Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP

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1 CLINICAL MENTAL HEALTH COUNSELING Students who are preparing to specialize as clinical mental health counselors will demonstrate the knowledge, skills, and practices necessary to address a wide variety of circumstances within the context of clinical mental health counseling. In addition to the common core curricular experiences, programs must provide evidence that student learning has occurred in the following domains. For each lettered standard listed below, counselor education programs must show where the content is covered in the curriculum. In accordance with the Evaluation of Students standards in Section IV, counselor education programs also must provide evidence, gathered at multiple points and using multiple measures, of student learning in each of the numbered domains below (Foundations, Contextual Dimensions, and Practice), not for individual standards listed under each domain heading. 1. FOUNDATIONS Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP A. history and development of clinical mental health counseling B. theories and models related to clinical mental health counseling C. principles of clinical mental health counseling, including prevention, intervention, consultation, education, and advocacy, and networks that promote mental health and wellness D. principles, models, and documentation formats of biopsychosocial case conceptualization and treatment planning A. origins, history, development and trends of community mental health and clinical mental health service delivery None None None Structures of community mental health and private practice and other systems of mental health care, and their evolution, should be included to prepare CMHCs for professional practice 1

2 E. neurological and medical foundation and etiology of addiction and co-occurring E. medical foundations and neurobiological etiologies of mental and cooccurring across the lifespan Neurobiological etiologies better describes the phenomena and relates more clearly to the complexities of F. psychological tests and assessments in clinical mental health counseling F. specific understanding of the role of trauma in the development of clinical mental health issues and G. psychological tests and assessments in clinical mental health counseling neuroscience and mental health NEW STANDARD 75-98% of CMHC clients are reported to have experienced at least one traumatic event (Mueser et al., 1998; Mueser et al., 2004; NCPTSD, 2008). This standard reflects the increased recognition of the role of trauma both in the etiology of mental health issues and treatment planning for CMHC clients. Re-lettered Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, R., Auciello, P., & Foy, D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66, Mueser, K. T., Salyers, M. P., Rosenberg, S. D., Goodman, L. A., Essock, S. M., Osher, F. C., Swartz, M. S., Butterfield, M. I., & the 5 Site Health and Risk Study Research Committee. (2004). Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: Demographic, clinical, and health correlates. Schizophrenia Bulletin, 30, The National Center for PTSD. (2008). The epidemiology of trauma and trauma related in children and youth. PTSD Research Quarterly, 19, 1-3. Retrieved from FOUNDATIONS Section Summary We recommend three substantive changes in the FOUNDATIONS section of the CMHC Draft #2 Standards. First, standard A should be expanded to include structural issues and trends within community mental health systems. We recommend the standard be expanded to include the origins and trends to ensure CMHC students are prepared beyond knowledge of the history, but may 2

3 understand organizational structures, trends, and directions within the field. Second, the term neurobiological is a more accurate, acceptable, and recognized term, changing the term from neurological and identifying specifically mental (rather than addiction) better defines the need for practitioners to understand the interplay of neuroscience and clinical mental health counseling. Finally, a standard that is specific to the role of trauma in the development of clinical mental health issues and is needed to reflect the increased recognition of the role of trauma both in the etiology and treatment of clients. 2. CONTEXTUAL DIMENSIONS Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP G. roles and settings of mental health H. roles and settings of clinical mental Add the word clinical and re-lettered counselors health counselors H. etiology, nomenclature, treatment, referral, and prevention of mental and emotional I. mental health service delivery modalities within the continuum of care, such as inpatient, outpatient, partial treatment and aftercare and the mental health counseling services networks I. program development and mental health service delivery models in private and public mental health center settings and in integrative health care settings J. etiology, nomenclature, treatment, referral, and prevention of mental and emotional in a culturally appropriate context Now standard K. NEW STANDARD - This standard emphasizes the current and future trends of community mental health and private practice and other systems of mental health care, and their evolution, should be included to prepare CMHCs for professional practice Re-lettered added culturally appropriate context to reinforce the importance of culture on the prevention, assessment, diagnosis, and treatment of mental and emotional Re-lettered 3

4 J. diagnostic process, including differential Now standard L. Re-lettered diagnosis and the use of diagnostic classification systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and/or the International Classification of Diseases (ICD) K. potential for substance use to mimic and/or co-occur with a variety of neurological, medical and psychological M differential diagnosis among the variety of biological/neurological, mental, and substance use Differential diagnosis is the accepted term in the practice of CMHC. Also, this wording recognizes the interplay of substance use and mental L. impact of crisis on individuals with N. impact of crisis and trauma on Same as above crisis and trauma are mental health diagnoses M. impact of biological/neurological mechanisms on mental health N. classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for appropriate medical referral and consultation O. legislation and government policy relevant to mental health counseling P. cultural factors relevant to clinical mental health counseling Q. professional organizations, preparation standards, and credentials relevant to the practice of clinical mental health counseling individuals with mental health diagnoses O. neurobiological mechanisms that contribute to both mental health and mental Now standard P. Q. legislation and government policy relevant to the practice of clinical mental health counseling MOVE TO PRACTICE. CHANGE LANGUAGE Now standard R. different Terminology is clearer and addresses the continuum of mental health and mental Added clinical, consistency of terms is useful Moved because the implications of cultural factors pervade all clinical components in the activities within the scope of practice of CMHC. 4

5 R. legal and ethical considerations specific Now standard S. to clinical mental health counseling S. record keeping, third party reimbursement, and other practice and management issues in clinical mental health counseling T. recordkeeping and third party reimbursement within both private and public integrated health care systems in clinical mental health counseling Including integrated health care systems more accurately reflects the contemporary practice of CMHC CONTEXTUAL DIMENSIONS G J Summary Again, we recommend the phrase Clinical Mental Health Counseling/Counselor or CMHC, is used consistently throughout the document to identify and distinguish this specialty practice (section G is re-lettered to H to accommodate prior suggestions). Add new Section (I) with proposed language: "program development and mental health service delivery models in private and public mental health center settings and in integrative health care settings." CMHCs are increasingly required to provide rationales and formal proposals for any proposed services in public mental health systems; knowledge of commonly-accepted program development and service delivery models in public, private, and especially in integrated health care, will be increasingly essential for CMHCs. Section H has been re-lettered to "J" to accommodate prior suggestions; the language "in a culturally appropriate context" has been added. This language has been added to reinforce the importance of culture in specific professional practice areas. Given population trends and complexities, and funding targets and program requirements in mental health systems, CMHCs need to understand, and be able to respond to, the impact of culture in each distinct knowledge base, which comprises the scope of practice of CMHCs. Section J has been re-lettered to "L" to accommodate prior suggestions. K N Summary K. Specific to standard K, we recommend that the standard not be restricted to neurological to the nervous system and incorporate the whole person by modifying the term to read biological/neurological. We further propose that the reference to substance use that mimic and/or co-occur with be replaced with the term differential diagnosis which is the accepted term among practitioners and better recognizes the interplay of substance use and mental. The standard (subsequently labeled M ) would then read Differential diagnosis among the variety of biological/neurological, mental, and substance use. 5

6 Specific to standard L, and based on the assumption that crisis and trauma are related but distinctly different, we would add the term trauma so as to have the standard (subsequently labeled N ) read impact of crisis and trauma on individuals with mental health diagnoses. The same reasoning applies to our position that standard M have a clearer and more complete continuum by adding the term mental disorder. Hence that standard (subsequently labeled O ) would read neurobiological mechanism that contribute to both mental health and mental disorder. Last, standard N would remain as written but would subsequently be labeled P. O - S Summary The changes recommended in this section are brief, but have profound implications to the preparation of CMHCs and the practice of CMHC. Again, we recommend the phrase Clinical Mental Health Counseling/Counselor or CMHC, is used consistency throughout the document to identify and distinguish this specialty practice. Standard O. would then read legislation and government policy relevant to the practice of clinical mental health counseling. The standard related to culture would best serve recipients of CMHC services if moved to the Practice Section (and expounded) because the implications of cultural factors pervade all clinical components in the activities within the scope of practice of Clinical Mental Health Counselors and cultural considerations are addressed in the core standards. Finally, by changing the wording to include integrated health care systems, the standards will more accurately reflect the contemporary practice of Clinical Mental Health Counselors. The proposed language would now read recordkeeping and third party reimbursement within both private and public integrated health care systems in clinical mental health counseling. 3. PRACTICE Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP T. intake interview, mental status evaluation, biopsychosocial history, mental health history, and psychological assessment for treatment planning and caseload management U. diagnostic interviews, biopsychosocial history and mental status exams Separated into two standards to differentiate between the practices of clinical interviewing and those of clinical assessment 6

7 V. use of educational, psychological, personality, and other clinical assessment instruments in the diagnosis and treatment of mental NEW STANDARD to protect the scope of practice of licensed CMHCs within integrated healthcare systems. It is imperative that we separately recognize the use of assessment instruments by U. techniques and interventions related to a broad range of mental health issues V. strategies for interfacing with the legal system regarding court referred clients W. evidence-based techniques and psychotherapeutic interventions related to a broad range of clinical mental health issues, including couples, family, career, addictions, and disabilities, within an integrated system of health care X. impact of cultural, social, and familial factors on mental health and illness, psychopathology, assessment, diagnosis and treatment planning across the lifespan Y. appraising the level of insight, motivation, stage of change, and recovery status in the treatment and intervention of clinical mental health issues Z. strategies for managing chronic or persistent mental Now standard AA. CMHCs to protect practice laws. to protect the scope of practice of licensed CMHCs within integrated healthcare systems. Specifically, the terminology of family counseling, psychotherapy, career and addictions must be written within in the standards to prevent challenges to existing licensure laws and practice privileges (e.g., IOM, managed care, etc.) MOVED FROM CONTEXT SECTION NEW STANDARD The addition of this standard acknowledges best practices and informs treatment planning of all clinically related issues. Furthermore, these facets are embedded throughout currently used diagnostic systems NEW STANDARD Working with these populations requires a different skill set and is governed by a different set of best practices 7

8 W. strategies to advocate for clients and BB. strategies to advocate for clients and Consistent use of clinical mental health mental health counseling clinical mental health counseling counseling PRACTICE Summary Clinical Mental Health Counselors need to be viewed as essential providers in the behavioral ecosystem and the overall health care system. It is critical that counselor education programs emphasize the applications of these professional practices. These practices should reflect the scope and specificity of the work of CMHCs. As a specialty area, the practice area should highlight the varied and unique skills of CMHCs. The language of the Practice standards should reflect the most recent expected and accepted usage. Many of the proposed changes protect the scope of practice of licensed CMHCs found in both licensure laws and within integrated healthcare systems, for example the ability to work with couples and families or address career, addictions, or disability issues. It also emphasizes the assessment and diagnostic training of the specialty. More specifically, standards for clinical interviewing skills and clinical assessment skills must be separated in order to emphasis the specific skills sets. Also included is a new standard for working with populations that require a different skill set and are governed by a different set of best practices, such as integrating cultural/social/familial aspects into clinical practice, engaging clients based upon their insight and motivation, and managing chronic or persistent mental. 8

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