Credentialing and Other Issues in Life Care Planning
Credentialing in support of one’s professional work in health-care-related fields has exploded with an apparent increasing array of certifications, licenses, educational degrees, and registrations available. Many credentials are backed by research, accreditation, and role and function studies, while others seemingly appear overnight with no apparent foundation for establishing credibility. Included in the previous statement is the nonaccredited and, in some instances, bogus degrees (doctorates included). Nonetheless, life care planners seem to be attracted to enhancing their list of credentials and willingly pay the associated costs.
Further complicating this issue is the apparent diversity of professional disciplines that is represented by the life care planners observed over the years (e.g., physicians, psychologists, certified rehabilitation counselors, nurses, occupational therapists, speech pathologists, social workers, and others). While this short post will not include a list of credible versus noncredible credentials, some hints or issues will be offered.
In the beginning, counselors, psychologists, and most other professions were unregulated. One could hang out a shingle advertising that he or she was, for an example, a barber and dentist. As time passed, more and more people formed organizations and set professional standards (T. Field, personal communication, November 7, 2007) or promoted protecting practice through implementation of laws or establishing certifications that would hopefully be required for employment in targeted settings. States began implementing laws intended to protect the welfare of their constituents. For example, all states require licensure to practice in the life care planning-relevant professions of physicians, nurses, and psychologists. Many states have licensure requirements for counselors, allied health therapists, prosthetists and orthotists, and others. However, there is no state that requires one to be licensed, registered, or certificated to prepare life care plans, though some businesses may require specific credentials.
Licenses, the most restrictive credential for rehabilitation professions, are issued by government entities and are expected to protect the health and welfare of citizens (Matkin, 1995). Licenses are typically thought of as being issued by states, but the federal government also grants licenses (such as the FCC). For purposes of life care planning, no state issues a license for life care planners, but an individual’s credential may require licensure, such as physician, nurse, or psychologist. A few states require rehabilitation counselors to be licensed if they offer services within the scope of practice as defined by the state. Although most professionals reading this post will know whether they are covered by licensing laws and regulations, one will need to determine if there are different requirements with moves from one state to another state. The primary issue is that, unlike certification or registration, one who is required to be licensed to practice, but is not, can be denied the opportunity to work within his or her profession. However, a person who completed medical school, for instance, but is not licensed as a physician could seemingly potentially be qualified to work as a life care planner as long as he or she does not practice medicine as defined by law. Note that some states have a title protection act and others have a practice protection act. In the State of Georgia, professional counseling has a practice protection law, which means that if one performs services as defined in the law as professional counseling, one must be licensed. In a title protection state, one may practice psychology, but may not call himself or herself a licensed psychologist unless licensed by that state.
Certification is described as a process by which an organization (governmental or nongovernmental) recognizes an individual for having met certain predetermined professional qualifications (Matkin, 1995). Organizations that certify individuals can be profit, nonprofit, or governmental but are not regulated by the government (CRCC, 2009a). The organizational structure can run the gamut from being governed by a single individual or controlled by a group overseen by an outside organization. Some certifications can be related to meeting extensive qualifications and passing a written or oral examination, or can be as simple as related to the work setting. For example, the first author is a certified educator by the National Council on Rehabilitation Education (NCRE), which means that he is employed 20 hours or more in an educational institution teaching rehabilitation counseling. (Note: the website, www.rehabeducators .org, on January 2, 2009 states,
“Membership structure is currently being revised. New information and application materials will be posted at the end of July, 2008,” so changes may be revealed soon, though 6 months later than indicated, no news was posted.) The NCRE may presume that for one to be employed by an institution of higher learning, the person’s credentials meet the intended criteria so no additional scrutiny is necessary.
Some organizations are structured such that the board or commissioners are elected or appointed representatives from groups that support the certification. For example, the Commission on Rehabilitation Counselor Certification (CRCC) consists of appointees from nine organizations and one public member (CRCC, 2009b). Also, in terms of history, the CRC, established in the mid-1970s, is one of the oldest certifications in the rehabilitation consulting arena, predating the nationally certified counselor (NCC), among other well-established credentials. At the other extreme, some certifications are offered by organizations that are effectively controlled by one person, which may or may not have a board or a group of commissioners.
The point of this discussion is that most, if not all, life care planners possess at least one certification, and the person may acquire highly valued certifications with a substantial history, with an extensive research base (including role and functions studies), and which enjoy a credible reputation throughout the membership or by stakeholders. Or, one may pay for a certification which has no real foundation or value when closely scrutinized. In the authors’ opinion, one way to assure basic credibility is to determine if the organization is accredited by the National Organization for Competency Assurance (NOCA), the parent company for the National Commission for Certifying Agencies (NCCA), which accredits certification organizations complying with its standards. As stated, “The mission of NCCA is to help ensure the health, welfare, and safety of the public through the accreditation of certification programs/organizations that assess professional competence” (NOCA, 2007, p. 1). In these authors’ opinion, it seems that if an organization is accredited by NCCA, then there is a mechanism by which the organization’s standards, by-laws, policies and procedures, and overall credentialing process have been determined satisfactory (approved) and there is ongoing review and evaluation by NCCA for reaccreditation. There may be other accrediting bodies that support a certification, but one would be advised to make sure the statement “accredited by” has validity and is not simply another shell of an organization that is intended to give the impression of legitimacy. The authors recognize that other evidence of credibility can be located and the expectation is that the reader will exercise due diligence before paying fees. One further note: certification does not stop one from practicing a profession, but does prohibit what one can call himself or herself. For example, one may practice rehabilitation counseling, but may not call himself or herself a Certified Rehabilitation Counselor (CRC) unless the Commission on Rehabilitation Counselor Certification’s requirements are met and the individual has been granted certification status through the CRCC.
In general, the authors summarize the previous information within a checklist format in Table below.
Registration is a term that can refer to someone who is either licensed or simply registered with an organization that represents a particular profession (e.g., licensing related to Registered Nurse or Occupational Therapist/Registered). As Matkin (1995) observes, “Registration is closely related to certification and licensure, in that once these forms of credentials are issued, the professional becomes listed by name and other pertinent information among other similarly designated members of a specialty. Thus a registry is a document that assists the public to identify qualified practitioners or businesses to perform specific services” (pp. 396—397). At one time, the primary author was registered within a state professional organization as a “qualified rehabilitation professional.” The purpose was to establish the basic credentials of rehabilitation counseling in a state that did not require licensure and to encourage insurance companies to only pay for the services of people who joined the voluntary registry. Although there was no examination, in order to be called a qualified rehabilitation professional certain credentials had to be met. At the time, numerous people of dubious qualifications were attempting to claim that they were qualified to work with people who were injured at work in order to be paid through the state’s workers’ compensation system. Another example in the State of Georgia is the “registered rehabilitation supplier” list maintained by the Georgia State Board of Workers’ Compensation, which indicates that individuals (both nurses and rehabilitation counselors) who are registered with the state (and pay an annual fee) have had their credentials reviewed and are deemed eligible to provide rehabilitation services to injured workers who are receiving Georgia state workers’ compensation benefits.
■S Is the organization not-for-profit or for-profit? (Comment: not-for-profits on the surface enjoy an appearance of better credibility or face validity than for-profit organizations. However, that business structure by itself is not a determining factor.)
■S Is the organization owned by an individual (profit or not-for-profit)? (Comment: an entity owned by an individual is less desirable.)
■S Is the organization run by elected or appointed commissioners, or is it effectively run or controlled by an individual? Do the commissioners serve “at the pleasure of” the owner? (Comment: an independent board or group of commissioners is desirable.)
■S Is the certification based upon research and a reliable role and function study? (Comment: preferably with approval and oversight by a university institutional review board.)
■S Does one need to pass a legitimate examination to become certified? (Comment: whether oral or written, there should be evidence that the exam, if one is required, is based on research. Attention should also be given to certificants who were “grandfathered” at the time they were certified, which implies they did not have to pass an examination to obtain certification.)
■S Do organizations that offer continuing education recognize the certification such that they offer credits for training? (Comment: if one attends several conferences and there are no available continuing education credits for a particular certification, it may mean that the credential is not valued.)
■S Are policies and procedures accessible to review before seeking certification, and do they protect stakeholders by providing for due process? Or can the owner, board, or commissioners take action for purported transgressions without notice to, or participation of, the certified professional? (Comment: it seems reasonable to expect that a consistent due process policy is in force, and NCCA standards require due process. See next question.)
■S Is the certification accredited by the National Commission for Certifying Agencies (NCCA) or another legitimate accreditation-related entity? (Comment: although the authors do not believe that this provision is a necessity, the oversight is desirable for organizations that offer certifications.)
Gianforte (1976, as cited in Matkin, 1995) noted that there can be state or national registries, with the advantage that national registration leads to reciprocity throughout the country whereas state registries may not extend beyond the borders of the respective state.
Accreditation can refer to educational institutions or other organizations. As noted previously, NCCA accredits organizations that meet certain standards. The operative word here is organization since the program or educational offerings are accredited whereas certification applies to individuals. Within educational institutions, accreditation can be numerous. For example, the university where the authors teach is accredited not only as a university, but the specific rehabilitation counseling program is also accredited by the Council on Rehabilitation Education (CORE). Further, some of the classes also meet the requirements for accreditation in school counseling, professional counseling, and school psychology. With regard to life care planning, the standards of rehabilitation counselor training identify knowledge content areas that include the mandate to teach life care planning elements as part of the rehabilitation counselor training program (CORE, 2008).
At the other extreme of programs accredited by well-established accreditation agencies are sham degrees offered by so-called universities that deliver, for a price, an impressive degree including, in some cases, transcripts (Bear & Bear, 2004). The degree may appear to be from an impressive university like Harvard, or a name very close to a recognized educational institution (in spelling or perhaps a slightly different name). Other such degrees are obtained through highlighting one’s experiences or attending a few classes that somehow meet the requirements for a doctorate. It is not uncommon for bogus degrees to claim they are accredited by equally bogus accreditation agencies. For anecdotal examples, the following is offered.
Several years ago, one rehabilitation-related organization began offering a doctorate but when the state officials in which the business was located were notified, an investigation revealed that state requirements for an educational institution were not met and they were forced to close. In another case, a person who claimed that he possessed a degree from a university and had several years of testifying to such achievement was pressed to provide proof. As it turned out, he did not have the degree to which he testified, which unraveled several settled litigation cases. Last, another testifying expert listed a PhD, which, when evaluated, was from an unaccredited program and the purported coursework additionally was not related to rehabilitation consulting or the area to which the PhD was claimed.
The authors hasten to add that in spite of some of the problems and issues listed previously, there are trustworthy and fully accredited undergraduate, graduate, and doctoral programs, including emerging and established distant learning and online educational offerings.
In summary, accreditation defines the requisite knowledge content areas to be offered by training and educational programs responsible for preparing individuals to enter an occupation (Matkin, 1995).
For the specialty practice of life care planning, certifications abound and are not regulated by governmental agencies. Each has its own requirements—and costs—which in some cases simply constitute an economic enhancement to the person(s) who owns the business. Others are substantial, well-researched, long-standing certifications from organizations that are NCCA accredited or are well recognized within the rehabilitation profession. (For example, CORE requires that a CRC coordinate accredited graduate rehabilitation counseling programs.) Further, registries and educational institutions may or may not be legitimate and, in some ways, “caveat emptor,” or let the buyer beware. Historically, in these authors’ opinion, one could assert certain achievements and perhaps successfully work without being caught. However, with the vast improvements in searching the Internet and increasing abilities of rehabilitation professionals, attorneys, and others to discover these data, it seems increasingly difficult for life care planners to fudge their credentials. Before one commits to a certification, registration, or degree program to support one’s contention that they are qualified as a life care planner, it is suggested that some of the concerns, guidelines, observations, issues, and such items as previously listed be considered.