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ICD-10-CM Compliance date is

October 1st 2015

Payers will only accept claims with ICD-10 codes with dates of service (or dates of discharge) on or after October 1st, 2015.  Payers will deny claims with invalid codes based on date of service or discharge. ICD-9 codes will be accepted on claims with dates of service (or dates of discharge) through September 30th, 2015.

The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT or HCPCS level II coding for outpatient procedures and physician services.

Major Differences Between

ICD-9-CM & ICD-10-CM

Comparison of ICD-9-CM

& ICD-10-CM

ICD-9-CM Code

A – Category of code

B – Etiology, anatomical site, and manifestation

XXX.XX

A B

ICD-10-CM Code

A – Category of code

B – Etiology, anatomical site, and/or severity

C – Extension

7th character for obstetrics, injuries, and external causes of injury

XXX.XXXX

A B C

Examples of ICD-9-CM vs

& ICD-10-CM

Description ICD-9 code ICD-10 code
Chronic motor or vocal tic disorder 307.22 F95.1
Psychotic disorder with delusions 293.81 F06.2
Mood disorder due to known physiological condition unspecified 293.83 F06.30
Unspecified schizophrenia unspecified 295.90 F20.9
Schizoaffective disorder, unspecified 295.70 F25.9
     

Let’s Review some ICD-10-CM

Psychiatric Conditions

DSM-V

Psychiatrists generally state diagnoses in accordance with the nomenclature used in the Diagnostic and Statistical Manual of Mental Disorders.

Most of these codes are the same as those used in ICD-10-CM, but the terminology may differ.

Actual coding assignments are made according to the classifications in ICD-10-CM.

Major Difference between DSM-V

and ICD-10

The Substance Use Section. While the DSM-5 eliminates the distinction between chemical abuse and dependence, the ICD-10 retains the categories of use, abuse, and dependence.

There are significantly more substance use diagnoses in the ICD-10 than there are in the DSM-5.

Because diagnoses in the DSM-5 have numerous possible iterations in the ICD-10, clinicians expecting a one-to-one code match need to be aware this is not the case.

ICD-10 Challenges

The number of actual diagnoses in each category has jumped significantly in the ICD-10 coding system

Another concern is that a single diagnosis code may represent very different conditions, ultimately necessitating more detailed clinician documentation

Improving clinical documentation requirements will be important for regulatory and auditing purposes. Given the inherent differences in the DSM-5 versus the ICD-10, decisions will need to be made about coding, diagnosing, terminology, and clinical documentation.

Crosswalks

In order to help providers arrive at the correct diagnosis in the ICD-10, “crosswalks” have been developed to help bridge the translation between the DSM and ICD.

Crosswalks typically map between the DSM and the ICD-10 codes to enable the clinician to pick the right code for billing purposes.

However, simply cross-walking between DSM-5 to the corresponding ICD-10 code will not produce an accurate code number.

The ICD-10 is more specific and contains many more diagnoses in the behavioral health section than the DSM-5 contains.

The code on the left is an ICD-9 code. The code on the right is an ICD-10 code. Beginning Oct. 1, 2015, you will need to use the code on the right.

Here is an excerpt from a page of

DSM-5 for post traumatic stress disorder

Where do you find the ICD-10

codes in DSM-5?

How do you code disorders that

now have multiple coding options?

Below is an illustration taken from the DSM-5.

The code on the left is an ICD-9 code. The code on the right is an ICD-10 code. Beginning Oct. 1, 2015, you will need to use the code on the right.

Organic Brain Syndrome

Since organic brain syndrome is used to describe a decrease in mental function due to a medical disease other than a psychiatric condition, it is coded to F09, Unspecified mental disorder due to known physiological condition.

The underlying physiological condition should be coded first

Altered Mental State

An alteration in level of consciousness not associated with delirium or another identified condition, is classified to category R40.

Mental Disorders Due to Known Physiological Conditions—F01-F09

Conditions reported in this ICD-10 code range include (when documented):

Dementia

Amnestic disorder due to known physiological condition

Delirium due to known physiological condition

Personality and behavioral disorders due to known physiological condition

Categories F01 – F09

This category reports mental disorders due to known physiological conditions grouped together on the basis of having a demonstrable etiology in cerebral disease, brain injury or other insult leading to cerebral dysfunction.

The cerebral dysfunction may be reported as either a primary or secondary diagnosis.

Primary Cerebral dysfunction

Primary cerebral dysfunction includes diseases, injuries and insults affecting the brain directly and selectively.

17

Secondary Cerebral Dysfunction

Secondary cerebral dysfunction includes systemic diseases and disorders which attack the brain only as one of the multiple organs or body systems involved.

ICD10 and Instructional Notes

You will encounter “instructional notes” intended to guide you to documentation which needs to be evident in the record to report the underlying physiological condition.

Example

Vascular dementia has an instructional note to code first the underlying physiological condition or sequelae of cerebrovascular disease.

An alteration in level of consciousness not associated with delirium or another identified condition is classified to category R40.

Category R40 in Chapter 18 of ICD-10-CM is further subdivided to indicate whether it is identified as somnolence, stupor, coma, persistent vegetative state or transient alteration of awareness.

Recording the Altered Mental

State ICD10 Category R40

An altered mental status or change in mental status of unknown etiology is coded to R41.82 “Altered mental status, unspecified”.

If the condition causing the change in mental status is known (and documented), do not assign code R41.82 – code the condition instead – if it recorded in the patient’s chart.

Unknown Etiology

Schizophrenic Disorders

Schizophrenic disorders are classified in ICD-10-CM in category F20 – with a 4th character indicating the type of schizophrenia

4th Character Options to Specify Schizophrenia

F20.0 Paranoid Schizophrenia

F20.1 Disorganized Schizophrenia

F20.2 Catatonic Schizophrenia

F20.3 Undifferentiated Schizophrenia

F20.5 Residual Schizophrenia

F20.8 Other

F20.81 Schizophrenia disorder

F20.89 Other Schizophrenia

F20.9 Schizophrenia unspecified

Affective Disorders

Major depressive disorder, bipolar disorders and anxiety disorders are classified under categories F30-F39

We need to code 4th & 5th characters!

Categories F32 and F33 report Major depressive disorders and are subdivided to provide information about the current severity of the disorder – such as mild, moderate, severe, etc.

Bipolar Affective Disorders

Bipolar affective diseases are divided into various types according to the documented symptoms displayed.

ICD-10-CM classifies bipolar disorders according to four categories

F30 Manic episode

F31 Bipolar disorder

F34 Persistent mood disorders

F39 Unspecified mood disorder

Anxiety, Dissociative, Stress-Related, Somatoform, and Other Nonpsychotic Mental Disorders—F40-F48

Diseases documented can be reported in ICD-10 include:

Phobic anxiety and anxiety disorders

Obsessive-compulsive disorders

Reaction to severe stress and adjustment

Dissociative conversion disorders

Somatoform disorders

Other nonpsychotic mental disorders

Behavioral Syndromes Associated with

Physiological Disturbances and Physical

Factors – F50-F59

The following disorders are reported here:

Eating disorders

Sleeping disorders

Sexual dysfunction not due to a substance or known physiological condition

Abuse of nonpsychoactive substances

Disorders of Adult Personality and Behavior— F60-F69

Categories reported here include:

Specific personality disorders—F60

Impulse disorders—F63

Gender identity disorders—F64

Paraphilias and sexual disorders—F65-F66

Other and unspecified disorders of adult personality and behavior—F68-F69

Mental Intellectual Disabilities— F70-F79

This block of codes reports mental Intellectual Disabilities according to severity (when documented):

Mild Intellectual Disabilities F70

Moderate Intellectual Disabilities—F71

Severe Intellectual Disabilities—F72

Profound Intellectual Disabilities—F73

Other and Unspecified Mental Intellectual Disabilities—F78-F79

Pervasive and Specific Developmental Disorders— F80-F89

This block of codes reports specific developmental disorders of:

Speech and language—F80

Scholastic skills—F81

Motor function—F82

Pervasive developmental disorders—F84

Other and unspecified disorders of psychological development—F88-F89

Behavioral and Emotional Disorders with

Onset Usually Occurring in Childhood and

Adolescence— F90-F98

This block of codes reports disorders with onset usually in childhood and adolescence but these codes may be used regardless of the age of the patient.

Code Range F90-F98 These categories report:

Attention-deficit hyperactivity disorders

Conduct disorders

Emotional disorders with onset specific to childhood

Disorders of social functioning with onset specific to childhood and adolescence

Tic disorders

Other behavioral and emotional disorders

Mental and Behavioral Disorders due

to Psychoactive Substance Use— F10-F19

These categories report mental disorders related to excessive use of substances.

Abuse is defined as taking alcohol/drugs to excess.

Dependence is defined as the chronic use of alcohol/drugs creating a dependence.

Alcohol-related disorders—F10

Opioid-related disorders—F11

Cannabis-related disorders—F12

Sedative-, hypnotic-, or anxiolytic-related disorders—F13

Cocaine-related disorders—F14

Other stimulant-related disorders—F15

Hallucinogen-related disorders—F16

Nicotine dependence—F17

Inhalant-related disorders—F18

Other psychoactive substance-related disorders—F19

ICD-10-CM Guidelines

In Remission

Selection of codes for “in remission” for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -.21) requires the provider’s clinical judgment.

The appropriate codes for “in remission” are assigned only on the basis of provider documentation.

Psychoactive Substance Use, Abuse

And Dependence

When the provider documentation refers to use, abuse and dependence of the same substance (e.g. alcohol, opioid, cannabis, etc.), only one code should be assigned to identify the pattern of use based on the following hierarchy:

If both use and abuse are documented, assign only the code for abuse

If both abuse and dependence are documented, assign only the code for dependence

If use, abuse and dependence are all documented, assign only the code for dependence

If both use and dependence are documented, assign only the code for dependence

Psychoactive Substance Use

As with all other diagnoses, the codes for psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis

The codes are to be used only when the psychoactive substance use is associated with a mental or behavioral disorder, and such a relationship is documented by the provider.

Pain disorders related to

psychological factors

Assign code F45.41, for pain that is exclusively related to psychological disorders.

Code F45.42, Pain disorders with related psychological factors, should be used with a code from category G89, Pain, not elsewhere classified, if there is documentation of a psychological component for a patient with acute or chronic pain.

General Equivalence Mappings

(GEMs)

The Centers for Medicare and Medicaid (CMS) and the Centers for Disease Control and prevention (CDC) created GEMs to ensure consistent national data when the U.S. adopts ICD-10.

The GEMs will act as a translation dictionary to bridge the “language gap” between the two code sets and can be used to map an ICD-9 code to an ICD-10 code and vice versa.

Purpose of GEMs

Designed to give all sectors of the healthcare industry that use coded data the tools to:

Convert large databases and test system applications

Link data in long-term clinical studies

Develop application-specific mappings

Analyze data collected before and after the transition to ICD-10-CM

Not a Substitute for Coding

The GEMs should not be used as a substitute for learning how to use the ICD-10-CM code sets.

“GEMs are not a substitute for learning ICD-10-CM coding. They’ll help you convert large data sets.”

Mapping simply links concepts in the two code sets, without consideration of context of specific patient information, whereas coding involves assigning the most appropriate code based on documentation and applicable coding guidelines.

ICD-10-CMS Resources

ICD-10-CM Official Guidelines for Coding and Reporting FY 2016

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2016-ICD-10-CM-Guidelines.pdf

Free lists of codes and ICD-9/ICD-10 mappings are available from CMS

https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html

This has 3 assignments; please cite relevant sources; assignments will be submitted through safe assign for plagiarism

Assignment 1: at least 250 words; APA format; please see powerpoint attachment

Respond to the following questions from your future position as a mental health counselor.    Be sure to follow the instructions below! 

Your textbook is your best source to start with.   Use of 2 additional professional sources is required.

1.  How does society define “abnormal behavior”?  How is “abnormal behavior” treated?  Other than counseling/psychotherapy, and medications, what other forms can treatment take?  

2.  Define in moderate detail, each of the following:  a one-dimensional model of conceptualizing abnormal behavior, and the multipath model of conceptualizing abnormal behavior.   Include the impact on treatment of each type of model.  Be clear and specific.

3.  What personal concerns do you have when you think about working with individuals who display abnormal behavior/mental illness?  What thoughts and feelings does this stir within you?

Assignment 2: at least a paragraph; APA format; see AMHCA attachment

Read through the AMHCA (American Mental Health Counseling Association) Standards posted in the Courseweek and discuss what kinds of specialized training is recommended for mental health counselors.

Assignment 3:

Please see power point attachment

1. In a paper of not less than 3 double spaced typed pages (NOT including Title Page and Reference Page; must be APA style),  using a minimum of 5 professional resources, complete the following in a well-thought out paper:

1.  Define the types and specific roles of behavioral health practitioners, including that of the clinical Mental Health Counselor.  

2.  What is collaborative mental health care?  Why is professional collaboration crucial to the treatment of mental health issues and disorders?  Give a specific case example.

3.  How do knowledge and usage of the DSM 5 and the ICD 10 diagnostic systems promote successful collaboration among mental health professionals,  as well as human service and integrated behavioral health care systems?

4.  Your textbook addresses some basic psychopharmacological information under the topic of “Biology-Based Treatment Techniques.”  What are the major classifications of medication used to treat mental health issues and disorders?  Define each one and list the name of a commonly prescribed medication in each classification.

What DSM 5 mean:

https://www.youtube.com/watch?v=j67-uC8icNE

Abnormal Behavior

1

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1

Psychopathology

Study of symptoms and causes of mental disorders

Objectives: describing, explaining, predicting, and modifying behaviors associated with mental disorders

People who work in the field strive to alleviate distress and life disruption of those with mental disorders

The Field of Abnormal Psychology

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Mental health professionals

Health care practitioners

Assists in diagnosis of a patient’s mental health

Psychodiagnosis

Attempts to describe, assess, and understand the situation

Treatment plan

Proposes course of therapy

Focuses first on most distressing symptoms

Describing Behavior

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Determine etiology (possible causes)

High priority for mental health professionals

Human behavior is complex

Multiple contributing factors

Explaining Behavior

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Various risk factors for violent behavior

Civil commitment (involuntary confinement)

Extreme decision impacting an individual’s civil liberties

Predicting Behavior

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5

Psychotherapy

Program of systematic intervention

Objective: improve a person’s behavioral, emotional, or cognitive state

Many types of therapies and professional helpers

Modifying Behavior

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Group therapy is one type of evidence-based therapy described in Chapter 1.

6

The Mental Health Professions

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Table 1.1 The mental health professions

7

The Mental Health Professions (cont’d.)

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Table 1.1 The mental health professions

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The most widely used classification system

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

A mental disorder is characterized by:

Disturbance in thinking, emotion, or behavior

Distress or difficulty with daily functioning

Not being culturally expected, not explained by religious or political beliefs

Views of Abnormality

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DSM Definitions

Questions to raise

When are symptoms or behavior significant enough to have meaning?

Is it possible to have a mental disorder without distress or discomfort?

What criteria are to be used in assessing symptoms?

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10

What is culture?

Learned behavior that members of a group transmit to the next generation

Viewpoints

Expression/determination of behaviors depends on lifestyles, cultural values, and worldviews

Symptoms and causes of mental disorders are independent of culture

Cultural Considerations in Abnormal Behavior

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E.g., hallucinations are considered normal and appropriate in some cultures whereas they are generally viewed as abnormal in American culture

11

Opinions of Thomas Szasz (1987)

A society labels behavior that is different as abnormal

Unusual belief systems are not necessarily wrong

Abnormal behavior a reflection of something wrong with society

Sociopolitical Considerations in Abnormality

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12

A Sampling of Lifetime Prevalence

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Figure 1.1 Lifetime prevalence of mental disorders in a sample of 10,000 U.S. adolescents

Source: Merikangas et al., 2010

13

Prevalence

Percentage of people in a population who have the disorder during a given interval of time

Dept. of Health and Human Services study

24.8 percent of U.S. adults have experienced a mental disorder in the past 12 months, excluding drug and alcohol disorders

Lifetime prevalence

Existence of a disorder during a person’s life

How Common Are Mental Disorders?

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$135 billion a year spent on mental health and substance abuse services in U.S.

25 percent of adults have a diagnosable mental health condition

Many more experience mental health problems not meeting criteria for disorder

57 percent of adults with severe mental health conditions not receiving treatment

Implications to Society

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Mentally ill are frequently stereotyped and stigmatized

Prejudice

Belief in negative stereotypes

Discrimination

Action based on prejudice

Self-stigma

Undermines self-worth and self-efficacy

Hinders recovery

Overcoming Social Stigma and Stereotypes

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16

National Alliance on Mental Illness (NAMI)

“You Are Not Alone” campaign

Goals: educating the public and reducing stigma

Commending more accurate portrayals of mental disorders in movies and TV

Efforts to Increase Public Awareness

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Public disclosures from well-known people such as actors and sports figures

Open acknowledgment and discussion of struggles

Reduces public social stigma

What you can do:

Be respectful when describing others in mental distress, choose words carefully

Encourage family and friends to seek help early

Decreasing Social Stigma

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Prehistoric and ancient beliefs

Evil spirits residing in a person’s body

Trephining

Exorcism

Naturalistic explanations: Greco-Roman thought

Early thinkers: Hippocrates (460-370 B.C.)

Brain pathology

Historical Perspectives on Abnormal Behavior – Ancient and Naturalistic

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19

Middle Ages

Reversion to supernatural explanations

Exorcism

Group hysteria

Tarantism

Witchcraft: 15th through 17th centuries

Period of social and religious reformers

Witch hunts

100,000 people (mostly women) executed

The Middle Ages Through the 17th Century

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14th through 16th centuries

Horrendous conditions in asylums

The rise of humanism

Philosophical movement emphasizing uniqueness and worth of the individual

Johann Weyer, German physician

Challenged prevailing beliefs of witchcraft

Sixteenth Century Perspectives

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Shift to more humane treatment of mentally disturbed people

Philippe Pinel (1745-1826)

Took charge of mental hospital in Paris

Removed chains, replaced dungeons with sunny rooms, and encouraged exercise

Changes shown to foster recovery

The Moral Treatment Movement
(18th and 19th Centuries)

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Benjamin Rush

“Father of U.S. Psychiatry”

Patients treated with respect and dignity, and gainfully employed during treatment

Dorothea Dix

Campaigned for better treatment of mentally ill

Clifford Beers

Wrote book on his experience with mental illness

Humane Treatment Movement in the U.S.

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The biological viewpoint

Mental disorders have a physical or physiological basis (Griesinger)

Idea flourished in the 19th century

Kraepelin (1856-1926)

Defined syndromes based on clusters of symptoms

Foundation for DSM used today

Causes of Mental Illness: Early Viewpoints

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Louis Pasteur’s germ theory of disease

Biological view gained greater strength

Discovery of general paresis

Degenerative physical and mental disorder

von Kfrafft-Ebing

Proved that mental symptoms of general paresis are linked to syphilis bacteria

Schaudinn

Isolated microorganism of general paresis

Causes: Early Viewpoints (cont’d.)

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25

Belief that mental disorders are caused by psychological and emotional factors

Friedrich Anton Mesmer (1734-1815)

Practiced therapies that evolved into modern hypnotism

Mesmer was discredited

Idea that suggestion could treat hysteria

Liébeault and Bernheim demonstrated psychological basis of mental illness

The Psychological Viewpoint

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Breuer

Discovered symptoms disappeared after female patient spoke about past trauma while in a trance

Freud (1856-1939)

Technique of psychoanalysis

Built on practices of Breuer

Cathartic method

Therapeutic use of verbal expression

Breuer and Freud

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Viewpoint rooted in laboratory science

Focus on directly observable behaviors

Also conditions that evoke, reinforce, and extinguish them

Alternative explanation

Offered successful procedures for treating some psychological conditions

Behaviorism

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The influence of multicultural psychology

Culture, race, ethnicity, gender, age, and socio-economic class relevant to understanding and treating abnormal behavior

Mental health professionals need to:

Increase cultural sensitivity

Acquire knowledge of diversity

Develop culturally relevant therapy approaches

Contemporary Trends in Abnormal Psychology

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29

Racial and Ethnic Composition of the U.S.

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Figure 1.2 2013 Census Projections: Racial and Ethnic Composition of the United States

Minorities now constitute an increasing proportion of the U.S. population. Mental health providers will increasingly encounter clients who differ from them in race, ethnicity, and culture.Source: http://quickfacts.census.gov/qfd/ states/00000.html

30

Cultural values and influences

Sociopolitical influences

Cultural and ethnic bias in diagnosis (e.g., the tendency to overpathologize)

Dimensions Related to Cultural Diversity

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31

Objectives

Study, develop, and achieve scientific understanding of positive human qualities that build thriving individuals, families, and communities

Focuses on human strength and capacity for resilience

Psychological resilience

Prevention

Positive Psychology

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32

Perspective that people with mental illness can recover

Live satisfying, hopeful, and contributing lives

Some of the recovery model assumptions

Recovery is possible and begins when person realizes that positive change is possible

Recovery involves occasional setbacks

Healing involves separating one’s identity from the illness

Recovery Movement

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The drug revolution in psychiatry

Introduction of psychotropic medications in the 1950s

Considered one of the great medical advances in the 20th century

Naturally occurring lithium found to radically calm some mental patients

Many drugs made available for different disorders

Resulted in depopulation of mental hospitals

Changes in the Therapeutic Landscape

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34

Some changes brought about by industrialization of health care

Business interests of insurers influence treatment duration

Cost-cutting focus affects hiring

Increased appreciation for research

Denial of coverage for unproven treatments

Technology-assisted therapy

Online programs

The Development of Managed Health Care

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What is abnormal psychology?

How do we differentiate between normal and abnormal behaviors?

What societal factors affect definitions of abnormality?

How common are mental disorders?

Review

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Why is it important to confront the stigma and stereotyping associated with mental illness?

How have explanations of abnormal behavior changed over time?

What were early explanations regarding the causes of mental disorders?

What are some contemporary trends in abnormal psychology?

Review (cont’d.)

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Understanding and Treating Mental Disorders

2

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1

One-Dimensional Models of Mental Disorders

Model

Attempts to describe a phenomenon that cannot be directly observed

Models are intrinsically limited and cannot explain every aspect of a disorder

Human behaviors are complex

Models of psychopathology

Biological, psychological, social, and socio-cultural

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2

Multipath Model

Considers the multitude of factors researchers have confirmed are associated with each disorder

Views disorders from a holistic framework

Some assumptions of the multipath model

Multiple pathways and influences contribute to the development of any single disorder

Not all dimensions contribute equally

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3

The Multipath Model

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Figure 2.1 The Multipath Model Each dimension of the multipath model contains factors found to be important in explaining mental disorders. Reciprocal interactions involving factors within and between any of these dimensions can also influence the development of mental disorders.

4

The Four Dimensions and Possible Pathways of Influence

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Figure 2.2 The Four Dimensions and Possible Pathways of Influence Conceptually, mental disorders arise from four possible dimensions (biological, psychological, social, and sociocultural) and from reciprocal interactions between factors within a dimension or among factors in multiple dimensions.

5

Aspects of the Multipath Model

Many disorders tend to be heterogeneous in nature

Different combinations within the four dimensions may influence development of a particular condition

Within each dimension, distinct theories exist

Same triggers or vulnerabilities may cause different disorders

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6

Dimension One: Biological Factors

The human brain

Forebrain controls all higher mental functions

Cerebrum

Cerebral cortex

Prefrontal cortex helps manage attention, behavior, and emotions

Limbic system

Role in emotions, decision-making, and memories

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7

Structures in the Limbic System

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Figure 2.5 The limbic system, comprised of an interconnected group of brain structures, controls emotional reactions and basic human drives. It is also involved in motivation, decision making, and the formation of memories.

8

Multipath Implications

Biological explanations are best considered in the context of other factors

Science suggests that most individual differences result from some combination of genetic and environment variations

People do not inherit a particular abnormality but rather, a predisposition to develop illness

Environmental forces (stressors) may activate the predisposition, resulting in a disorder

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9

Biochemical Processes within
the Brain and Body

The brain is composed of:

Neurons (nerve cells)

Dendrites

Axon

Glia cells that act in supporting roles

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10

Synaptic Transmission

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Figure 2.6 Synaptic Transmission Electrical impulses travel along the axon, through the synapse, and to the dendrites of the next neuron. Neurotransmitters facilitate the transmission of the impulse across the synapse.

11

Major Neurotransmitters
and Their Functions

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Table 2.2 Major neurotransmitters and their functions

12

Major Neurotransmitters
and Their Functions (cont’d.)

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Table 2.2 Major neurotransmitters and their functions

13

Neuroplasticity

Ability of the brain to evolve and adapt

The brain reacts to environmental circumstances by making new neural circuits and pruning old ones

“Neurons that fire together, wire together”

Chronic stress results in negative changes in brain activity

Exercise can produce positive changes

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Neurons that fire together, wire together: Nerve pathways that we used frequently become mylienated which makes them stronger and more efficient. When we practice a behavior it becomes more hard-wired over time.

14

Genetics and Heredity

Heredity: genetic transmission of traits

Chemical compounds outside the genome control gene expression

Whether genes are “turned on” or “turned off”

Genotype and phenotype

Genetic mutations

Epigenetics

Environmental factors trigger biochemical processes that affect gene expression

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Biology-Based Treatment Techniques

Psychopharmacology

Study of effects of psychotropic medications

Medication categories

Antianxiety drugs (e.g., benzodiazepines like Valium)

Antipsychotics (e.g., chlorpromazine)

Antidepressants (e.g., selective serotonin reuptake inhibitors like fluoxetine)

Mood stabilizers (e.g., lithium)

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Other Biological Approaches

Electroconvulsive therapy

Induce small seizures with electricity or magnetism

Can change brain chemistry and reverse some symptoms

Reserved for those not responding to other treatments

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Other Biological Approaches (cont’d.)

Neurosurgical and brain stimulation treatments

Psychosurgery (removing parts of brain)

Very uncommon today

Repetitive transcranial magnetic stimulation

Deep brain stimulation

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Criticisms of Biological Models and Therapies

Drugs are not always effective

Drugs do not cure mental illness

Side effects and interactions are possible

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Dimension Two: Psychological Factors

Four major perspectives

Psychodynamic

Behavioral

Cognitive

Humanistic-existential

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20

Psychodynamic Models

The components of personality

Id: pleasure principle

Ego: realistic and rational

Superego: moral considerations (conscience)

Psychosexual stages

Freud proposed that human personality largely developed during first five years of life

Defense mechanisms

Protect us from anxiety

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Contemporary Psychodynamic Theories

Adler and Erickson

Suggested that the ego has adaptive abilities

With the ability to function separately from the id

Bowlby and Mahler

Proposed that the need to be loved, accepted, and emotionally supported is of primary importance in childhood

©2017 Cengage Learning. All rights reserved.

22

Therapies Based on the Psychodynamic Model (cont’d.)

Psychoanalysis

Objective: uncover material blocked from consciousness

Free association

Dream analysis

Effect of experiences with early attachment figures

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Theories Based on the Psychodynamic Model

Interpersonal psychotherapy

Links childhood experiences with current relational patterns

Focus on current relational patterns

Helps clients learn more effective interaction strategies

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Behavioral Models

Concerned with the role of learning in development of mental disorders

Based on experimental research

Three paradigms

Classical conditioning (Ivan Pavlov)

Operant conditioning (B. F. Skinner)

Observational learning (Albert Bandura)

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25

Classical Conditioning Example

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Figure 2.8 A basic classical conditioning process: Dogs normally salivate when food is provided (left). With his laboratory dogs, Ivan Pavlov paired the ringing of a bell with the

presentation of food (middle). Eventually, the dogs would salivate to the ringing of the bell alone, when no food was near (right).

26

Behavioral Therapies

Exposure therapy

Graduated exposure

Flooding

Systematic desensitization

Social skills training

Criticisms of behavioral models and therapies

Often neglect inner determinants of behavior

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Cognitive-Behavioral Models

Thoughts profoundly affect emotions and behaviors

Beck and Ellis

A-B-C theory of emotional disturbance

A is an event

C is a person’s reaction

B are the person’s beliefs about A, which causes reaction C

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Ellis’s A-B-C Theory of Personality

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Figure 2.9 Ellis’s A-B-C Theory of Personality The development of emotional and behavioral problems is often linked to dysfunctional thinking. Cognitive psychologists assist their clients to identify and modify irrational thoughts and beliefs.

29

Third-Wave Cognitive-Behavioral Therapies

Nonreactive attention to emotions can reduce their power to create distress

Mindfulness

Conscious attention to the present

Dialectical behavior therapy (DBT)

Supportive and collaborative therapy

Reinforce positive actions

Acceptance and commitment therapy (ACT)

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Humanistic Models

Humans need unconditional positive regard

Person-centered therapy focuses on facilitating conditions that allow clients to grow and fulfill their potential

Maslow’s concept of self-actualization

The inherent tendency to strive for full potential

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Humanistic Therapies

Communicating respect, understanding, and acceptance are more important than techniques

Unconditional positive regard fosters self-acceptance

Self-growth aids in present and future problem solving

The relationship between client and therapist is critically important to outcome

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Dimension Three: Social Factors

Social-relational models

Healthy relationships are important for human development and functioning

Provide many intangible benefits

When relationships are dysfunctional or absent, individuals are more vulnerable to mental distress

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33

Family, Couples, and Group Perspectives

Family systems model

Behavior of one family member affects entire family system

Characteristics

Personality development strongly influenced by family characteristics

Mental illness reflects unhealthy family dynamics and poor communication

Therapist must focus on family system, not just an individual

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34

Social-Relational Treatment Approaches

Conjoint family therapeutic approach

Stresses importance of teaching message-sending and message-receiving skills to family members

Strategic family approaches

Consider family power struggles and move towards more healthy distribution

Structural family approaches

Reorganizes family in relation to level of involvement with each other

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35

Couples and Group Therapy

Couples therapy

Aimed at helping couples understand and clarify their communication, needs, roles, and expectations

Group therapy

Initially strangers

Share certain life stressors

Provides supportive environment

Allows therapist to observe patient’s actual social interactions

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36

Dimension Four: Sociocultural Factors

Emphasizes importance of several factors in explaining mental disorders

Race

Ethnicity

Gender

Sexual orientation

Religious preference

Socioeconomic status

Other factors

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37

Gender Factors

Higher prevalence of depression, anxiety, and eating disorders among women

Women experience greater stress in certain areas:

Lower wages;, less decision-making power

Expectations of combining chores, childcare, and paid work

Exposure to sexual harassment, interpersonal violence

Affects well-being and learning

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Socioeconomic Class

Lower socioeconomic class associated with:

Limited sense of personal control

Poorer physical health

Higher incidence of depression

Life in poverty subjects people to multiple stressors

Fulfilling life’s basic needs

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Immigration and Acculturative Stress

Acculturative stress

Associated with challenges of moving to a new country

Loss of social support

Hostile reception

Educational and employment challenges

Most common among first generation immigrants and their children

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Race and Ethnicity

Two early inaccurate, biased models:

Inferiority model

Deficit model

Multicultural model

Emerged in the 1980s and 1990s

A contemporary view that emphasizes the importance of considering a person’s cultural background and related experiences when determining normality and abnormality

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Sociocultural Conditions in Treatment

Multicultural counseling is the “fourth force” in psychotherapy

Multicultural counseling is assuming greater importance as our population becomes more diverse

Cultural factors, such as family experience and degree of assimilation, are important in assessment and intervention

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Review

What models of psychopathology have been used to explain abnormal behavior?

What is the multipath model of mental disorders?

How is biology involved in mental disorders?

How do psychological models explain mental disorders?

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Review (cont’d.)

What role do social factors play in psychopathology?

What sociocultural factors influence mental health?

Why is it important to consider mental disorders from a multipath perspective?

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AMHCA Standards for the
Practice of Clinical Mental
Health Counseling
Adopted 1979
Revised 1992, 1993, 1999, 2003, 2011, 2015, 2016, 2017,
and 2018

I. Introduction……………………………………………………………………………………………..1
A. Scope of Practice………………………………………………………………………………..2
B. Standards of Practice and Research……………………………………………………..3

II. Educational and Pre-degree Clinical Training Standards………………………..4
A. Program……………………………………………………………………………………………….4
B. Curriculum…………………………………………………………………………………………..4
C. Specialized Clinical Mental Health Counseling Training………………………5
D. Pre-degree Clinical Mental Health Counseling Field Work
Guidelines……………………………………………………………………………………………….5

III. Faculty and Supervisor Standards………………………………………………………….6
A. Faculty Standards…………………………………………………………………………………6
B. Supervisor Standards……………………………………………………………………………8

IV. Clinical Practice Standards……………………………………………………………………11
A. Post-degree/Pre-licensure………………………………………………………………….11
B. Peer Review and Supervision……………………………………………………………..11
C. Continuing Education………………………………………………………………………..11
D. Legal and Ethical Issues…………………………………………………………………….12

V. Recommend AMHCA Training…………………………………………………………….13
A. Biological Bases of Behavior……………………………………………………………..14
B. Specialized Clinical Assessment………………………………………………………….19
C. Trauma Informed Care……………………………………………………………………..21
D. Substance Use Disorders and Co-occurring Disorders…………………….27
E. Technology Assisted Counseling (TAC) …………………………………………..32
F. Integrated Behavioral Health Care Counseling…………………………..38
G. Aging and Older Adults Standards and Competencies………………………44
H. Child and Adolescent Standards and Competencies………………………….47

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 1

I. Introduction
Since its formation as a professional organization in 1976, the
American Mental Health Counselors Association, AMHCA, has
been committed to establishing and promoting vigorous standards
for education and training, professional practice, and professional
ethics for clinical mental health counselors. Initially, AMHCA sought
to define and promote the professional identity of mental health
counselors. Today, with licensure laws in all 50 states, AMHCA
strives to enhance the practice of clinical mental health counseling
and to promote standards for clinical education and clinical practice
that anticipate the future roles of clinical mental health counselors
within the broader health care system. As a professional association,
AMHCA affiliated with APGA (a precursor to the American
Counseling Association [ACA]) as a division in 1978; in 1998,
AMHCA became a separate not- for-profit organization, but retained
its status as a division of ACA.

In 1976, a group of community mental health, community
agency and private practice counselors founded AMHCA as the
professional association for the newly emerging group of counselors
who identified their practice as “mental health counseling.” Without
credentialing, licensure, education and training standards, or other
marks of a clinical profession, these early mental health counselors
worked alongside social workers and psychologists in the developing
community mental health service system as “paraprofessionals” or
“allied health professionals” despite the fact that they held master’s
or doctoral degrees. By 1979, the early founders of AMHCA
had organized four key mechanisms for defining the new clinical
professional specialty:

1) identifying a definition of mental health counseling;
2) setting standards for education and training, clinical practice,
and professional ethics;
3) creating a national credentialing system; and
4) starting a professional journal, which included research and
clinical practice content.

These mechanisms have significantly contributed to the professional
development of clinical mental health counseling and merit further
explication.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 2

A. Scope of Practice
A crucial development in mental health counseling has been
defining the roles and functions of the profession. The initial
issue of AMHCA’s Journal of Mental Health Counseling included
the first published definition of mental health counseling as
“an interdisciplinary, multifaceted, holistic process of: 1) the
promotion of healthy lifestyles; 2) identification of individual
stressors and personal levels of functioning; and 3) the preservation
or restoration of mental health” (Seiler & Messina, 1979). In
1986, the AMHCA Board of Directors adopted a more formal,
comprehensive definition: “clinical mental health counseling is
the provision of professional counseling services involving the
application of principles of psychotherapy, human development,
learning theory, group dynamics, and the etiology of mental
illness and dysfunctional behavior to individuals, couples,
families and groups, for the purpose of promoting optimal
mental health, dealing with normal problems of living and
treating psychopathology. The practice of clinical mental health
counseling includes, but is not limited to, diagnosis and treatment
of mental and emotional disorders, psycho- educational techniques
aimed at the prevention of mental and emotional disorders,
consultations to individuals, couples, families, groups, organizations
and communities, and clinical research into more effective
psychotherapeutic treatment modalities.”

Clinical mental health counselors have always understood that
their professional work encompasses a broad range of clinical
practice, including dealing with normal problems of living and
promoting optimal mental health in addition to the prevention,
intervention and treatment of mental and emotional disorders.
This work of clinical mental health counselors serves the needs
of socially and culturally diverse clients (e.g. age, gender, race/
ethnicity, socio- economic status, sexual orientation, etc.) across
the lifespan (i.e. children, adolescents and adults including
older adults and geriatric populations). Clinical mental health
counselors have developed a strong sense of professional
identity since 1976. AMHCA has sought to support this sense of
professional identity through legislative and professional advocacy,

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 3

professional standards, a code of ethics, continuing education,
and clinical educational resources, and support for evidence-
based best practices, research and peer-reviewed dissemination of
developments in the field.

B. Standards of Practice and Research
A key development for the profession was AMHCA’s creation of
education and training standards for mental health counselors in
1979. The Council for Accreditation of Counseling and Related
Educational Programs (CACREP) adopted and adapted these
AMHCA training standards in 1988 when it established the first
set of accreditation standards for master’s programs in clinical
mental health counseling. In keeping with AMHCA standards,
CACREP accreditation standards for the mental health counseling
specialty have consistently required 60 semester hours of graduate
coursework. AMHCA remained an active advocate for vigorous
clinical training standards through the 2009 CACREP accreditation
standards revision process, during which community counseling
accreditation standards were merged into the new clinical mental
health counseling standards. After careful review, AMHCA
endorsed the clinical mental health counseling standards.

Another important step in the further professionalization
of clinical mental health counseling, AMHCA established the
National Academy of Certified Mental Health Counselors, the
first credentialing body for clinical mental health counselors,
and gave its first certification examination in 1979. In 1993, this
certified clinical mental health counselor credential (CCMHC)
was transferred to the National Board for Certified Counselors
(NBCC). NBCC provides the Board Certification fo CCMHCs.
AMHCA clinical standards have always recognized and
incorporated the CCMHC credential as an important means
of recognizing that a clinical mental health counselor has met
independent clinical practice standards, despite significant
differences that exist among state counselor licensure laws, as well
as among educational and training programs.

Finally, since 1979, AMHCA published the Journal of Mental
Health Counseling, which has become widely recognized and cited

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 4

as an important contributor to the research and professional
literature on clinical mental health counseling.

Taken together, these four mechanisms (definition of scope
of practice; educational and training standards, professional
practice standards and code of ethics; credentialing; and
professional journal) resulted in the recognition of clinical mental
health counseling as an important profession to be included in
our health care system. In recognition of the central importance
of vigorous professional educational and clinical practice
standards, AMHCA has periodically revised its professional
standards in 1993- 94, 1999, 2003, and 2010- 11 to reflect evolving
practice requirements. These professional standards, as well as
the 2015 AMHCA Code of Ethics, constitute the basis from which
AMHCA continues to advocate for, and seek to advance, the
practice of clinical mental health counseling.

II. Educational and Pre- degree Clinical Training Standards
Required Education: Master’s in Clinical Mental Health Counseling
(60 semester hours)

A. Program
CACREP- accredited clinical mental health counseling program –
based on 2009 standards (endorsed by AMHCA Board) or master’s
degree in counseling (minimum of 48 semester hours) from a
regionally accredited institution. The 48 semester- hour minimum
will increase to 60 semester hours in January 2016.

B. Curriculum
Consistent with 2009 CACREP standards, clinical mental health
counseling programs should include the core CACREP areas and
specialized training in clinical mental health counseling. The core
CACREP areas include:

• Professional Orientation and Ethical Practice;
• Social and Cultural Diversity;
• Human Growth and Development across the lifespan;
• Career Development;
• Counseling theories and Helping Relationships;
• Group Work;

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 5

• Assessment;
• Research and Program Evaluation.

C. Specialized Clinical Mental Health Counseling Training:
These areas of Clinical mental health counselor preparation
address the clinical mental health needs across the lifespan
(children, adolescents, adults and older adults) and across socially
and culturally diverse populations:

• Ethical, Legal and Practice Foundations of Clinical Mental
Health Counseling;

• Prevention and Clinical Intervention;
• Clinical Assessment;
• Diagnosis and Treatment of Mental Disorders;
• Diversity and Advocacy in Clinical Mental Health

Counseling; and
• Clinical Mental Health Counseling Research and Outcome

Evaluation.
AMHCA recommends additional training in Clinical Mental

Health Counseling described in the following standards:
• Biological Bases of Behavior (including psychopathology

and psychopharmacology);
• Trauma Informed Care and;
• Co- occurring Disorders and Substance Use Disorders (mental

disorders and substance abuse).
This training may be completed as part of the degree program, in
post- master’s coursework, or as part of a certificate or continuing
education or CCMHC credential.

D. Pre- degree Clinical Mental Health Counseling Field Work
Guidelines

• Students’ pre- degree clinical experiences meet the minimum
training standards of 100 Practicum and 600 Internship hours.

• Students receive an hour of clinical supervision by an
independently and approved licensed supervisor for every
20 hours of client direct care. This field work supervision is
in addition to the practicum and internship requirements for
their academic program.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 6

• Students are individually supervised by a supervisor with no
more than 6 (FTE) or 12 total supervisees.

III. Faculty and Supervisor Standards
A. Faculty Standards
Faculty with primary responsibility for clinical mental health
counseling programs should have an earned doctorate in a field
related to clinical mental health counseling and identify with
the field of clinical mental health counseling. While AMHCA
recognizes that clinical mental health counseling programs have
the need for diverse non- primary faculty who may not meet all
of the following criteria, the following knowledge and skills are
required for faculty with primary responsibility for clinical mental
health counseling programs.

1. Knowledge
a. Demonstrate expertise in the content areas in which they teach
and have a thorough understanding of client populations served.

b. Involved in clinical supervision either as instructors or in the
field have a working knowledge of current supervision models
and apply them to the supervisory process.

c. Understand that clinical mental health counselors are asked
to provide a range of services including counseling clients
about problems of living, promoting optimal mental health, and
treatment of mental and emotional disorders across the lifespan.

d. Demonstrate training in the following:
• Evidence- based best practices
• Differential diagnosis and treatment planning
• Co- occurring disorders and substance use disorders
• Trauma, and its related forms (developmental, complex,

situation, chronic or toxic distress, moreal trauma,
historical trauma, etc.)

• Biological bases of behavior including
psychopharmacology

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 7

• Social and cultural foundations of behavior
• Individual family and group counseling
• Clinical assessment and testing
• Professional orientation and ethics
• Advocacy and leadership
• Case consultation and supervision with peers or

specialists, and
• Clinical supervision with a hierarchical or regulatory

supervisor.

e. Possess knowledge about professional boundaries as well
as professional behavior in all interactions with students
and colleagues.

2. Skills
a. Demonstrate clinical mental health skills by completing
licensure requirements including successful completion of
coursework, fieldwork requirements, licensure exams, and
licensure renewal requirements.

b. Demonstrate identification with the field of clinical mental
health counseling by their academic credentials, scholarship
and professional affiliations including their participation in
organizations which promote clinical mental health counseling
including AMHCA, ACA and ACES etc. Faculty who provide
clinical supervision in the program or on site are able to lead
supervision seminars which promote case analysis, small group
process and critical thinking.

c. Complete the equivalent of 15 semester hours of coursework
at the doctoral level in the clinical mental health specialty area or
a comparable amount of scholarship in this area.

d. Possess expertise in working with diverse client populations
in areas they teach including clients across the spectrum of
social class, ethnic/racial groups, lesbian, gay, bisexual and
transgendered communities, etc.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 8

e. Demonstrate and model the ability to develop and maintain
clear role boundaries within the teaching relationship.

f. Demonstrate the ability to analyze and evaluate skills and
performance of students.

B. Supervisor Standards
AMHCA recommends at least 24 continuing education hours or
equivalent graduate credit hours of training in the theory and practice
of clinical supervision for those clinical mental health counselors
who provide pre- or post-degree clinical supervision to CMHC
students or trainees. AMHCA recommends that clinical supervisors
obtain, on the average, at least 3 continuing education hours in
supervision per year as part of their overall program of continuing
education. Clinical supervisors should meet the following knowledge
and skills criteria.

1. Knowledge
a. Possess a strong working knowledge of evidence based and
best practices orientation with clinical theory and interventions
and application to the clinical process.

b. Understand the client population and the practice setting of
the supervisee.

c. Understand and have a working knowledge of current
supervision models and their application to the supervisory
process. Maintain a working knowledge of the most current
methods and techniques in clinical supervision knowledge of
group supervision methodology including the appropriate use
and limits of this modality.

d. Identify and understand the roles, functions and
responsibilities of clinical supervisors including liability in the
supervisory process. Communicates expectations and nature and
extent of the supervision relationship.

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 9

e. Maintain a working knowledge of appropriate professional
development activities for supervisees. These activities should be
focused on empirically based scientific knowledge.

f. Show a strong understanding of the supervisory relationship
and related issues, not limited to power differential, evaluation,
parallel process and isomorphic similarities and differences
between supervision and counseling, and qualities that enhance
the supervisor/supervisee working alliance for the benefit of
clients served.

g. Identify and define the cultural issues that arise in clinical
supervision and be able to routinely incorporate cultural
sensitivity into the supervisory process.

h. Understand and define the legal and ethical issues in clinical
supervision including:

• applicable laws, licensure rules and the AMHCA Code of
Ethics specifically as they relate to supervision;

• supervisory liability, respondent superior, and fiduciary
responsibility; and

• risk management models and processes as they relate to
the clinical process and to supervision.

i. Possess a working understanding of the evaluation process
in clinical supervision including evaluating supervisee
competence and remediation of supervisee skill development.
This includes initial, formative and summative assessment of
supervisee knowledge, skills and self- awareness with provisions
for clearly stated expectations, fair delivery of feedback and
due process. Supervision includes both formal and informal
feedback mechanisms.

j. Maintain a working knowledge of industry recognized financial
management processes and required recordkeeping practices
including electronic records and transmission of records

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 10

2. Skills
a. Possess a thorough understanding and experience in working
with the supervisees’ client populations. Be able to demonstrate
and explain the counselor role and appropriate clinical
interventions within the cultural and clinical context.

b. Develop, maintain and explain the supervision contract to
manage supervisee relationships with clear expectations including:
• frequency, location, length and duration of supervision meetings;
• supervision models and expectations of the supervisee and

the supervisor;
• liability and fiduciary responsibility of the supervisor;
• the evaluation process, instruments used and frequency of

evaluation; and
• emergency and critical incident procedures.

c. Demonstrate and model the ability to develop and maintain
clear role boundaries and an appropriate balance between
consultation and training within the supervisory relationship.

d. Demonstrate the ability to analyze and evaluate skills and
performance of supervisees including the ability to confront and
correct unsuitable actions and interventions on the part of the
supervisees. Provide timely substantive and formative feedback
to supervisees, along with providing cumulative feedback and to
train supervisees in techniques and methods in self-appraisal.

e. Present strong problem-solving and dilemma resolution skills
and practice skills with supervisees.

f. Develop and demonstrate the ability to implement risk
management strategies.

g. Practice and model self-assessment. Seek consultation as needed.

h. Conceptualize cultural differences in therapy and in supervision.
Incorporate and model this understanding into the supervisory

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 11

process.

i. Possess an understanding of group supervision techniques and
the role of group supervision in the supervision process.

j. Comply with applicable federal, state, and local law. Take
responsibility for supervisees’ actions, which include an
understanding of recordkeeping and financial management rules
and practice.

IV. Clinical Practice Standards
A. Post-degree/Pre-licensure
Clinical mental health counselors have a minimum of 3,000
hours of supervised clinical practice post-degree over a period
of at least two years. In the process of acquiring the first 3,000
hours of client direct and indirect contact in postgraduate
clinical experience, AMHCA recommends a ratio of one hour
of supervision for every 20 hours of on-site work hours with a
combination of individual, triadic and group supervision.

B. Peer Review and Supervision
Clinical mental health counselors maintain a program of
peer review, supervision and consultation even after they are
independently licensed. It is expected that clinical mental health
counselors seek additional supervision or consultation to respond
to the needs of individual clients, as difficulties beyond their range
of expertise arise. While need is to be determined individually,
independently licensed clinical mental health counselors must
ensure an optimal level of consultation and supervision to meet
client needs.

C. Continuing Education
Clinical mental health counselors at the post- degree and
independently licensed level must comply with state regulations,
certification and credentialing requirements to obtain and maintain
continuing educational requirements related to the practice of
clinical mental health counseling. Clinical mental health counselors

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 12

maintain a repertoire of specialized counseling skills and
participate in continuing education to enhance their knowledge of
the practice of clinical mental health counseling.

In accordance with state law, AMHCA recommends that in
order to acquire, maintain and enhance skills, counselors actively
participate in a formal professional development and continuing
education program. This formal professional development
ordinarily addresses peer review and consultation, continuum
of care, best practices and evidence-based research; advocacy;
counselor self-care and impairment, and AMHCA Code of
Ethics. Clinical mental health counselors who are involved in
independent clinical practice also receive ongoing training relating
to independent practice management, accessibility, accurate
representation, office procedures, service environment, and
reimbursement for services.

D. Legal and Ethical Issues
Clinical mental health counselors who deliver clinical services
comply with state statutes and regulations governing the practice
of clinical mental health counseling. Clinical mental health
counselors adhere to all state laws governing the practice of
clinical mental health counseling. In addition, they adhere to all
administrative rules, ethical standards, and other requirements of
state clinical mental health counseling or other regulatory boards.
Counselors obtain competent legal advice concerning compliance
with all relevant statutes and regulations. Where state laws lack
governing the practice of counseling, counselors strictly adhere
to the national standards of care and ethics codes for the clinical
practice of mental health counseling and obtain competent legal
advice concerning compliance with these standards.

Clinical mental health counselors who deliver clinical services
comply with the codes of ethics specific to the practice of clinical
mental health counseling. The AMHCA Code of Ethics outline
behavior which must be adhered to regarding commitment to
clients; counselor-client relationship; counselor responsibility
and integrity; assessment and diagnosis; recordkeeping, fee
arrangements and bartering; consultant and advocate roles;

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 13

commitment to other professionals; commitment to students,
supervisees and employee relationships.

Clinical mental health counselors are first responsible to
society, second to consumers, third to the profession, and last to
themselves. Clinical mental health counselors identify themselves
as members of the counseling profession. They adhere to the
codes of ethics mandated by state boards regulating counseling
and by the clinical organizations in which they hold membership
and certification. They also adhere to ethical standards endorsed
by state boards regulating counseling, and cooperate fully with the
adjudication procedures of ethics committees, peer review teams,
and state boards. All clinical mental health counselors willingly
participate in a formal review of their clinical work, as needed.
They provide clients appropriate information on filing complaints
alleging unethical behavior and respond in a timely manner to a
client request to review records.

Of particular concern to AMHCA is that clinical mental health
counselors who deliver clinical services respond in a professional
manner to all who seek their services. Clinical mental health
counselors provide services to each client requesting services
regardless of lifestyle, origin, race, color, age, handicap, sex, religion,
or sexual orientation. They are knowledgeable and sensitive to
cultural diversity and the multicultural issues of clients. Counselors
have a duty to acquire the knowledge, skills, and resources to assist
diverse clients. If, after seeking increased knowledge and supervision,
counselors are still unable to meet the needs of a particular client,
they do what is necessary to put the client in contact with an
appropriate mental health resource.

V. Recommended AMHCA Training
AMHCA recommends that clinical mental health counselors have
specialized training in addition to the generally agreed upon courses
and curricula endorsed by CACREP. These include the biological
bases of behavior, clinical assessment, trauma, and co- occurring
disorders technology assisted counseling, and integrated behavioral
health care counseling, working with children and adolescents,
and working with older persons. Knowledge and skills related to

AMHCA Standards for the Practice of Clinical Mental Health Counseling
(Revised 2018) 14

the biological bases of behavior may be covered in a single course
or more commonly across several courses or domains of inquiry.
The skills outlined in this document can be measured through
standardized testing, participation in class or team role- playing
exercises, case studies, research papers, reviews of treatment
plans, and reviews of progress notes in field work settings. It is
recommended that the following be addressed for students in mental
health counseling programs of study.

A. Biological Bases of Behavior
The origins of human thought, feeling, and behavior, from the
more to the less adaptive, are the result of complex interactions
between biological, psychological, and …

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