Like nearly all state systems in this profession, in New York there are levels to credentialing. At every level there are certain requirements that must be met in order to obtain credentialing, and certain privileges that counselors can gain. This is all outlined in the latest OASAS Substance Use Disorder (SUD) and Problem Gambling (PG) Counselor Scope of Practice document (2/24).
Why scope of practice rules are necessary
Scope of practice rules are put in place to prevent incompetent practice and protect both patients and counselors. It's an effort to prevent the harm that can come to patients and counselors from having unqualified healthcare workers in positions they lack the education and experience to hold. The scope of practice also outlines the expectations and limits of a healthcare worker's specific role. For instance, the scope of practice for a Substance Use Disorder Counselor in New York allows them to discuss MAT (Medication Assisted Treatment) options with their patients, but it does not allow counselors to prescribe those medications as they're not trained to do so. This protects patients from potential harm.
Another important area where the scope of practice protects patients is diagnosis. SUD Counselors are trained and authorized to diagnose substance use disorders and screen for and discuss mental health issues (especially with patients who have co-occurring disorders). SUD Counselors are also mandated to screen for medical issues and diseases during assessment. During treatment, SUD Counselors are allowed to discuss medical issues with their patients in circumstances where medical issues may be causing their patients distress that leads to the use drugs and/or alcohol. A counselor may also discuss these medical and mental health issues with patients for the purpose of providing referrals to licensed medical or mental health professionals. However, SUD Counselors are not allowed to diagnose mental health disorders nor medical conditions.
The scope of practice rules pertain to clinical supervision as well. This is done to protect counselors from the harm that can occur by being placed under the supervision of people who are not adequately trained and experienced. The NYS OASAS scope of practice document for CASACs states that only a person with at least an Associate degree in a related healthcare field, and at least the CASAC-II credential, can supervise counseling staff. Such a person has earned that right by putting in the hard work to earn experience hours and higher education.
The scope of practice rules are intended to be adhered to. Unfortunately, some facilities don't follow the scope of practice rules as they should.
Credentialing levels for New York Substance Use Disorder Counselors
An uncredentialed person is not recognized by OASAS as a QHP (Qualified Health Professional) and is not authorized to perform supervision of any kind.
CASAC-T - This acronym means 'Credentialed Alcoholism and Substance Abuse Counselor-Trainee.' This is the lowest level credential. Educationally, it requires only a high school diploma/GED. In addition, this credential level requires the completion of the 350 clock hours of the standardized curriculum set forth by NYS OASAS, a background check, and completion of one-time education requirements which are additional courses required by OASAS.
A counselor at this level is not recognized by OASAS as a QHP (Qualified Health Professional) and is not authorized to perform supervision of any kind.
CASAC-P - The acronym for this newer and widely misunderstood level stands for 'Credentialed Alcoholism and Substance Abuse Counselor-Provisional.' This credential requires a Bachelor's degree or higher in a related field, completion of the 350 clock hours of the standardized curriculum as set forth by NYS OASAS, a background check, completion of one-time education requirements which are additional courses required by OASAS, and a signed 'Verification of Employment/Intent to Hire' form from the supervisory staff of an OASAS-approved facility.
This means that in addition to completing a minimum of 4 years of collegiate education that culminated in a Bachelor's degree, a person pursuing the CASAC-P must then clear the extra one-time OASAS education requirements, successfully land a position in the field, and secure the written endorsement of an already-established supervisory-level clinician in the profession.
It's interesting to point out that the Bachelor's degree requirement for the CASAC-P is higher than the requirement for both the CASAC-I and the CASAC-II. The CASAC-I only requires a high school diploma/GED. The CASAC-II requires only an Associate degree in a related field.
A counselor at this level is not recognized by OASAS as a QHP (Qualified Health Professional) and is not authorized to perform supervision of any kind.
CASAC (sometimes referred to as CASAC-I) - This is the lowest level of final credentialing for an addiction counselor in New York state. Only those without a college degree receive it. To obtain it, a person must complete all of the requirements stated in the previously mentioned levels (with the exception of the CASAC-P degree requirement), complete all 6,000 hours of supervised practice, pass the IC&RC examination, and obtain two 'Evaluation of Ethical Competency and Ethical Conduct' forms from those in clinical supervisory positions.
A counselor at this level is not recognized by OASAS as a QHP (Qualified Health Professional), and is not authorized to perform supervision of any kind.
CASAC-II - This is the second level of final credentialing. To obtain it, a person must have at least an Associate degree in a related field, and have completed all of the requirements stated in the lower credentialing levels.
A counselor at this level is not recognized by OASAS as a QHP (Qualified Health Professional). However, they are authorized to perform administrative supervision.
A counselor at this level is recognized by OASAS as a QHP (Qualified Health Professional) and is authorized to perform both clinical and administrative supervision.
CASAC Master - This is the 4th and highest level of final credentialing. To reach this level, a person must earn a Master's degree or higher in a related field, have completed all of the requirements stated in the previously mentioned levels, and maintain their CASAC credentialed status for the past three years.
The CASAC-G
The CASAC-G acronym stands for 'Credentialed Alcoholism and Substance Abuse Counselor-Gambling.' It's not a standalone credential. It's a specialization rather than its own credential level. To obtain it, a counselor must complete the 60 hours of problem gambling core curriculum training. To activate it after completion, a counselor must be at least credentialed at the CASAC-I level. In addition, holders of the CASAC-G can only provide gambling addiction counseling within a program certified to offer gambling addiction treatment.
The impact of higher education on training hours
As previously noted, addiction counselors in New York are required to complete 6,000 hours of supervised training in order to reach final credentialing. NYS OASAS has crafted a system that rewards clinicians who have put in the hard work and expense of higher education. This system awards work experience credit to counselors, reducing the number of hours required to reach final credentialing. The system works as follows:
- An Associate degree in an approved healthcare field reduces the requirement by 1,000 hours
- A Bachelor's degree in an approved healthcare field reduces the requirement by 2,000 hours
- A Master's degree in an approved healthcare field reduces the requirement by 4,000 hours
OASAS has raised the bar
You may find some counselors at the Advanced CASAC level with an Associate degree as OASAS permitted that at one time. Over the years, OASAS has raised the bar. As of this writing, counselors at the Advanced CASAC level must hold at least a Bachelor's degree in a related field.
My thoughts on the CASAC leveling system
The more we know, the higher the quality of care we can deliver for our patients.
Higher education is the way forward
With drug and alcohol abuse remaining at alarming rates, we can't combat the problem without a robust workforce of well-educated, highly qualified, devoted clinicians. My hope is that more colleges and universities follow the direction and spirit OASAS has demonstrated. More degree programs in addiction—particularly at the Master's and Doctoral level—is the direction we need to be moving in, and it's long overdue. And, at the end of that, employers in the field should be providing well-educated counselors with wages and salaries that are more commensurate to the work and expense it took for them to reach those levels. This will incentivize higher quality professionals to enter the field and stay in the field, greatly reduce the long-standing issue of high turnover, deepen the profession's knowledge base, and enhance the quality of care that our patients receive.