ACA Annual Convention and Exposition Once again, the ACA Annual Convention & Exposition, March 21-25, 2007, in Detroit, offers attendees an excellent opportunity to earn continuing education credits. You can earn one CE contact hour for each hour of attendance at the Opening General Session, Keynote sessions, and all Education Sessions (PDF). Most attendees will be able to accumulate 14.5 CEs from these areas alone, but you also can earn up to 18 more by attending two full days of Pre-Convention Learning Institutes. Return home with up to 32.5 CE credits at no additional charge other than a $15 certificate processing fee. How do you get the credit? It's simple. The CE report form will be in your tote bag. Take it with you to all sessions. Then return the completed form to ACA with the $15 processing fee. You will receive your CE certificates 2-3 weeks after we receive your form. ACA convention sessions are approved by: NBCC, CRCC, APA, NAADAC and several state psychology and social work boards. Register today and rack up the CEs you'll need for 2007! If you've already registered for the Convention, consider coming a day or two earlier for pre-convention Learning Institutes. Questions? Call 800-347-6647, x222. Happy holidays and best wishes for the New Year. ACA Legislative Updates December 28, 2006 President Signs VA Bill  On December 22nd, President George W. Bush signed into law the Veterans Benefits, Health Care, and Information Technology Act of 2006 (S. 3421).  As a result, the bill became Public Law 109-461.  President Bush did not make any comment regarding the bill when he signed it. The American Counseling Association (ACA) and the American Mental Health Counselors Association (AMHCA) are pleased that President Bush signed the bill which includes a provision allowing LPCs to be appointed to positions within the Department of Veterans’ Affairs, Veterans Health Administration.  ACA and AMHCA look forward to working with the VA on the regulation regarding the LPC provision.  As the VA issues a proposed regulation and a comment period is announced, ACA and AMHCA will keep its members informed and let them know how to comment on the proposed regulation. For more information, please contact Scott Barstow at ACA at 800-347-6647, ext. 234 or by email at sbarstow@counseling.org December 22nd Department of Defense Studies Mental Health Issues  On December 20th, ACA and AMHCA addressed the members of the Department of Defense Task Force on Mental Health as part of its meetings in Arlington, VA.  ACA, represented by Legislative Representative Brian Altman, and AMHCA, represented by Director of Public Policy and Professional Issues Beth Powell, each addressed the Task Force to highlight the issue of independent practice authority for licensed professional counselors with TRICARE and other DOD programs.  As part of ACA and AMHCA’s comments to the Task Force both organizations highlighted the support of the National Military Families Association (NMFA).  In addition, a representative from NMFA also commented on the counselor provision during her address to the Task Force.  Brian and Beth also fielded questions from Task Force members and spoke to several members after the session officially ended.  ACA and AMHCA will submit written testimony to the Task Force as a follow up to our appearance at the Task Force meeting. Also on December 20th, the Washington Post published an article, provided below, which discusses a newly released study by the Department of the Army which notes that multiple tours of duty in Iraq significantly raises the risk of suffering from PTSD. The American Counseling Association (ACA) and its coalition partners, the American Mental Health Counselors Association (AMHCA) and the National Board for Certified Counselors (NBCC) will continue to advocate for independent practice authority for mental health counselors in TRICARE when the 110th Congress convenes in January 2007.    Repeat Iraq Tours Raise Risk of PTSD, Army Finds U.S. soldiers serving repeated Iraq deployments are 50 percent more likely than those with one tour to suffer from acute combat stress, raising their risk of post-traumatic stress disorder, according to the Army's first survey exploring how today's multiple war-zone rotations affect soldiers' mental health. More than 650,000 soldiers have deployed to Iraq or Afghanistan since 2001 -- including more than 170,000 now in the Army who have served multiple tours -- so the survey's finding of increased risk from repeated exposure to combat has potentially widespread implications for the all-volunteer force. Earlier Army studies have shown that up to 30 percent of troops deployed to Iraq suffer from depression, anxiety or post-traumatic stress disorder (PTSD), with the latter accounting for about 10 percent. The findings reflect the fact that some soldiers -- many of whom are now spending only about a year at home between deployments -- are returning to battle while still suffering from the psychological scars of earlier combat tours, the report said. "When we look at combat, we look at some very horrific events," said Col. Ed Crandell, head of the Army's Mental Health Advisory Team, which polled 1,461 soldiers in Iraq in late 2005. "They come back, they know they're going to deploy again," and as a result they don't ever return to normal levels of stress, Crandell said. Overall, soldiers in Iraq are facing a greater exposure to some key traumatic events than in the past, according to the report, the Army's third mental health survey conducted in Iraq since 2003. Seventy-six percent of soldiers surveyed, for example, said they knew someone who had been seriously injured or killed, and 55 percent experienced the explosion of a roadside bomb or booby trap nearby. The proportion of soldiers who reported that they suffered a combination of anxiety, depression and acute stress rose to 17 percent, compared with 13 percent in the last survey in 2004. Fourteen percent of soldiers surveyed said they have taken medications, such as antidepressants, for mental health problems. Combat stress is significantly higher among soldiers with at least one previous tour -- 18.4 percent, compared with 12.5 percent of those on their first deployment, the survey found. "The most likely explanation . . . is that a number of soldiers returned" to Iraq "with acute stress/combat stress symptoms" that were unresolved from previous tours, it said. Soldiers with multiple tours also reported greater concern over the length of the 12-month deployments than those on their first tours and were more likely to give lower ratings for their own morale and that of their units, which 55 percent described as low. This contrasts with 45 percent for soldiers overall, who rated unit morale higher than in the two earlier surveys, in 2003 and 2004. The report also found a doubling of suicides among soldiers serving in the Iraq war from 2004 to 2005, the latest period for which data are available. Twenty-two soldiers took their own lives in Iraq and Kuwait in 2005, compared with 11 in 2004 and 25 in 2003, Army officials said. "This is a concern for us," said Army Surgeon General Kevin Kiley in a briefing on the report, referring to the increase in suicides. Although the number who took their own lives remains within historical norms, "we consider one suicide to be too many," Kiley said. He said he is creating a "suicide prevention cell" to address the problem, as soldiers report having difficulty identifying comrades at risk. Most of the suicides are impulsive and related to relationship, financial or disciplinary problems rather than combat stress, he said. "We've had young soldiers who will get bad relationship news, and the first thing they do is walk to a port-a-potty and end their lives," leaving no opportunity for anyone to intervene, he said.The Army has significantly increased the number of mental health professionals in Iraq and Afghanistan, with the goal of treating soldiers more quickly and returning them to their units. About 20 to 40 soldiers are evacuated from Iraq each month for serious mental health problems, said Col. Cameron Ritchie, an Army psychiatrist. As a result, one positive finding of the survey was that 95 percent of soldiers reported that mental health care was readily available to them. In another improvement, the stigma associated with seeking help also decreased, with 28 percent of soldiers expressing concern that they would be seen as weak if they did so, compared with more than 30 percent in the 2003 and 2004 surveys. Still, stigma remains a problem, with Army research showing that less than 40 percent of soldiers with mental disorders seek care. In an effort to prevent soldiers returning with combat stress from being overlooked, the Army is expanding a pilot program in which primary-care doctors at Army bases are taught to screen their patients for PTSD and then coordinate specialized care, even if the patient declines to see a mental health expert. So far, the program has screened more than 4,100 soldiers at Fort Bragg, N.C., with about 10 percent of those turning up positive for PTSD or depression, said Col. Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center. "Many people who are struggling with their emotions after a wartime experience have mixed feelings about seeking assistance," he said. "We have to reach out to soldiers" through their primary doctors, Engel said.   For more information, please contact Brian Altman at ACA at 800-347-6647, ext. 242 or by email at baltman@counseling.org December 19th ACA UPDATE: Congress Ends with Flurry of Activity, and Unfinished Business The 109th Congress officially adjourned in the wee hours of the morning on December 9th after a final spurt of legislation.    Appropriations On appropriations, Congress punted.  With nine of the fiscal year 2007 appropriations measures unfinished, Congress passed a stopgap spending measure, or continuing resolution, funding all remaining programs—including those falling under the Departments of Labor, Health and Human Services, and Education—at the lowest of the House-passed, Senate-passed, or previous year funding level until February 15th of 2007.   Incoming Senate and House Appropriation Chairmen, Robert Byrd (D-WV) and David Obey (D-WI), announced in December that they will not seek to pass the remaining nine FY 2007 appropriations bills individually when the new Congress convenes in January. Instead, they will craft what is known as a “joint funding resolution” to fund federal agencies and programs until the end of FY 2007 (i.e., September 30, 2007). In addition, instead of passing a continuing resolution (CR), which provides a set amount of funding (currently set at  the lowest of the House-approved, Senate-approved, or FY 2006 level), the joint funding resolution would be a specific document that may provide additional money where necessary to keep agencies and programs operating. An assessment of needs will be conducted at the departmental and agency level and could possibly include individual programs.   Medicare Congress also passed Medicare legislation in the final hours of the session.  Facing a December 31st deadline to forestall a five percent physician pay cut under Medicare, Congress attached Medicare provisions to an unrelated tax and trade measure (H.R. 6111).  The bill does not include any provisions allowing additional providers to bill Medicare, or establishing coverage of additional services.  Although ACA is disappointed that reimbursement of licensed professional counselors was not included in the bill, Congressional sources have indicated that this was not due to policy objections.  Rather, counselor reimbursement and similar improvements in Medicare simply fell by the wayside as legislators scrambled to put together a bill in the last hours of the session.   Passage of the Medicare provisions actually makes it a virtual certainty that Congress will again consider Medicare legislation in 2007.  The physician payment issue was addressed only by postponing cuts for one year, and legislators are still interested in establishing pay-for-performance standards for medical care paid for by Medicare.  Democrats have also expressed strong interest in altering aspects of Medicare’s prescription drug coverage. ACA greatly appreciates the efforts of our champions on this issue during the 109th Congress.  Senators Craig Thomas (R-WY) and Blanche Lincoln (D-AR), as well as Rep. Barbara Cubin (R-WY) are to be applauded for their leadership in sponsoring the “Seniors Mental Health Access Improvement Act” (S. 784/H.R. 5324), focusing on coverage of licensed professional counselors and marriage and family therapists under Medicare.  A total of six bills were introduced in the 109th Congress that would have established Medicare coverage of licensed professional counselors, demonstrating an unprecedented level of awareness and support for our issue.  ACA will continue to prioritize this issue, and we are optimistic for our chances of success next year.  Mental Health Parity Although comprehensive mental health parity was not enacted during the 109th Congress, the tax and trade bill did include a one year renewal of the 1996 Mental Health Parity Act.  This law prohibits private sector health plans from setting annual and lifetime dollar limits for coverage of mental health services which are separate from and unequal to dollar limits for general medical services coverage.  ACA and other mental health advocacy organizations have long pushed Congress to enact full mental health parity legislation to prohibit other discriminatory insurance practices.  Unfortunately, the Republican leadership in the House of Representatives refused to bring the full parity bill (H.R. 1402) to the floor for a vote, despite the bill having more than 218 cosponsors.  Speaker-elect Nancy Pelosi has stated her intention to bring a mental health parity bill to the House floor for a vote in the 110th Congress.  Underage Drinking Bill Passed Another bill passed by Congress before adjournment was H.R. 864, the "Sober Truth on Preventing Underage Drinking (STOP) Act."  The bill was sponsored by Representative Lucille Roybal-Allard (D-CA), and authorizes several programs and activities aimed at preventing under-age drinking.  Under one of these, the Secretary of Education will administer a new $5 million per year program (subject to appropriations) of grants to prevent and reduce alcohol abuse at institutions of higher education.   The bill also requires the Secretary of Health and Human Services to issue an annual report card rating the performance of each State in enacting, enforcing, and creating laws, regulations, and programs to prevent or reduce underage drinking.  The Department of Health and Human Services will also be required to conduct or support research on underage drinking, including the impact alcohol use and abuse has upon adolescent brain development, the scope of the underage drinking problem, and progress in preventing and treating underage drinking. December 11 ACA Update - ACA Claims Major Legislative Victory for Counselors! Dear ACA Member: The Veterans Affairs (VA) health care system will soon be opened up to the counseling profession. In the final minutes of the legislative session, the 109th Congress passed legislation explicitly recognizing licensed professional counselors as health care providers within the VA health care system, which will allow counselors access to better paying jobs as mental health specialists, with the potential for promotion into supervisory positions. Passage of the legislation-the "Veterans Benefits, Health Care, and Information Technology Act of 2006," S. 3421-follows years of work by ACA and the American Mental Health Counselors Association to gain recognition of licensed professional counselors within the VA. Although rehabilitation counselors are recognized within the VA, licensed professional counselors have had only a limited role as mental health providers. Currently, the VA cannot hire counselors for mental health professional positions at the same pay grade as clinical social workers, nor can licensed professional counselors apply for supervisory positions open to clinical social workers and others. Pending signing of the legislation into law and the development of regulations, however, these roadblocks will disappear. ACA thanks-and congratulates!-those counselors who have advocated with us on this issue over the years, and encourages members to keep up-to-date on the implementation of the new policy by visiting our website, at www.counseling.org/publicpolicy. Full coverage on this topic will appear in the next issue of Counseling Today. Regards, Marie A. Wakefield ACA President 2006-2007 December 1 ACA UPDATE: Updated Student-to-Counselor Ratio Chart   The ratio of students to school counselors in U.S. elementary and secondary schools dropped slightly this year.  ACA's Office of Public Policy and Legislation has updated its chart showing state and national student-to-school counselor ratios.  The chart, based on recently released information from the U.S. Department of Education's National Center for Education Statistics, shows the current U.S. student-to-counselor ratio is 479:1, down from 488:1 last year.   The current chart is based on the total number of students enrolled in public elementary and secondary schools and the total number of "guidance counselors" employed in public schools during fall of the 2004-2005 school year. While the overall number of students enrolled in grades PreK-12 grew in size from the 2003-2004 school year, twenty-six states showed a decrease in student population.  The number of school counselors increased in most states, with Florida, Louisiana, and Texas gaining more than 150 counselors each.  Fifteen states showed a decrease in the number of school counselors, New Jersey having the greatest loss.  They showed a drop of 1,291 counselors although they had an increase of over 2,000 students, upping their student-to-counselor ratio from 376:1 to 585:1. The five states with the highest student-to-counselor ratios:  California 990:1, Minnesota 795:1, D.C. 775:1, Arizona 772:1, and Utah 746:1. The five states with the lowest student-to-counselor ratios (excluding Rhode Island):  Louisiana 218:1, Wyoming 218:1, Vermont 231:1, New Hampshire 251:1, and Hawaii 279:1.  Also available are the updated student-to-counselor ratio charts for elementary and secondary schools. These charts are available on ACA's webpage at: http://www.counseling.org/PublicPolicy/TP/ResourcesForSchoolCounselors/CT2.aspx.