10.58.07.02

.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Accredited educational institution" means a Board-approved college or university that is accredited by a national or regional accrediting body recognized by the Council on Post-Secondary Accreditation or through one of the following bodies recognized by the U.S. Department of Education:

(a) The Middle States Association of Colleges and Schools — the Commission on Higher Education;

(b) The New England Association of Schools and Colleges;

(c) The North Central Association of Schools and Colleges;

(d) The Northwest Association of Schools and of Colleges and Universities;

(e) The Southern Association of Colleges and Schools; or

(f) The Western Association of Colleges and Schools.

(2) "Appraisal" means:

(a) Selecting, administering, scoring, and interpreting instruments designed to assess an individual’s aptitudes, attitudes, abilities, achievements, interests, and personal characteristics; and

(b) Using nonstandardized methods and techniques for understanding human behavior in relation to coping with, adapting to, or changing life situations.

(3) "Approved alcohol and drug counselor supervisor" means a Board-approved:

(a) Licensed clinical alcohol and drug counselor;

(b) Health-care provider:

(i) Licensed under the Health Occupations Article, Annotated Code of Maryland; and

(ii) With 3 years of documented experience in alcohol and drug counseling;

(c) Certified professional counselor-alcohol and drug;

(d) Certified associate counselor-alcohol and drug with 3 years of documented experience in alcohol and drug counseling;

(e) Licensed clinical professional counselor;

(f) Licensed clinical marriage and family therapist; or

(g) Licensed clinical professional art therapist.

(4) "Biopsychosocial evaluation" means a comprehensive assessment of the patient addressing the following areas:

(a) Physical health;

(b) Employment or financial support;

(c) Drug and alcohol use;

(d) Treatment history;

(e) Legal history;

(f) Familial and social relationships;

(g) Educational background; and

(h) Mental health.

(5) "Case management" means the provision of services which assist participants in gaining access to:

(a) The full range of substance abuse services; or

(b) Any additional needed medical, social, financial assistance, counseling, educational, housing services.

(6) "Clinical supervision" means that the supervisor:

(a) Controls the supervisees’ work, and provides face-to-face or immediately available supervision;

(b) Evaluates completed work for technical soundness, appropriateness, and conformity to policy and requirements; and

(c) Confirms that all diagnoses are clinically supported by appropriate criteria, as:

(i) Defined in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases and Related Health Problems (ICD); and

(ii) Documented by signature and credentials.

(7) "Close supervision" means that the supervisor:

(a) Closely controls the supervisees’ work, and provides direct, face-to-face, or on-site supervision;

(b) Maintains control through review of case management and progress notes, treatment plan reviews, and other documentation as appropriate;

(c) Evaluates completed work for accuracy, detail, and adherence to instructions and established procedures; and

(d) Reviews and approves content for all diagnostic impressions and new treatment plans, as documented by signature and credentials.

(8) "Co-occurring disorders (CODs)" means the occurrence in any individual, simultaneously or sequentially, of two or more somatic or behavioral health disorders which may imply an interaction between the disorders that affect the course and prognosis of each diagnosis.

(9) "Diagnosis" means the identification of psychological problems, emotional, or mental disorders by a licensed clinician, using specified terms and criteria identified in the current editions of the:

(a) Diagnostic and Statistical Manual of Mental Disorders (DSM); or

(b) International Classification of Diseases and Related Health Problems (ICD).

(10) "Direct clinical counseling services" means the provision of face-to-face clinical professional counseling services to clients and their significant others that include, but are not limited to the following:

(a) Individual counseling;

(b) Group counseling;

(c) Family counseling;

(d) Couples counseling;

(e) Evaluation;

(f) Intake or Assessment;

(g) Diagnosis;

(h) Treatment planning with a client; and

(i) Crisis management or intervention.

(11) "Direct supervision" means supervision provided by a supervisor who is present on the premises where services are provided, and is available for consultation within the treatment area.

(12) Face-to-Face.

(a) "Face-to-face" means in the physical presence of an individual or using video conferencing which allows individuals to hear and see each other in synchronous points of time.

(b) "Face-to-face" does not include:

(i) Telephone supervision; or

(ii) Internet communication that does not involve synchronous video conferencing, such as instant messaging services and social networking sites.

(13) "Health and human services counseling field" means a specific degree program with a counseling emphasis, including but not limited to the following areas:

(a) Addictions counseling, including:

(i) Alcohol and drug counseling;

(ii) Substance abuse counseling; or

(iii) Chemical dependence counseling;

(b) Counseling practiced under Health Occupations Article, Title 17, Annotated Code of Maryland, including:

(i) Professional counseling;

(ii) Marriage and family therapy; or

(iii) Art therapy;

(c) Practice areas of other mental health care providers, including, but not limited to:

(i) Psychiatry;

(ii) Psychology;

(iii) Social work; or

(iv) Psychiatric nursing;

(d) Other academic concentrations in the health and human services field, including, but not limited to:

(i) Human services;

(ii) Behavioral health or behavioral sciences;

(iii) Rehabilitation counseling;

(iv) Counselor education;

(v) Counseling psychology; or

(vi) Human development.

(14) "Immediately available supervision" means supervision provided by a supervisor who is instantly available:

(a) In person;

(b) By telephone or other electronic means; or

(c) By designation of one or more supervisors in the absence of the supervisor of record.

(15) "Indirect clinical counseling services" means all case management and professional development activities related to the provision of clinical professional counseling services to a client that include but are not limited to the following:

(a) Referral;

(b) Intake or assessment by telephone or other means when client is not face-to-face;

(c) Receiving individual and group supervision on-site or at a university;

(d) Consultation with other professionals;

(e) Treatment planning with other professionals;

(f) Case staffing;

(g) Staff meetings;

(h) Related trainings and seminars;

(i) Record keeping;

(j) Report writing;

(k) Case note taking;

(l) Providing clinical training;

(m) Telephone triage;

(n) Case management;

(o) Program development; and

(p) Other clinical professional counselor administrative duties as required by the setting in which the clinical hours are accrued.

(16) "Licensed graduate alcohol and drug counselor" means an individual approved by the Board to practice graduate alcohol and drug counseling under the supervision of an approved alcohol and drug counselor supervisor while fulfilling the supervised clinical experience for licensure under:

(a) Health Occupations Article, §17-302(e), Annotated Code of Maryland; and

(b) Regulation .04 of this chapter.

(17) "Moderate supervision" means that the supervisor:

(a) Controls the supervisee’s work and provides face-to-face or immediately available supervision;

(b) Ensures that completed work and methods used are technically accurate and in compliance with instructions or established procedures;

(c) Provides more intense review for difficult assignments, if the supervisee has not previously performed similar assignments; and

(d) Reviews and approves content for all diagnostic impressions and new treatment plans, as documented by signature and credentials.

(18) Ongoing Process of Supervision.

(a) "Ongoing process of supervision" means that the supervisor is available to provide support for the supervisee’s day-to-day practice of alcohol and drug counseling, throughout the course of the supervisee’s scheduled work hours;

(b) "Ongoing process of supervision" includes close, moderate, or clinical supervision of an individual or a group.

(19) "On-site supervision" means supervision provided by a supervisor who is:

(a) Physically present in the facility where patient or client services are rendered; and

(b) Able to respond in person without delay.

(20) Participating in the development of diagnostic impressions.

(a) "Participating in the development of diagnostic impressions" means gathering information to support a diagnosis through:

(i) Screening and assessment activities;

(ii) Observations of signs and symptoms;

(iii) Reports of behaviors;

(iv) Collateral information acquired with the appropriate release; and

(v) The identification of specific disorders to be ruled out by the diagnosing clinician.

(b) "Participating in the development of diagnostic impressions" does not include diagnosis.

(21) "Practice clinical alcohol and drug counseling" means to engage professionally and for compensation in alcohol and drug counseling and appraisal activities by providing services for individuals, couples, families and groups involving:

(a) The application of counseling principles; and

(b) Methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions.

(22) "Psychotherapy" means providing clinical services which involve:

(a) The professional application of psychotherapy and counseling theories and methods, including but not limited to psychodynamic, cognitive, behavioral, humanistic, systems theories, or trauma informed care to assist the client in:

(i) Improving functioning;

(ii) Obtaining symptom relief;

(iii) Preventing psychosocial dysfunction;

(iv) Changing personality; or

(v) Maintaining improved functioning; and

(b) Situations in which the principal discourse involves, but is not limited to:

(i) Diagnosis of psychopathology based on standard diagnostic criteria;

(ii) Psychotherapeutic treatment of mental disorders, emotional disorders, and adjustment reactions utilizing clinically appropriate treatment modalities;

(iii) Childhood trauma and abuse;

(iv) Identifying and changing self-defeating patterns of behaving, thinking, feeling, believing, or interacting with others in systems;

(v) Developmental issues;

(vi) Personality development; or

(vii) Problems related to disorders of thinking, emotional suffering, addictions, behavior, or interpersonal dysfunctions.

(23) "Relative" means an individual connected to another by:

(a) Blood;

(b) Marriage;

(c) Guardianship; or

(d) Domestic partnership.

(24) "SBIRT" means Screening, Brief Intervention, and Referral to Treatment, including the following practices:

(a) Screening which quickly assesses the severity of substance use and identifies the appropriate level of treatment;

(b) Brief intervention which focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change; and

(c) Referral to treatment which provides individuals identified as needing more extensive treatment with access to specialty care.

(25) "Scope of competence" means that area within which the individual is proficient to practice based on:

(a) Education;

(b) Training;

(c) Supervised clinical experience; and

(d) Professional credentials.

(26) "Substance use disorders (SUDs)" means any problematic pattern of substance use leading to clinically significant impairment or distress, which is diagnosed using specified terms and criteria identified in the current editions of the:

(a) Diagnostic and Statistical Manual of Mental Disorders (DSM); or

(b) International Classification of Diseases and Related Health Problems (ICD).

(27) "Supervised clinical experience in alcohol and drug counseling" means alcohol and drug counseling services provided under the close or moderate supervision of an approved licensed or certified alcohol and drug counselor supervisor.

(28) "Supervisee" means any of the following who obtains the supervised clinical experience required by Health Occupations Article, §17-302, Annotated Code of Maryland:

(a) A licensed graduate alcohol and drug counselor;

(b) A certified associate counselor-alcohol and drug;

(c) A certified supervised counselor-alcohol and drug; or

(d) An alcohol and drug trainee.

(29) Supervision.

(a) "Supervision" means a formalized professional relationship between a supervisor and supervisee that involves:

(i) Directing, guiding, monitoring, instructing, and evaluating the supervisee’s alcohol and drug counseling practice throughout an ongoing process of supervision; and

(ii) Utilizes close, moderate, or clinical levels of supervision.

(b) "Supervision" includes an acceptance of direct responsibility for the patient services rendered by the supervisee, including continuous availability to the supervisee:

(i) In person;

(ii) Through written instructions;

(iii) By telephone or other electronic means; or

(iv) By designation of one or more supervisors in the absence of the supervisor of record as defined in Regulations .13—.16 of this chapter.

(30) "Trauma informed care" means including in treatment an approach that:

(a) Engages people with histories of physical, sexual, emotional, or mental trauma in a manner that recognizes the:

(i) Presence of a trauma history;

(ii) Consequences of the trauma; and

(iii) Neurological, biological, psychological, and social effects of trauma for the affected individual; and

(b) Addresses the vulnerabilities or triggers for these individuals while minimizing any harm.

(31) "Under the supervision of an approved alcohol and drug counselor supervisor" means:

(a) Engaging in an ongoing process that includes direct, on-site, face-to-face individual or group meetings focused on quality of delivery of alcohol and drug counseling services;

(b) Monitoring the performance of a:

(i) Licensed graduate alcohol and drug counselor

(ii) Certified associate counselor-alcohol and drug;

(iii) Certified supervised counselor-alcohol and drug; or

(iv) Alcohol and drug trainee;

(c) Providing documented and direct consultation, guidance, and instruction with respect to clinical skill and competency; and

(d) Improving counseling skills for a minimum of:

(i) 1 documented hour for each 40-hour work week; or

(ii) Not less than 2 documented hours per month for less than a 40-hour work week.

(32) "Written contract for supervision" means a Board-approved agreement between the supervisee and approved alcohol and drug supervisor that is initiated before beginning supervision and that details the scope of supervision and includes at a minimum the following:

(a) Name and credentials of the supervisor and the supervisee;

(b) Primary purpose, goals, and objectives of the supervision process;

(c) Details of provisions, including frequency, format, and case or chart review;

(d) Methods of documentation;

(e) Duties and responsibilities of the supervisor and the supervisee;

(f) Procedural considerations in the case of the supervisor’s absence; and

(g) Information regarding the supervisor’s scope of competence.