In response to the opioid epidemic, as well as part of a rollout of an across-the-board change in professional licensing, Vermont has revised the rules regarding counselors treating substance use disorders (SUDs). Gov. Phil Scott announced the change on Oct. 16.

“We hope this rule will get more treatment out there,” said Colin R. Benjamin, director of the state’s Office of Professional Regulation (OPR), which governs licensing of all professionals, including, since last year, SUD counselors. “The old way of restricting supervision for trainees was not serving the public,” he told ADAW. As a result, there will be more counselors available sooner. “We’ve heard from practitioners that right away they’re going to have more supervisors available, and we know of providers who will have more people on the front line with this,” he said.

Background

One origin of the state’s decision to regulate SUD counselors was, oddly, a 2015 Supreme Court ruling about dentists in North Carolina. Benjamin says that ruling made state regulation of professionals “the law of the land.” We pointed out that other states haven’t done this yet. “They haven’t reacted yet, but that doesn’t mean the law of the land isn’t what it is,” said Benjamin. “Some states are choosing to pick it up more quickly, and Vermont is one of those.”

The Office of Professional Regulation was formed three decades ago to “look at best practices from one profession to the next,” said Benjamin. “That’s built into our governing statute, long before the Supreme Court decision,” he said. “It’s my responsibility to do exactly what we did for alcohol and drug abuse counselors for every one of the 152 license types.” He noted that as general counsel for the OPR, he himself took the rules for real estate appraisers down from 40 pages to 10.

But the main reason for the change is the opioid epidemic and the need to get more counselors working in the state, said Benjamin.

According to Scott, about 100 to 200 more counselors are needed in the state, which currently has 693, including apprentice addiction professionals (AAPs), alcohol and drug counselors (ADCs) and licensed alcohol and drug counselors (LADCs).

IC&RC?

There are still issues that need to be worked out with IC&RC, which is under the impression that it no longer operates in Vermont. However, Benjamin said that the rules can be tweaked, and thinks that they are compatible with IC&RC so that counselors certified in other states can work in Vermont.

“This was an emergency rule, but we’re going to take a hard look at what we filed and go through more public hearings, to see if further revisions are needed,” Benjamin said.

And the state still looks at IC&RC as a partner.

“IC&RC were kind enough to share their standards during rule development, and based upon those, the streamlined Vermont ADC appears to match or surpass IC&RC standards,” said Gabriel M. Gilman, general counsel for the OPR. “But the streamlined Vermont LADC calls for 170 hours of SUD-specific training, whereas the IC&RC AADC standard calls for 180 hours of AADC-specific education. We’ll follow up with IC&RC to see if the ADC can be listed as an IC&RC-matched credential on their site. As we renew the emergency rules at 120-day intervals, we’ll assess whether boosting our SUD hours by 10 would benefit licensees by making them eligible for IC&RC certification.”

The state says that quality is not being jeopardized by the changes.

Scott said eliminating waiting lists is key, especially in Chittenden County, where the opioid epidemic is felt keenly. “We believe the crisis is growing,” Scott told reporters Oct. 16. “I don’t believe that we’ve identified all those who … need treatment, are seeking treatment, so we believe that opening the door, having this available to more Vermonters, is the answer.”

Summary of changes

The Office of Professional Regulation conducted a “strike-and-rewrite” replacement of its rules for AAPs, ADS and LADCs. The governor made these rules immediately effective starting Oct. 13, 2017.

Below is a summary of the changes:

  • Continuity: AAPs were limited to two renewals, effectively removing from the workforce any who lacked the means or the time to progress, as well as those who liked working in their current roles. The emergency rules allow AAPs to remain so indefinitely, if matriculated in SUD-related training.
  • Consistency: ADCs and LADCs were required to demonstrate 300 hours of SUD-specific education, requiring many applicants qualified in other states to return to educational programs for additional training before serving Vermonters. The emergency rules conform to the national standard, 270 hours, facilitating reciprocal recognition and practitioner mobility.
  • Efficiency: (1) AAPs and ADCs are now deemed to be on the roster of nonlicensed, noncertified psychotherapists. This halves the fees and paperwork required to remain credentialed. (2) An independent clinical social worker, psychologist, marriage and family therapist or clinical mental health counselor, licensed and in good standing in Vermont or a foreign jurisdiction, with at least one year of full-time addiction counseling experience and the core SUD competencies, may now test directly into a Vermont LADC license. (3) Clear, structured supervision paperwork is to be provided by the office, relieving the burden on clinical supervisors to document rule compliance, and relieving the burden on LADC advisors when reviewing applications. (4) Thirty pages of administrative regulations have been trimmed to 10 pages.
  • Degrees: Forty-eight-credit-hour MS degrees were denied recognition in favor of 60-hour MS degrees. The emergency rules open the field to those with 48-credit-hour degrees if they complete appropriate supplemental training, salvaging the significant value in the earned degree.
  • Core competencies: (1) Idiosyncratic SUD competencies set out 17 subcategories of mandatory education, each with a required hourly minimum not necessarily enforced by any other state. Few people, no matter how qualified, met these without undertaking additional education, often in topics irrelevant to their practice contexts. (2) The emergency rules harmonize SUD-competency requirements, embracing New Hampshire’s model of defining four public-health-critical competencies that must be demonstrated by all applicants, then allowing applicants to determine their own training ratios within other recognized categories. (3) Applicants who specialized in counseling psychology at the baccalaureate level were not advantaged under the old rules by comparison to applicants who studied accounting. The emergency rules allow applicants to demonstrate SUD-specific counseling training earned throughout their academic careers. (4) U.S. service members are afforded recognition of relevant military training, pursuant to 3 V.S.A. § 123(g).
  • Supervision: (1) Clinical supervision presented a devastating bottleneck for applicants, who could be supervised only by LADCs with multiple years of experience. The emergency rules capitalize on the deep experience of licensed independent clinical social workers, licensed clinical mental health counselors, board-certified physicians, psychologists, and licensed marriage and family therapists. Practitioners licensed in these fields, who demonstrate SUD core competencies and one year of SUD-counseling experience, may now serve as supervisors, and upon successful examination, may cross-qualify for the LADC license themselves. The emergency rules recognize a much broader range of qualifying supervision, at a direct supervision ratio of 1:40, rather than 1:20, allowing provider agencies the flexibility to meet real-world demands, and allowing the state’s most experienced practitioners to spend more time with patients, and less time signing supervision forms. Group supervision of as many as six unlicensed persons is permitted, as is supervision by video conference. Applicants may have multiple supervisors and may interrupt clinical supervision, for example, for pregnancy, illness or military service, without losing supervision credit. LADCs or LADC equivalents with five years’ full-time addiction-counseling practice in a foreign jurisdiction are presumed to have satisfied the supervised-clinical-practice hours required in Vermont, knocking down a major barrier to efficient interstate reciprocity and mobility.
  • Continuing education: (1) A complex and prescriptive continuing education regime is replaced with a relevance test. (2) Addiction Technology Transfer Center Network and National Association for Alcoholism and Drug Abuse Counselors programs are presumptively approved, eliminating unnecessary approval paperwork. (3) Designated agencies may provide as much as 30 of the 40 biennial continuing education hours required of licensees, encouraging in-service training and allowing licensees to maintain their credentials at lower cost. As a condition of recognition, agency continuing education training is opened to private practitioners and others, and agencies may charge reasonable fees to recover costs.

For frequently asked questions, go to https://www.sec.state.vt.us/professional-regulation/list-of-professions/alcohol-drug-abuse-counselors/frequently-asked-questions.aspx.

For the Supreme Court ruling on dentists, go to https://www.supremecourt.gov/opinions/14pdf/13-534_19m2.pdf.