Licensing Delays Snarl Mental Health Providers in New Hampshire

  • Raymond Yanklowitz, a West Central Behavioral Health employee who works in both Claremont, N.H., and Lebanon, N.H., has been trying to get his Vermont license recognized in New Hampshire since August 2018. Yanklowitz was photographed outside his office in Lebanon on Jan. 21, 2019. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Tuesday, January 22, 2019

Claremont — Raymond Yanklowitz is a licensed drug and alcohol counselor in Vermont, but last year he moved to Claremont and took a job working for West Central Behavioral Health.

The Lebanon-based community mental health center opened a new office in Claremont last year aiming to fill a gap in addiction treatment services in Sullivan County.

Yanklowitz applied for a license to practice in New Hampshire in August. He is still waiting.

“It’s just been a horror story,” he said of the delay.

Yanklowitz has had to drive to the New Hampshire Office of Professional Licensure and Certification in Concord on four separate occasions to provide additional paperwork and to clarify what information is lacking.

“I just feel like there’s something very wrong with the system,” Yanklowitz said.

As a result, though he can still work with clients, there are some things he cannot do. Without a license, he is not allowed to counsel clients with DWI convictions for the treatment they need in order to get their driver’s licenses back, he said. When people call him seeking such a service, he has to refer them elsewhere.

It turns out that Yanklowitz is not alone. As the region faces a shortage of mental health clinicians and drug and alcohol counselors, along with an increased need for services because of the opioid epidemic, there are lags in the time it takes for professional boards to approve licenses for clinicians seeking them, mental health providers say.

But, board members responsible for reviewing these applications say the problem is not that they act slowly, but that applicants often submit incomplete applications.

The licensing delays extend beyond people like Yanklowitz, who are licensed in other states, to also include those seeking new licenses and those seeking to be relicensed, said state Sen. Jay Kahn, D-Keene.

“It’s not one area,” Kahn said. It’s “not one firm. This is a statewide issue.”

Dartmouth-Hitchcock — which recently has become the Upper Valley’s “hub” for The Doorway-NH, the new “hub and spoke” system of services that New Hampshire is building to address the opioid crisis — is feeling the burden of these delays.

“We have had applicants who are in good standing in other states with years of experience who have trouble getting licensed here,” William Torrey, vice chairman of clinical services in Dartmouth-Hitchcock Medical Center’s department of psychiatry, said in an emailed statement.

The burden includes being asked to obtain further supervised experience or to track down reports from supervisors or former teachers from many years ago, he said.

“We have lost candidates and had to significantly delay start dates because of these kinds of requirements,” Torrey said.

Jacqui Abikoff, chairwoman of the state’s Board of Licensing for Alcohol and Other Drug Use Professionals, said in an email that she is “unaware of any systemic delays that clinicians are facing in the process of getting licensed by the LADC Board in well over a year.”

Similarly, Diane Vaccarello, chairwoman of the Board of Mental Health Practice that licenses counselors, social workers and therapists, said that her board does not see delays when applications are complete.

But when incomplete, applications can be held up, said Vaccarello, a Bedford, N.H.-based family and marriage counselor. It is the applicants’ responsibility to ensure that they provide a complete application for the board, which meets once a month, she said.

To understand what is expected of them, applicants need to read the relevant statutes that are available online, she said.

“It really is up there,” she said.

Staffing also may play a role. The mental health practice board, for example, has one staff person, Kelly Martin, whose voicemail sometimes is full, Vaccarello said. It soon will be advertising for a second administrator, said Peter Danlos, the Office of Professional Licensure and Certification’s executive director.

In 2016, Danlos’ office took over the responsibility of overseeing professional boards in the state and their budgets.

To improve efficiency in processing applications, Vaccarello said her board recently has begun fast-tracking applications from providers who are licensed in other states and who have been in good standing for at least five years.

“That’s working splendidly,” she said.

This is a strategy she said could be expanded to other boards.

As for a longer-term solution, Danlos said the Office of Professional Licensure is exploring working with other states through “interstate licensing compacts that would significantly reduce the approval process.”

The state already has entered into such compacts for nurses and physical therapists, which makes it easier for those providers to move from state to state, Danlos said.

Additionally, Danlos said, New Hampshire is working to implement online licensing software that would alert people when the information they are submitting is incomplete.

“Our goal is to make this process quick and make it less confusing,” he said.

Kahn, the state senator from Keene, has proposed a bill this session, Senate Bill 80, that would grant interim licensing to applicants in the mental health field if the board does not grant a regular license within 60 days.

“If there’s a legislative option to help support moving people into the workforce quicker and filling some of the vacancies that exist, hopefully we will find that,” Kahn said.

Such solutions may be too far in the future, however, to help in Yanklowitz’s case, said Suellen Griffin, West Central’s CEO. She said she fears that he might get sick of waiting and simply go back to working in Vermont, where he still is licensed and where state regulators say it takes three to five business days to process complete applications. It’s something Yanklowitz said he’s considered.

All this matters now because of a high demand for services amid a workforce shortage, Griffin said, which means that New Hampshire’s community mental health centers are operating with about a 10 percent vacancy rate.

“There’s an urgency now that there wasn’t before,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.