Natural Medicine Advisory Bulletin 14

Full Natural Medicine Advisory Board: AugustDuring brief opening updates, DORA Program Director Lorey Bratten shared that as of the meeting, eight facilitator training programs had applied for approval, most having been granted.Moving into new business, the Board discussed its upcoming annual report, which is required by statute. Board Chair Lundy shared an outline of the report, which the Board will complete in conjunction with the Office. According to Director Bratten, the Board has made several hundred recommendations, over 200 of which have been incorporated into rules. A representative from the Attorney General’s office informed the Board that the report is an opportunity for the Board to make legislative recommendations to the General Assembly.Next, the Board discussed a complete version of the Facilitator Ethical Code of Conduct, to be used by facilitator training programs when teaching facilitator ethics. Although the Board previously adopted a complete ethical code, only enforceable parts of the code were incorporated into rules, and the remaining portions are not found in any official documents. Following discussion about the size and unwieldiness of the complete code, the Board requested an additional version with references to enforceable rules, hoping to reduce redundancy and increase clarity.August’s meeting closed with the full Board approving the creation of a forms-specific subcommittee. The subcommittee will consist of:Bradley Conner, PhD, a licensed psychologist;Alisa Hannum, PhD, a clinical psychologist;Sue Sisley, MD, a clinical researcher;Clarissa Pinkola-Estés, PhD, a clinical psychologist; andSkippy Upton-Mesirow.***Combined Subcommittee: SeptemberAs requested by the Board in August, Office of Natural Medicine Licensure officials presented a streamlined version of the Facilitator Ethical Code of Conduct. At the suggestion of subcommittee chair Dr. Brad Conner, Program Director Lorey Bratten will create a companion to the ethical code containing the full text of relevant ethical rules.Next, the subcommittee discussed proposed changes to facilitator licensing and rules. Under new rules, facilitators are required to disclose whether they are a mandated reporter, or if they professionally interact with one in such a way that participant confidentiality is limited. Additionally, proposed rules provide discretionary exceptions to the general rule of protecting participant confidentiality for situations where the facilitator receives information indicating imminent harm, child abuse, and neglect. Regulators described these rules as allowing discretionary reporting. Separately, Colorado law defines certain professionals, including many health professionals, as mandatory reporters. Recognizing that subtle distinctions in reporting obligations may cause confusion for participants, the subcommittee identified a need to clearly explain limits of confidentiality during the informed consent process. This would include whether a facilitator was otherwise a mandatory reporter, if a facilitator works professionally with other facilitators that may be mandatory reporters, and exceptions to confidentiality rules under which a facilitator may break confidentiality. Dr. Sue Sisley pointed out that information received while under the influence of Natural Medicine may not be reliable, and asked if information received during an administration session be exempted. According to Office staff, the statutory requirement of mandatory reporters is a “reasonable belief,” regardless of the circumstances under which information is received.Discussing changes to definitions, the subcommittee first discussed the new definition of “consultant.” Dr. Sophia Chavez encouraged regulators to proactively engage with Indigenous communities and legacy healers about becoming consultants. The subcommittee requested an update on how the state has been engaging with these communities, which they understood to have been occurring.Subcommittee members were surprised to learn that, under the current rules, an individual could be licensed as a facilitator without ever practicing facilitation. Newly-proposed rules correct that particular concern, however someone could still be licensed without experience conducting preparation and integration sessions. This issue was corrected in an update presented to the full NMAB the following week, but has not been reflected in officially noticed proposed changes.Regarding changes to consultation requirements, Dr. Conner pushed back on a new rule requiring facilitators to engage in ongoing consultation, in addition to continuing education. Dr. Sophia Chavez concurred, and the subcommittee unanimously voted to recommend striking the ongoing consultation requirement.Regarding when preparation sessions can occur relative to an administration session, the subcommittee recommended that preparation sessions be conducted no more than 60 days, and not less than 24 hours, prior to an administration session. A related rule that would set limits on how many hours or sessions a facilitator may provide facilitation services in close succession was tabled for future discussion.***Natural Medicine Advisory Board: SeptemberSeptember’s meeting of the full Natural Medicine Advisory Board included a number of administrative affairs, such as announcing the resignation of Dr. Joshua Goodwin, approving the Board’s 2025 meeting calendar, and amending the Board’s bylaws to clarify that future appointments to the Board do not require confirmation by the Colorado Senate. The Board will vote on a new chair and vice-chair in November 2024. The training program-focused version of the Facilitator Ethical Code of Conduct, approved by the subcommittee a week prior, was presented to the Board and accepted.Discussing proposed changes to practicum requirements, Skippy Upton-Mesirow expressed concern that the current distribution of hours would conflict with a common supervised practice model. Under the “triad” model discussed, students spend equal time in the roles of observer, participant, and co-facilitator. According to several members of the Board, this model is commonplace, with practicums often taking the form of a weekend intensive. Dr. Sue Sisley pointed out that in Oregon, observation is the only form of permitted supervised practice, which may be an issue if Colorado rules require that students serve in the role of facilitator. In response, Program Director Lorey Bratten clarified that the proposed rules are not intended to prohibit practicum from taking place in Oregon, or even internationally. When questioned about the requirement that practicum supervisors be “affiliated” with a training program, staff indicated that a formal relationship, such as a contract, would be sufficient. Dr. Sisley also requested that rules be updated to be more clear about locations other than Healing Centers that can serve as a practicum site.The final discussion topic for September was a recommendation drafted by Dr. Sue Sisley. The recommendation urged the Colorado Department of Public Health and Environment to begin the process of engaging a vendor in the creation of a participant outcome database. Further, the recommendation would direct the Department of Revenue to engage the General Assembly in passing emergency legislation permitting outside funding for the project. Measuring and reporting on the efficacy of Natural Medicine Services is one of the longest-running questions for the Board, and has been mired in what some feel is unnecessary red tape. In Dr. Sisley’s view, the state’s statutory directive to report on “behavioral health impacts” necessarily includes participant outcomes. Board members Dr. Brad Conner and Dr. Alisa Hannum similarly felt that post-administration outcome data is necessary to inform best practices such as dosing, as well as appropriate standards of care. State officials, however, have taken a different stance. According to the Department of Revenue’s Natural Medicine Division, the statutory mandate regarding behavioral health impacts extends only to requesting available data from other state agencies. While the statute does require proactive collection of some data, the collection mandate does not include participant outcomes. Given the cash-fund nature of the program, state agencies are reluctant to undertake the creation of a participant outcome database, which some Board members have estimated to cost $1 million in the first year.One solution put forward would have the state seek outside funding, such as charitable donations, to initially fund the creation and maintenance of the database. However, for a state agency to accept private funding, express statutory authorization is required. Again, the Board seemed frustrated by the machinations of the government. Any legislative change authorizing private funding would require a bill sponsor in the Colorado General Assembly. Board members are prohibited from individually communicating with legislators, and the collective Board’s only direct channel of communication with the General Assembly is through its annual report. As a last resort, Dr. Sisley implored Division officials to utilize its existing government relations resources to identify a sponsor for an emergency bill in January. Frustratingly, Division officials declined to do so, citing vaguely a desire to adhere to the Department of Revenue’s policies.Despite these roadblocks, the Board voted to unanimously approve Dr. Sisley’s recommendation, with members emphasizing the unique, first-in-the-world opportunity to collect robust data on the efficacy of Natural Medicine. The recommendation will appear as the top priority in the annual report to the General Assembly in early 2025.



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