California

Money for MFTs

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Stipend and loan reimbursement programs for family therapists, updated for 2012 with current links, updated amounts, and additional programs.
                                                                                                                                                                                                                                                                                                           

A number of state and federal programs offer tens of thousands of dollars in stipends and loan reimbursements for marriage and family therapists to advance their careers. Generally, these programs aim to help bring mental health services to underserved areas and to reward therapists who dedicate themselves to such communities. Here are just a few of the programs MFTs may find enriching.

The federal National Health Service Corps program offers a whopping $60,000 in loan reimbursement, on top of the salary one would already make in an eligible position, for two years of service. Continue working in an NHSC-eligible position over time, and you can get as much as $360,000 in loan reimbursement for 16 years of full-time service. NHSC-eligible jobs can be found at the NHSC Jobs web site.

Also on the federal level, the Indian Health Service (IHS; www.ihs.gov) offers a similar program, awarding $20,000 per year for two years of service at an IHS site. (A cautionary note: MFTs are legally recognized for employment within IHS, but appear to fall within “other professions as determined by need” in the loan repayment program.)

The American Association for Marriage and Family Therapy (AAMFT) / US Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program awards stipends to cover education, plus funding to conduct research and travel to conferences and trainings, to doctoral students in MFT programs. These awards can be worth tens of thousands of dollars and are renewable for multiple years.

In California, there are additional state-based stipend and loan reimbursement programs. The awards offered by each of these programs are in addition to the salary one would already earn in an eligible position.

The California State MFT Stipend Program provides awards of $18,500 per year to MFT Interns who agree to work in public mental health positions in underserved areas for at least one year. In 2010 and again in 2011, 60 of these stipends were awarded through the statewide MFT Consortium, which covers most of the state; Loma Linda University and CSU-Chico each administered a handful of additional stipends through the same state fund. For 2012, Alliant International University (where I teach) also is administering its own stipend program, awarding 15 stipends per year of $18,500 each, distributed across our four CFT campuses.

There are separate stipend programs at the county level. The Los Angeles County MFT Stipend Program has awarded more than 300 stipends of up to $18,500 since 2005, with recipients committing to similar service requirements. San Diego County and Orange County have more recently launched similar programs.

Finally, the state offers MFTs and MFT Interns its Mental Health Services Provider Education Program, which awards up to $15,000 in loan reimbursement for two years of service in an underserved area, and its Mental Health Loan Assumption Program, which offers $10,000 in loan reimbursement for a one-year commitment. Though these programs are both run by the same state agency, their separate amounts and selection processes are because their funding comes through two distinct streams (license renewal fees, and the Mental Health Services Act). They have different application forms and run on different deadline cycles. The next MHLAP deadline is in August; the next MHSPEP deadline is in September.

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To put in a plug for my program: Alliant students are eligible for our own stipend program, the county programs in San Diego and Los Angeles, and the state and federal programs. Some campuses are still accepting applications for fall 2012; more information is available here: Alliant Couple and Family Therapy programs.

Are you aware of other federal or state-based programs that should be added to this list? Email me at ben[at]bencaldwell[dot]com and let me know, and I’ll be happy to expand this post.

Call for Change group offers non-rebuttal rebuttal

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MFT Call for Change group responds to my previous post, where I highlighted several of their erroneous statements about California.                                                                                                                                                                                     

The group calling themselves “MFTs Call for Change” (CFC) has posted a lengthy rebuttal to my earlier post criticizing CFC misstatements about California, specifically in areas related to the LPCC license and its development here.

Notably, they rarely, if ever, challenge my statements of fact. They claim that my post included “misinformation,” but their arguments are more often of the moving-the-target (“yes, but”) variety than they are factual disagreement. And they add at least one to the list of factual errors of their own.

  • CFC criticizes my statement that “When CAMFT was negotiating changes to various versions of the LPCC bill, they sought to make MFTs and LPCCs as indistinguishable as possible.” They would prefer I label this as my own belief, or an opinion of AAMFT-CA. But there’s no need. I saw, firsthand, CAMFT’s opposition to language supporting distinctiveness of professions during the negotiation process. Remember, CAMFT wanted grandparenting to be automatic for licensed MFTs based just on coursework (this version of the bill allowed exactly that), and indeed, CAMFT has continued to argue there are no meaningful differences in practice between the MFT and LPCC professions (as CAMFT themselves said, they believe “LMFTs and LCSWs may do in practice everything LPCCs may do“) — which would make the licenses effectively indistinguishable. That’s not my belief, that’s an argument CAMFT itself is continuing to make and act upon.
  • Along similar lines, CFC calls my discussion of CAMFT’s lawsuit against the BBS “patently irresponsible” because… well, I can’t tell why, exactly. I’m not even sure which part they’re taking issue with. CAMFT sued the BBS to try to make the “gap exam” for MFT grandparenting go away, based on their belief that the practices of the professions are indistinguishable. They have very clearly said so. That the lawsuit attempted to use technical means (like the BBS’s failure to consult with a state agency on exams, the one point of three in the lawsuit on which CAMFT won) to reach their desired ends (no gap exam) does not change those desired ends or the publicly-stated rationale behind them.
  • AAMFT-CA and AAMFT have not been “against the LPCC bill since its inception,” as CFC newly and falsely claims. Primary sources here tell the tale. California counselor legislation was first introduced in February 2005. In November 2005, nine months later, I first spoke to a legislative committee about AAMFT-CA’s concerns with bill language. Even then, AAMFT-CA took no formal position, as we understood the bill would be further amended. AAMFT-CA only formally opposed LPCC legislation in 2007 (this legislative committee analysis is the first mention of AAMFT-CA opposition), after it became clear that the legislation was moving in a direction that would hurt the MFT profession. Furthermore, in 2009, once we worked out the compromise language that became the LPCC law, AAMFT-CA’s opposition was removed [page 2], helping the bill pass. The larger AAMFT never took any formal position at all on the bill.
  • In discussing Kim Madsen, the BBS Executive Director, the CFC rebuttal suggests that in my post, “The reader has been lead [sic] to believe Ms. Madsen would be less than forthcoming” when discussing licensure issues. Nonsense. Ms. Madsen has been, in my experience, extremely professional, highly ethical, and very forthcoming, even when we have disagreed on policy. In my earlier post, what I suggested was that CFC, not Ms. Madsen, was being less than forthcoming by leaving out important details. This should have been evident in my preface “I suspect what Ms. Madsen said was…” Given my experiences with each of them, I trust her to be complete and forthcoming much more than I presently trust CFC to do so.

As I said previously, the CFC group seems to be well-meaning. I just don’t understand their dogged pursuit of this line of criticism. It is not supported by facts, and makes CFC look more interested in finding fault with AAMFT than actually supporting or developing the profession.

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If I did make any errors of fact — there or here — I would like to correct them. Email me at ben[at]bencaldwell.com, post a comment, or call for a change to my Twitter feed.

In “Gap Exam” and supervision rulings, California licensing board says MFTs and LPCCs are different

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In a unanimous vote, the California Board of Behavioral Sciences (BBS) today determined that a Gap Exam will be necessary for marriage and family therapists (MFTs) seeking licensure as professional clinical counselors (LPCCs). A separate ruling on supervision has similar themes.                                            

JudgesTools IconThe “Gap Exam” for currently-licensed MFTs seeking to grandparent into LPCC licensure will be shorter than regular licensing exams, and will focus on the differences in practice between MFT and LPCC.

In a separate vote, the BBS also agreed to move forward with a legislative proposal that would require LPCCs to complete additional coursework and experience in couple and family work in order to supervise MFT interns and trainees.

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Gap Exam

Today’s vote was the fourth the Board has taken on the Gap Exam issue, which has become controversial because of its broader implications about the distinctiveness of the professions. (For some of the history, see “CAMFT sues California licensing board” and “Ruling mixed in CAMFT-BBS gap exam lawsuit.” Full disclosure: I resigned CAMFT membership in response to their actions on this issue.) Earlier votes had been set aside for a variety of reasons; the most recent prior vote was set aside after CAMFT sued the BBS, and won on their argument that the BBS had not first consulted with the state’s Office of Professional Examination Services, as required in the law. The court ordered the BBS to set aside its prior vote and do the required consultation.

In that required consultation, OPES said they believed a Gap Exam was indeed necessary (last pages of PDF), and the BBS today voted to move forward with the Gap Exam. The exam development process will start immediately. Today’s hopefully-final vote supports the notion that while mental health professions have much in common, there are still meaningful differences between the practices of the specific professions.

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Supervision

Similar themes arose in discussion on supervision in mental health care. In current law, LPCCs must complete additional coursework and experience to be able to legally assess or treat couples and families. The question at hand was whether LPCCs who had not met those requirements should be able to supervise MFT trainees and interns who would be providing direct services to couples and families.

I argued the AAMFT-CA perspective, that one should not be legally able to supervise an activity that is outside of one’s own scope of practice. The BBS voted in agreement. Unlike the exam ruling, however, this vote was by no means a final determination. It merely moves forward proposed legislation that would allow LPCCs to supervise MFTs only if the supervisor has completed those additional requirements. The proposal still must go through the legislature and be signed by the Governor to become effective. CAMFT indicated they will oppose that provision during the legislative process. If CAMFT moves to simply kill the proposal, and is successful in doing so, LPCCs will be left with what is in current law — which prevents them from supervising MFT interns or trainees at all.

California’s complex plan to save mental health funding by slashing it

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To balance the state’s budget, Governor Jerry Brown has proposed raiding a state fund set aside to transform public mental health care. In return, he’s promising long-term fixes to the structural underfunding of public mental health. Is it a fair trade?

          
          
          

Side View Sacramento CapitolCalifornia Governor Jerry Brown has inhereted a budget deficit estimated at $25 billion, which everyone agrees will require significant changes in state services. One fix the Governor has proposed is raiding Mental Health Services Act (MHSA, originally known as Proposition 63) funds, an idea voters rejected as a budget fix in 2009.

This time around, Brown is proposing a novel compromise: let the state raid the MHSA fund on a one-time basis, and in return mental health services will get a longer-term, structural fix to chronic underfunding. It’s an intriguing proposal.

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Thanks to a the MHSA, a voter-approved tax on millionaires*, California currently has about $2 billion set aside specifically for the improvement of its public mental health system. This money is meant to be used to provide new and expanded services, train public mental health workers in current research-supported approaches, and generally transform the system to one that is modern, client-centered, and accountable. (By law, the money specifically cannot be used to pay for existing services, which are chronically underfunded.) Many marriage and family therapists are employed in public mental health in California, often in clinics funded by Medi-Cal.

Of course, in a budget crisis, it is easy to see how elected officials could view $2 billion sitting in the bank as a budget-solution-in-waiting. Governor Schwarzenegger proposed raiding this fund in 2009, asking voters to shift $460 million from MHSA funds into the state’s General Fund. The proposal was defeated by a landslide.

In contrast to the failed 2009 proposal, Governor Brown proposes a scheme that — at least in theory — could help the state budget in the short term and preserve mental health funding in the long term. It includes several moving parts:

  • Shifting $861 million from the MHSA reserve account to the General Fund. The shift would pay for current mental health services for the 2011-2012 fiscal year. Net impact: Bad. But could be worse. Obviously, this is a setback for planned MHSA-funded new and expanded programs, but the money would still be used to pay for mental health services, and would be a one-time shift.
  • Shifting responsibility for three mental health programs from the state to counties. The programs include Early and Periodic Screening, Diagnosis and Treatment (EPSDT); Medi-Cal mental health managed care; and special education mental health services (known to professionals as AB3632). Net impact: Unclear. “Local control” is sometimes better in concept than in reality; state administration ensures careful auditing to ensure money is being spent wisely, and consistency in program standards. County control of these services may lead to some cost savings, but those are often overstated.
  • Changing how the state funds mental health. Starting in the 2012-13 fiscal year, mental health services would be given an additional dedicated portion of state sales tax and vehicle license revenues. These are projected to grow at approximately a 6% annual rate. Net impact: Good. Currently, mental health programs are funded through a mechanism that grows at about 2% a year, according to the California Council of Community Mental Health Agencies — lower than normal inflation, and certainly not enough to account for any growth in patient population. This is a prime example of structural underfunding, which leads to ever-increasing caseloads and access-to-care problems.

All of this adds up to a proposal that has public mental health leaders more cautious than optimistic. The California Mental Health Directors Association asks a long list of good questions about the proposal, most of which are presently unanswered.

But the fact that a proposed $861 million raiding of public mental health funds is not being met with noisy protests from the agencies that rely on those funds is telling. It suggests that the proposal may have merit.

In the state’s current budget environment, we know lots of cuts will need to be made. Some of those cuts are likely to impact public mental health workers, including marriage and family therapists. Weathering the storm with a minimal amount of damage to public mental health, and even a potential long-term improvement to how it is funded, could be a very good outcome. Maybe.

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* Background on MHSA: As Governor Brown notes in his budget proposal,

To provide additional resources for county mental health services, voters passed the Mental Health Services Act (Proposition 63) in 2004. The intent of Proposition 63 was to reduce the long‑term adverse impact of untreated mental illness by developing services or expanding existing services at the local level. To fund these resources, Proposition 63 imposed a one‑percent surcharge on personal income over $1 million.

That tax brought in $2 billion more than expected in its first four years. (The budget proposal fails to mention that since then, the MHSA has brought in less than expected due to the worsening economy.) Counties have engaged in a long-term planning process for how they would use MHSA money to transform their mental health systems; by law, MHSA money was not to be used as simply a replacement funding stream for existing services. So while the MHSA currently has about $2 billion in reserves, counties have been planning for — indeed, counting on — that money to be available.

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.