CREDENTIALING, LICENSING, AND REIMBURSEMENT OF THE SUD WORKFORCE: A REVIEW OF POLICIES AND PRACTICES ACROSS THE NATION. APPENDIX D: Detailed Methodology: Licensing/Credentialing Review

12/01/2019

We reviewed states' licensing/credentialing board websites to identify requirements for every SUD counseling, SUD technician, peer recovery specialist, and SUD prevention specialist credential available within each state. At the time data were extracted, we classified each treatment credential either into one of the five categories defined in SAMHSA's model career ladder or the additional peer specialist category that is not included in that model. We based the classification primarily on the minimum degree required, but also considered how the state's career ladder is structured and where in that structure a title is situated, as well as whether independent practice without supervision is authorized under the credential. For example, if the highest available credential for SUD counselor in a state required only a bachelor's degree but authorized independent practice without supervision, we classified it in Category 4 even though SAMHSA's model ladder indicates a master's degree for this level. If authority for independent practice was not explicit in the information available on licensing/credentialing board websites, we reached out to the relevant board via email to clarify and used the information if it was provided. We also referred to a 2013 study[7] by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) that similarly mapped SUD credentials to SAMHSA's career ladder; we used this study as a reference when making classification determinations, but our results are not identical.

The initial classification of counseling credentials was performed by a single analyst, then reviewed by a second analyst for agreement. Once data were compiled for all states, we again reviewed the classifications for comparability within categories and made some adjustments. It is important to note that we had SOPe information for only a limited set of credentials; therefore, our classifications are not definitive but instead were used as a guiding framework. In states with credentials overseen by multiple boards, classification was especially difficult as the career ladders within the state were often overlapping. The method therefore involved some degree of subjectivity, discussed in the Limitations section of this report.

We pulled clinical supervisor credentials (e.g., CCS) into a separate category because the requirements are typically overlays to the requirements for an underlying credential (e.g., Certified Addiction Counselor).

For peer recovery specialists, we included credentials focused on SUD, either alone or in conjunction with mental health. We did not include peer credentials if the description was limited to mental health with no mention of SUD. If a state had more than one peer specialist credential--for example, one specific to SUD recovery and another for mental health or co-occurring disorders--we selected the SUD-specific credential as the most relevant to the study's research questions.

Our search was conducted between April and June 2018. The data were compiled in an Excel spreadsheet. Due to space limitations, we could not fit all extracted data elements into the tables in this report. Elements not shown are: the name of the board that oversees the credential, the board type, URL to the website where data were obtained, and tasks allowable under the credential's SOP (only available for one credential per state from the University of Michigan's online tool[8]). The grid below shows the elements presented in this report along with a definition of each.

Data Element Definition Where Displayed in This Report
State State abbreviation. Appendix A tables
Title Credential title. Appendix A tables
Affiliation Whether the credential is affiliated with IC&RC, NAADAC, both, or neither. Aggregated at the state-level, Exhibit 8
Minimum Degree Minimum degree required to obtain the credential. This field is not presented for peer recovery credentials as peer roles emphasize lived experience rather than educational achievement. Appendix A tables
Education Hours The required number of hours of education to obtain the credential, sometimes denoted in credit or semester hours. Appendix A tables
Practice Hours The number of required practice hours in the field to obtain the credential. Appendix A tables
Exam Name Name of the required examination, if any Appendix A tables
Continuing Ed Hours Number of hours of continuing education, per year (unless otherwise stated), required to maintain the credential. Appendix A tables
Renewal Period Period after which the credential is required to be renewed, in months. Appendix A tables
Reciprocity Yes/No whether a pathway for reciprocity was stated or confirmed via email by the board that oversees the credential. "Reciprocity" means the certification board would accept a similar credential from another state/jurisdiction if it meets certain requirements defined by the board. Appendix A tables
Focus For peer recovery credentials only, this field indicates whether the focus of the credential is: SUD-specific, mental health and/or SUD, or mental health and COD. Exhibit A7