My Testimony to the Board of Behavioral Health To Educate Schools on Unauthorized Practices: Conflict is Inevitable
Schools will never admit they are doing it wrong, the ADE will never give up federal funding. No one wants to ruffle feathers. This won't be easy.
This past Friday I was pleased to be invited to testify before the Arizona Board of Behavioral Health Examiners as they took up the issue of how to inform school districts of the implications of repealing their Practice Authority For School Counselors policy. You can read about my administrative petition and the Board’s formal policy repeal here.
The following is a transcript of my testimony. Prior to my turn to speak, the Board was considering how best to inform school districts - and what their central messaging should be. I sensed they were looking, rather naively, to simply “open a dialogue” with the Arizona Department of Education (ADE). They even were asking each other who could introduce contacts there to start a discussion. I was practically jumping out of my seat to speak at that point as I realized they haven’t grasped how much resistance they will face. The board chair noticed, and called me up.
At one point in the testimony, you’ll read skepticism from a board member who seems uncomfortable with the idea of going after school-based behavioral health workers. This board member was not at the prior meeting where they repealed the policy - and I suspect he hasn’t read my petition yet.
The bottom line is there is more work to be done. I believe I raised enough issues to cause them to pause simply asking the ADE for help - after hearing me speak, they’ve agreed to further discuss the issue at future meetings. I think that’s the right approach. What I am asking them to do is more complicated, more political maybe, than they initially expected.
One comment before you get to the transcript. Unlike the prior meeting, this time the Assistant Attorney General sitting closest to me looked a bit uncomfortable as the full significance of what I was asking of her client started to set in...
Good. She got it. I’m going to keep pressing there.
Transcript of March 8, 2024 testimony before the Board of Behavioral Health Examiners with minimal edits for clarity:
Chris Evans: As your executive director qualified the discussion on this item [regarding what constitutes the practice of behavioral health] at the beginning, you have licensees who are not engaged in psychotherapy, who are required to be licensed.
I can tell you now that the response from school districts will be massive resistance to anything you say if you couch it in terms of psychotherapy. Because what I've heard directly from superintendents is that “our counselors don't do psychotherapy, they do tier two or tier three interventions for support services” according to a multitiered support system model – which really amounts to one-on-one counseling.
Is one-on-one counseling, “psychotherapy?”
Where is that [line], in the spectrum of services that you do, applying professional mental health principles, and methods and treatments along that continuum – where is the line where an [unlicensed] licensee* should be licensed?
Because one-on-one counseling at school can happen at lunchtime. A counselor can pick a kid out of out of the lunch line and say come talk to me without a parent knowing about it, or consenting in advance. And then they're engaged in a private conversation behind closed doors. This is where these circumstances occur.
They have a master's degree in counseling, much like your licensees from ASU, they studied the same things, including psychotherapy. I mentioned that in my petition.
What we need is guidance, for those counselors to know this is where you need to be licensed at this point in your engagement with a child. And if you're not, and you're not getting parental consent, right, this is problematic. That's number one.
So, if you go to the ADE, I fear you're going to be looking at a political pissing match between agencies. There's a lot of money and a lot of funding, federal and state, for school counselors and social workers that you would be up against, and they would like to continue those sources of funding. So, I worry about that.
On making something public: this gets to my final point. Parents need to understand, they don't know the difference between a certified school counselor or social worker and a licensed one. They have no clue.
And in fact, when I first started bringing up my research on Twitter, they looked at me like I was
crazy or speaking Greek. They don't know the difference.
And they don't know that you are an investigative body with subpoena powers and disciplinary powers. If there are [unlicensed] licensees*, if there's a parent who has been injured because their child has met with a counselor, if a child has been injured because they've met with a counselor who was engaged in unauthorized behavioral health services, they should be able to come to you. They need to know that.
You don't need to go the ADE to tell them that you have that authority.
Parents need to hear that message directly from you, whether it's on your website, or in some kind of disclaimer of some sort. They need to hear directly from this body.
Board Member: I have a question for you before you leave, what's the best, what do you feel is the best option for that? What would you do? If you were given the option?
Chris Evans: I would write a disclaimer on your web page or some notice, on maybe perhaps on your website that says a “note on school counseling.” It's going to require some thought. The wording is going to be, as you suggested, very, you know, you're going to have to put some thought into it, to at least identify this is an issue that the unauthorized practice of behavioral health includes the application...I think the exact statute, and your counsel can correct me, the exact statute says “the assessment and treatment of mental disorders…okay, the professional application of mental health [techniques] to mental disorders.” It doesn't say psychotherapy.
Your unauthorized practice statute is not tied to psychotherapy. Because behavioral health is not just about psychotherapy. Look, that kind of statement, that would go to the public, either through your website, or as written in a letter or notice, would be helpful. So that anyone can go to you and see, go to your website to learn about what you are: we are not school counselors, we are not school social workers. They are not licensed to practice behavioral health.
Board member: Question. So, I guess I want to make a distinction, because what I don't want us to go down the route of is trying to, like you had mentioned, create some sort of tension between another governmental agency or try to regulate something that's not within our scope as a regulatory body. And say you have an LMSW [licensed master social worker], or you're licensed by this board in some capacity, but you're hired as a school counselor. And those jobs are responsibilities and duties as a school counselor, are you saying that sometimes they're going to cross over? And that is the concern here?
Chris Evans: Yes, absolutely.
Board member: Okay.
Chris Evans: So, right? They don't have a specific exemption from licensure. Their job duties with the multi-tiered systems of support plans that they have, in the American School Counseling Association model, requires them to go into what they call tier two, tier three interventions, which is to pull out a child and do one-on-one counseling. Intervention is, is actually pulling that child in for treating them with some perceived mental condition, or behavioral condition. It's part of the job description. Schools, like Mesa Public Schools, actively advertise on their website for school counselors who will follow the ASCA model of intervention and care.
This is problematic.
So, at some point, some conflict with ADE is inevitable, I think, for this board. [You want to] maintain your flexibility in determining on a case by case basis what constitutes behavioral health, but at the same time signal to the community, that they are not licensed to practice behavioral health.
Board Member: I think some are, Mesa specifically. There are folks that are contractors that are licensed by this board to provide those services, and in which case, I think we should be concerned about those folks only, but not the people that don't have licenses. I mean, I'm not saying we agree or disagree, but you know that that is that is the key here. Do they have a license? Or do they not.
Chris Evans. That’s correct…[but] agencies are hired by school districts to provide behavioral health services - agencies being third parties, those presumably are licensed through this body.
Board Chair: I think that’s the difference. The counselors are contracted through an agency to their own school and provide services, they are doing psychotherapy, so we have jurisdiction. But I think what you're saying is that some of the school counselors they aren’t licensed, but they are credentialed, right, because they are credentialed through this other program. Right? They could potentially be doing behavioral health services, psychotherapy. And yeah…does that make sense?
Chris Evans: Certified by ADE, not licensed by BBHE.
Board Chair: Well, even if they are, if they are doing psychotherapy, they need to be doing the assessment. Alright. So, I think we need to continue discussion of this. Ms. Zavala [executive director], what do you think? Maybe, you know, keep it on future agendas. Okay? Thank you very much.
Chris Evans: Thank you.
((*I was referring to an unlicensed individual here.))
End.