CEFS 500 Week 8 DB Forum 2 Example

Discussion Board Forum 2: Thread and Reply

CEFS 500 Orientation to Counselors Professional Identity and Function, Discussion Board Forum 2 (thread and reply)

Thread by [Student Name]

The prompt and the classmate's post are composites standing in for the course's own forum; the law, Scripture and published studies are real; the requirements follow Liberty's public course guide for CEFS 500.

Thread

Until 2024, Medicare did not pay licensed professional counselors directly, which left many older adults unable to use their coverage to see one. That changed with the Consolidated Appropriations Act (2022), the year-end federal spending law enacted for fiscal year 2023, which allowed Medicare to pay marriage and family therapists and mental health counselors for covered services beginning January 1, 2024. The change came after years of lobbying by counseling organizations, and Granello and Young (2019) treat that kind of advocacy, including the push for recognition by public insurers, as part of counselor identity. The change is a reminder that professional identity includes the policies that decide which clients counselors may serve.

The change matters because the need is large and the workforce small. Bartels and Naslund (2013) warned that by 2030 the United States will have less than one geriatric psychiatrist for every 6,000 older adults with mental health or substance use disorders, and they argued that expanding other parts of the workforce, using technology and changing federal policy could help close the gap. Adding counselors to Medicare does exactly that, by bringing a large licensed workforce into the system that pays for most older adults' care.

The change also asks something of counselors. Those who wish to serve Medicare clients must enroll as providers, learn Medicare's documentation and billing rules, and build competence in issues common in later life, such as grief, chronic illness, cognitive decline and caregiving stress. Students preparing now can seek practicum sites that serve older adults and take electives in aging. Counselors will also need to coordinate with physicians, since many older clients see several specialists and take medications that affect mood and memory.

A policy change opens a door, but counselors still have to walk through it with the right training. Scripture calls God's people to honor the elderly (English Standard Version Bible, 2001/2016, Leviticus 19:32), and making competent counseling available to them under their own coverage is one practical way the profession can do so.

Classmates: would you consider working with older adults now that Medicare coverage is available?

Reply to Jasmine

Jasmine, you argued that state licensure rules limit counselors who want to see clients by telehealth across state lines, since a counselor generally must be licensed where the client is located. That is an important point for new counselors who expect to practice online, especially those living near a state border or planning to move after graduation. Research on telebehavioral health shows that the challenges go beyond licensure. Glueckauf et al. (2018), surveying psychologists about their telebehavioral practice, documented the technologies practitioners used, the ethical issues they faced and the training they still needed, which suggests that competence in telehealth has to be learned rather than assumed, even by experienced clinicians. For counselors, that means learning the rules of each client's state, checking whether interstate agreements apply, and studying the ethical standards for distance counseling before offering it. Do you think graduate programs should require a full course in telehealth practice, or is supervised experience enough?

References

Bartels, S. J., & Naslund, J. A. (2013). The underside of the silver tsunami: Older adults and mental health care. The New England Journal of Medicine, 368(6), 493-496. https://doi.org/10.1056/NEJMp1211456

Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, 136 Stat. 4459 (2022).

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E. (2018). Survey of psychologists' telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(3), 205-219. https://doi.org/10.1037/pro0000188

Granello, D. H., & Young, M. E. (2019). Counseling today: Foundations of professional identity (2nd ed.). Pearson.