July 1st, 2016

New rules expand treatment options

According to the Centers for Disease Control, 13 to 20 percent of children in the U.S. experience a mental health disorder in a given year. It is a staggering number, exacerbated by the fact that treatment options for children are limited because of constraints on parents’ time and schedules or due to the limited availability of trained professionals.

“If you look at this state,” said Nicholas Covino, Psy.D., president of William James College, (formerly Massachusetts School of Professional Psychology), “if you are mom or dad, 70 percent of the time you can’t find mental health professionals to take care of your kid. There is a significant problem in mental health care and no one is talking about it.”

With changes to licensing requirements passed by the Massachusetts legislature in 2014, the state has eased the path for clinical treatment in a school setting for children facing mental health issues.

Under the sponsorship of Rep. Ruth Balser (D-Newton) the bill was filed to loosen restrictions on when a school setting can fulfill supervisory training requirements.

The bill was originally introduced separately but was then passed as part of a reduction of gun violence bill signed into law by then-Governor Deval Patrick.

“We looked at this as really almost an oversight that needed to be corrected,” said Balser. “Psychologists work in many settings and we needed to update the laws to reflect that. In the end, it was part of the gun violence bill, appropriate because that legislation needed to include attention to mental health issues.”

As the Board of Registration in Psychology starts to implement the law, the licensing regulations they have created will allow for treatment options closer to where the students spend most of their time, in the schools themselves.

“As long as the site meets other criteria, schools are no longer automatically ruled out just because they are schools,” said Randi Dorn, Ed.D., ABPP, director of training in the doctoral clinical psychology program at William James.

Licensing requirements in Massachusetts require that psychologists be certified as “health service providers” in order to provide clinical services. The certification requires two years of supervised practice, one of which must be in a “health service training program.”

“As a result of the recent statutory change, the board has proposed regulations to address this issue,” said Chris Goetcheus, director of communications at the Massachusetts Office of Consumer Affairs and Business Regulation. “The proposed changes are intended to broaden the number and variety of settings where an HSP candidate can complete his/her year of supervised practice in a health service training program, while also ensuring a broad range of exposure and opportunities in that training experience.”

Before the change, a psychologist was required to complete supervised training in another setting, a hospital or mental health clinic, for example. The result, according to Covino, were fewer school-based psychologists.

“Historically,” said Covino, “people were sent to mental health centers to get training and had to leave the schools. Then we lose people who wind up in the mental health system because they trained there and find value there. We are moving our resources away from the schools.”

Currently, the Allied Mental Health Board oversees certification for “school psychologists,” who are not licensed for clinical work and generally provide assessments, evaluations and psychological testing.

In this situation, students must be referred out for treatment. This extra step, however, often results in less than optimal treatment with the extra time and expense limiting many parents’ abilities to get their child to sessions.

The main issue for increasing treatment in school settings, said Covino, will be to raise awareness among educators of the differences in services that can be offered by professionals and in helping them to see the need for licensed psychologists close to where the children spend most of their day.

“Everyone needs to understand the importance of bringing mental health professionals to the kids where they are,” said Covino. “If anywhere from 1-2 out of 20 children in every classroom has a diagnosable mental illness, and others have transient issues, and they are disruptive, everyone suffers.

We need to get better about understanding that we need to bring resources to the children with mental health issues and challenges and the best place to do that is in the schools.”

By Catherine Robertson Souter

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