California’s 90-day rule for MFTs: An explainer

California Board of Behavioral SciencesWhen the Board of Behavioral Sciences Policy Committee meets this Friday in Sacramento, the agenda will include discussion of the “90-day rule” for marriage and family therapists. The committee previously recommended that the rule be scrapped. Both CAMFT and AAMFT-CA are fighting hard to keep it. What is the 90-day rule, and why does it matter so much?

What’s the rule?

First, a quick explanation of what the 90-day rule actually is. If you’re an MFT in California, you can gain up to 1,300 hours toward your licensure requirement while enrolled in your master’s degree program. That experience, typically called a practicum or a traineeship, is overseen by both a clinical supervisor and your university. After you graduate, you apply to the state for an Associate registration (formerly known as an Intern registration). If you apply for Associate registration within 90 days of your degree posting date, any hours of supervised experience you gain between that degree posting date and the date that your registration is granted can also count toward licensure. By allowing those hours to count, the pathway to licensure is shortened, at least a little bit. It also means that recent MFT graduates who have been working as trainees in a clinic where they intend to keep working post-registration can continue seeing clients at that clinic while awaiting their registration number, knowing those hours will count toward licensure.

Why is it specific to MFTs?

Social workers (on their way to LCSW licensure) don’t have a similar rule. They are not allowed to count pre-degree hours in California. The hours that do count toward licensure do not begin until they have a registration number in hand. For MFTs, since they can count pre-degree hours, it wouldn’t make sense to say that pre-degree hours can count, and hours after registration can count, but the hours in between graduation and registration cannot. Interestingly, clinical counselors (on their way to LPCC licensure) also can’t count pre-degree hours, but they do have a parallel 90-day rule allowing for hours between graduation and registration to count.* Like the MFT rule, the 90-day rule for PCCs would also be scrapped under the proposal discussed below.

Why was there a vote to remove the rule?

Last year’s Assembly Bill 93 was the result of exemplary work the BBS did over the course of more than a year prior to the bill’s introduction. Through their Supervision committee, the BBS went around the state, holding public meetings to gather feedback about what updates were needed to the state’s supervision standards. They ultimately developed a set of proposed new rules with a lot to like. The minimum training to become a supervisor would be 15 hours (up from the current 6 for MFTs and PCCs). The Supervisor Responsibility Statement would much more clearly spell out supervisors’ responsibilities. Supervision with one supervisor and two supervisees would count as individual supervision.

All these good ideas were put on hold when the bill stalled in a Senate committee. Although the bill itself did not propose any changes to the 90-day rule, and there appear to be no known instances of public safety concerns arising from allowing MFTs or PCCs to count hours between graduation and registration, the committee was unwilling to move the bill forward unless the 90-day rule was killed off. (They were concerned that the time between graduation and registration was time when MFTs and PCCs would be working outside of the supervision of a university and without a background check performed by the state. It’s a reasonable concern, though again, there are no known incidents where the rule has caused a safety issue.)

What happens this Friday?

The BBS is now in the awkward position of needing to kill off the 90-day rule to move their otherwise-good supervision bill forward. If they don’t, the good work of their Supervision Committee will be largely lost. So, last October, the BBS Policy and Advocacy Committee voted to kill off the 90-day rule, with a two-year phase-out period. Their vote is technically a recommendation to the full board, which will take up the issue on February 22 in Sacramento.

This Friday’s committee meeting is important because both CAMFT and AAMFT-CA have pushed the committee to reconsider. Both associations believe the 90-day rule is worth keeping, and CAMFT developed compromise language that would keep the rule intact for most, although not all, MFT and PCC graduates: Hours between graduation and registration could count as long as the person was working at a facility that required a Live Scan background check as a condition of employment.

CAMFT’s compromise language has been reviewed and accepted by staff for that Senate committee, so there’s a good chance it would move forward. But the bill belongs to the BBS, not CAMFT, so the BBS would have to agree to the new language. Quoting CAMFT’s letter on the subject:

To now remove the 90 day rule, given there is a viable alternative, actually decreases consumer protection — it disrupts continuity of care, increases patient abandonment, and amplifies pre-licensee exploitation for no reasonable or sensible purpose.

If you’re wondering about the client care components there, remember that many MFTs work in the same clinics after graduation that they did before graduation. If they can’t count hours between graduation and registration, many would simply not see clients in that time — either of their own volition, or as a mandate from their employer. Abandonment and continuity of care are real concerns.

If you’re wondering about that last part — “amplifies pre-licensee exploitation” — go back to the second paragraph here. The 90-day rule shortens the pathway to licensure. Eliminating it would make it harder for some MFTs and PCCs to complete their hours on time. It would leave them more desperate to get hours as they approach the state’s six-year limit. (More on that in a separate explainer article to come.) And pre-licensed therapists who are desperate to get hours done are more willing to work in positions that are exploitive simply to get those hours.

The Policy committee votes on CAMFT’s compromise language Friday. Whatever the outcome of that vote, the issue goes to the full board for their final decision on February 22.

* Correction, Feb. 6: This article originally reported that California PCCs do not have the 90-day rule. They do, and the article has been accordingly updated throughout. We regret the error.