Expand Your Practice With the Counseling Compact

After years of preparation, the Counseling Compact recently began issuing privileges to practice in the states of Arizona and Minnesota. This means that Counselors who live in and are licensed in Arizona can apply for privileges in Minnesota, and vice versa. The Compact Commission and boards are making the technology and system preparations necessary to issue privileges in other compact states, and new opportunities to apply for privileges will be announced as they become available. For Counselors intending to diversify or expand their practice, the Counseling Compact offers new and unprecedented opportunities.

Amanda DeDiego, PhD, NCC, BC-TMH, ACS, LPC, ART, has researched the Counseling Compact extensively and is lead author of the article "Counseling and the Interstate Compact: Navigating Ethical Practice Across State Lines” published in The Professional Counselor journal.

“The compact is a really exciting opportunity for our field as a whole in terms of mental health professionals,” says Dr. DeDiego. “We’ve made a lot of progress and are some of the first to establish these interstate compacts in the mental health realm. For Counselors, the Compact offers a lot of opportunities to expand their reach.”

At a fundamental level, the Counseling Compact offers the opportunity for Counselors to live and work in different communities. But what does that look like in practice? Counselors practicing under the Counseling Compact have opportunities for working both in person and via telehealth.

“I think telehealth is going to be probably the most practical and common use of the Compact, being able to provide services in my neighboring states to be able to diversify my practice,” says Dr. DeDiego.

However, the Compact also offers advantages for Counselors focusing on in-person services. In particular, the Compact provides greater flexibility and convenience for Counselors living near a state border or those who frequently relocate, such as military spouses.

“Part of the impetus behind the Compact was related to our military service families, and them having to relocate to different states due to their military service and, potentially, spouses of those individuals having a lot of barriers to being able to get licensed in different states for maybe a couple of months at a time,” says Dr. DeDiego.

In addition to these briefer periods working outside one’s home state, the Counseling Compact can make permanent relocation easier for any Counselor who needs to move between states.

“You’re going to be able to consider a lot more options in terms of geographic availability and potentially portability and moving to different states,” explains Dr. DeDiego. “The nice thing under the Counseling Compact is that you can have a home state license, you can get privilege to practice in another state within the Compact system [that is actively issuing privileges], and then you can transfer your home license to that other state.”

In addition to these benefits, Dr. DeDiego imagines new opportunities that were totally unavailable to Counselors previously.

“There would be potentially some opportunities for something like a traveling Counselor,” she says. “Just like we have traveling nurses who do filling in of needs in areas for a temporary period of time, the Counseling Compact would actually open that up as an option for Licensed Professional Counselors to come in for 6 weeks at a time, fill some gaps, provide some services and then travel back home.”

For some Counselors, the Counseling Compact may be the reason to enter into telehealth practice for the first time. This requires some preparation, but the opportunities are well worth it, explains Dr. DeDiego.

“I think that it’s definitely intimidating if you’re a clinician who’s never practiced via telehealth before and it’s important to seek some training, consultation, or mentorship from individuals who have practiced via telehealth before,” she says. “But the really nice thing about adopting telehealth practice is you expand your reach and you expand your possibilities when it comes to your services. For example, maybe where you live, there’s a really saturated market when it comes to your specialty, but in rural communities, that specialty can be something that’s desperately needed.”

For Counselors who wish to specialize in a narrow focus, this expanded reach might make it possible. Reaching a wider audience via telehealth under the Counseling Compact can make a specialty practice sustainable in a way it might not be in a limited geographic area. This increased access to specialty services benefits the public, too, explains Dr. DeDiego.

“Broader availability of specialty services is such a game changer,” she says. “It’s literally lifesaving. I live in a predominantly rural state and, just to give a really practical example, it’s incredibly hard to find anybody who has specialized in treating eating disorders. There just is no one. If I all of a sudden have all of these other referral options to individuals who have a lot more training in eating disorders than I have, then that allows me to not feel like I have to try to put together with scissors and tape enough services to meet the entirety of my community’s needs.”

The Counseling Compact offers a great opportunity for Counselors looking to expand their business as well as their reach and expertise. This in turn benefits communities and clients, explains Dr. DeDiego.

“From a business perspective as a private practice, I’m no longer limited by geography,” says Dr. DeDiego. “We might have options to build a really robust practice community that includes clinicians from different states with different specialty options. And so now instead of operating in isolation, I have this entire network of individuals within my own practice that I can tap into, and I can connect with, and I can refer to. So, there’s a lot of benefit for the community and there’s a lot of benefit for the clinicians to be able to expand their skill set, be able to get exposure to expertise that they don’t otherwise have available, which makes you stronger as a clinician, therefore serving the community better.”

At its core, the Compact makes practicing across multiple states easier. A Counselor using a privilege to practice in other states only needs to fulfill licensure renewal requirements in their home state. This will be a great relief to Counselors who would otherwise need to juggle licensure requirements in multiple states.

When practicing under Compact privileges, Counselors should be aware of the ethical and legal requirements for practicing between states in order to avoid any issues. This includes complying with state laws in any state where a Counselor provides services. For some states, a privilege to practice requires taking the relevant jurisprudence examination. However, even if that isn’t required, a Counselor must understand and comply with the relevant laws. 

“If I’m going to be practicing in multiple states, I need to have working knowledge of the scope of practice, of the laws, of the things that govern my practice in those different states,” explains Dr. DeDiego. “Claiming that I don’t know the rules is not an excuse for breaking the rules. And the cool thing about the Compact is that we’ve got this centralized database across the country to track disciplinary action. So, if I violate ethics or I violate the law in different states, everybody knows about it. It impacts not just my license in that state where I have a privilege, but privilege for all of it.” At its core, this serves to protect clients.

Among other common topics, clinicians should be familiar with the age of medical consent laws, confidentiality laws, and mandated reporting laws, all of which vary from state to state.

“The compact makes privileges super easy, but there are a lot of things that need to be considered prior to actually using those to practice in multiple states” says Dr. DeDiego. “They’re not really hard barriers, but they’re things that we’re going to have to think through and work through and plan for.”

She suggests that now, while waiting for additional states to roll out Compact privileging, is a great time to research laws and regulations in the states that a Counselor plans to work in. Counselors can begin crafting a professional disclosure statement for each state, one that reflects those laws and regulations and that informs clients of how to report concerns when a Counselor is practicing under privilege rather than a license in that state.

Another ethical obligation for Counselors is to create a safety plan, which requires unique considerations when working via telehealth.

"If I had a client in my office who’s in crisis or potentially suicidal or homicidal, I might feel very confident in how to approach that situation,” says Dr. DeDiego. “If the client is maybe in a different state, I have to make sure—and I have an ethical obligation to know—what the local resources are, how my client is going to access those resources, and to put together a risk management or suicide safety plan as part of my common practice when I work via telehealth.”

Outside of legal and ethical concerns, Counselors should be prepared for the practical considerations of working in multiple states.

“Working within the Counseling Compact to get privileges does not automatically make you in-network or paneled with insurance providers in that particular state,” explains Dr. DeDiego. “Medicare is a federal system. You don’t run into as many barriers billing for folks that are located in different states. But in a lot of private insurance, and certainly in Medicaid, there’s going to be a secondary step for you to apply for in-network status.”

Dr. DeDiego suggests that Counselors research insurance requirements in advance of applying for the privilege to practice. Dealing with insurance makes additional work for Counselors, but brokering services exist that can help with paneling.

Counselors are accustomed to navigating ethical and legal requirements in order to provide safe and effective services, and in that way, working under the Counseling Compact is nothing new. The opportunities it provides, however, are unlike any previously available.

“It’s a super exciting time in our field, because right around the same time that we became recognized entities within the federal Medicare system, now we have this ability to work in different states and have easier portability of licensure,” says Dr. DeDiego. “It’s a huge advancement in the field and one that has been in progress in some form or fashion for probably at least 15 years. And there’s so many people who have contributed their effort and energy and advocacy work to make this happen. And now as a profession, we get to embrace these new opportunities . . . and make sure that we’re innovating and growing in ways that serve the community in the best way possible.”

To stay up to date on the latest information about the Counseling Compact, watch the “Unpacking the Counseling Compact” series.

Amanda DeDiego, PhD, NCC, BC-TMH, ACS, LPC, ART, is Interim Dean of University of Wyoming Casper and an Associate Professor of Counseling at the University of Wyoming. She received a PhD in Counselor Education from the University of Tennessee and an MS in Community Counseling from the University of North Georgia. As a researcher, she is committed to exploration of contributors to health disparities in mental health care at various systemic levels and understanding issues of health equity for marginalized and underserved communities. This includes exploring creative tools, interventions, and innovative counselor training approaches to help best meet the needs of diverse populations. She has over 10 years of clinical experience treating mental health conditions and an established record of research including quantitative, qualitative, mixed methods, and program evaluation. She is also a practicing Licensed Professional Counselor and licensed auricular acupuncturist with Winds of Change Therapy, in Casper, Wyoming. 

**Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.