Performance audit and sunset review, Arizona Board of Behavioral Health Examiners: a report to the Arizona Legislature

              A REPORT
TO THE
ARIZONA LEGISLATURE
Debra K. Davenport
Auditor General
Performance Audit and Sunset Review
Arizona Board
of Behavioral
Health Examiners
Performance Audit Division
August • 2012
REPORT NO. 12-03
The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of five senators and five
representatives. Her mission is to provide independent and impartial information and specific recommendations to improve the opera-tions
of state and local government entities. To this end, she provides financial audits and accounting services to the State and political
subdivisions, investigates possible misuse of public monies, and conducts performance audits of school districts, state agencies, and
the programs they administer.
The Joint Legislative Audit Committee
Audit Staff
Copies of the Auditor General’s reports are free.
You may request them by contacting us at:
Office of the Auditor General
2910 N. 44th Street, Suite 410 • Phoenix, AZ 85018 • (602) 553-0333
Additionally, many of our reports can be found in electronic format at:
www.azauditor.gov
Dale Chapman, Director
Jeremy Weber, Manager and Contact Person
Brian Miele, Team Leader
Rose Tarbell
Representative Carl Seel, Chair
Representative Tom Chabin
Representative Justin Olson
Representative David Stevens
Representative Anna Tovar
Representative Andy Tobin (ex officio)
Senator Rick Murphy, Vice Chair
Senator Andy Biggs
Senator Rich Crandall
Senator Linda Lopez
Senator David Lujan
Senator Steve Pierce (ex officio)
2910 NORTH 44th STREET • SUITE 410 • PHOENIX, ARIZONA 85018 • (602) 553-0333 • FAX (602) 553-0051
MELANIE M. CHESNEY
DEPUTY AUDITOR GENERAL
DEBRA K. DAVENPORT, CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
August 30, 2012
Members of the Arizona Legislature
The Honorable Janice K. Brewer, Governor
Mr. Kirk Bowden, Chair
Arizona Board of Behavioral Health Examiners
Ms. Debra Rinaudo, Executive Director
Arizona Board of Behavioral Health Examiners
Transmitted herewith is a report of the Auditor General, A Performance Audit and Sunset
Review of the Arizona Board of Behavioral Health Examiners (Board). This report is in
response to Laws 2008, Ch. 70, §4, and was conducted under the authority vested in the
Auditor General by Arizona Revised Statutes (A.R.S.) §41-1279.03. The Office of the Auditor
General has also conducted a sunset review of the Board pursuant to an October 26, 2010,
resolution of the Joint Legislative Audit Committee. This sunset review was conducted as part of
the sunset review process prescribed in A.R.S. §41-2951 et seq. I am also transmitting within
this report a copy of the Report Highlights for this audit to provide a quick summary for
your convenience.
As outlined in its response, the Board agrees with all of the findings and plans to
implement all of the recommendations.
My staff and I will be pleased to discuss or clarify items in the report.
This report will be released to the public on August 31, 2012.
Sincerely,
Debbie Davenport
Auditor General
Attachment
cc: Arizona Board of Behavioral Health Examiners Members
Board investigates complaints—The
Board is responsible for investigating
complaints against licensed behavioral
health professionals and taking
appropriate nondisciplinary and
disciplinary action, if necessary. The Board
investigates two types of complaints—
those received from the public and those
opened by the Board’s credentialing
committees. Four credentialing
committees, one for each behavioral
health discipline, assist the Board in
regulating the four licensed professions.
The committees may open complaints to
determine whether licensure applicants or
licensees renewing their license have
committed unprofessional conduct, such
as failing to disclose a criminal arrest on
the application form. The Board relies on
staff investigations and committee
recommendations in deciding whether to
dismiss complaints or take disciplinary
action.
Majority of complaints are not resolved
in a timely manner—We have found that
Arizona health regulatory boards should
resolve complaints within 180 days of
receiving them. However, the
median time it took the Board
to resolve complaints was 248
days for the complaints it
closed in 2010 and 2011, and
about 60 percent of these
complaints took longer than
180 days to resolve.
In one case involving a thera-pist’s
inappropriate activities
with a 16-year-old client, it
took the Board 4.5 months to
begin substantial investigative
work. It took another 4.5
months before the licensee
signed a consent agreement
that revoked his license.
2012
August • Report No. 12-03
Arizona Board
of Behavioral
Health Examiners
Our Conclusion
The Arizona Board of
Behavioral Health
Examiners (Board)
regulates the practice of
behavioral health
professionals by licensing
counselors, marriage and
family therapists, social
workers, and substance
abuse counselors, and by
investigating allegations of
unprofessional conduct
and ordering appropriate
discipline. The Board has
had problems with the
timeliness of handling
complaints caused by
delays in beginning
substantial investigative
work, commencing an
investigation when none
was needed, and
duplicating reviews of
cases proposed for
dismissal. As a result, the
majority of cases closed in
2010 and 2011 were
resolved more than 180
days after the complaint
was received. Although the
Board has already taken
steps to address some
timeliness issues, more
needs to be done.
REPORT
HIGHLIGHTS
PERFORMANCE AUDIT
Board should improve complaint resolution timeliness
The Board has authority to restrict, limit, or
summarily suspend a license if public
safety warrants emergency action, and the
Board acted quickly in five such cases in
2010 and 2011 where it determined that it
had sufficient evidence to pursue emer-gency
action prior to fully resolving the
complaint. In those cases, it took the
Board a median time of 26 days to
execute consent agreements to suspend
the licenses. In 2012, the Board revoked a
license only 4 days after receiving the
complaint, when the licensee signed a
consent agreement admitting to having
sexual relations with a client in prison and
indirectly giving money to the client.
Three factors hindered complaint-resolution
timeliness:
• The length of time before substantial
investigation began—There was a
delay in public complaints’ being
investigated, which board officials
attributed in part to not enough
investigative staff. Staff took a median
time of 174 days to begin substantial
investigative work on 21 public
complaints reviewed by auditors. This
Length of Time to Resolve Complaints
Calendar Years 2010 and 2011
223 Total Complaints
(90)
(63)
(56)
(14)
REPORT
HIGHLIGHTS
PERFORMANCE AUDIT
August 2012 • Report No. 12-03
A copy of the full report is available at:
www.azauditor.gov
Contact person:
Jeremy Weber (602) 553-0333
delay in investigating cases has also contributed
to the growing number of open cases. Between
2010 and 2011, the Board opened 83 more
complaints than it closed, and as of March
2012, the Board had 191 open complaints, 79 of
which had not been assigned to an investigator,
including 20 complaints that had been waiting
for over 1 year to be assigned.
• Opening cases that could have been dis-missed
without investigation—Historically, the
Board opened all complaints against its licens-ees,
including allegations that did not need to
be investigated because they did not constitute
violations of board statutes or rules.
• Duplicate reviews of complaint dismissals—
Complaints that are dismissed are first reviewed
by a credentialing committee and then forward-ed
to the Board for dismissal, which adds 30
days or more to the complaint-resolution pro-cess.
However, credentialing committees have
statutory authority to dismiss complaints.
The Board has taken steps to resolve complaints
more quickly but should take additional steps. In
May 2012, the Board directed staff to begin screen-ing
out complaints that do not need investigation,
and staff developed procedures to do the screen-ing.
The Board should also develop policies to allow
credentialing committees to dismiss more
complaints. In addition, the Board should analyze
its investigative staffing needs by continuing to
assess the efficiency of the investigation process,
determine the workload, and then determine staffing
needs.
Complaint priority not sufficiently based on the
level of risk to the public—Prior to the audit, the
Board lacked an adequate approach to prioritize
complaints based on risk to the public. For
example, a licensee’s sexual contact with a client
was assigned the same priority as borrowing money
from or socializing with a client. In June 2012, the
Board revised its procedures to use a more risk-based
approach to prioritizing complaints. Now,
complaints alleging conduct that poses an
imminent threat of substantial danger to public
safety have a high priority while potentially harmful
conduct that does not pose a substantial danger or
imminent threat has a medium priority. The Board
also revised its procedures to better monitor high-priority
complaints and ensure that investigative
work begins promptly.
Complaint resolution time sometimes
understated—For some complaints, we found that
the time it took for the Board to resolve the
complaint was understated in its database. This
was because board staff recorded the “closed”
date as the date the Board made a decision to
resolve the complaint rather than when the decision
was finalized. In 3 of 30 cases we reviewed, the
actual “closed” date was 1 to 2 months later than
what board staff had recorded. In two additional
cases, the “open” date was underreported by more
than 2 months because staff recorded the date that
they began to work on a case rather than the date
when a credentialing committee had officially
opened it. The Board has since adjusted its
procedures to clearly define when a complaint is
opened and closed.
Recommendations:
The Board should:
• Continue to screen and better prioritize com-plaints,
monitor high-priority complaints, and
ensure that complaint data accurately reflects
the time it takes to resolve complaints.
• Develop policies allowing credentialing commit-tees
to dismiss more complaints.
• Analyze investigative staffing needs by continu-ing
to assess the efficiency of the investigation
process, determine the workload, and then
determine staffing needs.
Arizona Board
of Behavioral
Health Examiners
TABLE OF CONTENTS
continued
Office of the Auditor General
page i
Introduction 1
Finding 1: Board should improve complaint resolution
timeliness 7
Board investigates complaints 7
Complaint resolution often untimely 8
Board should address factors contributing to untimely complaint resolution 10
Board should immediately investigate high-priority complaints and
better monitor their progress 14
Complaint data understated total time to resolve some complaints 15
Recommendations 16
Sunset Factors 17
Appendix A: Methodology a-i
Agency Response
Tables
1 License Types, Number of Active Licenses, and Education and Experience
Requirements for Licensure by Behavioral Health Profession
As of May 2012
(Unaudited) 3
TABLE OF CONTENTS
concluded
State of Arizona
page ii
Tables (Continued)
2 Schedule of Revenues, Expenditures, and Changes in Fund Balance
Fiscal Years 2010 through 2012
(Unaudited) 6
3 Number of Complaints Opened and Closed
Calendar Years 2010 and 2011 11
Figure
1 Length of Time to Resolve Complaints
Calendar Years 2010 and 2011 8
Board responsible for regulating licensed
behavioral health professionals
Board’s mission
Created in 1988, the Board’s mission is to establish and maintain standards of
qualifications and performance for licensed behavioral health professionals in
the fields of counseling, marriage and family therapy, social work, and
substance abuse counseling, and to regulate the practice of licensed
behavioral health professionals for the protection of the public (see textbox).
The Board accomplishes this mission by licensing behavioral health
professionals, investigating and resolving complaints, and disciplining violators.
The Board was originally established to offer voluntary certification to behavioral
health professionals. However, Laws 2003, Ch. 65, revised state laws to
require behavioral health professionals practicing psychotherapy to be
licensed beginning July 1, 2004.1 Statute exempts certain individuals from
licensure, including those employed by an agency licensed by the Arizona
Department of Health Services and individuals employed by the Arizona
Department of Economic Security or an agency it licenses.
The change from voluntary certification to licensure was initiated by a coalition
of professional associations representing the four professions regulated by the
Board. The coalition sought this change to better protect vulnerable clients
1 A.R.S. §32-3251 defines psychotherapy as “a variety of treatment methods developing out of generally
accepted theories about human behavior and development.”
page 1
Scope and Objectives
INTRODUCTION
The Office of the Auditor
General has conducted a
performance audit of the
Arizona Board of Behavioral
Health Examiners (Board)
pursuant to Laws 2008, Ch.
70, §4. This audit was
conducted under the
authority vested in the
Auditor General by Arizona
Revised Statutes (A.R.S.)
§41-1279.03. The Office of
the Auditor General has
also conducted a sunset
review of the Board
pursuant to an October 26,
2010, resolution of the Joint
Legislative Audit
Committee. This review
was conducted as part of
the sunset review process
prescribed in A.R.S. §41-
2951 et seq. This
performance audit and
sunset review addresses
the Board’s complaint
resolution process and
includes responses to the
statutory sunset factors.
Office of the Auditor General
Licensed behavioral health professionals
Counselors—Work with individuals, families, and groups to treat
mental, behavioral, and emotional problems and disorders.
Marriage and family therapists—Diagnose and treat mental and
emotional disorders within the context of marriage, couples, and
family systems.
Social workers—Counsel individuals, families, and communities,
and provide social service assistance through various
organizations, such as schools and public social agencies.
Substance abuse counselors—Counsel individuals and families
on addiction prevention, treatment, recovery support, and
education.
Source: Auditor General staff analysis of behavioral health professional associations’
Web sites.
page 2
State of Arizona
from unqualified professionals who were allowed to practice under the State’s
voluntary certification program. Further, Arizona was reportedly one of the few states
that did not require licensure. Laws 2003, Ch. 65, also made numerous changes to
the Board’s statutes. These changes included providing the Board with more
disciplinary options, expanding the Board’s ability to investigate complaints, and
establishing procedures for complaint hearings and due process for licensees.
Licensing requirements
General requirements for licensure are similar across all four professions that the
Board regulates and include: (1) obtaining an approved college degree; (2) passing
an approved exam, such as those from the National Board for Certified Counselors
or the Association of Social Work Boards; and (3) obtaining a certain amount of
supervised work experience when applying for a license to practice independently.
However, as shown in Table 1 (see page 3), the educational and supervision
requirements vary by profession as prescribed in the Board’s statutes and rules.
Statute also requires the Board to perform criminal background checks on applicants
before approving an initial license. As shown in Table 1, the Board had 8,639 active
licenses across the four professions as of May 2012.
Professionals licensed in another state who wish to practice in Arizona may apply for
a reciprocal license. According to A.R.S. §32-3274, the Board may issue reciprocal
licenses to behavioral health professionals if they are currently licensed or certified in
their particular behavioral health profession by another state regulatory agency at an
equivalent or higher practice level as determined by the Board. In addition to meeting
the State’s basic requirements for licensure as defined in statute, an applicant for a
reciprocal license must also be currently licensed or certified in the discipline applied
for and have been licensed at the same practice level for at least 5 years and have
engaged in the practice of behavioral health for at least 6,000 hours during those 5
years. Further, statute requires that there were minimum education, work experience,
and clinical supervision requirements in effect at the time the person was licensed or
certified by the other state regulatory agency and that the licensing or certifying state
agency verifies that the person met those requirements in order to be licensed or
certified in the other state.
Complaint investigation and discipline
The Board is responsible for investigating complaints against licensed behavioral
health professionals and taking appropriate nondisciplinary or disciplinary action, if
necessary. A.R.S. §32-3281 states that the Board may investigate any evidence that
appears to show that a licensee is or may be incompetent, guilty of unprofessional
conduct, or mentally or physically unable to safely engage in the practice of
page 3
Office of the Auditor General
Table 1: License Types, Number of Active Licenses, and Education and Experience
Requirements for Licensure by Behavioral Health Profession
As of May 2012
( Unaudited)
1 In addition to education and experience requirements, behavioral health professionals must also pass professional exams to
obtain a license.
2 Independent license that allows a licensee to practice without supervision.
Source: Auditor General staff analysis of A.R.S. §§32-3291 through 32-3321; Arizona Administrative Code R4-6-401 through R4-6-
707; and licensing data provided by board staff.
)
License Types
Number of
Active
Licenses
Education and Experience
Requirements for Licensure1
Counseling
Associate Counselor
814 Master’s degree or higher in counseling
Professional Counselor2
2,353 In addition to the above, 3,200 hours of supervised
work completed in no less than 2 years
Marriage and Family Therapy
Associate Marriage and
Family Therapist
129 Master’s degree or higher in a behavioral science with
specialized coursework in marriage and family therapy
Marriage and Family
Therapist2
316 In addition to the above, 3,200 hours of supervised
work completed in no less than 2 years
Social Work
Bachelor Social Worker
118 Bachelor’s degree in social work
Master Social Worker
1,259 Master’s degree or higher in social work
Clinical Social Worker2
2,028 Master’s degree or higher in social work and 3,200
hours of supervised work completed in no less than 2
years
Substance Abuse Counseling
Substance Abuse
Technician
34 Associate degree in chemical dependency or a
bachelor’s degree in behavioral science
Associate Substance
Abuse Counselor
193 Bachelor’s degree in a behavioral science and 3,200
hours of supervised work completed in no less than 2
years; or a master’s degree
Independent Substance
Abuse Counselor2
1,395
Master’s degree or higher and 3,200 hours of
supervised work completed in no less than 2 years
Total Active Licenses 8,639
behavioral health. Unprofessional conduct includes misrepresentation of a fact by an
applicant or licensee, either oral or written, and any conduct or practice that is
contrary to recognized standards of ethics in the behavioral health profession or that
constitutes a danger to the health, welfare, or safety of a client. In addition, A.R.S.
§32-3275 requires the Board to ensure that
license applicants have not engaged in any
conduct that would constitute grounds for
disciplinary action against a licensee. After
completing an investigation, the Board may
dismiss the complaint or take nondisciplinary or
disciplinary actions (see textbox).
In addition, the Board provides the public with
information about licensed behavioral health
professionals on its Web site. A search for
professionals retrieves their licensing status and
disciplinary history, including any pending
complaints. The Web site also informs the public
that they may call the board office to obtain
additional information about dismissed
complaints and nondisciplinary actions taken
against a professional.
Organization and Staffing
The Board consists of eight governor-appointed members, including one professional
member from each of the licensed professions and four public members. Board
members are eligible to serve two consecutive 3-year terms. The Board is assisted
in its duties by four credentialing committees as well as board staff led by an
executive director. Specifically:
• A.R.S. §32-3261 establishes four credentialing committees to represent each of
the licensed professions. Each committee consists of four professional
members, including the respective professional serving on the Board, and one
public member. Similar to the Board, committee members are appointed by the
Governor and may serve two consecutive 3-year terms. These committees
review initial and renewal license applications and recommend the approval or
denial of licenses to the Board. The committees also review complaint
investigations and make recommendations to the Board regarding complaint
dismissals and nondisciplinary or disciplinary actions.
• The Board was appropriated 17 full-time equivalent (FTE) staff positions for
fiscal year 2012. In addition to the executive director, the Board employs staff to
process license applications and renewals, investigate complaints, prepare
page 4
State of Arizona
Board’s nondisciplinary and disciplinary options
Nondisciplinary options
• Dismiss the complaint
• Issue a letter of concern
• Require continuing education
Disciplinary options
• Impose civil monetary penalties of up to $1,000 per violation
• Issue a decree of censure
• Impose a probation term
• Accept the voluntary surrender of a license
• Suspend, revoke, or deny licensure
Source: Auditor General staff review of A.R.S. §32-3281.
license application and complaint files for credentialing committee and/or board
review, and provide information to the public. As of June 2012, the Board had four
vacant positions that it reported were primarily dedicated to complaint
investigations.
Budget
The Board does not receive any State General Fund monies. Rather, the Board’s
revenue comes primarily from initial and renewal license application fees. The Board’s
initial license application fee is $250 plus an additional fee of either $100 for a license
to practice under direct supervision or $250 for a license to practice without supervision.
The fee for a biennial renewal license application is $350. The Board is also required
to remit 10 percent of all its revenues to the State General Fund. As shown in Table 2
(see page 6), during fiscal year 2012, the Board received approximately $1.7 million in
revenues and remitted nearly $175,000 to the State General Fund. The Board’s
expenditures were approximately $1.5 million in fiscal year 2012, with nearly 70 percent
of this amount spent for personnel costs, including employee-related costs. Specifically,
for fiscal year 2012, the Board’s personnel costs totaled more than $1 million, which is
within the Board’s authorized appropriation. This represented an increase of more than
$200,000 from the Board’s fiscal year 2011 personnel costs of nearly $800,000.
According to a board official, the increase in personnel costs was needed to fill critical
staff vacancies, for the legislatively authorized addition of an extra pay period to fiscal
year 2012, and for competitive staff salary adjustments to be comparable with staff
salaries at other Arizona regulatory boards. Finally, the Board’s end-of-year fund
balance has nearly doubled since fiscal year 2009, from $684,146 to more than $1.2
million at the end of fiscal year 2012.
page 5
Office of the Auditor General
page 6
State of Arizona
Table 2: Schedule of Revenues, Expenditures, and Changes in Fund Balance
Fiscal Years 2010 through 2012
(Unaudited)
1 Licenses and fees fluctuate because the Board renews licenses every 2 years and the number of license renewals varies.
2 As required by A.R.S. §32-3254, the Board remits 10 percent of all revenues to the State General Fund.
3 According to a board official, the increase in personnel costs was needed to fill critical staff vacancies, for the legislatively
authorized addition of an extra pay period to fiscal year 2012, and for competitive staff salary adjustments to be comparable
with staff salaries at other Arizona regulatory boards.
4 Amount primarily consists of transfers to the State General Fund in accordance with Laws 2010, 7th S.S., Ch. 1, §148; and
Laws 2011, Ch. 24, §§108, 129, and 138 to provide support for state agencies.
Source: Auditor General staff analysis of the Arizona Financial Information System (AFIS) Accounting Event Transaction File and the
AFIS Management Information System Status of General Ledger-Trial Balance screen for fiscal years 2010 through 2012.
2010 2011 2012
Revenues:
Licenses and fees1 $ 1,589,088 $ 1,537,568 $ 1,700,194
Charges and sales for goods and services 27,328 29,350 29,729
Fines, forfeitures, and penalties 15,975 19,400 15,700
Other 324
Gross revenues 1,632,391 1,586,318 1,745,947
Remittances to the State General Fund2 ( 163,341) ( 158,746) ( 174,632)
Net revenues 1,469,050 1,427,572 1,571,315
Expenditures and transfers:
Personal services and related benefits 840,305 792,349 1 ,016,609 3
Professional and outside services 188,213 229,754 228,675
Travel 2,316 2,426 7,201
Other operating 168,988 152,741 171,876
Equipment 11,742 25,779 40,823
Total expenditures 1,211,564 1,203,049 1,465,184
Net operating transfers out4 1,100 34,273 22,279
Total expenditures and transfers 1,212,664 1,237,322 1,487,463
Net change in fund balance 256,386 190,250 83,852
Fund balance, beginning of year 684,146 940,532 1,130,782
Fund balance, end of year $ 940,532 $ 1,130,782 $ 1,214,634
Board should improve complaint resolution
timeliness
FINDING 1
page 7
Board investigates complaints
The Board is responsible for investigating complaints against licensed
behavioral health professionals and taking appropriate nondisciplinary or
disciplinary action, if necessary. According to Arizona Revised Statutes (A.R.S.)
§32-3281, the Board may investigate complaints indicating that a licensee may
be incompetent, guilty of unprofessional conduct, or mentally or physically
unable to safely practice behavioral health. In addition, A.R.S. §32-3275
requires the Board to ensure that license applicants have not engaged in any
conduct that would constitute grounds for disciplinary action against a
licensee. The Board investigates two types of complaints—those received
from the public and those opened by the Board’s credentialing committees as
part of the license application or renewal process (see textbox).1
Examples of public complaints that the Board has received include licensees
engaging in a nonprofessional relationship with a client, practicing outside the
appropriate scope of practice, and abusing drugs and alcohol at work.
Examples of complaints opened by credentialing committees include
applicants failing to disclose a criminal arrest on the application form and
receiving unfavorable reviews from supervisors. The Board opened 172
complaints for investigation in calendar year 2011. The Board’s complaint-handling
procedures include steps for determining which complaints should
have processing priority and for taking emergency action, if warranted, in
advance of fully resolving a complaint.
1 A.R.S. §32-3261 establishes four credentialing committees, each representing one of the four licensed
professions. These committees assist the Board by reviewing license applications and complaint investigations.
See the Introduction, pages 4 through 5, for additional information.
The Arizona Board of
Behavioral Health
Examiners (Board) has not
resolved many of its
complaints in a timely
manner, and should
continue taking steps to
address the timeliness of
its complaint handling.
More than half of the
complaints closed by the
Board in calendar years
2010 and 2011 were not
resolved within the 180-day
standard used to evaluate
Arizona health regulatory
boards. Lengthy complaint
resolution times can put
public safety at risk
because licensees can
continue practicing
unchecked until the Board
takes action. Three factors
contributed to lengthy
complaint resolution time
frames: (1) long periods
often elapsed before
investigations of the
allegations began, (2) some
complaints were opened
for investigation even when
no investigation was
needed, and (3) complaints
that were recommended
for dismissal were reviewed
more than statutorily
required. In addition to its
problems with timeliness,
the Board did not have
adequate procedures to
classify and monitor high-priority
complaints, or to
ensure that complaint open
and close dates entered
into the Board’s complaint
database accurately
reflected the total time
taken to resolve
complaints. The Board has
already taken steps to
address several of these
matters, but more needs to
be done.
Office of the Auditor General
Two types of complaints
• Public complaints—Complaints received from members of
the public, usually in a written document, which are then
opened for investigation.
• Committee-opened complaints—Complaints opened by the
Board’s credentialing committees as part of the licensure
process to determine whether licensure applicants or licensees
renewing their license have committed unprofessional conduct.
Source: Auditor General staff analysis of 30 complaint case files and the Board’s
written procedures.
After a complaint is investigated by board staff, the applicable credentialing
committee reviews the investigation and recommends a course of action to the
Board, such as dismissing the complaint, denying licensure to an applicant, or
entering into a consent agreement with a licensee to limit or restrict the licensee’s
practice or rehabilitate the licensee. After reviewing the investigation and the
committee’s recommendation, the Board makes the final decision for resolving the
complaint.
Complaint resolution often untimely
Many of the Board’s complaints—including complaints that it designates as high
priority—have not been resolved in a timely manner. Lengthy complaint resolution
can put the public at risk because licensees under investigation can continue to
practice. Conversely, if the complaint proves to be unwarranted, lengthy resolution
can adversely affect the licensee.
Majority of complaints not resolved in timely manner—The Office of the
Auditor General has found that Arizona health regulatory boards should resolve
complaints within 180 days of receiving them, which includes the time to both
investigate and adjudicate complaints. This is the
standard against which other Arizona health regula-tory
boards are evaluated. Auditors’ analysis of
board data for the 223 complaints the Board closed
in calendar years 2010 and 2011 showed that the
median time to resolve these complaints was 248
days. As shown in Figure 1, approximately 60 per-cent
of these complaints took longer than 180 days
to resolve, and some took much longer. Specifically,
28 percent of the complaints took between 181 days
to 1 year to resolve, 25 percent took between 1 and
2 years to resolve, and 6 percent took more than 2
years to resolve.1
Complaints taking more than 180 days to be
resolved included some that the Board had
designated as high priority. Auditors reviewed 10
such complaints closed in calendar years 2010 and
2011 and found that 6 of the 10 high-priority
complaints took more than 180 days to resolve.
Specifically, the number of days it took the Board to
1 The percentage of complaints taking longer than 180 days to resolve is potentially even higher than reported in Figure
1. In a review of 30 complaint files closed between January 2010 and January 2012, auditors found that, in some
instances, board data understated the time it took to resolve complaints by approximately 1 to more than 2 months
(see page 15 for additional information).
page 8
State of Arizona
Figure 1: Length of Time to Resolve Complaints
Calendar Years 2010 and 2011
Source: Auditor General staff analysis of the Board’s database for all
complaints closed in calendar years 2010 and 2011.
223 Total Complaints
(90)
(63)
(56)
(14)
resolve the 10 high-priority complaints ranged from 153 to 420 days, with a median
time of 237 days. For example:
• Board took 9 months to revoke license for inappropriate conduct with a
minor—This high-priority complaint involved allegations that a licensee had
engaged in inappropriate, nontherapeutic conduct when providing home-based
therapy for a 16-year-old client whom the licensee had treated for more than 1
year. In all, the Board took approximately 9 months to substantiate the complaint’s
allegations and take disciplinary action. Board documentation indicated that staff
did not begin substantial investigative work until more than 4.5 months after
receiving the complaint. Once substantial investigative work began, board staff
found that three of the licensee’s prior supervisors had concerns about his failure
to maintain appropriate professional boundaries. The investigation found that the
licensee stayed at the client’s house very late on several occasions, gave the
client a massage, watched television with the client, and bought some clothing for
the client. The licensee eventually admitted that some of his nontherapeutic
activities with the client were inappropriate and signed a consent agreement that
revoked his license approximately 4.5 months after substantial investigative work
began.
The Board acted more quickly in instances auditors reviewed where the Board
determined that it had sufficient evidence to pursue emergency action prior to fully
resolving the complaint. According to statute, if the Board finds that public safety
imperatively requires emergency action, the Board may restrict, limit, or summarily
suspend a license pending proceedings for disciplinary action. The Board indicated
that once it has sufficient evidence that public safety is at risk and that emergency
action can be taken, it will summarily suspend a license or, more typically, offer an
interim consent agreement to suspend a license. Although board records indicated
that it has not summarily suspended a license since 2009, the Board executed interim
consent agreements to suspend licensees from practicing in five instances during
calendar years 2010 and 2011.1 The median length of time between receiving the
complaint and executing the consent agreements in these five cases was 26 days.2 In
addition, board officials reported that when licensees immediately admit to serious
unprofessional conduct, the Board will offer a consent agreement to revoke a license.
For example, in March 2012, the Board held an emergency meeting to accept a
consent agreement to revoke the license of a counselor employed at a prison within 4
days of receiving a complaint after she admitted to engaging in a sexual relationship
with a client and indirectly giving money to the client.
1 The Board entered into two other interim consent agreements during calendar years 2010 and 2011, but these two
agreements had unique characteristics that led auditors to exclude them from the group cited above. In one case, the
agreement suspended a license that had already been inactivated before the complaint was opened, and in the other,
the case was elevated to emergency status less than a month before the agreement was executed. The first of these two
cases took more than 180 days to enter into an interim consent agreement; the second took nearly 180 days.
2 For these five complaints, the range of time taken to execute the interim consent agreements was 19 to 92 days.
page 9
Office of the Auditor General
The Board acted more
quickly on complaints when
it determined it had
sufficient evidence to
pursue emergency action.
Lengthy complaint processing can affect public safety and licens-ees—
Delays in resolving complaints can affect public safety. Licensees alleged
to have violated board statutes and rules can continue to practice while under
investigation, even though they may be unfit to do so or may need supervision. In
such instances, lengthy investigations may delay board actions that protect the
public, such as suspending or revoking a license. Conversely, if complaints turn
out to have no merit, licensees themselves can be affected by a lengthy resolution
process. For example, a board official said that it may be difficult for those with
open complaints to find a new job, obtain new professional liability insurance, or
obtain licensure in another state. In addition, a licensee’s practice could also be
impacted because, although complaint allegations and investigations are confi-dential,
potential clients can find out on the Board’s Web site whether licensees
have a pending complaint against them.
Board should address factors contributing to untimely
complaint resolution
Auditors identified three factors that contributed to untimely complaint resolution.
First, public complaints waited a long time to be investigated, which board officials
attributed in part to not enough investigative staff. Second, the Board opened
complaints for investigation even when the complaints did not constitute violations of
board statutes or rules. Third, complaints that credentialing committees recommend
for dismissal continue on to board review, taking additional time and attention even
though statute authorizes the committees to dismiss complaints that are without
merit. To resolve complaints in a more timely manner, the Board should continue
implementing newly established processes for screening out complaints that do not
need investigation; allow credentialing committees to dismiss more complaints
without forwarding them to the Board for approval as allowed by statute; and conduct
analyses to determine investigative staffing needs.
Three factors hindered complaint resolution timeliness—Auditors iden-tified
three factors that slowed complaint resolution in the following ways:
• Public complaints waited a long time to be investigated—Public complaints
auditors reviewed waited for a median time of nearly 6 months before
substantial investigative work began (see textbox, page 7, for a definition of
public complaints). Auditors reviewed 21 public complaints closed in calendar
years 2010 and 2011, including the 10 high-priority complaints discussed
previously, and found that board staff took a median time of 174 days to begin
substantial investigative work on these complaints, including one complaint
where it took board staff 558 days to begin substantial investigative work.1
1 Auditors determined the approximate date that substantial investigative work began based on documents available in
complaint case files. Substantial investigative work includes activities such as sending out subpoenas for information
or interviewing witnesses, and does not include administrative work done soon after a complaint is received, such as
notifying the licensee of the complaint.
page 10
State of Arizona
It took board staff a median
time of 174 days to begin
substantial investigative
work on 21 public
complaints auditors
reviewed.
Waiting to begin substantial investigative work accounted for the majority of
time it took to resolve 11 of these 21 complaints.
The inability to complete investigations is contributing to an increase in the
number of open complaints. As shown in Table 3, auditors’ analysis of the
Board’s database indicated that the Board opened more complaints than it
closed in calendar years 2010 and
2011, resulting in a growing
number of open complaints.
Specifically, during calendar
years 2010 and 2011, the Board
opened 83 complaints more
than it closed. Additionally, as of
March 2012, the Board’s
database indicated that it had
191 open complaints, 79 of
which had not yet been assigned
to an investigator, including 20
complaints that had been waiting
to be assigned to an investigator
for more than 1 year.
Board officials reported several reasons why the number of open complaints
has increased, including increases in the number of complaints opened over
the past several years and an increase in the severity and complexity of
complaints. As shown in Table 3, the number of complaints opened increased
from 134 complaints in calendar year 2010 to 172 complaints in calendar year
2011. Board officials also provided documentation showing an increase in the
percentage of closed complaints resulting in suspensions and revocations that
has occurred since fiscal year 2009, which they cited as evidence of the
increasing severity and complexity of complaints. In addition, board officials
reported that many licensees deny complaint allegations and that the allegations
are often difficult to prove, which increases the time needed to investigate and
gather sufficient evidence to substantiate the allegations.
Finally, board officials indicated that vacancies in its investigative staff positions
have affected the Board’s ability to keep up with complaints. According to a
board official, few investigators the Board has hired have the skills and abilities
to effectively investigate complaints, and as of June 2012, only 3 of the 10
investigators that it had hired since January 2007 still worked for the Board.
Further, two of the Board’s seven investigative staff positions were vacant as of
June 2012, although a contractor filled one of the vacant positions. In addition,
the Board had two other vacant positions that board officials reported would
mostly be dedicated to helping investigate complaints.
page 11
Office of the Auditor General
Table 3: Number of Complaints Opened and Closed
Calendar Years 2010 and 2011
Calendar
Year
Complaints
Opened
Complaints
Closed1
Increase to Total
Open Complaints
2010 134 95 39
2011 172 128 44
Totals 306 223 83
1 Includes complaints opened in prior calendar years.
Source: Auditor General staff analysis of the Board’s database.
page 12
State of Arizona
• Board has opened complaints that did not need investigation—Historically,
the Board has opened all complaints against its licensees, including
allegations that did not need to be investigated because they did not constitute
violations of board statutes or rules. Statute does not require the Board to
investigate all complaints it receives, and other Arizona health regulatory
boards screen out complaints if the alleged activity does not violate statutes
or rules. Board staff screen out complaints that are not within its jurisdiction,
such as complaints against professionals regulated by another state board,
and forward them to the appropriate state agencies. However, prior to the
audit, the Board opened for investigation all other complaints it received,
including allegations that did not constitute violations of board statutes or
rules. For example, board staff investigated a complaint from a counselor’s
ex-wife who alleged that the counselor had abused their son even though the
counselor, after being notified of the complaint, promptly mailed the Board
documentation from Arizona’s Child Protective Services stating that the child-abuse
allegation had been unsubstantiated. Board staff began substantial
investigative work 18 months after the complaint was received, and the Board
dismissed the case approximately 2 months later.
• Dismissed complaints reviewed by both a credentialing committee and
the Board—Complaints that are dismissed are reviewed by both a credentialing
committee and the Board, and this dual review can add approximately 30
days or more to the complaint resolution process. According to statute, all
complaints must be reviewed by both a credentialing committee and the
Board before discipline can be administered. However, statute allows the
Board’s credentialing committees to dismiss complaints that the committees
determine have no merit. Despite this authority, board staff indicated that the
credentialing committees typically forward dismissal recommendations for
board consideration at the next board meeting, where the Board generally
accepts the committees’ recommendations for dismissal. Between January
2010 and May 2012, the Board accepted all but one of the credentialing
committees’ recommendations for dismissal. As a result, most dismissed
complaints take longer to resolve than may be necessary. This additional step
affects a substantial number of complaints: approximately 35 percent of
complaints closed in calendar years 2010 and 2011 were dismissed.
Board should take steps to resolve complaints more quickly—The
Board should improve complaint resolution timeliness by doing the following:
• Screen out complaints that do not need investigation—To reduce
unnecessary work, the Board should screen out complaints that do not need
to be opened for investigation. The Board has already taken initial steps in this
regard. Specifically, in response to the audit, the Board directed its staff in May
2012 to begin screening out complaints that do not need to be opened for
investigation, including allegations that do not constitute unprofessional
conduct as defined by statute. By June 2012, board staff developed related
Prior to the audit, the Board
investigated all complaints
it received, including
allegations that did not
constitute violations of
board statutes or rules.
page 13
Office of the Auditor General
procedures for screening out these types of complaints. Following these
procedures should help the Board and its staff screen out complaints that do
not need to be opened. The Board should further revise these procedures, if
necessary, to ensure they appropriately accomplish their intended effect.
• Allow credentialing committees to dismiss more complaints—To help
speed up the final stages of complaint resolution, the Board should develop
and implement policies and procedures to allow its credentialing committees to
dismiss more complaints. Specifically, the Board should establish written
guidelines regarding (1) the types of complaints that the credentialing
committees can dismiss without forwarding for board review and (2) the types
of dismissal recommendations the committees should still forward to the Board
for review—for example, dismissal recommendations involving high-risk or
complex complaints.
• Conduct analyses to determine investigative staffing needs—As discussed
previously, board officials reported that investigative staff vacancies have
affected the Board’s ability to keep pace with incoming complaints. As a result,
the Board should:
◦ Continue to assess the efficiency of its complaint investigation processes.
This would help ensure these processes are as efficient as possible. In
addition to some steps it has already taken, the Board should continue to
identify ways to streamline investigative processes; eliminate tasks, as
appropriate; and assign appropriate administrative investigative tasks to
support staff.
◦ Determine its investigative workload, including an estimate of its future
investigative workload, and document the results. Doing so will help give the
Board the information it needs to then determine its investigative staffing
needs.
◦ Determine investigative staffing needs and document the results. The Board
should conduct separate analyses to identify both its staffing needs and how
it can better hire and retain qualified investigators. First, based on ensuring
the efficiency of its complaint investigation processes and its workload
estimate, the Board should determine how many investigators it needs to
process complaints in a timely manner. Second, the Board should determine
how it can better identify, hire, and retain qualified investigators. If after
completing these analyses and improving its retention of investigative staff
the Board determines that additional investigators are needed, the Board
may be able to request additional appropriations to use some of its
increasing end-of-year fund balance to hire additional staff if needed (see
Table 2, page 6).
Board officials reported that
investigative staff vacancies
have affected complaint
resolution timeliness.
page 14
State of Arizona
Board should immediately investigate high-priority
complaints and better monitor their progress
Prior to the audit, the Board lacked an adequate approach to prioritize complaints
based on risk and did not monitor high-priority complaints to ensure they were
resolved in a timely manner. As a result of the audit, the Board has taken some steps
to improve its processes in these areas. The Board should ensure that its changes
are adequate to ensure high-priority cases are quickly resolved and modify or
augment these steps as necessary.
Board procedures not sufficiently risk-based—Prior to the audit, the Board
lacked an adequate risk-based approach to prioritize complaints. The Board’s
identification of high-priority complaints was not based on the level of risk to the
public. Rather, its approach called for designating complaints as high-priority
across a wide range of potential risk levels. For example, engaging in inappropri-ate
sexual contact with a client, having a dual relationship with a client by borrow-ing
money from or socializing with the client, and engaging in inappropriate
actions toward supervisees were all considered high-priority complaints, even
though the risk to the public varied among these types of allegations. The Board’s
criteria for medium-priority complaints likewise did not address public risk. Rather,
medium-priority complaints were mainly those opened by a credentialing commit-tee
and needing to be resolved within a certain time frame to meet licensing
requirements. Because priorities were not risk-based, complaints with lower public
risk were potentially investigated before complaints that carried greater public risk.
Further, the Board did not have guidance for staff to determine when a high-prior-ity
complaint required emergency action.
In response to the audit, the Board revised its written procedures in June 2012 to
improve its risk-based approach to prioritizing complaints. Specifically, the revised
procedures classify high-priority complaints as complaints regarding actions that
pose substantial danger to public safety and represent an imminent threat, and
classify medium-priority complaints as complaints regarding actions that are
potentially harmful but not a substantial danger or imminent threat. The revised
procedures also give examples of each type of complaint. Additionally, the Board
revised its written procedures in June 2012 to identify when the risk to public safety
requires emergency action on a complaint. Following these revised procedures
will help ensure that higher-risk complaints are investigated before lower-risk
complaints, and that emergency action is taken when appropriate. The Board
should further revise these procedures, if necessary, to ensure they appropriately
accomplish their intended effect.
Board should better monitor high-priority complaints—Prior to the audit,
the Board lacked written procedures to monitor high-priority complaints to ensure
that investigative work began promptly and to ensure these complaints were
resolved in a timely manner. Instead, board officials reported that they informally
In response to the audit,
the Board revised its
procedures to better
prioritize complaints.
page 15
Office of the Auditor General
monitored the progress of these complaints. However, as discussed previously,
auditors reviewed 10 complaints that the Board identified as high-priority and found
that the Board took more than 180 days to resolve 6 of the 10 complaints. Further,
auditors found that board staff took a median time of about 2.5 months to begin
substantial investigative work on these 10 complaints, with specific times ranging
from 5 to 196 days.
In response to the audit, board staff revised its written monitoring procedures in
June 2012. Based on these changes, the procedures now state that high-priority
complaints will be immediately investigated, that high-priority cases that warrant
emergency action—such as a possible summary suspension—should be scheduled
before the Board within 1 month of receipt, that all other high-priority cases should
be resolved within 4 months of receipt, and that medium-priority cases should be
resolved within 5 months of receipt. In addition, the procedures state that high- and
medium-priority cases should be monitored monthly on a tracking log and that
investigators will report to the investigations manager on the progress of specific
complaints at defined intervals. Following these revised procedures will help ensure
that high-priority complaints are monitored. The Board should further revise these
procedures, if necessary, to ensure they appropriately accomplish their intended
effect.
Complaint data understated total time to resolve some
complaints
Based on a review of the 21 public and 9 committee-opened complaints closed
between January 2010 and January 2012, auditors found that board data understated
the time it took to resolve some of these complaints. Specifically, the database
understated the time it took to resolve 3 of the 30 complaints by approximately 1 to 2
months because, consistent with board policy at the time, board staff entered the
“closed” date as the date the Board made a decision to resolve the complaint rather
than when the decision was finalized. For example, in one case, the Board’s executive
director signed a board order revoking a professional’s license about 1 month after the
Board made its decision to do so. In addition, the database understated the time it
took to resolve two additional complaints by more than 2 months because board staff
incorrectly entered the “open” date as the date when staff began working on the
complaint rather than the date when one of the Board’s credentialing committees
opened the complaint. In response to the audit, the Board revised its procedures in
June 2012 to clearly define which dates should be used to accurately reflect when a
complaint is opened and closed. Following its revised procedures will help ensure that
complaint data accurately reflect the time it takes to resolve complaints. The Board
should further revise these procedures, if necessary, to ensure they appropriately
accomplish their intended effect.
In response to the audit,
the Board revised its
procedures to better
monitor priority complaints.
page 16
State of Arizona
Recommendations:
1.1 To ensure that recent changes to the Board’s complaint-handling policies and
procedures are improving various aspects of the complaint resolution process,
the Board should continue the steps it has taken to (1) screen out complaints
that do not need to be opened for investigation, (2) better prioritize complaints
on the basis of risk, (3) monitor high-priority complaints, and (4) ensure that
complaint data accurately reflect the time it takes to resolve complaints. The
Board should further revise these procedures, if necessary, to ensure they
appropriately accomplish their intended effect.
1.2 The Board should develop and implement policies and procedures allowing its
credentialing committees to dismiss more complaints, and should establish
written guidelines regarding (1) the types of complaints that the credentialing
committees can dismiss without forwarding for board review and (2) the types
of dismissal recommendations the committees should still forward to the
Board for review—for example, dismissal recommendations involving high-risk
or complex complaints.
1.3 The Board should conduct analyses to determine investigative staffing needs.
Specifically, the Board should:
a. Continue to assess the efficiency of its complaint investigation processes.
In addition to some steps it has already taken, the Board should continue
to identify ways to streamline investigative processes; eliminate tasks, as
appropriate; and assign appropriate administrative investigative tasks to
support staff.
b. Determine its investigative workload, including an estimate of its future
investigative workload, and document the results.
c. Determine investigative staffing needs and document the results. The
Board should conduct separate analyses to identify both its staffing needs
and how it can better hire and retain qualified investigators. First, based
on ensuring the efficiency of its complaint investigation processes and its
workload estimate, the Board should determine how many investigators it
needs to process complaints in a timely manner. Second, the Board
should determine how it can better identify, hire, and retain qualified
investigators.
d. If after completing these analyses and improving its retention of investigative
staff the Board determines that additional investigators are needed, the
Board may be able to request additional appropriations to use some of its
increasing end-of-year fund balance to hire additional staff if needed.
page 17
1. The objective and purpose in establishing the Board and the extent
to which the objective and purpose are met by private enterprises in
other states.
Created in 1988, the Board’s mission is to establish and maintain
standards of qualifications and performance for licensed behavioral
health professionals in the fields of counseling, marriage and family
therapy, social work, and substance abuse counseling, and to regulate
the practice of licensed behavioral health professionals for the protection
of the public. The Board was originally established to offer voluntary
certification to behavioral health professionals. However, Laws 2003, Ch.
65, revised state laws to require behavioral health professionals practicing
psychotherapy to be licensed beginning July 1, 2004.1 This change was
initiated by a coalition of professional associations representing the four
professions regulated by the Board to better protect vulnerable clients
from unqualified professionals who were allowed to practice under the
State’s voluntary certification program. Statute exempts certain individuals
from licensure, including those employed by an agency licensed by the
Arizona Department of Health Services and individuals employed by the
Arizona Department of Economic Security or an agency it licenses.
Auditors did not identify any states that met the objective and purpose of
the Board through private enterprises.
2. The extent to which the Board has met its statutory objective and
purpose and the efficiency with which it has operated.
The Board has generally met its statutory objective and purpose, but
needs improvement in some areas. Some examples in which the Board
has efficiently met its objectives and purposes include:
• Board licenses qualified applicants in a timely manner—The
Board has implemented policies and procedures to help ensure it
issues licenses to qualified applicants that meet requirements
established in board statutes and rules. In addition, the application
forms contain detailed requirements and instructions for licensure.
Further, applicants are required to demonstrate completion of
needed supervision hours and have their supervisors provide
notarized statements that those requirements have been met. Board
1 A.R.S. §32-3251 defines psychotherapy as “a variety of treatment methods developing out of generally
accepted theories about human behavior and development.”
SUNSET FACTORS Sunset factor analysis
In accordance with Arizona
Revised Statutes (A.R.S.)
§41-2954, the Legislature
should consider the factors
included in this report in
determining whether the
Arizona Board of Behavioral
Health Examiners (Board)
should be continued or
terminated.
This analysis includes a
recommendation for the
Board to continue working
with stakeholders to help
resolve concerns regarding
various board processes
and requirements (see
Sunset Factor 2, pages 19
through 22).
Office of the Auditor General
page 18
State of Arizona
procedures require staff to review license applications to ensure that
required information is submitted, and communicate to applicants if they
have not provided necessary documentation.
Auditors reviewed a sample of nine licensing applications approved or
denied between April 2009 and December 2011 and found that board staff
and credentialing committee members reviewed the applications to ensure
applicants were qualified. Specifically, after receiving these applications,
board staff used a checklist form to document that applicants submitted all
necessary paperwork. Next, two members of the applicable credentialing
committee reviewed the applications to determine whether applicants met
the minimum qualifications, and documented their review on the checklist.
According to statute, credentialing committees can review and recommend
that the Board approve or deny the applications, or request additional
information based on their review. The committees’ decisions were then
sent to the Board for final approval.
In addition, board records indicated that licenses are generally processed
within the overall time frame allowed by board rules. Arizona Administrative
Code (AAC) R4-6-302 requires the Board to complete its overall review of
licensing applications within 270 days. The Board’s annual reports to the
Governor’s Regulatory Review Council for fiscal years 2009 through 2011
indicated that nearly 100 percent of the initial license applications were
issued or denied within the required time frames. The nine applications
auditors reviewed were also processed within the overall time frame allowed
by board rules.
• Board disciplines acts of unprofessional conduct—The Board
investigates complaints and administers discipline when it finds that
licensees have engaged in unprofessional conduct. Auditors reviewed 10
complaints closed in calendar years 2010 or 2011 and found that the Board
appropriately dismissed complaints without merit and took disciplinary
action when complaint allegations were substantiated.
• Board provides appropriate public information—Auditors’ review of the
Board’s public information practices found that its staff provide appropriate
public information over the phone and on its Web site. The Board has
written procedures for its staff to follow regarding written public records
requests and the provision of public information. Auditors placed two
anonymous phone calls to the Board in February and April 2012 to request
information about specific licensees and found that the board staff provided
appropriate information, including the status of a professional’s license and
any disciplinary actions taken against the professional. In addition, auditors
reviewed the Board’s Web site for information about specific licensees and
found that the information complied with A.R.S. §32-3214, which prohibits
state agencies from providing information on their Web sites regarding
page 19
Office of the Auditor General
dismissed complaints and nondisciplinary actions or orders taken against
licensees.
However, the audit found that the Board can better meet its statutory objectives
by:
• Improving the timeliness of its complaint resolutions—As discussed in
Finding 1 (see pages 7 through 16) the Board has not resolved many
complaints in a timely manner, and should continue taking steps to improve
complaint resolution timeliness. Specifically, more than half of the 223
complaints the Board closed in calendar years 2010 and 2011 were not
resolved in the 180-day standard used to evaluate the complaint-processing
time for Arizona health regulatory boards. Approximately 25 percent of these
complaints took between 1 and 2 years to resolve, and 6 of the 10 high-priority
complaints auditors reviewed took longer than 180 days to resolve.
Three factors contributed to untimely complaint resolution. First, public
complaints waited a long time to be investigated. Second, the Board opened
complaints for investigation that did not allege violations of board statutes or
rules. Third, complaints that credentialing committees recommend for
dismissal continue on to board review, taking additional time and attention.
As a result, the Board should continue implementing newly established
processes for screening out complaints that do not need investigation, allow
credentialing committees to dismiss more complaints without forwarding
them to the Board for approval, and conduct analyses to determine
investigative staffing needs.
In addition to its problems with timeliness, the Board did not have adequate
procedures to classify and monitor high-priority complaints, or to ensure that
complaint open and close dates entered into the Board’s complaint database
accurately reflected the total time taken to resolve complaints. As a result of
the audit, the Board has taken some steps to improve its processes in these
areas. The Board should ensure that its changes are adequate and modify
or augment these steps as necessary.
• Continuing to work with stakeholders to address concerns—During the
audit, various stakeholders expressed concerns to the Board regarding its
processes and requirements. Stakeholders also communicated concerns to
auditors. For example:
◦ Licensing process—Some stakeholders reported that the Board did
not provide a user-friendly licensure process and that it could do more
to help applicants through the process—especially when they were
applying for an independent license, which allows a licensee to practice
without supervision. To qualify for a license to practice independently,
applicants must document that they have worked a certain number of
page 20
State of Arizona
hours under the supervision of a qualified supervisor, including clinical
supervision hours.1 In addition, applicants must ensure their supervisors
maintain documentation for each instance of clinical supervision that
includes the names and signatures of the supervisor and supervisee.
Further, applicants’ clinical supervisors must have completed
continuing education on specific topics, such as the role and
responsibility of a clinical supervisor and concepts of supervision
methods and techniques, to be considered qualified supervisors.
Although the Board began to offer courtesy reviews in November 2011
to help clinical supervisors determine if their training met requirements,
stakeholders still reported having difficulty meeting some independent
licensure requirements and suggested that the Board could help
resolve this difficulty by creating standard forms to document
supervision hours and pre-approving qualified supervisors (see
Sunset Factor 11, page 26, for additional information about the
Board’s independent licensure requirements).
Additionally, some stakeholders reported disagreeing with or not
understanding the Board’s application of licensure requirements
specified in statute and rule during its review of license applications.
Although auditors observed that credentialing committee and board
members strictly applied licensure requirements during their review of
license applications and were particular about the documentation
applicants provided, this strict review appeared to be within the
Board’s statutory authority. Additionally, based on the nine license
applications auditors reviewed, the Board followed an adequate
process to determine whether applicants met application requirements.
Further, legislation passed in 2012 should help license applicants to
request assistance during the application process. Specifically, Laws
2012, Ch. 352, added A.R.S. §41-1001.02, which states that, before
submitting an application for a license, an applicant for licensure may
make a written request for clarification of an agency’s interpretation or
application of a statute, rule, or substantive policy statement. The law
requires the agency to respond within 30 days of receiving the request
and to give the requestor an opportunity to meet to discuss the
agency’s clarification.
◦ Licensing requirements—Some stakeholders said it was challenging
to obtain a reciprocal license because they found it difficult to meet the
Board’s standards involving education, supervision, and continuous
practice of behavioral health for 5 years prior to applying. Auditors
found that requirements for obtaining a reciprocal license varied
1 AAC R4-6-101 defines clinical supervision as face-to-face, videoconferencing, or telephonic direction or oversight
provided by a qualified individual to evaluate, guide, and direct all behavioral health services provided by a licensee to
assist the licensee to develop and improve the necessary knowledge, skills, techniques, and abilities to allow the
licensee to engage in the practice of behavioral health ethically, safely, and competently.
page 21
Office of the Auditor General
among eight other western states auditors reviewed (see Sunset Factor
11, page 27, for additional information).
◦ Other concerns—Some stakeholders also reported other areas of
concern. For example, one stakeholder questioned the Board’s practice
of not allowing licensees with complaints against them to review
investigative materials prior to staff submitting them to the credentialing
committee members for their initial review. According to A.R.S. §32-
3206, Arizona health regulatory boards must provide certain investigative
information to licensees before a formal interview or a hearing, but the
Board’s statutes do not otherwise require the Board to provide a
licensee with access to investigative materials. Although not required,
the Arizona Medical Board reported it provides licensees with copies of
all investigative information before a complaint is reviewed by a
committee, and the Arizona State Board of Nursing reported it provides
access to some investigative material before a licensee’s case is initially
discussed in a public meeting. However, a board official reported that
the Board’s limited staff resources prevent it from providing the type of
early access to investigative materials provided by these two boards.
Stakeholders provided other examples of concerns with how the Board
dealt with specific licensure applicants. After reviewing the information
provided and the Board’s related processes, auditors did not find that
the Board acted outside of its authority. For example, one concern was
that, as an applicant continued through the licensure process, a
credentialing committee found a problem with the applicant’s
documentation after it had not found a problem in a prior review.
However, the Board and its credentialing committees are responsible for
ensuring that applicants meet the qualifications established in the
Board’s statutes and rules, and re-examining previously submitted
forms when an applicant is still in the process of applying for a license
is within the Board’s purview.
The Board began meeting with organizations that represent various
behavioral health professionals in March 2012 to discuss their concerns and
held a total of four meetings with these stakeholders through June 2012. In
addition, the Board took other steps during the audit to help resolve some
stakeholder concerns. For example, in June 2012, the Board revised two of
its form letters to applicants and posted guidance for applicants on its Web
site to clarify the licensing process and help prevent common errors made
by applicants. In addition, the Board revised its Web site in June 2012 to
update its guidance regarding substance abuse licensure requirements,
which had previously been incomplete. For example, the guidance had not
described coursework that would not meet licensure requirements. Further,
as of August 2012, the Board was in the process of drafting a standardized
page 22
State of Arizona
clinical supervision form that applicants for a license to practice
independently and their supervisors could use to document this supervision.
Several stakeholders reported that some progress had been made in
addressing their concerns but indicated that additional progress is needed.
In addition, some stakeholders expressed interest in continuing to meet to
address outstanding concerns. One stakeholder group did express
dissatisfaction with the progress that the Board has made to address
certain concerns, such as reciprocal licensure requirements and licensee
access to investigative materials. Therefore, the Board should continue
meeting with stakeholders to discuss their concerns and take actions, as
appropriate, to address them.
3. The extent to which the Board serves the entire State rather than specific
interests.
The Board serves licensees, their clients, and the public throughout the State by
ensuring that behavioral health professionals licensed in this State are qualified
to practice psychotherapy. In addition, it provides a mechanism for the public to
file complaints against behavioral health professionals. Further, the Board
provides the public with information through its Web site regarding licensed
behavioral health professionals’ licensing status and disciplinary history, as well
as whether they have any pending complaints. The Web site also informs the
public that it may call the board office to obtain information about dismissed
complaints and nondisciplinary actions taken against a licensee.
4. The extent to which rules adopted by the Board are consistent with the
legislative mandate.
General Counsel for the Office of the Auditor General has analyzed the Board’s
rule-making statutes and believes that the Board has established rules required
by statute, with one exception. Specifically, the Board has not created rules to
address A.R.S. §32-3271(A)(2), which permits a nonresident to perform
behavioral health services, without a license, for not more than 90 days in a
calendar year. Although this statute requires that the Board establish a rule
limiting behavioral health services performed by nonresidents, the statute
appears to establish the parameters for such services without the need for
additional explanation in rules.
5. The extent to which the Board has encouraged input from the public before
adopting its rules and the extent to which it has informed the public as to
its actions and their expected impact on the public.
The audit found that the Board has encouraged input from stakeholders before
adopting rules. Although the Board was exempt from the formal rule-making
process when mandatory licensure began in fiscal year 2005, it submitted its
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Office of the Auditor General
proposed rules in the Arizona Administrative Register and obtained stakeholder
input before adopting rules implementing licensure. In addition, the Board
reported that it participated in a workgroup with stakeholders that spent 2 years
developing proposed changes to reciprocal license requirements (see Sunset
Factor 8, pages 24 through 25, for additional information).
The audit also found that the Board has complied with the State’s open meeting
law for its November 2011 board meeting and credentialing committee meetings.
For example, as required by the open meeting law, the Board and its credentialing
committees posted meeting notices and agendas on the Board’s Web site at
least 24 hours in advance.1 In addition, the Board posted the notices and agendas
at the locations where the Board’s Web site states they will be posted. The Board
posts written meeting minutes on its Web site, and staff reported that audio
recordings of meetings are available within 3 business days. However, in
accordance with its records retention policy, the Board destroys the audio
recordings 3 months after the Board approves the written meeting minutes. In
addition, auditors determined that the Board’s meeting notices and written
minutes complied with statute. The Board also provided a call to the public during
board and committee meetings auditors observed, inviting members of the public
and professional stakeholders to address board/committee members regarding
items on the agenda or professional concerns. Finally, the Board notifies licensees
of changes in its practices through its Web site and written correspondence.
6. The extent to which the Board has been able to investigate and resolve
complaints that are within its jurisdiction.
The Board has sufficient statutory authority to investigate and resolve complaints
within its jurisdiction and has various nondisciplinary and disciplinary options
available to use, such as issuing a letter of concern, and suspending or revoking
a license. However, as discussed in Finding 1 (see pages 7 through 16), auditors
found that the Board did not resolve many complaints in a timely manner and that
it should continue taking steps to address the timeliness of its complaint handling
(see Sunset Factor 2, page 19, for additional information).
7. The extent to which the Attorney General or any other applicable agency of
state government has the authority to prosecute actions under the enabling
legislation.
The Attorney General is the Board’s attorney according to A.R.S. §41-192, and, as
such, has authority to prosecute a class 2 misdemeanor such as a violation of
board law or rule according to A.R.S. §32-3286. In addition, a county attorney
could also prosecute a class 2 misdemeanor pursuant to A.R.S. §11-532.
1 In addition to November 2011 board and committee meetings, auditors observed the posting of notices and agendas for
the May 2012 board meeting and one June 2012 committee meeting.
page 24
State of Arizona
8. The extent to which the Board has addressed deficiencies in its enabling
statutes that prevent it from fulfilling its statutory mandate.
The Board reported that it has sought statutory changes, usually in conjunction
with its stakeholders, to address deficiencies in its statutes. These include the
following:
• Laws 2008, Ch. 134, §2, amended A.R.S. §32-3272 to authorize the Board
to raise its licensing fee cap from $250 to $500.
• Laws 2008, Ch. 134, §4, amended A.R.S. §32-3321 to expand the types of
degrees that would qualify an applicant for the substance abuse technician
license to include any bachelor’s degree in behavioral health science with
an emphasis in counseling. Prior to the amendment, the only acceptable
degree was an associate of applied science degree in chemical dependency
with an emphasis in counseling. As of January 1, 2009, either type of
degree may be used to obtain licensure as a substance abuse technician.
• Laws 2008, Ch. 134, §3, amended A.R.S. §32-3274 to clarify requirements
for a reciprocal license. Prior to this amendment, statute allowed the Board
to grant reciprocal licenses to applicants from other states if applicants
could provide documentation of active licensure or certification at an
equivalent designation. More specifically, board rules required an applicant
for a reciprocal license to “substantially meet the current requirements for
Arizona licensure.” However, a board official reported that this requirement
was unclear and a workgroup of board representatives and stakeholders
spent 2 years developing proposed changes to reciprocal license
requirements. As a result, statute was revised to require recipients of a
reciprocal license to:
◦ Hold a license or certificate in good standing in behavioral health by
another state regulatory agency;
◦ Have held this credential in the same discipline and practice level for
a minimum of 5 years;
◦ Have practiced a minimum of 6,000 hours in the 5 years prior to
application;
◦ Be licensed or certified in a state with minimum education, work
experience, and clinical supervision requirements in effect at the time
the person was licensed or certified and provide verification from the
other state licensing or certifying agency that the person met those
requirements in order to be licensed or certified;
◦ Have passed an exam required for the license sought; and
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Office of the Auditor General
◦ Meet any other requirements prescribed by the Board.
In addition, before practicing without supervision in Arizona, reciprocal
license holders must practice under the direct supervision of a licensee for a
minimum of 1,600 hours within at least 1 year after issuance of the reciprocal
license, receive a minimum of 50 hours of qualifying clinical supervision
during that period, and demonstrate competency.
9. The extent to which changes are necessary in the laws of the Board to
adequately comply with the factors listed in this sunset law.
The audit did not identify any needed changes to board statutes.
10. The extent to which the termination of the Board would significantly affect the
public health, safety, or welfare.
Terminating the Board would affect the public’s health, safety, and welfare if its
regulatory responsibilities were not transferred to another entity. As stated in
Sunset Factor 1 (see page 17), the State’s transition from voluntary certification to
mandatory licensure of behavioral health professionals was initiated by a coalition
of professional associations representing the four professions regulated by the
Board to better protect vulnerable clients from unqualified professionals who were
allowed to practice under the State’s voluntary certification program. Further, as
discussed in Sunset Factor 11, all 50 states license counselors, marriage and
family therapists, and social workers, and regulate the substance abuse treatment
profession.
The Board protects the public by ensuring that licensed behavioral health
professionals are qualified to practice psychotherapy and by receiving and
investigating complaints against licensees alleging incompetence or
unprofessional conduct and taking appropriate disciplinary action against
licensees when allegations have been substantiated. The Board also provides
information to the public about licensees’ licensing status, disciplinary history, and
pending complaints. These functions appear necessary to help protect the public
from potential harm. For example, auditors reviewed complaints investigated by
the Board alleging actions by licensees that posed a threat to the public, including
sexual misconduct, substance abuse, and practicing outside a licensee’s
appropriate scope of practice.
11. The extent to which the level of regulation exercised by the Board compares
to other states and is appropriate and whether less or more stringent levels
of regulation would be appropriate.
The audit found that the level of regulation exercised by the Board is generally
similar to that in other states and appears appropriate. According to professional
organizations’ Web sites, all 50 states license counselors, marriage and family
page 26
State of Arizona
therapists, and social workers.1 In addition, according to an official from an
international credentialing organization that establishes standards for the
credentialing of addiction-related professionals, all 50 states also regulate the
substance abuse treatment profession, but the form of regulation varies from
state to state. For example, some states regulate the profession through
licensure or certification of professionals, while other states may license or
certify treatment programs and/or treatment facilities. According to the Addiction
Technology Transfer Center Network Web site, at least 30 states have agencies
that oversee the licensing or certification of substance abuse counselors,
including the following western states: Arizona, Colorado, Montana, Nevada,
New Mexico, Utah, Washington, and Wyoming.
Auditors reviewed specific licensing requirements in eight western states
regarding independent licensure and licensing exemptions and found that
Arizona’s requirements were generally in line with those in the other states.2
Specifically:
• Independent licensure—The Board’s requirements for obtaining an
independent license to practice without supervision were generally similar
to the other states’ requirements. For example, all nine states, including
Arizona, typically required the following:
◦ A relevant master’s degree or higher degree;
◦ Passing the prescribed examination;
◦ Working a certain number of hours under supervision, which generally
ranged from 1,000 to 4,000 hours depending on the state and
profession; and
◦ Obtaining a certain number of clinical supervision hours, which
generally ranged from 50 to 200 hours depending on the state and
profession.3
• Licensing exemptions—Similar to Arizona, others states also exempt
some professionals from licensure. For example, six of the other eight
states exempt persons employed by specified government agencies or by
an employer that is certified or licensed by certain government agencies.
Arizona exempts certain individuals from mandatory licensure, including
1 Auditors reviewed the Web sites from the American Association of State Counseling Board, Association of Marital and
Family Therapy Regulatory Boards, and Association of Social Work Boards to obtain licensing information for the 50
states as of May 2012.
2 The eight other western states were California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington.
3 AAC R4-6-101 defines clinical supervision as face-to-face, videoconferencing, or telephonic direction or oversight
provided by a qualified individual to evaluate, guide, and direct all behavioral health services provided by a licensee to
assist the licensee to develop and improve the necessary knowledge, skills, techniques, and abilities to allow the
licensee to engage in the practice of behavioral health ethically, safely, and competently.
page 27
Office of the Auditor General
those employed by an agency licensed by the Arizona Department of Health
Services and individuals employed by the Arizona Department of Economic
Security or an agency it licenses.
Auditors also reviewed reciprocal licensure requirements in these eight western
states and found that requirements varied by state and profession. These states
offered reciprocal licenses, licensure by endorsement, or had some other process
to assess whether applicants’ qualifications met in other states were substantially
equivalent to the standards of their state.1 In general, these states required
applicants holding a credential in another state to either possess qualifications
substantially equivalent to their state’s requirements and/or meet specific
requirements such as being licensed for 1 to 5 years or to have practiced for
approximately 1,000 to 5,000 hours (see Sunset Factor 8, pages 24 through 25,
for information regarding Arizona’s reciprocal licensure requirements). However,
none of these states required reciprocal license holders to practice under the
supervision of another licensee for at least 1 year as required in Arizona.
As mentioned in Sunset Factor 2 (see pages 20 through 21), some stakeholders
said it was challenging to obtain a reciprocal license in Arizona because they
found it difficult to meet the Board’s standards. The difficulty in obtaining a
reciprocal license in Arizona or in other states partially depends on applicants’
individual circumstances, such as their work experience and/or the requirements
they had to meet when initially licensed. Board officials reported that the Board’s
reciprocal licensure requirements are less stringent than they used to be.
Specifically, they indicated that the former requirement of having applicants for
reciprocal licensure substantially meet the current requirements for Arizona
licensure offered limited reciprocity and that the revised requirements, passed in
the 2008 legislative session, were created with the help of stakeholders to make
it easier for reciprocal license applicants to obtain a license while still ensuring that
the applicants are qualified (see Sunset Factor 8, pages 24 through 25, for
additional information regarding the revised requirements). However, during the
audit, stakeholders expressed concerns regarding the Board’s reciprocal
licensure requirements, and the Board began meeting with stakeholders in March
2012 to discuss these and other concerns.
The audit did not identify areas where less or more stringent levels of regulation
would be appropriate.
1 Regulatory agency staff in Nevada and Washington said that their states do not offer reciprocal licenses for behavioral
health professionals, but that their states had a process to possibly accept applicants’ prior education, exams, and/or
supervised work experience obtained when they had applied for licensure in another state.
12. The extent to which the Board has used private contractors in the
performance of its duties as compared to other states and how more
effective use of private contractors could be accomplished.
Similar to other western states auditors reviewed for the information provided in
Sunset Factor 11, the Board has used private contractors for various services.
For example, board management reported that the Board has contracted with
various clinical experts to review complaint investigations that are highly
contested by licensees, provide guidance to staff regarding clinical issues, and
provide expert testimony on behalf of the Board in formal administrative
hearings. In addition, the Board contracts out investigative work to individuals
prior to offering them full-time employment as board investigators. As of June
2012, the Board had hired and retained one of the five investigators that it
contracted with between July 1, 2009, and December 31, 2011. Further, the
Board has contracted with a consultant to assist with information technology
needs such as developing and maintaining the Board’s licensing and complaint
database.
Seven of the eight western states auditors contacted indicated that their state
used private contractors for clinical expertise, investigations, and/or information
technology services to assist with regulating behavioral health professionals.
Some of these states reported that they contract for other types of services as
well. For example, management from the Colorado Department of Regulatory
Agencies reported that Colorado contracts with a company for credential review
services for its licensed professional counselor designation. According to the
application form for this license, this company helps ensure that applicants
meet education requirements for licensure if they did not earn a degree from an
accredited counseling program. In Arizona, this function has been performed by
the Board’s credentialing committees; however, the Legislature increased the
Board’s fiscal year 2013 appropriation so that it may similarly contract for
curriculum reviews of nonaccredited counseling programs to ensure that
applicants meet education requirements. In addition, management from the
Utah Division of Occupational and Professional Licensing reported that Utah
contracts with the Association of Social Work Boards to administer exams.
Similarly, management from the California Board of Behavioral Sciences
reported that California contracts for the development and proctoring of
licensure exams.
The audit did not identify any additional areas where the Board should consider
using private contractors.
page 28
State of Arizona
APPENDIX A Methodology
page a-i
Auditors used various methods to study the issues in this report. These
methods included reviewing board statutes, rules, and policies and procedures;
interviewing a current and former board member, staff, and various stakeholders;
and reviewing information from the Board’s Web site.
In addition, auditors used the following specific methods to meet its audit
objectives:
• To determine whether the Board’s processes and practices helped
ensure that complaints are handled appropriately and in a timely manner,
and that discipline is administered in accordance with statute and rule,
auditors reviewed a sample of 30 complaints that were closed between
January 2010 and January 2012, including 21 complaints filed by the
public and 9 complaints opened by the Board’s credentialing committees.1
Auditors also analyzed data from the Board’s complaint database to
assess the Board’s timeliness in resolving the 223 complaints that were
closed in calendar years 2010 and 2011 and reviewed a database report
regarding open complaints as of March 2012. In addition, auditors
reviewed the Board’s meeting minutes from January 2010 through May
2012, the Board’s Adverse Action Tracking Form for calendar years 2009
through 2012, and a March 2012 complaint in which the Board took
emergency action against a licensee. Further, auditors reviewed
investigative practices from the Arizona Medical Board and the Arizona
State Board of Nursing.
• To determine whether the Board’s processes and practices helped
ensure that new licenses are issued in a timely manner to qualified
applicants, auditors reviewed a sample of nine licensing applications,
including five approved and four denied license applications.2 Auditors
also reviewed the Board’s license application materials and reports
submitted to the Governor’s Regulatory Review Council for fiscal years
2009 through 2011 regarding the Board’s timeliness in approving or
denying licenses.
• To assess whether the Board shares appropriate information regarding
licensees with the public, auditors placed two anonymous phone calls to
board staff in February and April 2012 requesting information about four
1 To assess the Board’s overall complaint-resolution process, auditors reviewed 10 complaints selected to
represent the major forms of discipline and the four professions regulated by the Board. To assess the Board’s
timeliness in resolving complaints, auditors reviewed an additional 20 complaints.
2 Auditors selected nine licensing applications approved or denied between April 2009 and December 2011 to
represent for the different license types, including reciprocal licenses and licenses to practice independently,
and each of the four professions regulated by the Board.
This appendix provides
information on the methods
auditors used to meet the
audit objectives.
This performance audit was
conducted in accordance
with generally accepted
government auditing
standards. Those
standards require that we
plan and perform the audit
to obtain sufficient,
appropriate evidence to
provide a reasonable basis
for our findings and
conclusions based on our
audit objectives. We
believe that the evidence
obtained provides a
reasonable basis for our
findings and conclusions
based on our audit
objectives.
The Auditor General and
staff express appreciation
to the Arizona Board of
Behavioral Health
Examiners (Board), its
Executive Director, and
staff for their cooperation
and assistance throughout
the audit.
Office of the Auditor General
licensees and compared the information provided to the Board’s complaint
database. Auditors also reviewed licensing and complaint history information
about specific licensees on the Board’s Web site and assessed whether the
information provided was consistent with statutory requirements.
• To obtain information used in the Introduction section, auditors compiled and
analyzed unaudited information from the Arizona Financial Information System
(AFIS) Accounting Event Transaction File for fiscal years 2010 through 2012 and
the AFIS Management Information System Status of General Ledger-Trial
Balance screen for fiscal years 2010 through 2012. In addition, auditors reviewed
the Board’s organizational chart, reviewed professional associations’ Web sites,
and reviewed board database reports regarding the number of licenses by
license type.
• To obtain information used in the sunset factors, auditors reviewed various
professional organizations’ Web sites that provided information regarding the
regulation of behavioral health for all 50 states as of May 2012, and interviewed
representatives from professional organizations regarding the regulation of
substance abuse counselors.1 Additionally, auditors reviewed statutory and rule
requirements in eight other western states regarding reciprocal licenses,
independent licenses, and licensing exemptions.2 Auditors also contacted staff
from agencies that regulate behavioral health in these eight states to obtain
information about their use of private contractors. In addition, auditors attended
the November 2011 board meeting and reviewed the associated public meeting
notice, agenda, and meeting minutes. Auditors also attended the November
2011 meetings for three of the Board’s credentialing committees, including the
counseling, social work, and substance abuse credentialing committees, and
reviewed the associated public meeting notices and agendas. Further, auditors
tested whether board staff posted public notices and agendas for these
meetings, the May 2012 board meeting, and the June 2012 marriage and family
therapy credentialing committee meeting in compliance with open meeting law.
• Auditors’ work on internal controls included reviewing the Board’s policies and
procedures for ensuring compliance with board statutes and rules. For example,
auditors reviewed policies and procedures and tested the Board’s compliance
with various policies and procedures and/or board statutes and rules, for
complaint handling, licensing, and providing information to the public. In
addition, auditors conducted data validation work to assess the reliability of the
Board’s complaint database information used to assess complaint resolution
timeliness. Specifically, auditors interviewed board staff, reviewed data policies
and procedures, and compared information in the database against hard-copy
complaint files. Although auditors found that, in some instances, board data
1 These included Web sites from the following professional organizations: the American Association of State Counseling
Board, Association of Marital and Family Therapy Regulatory Boards, Association of Social Work Boards, and Addiction
Technology Transfer Center Network.
2 The eight other western states were California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, and Washington.
page a-ii
State of Arizona
understated the time it took to resolve complaints by approximately 1 to more than
2 months, auditors determined that the Board’s database was sufficiently reliable
for the purposes of the audit. Auditors’ conclusions on these internal controls are
reported in Finding 1 (see pages 7 through 16), and Sunset Factor 2 (see pages
17 through 22).
page a-iii
Office of the Auditor General
AGENCY RESPONSE
Performance Audit Division reports issued within the last 24 months
Future Performance Audit Division reports
Arizona State Parks Board
Arizona State Schools for the Deaf and the Blind
11-09 Arizona Department of Veterans’
Services—Veterans’ Donations
and Military Family Relief Funds
11-10 Arizona Department of Veterans’
Services and Arizona Veterans’
Service Advisory Commission—
Sunset Factors
11-11 Arizona Board of Regents—
Tuition Setting for Arizona
Universities
11-12 Arizona Board of Regents—
Sunset Factors
11-13 Department of Fire, Building and
Life Safety
11-14 Arizona Game and Fish
Commission Heritage Fund
12-01 Arizona Health Care Cost
Containment System—
Coordination of Benefits
12-02 Arizona Health Care Cost
Containment System—Medicaid
Eligibility Determination
10-07 Arizona Department of
Agriculture—Sunset Factors
10-08 Department of Corrections—
Prison Population Growth
10-L1 Office of Pest Management—
Regulation
10-09 Arizona Sports and Tourism
Authority
11-01 Department of Public Safety—
Followup on Specific
Recommendations from
Previous Audits and Sunset
Factors
11-02 Arizona State Board of Nursing
11-03 Arizona Department of Veterans’
Services—Fiduciary Program
11-04 Arizona Medical Board
11-05 Pinal County Transportation
Excise Tax
11-06 Arizona Department of Veterans’
Services—Veteran Home
11-07 Department of Corrections—
Oversight of Security Operations
11-08 Department of Corrections—
Sunset Factors