Education is the Weakest Link in the Addictions Treatment Industry
Posted on 07. Nov, 2009 by admin in General
Public policy involves a governmental response to an issue or concern. Public policy is also an enacted series of actions involving regulation, funding, and system management. All public policy decisions are driven by values, beliefs, and attitudes that are held by governmental decision makers. State and local governments are charged to oversee the response to the concern of substance use and other behavioral disorders.
Nationally public policy in this area has traditionally been grounded in an ideological perspective that classes these disorders as distortions of character that are best addressed through a criminal justice response. Underlying this perspective is a historically consistent generalized judgment that individuals with these disorders are weak of character. Those who hold these perspectives often cite the lack of volitional control despite significant consequences as their evidence of moral failing. These judgments continue to drive our national response to addictive disorders as evidenced in how substance use disorder treatment funding is prioritized. Changing public opinion through education is one necessary policy objective. Changing public opinion, however, will not address the primary policy objective which is to ensure counselor competence. A competent workforce is unarguably critical to address addictive disorders as a major public health concern. Competence development demands that scientific evidence in the areas of clinical and educational best practices must be properly deployed.
Addictive disorders cut across all aspects of our society. They impact all classes and demographic segments of those who live in the United States making addictive disorders a significant concern for all Americans. Americans should also be concerned about the effectiveness of treatment provider systems and oversight bodies. It is worthwhile to consider how the above entities affect counselor competence because credentialing is primarily a state function.
In theory, public opinion is meant to influence legislative decision through voting and lobbying by constituent groups. Those with addictive disorders meet the criteria for being a disenfranchised group thus impeding their ability to act as a lobbying body. Treatment providers and Credentialed Counselors also lack a unified voice. In order to change the inequitable policy debate, counselors, those with addictive disorders, and their families need to be organized into collective advocacy groups.
If the addictions industry does not take action and evolve, then it stands the chance of being subsumed by other disciplines. While the rest of the world follows a public health model, the United States spends its drug monies on militaristic interventions and the treatment industry squabbles over the legitimacy of “Harm Minimization.” In this environment, educating addictions counselors takes a back seat to the big money initiatives that are more immediately supported by the court of public opinion. The reason is due, in part, to the fact that the “disease” of addiction remains stigmatized by society as well as our medical and criminal justice systems. Chemical dependency is not viewed as “important” as other mental health or medical issues, resulting in a lower standard for educational development and professionalism.
The addictions treatment industry has voiced a concern regarding the lack of qualified staff. The concern has been termed “a workforce crisis.” To address the crisis, the response generally has been focused on workforce recruitment and retention. Recruitment and retention are important, but they do not involve ensuring that counselors have the critical determinants for success. Sequentially-developed competence through education and experience is an unarguable determinant for success.
Developing schemes to entice people to enter the field cannot logically address the root issues that are a central part of the industries vocational instability. From my perspective, the instability is rooted in the lack of a professional identity for credentialed alcoholism and substance abuse counselors (CASACs). Developing a professional identity involves unifying standards around the scope of practice, canon of ethics, industry specific jargon, and competency development processes.
The age of the paraprofessional has reached its zenith, and the time to develop a professional identity is now. To transform the system, an identity that is grounded in industry-specific best practice research, nomenclature, and education and practice standards must become institutionalized through policy driven standards.
It is not clear whether current credentialing processes reach their stated policy objectives. Does the credential meet the needs of the individual counselor, the general public, and the treatment industry?
The credential exists as one element of a public policy response to substance use disorders. Credentialed counselors are those who are charged with providing treatment or enacting policy on a daily basis. The oversight of their activities is provided by state and local oversight and monitoring bodies. It is important to note that treatment practice is heavily regulated,` while counselor educational systems are not. Each state has its own regulations that prescribe addictions treatment services. State regulations also prescribe the credentialing processes required to gain the title and privilege that are an inherent part of being credentialed.
The central question involves what the credential is supposed to accomplish and whether it reaches its intended policy objective. The charge of credentialing bodies is to issue credentials, establish minimum qualification standards, and to revoke credentials as necessary. It is important to note that this generally accepted charge does not involve competence development processes. The credentialing process provides minimum qualification measures and bureaucratic hurdles rather than competence measures. Based on this logic, a credential is not a reflection of competence; it is more of an event as in when one passes each bureaucratic requirement.
The majority of states are connected with the International Certification and Reciprocity Consortium or ICRC. Those states that are members of the ICRC follow the ICRC credentialing guidelines. The guidelines outline the required amount of work experience hours and education. The ICRC also outlines the main elements of the credentialing examination. The credentialing application process is administered by the individual states.
Credentialing is not a competency development process. It is a minimum qualification benchmark. Based on this reality, the question then becomes, who or what group oversees the competency development standards? The reality is that there is no one group that outlines and oversees competency development standards. Thus, the educational development systems are laissez faire in that they are unregulated. When this is the case, then individuals are left to determine what competence development means alone. Most individuals who are not educators do not know what a competence development process is and, thus, they are left to exist in a proverbial educational “wild west.”
Today, counselor competence development is defined by the individual and not by the system. It may be argued that individual educational providers are the ones that outline the competence development process; this argument rests on the assumption that these individuals and groups know what competence development processes are and how to enact these processes. In comparison, most other areas of human services competency development processes are standardized through accreditation.
Counselor credentialing, as it stands, does not claim to ensure the competence of counselors. The language, “minimum qualification standards” refer to one’s ability to sit for a test and is not a test of one’s ability. An assurance of basic education is impossible without competence development standards. Standardized educational processes are a fundamental aspect that defines what it means to be a profession. How can evidence-based practice be expected without evidenced based competency development?
Is the system meeting the needs of the individual counselor that depends on how the needs are defined? From an educational perspective, a unified system does not exist and this brings the meeting of the educational needs into question.
Are the time, effort, and expense of earning the counseling credential worth the effort?
The credential provides a vocational identity but cannot provide title security. Title security is brought about by establishing what it means to be a bona fide substance use disorder treatment professional. The foundation of title security is a clear scope of practice, standardized education, and title specific privileges. Title security conveys the rights, privileges, and security that are acquired when someone successfully passes through a competency development process. Our system lacks title security because it does not meet the above criteria. Consider that CASACs who earn the credential are commonly treated as second class to other related disciplines that have no addictions specific education. In order to compete and be recognized as valid, counselors need professional education by professional educators who have a working knowledge of substance use disorder treatment best practices.
My belief is that bureaucratic oversight bodies are not well equipped to lead those who seek to gain the skills that will serve them well in the pursuit of helping others. A criminal justice policy perspective is dissonant to the growth of professional healers. Bureaucratic institutions, by definition, are not designed to develop those who are called to enter a vocation.
Without standards, the problem is that education has become a commodity to be purchased, rather than an apprenticeship process. When education becomes commoditized then profit takes precedence over learning. Counselor education within the substance use disorder treatment industry is an example of a commoditized structure. In this model, the consumer of educational services is at a disadvantage because they are mandated to acquire education to enter the industries workforce, but he/she is not guided on what the educational process should be. A dynamic is constructed wherein the consumer must determine what competency development is. When left in this position, the individual turns to educators for guidance on the process; educators who may or may not have an understanding of how competency is best developed.
An industry without standards fails to meet the definition of an industry.
There is a clear inequity in the access to education and a socio-economic educational divide is becoming apparent. The inequity exists between those who have the means to seek higher education and those who do not. Does it make sense to seek a counseling credential when you can run an agency as a social worker with no addictions education or experience? A significant percentage of addictions treatment programs are administrated by social workers who have little or no addictions treatment education. In literal practice, the industry is saying that addictions education is not necessary to provide treatment services.
Substance use disorder counselor education is, for the most part, unregulated wherein most anyone with minimal relevant education can open a training program. Unregulated systems by definition rely on the market to regulate it. The logic here is that poor providers of educational services will be driven out of business by the lack of consumers. The substance use disorder industry is the only human service discipline that follows this model with most other disciplines applying competency development standards that are enforced by accrediting bodies. The status quo is a lack of attention to basic educational standards. Education theory is not commonly integrated into instructional practice. Incorporating instructional best practices is essential to transform the addictions counselor landscape.
The unregulated system cannot be measured. Thus, consumers are exposed to a wide variance in terms of quality and instructional qualification. The general public is forced by the system to interface with providers the competence of which cannot be guaranteed. It is dysfunctional to have a credentialing process without a supporting educational system. Pass rates can be expected to be low when educational systems are not standardized and the solution is not exam preparation courses, but standardized competency development processes.
The industry is forced to accept into its ranks a workforce that is educated according to no set standard. An industry cannot expect consistency and professionalism from a workforce that is educated according to what is most profitable. The workforce crisis is not an issue of recruitment and retention; rather it is an issue of an industry that has not developed a fundamental aspect of its infrastructure. It is surprising that the general public and treatment provider organizations accept the irrationality of a laissez fair counselor development system. The industry has evolved from the only requirement to be a counselor is to be in recovery. The next step in the evolution has been recognition that addictions specific training is required to provide addictions treatment services. My belief is that in order to survive, the industry will need to adopt standardized educational requirements.
Competent addictions treatment requires specific knowledge, skills, and attitudes. How does the industry ensure that individuals are competent to practice? Those that are competent to practice demonstrate the requisite knowledge, skills, and attitudes.
The ICRC credentialing examination is comprised of a written test. From a factor analysis perspective, multiple-choice tests are ineffective at measuring a range of competencies. One cannot demonstrate ability through a written response; a written response can only be used to describe or to illustrate an understanding. Multiple-choice tests primarily assess memorized knowledge and not performance ability. The educational process should demonstrate the relationship between the educational process and job performance. The knowledge that is measured should be process oriented as operationally defined information that is necessary to perform a job specific task.
If the credentialing process involves a minimal qualification application process and a written examination only; then it cannot logically measure the requisite knowledge, skills, and attitudes. It may be argued that supervisors are directly responsible for competency development that is specific to the addictions counseling competencies. Again, this argument is based on an assumption that supervisors are acting as competent instructors. My understanding is that the majority of supervisors are acting without instructional training. It would be ideal if supervision processes were in synch with commonly accepted research-driven competency development standards.
The paraprofessional credential does not carry the immediately recognized and accepted validity of other disciplines like nursing. People generally seek education and subsequent credentialing to be able to earn a living wage and many have told me that the compensation is not worth the effort that it takes to gain the credential? My observation is that individuals from other fields such as social work earn higher wages without demonstrating any addiction specific education or training. Should these social workers and psychologists be forced to demonstrate competence prior to working within the addictions treatment industry? Some states require a graduate degree for advanced practice. Should that degree be addictions studies specific?
Addictive or behavioral disorders are extremely complex in their etiology, symptom manifestation, and treatment requirements. Co-occurring disorders further complicate the treatment of this class of disorders. These realities demonstrate the critical need for professional educational systems that guarantee addictions specific clinical education. Current credentialing requirements involve minimal addictions specific education and no set clinical protocols. Further, the credentialing requirements do not mandate work experiences that involve the full range of clinical competencies thus effectively nullifying the concept of work experience competency development.
The intent and the values behind the process should involve development of competence. Minimal qualifications currently involve 350 hours of education (knowledge) and 6000 hours of work experience with a sign off that the experience involved addictions competencies. I assert that these requirements have had an adverse impact on the labor market because the requirements are not in line with business necessity. In other words, a disconnect exists between the credentialing process and job performance requirements. The process does not provide a guarantee of competence and title validity that provides occupational desirability.
The paradigm shift that I am suggesting involves moving our attention and efforts into a standardized competency development processes. The scope of practice may be integrated into the competency development process through occupational benchmarks against which the candidate can be measured. Tests should include a valid sample of job specific competencies. This type of test requires candidates to demonstrate conceptual, analytical, critical thinking, and interpersonal relational skills.
Degraded qualification and educational processes parallel a decrease in occupational identity. The counselor development system is unquestionably not meeting the demand for bona fide substance use disorders treatment professionals. Recruitment and retention are peripheral to the structural flaw that is apparent as to how counselors are developed.
