Existing law, the Psychology Licensing Law, provides for the licensing and regulation of psychologists and requires a person applying for licensure as a psychologist to have completed specified coursework or training. Existing law also requires licensed psychologists to participate in continuing professional development as a prerequisite for renewing their licenses. Existing law requires a person applying for relicensure or for reinstatement to an active license status to certify under penalty of perjury that he or she has fulfilled the continuing professional development requirements. Existing law defines continuing professional development as certain continuing education learning activities and provides requirements for continuing education courses approved to meet the continuing professional development requirements.

This bill, effective January 1, 2020, would require an applicant for licensure as a psychologist to complete a minimum of 6 hours of coursework or applied experience under supervision in suicide risk assessment and intervention. The bill would also require, effective January 1, 2020, as a one-time requirement, a licensed psychologist to have completed this suicide risk assessment and intervention training requirement prior to the time of his or her first renewal. The bill would also require, effective January 1, 2020, a person applying for reactivation or for reinstatement to have completed this suicide risk assessment and intervention training requirement. The bill would require that proof of compliance with this provision be certified under penalty of perjury that he or she is in compliance with this provision and be retained for submission to the board upon request. By expanding the crime of perjury, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Psychology Licensing Law, provides for the licensing and regulation of psychologists and requires a person applying for licensure as a psychologist to have completed specified coursework or training. Existing law also requires licensed psychologists to participate in continuing professional development as a prerequisite for renewing their licenses. Existing law requires a person applying for relicensure or for reinstatement to an active license status to certify under penalty of perjury that he or she has fulfilled the continuing professional development requirements. Existing law defines continuing professional development as certain continuing education learning activities and provides requirements for continuing education courses approved to meet the continuing professional development requirements.

This bill, effective January 1, 2020, would require an applicant for licensure as a psychologist to complete a minimum of 6 hours of coursework or applied experience under supervision in suicide risk assessment and intervention. The bill would also require, effective January 1, 2020, as a one-time requirement, a licensed psychologist to have completed this suicide risk assessment and intervention training requirement prior to the time of his or her first renewal. The bill would also require, effective January 1, 2020, a person applying for reactivation or for reinstatement to have completed this suicide risk assessment and intervention training requirement. The bill would require that proof of compliance with this provision be certified under penalty of perjury that he or she is in compliance with this provision and be retained for submission to the board upon request. By expanding the crime of perjury, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Psychology Licensing Law, provides for the licensing and regulation of psychologists and requires a person applying for licensure as a psychologist to have completed specified coursework or training. Existing law also requires licensed psychologists to participate in continuing professional development as a prerequisite for renewing their licenses. Existing law requires a person applying for relicensure or for reinstatement to an active license status to certify under penalty of perjury that he or she has fulfilled the continuing professional development requirements. Existing law defines continuing professional development as certain continuing education learning activities and provides requirements for continuing education courses approved to meet the continuing professional development requirements.

This bill, effective January 1, 2020, would require an applicant for licensure as a psychologist to complete a minimum of 6 hours of coursework or applied experience under supervision in suicide risk assessment and intervention. The bill would also require, effective January 1, 2020, as a one-time requirement, a licensed psychologist to have completed this suicide risk assessment and intervention training requirement prior to the time of his or her first renewal. The bill would also require, effective January 1, 2020, a person applying for reactivation or for reinstatement to have completed this suicide risk assessment and intervention training requirement. The bill would require that proof of compliance with this provision be certified under penalty of perjury that he or she is in compliance with this provision and be retained for submission to the board upon request. By expanding the crime of perjury, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 THIRD READING  

Bill No: AB 89

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/5/17

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 72-1, 4/20/17 - See last page for vote

SUBJECT:

SOURCE: California Board of Psychology

DIGEST:

This bill requires an applicant for licensure as a psychologist to show completion of at least six hours of coursework or applied experience in suicide risk assessment and intervention after January 1, 2020.

ANALYSIS:

Existing law:

1. Establishes the Board of Psychology (BOP) in the Department of Consumer Affairs to administer the Psychology Licensing Law. (Business and Professions Code (BPC) § 2900)
2. Prohibits any person from engaging in the practice of psychology, or representing themselves to be a psychologist, without a license, as specified. (BPC § 2903(a))
3. Requires each applicant for licensure to have engaged for at least two years in supervised professional experience under the direction of a licensed psychologist, as specified, or under suitable alternative supervision as determined by the BOP, at least one year of which shall be after being awarded the doctorate in psychology. (BPC § 2914 (d)(1))
4. Requires each applicant for licensure to take and pass an examination unless otherwise exempted by the BOP. (BPC § 2914 (e))
5. Requires each applicant for licensure to show, by evidence satisfactory to the BOP, that they have completed training in the detection and treatment of alcohol and other chemical substance dependency. (BPC § 2914 (f))
6. Requires each applicant for licensure to show by evidence satisfactory to the BOP that they have completed coursework in spousal or partner abuse assessment, detection, and intervention. This requirement applies to applicants who began graduate training during the period commencing on January 1, 1995, and ending on December 31, 2003. (BPC § 2914 (g)(1))
7. Requires each applicant for licensure who began graduate training on or after January 1, 2004, to show by evidence satisfactory to the BOP that he or she has completed a minimum of 15 contact hours of coursework in spousal or partner abuse assessment, detection, and intervention strategies, including knowledge of community resources, cultural factors, and same gender abuse dynamics. An applicant may request an exemption from this requirement if he or she intends to practice in an area that does not include the direct provision of mental health services. (BPC § 2914 (g)(2))

This bill:

1. Requires an applicant for licensure as a psychologist, effective January 1, 2020, to show on his or her application the completion of a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention in one of the following ways:
   1. Obtained as part of his or her qualifying graduate degree program. To satisfy this requirement, the applicant must submit to the BOP a written certification from the registrar or training director of the educational institution or program from which the applicant graduated stating that the coursework required is included within the institution’s curriculum required for graduation at the time the applicant graduated, or within the coursework that was completed by the applicant.
   2. Obtained as part of his or her applied experience. Applied experience can be met in any of the following settings: practicum, internship, formal postdoctoral placement that meets specified requirements, or other qualifying supervised professional experience. The applicant must submit to the BOP a written certification from the director of training for the program or primary supervisor where the qualifying experience has occurred, stating that the training required is included within the applied experience.

c) By taking a continuing education course that meets specified requirements and that qualifies as a continuing education learning activity category. The applicant must submit to the BOP a certification of completion.

1. Requires each licensee prior to the time of his or her first renewal, and each applicant for reactivation or reinstatement to an active license status, to have completed a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention, as specified, effective January 1, 2020, as a one-time requirement. Proof of compliance shall be certified under penalty of perjury that he or she is in compliance and shall be retained for submission to the BOP upon request.
2. Declares that no reimbursement is required by this act pursuant to the California Constitution.

Background

The Center for Disease Control and Prevention reports that in 2015, suicide was the tenth leading cause of death for individuals of all ages, and the second leading cause of death of individuals aged 15-34. According to a 2013 article in the journal, Training and Education in Professional Psychology, “Suicide risk assessment training for psychology doctoral programs: Core competencies and a framework for training,” the authors found that “Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment.” In an attempt to remedy this, Assemblymember Levine introduced AB 2198 in 2014. The bill would have required a psychologist, marriage and family therapist, educational psychologist, professional clinical counselor and clinical social worker to complete a minimum of 15 hours of coursework on suicide and each licensee seeking renewal to take six hours of continuing education coursework in suicide risk assessment and intervention. The bill passed the Legislature, but the Governor vetoed the bill, urging California’s “licensing boards to evaluate the issues which this bill raised and take whatever actions are needed.”

With this directive, the California Board of Psychology -- which opposed the original bill -- conducted a multi-year review of suicide prevention training for psychologists. The review included two surveys of doctoral programs, pre- and post-doctoral internship and practicum programs, and a review of licensure requirements in 2015-2016. The survey indicated that while most students and trainees were receiving some level of education or training in suicide risk assessment and intervention, almost 3% of all students were not receiving training in risk assessment and over 7% were not receiving training in suicide intervention. There were also variances in the amount of education and training being provided to psychologists and applicants.

After conducting this survey, the BOP came to the conclusion that additional suicide prevention training was necessary.

This bill requires an applicant for licensure and renewal to show completion of at least six hours of coursework or applied experience in suicide risk assessment and intervention after January 1, 2020.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 6/26/17)

California Board of Psychology (source)

American Foundation for Suicide Prevention

American Medical Response

California Mental Health Planning Council

California Mental Health Services Authority

California Professional Firefighters

California State Sheriff’s Association

CalTrain

Caminar for Mental Health

Children Now

County Behavioral Health Directors Association

General Federation of Women’s Clubs Woman’s Club of Cypress

Marin County Sheriff’s Office

National Alliance on Mental Illness of Santa Cruz County

Project Safety Net

San Francisco Suicide Prevention

Santa Clara County Board of Supervisors

Stanislaus County Sheriff’s Department

Trevor Project

Uplift Family Services

OPPOSITION: (Verified 6/26/17)

California Psychological Association

Santa Clara County Psychological Association

ARGUMENTS IN SUPPORT: The California Board of Psychology writes in support, “AB 89 will not only help promote public health through improving the state’s suicide prevention efforts, but also puts California in a leadership role with other states that protect consumers of psychological services through mandatory training in this critical area. AB 89 takes a critical first step in improving the state’s suicide prevention efforts by meeting on of the goals of the 2008 ‘California Strategic Plan on Suicide Prevention: Every Californian is a Part of the Solution,’ which proposed developing and implementing guidelines to promote effective and consistent suicide prevention by incorporating suicide prevention training in existing licensing, credentialing, and graduate school programs. Furthermore, AB 89 puts California in line with six other states that require psychologists and licensed health care professionals to obtain specified minimum number of hours of education or training in suicide risk assessment and intervention. By ensuring all psychologist meet a minimum level of education or training in suicide prevention, AB 89 enhances the state’s suicide prevention efforts and protects consumers of psychological services who rely on psychologists having the basic education and training required to identify and aid a patient with suicidal ideation in finding competent treatment.”

The Trevor Project writes in support of this bill that according to a recent national survey, 40 percent of transgender adults have reported having made a suicide attempt, 92 percent of which attempted suicide before the age of 25. National research shows that 77 percent of those that die by suicide had contact with their primary care provider in the year before their death.

ARGUMENTS IN OPPOSITION: California Psychological Association bases their opposition to AB 89 on the premise that this bill targets psychologists, who are: “…the practitioners within our healthcare system that have the most extensive training of any behavioral health professionals.” California Psychological Association is content with the current percentage of all training programs that include some sort of lesson in the principles of suicide risk assessment and intervention, which is 95 percent. California Psychological Association instead advocates for allocating more resources to other strategies for suicide prevention that depend on the individual at risk having already been properly assessed for risk of suicide. These alternative prevention measures include: strengthening economic supports and access and delivery of suicide care, creating protective environments by reducing access to lethal means among persons at risk of suicide, promoting connectedness with peer norm programs; teaching coping and problem solving skills, and gatekeeper training.

ASSEMBLY FLOOR: 72-1, 4/20/17

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dababneh, Dahle, Daly, Flora, Fong, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Voepel, Waldron, Weber, Wood, Rendon

NOES: Eggman

NO VOTE RECORDED: Brough, Frazier, Gallagher, Jones-Sawyer, Mathis, Ridley-Thomas, Ting

Prepared by:

6/28/17 15:21:16

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: AB 89 Hearing Date: June 5, 2017

Subject: Psychologists: suicide prevention training

SUMMARY:

Requires an applicant for licensure as a psychologist to show completion of at least 6 hours of coursework or applied experience in suicide risk assessment and intervention after January 1, 2020.

Existing law:

1. Establishes the Board of Psychology (BOP) in the Department of Consumer Affairs to administer the Psychology Licensing Law. (Business and Professions Code (BPC) § 2900)
2. Prohibits any person from engaging in the practice of psychology, or representing themselves to be a psychologist, without a license, as specified. (BPC § 2903(a))
3. Requires each applicant for licensure to have engaged for at least two years in supervised professional experience under the direction of a licensed psychologist, as specified, or under suitable alternative supervision as determined by the BOP, at least one year of which shall be after being awarded the doctorate in psychology. (BPC § 2914 (d)(1))
4. Requires each applicant for licensure to take and pass an examination unless otherwise exempted by the BOP. (BPC § 2914 (e))
5. Requires each applicant for licensure to show, by evidence satisfactory to the BOP, that they have completed training in the detection and treatment of alcohol and other chemical substance dependency. (BPC § 2914 (f))
6. Requires each applicant for licensure to show by evidence satisfactory to the BOP that they have completed coursework in spousal or partner abuse assessment, detection, and intervention. This requirement applies to applicants who began graduate training during the period commencing on January 1, 1995, and ending on December 31, 2003. (BPC § 2914 (g)(1))
7. Requires each applicant for licensure who began graduate training on or after January 1, 2004, to show by evidence satisfactory to the BOP that he or she has completed a minimum of 15 contact hours of coursework in spousal or partner abuse assessment, detection, and intervention strategies, including knowledge of community resources, cultural factors, and same gender abuse dynamics. An applicant may request an exemption from this requirement if he or she intends to practice in an area that does not include the direct provision of mental health services. (BPC § 2914 (g)(2))

This bill:

1. Requires an applicant for licensure as a psychologist, effective January 1, 2020, to show on his or her application the completion of a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention in one of the following ways:
   1. Obtained as part of his or her qualifying graduate degree program. To satisfy this requirement, the applicant must submit to the BOP a written certification from the registrar or training director of the educational institution or program from which the applicant graduated stating that the coursework required is included within the institution’s curriculum required for graduation at the time the applicant graduated, or within the coursework that was completed by the applicant.
   2. Obtained as part of his or her applied experience. Applied experience can be met in any of the following settings: practicum, internship, formal postdoctoral placement that meets specified requirements, or other qualifying supervised professional experience. The applicant must submit to the BOP a written certification from the director of training for the program or primary supervisor where the qualifying experience has occurred, stating that the training required is included within the applied experience.

c) By taking a continuing education course that meets specified requirements and that qualifies as a continuing education learning activity category. The applicant must submit to the BOP a certification of completion.

1. Requires each licensee prior to the time of his or her first renewal, and each applicant for reactivation or reinstatement to an active license status, to have completed a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention, as specified, effective January 1, 2020, as a one-time requirement. Proof of compliance shall be certified under penalty of perjury that he or she is in compliance and shall be retained for submission to the BOP upon request.
2. Declares that no reimbursement is required by this act pursuant to the California Constitution.

FISCAL EFFECT:

According to the Assembly Appropriations Committee analysis dated April 5, 2017, this bill has minor and absorbable workload and costs to the BOP for verifying an applicant has completed required coursework.

COMMENTS:

1. Purpose. This bill is sponsored by the California Board of Psychology. According to the Author‘s office, “Studies show that suicide is the 11th leading cause of death in the state and, on average, one person dies of suicide every two hours. In California, twice as many people die of suicide annually than by homicide. Studies estimate that 32 percent of people who die by suicide have had contact with mental health services within a year of their death. There is no requirement on the books that mental health professionals have training in suicide assessment, treatment, and management.” This bill ensures that psychologists receive the appropriate training in suicide assessment, treatment, and management, thereby protecting public health.
2. Background. The Center for Disease Control and Prevention reports that in 2015, suicide was the tenth leading cause of death for individuals of all ages, and the second leading cause of death of individuals aged 15-34. According to a 2013 article in the journal, Training and Education in Professional Psychology, “Suicide risk assessment training for psychology doctoral programs: Core competencies and a framework for training,” the authors found that “Clinical and counseling psychology programs currently lack adequate evidence-based competency goals and training in suicide risk assessment.” In an attempt to remedy this, Assemblymember Levine introduced AB 2198 in 2014. This bill would have required a psychologist, marriage and family therapist, educational psychologist, professional clinical counselor and clinical social worker to complete a minimum of 15 hours of coursework on suicide and each licensee seeking renewal to take
   6 hours of continuing education coursework in suicide risk assessment and intervention. The bill passed the Legislature, but the Governor vetoed the bill, urging California’s “licensing boards to evaluate the issues which this bill raised and take whatever actions are needed.”

With this directive, the California Board of Psychology -- which opposed the original bill -- conducted a multi-year review of suicide prevention training for psychologists. The review included two surveys of doctoral programs, pre- and post-doctoral internship and practicum programs, and a review of licensure requirements in 2015-2016. The survey indicated that while most students and trainees were receiving some level of education or training in suicide risk assessment and intervention, almost 3% of all students were not receiving training in risk assessment and over 7% were not receiving training in suicide intervention. There were also variances in the amount of education and training being provided to psychologists and applicants.

After conducting this survey, the Board of Psychology came to the conclusion that additional suicide prevention training was necessary.

This bill requires an applicant for licensure and renewal to show completion of at least 6 hours of coursework or applied experience in suicide risk assessment and intervention after January 1, 2020.

1. Prior Legislation. AB 2198 (Levine, 2014). This bill would have required a psychologist, marriage and family therapist, educational psychologist, professional clinical counselor, and clinical social worker who began graduate study on or after January 1, 2016, to complete a minimum of 15 contact hours of coursework in suicide assessment, treatment, and management before he or she may be issued a license. This bill would have also required applicants for license renewal who graduated prior to the January 1, 2016 cut-off date to six-hour continuing education course in suicide assessment, treatment, and management in order to renew his or her license. This bill was vetoed by Governor Brown who cited hesitation to exacerbate California’s burdensome regulatory system as his basis for the veto, stating: “California has an extensive regulatory scheme that aims to ensure that California physicians, psychologists and counselors are skilled in the healing arts to which they have committed their lives. Rather than further legislating in this field, I would ask our licensing boards to evaluate the issues which this bill raises and take whatever actions are needed.”
   
2. Arguments in Support. The California Board of Psychology writes in support, “AB 89 will not only help promote public health through improving the state’s suicide prevention efforts, but also puts California in a leadership role with other states that protect consumers of psychological services through mandatory training in this critical area. AB 89 takes a critical first step in improving the state’s suicide prevention efforts by meeting on of the goals of the 2008 ‘California Strategic Plan on Suicide Prevention: Every Californian is a Part of the Solution,’ which proposed developing and implementing guidelines to promote effective and consistent suicide prevention by incorporating suicide prevention training in existing licensing, credentialing, and graduate school programs. Furthermore, AB 89 puts California in line with six other states that require psychologists and licensed health care professionals to obtain specified minimum number of hours of education or training in suicide risk assessment and intervention. By ensuring all psychologist meet a minimum level of education or training in suicide prevention, AB 89 enhances the state’s suicide prevention efforts and protects consumers of psychological services who rely on psychologists having the basic education and training required to identify and aid a patient with suicidal ideation in finding competent treatment.”

The president of the National Alliance on Mental Illness of Santa Cruz County writes in support, noting that her 24 year old son, Nate, died by suicide while seeing a psychiatrist, a social worker, and a therapist. All failed to properly assess Nate’s risk of suicide, and failed to take the proper steps for suicide intervention.

The Trevor Project, in support of this bill, notes that according to a recent national survey, 40 percent of transgender adults have reported having made a suicide attempt, 92 percent of which attempted suicide before the age of 25. National research shows that 77 percent of those that die by suicide had contact with their primary care provider in the year before their death.

1. Arguments in Opposition. California Psychological Association bases their opposition to AB 89 on the premise that this bill targets psychologists, who are: “…the practioners within our healthcare system that have the most extensive training of any behavioral health professionals.” California Psychological Association is content with the current percentage of all training programs that include some sort of lesson in the principles of suicide risk assessment and intervention, which is 95 percent. California Psychological Association instead advocates for allocating more resources to other strategies for suicide prevention that depend on the individual at risk having already been properly assessed for risk of suicide. These alternative prevention measures include: strengthening economic supports and access and delivery of suicide care, creating protective environments by reducing access to lethal means among persons at risk of suicide, promoting connectedness with peer norm programs; teaching coping and problem solving skills, and gatekeeper training.

SUPPORT AND OPPOSITION:

Support:

California Board of Psychology (Sponsor)

American Foundation for Suicide Prevention

American Medical Response

California Mental Health Planning Council

California Mental Health Services Authority

California Professional Firefighters

California State Sheriff’s Association

CalTrain

Caminar for Mental Health

Children Now

County Behavioral Health Directors Association

General Federation of Women’s Clubs Woman’s Club of Cypress

Marin County Sheriff’s Office

National Alliance on Mental Illness of Santa Cruz County

Project Safety Net

San Francisco Suicide Prevention

Santa Clara County Board of Supervisors

Stanislaus County Sheriff’s Department

Trevor Project

Uplift Family Services

Opposition:

Santa Clara County Psychological Association

California Psychological Association

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 89

Author:(Levine)

As Introduced Ver:

Majority vote

SUMMARY: Requires, on January 1, 2020, an applicant for licensure as a psychologist to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention, as specified; and also requires an applicant for renewal to complete a one-time requirement of a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention. Specifically, this bill:

1. Requires an applicant for licensure as a psychologist, beginning January 1, 2020, to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention and specifies that the requirement can be met in one of the following ways:
   1. Obtained as part of an applicant's qualifying degree program in which the applicant must submit to the Board of Psychology (Board) a written certification from the registrar or training director of the educational institution or program from which the applicant graduated stating that the required coursework is included within the institution's curriculum required for graduation at the time the applicant graduated or within the coursework that was completed by the applicant;
   2. Obtained as part of an applicant's applied experience which can be met in practicum, internship, or formal postdoctoral placement, as specified, or other qualifying supervised professional experience, and the applicant must submit to the Board a written certification from the director of training for the program or primary supervisor where the qualifying experience has occurred stating that the required training is include within the applied experience; or
   3. Acquired through a continuing education a course, as specified.
2. Requires a licensee, as a one-time requirement, prior to the time of the licensee's first renewal, after January 1, 2020, or for an applicant for reactivation or reinstatement to an active license to complete the coursework specified in number 1) above.
3. States that no reimbursement is required by this act pursuant to the California Constitution Section 6 of Article XIIIB because the only costs that may be incurred by a local agency or school district will be incurred because this act creates new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, as specified.

FISCAL EFFECT: According to the Assembly Appropriations Committee, minor and absorbable workload and costs to the Board of Psychology for verifying an applicant has completed required coursework (Psychology Fund).

COMMENTS:

Purpose. This bill is sponsored by the Board of Psychology. According to the author, "studies estimate that 32% of people who die by suicide have had contact with mental health services within a year of their death. There is no requirement on the books that mental health professionals have training in suicide assessment, treatment and management. Most people would assume that if [patients need] help with suicide prevention that they should [seek] a mental health professional who has experience with suicide assessment, treatment and management. This bill is necessary to ensure that mental health professionals receive the appropriate training in suicide assessment, treatment and management, thereby protecting public health."

Background. Suicide Statistics. According to the 2017 suicide facts and figures produced by the American Foundation for Suicide Prevention, suicide is the 11^th leading cause of death in California and ranks the second leading cause of death for individuals between the ages of 25-34. Nationally, suicide is the 10^th leading cause of death. In State Laws: Training for Health Professionals in Suicide Assessment, Treatment and Management produced by the American Foundation for Suicide Prevention it was stated that "Mental health professionals regularly come into contact with individuals who are at risk of suicide. Despite the comorbidity of mental health disorders and suicide, the vast majority of mental health professionals—a group that includes psychiatrists, psychologists, social workers, licensed counselors, and psychiatric nurses—do not typically receive routine training in suicide assessment, treatment, or risk management."

Suicide Prevention Strategies. The World Health Organization's 2012 Health Evidence Network report entitled, For Which Strategies of Suicide Prevention is There Evidence of Effectiveness, examined suicide prevention strategies utilized in Europe, the country with the highest suicide rates, and found that limiting access to means was the most effective strategy. Similarly, the American Foundation for Suicide Prevention promotes teaching general practitioners to recognize and treat depression and limiting access to means as the most successful preventative efforts. The U.S. Surgeon General's Call to Action to Prevent Suicide suggests to, "…improve the ability of primary care providers to recognize and treat depression, substance abuse and other major mental illnesses associated with suicide risk and increase the referral to specialty care."

Academic Standards Addressing Suicide. Mental health professionals receive academic and clinical training that includes the identification and assessment of psychopathology including the assessment of suicidality and intervention strategies for dealing with patients in crisis. The American Psychological Association and the Council on Social Work Education accredit programs of psychology and social work respectively, and set standards for the coursework and clinical training that students receive. These bodies require that coursework address areas such as, dysfunctional behavior or psychopathology, theories and methods of assessment and diagnosis and effective intervention. Both the Marriage and Family Therapist (MFT) and Licensed Professional Clinical Counselor (LPCC) statutes require that students receive training in, "the patient dangerous to self or others." The LPCC statute further requires training in multidisciplinary responses to crises and emergencies, crisis and trauma counseling, assessment strategies for clients in crisis and principles of intervention for individuals with mental or emotional disorders during times of crises.

Continuing Education (CE) Requirements for Licensed Clinical Psychologists. Psychologists are required to take a specified one-time, CE course in spousal or partner abuse assessment, detection and intervention strategies, and a one-time three hour CE course in aging and long-term care, or show proof to the Board of its equivalent in teaching or practicing experience. This bill would add a requirement that all psychologists, through a qualified degree program, as part of supervised experience, or by CE coursework complete a minimum of six hours of coursework or applied experience in suicide risk and assessment. This bill requires all new licensure and renewal applicants to satisfy this requirement beginning January 1, 2020. The author notes that currently six other states mandate some form of training in suicide assessment, treatment and manager for health professionals.

Prior Attempts at Mandating Suicide Prevention Training. In 2014, AB 2198 (Levine) was introduced which would have required all licensed mental health professionals, to complete a training program in suicide assessment, treatment and management through continuing education. That bill was ultimately vetoed by the Governor. In the Governor's veto message, he stated…"California has an extensive regulatory scheme that aims to ensure that California physicians, psychologists and counselors are skilled in the healing arts to which they have committed their lives. Rather than further legislating in this field, I would ask our licensing boards to evaluate the issues which this bill raises and take whatever actions are needed."

In response to the directive in the Governor's veto message of AB 2198 (Levine), the Board conducted a survey in 2015 which was sent to graduate internships and clinical programs to better identify the coverage of suicide assessment, treatment, and management in psychology graduate and internship programs. Over 90% of survey respondents indicated that suicide risk, intervention and assessment are included in coursework and/or field experience. Despite these statistics, the licensing committee of the Board recommended, and the full Board approved the proposed requirement for all current and future licensees to take or provide proof to the Board that he or she has completed a minimum of six hours of coursework or applied experience in suicide risk and assessment. As the survey results identified, there may be programs that offer more or less than six hours of direct training and certain internship/experience and certain programs may more extensively cover this topic.

Analysis Prepared by: Elissa Silva and / B. & P. / (916) 319-3301 FN: 0000109

Le Ondra Clark Harvey, Ph.D.

Date of Hearing: April 5, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 89

Author:(Levine) – As Introduced Ver:January 9, 2017

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires, effective January 1, 2020, an applicant for psychologist licensure or licensure renewal to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention.

FISCAL EFFECT:

Minor and absorbable workload and costs to the Board of Psychology for verifying an applicant has completed required coursework (Psychology Fund).

COMMENTS:

1. Purpose. This bill is sponsored by the Board of Psychology to impose a requirement that psychologists receive training in suicide assessment, treatment and management.
2. Background. The Board conducted a survey in 2015 to identify the coverage of suicide issues in psychology graduate and internship programs, and found most survey respondents indicated that suicide risk, intervention and assessment are included in coursework and/or field experience. The Board seeks a minimum standard of 6 hours of coursework or applied experience in suicide risk and assessment, for new applicants and existing licensees, to ensure all psychologists are trained in this area.
3. Support. This bill is sponsored by the Board of Psychology and supported by the County Behavioral Health Directors Association of California and various mental health, children's, and public safety advocacy groups. The Board believes their survey showed a necessity for Board leadership to require a minimum number of hours on this topic.
4. Opposition. California Psychological Association opposes this bill. They argue psychologists have the most extensive training of any behavioral health professional, and that the survey conducted by the Board showed students were already being taught the principles of suicide prevention through their coursework and in experiential learning settings.
5. Prior Legislation. AB 2198 (Levine), of the 2013-14 Legislative Session, a similar bill that also applied to other mental health professionals, was vetoed by the Governor, who requested the mental health licensing boards "evaluate the issues which this bill raises and take whatever actions are needed."

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: March 28, 2017

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Rudy Salas, Chair

ABPCA Bill Id:AB 89

Author:(Levine) – As Introduced Ver:January 9, 2017

SUBJECT: Psychologists: suicide prevention training.

SUMMARY: Requires, on January 1, 2020, an applicant for licensure as a psychologist to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention, as specified; and also requires an applicant for renewal to complete a one-time requirement of a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention.

EXISTING LAW:

1. Requires an applicant for licensure as a psychologist to: (Business and Professions Code (BPC) Section 2914 Section (C)(1), (d)(1), (e), (f), (g)(1-2)
   
   1. Possess an earned doctorate degree in in psychology, educational psychology, or in education with the field of specialization in counseling psychology or educational psychology, as specified;
      
   2. Have engaged for at least two years in supervised professional experience under the direction of a licensed psychologist, as specified;
      
   3. Take and pass an examination; and,
      
   4. Show by evidence satisfactory to the Board that the applicant has completed training in the detection and treatment of alcohol and other chemical substance dependency and has completed coursework in spousal or partner abuse assessment; as specified.
      
2. Requires the Board to encourage every licensed psychologist to take continuing professional development in geriatric pharmacology. (BPC Section 2914.1)
   
3. Requires the Board to encourage licensed psychologists to take continuing professional development in psychopharmacology and biological basis behavior. (BPC Section 2914.2)
   
4. Requires any applicant for licensure as a psychologist who began graduate study after January 1, 2004, to complete a minimum of 10 contact hours or coursework in aging and long-term care and after January 1, 2012, the coursework must include instruction on the assessment and reporting as well as treatment related to elder and dependent adult abuse and neglect, as specified. (BPC Section 2915)
5. Requires a renewal applicant to complete 36 hours of approved continuing professional development in the preceding two years, prior to renewal. (BPC Section 2915(a))

THIS BILL:

1. Requires an applicant for licensure as a psychologist, beginning January 1, 2020, to complete a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention and specifies that the requirement can be met in one of the following ways:
   1. Obtained as part of an applicant's qualifying degree program in which the applicant must submit to the Board of Psychology (Board) a written certification from the registrar or training director of the educational institution or program from which the applicant graduated stating that the required coursework is included within the institution's curriculum required for graduation at the time the applicant graduated or within the coursework that was completed by the applicant;
   2. Obtained as part of an applicant's applied experience which can be met in practicum, internship, or formal postdoctoral placement, as specified, or other qualifying supervised professional experience, and the applicant must submit to the Board a written certification from the director of training for the program or primary supervisor where the qualifying experience has occurred stating that the required training is include within the applied experience; or
   3. Acquired through a continuing education a course, as specified.
2. Requires a licensee, as a one-time requirement, prior to the time of the licensee's first renewal, after January 1, 2020, or for an applicant for reactivation or reinstatement to an active license to complete the coursework specified in number 1 above.
3. States that no reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, as specified.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the Board of Psychology. According to the author, "studies estimate that 32% of people who die by suicide have had contact with mental health services within a year of their death. There is no requirement on the books that mental health professionals have training in suicide assessment, treatment and management. Most people would assume that if [patients need] help with suicide prevention that they should [seek] a mental health professional who has experience with suicide assessment, treatment and management. This bill is necessary to ensure that mental health professionals receive the appropriate training in suicide assessment, treatment and management, thereby protecting public health."

Background. Suicide Statistics. According to the 2017 suicide facts and figures produced by the American Foundation for Suicide Prevention, suicide is the 11^th leading cause of death in California and ranks the second leading cause of death for individuals between the ages of 25-34. Nationally, suicide is the 10^th leading cause of death. According to information provided by the National Institute of Mental Health, "suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex and there is no single cause."

In State Laws: Training for Health Professionals in Suicide Assessment, Treatment and Management produced by the American Foundation for Suicide Prevention it was stated that "Mental health professionals regularly come into contact with individuals who are at risk of suicide. Despite the comorbidity of mental health disorders and suicide, the vast majority of mental health professionals—a group that includes psychiatrists, psychologists, social workers, licensed counselors, and psychiatric nurses—do not typically receive routine training in suicide assessment, treatment, or risk management."

Suicide Prevention Strategies. The World Health Organization’s 2012 Health Evidence Network report entitled, For Which Strategies of Suicide Prevention is There Evidence of Effectiveness, examined suicide prevention strategies utilized in Europe, the country with the highest suicide rates, and found that limiting access to means was the most effective strategy. Similarly, the American Foundation for Suicide Prevention promotes teaching general practitioners to recognize and treat depression and limiting access to means as the most successful preventative efforts. The U.S. Surgeon General’s Call to Action to Prevent Suicide suggests to, “…improve the ability of primary care providers to recognize and treat depression, substance abuse and other major mental illnesses associated with suicide risk and increase the referral to specialty care.”

Academic Standards Addressing Suicide. Mental health professionals receive academic and clinical training that includes the identification and assessment of psychopathology including the assessment of suicidality and intervention strategies for dealing with patients in crisis. The American Psychological Association and the Council on Social Work Education accredit programs of psychology and social work respectively, and set standards for the coursework and clinical training that students receive. These bodies require that coursework address areas such as, dysfunctional behavior or psychopathology, theories and methods of assessment and diagnosis and effective intervention. For MFTs and LPCCs their required courses are outlined in statute. Both the MFT and LPCC statutes require that students receive training in, “the patient dangerous to self or others.” The LPCC statute further requires training in multidisciplinary responses to crises and emergencies, crisis and trauma counseling, assessment strategies for clients in crisis and principles of intervention for individuals with mental or emotional disorders during times of crises.

CE Requirements for Licensed Clinical Psychologists. Psychologists are regulated by the Board. Applicants for licensure as a psychologist are required to possess an earned doctorate degree in psychology from an approved or accredited educational institution. In addition, applicants must complete specified coursework in spousal or partner abuse assessment, detection and intervention, and training in the detection and treatment of alcohol and other chemical substances dependency. All psychologists seeking licensure renewal must obtain training in the subject of laws and ethics before they apply to the practice of psychology in California. Additionally, psychologists are required to take a specified one-time, CE course in spousal or partner abuse assessment, detection and intervention strategies, and a one-time three hour CE course in aging and long-term care, or show proof to the Board of its equivalent in teaching or practicing experience. A psychologist may request an exemption from CE requirements if they meet specified criteria. This bill would add a requirement that all psychologists, through a qualified degree program, as part of supervised experience, or by CE coursework complete a minimum of six hours of coursework or applied experience in suicide risk and assessment. This bill requires all new licensure and renewal applicants to satisfy this requirement beginning January 1, 2020. The author notes that currently six other states mandate some form of training in suicide assessment, treatment and manager for health professionals.

Prior Attempts at Mandating Suicide Prevention Training. In 2014, AB 2198 (Levine) was introduced which would have required all licensed mental health professionals, to complete a training program in suicide assessment, treatment and management through continuing education. That bill was ultimately vetoed by the Governor. In the Governor's veto message, he stated…"California has an extensive regulatory scheme that aims to ensure that California physicians, psychologists and counselors are skilled in the healing arts to which they have committed their lives. Rather than further legislating in this field, I would ask our licensing boards to evaluate the issues which this bill raises and take whatever actions are needed."

In response to the directive in the Governor’s veto message of AB 2198 (Levine), the Board conducted a survey in 2015 which was sent to graduate internships and clinical programs to better identify the coverage of suicide assessment, treatment, and management in psychology graduate and internship programs. Over ninety percent of survey respondents indicated that suicide risk, intervention and assessment are included in coursework and/or field experience. Despite these statistics, the licensing committee of the Board recommended, and the full Board approved the proposed requirement for all current and future licensees to take or provide proof to the Board that he or she has completed a minimum of 6 hours of coursework or applied experience in suicide risk and assessment. As the survey results identified, there may be programs that offer more or less than six hours of direct training and certain internship/experience and certain programs may more extensively cover this topic.

Current Related Legislation. AB 326 (Salas) of the current legislative session requires an applicant for licensure under the Board of Barbering and Cosmetology to take a one-hour training on domestic violence and sexual assault awareness as part of their educational requirements, as specified. Status: This bill is currently pending in the Assembly Committee on Business and Professions.

Prior Related Legislation. AB 2198 (Levine) of 2014, would have required a psychologist, marriage and family therapist, educational psychologist, professional clinical counselor and clinical social worker, who began graduate study on or after January 1, 2016, to complete a minimum of 15 hours of coursework on suicide prevention, before being issued a license. In addition, it would have commencing January 1, 2016, require a person licensed in these professions who began graduate study prior to January 1, 2016, to take a six-hour continuing education course on suicide prevention in order to renew a license. Status: This bill was vetoed by the Governor.

AB 2435 (Lowenthal), Chapter 552, Statutes of 2010, requires psychologists, LMFTs, LCSWs, and LPCCs to have instruction and training in the recognition and reporting of suspected elder and dependent adult abuse as requirements for licensure.

ARGUMENTS IN SUPPORT:

The Board of Psychology writes in support, "After much consideration and deliberation, our Board feels it is time to take a leading role in this area and require suicide prevention training of our licensees. In response to the Governor's veto message of AB 2198 [(Levine) of 2014], relating to mandated one-time continuing education coursework in suicide prevention, the Board conducted surveys of doctoral programs and pre-and post-doctoral internships and practicum programs and reviews of licensure requirements for licensed psychologists in 2015 and 2016…the Board carefully weighed the data collected and the public input received during the review process, and determined that this issue required Board leadership and action…the Board decided to pursue a statutory requirement to establish a minimum number of hours of education or training in suicide risk assessment and intervention. [This bill will not only help promote public health through improving the state's suicide prevention efforts, but also put California in a leadership role with other states that protect consumers of psychological services through mandatory training in this critical area.

The California State Sheriffs' Association writes in support, "[This bill] makes a minimum of six hours of coursework or experience in suicide risk assessment and intervention as a requirement for a psychologist's licensure, or renewal or reinstatement of their license. By better equipping psychologists with additional training and education, these professionals can better identify individuals who may be at risk of suicide and better address their needs."

Children Now writes in support, "…Currently, six other states require psychologists and health care professionals to obtain a minimum number of hours of education or training in suicide risk assessment and intervention, and it is time for California to take a leading role in helping prevent suicide."

The County Behavioral Health Directors Association of California writes in support, "…Assuring that all healthcare professionals are well-versed in suicide assessment, treatment, and management may save lives. Continuing professional education is already an important part of professional development. Making it explicit that suicide assessment, treatment, and management are a part of the psychologist training will help prevent avoidable deaths."

Didi Hirsch Mental Health Services writes in support, "[this bill] is a step in the right direction to meeting the strategic plan's goals by ensuring that all psychologists have a minimum level of training in this critical area."

The National Alliance on Mental Illness writes in support, "Suicides in California are on the rise, exceeding four thousand (4,000) deaths in the last several years. Few realize that suicides exceed homicide in California as a cause of death. Something needs to be done. This bill addresses one key action that you can take to help prevent suicides."

ARGUMENTS IN OPPOSITION:

The California Psychological Association writes in opposition, "CPA is opposed to [this bill] as [it] targets only psychologists, the practitioners within our health care system who have the most extensive training of any behavioral health professionals. A previous similar bill that mandated most mental health professionals received additional training was vetoed by the Governor in 2014. As the time of the veto, he asked the licensing Board to conduct a survey to determine the level or training in the area of suicide risk assessment and prevention. The survey results overwhelmingly showed that students were being taught the principles of suicide prevention not only in their coursework, but also in experiential learning settings including supervised practicum, and pre-doctoral and post-doctoral internships.

POLICY CONSIDERATIONS:

In the spirit of supporting suicide prevention efforts, this bill requires both applicants for licensure and licensed psychologists to provide proof to the Board that he or she has completed a minimum of six hours of coursework or applied experience under supervision in suicide risk assessment and intervention. Currently, the only required coursework specified in statute for licensed psychologists is a requirement for a minimum of 10 hours of coursework in aging and long term care and treatment related to elder and dependent adult abuse and neglect. In addition, BPC Section 2914.1 and 2914.2 requires the Board to encourage all licensees to take continuing professional development in geriatric pharmacology and in psychopharmacology and biological basis of behavior. The author may wish to explain to the Committee why licensed psychologists, the mental health professions with the highest amount of training and education, were determined to be deficient in suicide risk assessment and intervention coursework and training. In addition, the author may wish to explain to the Committee why other health professionals who have greater access to individuals, e.g. physicians and law enforcement professionals, were not included in this measure.

REGISTERED SUPPORT:

Board of Psychology (sponsor)

California Professional Firefighters

California State Sheriffs' Association

Children Now

County Behavioral Health Directors Association of California

Didi Hirsch Mental Health Services

National Alliance on Mental Illness

Three individuals

REGISTERED OPPOSITION:

California Psychological Association

Analysis Prepared by: Elissa Silva and Le Ondra Clark Harvey, Ph.D. / B. & P. / 916-319-3301