Читать книгу Counseling Leaders and Advocates - Группа авторов - Страница 49

The role of the mental health counselor as an advocate for clients and the profession is long-standing but is increasing in importance in the current political landscape. As mentioned previously, the counseling profession has been making inroads working with the VA and has achieved reimbursement for services with TRICARE. Other areas of leadership and advocacy in which counselors can engage are working toward reimbursement for Medicare, licensure portability, and other social issues (e.g., eliminating conversion therapy and police violence). This work can be done in accordance with the previously listed advocacy models, including the ACA Advocacy Competencies (Toporek & Daniels, 2018).

Medicare is the public health plan for individuals over the age of 65 and for younger individuals with long-term disabilities. By the year 2030, this will include more than 80 million individuals as the “silver tsunami” of baby boomers (i.e., those born between 1946 and 1964) grows older and relies on Medicare for physical and mental health care coverage (Bartels & Naslund, 2013). Today licensed professional counselors are not reimbursed for their work by Medicare, and they will not be able to serve Medicare clients if the current situation remains. Today there is a shortage of behavioral health professionals (USDHHS, 2020), and this raises serious concerns for seniors and the counselors trying to serve them (Fullen et al., 2019). As mental health counselors, we have a duty to use client advocacy and counselor advocacy to push for reimbursement for Medicare services.

Counselors are in a difficult place with direct client advocacy when it comes to Medicare, whether they offer pro bono or sliding scale services or refer clients to other providers (Fullen et al., 2019). This issue has been targeted by the government affairs group in ACA as a national priority, which is focusing on legislative advocacy to help potential clients and our profession. Counselors are encouraged to write to their congressional representatives (in the U.S. House and Senate), focusing their legislative advocacy on three themes that address Medicare reimbursement: mental health parity, long-term program savings, and the wellness paradigm (Fullen, 2016). Collaborating with those reliant on Medicare and the agencies advocating with seniors and those with disabilities may broaden these efforts and better inform legislators of the unmet mental health and wellness needs of these individuals.

Cooperative advocacy may lead to in-person visits en masse, which can create a formidable presence and require the attention of elected officials. However, social distancing guidelines brought on by the coronavirus pandemic have made in-person advocacy more difficult, if not impossible. In response, counselors can utilize the increasingly common venues of social media, video conferencing (e.g., Zoom), and the tried-and-true methods of letter writing and call-in campaigns (e.g., phone zaps) to express their voice to those with legislative power (It’s Going Down, 2018). Sustained efforts are necessary, including efforts on behalf of those approaching retirement who could lose their current providers as they switch to Medicare, as well as those living in professional health shortage areas (see Fullen et al., 2019, for additional counselors’ experiences). While counselors wait for legislative changes, they can network with other providers offering sliding-scale and pro bono services through organizations such as the Open Path Psychotherapy Collective (https://openpathcollective.org/), although these alternatives are clearly limited and are not likely to address the large-scale needs of these populations.

Licensure portability is another important topic for clinical mental health counselors, and it affects every licensed and license-eligible clinician. Although counselor licensure now exists in every state in the nation, education and examination requirements as well as professional titles vary, preventing counselors from moving between states to practice (Bayne & Doyle, 2019). Unifying licensure under the CACREP Standards or the equivalent has been a major focus among many counseling leaders and professional advocates (Kaplan & Kraus, 2018), and a few states (Arkansas, Kentucky, North Carolina, Ohio, Utah, and Virginia) have adopted these standards (Lawson et al., 2017). For counselors moving to other states, differences in requirements may result in counselors having to take new examinations, complete new coursework, and engage in other lengthy tasks to pursue licensure, delaying their ability to produce income and putting their financial status in jeopardy. Furthermore, telebehavioral health is becoming an integral part of our work, yet counselors can work only with those whose primary residence is in the same state as that of the counselor, limiting the reach that counselors can have in global crises.

As counselors consider advocating and providing servant leadership on these issues, we suggest developing advocacy knowledge and relationships through the extensive writing of Kaplan and others (Kaplan & Gladding, 2011; Kaplan & Kraus, 2018) and through professional organizations involved in the collaborative project titled “20/20: A Vision for the Future of Counseling” (Kaplan et al., 2014). ACA currently has many web pages dedicated to this topic that are useful for students, practitioners, and educators. In addition, Bohecker and Eissenstat (2020) suggest investigating the licensure language model as a way forward for license portability for professional counselors. Thinking ecologically, this process involves local and regional counseling communities and states and a national push for licensure, advocacy that any counselor may join.

Client advocacy concerns for clinical mental health counselors are discussed elsewhere in this text and are in continual development at the grassroots level. Some of these concerns include eliminating conversion therapy for the safety of LGBTQ+ clients and especially youth (Fore, 2014; Streed et al., 2019), eliminating police violence for the safety of Black, Indigenous, and people of color (Bryant-Davis et al., 2017; Hargons et al., 2017; Washington & Henfield, 2019), fighting climate change (Hilert, 2020), and fighting immigration enforcement and use of documentation to harm individuals who are undocumented (ACA, 2020a; Hacker et al., 2012), among others. We strongly suggest that counselors look toward their own communities to better understand the local needs for advocacy work. Working at the local level will have the most immediate impact on their clients and future clients, and this work has the potential to expand into advocacy for larger systemic concerns.