Up here in North Dakota, where we get around on sled dogs and live in igloos year-round, there are 38 LMFTs to serve a large, rural state. With high occurrences of substance use disorders, mental health conditions, and family and trauma-related stressors, there is often significant distance between clients and the nearest mental health practitioner. Despite lacking mental health provider access statewide, our profession has struggled to gain reimbursement and provider status of our allied professionals, making the already difficult work of MFTs in North Dakota more challenging.
In North Dakota, legislative sessions are held every other year which results in an intense session for the house and senate representatives. This legislative session, a bill was proposed with a tier system that would have placed MFTs below our master’s educated allied professionals. There was reasonable concern that this might be used in the future for reimbursement and defining of qualifications for mental health professionals, which would have been immeasurably detrimental to MFTs. To further complicate this impending challenge to our practice, the North Dakota division of AAMFT (NDAMFT) had a complete change in officers in October, 2016 (right before the legislative session), making legislative efforts and advocacy an even more daunting task.
Thankfully, AAMFT’s advocacy team helped NDAMFT solidify our goals for the legislative session and identify the steps we could take to protect our profession in ND. With their help and guidance, our small division in North Dakota quickly learned some of the necessary language and skills to combat this unjust tier system placement. AAMFT also helped us hire a lobbyist, a task that would have been impossible without the Practice Protection Fund. Without this financial assistance and guidance from AAMFT, there is no doubt that MFTs would have remained on a tier beneath our other master’s educated allied professionals, perhaps changing the trajectory of the profession for the worse in North Dakota.
Together with our AAMFT advisors, lobbyist, and the grassroots efforts of our small membership, we crafted an amendment for this bill and created template letters and guides for our membership and allies to unify our message to the legislature. In our efforts to gain approval for our amendment, we held weekly strategy meetings with our lobbyist and AAMFT, made our presence known at hearings (even when we could not testify), wrote testimony, gave oral testimony, created fact-sheets comparing the profession to allied professions, and started utilizing grassroots outreach. Due to the small number of MFTs in the state, allied professionals, hospital administrators, and professors were recruited to help advocate for our profession (sometimes more than once for the same message to be conveyed).
Our experience during this session could only be described as a roller coaster. The Senate denied our amendment, which was later approved by the house after oral and written testimony from MFTs and allied professionals. The bill had to be heard in a conference committee due to continued opposition by some of the senate members. During these hearings, we were able to turn to some of the long standing MFTs in our state, some of which hold positions on our licensure board, to attest to facts and dispel myths about MFT qualifications. This effort was a turning point on the conference floor, and our amendment was approved and signed by our governor after a lengthy and heart-wrenching session. LMFTs are now listed on the same tier as Licensed Independent Clinical Social Workers and Professional Clinical Counselors. One of the main lessons we learned during this session is the imperative need for interim work with the legislature to advocate for the profession before a bill is drafted.
Looking back at this whirlwind of a session, NDAMFT is incredibly grateful to have had the guidance and support of AAMFT in strategizing and accessing the Practice Protection Fund. With this, we were able to access an excellent lobbyist who knew our state’s legislature well and was as dedicated to our goals as we were throughout the session. We are proud to have had their support that will help advance our profession up here in North Dakota!
Shauna Erickson M.S., LMFT, Division President