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
A. origins, history, development and trends of community mental health and clinical mental health service delivery
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
B. theories and models related to clinical mental health counseling
None
C. principles of clinical mental health counseling, including prevention, intervention,
consultation, education, and advocacy, and networks that promote mental health and wellness
None
D. principles, models, and documentation formats of biopsychosocial case
conceptualization and treatment planning
Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP E. neurological and medical foundation and
etiology of addiction and co-occurring disorders
E. medical foundations and neurobiological etiologies of mental disorders and co-occurring disorders across the lifespan
Neurobiological etiologies better
describes the phenomena and relates more clearly to the complexities of
neuroscience and mental health F. specific understanding of the role of
trauma in the development of clinical mental health issues and disorders
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. F. psychological tests and assessments in
clinical mental health counseling
G. psychological tests and assessments in clinical mental health counseling
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, 493-499.
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, 45-57.
The National Center for PTSD. (2008). The epidemiology of trauma and trauma related disorders in children and youth. PTSD Research Quarterly, 19, 1-3. Retrieved from http://www.ptsd.va.gov/professional/newsletters/research-quarterly/v19n1.pdf 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
acceptable, and recognized term, changing the term from “neurological” and identifying specifically “mental disorders” (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 disorders 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
counselors
H. roles and settings of clinical mental health counselors
Add the word “clinical” and re-lettered
I. program development and mental health service delivery models in private and public mental health center settings and in integrative health care settings
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 H. etiology, nomenclature, treatment,
referral, and prevention of mental and emotional
disorders
J. etiology, nomenclature, treatment, referral, and prevention of mental and emotional
disorders in a culturally appropriate context
Re-lettered – added “culturally appropriate context” to reinforce the importance of culture on the prevention, assessment, diagnosis, and treatment of mental and emotional disorders
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
Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP J. diagnostic process, including differential
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)
Now standard L. Re-lettered
K. potential for substance use disorders to mimic and/or co-occur with a variety of neurological, medical and psychological disorders
M differential diagnosis among the variety of biological/neurological, mental, and substance use disorders
Differential diagnosis is the accepted term in the practice of CMHC. Also, this wording recognizes the interplay of substance use disorders and mental disorders
L. impact of crisis on individuals with mental health diagnoses
N. impact of crisis and trauma on
individuals with mental health diagnoses
Same as above – crisis and trauma are different
M. impact of biological/neurological mechanisms on mental health
O. neurobiological mechanisms that contribute to both mental health and mental disorders
Terminology is clearer and addresses the continuum of mental health and mental disorders
N. classifications, indications, and
contraindications of commonly prescribed psychopharmacological medications for appropriate medical referral and consultation
Now standard P.
O. legislation and government policy relevant to mental health counseling
Q. legislation and government policy relevant to the practice of clinical mental health counseling
Added “clinical”, consistency of terms is useful
P. cultural factors relevant to clinical mental health counseling
MOVE TO PRACTICE. CHANGE LANGUAGE
Moved because the implications of cultural factors pervade all clinical components in the activities within the scope of practice of CMHC.
Q. professional organizations, preparation standards, and credentials relevant to the practice
of clinical mental health counseling
R. legal and ethical considerations specific to clinical mental health counseling
Now standard S.
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” disorders –disorders to the nervous system– and incorporate the whole person by modifying the term to read “biological/neurological” disorders. We further propose that the reference to substance use disorders 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 disorders and mental disorders. The
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 o f 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
V. use of educational, psychological, personality, and other clinical assessment instruments in the diagnosis and treatment of mental disorders
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 CMHCs to protect practice laws. U. techniques and interventions related to a
broad range of mental health issues
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
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.)
X. impact of cultural, social, and familial factors on mental health and illness, psychopathology, assessment, diagnosis and treatment planning across the lifespan
MOVED FROM CONTEXT SECTION
Y. appraising the level of insight,
motivation, stage of change, and recovery status in the treatment and intervention of clinical mental health issues
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
Z. strategies for managing chronic or persistent mental disorders
NEW STANDARD – Working with these populations requires a different skill set and is governed by a different set of best practices
V. strategies for interfacing with the legal system regarding court referred clients
Existing Student Learning Objectives Proposed Changes Feedback or Rationale to CACREP W. strategies to advocate for clients and
mental health counseling
BB. strategies to advocate for clients and clinical mental health counseling
Consistent use of “clinical mental health 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