMHCA, 2017)

10. Association of Social Work BoardsASWB created a Mobility Task Force and developed the Model Regulatory Standards for Technology and Social Work Practice. • ASWB offers services through a Registry. This verifies the following categories of information: • Identity • Education • Social work examination results • Licensing history • Clinical supervision (if applicable) • Disciplinary actions reported to ASWB’s Public Protection Database • Continuing education courses completed • References • Employment history • Other professional credentials (ACSW, BCD, QCSW, etc.)

11. What is the Federal Government doing? • On March 16, 2017, the Federal Trade Commission (FTC) announced the creation of the agency's Economic Liberty Task Force (ELTF). • The Task Force addresses the proliferation of occupational licensing and related barriers to economic opportunity, and promotes consideration of less restrictive alternatives in situations where licensing may be unnecessary.

12. FTC Economic Liberty Task Force • On July 27, 2017 the Federal Trade Commission (FTC) Economic Liberty Task Force held its first roundtable to examine ways to mitigate the effects of state-based occupational licensing requirements that make it difficult for license holders to obtain licenses in other states. • The Task Force’s mission is to address the proliferation of occupational licensing and related barriers to economic opportunity, and promote consideration of less restrictive alternatives in situations where licensing may be unnecessary.

13. Difficulty of license mobility has been a central topic for this Task Force. • “Occupational licensing can sometimes be necessary to protect public health and safety, which benefits consumers and serves important state policy interests. But even in those situations, state-specific licensing requirements can impose barriers to entry on qualified workers who have moved from another state, or want to work across state lines(FTC, 2017)

14. Second FTC ELTF Roundtable, 2017 • November, 2017, the FTC ELTF held their second roundtable, entitled The Effects of Occupational Licensure on Competition, Consumers, and the Workforce: Empirical Research and Results • There is no distinction between “professional licenses” and “occupational licenses”. • Several studies are being conducted to identify the usefulness or necessity of licenses. • There are concepts that licensure serves as a monopoly of resources, barrier to work entry, restrict supply to increase cost, create stability in the labor force, and protects the public.

15. 2017 AMFTRB Model for Licensure by Endorsement • The goal is to create a pathway for licensure for multi-state practice for MFTs with an expedited license process without the formal reviews normally utilized. • This proposal will reduce state staff work load and potentially increase protection of the public, as more licensed clinicians under each state’s jurisdiction are available for underserved populations and areas as well as via the use of teletherapy.

16. 2017 AMFTRB Model for Licensure by Endorsement - Continued • The AMFTRB 2017 policy recommends that licensed applicants from another state, • who have been licensed for one (1) renewal period • and are in good standing with their State’s Licensing Board, • who passed a licensing exam, • and completed a background check, would be accepted for licensure. This time reduction is based on the fact that the previous state has already confirmed minimal competence of the licensee, including review of academic credentials and supervised experience hours.

17. AMFTRB Form and Website links • In an attempt to assist State Boards with this policy, AMFTRB has developed a unified form for use by all states that could be used to expedite the licensure process of those already licensed in another state that have completed one (1) renewal period as a LMFT. • We posted an audio PowerPoint presentation link, on our website, from AMFTRB’s Annual Meeting of State Delegates, September 2017, in which this policy was introduced. A second video, from the state of California’s Executive Director’s response shared at the meeting, was also posted on our website.

18. AMFTRB Shared the Policy Recommendation with the States • Next, the AMFTRB sent the Executive Directors, State LMFT Board Staffs, and AMFTRB State Delegates an email to introduce the proposed Mobility Policy recommendations and requested feedback. • A few weeks later, , a member of AMFTRB’s Board of Directors reached out to each state again to follow up on any feedback and progress with this policy recommendation. • The following presentation by Jennifer Smothermon will look at the responses we received. Then we would like you to share your thoughts and ideas regarding the recommendations and your state’s needs.

19. https://www.ftc.gov/system/files/documents/videos/effects-occupational-licensure-competition-consumers-workforce-empirical-research-results/ftc_effects_of_occupational_licensure_roundtable_transcript.pdfhttps://www.ftc.gov/system/files/documents/videos/effects-occupational-licensure-competition-consumers-workforce-empirical-research-results/ftc_effects_of_occupational_licensure_roundtable_transcript.pdf

20. References • American Counseling Association. (2017). ACA continues push forward for licensure portability. Counseling Today. Retrieved from https://ct.counseling.org/2017/06/aca- continues- push-forward-licensure-porta • American Mental Health Counselors Association. (2017). Retrieved from http://www.amhca.org/2017portability. • American Mental Health Counselors Association. (2017). Counseling organizations propose portability process to increase access to care. Retrieved from American Mental Health Counselors Association. (2017).

21. Association of Social Work Boards. (2017). Social Work practice mobility. Retrieved from http://movingsocialwork.org/ • Federal Trade Commission. (2017). FTC announces second roundtable, The Effects of Occupational Licensure on Competition, Consumers, and the Workforce: Empirical Research and Results. Retrieved at https://www.ftc.gov/system/files/documents/videos/effects- occupational-licensurecompetition-consumers-workforce- empirical-research results/ftc_effects_of_occupational_licensure_roundtable_trans cript.pdf

22. Federal Trade Commission. (2017). FTC announces first Economic Liberty public roundtable: Focus on license portability and job mobility. Retrieved at https://www.ftc.gov/news-events/press- releases/2017/06/ftc-announces-first-economic-liberty-public-roundtable. • FTC (2017). Prepared Statement of the Federal Trade Commission on Competition and Occupational Licensure. H- https://www.ftc.gov/system/files/documents/public_statements/1253073/house_testimony_licensing

23. Interstate Medical Licensure Compact: A faster pathway to medical licensure. (2017). Retrieved from http://www.imlcc.org/. • Robin, L.A. (2014). Medical License Portability and Evolving Telemedicine Standards. FTC Examining Health Care Competition Workshop. Retrieved from file:///G:/AMFTRB/robin_- _medical_license_portability_and_evolving_telemedicine_standards_protecting_patients_and_expanding_acces s.pdf