Texas Mental Health Crisis: Intern Supervision and Underserved Areas

Texas supervisor training program, speaking, consulting

Texas We Have a Problem

Here’s the thing. In light of recent events I want to speak to all of the problems Texas has when it comes to providing excellent, accessible, and affordable mental health care. I want to outline solutions, propose law changes, and rally the troops. Texas seems to enjoy competing for 49th or 50th place when it comes to quality mental health care in America and this little blog post probably won’t change that. So, as a counselor supervisor, counselor educator, and practicing clinician, I will talk about what I know. This post is about counselor intern supervision and supervisor training.

For those readers who aren’t familiar with Texas rules governing licensed professional counselors:

  • Every Licensed Professional Counselor (LPC) in Texas must spend 3000 hours as a Licensed Professional Counselor Intern under the supervision of a Licensed Professional Counselor Supervisor (LPC-S).
  • There are places in Texas where there are no licensed professional counselors or supervisors (see the white areas in the map below).
  • There are strict limits on the number of supervision hours interns can accrue using technology.

Training more supervisors in rural areas and lifting the restrictions on webcam supervision would be easy first steps to helping Texans gain access to quality mental health care.

Texas supervisor training program, speaking, consulting

 

Counselors and Webcams

Increasing allowable intern supervision hours via technology is a no-brainer. The Telemedicine Wellness, Intervention, Triage, and Referral Project at the Texas Tech University Health Sciences Center is pioneering the use of technology to screen junior high and high school students, identify those most at risk for committing violence in schools, and intervene before anything happens. Data are already showing that the screenings have helped avert violent incidents and provide students the help they need. Why can’t interns attend supervision using the same technology? Counseling graduates on the fence about where to practice might choose underserved areas if they did not have to travel long distances to receive face to face supervision. Arguments against using technology in mental health are archaic and have become a roadblock to care.

Counselor Supervision Training

Changing the rules about technology and supervision is only a start. Long story short, we need seasoned counselors and counselor supervisors in underserved areas. One LPC Supervisor Course attended by five participants who agree to take on just two interns can impact hundreds of people in need of quality mental health care. Recently I, along with Dr. Christopher Taylor offered a six hour course to twenty participants in El Paso interested in offering their own 40 hour training. How exciting is that? Twenty seasoned licensed professional counselor supervisors near one of the most underserved areas in the state are now trained and willing to provide their own courses. Their impact alone could be a game-changer for interns who feel called to work in underserved areas.

Texas supervisor training, speaking, consulting

Lifting limits on technology and increasing the number of supervisors won’t solve everything but it’s a start. We still need to give interns the ability to bill Medicaid. We still need to convince the military and Tricare to hire licensed professional counselors. And we need to help Medicare understand that refusing to allow counselors to be credentialed under their plans makes them part of the problem. Texas, we need counselors and supervisors more than ever before. And we need them now.

The Good, the Bad and the Ugly: Creating a Counselor Supervisor Training Course

Supervisor training consulting speaking
Interesting Day at the LPC Board Meeting

I was at the Texas LPC Board meeting for Applications and Supervision Issues Committees Meeting June 15, and it was an interesting day. The cases that disturbed me the most were the ones involving forty-hour supervisor training courses that were not following the rules. Issues included:

·       Supervisor training instructors allowing their continuing education provider status lapse and teaching the course anyway

·       Supervisor training offered to LPCs by non-LPCs

·       Supervisor training courses that did not offer enough ethics CEs to meet the Texas LPC requirements

·       Supervisor courses that were listed on the LPC Board’s list of approved providers who do not currently meet the LPC board requirements

The Domino Effect

Anyone can make a mistake. Offering a forty-hour training is hard work and there is a lot to keep up with. Mistakes in the 40-hour training arena are compounded, however, because of the number of people involved. When the mistake is discovered, any action by the board will affect several new supervisors, dozens of counseling interns, and who-knows-how-many clients on the interns’ rosters. Anyone creating a supervisor training course must be aware of this domino effect.

I co-created the Kate Walker Training 40-Hour Supervisor Training course alongside my mentor Dr. Judy DeTrude in 2007 (when we were achievebalance.org). I had NO idea what I was doing and without her knowledge and guidance the course would have fizzled early on. Now in 2017 we are about to begin Cohort 30 and our curriculum is stronger than ever.

Speaking to Future Supervisor Trainers

When I am speaking at events or consulting one-on-one with mental health professional, I find most want to know how to grow in their career and give back to their community. Many want to know how to create their own 40 hour training course. Here is what I tell them:

1.     Don’t do it alone. Working with a co-creator, involving other LPC or LMFT instructors, having colleagues I can consult with at any time means that although my name is on the certificate, I am not making decisions in a vacuum.

2.     Read the rules. A lot. I know this sounds obvious, but you are creating a train-the-trainer course so you must know the rules better than anyone who will be taking your course. This means going to disciplinary hearings as well.

3.     Develop an adult-learning-model teaching style. No one wants death by PowerPoint. If you have never taught or managed grown-ups before then get some practice. Offer to teach some local community college courses or substitute teach at a local high school,

4.     Assess, assess, assess. The only way you will know if you are teaching what you think you are teaching is to ask your participants if they understand. The KWT Training Course instructors conduct an assessment after each learning module so we know if we are teaching the material effectively.

5.     Have fun! A forty-hour training can be pretty intense. Break it up, show You Tube Videos, do group work, and play with marshmallows and spaghetti. The people who take this course are your colleagues and friends. Welcome them to the supervisor community!

There is a good, bad, and ugly side of creating and delivering an effective counselor supervisor training course. If you would like more information about starting your own course, give us a call. We’d love to help you out!

Keep on Growing: Why an Excellent Supervisor Refresher Course Matters

Supervisor Refresher Training Course

Keep on Growing: Why an Excellent Supervisor Refresher Course Matters

 

Email 1 (counselor): Do counselor supervisors need continuing education?

Email 2 (me): Yep

Email 3 (counselor): Will your Supervisor Refresher Course count for supervisor continuing education?

Email 4 (me): Yep

Email 5 (counselor): Do I have to travel to take it?

Email 6 (me): Nope. You can actually attend our live class virtually.

Two email exchanges later and this counselor had signed up for an amazing LPC/LMFT Supervisor Refresher Course for his continuing education.

Most states require continuing education for mental health providers holding the supervisor designation. The problem? Good ones are hard to find. Face to face supervisor refresher courses are held infrequently and usually require travel. Online courses can be sketchy at best, or contain out of date information, errors, and broken links to malfunctioning exams.

An excellent Supervisor Refresher Course will help you:
  • Understand the most recent law changes and professional organizations’ codes of ethics
  • Develop a solid remediation plan for difficult supervisees that will enhance their development and protect your license
  • Implement supervision interventions through a theory driven model
  • Work with any supervisee regardless of his or her level of skill development.
  • Utilize interventions and relationship dynamics to help guide supervisees towards a goal.
  • Engage supervisees in their own learning, career development, and professional identify development.
  • Feel confident and have fun supervising!

At Kate Walker Training we offer our Supervisor Refresher Courses four times each year. Each course is divided into modules:

  • Module 1: Conceptualizing supervision, supervisor roles and responsibilities, supervision methods and techniques including group supervision
  • Module 2: Roles for supervision and standards of practice and organizing the supervision experience/executive and administrative tasks including plan, contract, time for supervision, record keeping, and reporting
  • Module 3: Authorized counseling methods and practice and experience requirements for internship: LPC and LMFT Codes/Ethics side by side
  • Module 4: Standards of practice managing critical incidents in supervision, ethical decision making model, ethical dilemmas and legal Issues
  • Module 5: Multicultural Competencies and Ethics, Evaluation in Supervision


The best part about our Supervision Refresher Courses?

They are packed full of information for non-supervisors too! Our Module 3 Side by Side is one of our most popular courses because we go over the most up-to-date information that all counselors need to know.

Signing up for a refresher course is easy

Step 1 – go to https://katewalkertraining.com/courses/counselor-supervisor-refresher-ceu/

Step 2 – Click the ‘Register’ button

Step 3 – Check the boxes for the modules you’d like to attend.
Whether you are a counselor supervisor or not, if you feel a calling to help even more people and you are ready to become an even greater asset to your profession and your community, then the Supervisor Refresher Course is for you. It’s intended to be fun and engaging but also stimulating and in-depth.

Come immerse yourself and invest in your future, your profession, and your world.

Remediation: It’s the Law

Supervising interns is one of the most powerful ways to impact your community and the counseling profession. With supervising, however, comes increased liability. In Texas, both LPC and LMFT codes specify that supervisors share and/or bear full responsibility for their supervisees’ actions and that can be intimidating. You may have a supervisee who resists your instruction or who lacks clinical skills. Maybe you discover that your supervisee is so anxious that he or she hides important information from you. These are scary situations that can impact your license. If you determine that your supervisee is struggling to meet the requirements to become a Licensed Professional Counselor or a Licensed Marriage and Family Therapist, can you ‘fire’ them immediately? While every situation is different (and of course if you have a complicated case, consult your attorney) both licensing boards require a remediation plan first.

LPC (as of this writing):

681.93 (e) (4) If a supervisor determines that the LPC Intern may not have the counseling skills or competence to practice professional counseling under a regular license, the supervisor shall develop and implement a written plan for remediation of the LPC Intern.

LMFT (as of this writing):

801.143 (f) (4) If a supervisor determines that the LMFT Associate may not have the therapeutic skills or competence to practice marriage and family therapy under a regular license, the supervisor shall develop and implement a written plan for remediation of the LMFT Associate.

What does a good remediation plan contain?

  • Issues stated in terms of specific, observable, behaviors

You can’t remediate ‘attitude’ or ‘flaky,’ but you can remediate ‘has forgotten to bring case notes four times in the last two months,’ and ‘takes phone calls and answers texts during supervision.’

  • Specific, measurable, attainable, realistic, trackable goals (SMART goals) with accountability dates
  1. Research the LPC and LMFT rules regarding intern and supervisor liability and write a one page paper – Due March 3, 2016
  2. Attend supervision one extra hour each week (at the supervisee’s expense) for a total of eight hours for the month of March – Due March 31, 2016
  3. Refrain from cell phone use completely during supervision – Due immediately
  • A ‘strike 2’ clause if the intern struggles to complete the assignments by the specified due dates
  • A paragraph stating that failure to complete the initial and ‘strike 2’ remediation assigments will result in termination of the supervision relationship

It is important to mention here that there are preemptive steps to remediation. Supervisors who have contracts that are unclear or an evaluation process that is sporadic or missing altogether will experience issues with communication, skill building, and the supervisory relationship. Before you remediate, ask yourself:

  • Did I teach the issues that I am trying to remediate?
  • Did I lay the foundation for our supervisory relationship in our supervision contract?
  • Do I regularly evaluate my supervisees so I can establish teaching/learning objectives in a meaningful way?

If the answer to any of these questions is ‘no’ or ‘I’m not sure,’ please consider revisiting those items before you begin supervising or take on your next supervisee. Remember, your license is on the line!

 

Where Are the New Rules?

According to the LPC board website November 19, 2015 https://www.dshs.state.tx.us/counselor/lpc_rules/

“The proposed rules posted in the May 15, 2015 issue of the Texas Register have been withdrawn by the Texas State Board of Examiners of Professional Counselors for further review and editing. The notice of withdrawal of the proposed rules will be published in the July 3, 2015 issue of the Texas Register.”

So where are the new rules?

When board members visited the Texas Counseling Association Professional Growth Conference November 4-6 2015 in Corpus Christi, Texas this was a very popular question. With so many things from distance counseling to continuing education for board members up for grabs, counselors wanted to know when the rules would be available again for discussion and input. Like any good bureaucracy, it might take some time, so watch the Texas LPC website and stay connected to your professional organizations like the Texas Counseling Association for the most up-to date information.