Ben Caldwell

California CE providers routinely violate ad regulations

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A review of 15 advertisements for continuing education events for California MFTs and LCSWs finds that all of them violate state regulations by leaving out required information. If no one is complaining, do we need the regulations?                                                     

Forget-me-not2-croppedContinuing education providers in California are expected to offer some basic information about themselves and their events when advertising, just as licensed marriage and family therapists are expected to have our licensure information attached to any advertising we do. Ideally, these disclosure requirements prevent less-than-reputable folks from putting on less-than-worthwhile CE events to swindle therapists out of money.

But no one is following the requirements.

And that’s a literal “no one,” at least in our sample. Not one advertisement followed the letter of the law.

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We (my research assistant and I) reviewed ads from every issue in volume 21 (2009) of The Therapist magazine, published by the California Association of Marriage and Family Therapists every two months. We want to emphasize that CAMFT is not in any way responsible for policing outside ads; it is the CE providers who are solely responsible for their own advertising content. We found a total of 15 unique ads, many of which appeared in multiple issues; we did not count duplicates in our calculations.

Section 1887.9 of the California Code of Regulations (it can be viewed in the BBS laws & regulations booklet, page 142 by the on-page numbering, page 149 of the PDF) requires all CE providers to:

ensure that information publicizing a continuing education course is accurate and includes the following:

(a) the provider’s name;

(b) the provider number, if a board-approved provider;

(c) the statement “Course meets the qualifications for _______ hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences”;

(d) the provider’s policy on refunds in cases of non-attendance by the registrant; and

(e) a clear, concise description of the course content and objectives.

Providers seem to be simply ignoring this. We found a total of 15 unique ads for in-person CE events. We ignored ads for online or mail-in courses; they usually were advertising the provider, and not a specific course, and thus they are probably not subject to the above requirements.

We found that among the 15 ads we reviewed, providers routinely ignored all of the required information except the provider’s name:

Item Ads
containing		 Ads
missing		 % of ads
containing
1. Provider name 14 1 93%
2. Provider number 7 8 47%
3. “Meets qualifications”
statement		 0 15 0%
4. Refund policy 2 13 13%
5. Course description 8 7 53%

Another way to look at this is to see what proportion of ads had 2, 3, 4, or all 5 of the required pieces of information:

Items present Ads % of all ads
One or more 15 100%
Two or more 11 73%
Three or more 3 20%
Four or more 2 13%
All five 0 0%

The requirements exist to ensure that when licensees hand over their money to CE providers, the licensee knows what they are signing up for and those hours will legitimately count toward the licensee’s continuing education requirement. But the BBS does not enforce those requirements unless they receive a complaint, and such complaints are rare: in a 7-month span reported here, the BBS received just three complaints against continuing education providers. (And those were not likely to have been about advertising, judging by prior complaint data.) For comparison, there are more than 2,000 approved CE providers in the state.

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The relative rarity with which the requirements are followed, combined with the relative lack of complaints against continuing education providers, raises an important question: Are these regulations really helping anybody?

Certainly the BBS has better things to do with its enforcement unit than go after such minor omissions. Maybe it would be better to take the requirements off the books entirely.

Or, maybe the current landscape is just fine. After all, it allows licensees who feel they have been duped by unscrupulous CE providers to complain, and gives the BBS leverage to act against the provider who failed to advertise appropriately. It’s the CE-advertising equivalent of jaywalking: we all want the cops to focus their work on more important things, and it’s really only a problem when somebody gets hurt.

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If you’re wondering, the flowers in the picture are forget-me-nots. Seemed appropriate.

Wyoming bill would require counseling before marriage or divorce

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With some exceptions, three hours of premarital or pre-divorce counseling would be required. For divorcing couples, it’s good policy, even though it is unlikely to reduce divorce rates. It is much harder to justify the premarital requirement, on either a clinical or policy level.

Boutonniere-whitesuitA bill introduced in this year’s session of the Wyoming state legislature, HB0065, would require couples to attend three hours of premarital counseling before obtaining a marriage license, and three hours of marriage counseling before obtaining a divorce.

While there is little data to suggest that any three-hour process for couples already planning to split up will make much of a dent in the state’s divorce rate, requiring divorce counseling is a good idea for other reasons. Divorce education reduces conflict in the divorce process, particularly where custody is concerned (see this summary of several studies on divorce education for parents), and saves the divorcing couple as well as the public a significant amount of money in the process. Three hours is not an unduly burdensome amount, and the a judge can waive the requirement if the court finds there is “clear and convincing evidence that marital counseling will not lead to a reconciliation of the parties” — an important consideration for victims of relationship violence. Several states have adopted such programs, often similar to one called “Children in the Middle,” with good results.

The premarital counseling requirement is harder to support, either on a policy or scientific level — and this is coming from a guy who specializes in couples work (San Diego marriage counseling) and loves premarital counseling.

There is ample evidence that these relationship education programs improve communication, but it is unclear whether premarital education actually improves relationship satisfaction or stability, and there is virtually no evidence to suggest they actually have a long-term impact on divorce. (That’s primarily due to a lack of data, not studies showing failure.) A recent, thorough review in the journal Family Relations described current research on the very basic question of whether these programs work as “not as settled as program developers and practitioners might assume or like it to be.” There are at least three large-scale, federally-funded demonstration projects of premarital education (Appendix 2) underway now that should provide clearer answers.

In the meantime, these programs continue to grow because they are, in the words of one report, “popular and valued.” And there is some evidence to suggest they have a greater impact on low-income families, who do suffer from higher long-term divorce rates.

But here’s the catch. In the studies that have been done, as well as the large studies underway now, few have suggested that just three hours of education would be enough to even expect an impact. The federally-funded studies use programs of at least 24 hours of education. Most programs utilize at least 12 hours. Anything under eight hours was considered in the Family Relations review to be a “low-dosage” program.

This is why it’s so hard to get behind the premarital requirement in the proposed Wyoming law. I could see requiring 12 hours, and I can certainly understand requiring none. But three hours? It adds a hurdle to marriage, without sufficient reason to believe it will have a lasting positive impact. And while I believe quite strongly that premarital education can be effective, I cannot support requiring an amount of it that is too low to have any likely effect. Wyoming and other states should either require enough premarital education to make a lasting difference, or none at all.

Update: The bill died in its first committee in February 2011.

Insights from 5 1/2 years of California MFT license exam data: A defense of underperforming programs

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Some MFT programs’ graduates perform poorly on California’s MFT licensing exams. Don’t assume that means the program is of poor quality; there may be good reasons.

Graduation hat1We’ve seen that there are huge differences in performance on the California marriage and family therapy licensing exams based on what graduate program the test-takers attended. We’ve also seen that for-profit MFT programs should not be dismissed simply because they aim to make money; Argosy graduates do particularly well on the exams, while University of Phoenix graduates do not. I’ve said before, though, that there are lots of things to consider when choosing a graduate program in MFT, and that graduates’ exam performance should only be one of many such considerations. Indeed, there are some major problems with putting too much stock in exam data.

If you are looking at graduate programs, and are concerned about your prospective MFT program’s exam pass rate, here are three reasons why you may want to ignore the exam data:

  • Programs can and do improve. Exam data reflects students who graduated years earlier. Remember, it takes the average MFT intern in California more than four years to move from graduation to the licensing exams. That number is a bit lower for graduates of COAMFTE-accredited programs, primarily because they do more practicum hours while still in school. Nonetheless, if you are looking at MFT licensing exam data from 2009 and earlier, you will find very little information on anyone who graduated much past 2005, and nothing to tell you which programs have gotten better or worse since then. Consider the recently-COAMFTE-accredited programs at Chapman University and Hope International University. Their national accreditation should arguably make them more appealing (and thus competitive) programs for prospective students and faculty alike. That’s important, and simply is not reflected in currently-available exam data.
  • Programs seek to give students opportunities. Consider for a moment the state’s worst-performing program, according to a table that appeared in Part I of this series: Pacific Oaks College. Based on the pass-rate statistic alone, one might presume that the Pacific Oaks program is not very good. But that conclusion can’t safely be made from that data. Pacific Oaks, over the past few years, has specifically sought to provide opportunities to historically underserved populations, creating cohorts specifically for African-American Family Therapy and Latino Family Therapy. (This outreach is vital: Lots of evidence suggests that the mental health workforce is not meeting the needs of minority populations, either in California or around the US.) Students in these cohorts may lack the family, economic, and social support, as well as the earlier educational opportunities, that other students often have. Pacific Oaks goes to great length to remediate these earlier deficits, and may be doing more, with less, than programs who start with more economically- and educationally-advantaged students. When financial and accreditation concerns threatened to close the Pacific Oaks in 2009, I was one of many who stood up in defense of keeping the program alive, and have no reservations about having done so.
  • Programs have no control over what students do after graduation. A program can really only control what happens from the time students are in the program to the time they graduate — and even then, programs have limited control over how well their students prepare themselves. A great supervisor can help an MFT Intern/Associate make up for deficiencies in their education, and help get them ready for licensing exams. Poor supervision may leave the Intern/Associate on their own to prepare, or even offer incorrect information that ultimately harms one’s chance of passing the exams. And of course, programs have no control over whether their graduates use MFT exam prep programs, although there is little evidence that these prep classes actually impact MFT exam pass rates.

Of course, before you do go dismissing a program’s exam pass rate, take some steps to get reassurance that you are making that decision wisely. If you are considering attending a program whose graduates have not performed well on recent licensing exams, ask the program (1) why, (2) what they’re doing about it, and (3) what evidence they have that they’re getting better. If the program can’t pass that test, then it’s time to wonder whether you would be able to pass yours.

Ruling mixed in CAMFT-BBS “gap exam” lawsuit

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Court finds the BBS must consult with Office of Professional Examination Services to determine whether a “gap exam” is needed for MFTs seeking LPCC licensure.

JudgesTools IconAt 11:00 this morning, the California Superior Court for Sacramento County issued a tentative ruling in the CAMFT-BBS lawsuit over MFTs who wish to be grandparented into LPCC licensure. It leaves hanging the question of whether there will actually be such an exam — though it appears highly likely.

I’ve previously written about the issue here and here, the first of which offers a better review of the details.

Today’s ruling is mixed, siding with the BBS on two key questions and with CAMFT on one:

  1. The BBS was within its authority in determining that “the profession” and “the practice of the profession” mean effectively the same thing.
  2. The BBS was within its authority (and reading the law reasonably) in determining that those seeking grandparenting into LPCC licensure must be tested on any differences between the professions.
  3. The BBS went beyond its authority by determining that a “gap exam” was necessary without adequate consultation with the state’s Office of Professional Examination Services (OPES), as required by law.

Ultimately, the court orders that the decision to require a “gap exam” be set aside until the OPES consultation has taken place (which must be within 60 days) and the BBS makes a determination based in part upon the results of that consultation. Since the BBS and its contracted consultant both previously concluded that there were meaningful differences between the professions, the court ruling on the first two questions above suggests a strong likelihood that the BBS will go forward with an exam, but it is not fully certain.

You can read the ruling in full here.

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Updated 1-30-2011: The court heard oral argument on Friday, to no effect — it adopted what had been the tentative ruling. The BBS now has 60 days to consult with OPES and make a final determination on the need for a gap exam.

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Update 2-6-2011: CAMFT has released their spin on the Gap Exam ruling, which seems sure to mislead at least some readers. There’s nothing there that’s technically incorrect, but it takes a fair amount of reading to get the full picture. People who just read the headline, or even the headline and the first couple of paragraphs, will likely come away believing there will be no Gap Exam. Since CAMFT lost on the two substantive arguments that would suggest the exam is unnecessary, it still seems likely that an exam will be given.

Also updated the headline, as the court adopted its tentative ruling.

CAMFT changing therapist-referral site to “Counseling”

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CAMFT is rebranding their therapist-referral site as CounselingCalifornia.com. The change, and how it was announced, continue CAMFT’s pattern of treating MFTs and LPCCs as indistinguishable.

In an announcement on November 1, the California Association of Marriage and Family Therapists (CAMFT) said it would be re-branding its therapist-referral web site as CounselingCalifornia.com. While their email described this as an effort largely to improve search engine optimization, it also fits their pattern of making marriage and family therapy (and the MFT license) indistinguishable from counseling (and the LPCC license). The change will take effect on January 4, exactly three days after the Board of Behavioral Sciences begins accepting applications for LPCC licensure through grandparenting.

Notably, not once in CAMFT’s email announcement did they refer to their own clinical members as what they are by licensure: “marriage and family therapists.” Instead, the clinicians who would gain referrals through the site (limited to CAMFT’s Clinical Members, which at this time means just MFTs) were referred to only as “therapists” or “licensed therapists.” The words “marriage” and “family” were nowhere to be found. The name change for the referral site, and the announcement of that change, certainly leave the door open for the site to be a referral site for both MFTs and LPCCs.

I can understand that, from an organizational-numbers point of view, it may benefit CAMFT to be as welcoming as possible to LPCCs as that license opens in California. However, CAMFT’s continuing efforts to make MFTs and LPCCs indistinguishable work against the best interests of both professions, who should collaborate effectively when it benefits us (lobbying for Medicare reimbursement, for example) and be able to advance our unique professions when it benefits us (publishing journals or holding conferences, for example). The constant push to make us indistinguishable, culminating in a lawsuit against the BBS, was enough for me to finally cancel my CAMFT membership. It will be interesting to see how other MFTs who value the MFT title will respond, especially if this pattern continues.

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Another reason CAMFT likely changed the name: The existing name has earned them the unlucky honor of being regularly counted among the unintentionally worst company URLs on many a list.

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CAMFT is separate and independent from both AAMFT and its California Division.