Credentialing Determination Request Inst r uctions

REQUIRMENT:

Credentialing forms and unofficial transcripts (if applicable) are required from applicants who are applying for a position at the Health Department that require the following:

QMHA Qualified Mental Health Associate

QMHP Qualified Mental Health Professional

LMP Licensed Medical Professional (Behavioral Health)

CADC Certified Alcohol & Drug Counselor (I, II, III)

PURPOSE:

Credentialing forms are used to determine credentialing qualifications.

COMPLETING THE FORM:

The top portion of the form requires your name, the date that you are completing the form, the classification that you are applying for and the credentialing status that you are applying for. You do not need to indicate the name of the supervisor if you do not know it.

Education

If you have a degree, list the name(s) of the college or university that you earned your degree(s) at, the major/minor, degree earned, and the month/year that the degree was awarded.

If you have education that did not result in a degree being awarded, indicate the college or university, major/minor, but leave the degree earned and date(s) columns blank.

If you are currently working on a degree, indicate the college or university, major/minor, leave the degree earned column blank and indicate the date that it is anticipated that the degree will be awarded.

Licenses / Certifications

If you have a license or certification that is relevant to the credentialing that you are applying for, indicate if the license or certification is current or not, the type of license (e.g. CADC, LCSW, LPC, RN) and the expiration date of the license. You do not need to indicate licenses or certifications such as CPR, AED, drivers license, etc., that are not relevant to the position.

Experience

You should document any experience that you may have that is relevant to the position and credentialing status that you are applying for. Indicate the name of the position or title, the employer or location, the start and end dates and the hours per week that you worked while gaining the experience.

Competencies

The next sections of the form is for you to list any training, education and/or experience that you have in specific areas, which are required competencies of each credential. These are the competencies that prior employers will be rating if we call for references. If you are a successful candidate, we will use this information in determining if you have the required competencies for the credentialing status that you are applying for. There may be additional practical exams or interview questions that will also help us determine competencies.

Applicant Signature

When you have completed the Credentialing Determination Request form, finish up by signing and dating the form.

COMPLETED FORMS:

Submit the completed Credentialing Determination Request with your application.

TRANSCRIPTS:

Submit copies of your transcript (do not submit official transcripts) with your application. If you are chosen to fill the position that you are applying for, you will be required to submit the official transcript within 30 days from the date of hire.

QMHA – Submit copies of transcript that indicate that you have earned a Bachelor’s degree in a behavioral health field (see below). If you do not have a degree in a behavioral health field, you must indicate a minimum of 3 years of relevant training, education and/or experience.

QMHP – Submit copies of transcript that indicate that you have earned a Master’s degree in a behavioral health field (see below). You do not need to submit transcript for your Bachelor’s degree.)

LICENSES / CERTIFICATIONS:

If you have a license or certification that will be considered for determining credentialing, submit it with your application.

QMHP – If you have a license such as a LCSW that requires a Master’s degree, or have a Registered Nursing license, you should submit a copy of the license with your application and credentialing form. If you have such a license, you do not need to submit a copy of your Master’s degree transcripts.

CADC (I, II, III) – If you are applying for a position that requires a CADC you must submit a copy of your certification with your application and credentialing form.

TRAINING:

You do not need to attach proof of training that is listed on your credentialing form. If you are a successful candidate, we may request proof prior to making a job offer.

QUESTIONS: If you have questions regarding the completion of the Credentialing Determination Request or the documents that may need to be attached, please contact Karri Tinney at (503) 373-3776.

Behavioral Health Credentialing Definitions and Qualifications

Qualified Mental Health Associate

An individual must meet the following minimum qualifications to be credentialed as a Qualified Mental Health Associate (QMHA):

"Qualified Mental Health Associate" or "QMHA" means a person delivering services under the direct supervision of a Qualified Mental Health Professional (QMHP) and meeting the following minimum qualifications as documented by the provider:

(a) A bachelor's degree in a behavioral sciences field; or

(b) A combination of at least three year's relevant work, education, training or experience;

AND

(c) Has the competencies necessary to:

(1) Demonstrate the ability to communicate effectively;

(2) Understand mental health assessment, treatment and service terminology and apply each of these concepts;

(3) Implement skills development strategies and identify, implement and coordinate the services and supports identified in an Individual Service and Support Plan (ISSP).

Calculation of education , training and experience will be determined using the following formulas:

Coursework : 13 credits = 1 year

Coursework in behavioral science, i.e., psychology, counseling

Training : 450 hours = 1 year

Relevant training in behavioral health science areas

Experience : 2080 hours = 1 year

Relevant experience in behavioral health field (Experience working with Individuals with Developmental Disabilities and in Alcohol & Drug field may count as half depending on actual work duties)

Qualified Mental Health Professional

An individual must meet the following minimum qualifications to be credentialed as a Qualified Mental Health Professional (QMHP):

"Qualified Mental Health Professional" or "QMHP" means a Licensed Medical Practitioner (LMP) or any other person meeting one or more of the following minimum qualifications as authorized by the LMHA or designee:

(a) Bachelor’s degree in nursing and licensed by the State of Oregon;

(b) Bachelor’s degree in occupational therapy and licensed by the State of Oregon;

(c) Graduate degree in psychology;

(d) Graduate degree in social work;

(e) Graduate degree in recreational, art, or music therapy; or

(f) Graduate degree in a behavioral science field.

AND

(g) Has the competencies necessary to:

(1) Demonstrate the ability to conduct an assessment, including identifying precipitating events, gathering histories of mental and physical health, alcohol and other drug use, past mental health services and criminal justice contacts, assessing family, cultural, social and work relationships, and conducting a mental status examination, complete a five-axis DSM diagnosis, write and supervise the implementation of an Individual Service and Support Plan (ISSP) and provide individual, family or group therapy within the scope of their training.

*Marion County Health Department direct service personnel with QMHP status prior to April 2, 1996 who do not meet the revised QMHP criteria outlined in the revised OAR, Medicaid Payment for Rehabilitative Mental Health Services Rule, effective April 2, 1996, have been grandfathered under the current QMHP definitions.

Licensed Medical Practitioner

An individual must meet the following minimum qualifications to be credentialed as a Licensed Medical Practitioner (LMP):

"Licensed Medical Practitioner" or "LMP" means a person who meets the following minimum qualifications as documented by the Local Mental Health Authority (LMHA) or designee:

(a) Physician licensed to practice in the State of Oregon; or

(b) Nurse Practitioner licensed to practice in the State of Oregon; or

(c) Physician's Assistant licensed to practice in the State of Oregon

AND

(d) Whose training, experience and competence demonstrate the ability to conduct a mental health assessment and provide medication management.

For ICTS and ITS providers, LMP means a board-certified or board-eligible child and adolescent psychiatrist licensed to practice in the State of Oregon.

Pending CADC

An individual must meet the following minimum qualifications to be credentialed as a Pending CADC:

(a) Completion of all educational requirements for entry-level certification of a certifying body accepted by the state of Oregon (ACCBO, NAADAC or the Northwest Indian Alcohol and Drug Specialist Certification Board) at the time of hire. At the time of hire, the supervisor will formulate a plan for the employee to complete the necessary contact and supervision hours to obtain certification within 6 months from the date of hire.

(b) The employee will obtain CADC 1 within 1 year from date of hire.

CADC I

An individual must show proof of CADC I certification through the Addiction Counselor

Certification Board of Oregon (ACCBO).

CADC II

An individual must show proof of CADC II certification through the Addiction Counselor Certification Board of Oregon (ACCBO).

CADC III

An individual must show proof of CADC III certification through the Addiction Counselor Certification Board of Oregon (ACCBO).

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