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The Counselor, Social Workers, and Marriage and Family Therapist (CSWMFT) Board has proposed changes to the Ohio Administrative Code rules discussed below. The rules are scheduled for a public hearing on April 23, 2024, and public comments are due by this date. Please reach out to BMD Member Daphne Kackloudis for help preparing comments on these rules or for additional information.

OAC 4757-5-02 (Standards of Ethical Practice and Professional Conduct: Clients/Consumers of Services)

Under the revised rule, when licensees and registrants provide services in public settings (including residential or institutional settings, or similar locations where confidentiality cannot be maintained), the licensee or registrant must obtain written consent from the client or guardian, or verbal consent if written consent is not possible, prior to providing services. Further, the rule prohibits licensees and registrants from duplicating professional services to a current or prospective client who is receiving treatment from another provider. Providers are required by this rule to determine the appropriateness of potential duplication of services regardless of the funding source for client treatment.

Additionally, when a client discloses that they are receiving treatment from another licensed professional for the same or similar presenting issues, to minimize potential confusion in treatment and avoid duplicate billing, licensees and registrants should consider the client’s needs and the nature of the presenting treatment issues prior to providing services or treatment. The licensee or registrant must discuss these issues with the prospective client.

Further, the rule prohibits licensees and registrants from using without the written consent of the client or guardian identifiable information; videos or pictures of clients; or pictures, videos, or other representations of work product created during treatment in advertisements, social media, or other promotional materials. The consent should outline the terms of use, the media for distribution and time period of potential use, and the process for terminating consent. In obtaining consent, licensees and registrants must clearly communicate that consent is voluntary.

Finally, the revised rule states that any physical touching of clients must occur with the consent of the client and be within practice standards at the time services are rendered.

OAC 4757-5-03 (Standards of Ethical Practice and Professional Conduct: Multiple Relationships)

The revised rule adds the requirement that licensees and registrants decline gifts from a client. Examples of gifts may include, but are not limited to food, material goods, gift certificate/gift card, artwork or products resulting from treatment. A licensee may accept a gift of nominal value if the licensee determines that, for treatment reasons, not accepting the gift will result in diminishing the licensee’s ability to provide appropriate client care. In accepting a gift of nominal value, the license must discuss with the client the ethical limitations of accepting gifts.

OAC 4757-5-09 (Standards of Ethical Practice and Professional Conduct; Record Keeping)

For each client/consumer of services, a licensee or registrant must keep records and case notes for seven years. Records and case notes should include the dates of counseling, social work, marriage and family therapy services, art therapy, and music therapy services; types of counseling, social work, marriage and family therapy, art therapy, or music therapy services; and billing information. However, client records are no longer required to include a brief summary of the session. OAC 4757-5-11 (Standards of Ethical and Professional Conduct: Change of Name and/or Address). Under the rule, all licensees or registrants are required to notify the Board of any changes of name or mailing address within 45 days of the change. Previously, they were required to notify the board within 90 days.

OAC 4757-11-03 (Internal Records Management to Maintain Confidentiality)

The revised rule adds language that all investigatory records are considered confidential and access to these records is strictly on a need-to-know basis. Staff should not have access to the investigation records without the prior approval of the executive director, the executive director's designee, the board chair, or the vice chair of the board.

OAC 4757-17-01 (Counseling Supervision)

The revised rule sets forth a new definition of clinical/work supervision. Clinical/work supervision is supervision required of licensed professional counselors whose practice includes the diagnosis and treatment of mental and emotional disorders.

Clinical/work supervision requires the evaluation of the supervisee's performance; professional guidance to the supervisee; approval of the supervisee's intervention plans and their implementation; the assumption of responsibility for the welfare of the supervisee's clients; and assurance that the supervisee functions within the limits of the supervisee's license.

The assessment, diagnosis, treatment plan, revisions to the treatment plan, correspondence and transfer or termination of the client(s) must be approved by the supervisor and shall be made available to the board upon request. Licensed professional counselors must disclose to their clients on all printed and electronic material that they are under the supervision of an appropriately licensed mental health professional when diagnosing and treating mental and emotional disorders.

The revised rule also contains new definitions of training supervision, individual supervision, and group supervision.

• Training supervision is supervision of all individuals who are gaining the experience required for a license as a licensed professional clinical counselor, or a license as a licensed professional counselor, or a counselor trainee registered with the Board and enrolled in a practicum or internship class. Training supervision is provided for the purposes of obtaining a license and/or development of new areas of proficiency while providing services to clients. The training supervisor is responsible for providing direction to the supervisee, who applies counseling theory, standardized knowledge, skills, competency, and applicable ethical content in the practice setting. The supervisor and the supervisee both share responsibility for carrying out their role in this collaborative process of professional growth and development. Supervision must start with an initial face-to-face meeting, which may be conducted via videoconferencing, after which communication may be in person, via videoconferencing, or by phone. Training supervision must include an average of one hour of contact between the supervisor and supervisee for every twenty hours of work by the supervisee.
• Individual supervision consists of an interactive face-to-face meeting between one supervisor and no more than two supervisees.
• Group supervision consists of an interactive face-to-face meeting with one supervisor and no more than eight supervisees.

The revised rule removes the requirement that, when the training supervisor and licensed professional counselor are employed by the same agency, the licensed professional clinical counselor with supervision designation is responsible for all diagnoses, change in diagnoses, individualized services plans, and correspondence to any third party outside of the agency. The revised rule also adds language that supervisors have no obligation to maintain supervision records, however supervisors may do so to ensure they are able to properly document supervision hours. Further, the supervision records can now be acknowledged by the supervisor quarterly (but the rule doesn’t define what “acknowledged” means).

Upon completion of the required supervision hours to qualify for a licensed professional clinical counselor license, the licensed professional counselor must now request that the licensed professional clinical counselor with supervision endorsement who last provided training supervision submit all accrued training supervision hours to the Board using their designated form. In submitting the hours (after all training supervision requirements have been met), the supervisor must review the log maintained by the licensed professional counselor and also consider any notes or recommendations of previous supervisors when submitting the evaluation. In submitting the hours, the supervisor is not obligated to provide a recommendation for independent licensure if the supervisor has determined the supervisee is not qualified at that time for independent practice.

Additionally, the revised rule adds language that a licensed professional clinical counselor may provide clinical/work supervision to licensees of the Ohio Chemical Dependency Professionals Board when such licensees are working solely with substance use disorder clients. The licensed professional clinical counselor who does so must have the appropriate education, training and supervised experience in substance use disorder practice.

Finally, a licensed professional counselor, when working only with substance use disorder clients, but not dual-diagnosis clients, may receive clinical/work supervision from a licensed independent chemical dependency counselor or licensed independent chemical dependency counselor clinical supervisor licensed by the Ohio Chemical Dependency Professionals Board.

OAC 4757-21-01 (Scope of Practice for a Registered Social Work Assistant)

Under the rule, a social work assistant may work under the direct supervision of an advanced practice registered nurse-clinical nurse specialist or advanced practice registered nurse-certified nurse practitioner who is certified in psychiatric-mental health by the American Nurses Credentialing Center. The revised rule removes the ability for a registered nurse who holds a master's degree in psychiatric nursing to directly supervise a social work assistant.

OAC 4757-23-01 (Social Work Supervision)

The revised rule adds new requirements for the clinical supervision for social workers:

• The supervisor must have access to the supervisee's client documentation.
• Supervision must occur on a regular and consistent basis, such that the supervisor can evaluate the client’s progress and the performance of the supervisee.
• The clinical/work supervisor will review the case notes of the licensed social worker.
• The assessment, diagnosis, treatment plan, revisions to the treatment plan, correspondence and transfer or termination of the client(s) shall be approved by the supervisor.

Further, licensed social workers must disclose to their clients on all printed and electronic material that they are under the supervision of an appropriately licensed mental health professional when diagnosing and treating mental and emotional disorders.

The revised rule also sets forth new definitions of training supervision, individual supervision, and group supervision.

• Training supervision means supervision for the purposes of obtaining a license and/or development of new areas of proficiency while providing services to clients. The training supervisor is responsible for providing direction to the supervisee, who applies social work theory, standardized knowledge, skills, competency, and applicable ethical content in the practice setting. The supervisor and the supervisee both share responsibility for carrying out their roles in this collaborative process of professional growth and development. Training supervision may be individual supervision or group supervision. Supervision must start with an initial face-to-face meeting after which communication may be in person, via videoconferencing, or by phone.
• Individual supervision consists of an interactive face-to-face meeting between one supervisor and no more than two supervisees.
• Group supervision consists of an interactive face-to-face meeting with one supervisor and no more than eight supervisees.

Additionally, under the revised rule, social workers engaged in social psychotherapy in an agency setting can now be supervised by an advanced practice registered nurse-clinical nurse specialist or advanced practice registered nurse-certified nurse practitioner who is certified in psychiatric-mental health by the American Nurses Credentialing Center.

Further, training supervision of licensed social workers by licensed independent social workers with a supervision designation requires the supervisor to complete and forward to the Board all supervision evaluations within 30 days of completing supervision with a supervisee. Previously, the supervisor had to complete and forward to the board all supervision evaluations within 30 days of receipt of the form from their supervisee.

The revised rule also allows a licensed independent social worker to provide clinical/work supervision to licensees of the Ohio Chemical Dependency Professionals Board when such licensees are working solely with substance use disorder clients. The licensed independent social worker who does so must have the appropriate education, training and supervised experience in substance use disorder practice. A licensed social worker, when working with solely substance use disorder clients, but not dual-diagnosis clients, may receive clinical/work supervision from a licensed independent chemical dependency counselor or licensed independent chemical dependency counselor clinical supervisor licensed by the Ohio Chemical Dependency Professionals Board. Further, while supervisors have no obligation to retain supervision records, they may do so to ensure they are able to properly document supervision hours. Upon completion of the required supervision hours to qualify for a licensed independent social worker license, the licensed social worker should request that the licensed independent social worker with supervision endorsement who last provided training supervision submit all accrued training supervision hours to board using the logs maintained by the supervisee. The supervisor shall submit the training supervision hours using the online form provided by the board. Supervisors who fail to timely submit supervision hours upon a request by a supervisee may be subject to disciplinary action.

Lastly, the revised rule adds language that a licensed social worker may not be in solo private practice. A licensed social worker must be employed or contracted with an agency, practice, or independently licensed professional who can provide clinical/work supervision in accordance with this rule.

OAC 4757-29-01 (Marriage and Family Therapy Supervision)

Under the rule, an independent marriage and family therapist may provide clinical/work supervision to licensees of the Ohio Chemical Dependency Professionals Board when such licensees are working solely with substance use disorder clients. The independent marriage and family therapist who does so must have the appropriate education, training and supervised experience in substance use disorder practice. A marriage and family therapist, when working with solely substance use disorder clients, but not dual-diagnosis clients, may be supervised by a licensed independent chemical dependency counselor or licensed independent chemical dependency counselor clinical supervisor licensed by the Ohio Chemical Dependency Professionals Board.

Please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com with any questions.