To the members of the House Education Committee:
My name is Ann Marie Banfield. I am offering testimony on SB 684-FN.
I. Authorizes the department of education to adopt rules relative to federal funding available to schools under New Hampshire’s Medicaid program.
II. Permits professionals certified by the department of education who are providing medical services in public schools to be licensed by medical and health care boards.
When I began reading through SB 684, the three main areas of concern I had were:
1) The qualifications of individuals treating children for their mental health
2) If these individuals were required to adhere to a strict code of ethics supportive of informed parental consent
3) The importance of maintaining the privacy of the student receiving care.
SB684 includes language that describes some of the qualifications and, education an individual would need in order to treat a child for their mental heath. I am not sure that all of the professionals have the best qualifications I would expect if my child were to receive mental health treatment at school.
For instance, a licensed Child Psychologist who has a Phd and extensive clinical training offers children the best possible care. I hope you will consider the importance of the credentials and clinical training these professionals should have prior to licensing.
In New Hampshire, an applicant for licensure must have received their doctoral degree from a regionally accredited institution. The doctoral program itself must also meet certain requirements, including coursework in specific areas, a minimum amount of in-person attendance, and a predoctoral internship (which will later count towards their required supervised professional experience hours for licensure).
Once they have earned a PsyD or PhD in psychology, they can begin the process of becoming licensed in New Hampshire. To do this, they need to complete two years of supervised professional experience, submit an application to the Board, and pass two exams.
Before being issued a license to practice psychology in New Hampshire, they must complete two years (3,000 hours) of supervised professional experience (SPE). During both of these years, they must receive regular supervision from a licensed psychologist with whom they do not have a dual relationship (e.g., they cannot be family or a friend).
The first year (1,500 hours) of SPE will be earned during the internship that they are required to complete during their doctoral program.
The second year (1,500 hours) must be completed after they have earned their doctoral degree. They must receive at least one hour of individual supervision per week during this year (and at least 50 hours over the course of the year).
They will also need to request three letters of recommendation as well as their graduate transcripts and include them with their application.
The Board requires them to answer multiple essay questions about ethical issues related to the practice of psychology. These questions are included in the application packet and their responses must be deemed satisfactory by the Board. These questions are separate from the national psychology exam they will also need to pass to earn their license. Each essay question response include references to relevant sources such as the APA Code of Ethics.
I thought it was important to mention the intense amount of work that must be completed before a psychologist is awarded their license in New Hampshire. This is very different from what is required from a School Psychologist-Specialist who completes a Masters Program.
This set’s the School Psychologist-Doctoral professionals apart from anyone else . Some other school personnel may offer social services to families but they do not have the same background as the individual who has to go through the extensive education and training.
For instance in SB 684:, XI. “Psychotherapist” means a psychologist, licensed school psychologist-doctoral, or licensed school psychologist-specialist licensed under this chapter who performs or purports to perform psychotherapy.
Should the psychologist-specialist, who does not have the extensive education and training, be qualified to perform this duty?
What Code of Ethics will these licensed professionals be required to follow?
SB 684 : VII.(a) Ethical standards, as promulgated by the American Psychological Association, required to be met by each psychologist licensed under this chapter, and how a psychologist license may be revoked for violation of these standards.
The APA (American Psychological Assoc.) Code of Ethics is very clear when it comes to parental consent:
9.03 Informed Consent in Assessments
(a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in Standard 3.10.
3.10 Informed Consent
(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’ preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual’s rights and welfare.
Parents can feel confident when their child’s mental health provider is required to follow a Code of Ethics that requires informed consent from parents and guardians.
The ethical codes would apply to both the Psychologist-Doctoral and the Psychologist- Specialist. I would ask that the APA Code of Ethics also apply to every professional administering mental health treatment or assessments to children in the public school. The list of behavioral treatments listed in SB 684 can be administered by teachers, Guidance Counselors or Social Workers.
SB 684 does include a provision for parental consent to treatment but it’s also important that anyone providing mental health treatment or assessment adhere to those same ethical boundaries.
Every Student Succeeds Act requires informed written consent from parents for children who receive mental health service or assessment. This provision in ESSA should be included in the language so that school policy will reflect federal law. (See attached ESSA Section 4002 General Provisions)
Federal law requires screening of all Medicaid treatment providers including those performing services in schools. This means verifying the qualifications, licensure, and certifications of treatment providers upon hire and at the time of licensure or certification renewal. Schools or their designees must perform monthly screening of treatment providers for exclusions against the Office of Inspector General (OIG) exclusion and sanction database which is located at https://exclusions.oig.hhs.gov. Shouldn’t this be added to SB 684?
Finally, this legislation should specifically spell out privacy protections for children receiving medical or psychological assessments or treatment by any individual working with children.
For instance, what about group therapy where other students may be present? Where are the records kept? How are those records kept secure? This may not be the focus of federal requirements for medicaid reimbursement, but it should be the focus from legislators assigned to drafting this legislation.
Some of the biggest critics of direct funding of medicaid to schools will cite the lack of privacy protections. The Multi-Tiered System of Support mentioned in SB 684 can include screening of all students to identify behavior/mental health disabilities and interventions on all children. The Diagnostic and Statistical Manual of Mental Disorders (DSM) codes must be used for billing. When that is done every child is then coded. How is any of this sensitive personal data protected? Are parents fully informed as to who will have access to the data? If a child is coded in any way using a DSM code, a parent should be informed and, have the ability to appeal that designated code.
This may be legislation directed specifically at medicaid reimbursement, but it should include the best possible outcomes for children. That means hiring individuals who are best qualified to assess and treat a child’s mental health, strict adherence to ethical codes supportive of informed parental consent and, strict privacy protections for New Hampshire Students.