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Submission For The Record of California Association of Marriage and Family Therapists

Mr. Chairman, Members of the Committee, the California Association of Marriage and Family Therapists (CAMFT), with over 29,000 members, is an independent professional organization representing the interests of licensed marriage and family therapists (MFTs) in the state of California. With its membership, CAMFT represents more than half of the 54,000 licensed MFTs in the United States. CAMFT is dedicated to advancing the profession as an art and a science, to maintaining high standards of professional ethics, to upholding the qualifications for the profession, and to expanding the recognition and awareness of the profession.

We are all painfully aware of the multitude of mental health problems that a number of veterans are dealing with today. The Congress has recognized that part of the solution to dealing with this problem is to make more mental health professionals available to treat these conditions being experienced by our veterans. With the passage of the Veterans Benefits, Health Care, and Information Technology Act of 2006, PL 109-461 and the Veterans' Mental Health and Other Care Improvements Act of 2008, PL 110-387, Marriage and Family Therapists are now recognized by the Department of Veterans Affairs as a provider of mental health services to both veterans and their family members. In order to implement the law, the Department of Veterans Affairs (VA) had to create employment standards by which their individual facilities could hire qualified MFTs. (Copy attached as Appendix A) From the outset, we believe that the VA has been seriously misinformed about how MFTs practice. Consequently, the qualification standard needs to be significantly reworked to reflect the actual way MFTs practice throughout the United States.

Education Requirements

Standard 2(b) sets forth the education requirement for MFTs who wish to work for the VA. This standard requires MFTs to have graduated from master's programs approved by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), or programs accredited by a "nationally accredited program conferring a comparable mental health degree as specified in the qualification standard of those disciplines (Social Work, Psychiatric Nursing, Psychology, and Psychiatry)." CAMFT believes that these requirements are much too limiting. (Additionally, we are informed that MFTs in other states such as New York, Florida, and Texas as well are graduates of non-COAMFTE approved schools.) In actuality, very few MFT programs are approved by COAMFTE or accredited by national organizations. It is anticipated that 90 percent of California MFT graduates are from programs that are NOT COAMFTE accredited. Further, COAMFTE accredits only those degree programs that are already accredited by a regionally accepted accrediting body. Given that there are 99 Veteran's Facilities in California, eliminating 90 percent of the pool of potential VA MFTs , who are licensed by the State of California in the profession, is a disservice to our veterans. Moreover, we are puzzled by the naming of the other disciplines (Social Work, Psychiatric Nursing, Psychology, and Psychiatry) for comparison purposes. MFTs are a separate and distinct discipline licensed to provide mental health services for individuals, adults, couples, '!,'; families, children, and adolescents, and groups. In California, MFTs may have master's or doctoral degrees in marriage and family therapy; marriage and family child counseling; 'psychology; counseling psychology; or, counseling with an emphasis in' marriage, faruily, and child counseling. The education of MFTs is comparable to what is required for licensed professional counselors with additional content required to work with couples, families, and children. In California, an MFT can earn the underlying master's or doctor's degree from a school, college, or university that is accredited by a regional accrediting agency recognized by the United States Department of Education, or by a school, college, or university approved by the Bureau of Private Post Secondary Education (see California Business & Professions Code §4980.37(b), Copy attached as Appendix B). CAMFT believes that regional accreditation should be the standard required by the VA.

Ability to Diagnose and Treat

Standard 2 (c) sets forth the licensure requirement for MFTs who wish to work for the VA. This section needs to recognize that MFTs do diagnose and treat individuals with mental illness. In California, by law, the master's or doctor's program leading to licensure as an MFT must train students to diagnose, assess, and treat mental disorders (see California Business & Professions Code § 4980.37 (e)(1), Copy attached as Appendix C).

Moreover, MFTs diagnose and treat mental disorders in government agencies, nonprofit counseling agencies, and private practices. And, MFTs are reimbursed by public mental health programs, TRICARE, and private insurance companies for providing such work. MFTs, like other mental health professionals, diagnose and treat mental disorders. They are trained to do such work; they are tested by licensing boards on their ability to do such work; and, they get paid by public and private sources to do such work. CAMFT believes that this reality needs to be reflected by the VA in the MFT qualification standard.

Every week a new study or report emphasizes the growing mental health needs of our veterans and the. shortage of mental health providers to minister to them. The members of CAMFT are anxious and willing to be added to the staff of VA facilities to provide for the needs of this patient population. Unless the standards are changed, a vast resource of mental health professionals in California and other parts of the country will be unavailable to care for our veterans. Thank you.


APPENDIX A

Department of Veterans Affairs                                                                      VA  Transmittal Sheet
Handbook 5005/
Washington, DC 20420

STAFFING

  1. REASON FOR ISSUE: To establish a Department of Veterans Affairs (VA) qualification standard for Marriage and Family Therapist, GS-I0l, appointed under 38 U.S.C. § 7401(3).
  1. SUMMARY OF CONTENTS/MAJOR CHANGES: This handbook contains mandatory procedures on staffing. This revision establishes the Marriage and Family Therapist occupation under VA's Title 38 Hybrid excepted service employment system in accordance with the "Veterans Benefits, Health Care, and Information Technology Act of 2006" (Public. Law 109-461). Authority is given to the Secretary of the VA under 38 U.S.C. § 7402 to prescribe qualifications for occupations identified in 38 U.S.C. § 7401(3). The pages in this policy are to be inserted in part II of VA Handbook 5005. This new qualification standard will be incorporated into the electronic version of VA Handbook 5005 that is maintained on the Office of Human Resources Management
  1. RESPONSIBLE OFFICE: The Recruitment and Placement Policy Service. (059), Office of the Deputy Assistant Secretary for Human Resources Management.
  1. RELATED DIRECTIVE: VA Directive 5005, Staffing.
  1. RESCISSIONS: None.
CERTIFIED BY: BY DIRECTION OF THE
SECRETARY OF VETERANS
AFFAIRS:
   
Roger W. Baker
Assistant Secretary for
Information and Technology
John U. Sepulveda
Assistant Secretary for
Human Resources and Administration

 


VA HANDBOOK 5005/
PART II

CONTENTS-CONTINUED

PARAGRAPH  

PAGE

APPENDICES-Continued    
     
II-G14. OCCUPATIONAL THERAPIST QUALIFICATION STANDARD II-G14-1
II-G15. LICENSED PHARMACIST QUALIFICATION STANDARD II-G-15-1
II-G16. DOCTOR OF CHIROPRACTIC QUALIFICATIONS STANDARD II-G16-1
II-G17. DEVELOPMENT OF QUALIFICATION STANDARDS FOR VETERANS HEALTH ADMINISTRATION (VHA) POSITIONS FILLED UNDER 38 U.S.C.§ 7401(3) II-G17-1
II-G18. PSYCHOLOGIST II-G18-1
II-G19. NUCLEAR MEDICINE TECHNOLOGIST II-G19-1
II-G20. DIETITIAN II-G20-1
II-G21. KINESIOTHERAPIST II-G21-1
II-G22. OCCUPATIONAL THERAPY ASSISTANT II-G22-1
II-G23 PHYSICAL THERAPY ASSISTANT II-G23-1
II-G24. MEDICAL TECHNOLOGIST II-G24-1
II-G25. DIAGNOSTIC RADIOLOGIC TECHNOLOGIST II-G25-1
II-G26. THERAPEUTIC RADIOLOGIC TECHNOLOGIST II-G26-1
II-G27. MEDICAL INSTRUMENT TECHNICIAN II-G27-1
II-G28. PHARMACY TECHNICIAN II-G28-1
II-G29. AUDIOLOGIST II-G29-1
II-G30. SPEECH LANGUAGE PATHOLOGIST II-G30-1
II-G31. AUDIOLOGIST/SPEECH LANGUAGE PATHOLOGIST II-G31-1
II-G32. ORTHOTIST-PROSTHETIST II-G32-1
II-G33. MEDICAL RECORD ADMINISTRATOR II-G33-1
II-G34 PROSTHETIC REPRESENTATIVE II-G34-1
II-G35. MEDICAL RECORD TECHNICIAN II-G35-1
II-G36. DENTAL ASSISTANT II-G36-1
II-G37. DENTAL HYGIENIST II-G37-1
II-G38. BIOMEDICAL ENGINEER II-G38-1
II-G39. SOCIAL WORKER II-G39-1
II-G40. BLIND REHABILITATION SPECIALIST II-G40-1
II-G41. BLIND REHABILITATION OUTPATIENT SPECIALIST II-G41-1
[II-G42. MARRIAGE AND FAMILY THERAPIST II-G42-1
II-G43. LICENSED PROFESSIONAL MENTAL HEALTH COUNSELOR II-G43-1]
     
II-H APPOINTMENT PROCEDURES BY OCCUPATION/ASSIGNMENT  
II-H1. PROCEDURES FOR APPOINTING PHYSICIANS TO SERVICE CHIEF AND COMPARABLE POSITIONS II-H1-1
II-H2. PROCEDURES FOR APPOINTING DENTISTS AND EFDAS II-H2-1
II-H3. PROCEDURES FOR APPOINTING PODIATRISTS II-H3-1
II-H4. PROCEDURES FOR APPOINTING OPTOMETRISTS II-H4-1
II-H5. RECRUITMENT, APPOINTMENT, ADVANCEMENT, CHANGE IN ASSIGNMENT AND REASSIGNMENT OF REGISTERED NURSES (RNs) IN GRADES IV AND V II-H5-1
II-H6. PROCEDURES FOR APPOINTING NURSE ANESTHETISTS TO SECTION CHIEF POSITIONS II-H6-1
II-H7. PROCEDURES FOR APPOINTING PHYSICIAN ASSISTANTS AT CHIEF GRADE II-H7-1
II-H8. PROCEDURES FOR APPOINTING CHIEF OF PHARMACY SERVICE (ALL GRADES), CLINICAL/PHARMACY SPECIALISTS, AND PROGRAM SPECIALISTS, AND PROGRAM SPECIALISTS AT GRADES GS-13 AND ABOVE II-H8-1
II-H9. PROCEDURES FOR APPOINTING OCCUPATIONAL AND PHYSICAL THERAPISTS AS SECTION CHIEF II-H9-1
II-H10. PROCEDURES FOR APPOINTING DOCTORS OF CHIROPRACTIC II-H10-1
II-I. ENGLISH LANGUAGE PROFICIENCY II-HI-1
II-J. REQUESTS FOR APPROVAL TO PETITION THE UNTIED STATES DEPARTMENT OF STATE (DOS) FOR SUPPORT OF A WAIVER OF THE 2-YEAR HOME RESIDENCE REQUIREMENT OF THE UNITED STATES EXCHANGE VISITOR PROGRAM II-J-1
II-K. RCVL (RESIDENT/TRAINEE CREDENTIALS VERIFICATION LETTER) II-K-1
II-L. CREDENTIALING CHECKLIST II-L-1
II-M. SAMPLE CONSULTANT CERTIFICATE II-M-1
II-N. CAREER INTERN PROGRAM II-N-1
II-O. ORGANIZATIONAL LOCATION OF HYBRID TITLE 38 PROFESSIONAL STANDARDS BOARDS II-O-1
II-P. PROCEDURES FOR SELECTING HYBRID TITLE 38 PROFESSIONAL STANDARDS BOARDS MEMBERS II-P-1
II-Q. PRESIDENTIAL MANAGEMENT FELLOWS PROGRAM II-Q-1

*Use in conjunction with the OPM Standard.


 VA HANDBOOK 5005/
PART II
APPENDIX G42

[APPENDIX G42. MARRIAGE AND FAMILY THERAPIST QUALIFICATION STANDARD
GS-101
Veterans Health Administration

1.      COVERAGE. The following are requirements for appointment as a Marriage and Family Therapist (MFT) in the Veterans Health Administration (VHA). These requirements apply to all VHA MFTs in the GS-l0 I series, including those assigned to VA Medical Centers, Community-Based Outpatient Clinics (CBOCs), Vet Centers, Veterans Integrated Service Network (VISN) offices, and VHA Central Office.

2.      BASIC REQUIREMENTS. The basic requirements for employment as a VHA MFT are prescribed by statute in 38 U.S.C. 7402(b)(10), as amended by section 201 of Public Law 109-461, enacted December 22, 2006. To qualify for appointment as an MFT in VHA, all applicants must:

    a.  Citizenship. Be a citizen of the United States. (Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with chapter 3, section A, paragraph 3g, this part.)

    b.  Education. Hold a master's degree in marriage and family therapy from a program approved by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) or have graduated from a nationally accredited program conferring a comparable mental health degree as" •. specified in the qualification standards of those disciplines (Social Work, Psychiatric Nursing, ' , Psychology, and Psychiatry). All additional course work taken to be accepted for MFT licensure must come from a nationally accredited program in one of the above areas.

NOTE: .A doctoral degree in marriage and family therapy from a COAMFTE approved program is considered to be a comparable mental health degree. .

    c. Licensure. Persons hired or reassigned to MFT positions in the GS-l0 I series in VHA must hold a full, current, and unrestricted license to independently practice marriage and family therapy in a State.

(1) Exception. The appointing official may waive the licensure requirement for persons who are otherwise qualified, pending completion of state prerequisites for licensure examinations for a period not to exceed 2 years from the date of employment on the condition that MFTs appointed on this basis provide care only under the supervision of a fully licensed MFT. Non-licensed MFTs who otherwise meet the eligibility requirements may be given a temporary appointment as a graduate MFT under the authority of 38 USC 74057405( c )(2)(B) This exception only applies at the entry level (GS-9). For grades at or above the full performance level, the candidate must be licensed.

(2) Failure to Obtain License. In all cases, unlicensed MFTs must actively pursue meeting state prerequisites for licensure starting from the date of their temporary appointment. At the time of appointment, the supervisor will provide the unlicensed MFT with the written requirements for licensure, the timeframe by which the license must be obtained, and the consequences for not becoming licensed by the deadline. Failure to obtain a license within the prescribed amount of time will result in removal from the GS-101 MFT series and may result in termination of employment.

(3) Loss of Licensure. Once licensed, MFTs must maintain a full, valid and unrestricted license to remain qualified for employment. Loss of licensure will result in removal from the GS-101 MFT series and may result in termination of employment.

    d.   Physical Requirements. See VA Directive and Handbook 5019.

    e.   English Language Proficiency. MFTs must be proficient in spoken and written English in accordance with VA Handbook 5005, part II, chapter 3, section A, paragraph 3j.

3. GRADE REQUIREMENTS

    a.  Creditable Experience

(1) Knowledge of Current Professional Marriage and Family Therapy Practices. To be creditable, the experience must have required the use of knowledge, skills, and abilities associated with current professional marriage and family therapy practice. The experience must be post-master's degree or above. Experience satisfying this requirement must be active professional practice, which is paid/non-paid employment as a professional MFT, as defined by the appropriate state licensing board.

(2)  Quality of Experience. Experience is only creditable if it is obtained following graduation with a master's degree in marriage and family therapy or comparable degree in mental health (Social Work, Psychiatric Nursing, Psychology, and Psychiatry) from an accredited training program and includes: work as a professional MFT directly related to the position to be filled. Qualifying experience must also be at a level comparable to. marriage and family therapy experience at the next lower grade level. For all assignments above the full performance level, the higher level duties must consist of significant scope, administrative :independence, complexity (difficulty) and range of variety as described in this standard at the specified grade level and be performed by the incumbent at least 25 percent of the time.

(3)  Part-Time Experience. Part-time experience as a professional MFT is creditable according to its relationship to the full-time workweek. For example, an MFT employed 20 hours a week, or on a 1/2­time basis, would receive 1 full-time workweek of credit for each 2 weeks of service.

(4) Fellowships or Post-Graduate Training. Fellowship and post-graduate training programs are typically in a specialized area of clinical practice, e.g., group or family practice. Training as a fellow or post-graduate may be substituted for creditable experience on a year-for-year basis.

(5) Practicum in a VA Setting. A VHA practicum experience may not be substituted for experience, as the practicum (field placement) is completed prior to graduation with a master's degree in marriage and family therapy or comparable mental health degree.

    b. Grade Determinations. In addition to the basic requirements for employment, the following criteria must be met when determining the grade of candidates.

(1) GS-9 Marriage and Family Therapist (Entry Level)

(a)  Experience, Education and Licensure. GS-9 is the entry level grade for the GS-l01 Marriage and Family Therapist series and is used for licensed MFTs with less than one year of experience (post­master's degree) or for MFTs (master's or doctoral level) who are graduates not yet licensed at the independent practice level. Unlicensed MFTs at the GS-9 level have completed the required education listed in paragraph 2b above, and are working toward completion of prerequisites for licensure. In addition, the candidates must demonstrate the KSAs in subparagraph (b) below.

(b) Demonstrated Knowledge, Skills, and Abilities

1. Basic knowledge of human development throughout the lifespan, including interventions based on research and theory, family and system interaction formal diagnostic criteria, risk assessment, evidence­based practice and assessment tools.

2. Ability to assess, with supervision, the psychosocial functioning and needs of patients and their family members, and the knowledge to formulate, implement, and re-evaluate a treatment plan through continuous assessment identifying the patient's problems, strengths, readiness to change, external influences and current events surrounding the origins and maintenance of the presenting issue, and interactional patterns within the client system. This includes the utilization of testing measures where appropriate.

3. Ability to provide counseling and/or psychotherapy services to individuals, groups, couples and families in a culturally competent manner that facilitates change through restructuring and reorganizing of the client system with supervision.

4. Ability to establish and maintain effective working relationships with clients, colleagues, and other professionals, with supervisory guidance as needed. This includes the ability to communicate effectively, both orally and in writing, with people from varied backgrounds, and to communicate the MFT perspective in interdisciplinary staff meetings while respecting the roles and responsibilities of other professionals.

5. Basic knowledge and understanding of existing relevant statutes, case law, ethical codes, and regulations affecting professional practice of marriage and family therapy. This includes the ability, under close supervision, to assist clients in making informed decisions relevant to treatment, including limits of confidentiality.

6. Ability to organize work, set personal priorities and meet multiple deadlines as assigned by the supervisor.

7. Ability to use computer software applications for drafting documents, data management, maintaining accurate, timely and thorough clinical documentation, and tracking quality improvements.

(c) Assignments. Individuals assigned, as GS-9 MFTs are considered to be at the entry level and are closely supervised, as they are not yet functioning at the independent practice level conferred by independent licensure. MFTs at the GS-9 entry level are typically assigned to VHA program areas that do not require specialized knowledge or experience. Since these MFTs are not practicing at an independent level, they should not be assigned to program areas where independent practice is required, such as in a CBOC, unless there is a licensed MFT in the program area who can provide supervision for practice. GS-9 MFTs provide mental health services under close supervision and within the ethics and guidelines of the professional standards set by AAMFT.

(2) GS-ll Marriage and Family Therapist (Full Performance Level)

(a) Experience, Education and Licensure. In addition to the basic requirements, the GS-11 full performance level requires completion of a minimum of 1 year of post-master' s degree experience in the field of health care marriage and family therapy work (VA or non-VA experience) and licensure in a state at the independent practice level. In addition, the candidate must be licensed to practice at the independent practice level and must demonstrate the KSAs in subparagraph (b) below.

OR,

A doctoral degree in marriage and family therapy or comparable degree in mental health from an accredited training program (see page 2.b. NOTE above) may be substituted for the required 1 year of professional marriage and family therapy experience in a clinical setting. In addition, the candidate must be licensed to practice at the independent practice level and must demonstrate the KSAs in subparagraph (b) below.

(b) Demonstrated Knowledge, Skills, and Abilities

1. Knowledge of human development throughout the lifespan, interventions based on research and theory, family and system interaction, formal diagnostic criteria, risk assessment, evidence based practice-and assessment tools.

2. Ability too independently assess the psychosocial functioning and needs of patients and their family members, and the knowledge to formulate, implement, and re-evaluate a treatment plan through continuous assessment identifying the patient's problems, strengths, readiness to change, external influences and current events surrounding the origins and maintenance of the presenting issue, and interactional patterns within the client system. This includes the utilization of testing measures where appropriate.

3. Ability to provide counseling and/or psychotherapy services to individuals, groups, couples and families in a culturally competent manner that facilitates change through restructuring and reorganizing of the client system.

4. Ability to establish and maintain effective working relationships with clients, colleagues, and other professionals in collaboration throughout treatment regarding clinical, ethical and legal issues and concerns. This includes the ability to represent and educate others regarding the MFT perspective in interdisciplinary staff meetings while respecting the roles and responsibilities of other professionals working with the client.

5. Knowledge and understanding of existing relevant statutes, case law, ethical codes, and regulations affecting professional practice of marriage and family therapy. This includes the ability to assist clients in making informed decisions relevant to treatment to include limits of confidentiality.

6. Ability to provide orientation, training and consultation to new MFTs including clinical oversight of MFT graduate students, and/or provide supervision to pre-licensure MFTs.

7. Skill in the use of computer software applications for drafting documents, data management, maintaining accurate, timely and thorough clinical documentation, and tracking quality improvements.

(c) Assignments. This is the full performance level for MFTs. GS-ll MFTs are licensed to independently practice marriage and family therapy and to provide other mental health services within the ethics and guidelines of the professional standards set by AAMFT. They may be assigned to all program areas that provide mental health services. MFTs at this level may also be involved in program evaluation and/or research activities.

(3) GS-12 Marriage and Family Therapist Supervisor

(a) Experience, Education, and Licensure. In addition to the basic requirements, completion of 1 year of progressively responsible assignments and experience equivalent to the GS 11 level which demonstrates knowledge, skills, and abilities that are directly related to the specific assignment. In addition, the candidate must demonstrate the professional KSAs in subparagraph (b) below.

(b) Demonstrated Knowledge, Skills, and Abilities

1 Ability to assess qualifications and abilities of current and prospective employees to include staff performance evaluation.

2. Ability to identify professional development needs of other MFTs and guide them in current practice guidelines.

3. Ability to collaborate with members of other disciplines and supervisors and to represent the profession both in and outside of VHA. This includes knowledge of the roles, contributions, and interrelationships with other disciplines.

4.  Ability to administratively supervise in areas related to the provision of marital and family services. This includes knowledge of VA policy and procedures as well as fair, principled, and decisive leadership practices.

5.  Ability to clinically supervise in areas related to the provision of marital and family therapy services to accomplish organizational goals and objectives.

(c)  Assignment. MFT Supervisors typically supervise MFT professional staff which may include experienced MFTs, and program coordinators. Supervisory MFTs at this level may be assigned to any program area and may be involved in program evaluation and/or research activities. Supervisory MFTs are licensed to independently provide marital and family therapy services which may include coordinator responsibilities and to supervise for licensure other MFTs within the ethics and guidelines of the professional standards set by AAMFT.

(4) GS-12 Marriage and Family Therapist Program Coordinator

(a) Experience, Education, and Licensure. In addition to the basic requirements, completion of 1 year of progressively responsible assignments and experience equivalent to the GS-11 level which demonstrates knowledge, skills, and abilities that are directly related to the specific assignment.  In addition, the candidate must demonstrate the professional KSAs in subparagraph (b) below.

(b) Demonstrated Knowledge, Skills, and Abilities

1. Ability to organize work, set priorities, meet multiple deadlines, delegate tasks and facilitate team building.

2. Ability to manage and direct the work of others to accomplish program goals and objectives.

3. Ability to devise innovative ways to adapt work operations to new and changing programs, to develop staffing and budget requirements, and to translate management goals and objectives into well coordinated and controlled work operations and ensure compliance with pertinent VHA policies.

4. Ability to establish and monitor production and performance priorities and standards and program evaluation criteria.

(c) Assignment. MFT Program Coordinators are administratively responsible for a clinical program providing treatment to patients in a major specialty such as, but not limited to homeless veterans program, and mental health intensive case management (MHICM). They may be the sole mental health practitioner in this specialty at the facility and typically provide direct patient care services in the program area. They manage the daily operations of the program, develop policies and procedures for program operation and prepare reports and statistics for facility, VISN and national use. They may be responsible for the program's budget. At this level, GS-12 MFTs are licensed to independently provide mental health services and to supervise for licensure other MFTs within the ethics and guidelines of the professional standards set by AAMFT. Other assignments of equal complexity and responsibility may be approved on an individual basis where warranted.

(5) GS-13 Marriage and Family Therapist Program Manager

(a) Experience, Education, and Licensure. Inl addition to the basic requirements, completion of 1 year of progressively responsible assignments and experience equivalent to that obtained at the GS-12 level which demonstrates knowledge, skills, and abilities that are directly related to the specific assignment.

(b) Demonstrated Knowledge, Skills, and Abilities

1. Skill in assessing qualifications and abilities of current and prospective employees to include staff performance evaluation.

2. Ability to facilitate professional development of other MFTs and guide them in current practice guidelines.

3. Ability to contribute to professional development of staff members across a variety of disciplines within program specific area.

4. Ability to collaborate with leaders of other disciplines within facilities, the community, VISN, and VACO.

5. Skill in managing and directing the work of others to accomplish program goals and objectives, reporting requirements and ability to devise ways to adapt work operations to new and changing programs, staffing and budget requirements. This includes knowledge of VA policy and procedures as well as fair, principled and decisive leadership practices.

6. Ability to analyze organizational and operational problems and to develop and implement solutions that result in sound operation of the program.

7. Ability to clinically supervise in areas related to the provision of marital and family therapy services to accomplish organizational goals and objectives.

8. Knowledge of the roles, contributions and interrelationships of other disciplines within the program.

(c) Assignment

1. MFT Program Managers have broad program management responsibilities which include the operation and management of key clinical, training, or administrative programs. Responsibilities include development and implementation of programs, policies and procedures; oversight of administrative and programmatic resources; and monitoring of outcomes using a data driven quality assurance process. Decisions made affect staff and other resources associated with the programs managed and are made while exercising wide latitude and independent judgment. Such programs deliver specialized, complex, highly professional services that are important program components and significantly impact the health care provided to Veterans. They have responsibility for staffing, work assignments, budget, clinical services provided and admission criteria for the program, day-to-day program operations and all reporting requirements. Additionally, program managers at this grade generally have collateral assignments determined by the needs of the local facility, the VISN, and or VACO.

2. Managers may also have full responsibility for oversight of the professional practice of MFTs to assure the highest quality of mental health care provided to veterans throughout the facility and affiliated clinics. This responsibility also includes insuring that all MFTs in the facility and its affiliated clinics meet the requirements of this qualification standard. At this advanced performance level, GS-13 MFTs are licensed to independently provide marital and family therapy services with program management responsibilities.

(6) GS-14 Marriage and Family Therapist Program Manager Leadership Assignments (Care Line Manager/VISN/National)

(a) Experience, Education, and Licensure. In addition to the basic requirements, completion of I year of progressively responsible assignments and experience at the GS-13 level which demonstrates knowledge, skills, and abilities that are directly related to the specific assignment.

(b) Demonstrated Knowledge, Skills, and Abilities. In addition to meeting the KSAs for GS-13 level, the candidate must demonstrate the KSAs below:

1. Advanced knowledge and skill in management/administration of multidisciplinary mental health programs at complex facilities and/or across multiple sites which includes supervision, consultation, negotiation, and monitoring.

2. Demonstrated global knowledge of mental health counseling practice to develop, maintain, and oversee programs in all settings.

3. Ability to provide consultation on policy implementation, qualification standards, counseling practice, and competency with medical center director, VISN, or national program managers that are consistent with organizational goals and objectives.

4.  Advanced knowledge of evidence-based practices and mental health practice guidelines in multiple professional areas, and the ability to use these resources to guide the program staff in providing appropriate treatment interventions.

5.  Ability to influence high level officials in adoption of, and conformance to, performance measures, monitors, and other policy guidelines.

(c) Assignment. Typical assignments include serving at a facility as a care line manager or at the VISN/VACO level. A care line manager is assigned to manage, direct, and oversee complex treatment programs within the medical center. Supervisory responsibilities cover multiple disciplines that may be separated geographically or in multi-division facilities. They have responsibility for staffing, work assignments, budget, clinical services provided and admission criteria for the program, day-to-day program operation, and all reporting requirements. Leadership positions at the VISN or national level are characterized by their scope, level of complexity, significant impact on VHA mission, significant importance to the VISN, etc. They direct a mental health, behavioral science, other patient care program component at the VISN or national level or direct organizational development at the national level. Duties are exercised with wide latitude, autonomy, and independence. They have delegated authority to determine long range work plans and assure that implementation of the goals and objectives are carried out. They may serve as consultants to other management officials in the field, VISN, or national level.

4. DEVIATIONS

a. The appointing official may, under unusual circumstances, approve reasonable deviations to the grade determination requirements for MFTs in VHA whose composite record of accomplishments, performance, and qualifications, as well as current assignments, warrant such action based on demonstrated competence to meet the requirements of the proposed grade.

b. Under no circumstances will the educational or licensure requirements be waived for grade levels GS-11 or above.

c. The placement of individuals in grade levels not described in this standard must be approved by the Under Secretary for Health, or designee, in VHA Central Office.

Authority 38 U.S.C. 7402, 7403]


Appendix B

4980.37.

(b) To qualify for a license or registration, applicants shall possess a doctor's or master's degree in marriage, family, and child counseling, marriage and family therapy, psychology, clinical psychology, counseling psychology, or counseling with an emphasis in either marriage, family, and child counseling or marriage and family therapy, obtained from a school, college, or university accredited by a regional accrediting agency recognized by the United States Department of Education or approved by the Bureau for Private Postsecondary and Vocational Education. The board has the authority to make the final determination as to whether a degree meets all requirements, including, but not limited to, course requirements, regardless of accreditation or approval. In order to qualify for licensure pursuant to this section, a doctor's or master's degree program shall be a single, integrated program primarily designed to train marriage and family therapists and shall contain no less than 48 semester or 72 quarter units of instruction. This instruction shall include no less than 12 semester units or 18 quarter units of coursework in the areas of marriage, family, and child counseling, and marital and family systems approaches to treatment. The coursework shall include all of the following areas:

(1) The salient theories of a variety of psychotherapeutic orientations directly related to marriage and family therapy, and marital and family systems approaches to treatment.

(2) Theories of marriage and family therapy and how they can be utilized in order to intervene therapeutically with couples, families, adults, children, and groups.

(3) Developmental issues and life events from infancy to old age and their effect on individuals, couples, and family relationships. This may include coursework that focuses on specific family life events and the psychological, psychotherapeutic, and health implications that arise within couples and families, including, but not limited to, childbirth, child rearing, childhood, adolescence, adulthood, marriage, divorce, blended families, stepparenting, abuse and neglect of older and dependent adults, and geropsychology.

(4) A variety of approaches to the treatment of children.

The board shall, by regulation, set forth the subjects of instruction required in this subdivision.


Appendix C

(e) In order to provide an integrated course of study and appropriate professional training, while allowing for innovation and individuality in the education of marriage and family therapists, a degree program that meets the educational qualifications for licensure or registration under this section shall do all of the following:

(I) Provide an integrated course of study that trains students generally in the diagnosis, assessment, prognosis, and treatment of mental disorders.

(2) Prepare students to be familiar with the broad range of matters that may arise within marriage and family relationships.

(3) Train students specifically in the application of marriage and family relationship counseling principles and methods.

(4) Encourage students to develop those personal qualities that are intimately related to the counseling situation such as integrity, sensitivity, flexibility, insight, compassion, and personal presence.

(5) Teach students a variety of effective psychotherapeutic techniques and modalities that may be utilized to improve, restore, or maintain healthy individual, couple, and family relationships.

(6) Permit an emphasis or specialization that may address anyone or more of the unique and complex array of human problems, symptoms, and needs of Californians served by marriage and family therapists.

(7) Prepare students to be familiar with cross cultural mores and values, including a familiarity with the wide range of racial and ethnic backgrounds common among California's population, including, but not limited to, Blacks, Hispanics, Asians, and Native Americans.