Putting Health Back into Clinical Mental Health Counseling -  
A Historical Perspective
By: Jim Messina, Ph.D., CCMHC, NCC
Taken from Presentations Presented at State Mental Health Counselors Conferences

 Florida MHCA on February 10, 2012 and Utah MHCA May 10, 2013

with additioanl historical references

Why the Need for this Proposal? The Affordable Care Act which comes into full regulatory power in 2014 is implementing support for both Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO) which involve primary care physicians and specialists in Medicine and Behavioral Health in the creating of a system of integrated medicine in which patients wellness is promoted by addressing the myriad of mental health issues which stem from the patient’s: emotional response to diagnoses of acute or chronic medical conditions, need for compliance with medical directives given them to address their medical issues, need to adopt a personal wellness program which their long term health and quality of life. If Counselors who are licensed in their respective states are to be easily recognized as having the clinical expertise, competence and formal training to become members of the integrated medicine teams emerging from the changes in healthcare funding it is imperative that their professional identity be a clear statement that “Health” is their focus and the can perform “Clinical” work in Behavioral Medical settings.

What is preventing Counselors from being recognized as “Health” Team Players?

The professional identify of Clinical Mental Health Counselors has been weakened since the coining of the title and formation of the National Association and National Certification to recognize the title in 1979. Unfortunately only 15 state have licensure for Clinical Mental Health Counselors or Licensed Mental Health Counselors. The other 35 states over the year licensed LPC’s (Licensed Professional Counselors) which unfortunately does not promote the professional identify of Clinical Mental Health Counselors and clearly took the “Health” out of Clinical Mental Health Counseling.

Has there been advocacy previously taken to address this issue?

Over the years there have been efforts in journal articles and professional newsletters to get the counseling profession to wake up to the need to have a unified title of Clinical Mental Health Counselor. Jason King from Utah has been an outspoken advocate for need to get all licensed counselors under the title Clinical Mental Health Counselors. He wrote a letter in the ACA Counseling Today on this matter in 2006 (Click here to download) and in 2006 in the AMHCA Advocate he voiced similar concerns (Click here to download). In 2006 he also posted another article on the Advocate on Primary Care and Mental Health (Click here to download).  Because he was so concerned about the professional identity issue he did his doctoral internship on the topic which was summarized in a journal article appearing in Vistas (Click here for the article). Jason King and his fellow Mental Health Counselor Gray Otis in Utah were so driven to get Health back into Clinical Mental Health that they were successful in getting the Utah licensing regulatory office to change the LPC title in Utah to Clinical Mental Health Counselor which became official in 2012. This effort was done so successfully that now in Utah 120 CMHC’s are being recognized as competent professionals in the Behavioral Medicine world which is placing them exactly where we want to see all counselors to be by the full enactment of the Affordable Care Act in 2014.

What have the National Counselor Organizations done to address putting “Health” back into Clinical Mental Health Counseling?

The Council for Accreditation of Counseling and Related Education Programs (CACREP) in 2009 made it official that all Clinical Mental Health Counseling Training Programs must be 60 graduate credits and cover the issue which will make them competent in the mental health world. In 2016 they will roll out new standards and there is an urgent need for Clinical Mental Health Counselors to stand up and advocate for expanded criteria which will better prepare them for the emerging Integrated Medicine and Behavioral Health Models which are emerging in our field. Jason King has written in the AMHCA Advocate calling for the inclusion of Psychopharmacology training in Clinical Mental Health Training Programs (Click here to download) and he also wrote in the Advocate about The 6 Keys to Mental Health (Click here to download) and how counselors could be effective interventionists with clients suffering from chronic pain (Click here to download)

The American Counseling Association (ACA) called a 20/20 Vision initiative in 2006 to address the lack of transportability between states of licensed counselors. They involved all of the counseling national stakeholders including the Council on the American Association of State Counseling Boards (AASCB), the National Board of Certified Counselors (NBCC), The Council for Accreditation of Counseling and Related Education Programs (CACREP) and thirty other associations.   The 20/20 Vision team in 2012 concluded that the ideal way to accomplish this would be to require the LPC as the national standard for the entry level into licensure for all states.  Clearly this was not a “putting health back into clinical mental health counseling” move.

In 1976 there was no existing division in APGA (now the American Counseling Association-ACA) for counselors who worked directly in the mental health field. Nancy Spisso a colleague of mine at the Escambia County Mental Health Center pointed out a letter in the APGA Guidepost from a group in Wisconsin who were suggesting that APGA needed a division to address counselors who worked on “non-traditional” settings such as Mental Health Centers, Marriage and Family Counseling Centers and other Public Health Agencies with a Mental Health identity. When Nancy showed me the letter, I said:"Let’s make this thing happen!"

I had been the American School Counselors Association (ASCA) National Negotiation Committee Chair in 1972-75 and knew the then President of APGA Thelma Daly because of my work with ASCA when she was the President of ASCA. I also knew the Executive Director of APGA Chuck Lewis through my previous work with ASCA and felt comfortable working with both Thelma and Chuck to get the new Division request formulated and acted upon.

I immediately called Thelma Daly the day I read the Guidepost letter and asked her help to pursue formation of the new division; she then referred me to Chuck Lewis who immediately informed me of the steps to take and then sent me the required documentation to me by mail.

Nancy and I then wrote our letter to the Guidepost announcing our intention of forming a new division with APGA called The American Mental Health Counselor’s Association. We chose the name since we believed that all counselors who do the type of work outlined in the Wisconsin letter to the Editor all fell under the rubric of Mental Health. We coined the term "Mental Health Counselor" that day and 36 years later it is still the best term to describe counselors who are involved in the myriad of tasks which do not fit the rubric of school, rehabilitation, vocational, college personnel, or counselor education.

We unfortunately never realized that by using the term "mental health counselors" we actually were bringing Developmental Counseling into a field which most of the then current counselor educators had no idea of what it entailed but more importantly those training programs were based in Colleges of Education around the country which were not in a political position to support the concept that students out of Schools of Education did "clinical mental health work" which was considered behavioral medicine. We entered the field of clinical behavioral medicine without any educational underpinning for our new professional identity.

Status of the Early Goals set for AMHCA

Although we just wanted to create a division within APGA for mental health counselors, early on we realized that we had begun a profession which now needed the hallmarks of such a profession. So the goals for AMHCA were to provide our profession with those hallmarks: Code of Ethics, National Certification, State Licensure, Competency Based Educational Accreditation Standards and the promotion research in the field of mental health.

1. Code of Ethics: the First Code was written immediately based on the then current APGA (ACA) Code and since then additional Codes which affect mental health counselors were written and updated for the American Counseling Association, the National Academy of Clinical Mental Health Counselors and the National Board for Certified Counselors.

2. Nationally recognized Credential: Creation of the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) was the Goal of my year as President of AMHCA during 1978-79. The Academy was based on competency based assessment model and gained recognition for the first national certification body which required work samples from candidates. The National Academy then joined forces with the National Board of Certified Counselors (NBCC) and the CCMHC is one of a number advanced certifications open to the 48,000 Nationally Certified Counselors (NCC). Today AMHCA is now promoting a new designation, the AMHCA Diplomate: Diplomate and Clinical Mental Health Specialist (DCMHS) which is based on Graduate Training, Licensure, work experience and specialized training and one significant criteriaum for such a designation will be having the CCMHC.

3. State based Licensure for independent practice-In 1980 after the Academy was established I wrote the legislative language for the first Licensed Mental Health Counselors in Florida. In 1982 it passed the legislature and in 1983 over 1800 counselors become LMHC’s today we now have over 7000 LMHC’s with over 1100 MHC residents working on getting their license. There are only 15 states currently which license counselors with Mental Health in their title. There are however 50 states which license Professional Counselors which weakens the Mental Health Counselor identity. According to the American Counseling Association (ACA, 2011) in the USA there are 120,000 Licensed Professional Counselors; 54,785 Licensed Marriage & Family Therapists and 202,924 Licensed Social Workers. In line with the licensure of counselors, there is an effort being coordinated by the American Counseling Association (ACA) and the American Association of State Counseling Boards (AASCB) called the 20/20 A Vision for the Future of Counseling begun in 2010 to establish a definition of counseling with unified standards for training, certification and licensure so that they can create a portability system of licensure which will benefit counselors and strengthen the counseling profession. The definition of counseling which 20/20 developed is: Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

4. Educational Standards: This was the area of tension from the get go between APGA counselor educators and the young AMHCA leadership. Counselor Educators fought efforts to establish accreditation standards for Mental Health Counseling Programs. In 1992 under the AMHCA Presidency of Roberta Driscoll Morowitz, I agreed to take on the effort to identify a means to accredit mental health counselor training programs with a competency based model called the Orlando Model which created the National Commission for Mental Health Counseling. It published in 1995 a monograph Mental Health Counseling in the 90’s (Altekruse & Sexton, 1995) which reported on a national research using 1500 CCMHC’s to identify the competencies needed to do mental health counseling so as to assist in identifying what competencies are needed in counselor education programs. Unfortunately in 1995 the AMHCA Board of Directors chose to transfer their funding from the National Commission to its efforts to establish its free standing office in DC and the effort to accredit Mental Health Counseling Programs took a back seat until the new Mental Health Counseling Training Standards of CACREP came out in 2009, 14 years later.  Today there are only about 74 CACREP programs which are accredited for Mental Health Counseling Training. 12 of these programs are in Florida! Community counseling was the politically less threatening term which Counselors Educators adopted in 2001 and there were 160’s of these programs in counseling programs. This had weakened the growth and recognition of the Mental Health Counseling Profession and was a contentious issue when CACREP eliminated the Community Counseling Standards in 2009 and replaced them with Mental Health Counseling Standards of 60 graduate hours. Over 36 later years and finally there is a unified accreditation standard for the training of Mental Health Counselors.New standards for CACREP will be coming out in 2016 and they are not much different than what came out in 2009.

5. Body of Theory and Research specific to the profession: the Journal of Mental Health Counseling was established in 1976 and Bill Weikel as the first editor. The first edition of the Journal came out in 1979 after AMHCA was formally recognized as a formal division of APGA and today they are in their 34th volume. Unfortunately there has never been any theoretical model of counseling which was developed in the past three decades that had as its roots Mental Health Counseling. Also there has not been significant research done on the effectiveness of the work of Mental Health Counselors. This has weakened the impact of the profession among the other Mental Health Professions and it is an issue which needs attention by the professional organizations involved with Mental Health Counselors.

Mental Health Counselors Today in Florida

Mental Health Counseling as a profession is best established and recognized in the State of Florida. There are 7784 Licensed Mental Health Counselors (LMHC) and 1100 Residents for LMHC Licensure in Florida.

LMHC’s are employed in a variety of settings: Private Practice, Public and Private Mental Health Agencies, Schools, Junior Colleges and Universities.

LMHC’s in 2005 became recognized as legal agents of the Baker Act which is the involuntary admission of clients into Psychiatric Receiving Facilities. LMHC’s are reimbursed by most private health insurance companies in close parity with Psychologist and other mental health professions. LMHC’s are not covered by Medicaid but it is in the offing. LMHC’s graduates of CACREP approved programs are now recognized for VA employment and Tricare reimbursement.

Out of 74 CACREP Clinical Mental Health Counselor Training Programs in the nation there are 14 in Florida:

1. Argosy Sarasota
2. Barry University
3. Florida Atlantic University
4. Florida Gulf Coast University
5. Florida International University
6. Florida State University
7. Rollins College
8. Troy University Southeast Region: Orlando, Tampa, Ft. Walton Beach, Panama City & Pensacola
9. University of Central Florida
10. University of Florida
11. University of South Florida
12. University of North Florida
13. Cappella University (online)
14. Walden University (online)

These 14 Schools of Graduate Education provide the CACREP approved Mental Health Counseling Training program of 60 graduate credit hours or more, along with a 1000 hour internship.

What is the Future for Mental Health Counseling in the US?

The market for Mental Health Counselors in the USA is changing. There is a shift in population growth and priorities among third party payers and these changes require that Mental Health Counselors begin to prepare for change in settings where they will be practicing their professional trade.

1. Impact of the Affordable Care Act (ACA)‘s with its ACO’s for Clinical Mental Health Counseling Services

Another impact of the ACA is the Patient-centered medical home (PCMH) model. This model calls for the coordination and integration of medical services through the primary care provider and for a “whole person orientation” to medical treatment. This model is currently implemented at some level in the VA and Federally Qualified Health Centers (FQHC’s).

The ACA has called for the creation of Accountable Care Organizations (ACO’s) to provide comprehensive services to Medicare recipients with a strong primary care basis. This model can include the integration of mental and behavioral health services into the Patient-Centered Medical Home (PCMH) which could enhance patient outcomes and it is this integrated behavioral medical approach opens a massive opportunity for clinical mental health counselors. This model of integrating mental, behavioral and medical services under one roof has the potential of controlling the costs for patients and as long as ACA remains the law of the land this is a future of professional growth for the mental health counseling profession. To be prepared to fill this evolving behavioral medicine role, it is imperative that clinical mental health counseling training programs establish training for future practitioners in these integrated medical settings.

An Accoutable Care Organization (ACO) is a large local health system. It usually includes more than one hospital and a number of primary care clinics. Examples in Florida would be Bay Care on the West Coast and the Florida Hospital System in Central Florida. It is this whole system which is in charge of the care of its patients. The providers refer to other specialists inside of their own system. These ACO’s have their own group of providers (which could include Clinical Mental Health Counselors) and by referring within the system controls costs. The ACO’s are then responsible not only for their costs but also for the quality of their services to their patients. The providers are paid a flat fee that is risk adjusted for the severity of the issues facing the patients. The ACO model is one where this type of organization assumes the financial risk rather than the government, business or insurance companies. Where Clinical Mental Health Counselors and how they will be paid may change greatly in the future as these ACO’s become reality after the full implementation of the ACA in 2014.

In addition to the movement towards the ACO’s and due to the decreasing or increasingly complicated reimbursement from medical insurance companies there is a financial reality to be faced that solo or group private practices of LMHC’s or any other mental health profession for that matter is greatly challenged which will require a grouping together of multiple licensed mental health professionals into large group practices which can negotiate for contracts not only with insurance companies but also with public and private Mental Health Agencies, the courts, juvenile treatment facilities, Hospitals, Nursing Homes, etc.

2. Impact of the Affordable Care Act (ACA)‘s with its Preventive Services for Mental Health Counseling Services

Under the ACA, if a person has a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without the policy holder having to pay a copayment or co-insurance or meet a deductible. This applies only when these services are delivered by a network provider. 

1. Alcohol Misuse: screening and counseling
2. Alcohol and Drug Use: assessment for adolescents
3. Behavioral Assessment for children of all ages
4. Depression: screening for adults and adolescents
5. Developmental screening: for children under age 3, and surveillance throughout childhood
6. Diet: counseling for adults at higher risk for chronic disease
7. Obesity: Screening and counseling for adults and children
8. Sexually Transmitted Infection (STI): prevention counseling for adults and adolescents at higher risk who are sexually active
9. Tobacco Use: screening for all male and female adults and cessation interventions for tobacco users and expanded counseling for pregnant tobacco users

For Women: beginning August 1, 2012

1. Domestic and interpersonal violence: screening and counseling for all women
2. Well-woman visits: to obtain recommended preventive services for women under 65

3. Increasing Need for Behavioral Medicine Interventions due to the ACA act. Mental Health Counselors are ideally situated to provide Behavioral Medical Interventions based on their training and background. They need to promote themselves in the following setting:

1. General Practice; Family Practice and Internal Medicine Settings
2. Rehabilitation Centers and Practices
3. General and Specialized Hospitals
4. Senior Citizen’s Independent housing;  Assisted Living and Nursing Homes

4. The Mental Health impact on Veterans of the Iraq and Afghanistan Wars. It is well known that one in three US service members returning from these wars in the past ten years, experience signs of combat stress, depression, post-traumatic stress disorder (PTSD) or symptoms of traumatic brain injury (TBI). It is also well known that only about 50% of these veterans will receive their health care through the VA. The remaining vets and their families will seek care in community settings by primary care and community mental health clinicians. It is imperative that Clinical Mental Health Counselors be proactive and get as much clinical training as possible to be able to effectively work with these veterans who have served our country with the best interventions as possible.  For full coverage on what the OIF and OEF Veterans of the Iraq and Afghanistan Wars need go to Focus on the Military on this website at: coping.us/focusonthemilitary.html.

5. Due to major natural and human disasters there has been a growth in the need for experts in Trauma and mental health counselors are positioned well to work in such settings as: family court appointed domestic violence programs, Red Cross, FEMA, SAMSHA and State Departments of Mental Health subsidized mental health recovery centers post disasters such as after 911 and Katrina.

6. Due to the aging of America and the growth of Palliative Care programs such as Hospice there is a huge need for mental health professionals to provide behavioral medical supports for the chronic and terminally ill in such settings as Hospice, Hospitals, Nursing Homes, Bereavement programs around the state.

7.  Due to the growth of State Regulations surrounding the welfare of children due to divorce there is an increased need for Mental Health Professionals who are versed and skilled in the process of providing Mediation of disputes in such settings family courts, law practices, and children serving agencies

What Does the Mental Health Counseling Field Need to Do to Keep Up

The above listed changes will require Mental Health Counselors to be on parity with the other Mental Health Professions in terms of understanding and being conversed in the following domains:

1. Evidence Based Practices for the Treatment of Mental Disorders: There is a glaring lack of emphasis on Evidence Based Practices in the CACREP standards for Mental Health Counselors nor does the 491 Board Standards in Florida require such an emphasis for the course work required for the LMHC. However the AMHCA 2011 standards have pushed for the use of Evidence Based Practices. There are no current Mental Health Counseling Texts which emphasize Evidence Based Practices – which in the main are Cognitive Behavioral in approach with a time limited target and solution focused. Rather most Mental Health Counselors are still being taught in the old traditional developmental counseling model of Interviewing with the Rogerian Model, counseling with a whole host of models with no researched based validity, and entering their practicum and internships to learn on the job the Evidenced Based Practices which are recognized in the Mental Health Field.

2. Psychopharmacology: There is also a glaring lack of emphasis on teaching Mental Health Counselors about Psychopharmacology. CACREP does not require a course in Psychopharmacology nor does the 491 Board Standards in Florida require such training. This is a major area of deficiency in the training of Mental Health Counselors since it puts them at a disadvantage of being on an equal footing with their fellow mental health professional colleagues and lessens their ability to interface effectively with medical practitioners as the field enters the challenges of becoming more Behavioral Medicine oriented.

3. Neuroscience: Another glaring deficiency is the lack of emphasis on teaching Mental Health Counselors about Neuroscience. CACREP does not require a course in Neuroscience nor does the 491 Board Standards in Florida require such training. This is another major area of deficiency in the training of Mental Health Counselors since it again puts them at a disadvantage of being on an equal footing with their fellow mental health professional colleagues and lessens their ability to interface effectively with medical practitioners as the field enters the challenges of becoming more Behavioral Medicine oriented.

4. Behavioral Medicine: Another major emphasis lacking in the teaching and training of Mental Health Counselors is the whole field of Behavioral Medicine. CACREP does not require a course in Behavioral Medicine nor does the 491 Board Standards in Florida require such training. This is another major area of deficiency in the training of Mental Health Counselors since it again puts them at a disadvantage of being on an equal footing with their fellow mental health professional colleagues and lessens their ability to interface effectively with medical practitioners as the field enters the challenges of becoming more Behavioral Medicine oriented.

5. Traumatology and Bereavement Training: There is a glaring lack of emphasis on teaching mental health counselors to be on the front lines for recovery from trauma and for dealing sufficiently with bereavement. CACREP does not require a course in Traumatology or Bereavement Counseling nor does the 491 Board Standards in Florida require such training.

6. Mediation Training: There is no discussion currently in Mental Health Counseling Programs about the growth of Family and or Organizational Mediation Practices and yet there are many LMHC’s who are trained and working as mediators for family courts etc. CACREP does not require a course in Mediation nor does the Florida State Licenseing 491 Board Standards in Florida require such training. However this is an area which LMHC’s need more direction and education on.

What you can do to be better prepared for the future?

Consider the following for yourself if you are a mental health counselor:

1. Maintain your membership in AMHCA and your state and regional Mental Health Counseling Associations so as to give our field the visibility it needs in years to come and recruit your fellow Licensed Mental Health Counselors (or LPC’s) to also become full members in these associations
2. Live by the Codes of Ethics of AMHCA, ACA and NBCC.
3. Get yourself certified as a NCC and CCMHC with the NBCC to give more credibility to the reality that Mental Health Counselors on the national level are accountable in maintaining the highest standards of self-monitoring and accountability through this national certification effort.
4. Maintain your state license and support all efforts to improve the standards of your respective state licensing boards.
5. Advocate with the 20/20: A Vision for the Future of Counseling delegates from the 29 related counseling associations to delineate a common licensure title which incorporates the title “Mental Health Counseling”, and a licensure scope of practice which includes a Behavioral Medicine Orientation, and licensure educational requirements which are in tune with the needs of our clients who have experienced a full gamut of emotional and physical challenges.
6. Work with your state and regional Mental Health Counseling Associations and Local State Graduate Mental Health Counseling Training Programs to insure that on a bi-annual basis they offer continuing education courses updating on Evidenced Based Practices; Psychopharmacology; Neuroscience; Behavioral Medicine Interventions and Traumatology and Bereavement Counseling. Then take these courses bi-annually.
7. Take courses which enable you to offer your services for veterans and their families from the Iraq and Afghanistan war, beginning with: From the war zone to the home front supporting the mental health of veterans and their families. To see the course click here.
8. Work with the medical community to gain credibility of your credentials to work in the ACO’s which are being organized in your communities and states

Consider the following for AMHCA and your state Mental Health Counseling Association’s Legislative Committees to begin to advocate with the State’s Licensing Boards to do the following:
1. Require that all curriculums for LMHC’s be based on Evidenced Based Practices for Mental Health Disorders

2. Require that LMHC must have at least one course in each of the following

1. Psychopharmacology
2. Neuroscience
3. Behavioral Medicine Interventions
4. Traumatology and Bereavement Counseling
5. Psychopharmacology
6. Neuroscience
7. Behavioral Medicine Interventions
8. Traumatology and Bereavement Counseling

3. Assist AMHCA and ACA to advocate with CACREP to include the same directives being advocated with the State Licensing Boards by requiring that all curriculum for MHC’s be Evidenced Based Practices for Mental Health Disorders and require one course in each of the following:

4. Specifically here in Florida encourage FMHCA to work with the Mediation Training Center at FMHI to provide LMHC’s and LMHC’s in the state with Training a specialized Family Mediation Training program so that more Mental Health Counselors in the State are provided an opportunity to understand the impact of such a service on their professional practice.

Conclusion

My wife Connie and I called our son the “AMHCA baby” because he was born in 1976 just as we initiated AMHCA allowing Connie to be our secretary that first year of our son’s life. Our son the “AMHCA Baby” will be 36 this year. He is married and completing a post graduate fellowship. In July he will be joining the staff of a Hospital and Medical School. Our “AMHCA Baby” has grown up to be a very responsible and mature young man. Yes he still has challenges ahead of him as he settles into his new role in July. AMHCA’s growth parallels closely our “AMHCA Baby.” The profession of Mental Health Counseling is entering a new era of Behavioral Medicine and for that reason it needs to tighten up its standards and gain more training for professionals to face the challenges ahead. I stand ready to assist AMHCA and its state chaptersto help theirmembership to advocate for those things needed to help prepare themselves for the next thirty years.

Chronological Listing of References

Messina, J. J.; Breasure, J.; Jacobson, S.; Leymaster, R.; Lindenberg, S.; & Scelsa, J. (1978).  Blueprint for the advancement of the counseling profession. Unpublished text, AMHCA: Washington, D. C.

Seiler, G. & Messina, J. J. (1979).  Toward professional identity:  The dimensions of mental health counseling in perspective.  American Mental Health Counselors Association Journal, 1, 3-8. Retrieved from: http://www.coping.us/mhcprofessionalstandards.html

Messina, J. J. (1979).  Why establish a certification system for professional counselors?  A rationale. American Mental Health Counselors Association Journal , 1, 9-22. Retrieved from: http://www.coping.us/mhcprofessionalstandards.html

AMHCA Certification Committee (1979). The Board of Certified Counselors procedures.  American Mental Health Counselors Association Journal, 1, 23-28. Retrieved from:
http://www.coping.us/mhcprofessionalstandards.html

AMHCA/NACCMHC Blue Ribbon Task Force (1980). Standards and procedures for competency based mental health counselor training programs.  Unpublished Text, AMHCA: Washington,   D. C.

Weikel, W. J. (1985).  American Mental Health Counselors Association.  Personnel and Guidance Journal , 63, 457-60.

Messina, J. J. (1985).  The National Academy of Certified Clinical Mental Health Counselors: Creating a new professional identity.  Journal of Counseling and Development, 63, 607-608.

McCormick, N. J. & Messina, J. J. (Eds.) (1987).  Professionalization - the next agenda for the mental health counseling profession:  The proceedings of the 1987 AMHCA think tank. AMHCA: Washington, DC

Seiler, G. Brooks, D. K. & Beck, E. S. (1990).  Training standards of the American Mental Health Counselors Association: History, rationale and implication.  In G. Seiler (Ed.) The mental health counselor’s sourcebook  (pp. 61-77), New York:  Human Sciences Press, Inc.

AMHCA Board of Directors (1993).  Standards for the clinical practice of mental health counseling. In AMHCA leader handbook, AMHCA: Washington, D. C

Covin, T. M.  (1994). Credentialing - an Orlando model project report.  Unpublished Text, AMHCA:  Washington, D. C.

Altekruse, M. K. & Sexton, T.L. (1995), Mental Health Counseling in the 90's: A Research Report for Training and Practice. Tampa, FL: National Commission for Mental Health Counseling - An Orlando Model Monograph Series Monograph.

Council for the Accreditation of Counseling and Related Education Programs (CACREP), (2009), 2009 Standards, CACREP, Washington, DC. Retrieved at: http://www.cacrep.org/doc/2009%20Standards%20with%20cover.pdf

ACA. (2010-2012). 20/20 A Vision for the Future of Counseling. Washington, DC:Retrieved at: http://www.counseling.org/20-20/index.aspx

US DHHS. (2010-2012). The Health Care Law and You: The Affordable Care Act (ACA).
Washington DC. Retrieved at: http://www.healthcare.gov/law/index.html

American Counseling Association (2011). 2011 Statistics on Mental Health Professions.
Washington,DC. Retrieved at: http://www.counseling.org/PublicPolicy/PDF/
Mental_Health_Professions%20_Statistics_2011.pdf Click here to get page

AMHCA Board of Directors (2011).  Standards for the clinical practice of mental health  counseling. AMHCA, Washington, DC. Click here to download

Otis, G. (2012). How does the DCMHS benefit you and the profession? AMHCA Advocate, 35(1):3-4. Retrieved at: http://www.amhca.org/assets/news//Advocate_FEB_2012_-3.pdf