Support Our Essential Social Work Workforce
2021 Blueprint of Federal Social Policy Priorities: Recommendations to the Biden-Harris Administration and Congress
The nation’s 700,00 social workers are an essential workforce and have been since the founding of the profession over a century ago. We are among the most racially diverse mental and behavioral health and healthcare professions and provide critically needed services to millions of Americans every day in a broad range of settings including healthcare facilities, schools, child welfare, community agencies, correctional institutions, and private practice. The Master’s degree is the terminal degree in our profession.
A subset of our profession, clinical social workers (CSWs), are eligible to participate in Medicare and Medicaid. CSWs were first included in these government programs in 1989. All states have licensing requirements for CSWs. The definition of clinical social work and their scope of practice are articulated in the Social Security Act and in state regulation. CSWs aim to improve and/or restore the psychosocial and/or social functioning of individuals, couples, families and groups. This is guided by the “person in the environment” framework that is central to social work practice.
The services provided by social workers are in higher demand than ever due to COVID-19, but the supply is not projected to keep pace with demand without policy action. The Bureau of Labor Statistics projects that the employment of social workers is expected to increase much faster than average for all occupations through 2029 (13 percent growth rate compared with an average growth rate of 6 percent) (Bureau of Labor Statistics, 2020). In particular, the areas of aging, child welfare, mental and behavioral health, veterans’ issues, health, education, and corrections will see a rapid increase in the need for professional social work services in the near future. Of particular note, almost all child welfare programs struggle with recruiting and retaining qualified and effective child welfare staff. Turnover rates remain high, at 20 to 50 percent nationally (National Child Welfare Workforce Institute, 2020). Federal investments in social work and social work education are critically needed to ensure that there is a sufficient supply of social workers to meet evolving demands.
Additional barriers to maintaining a strong, stable workforce are the pervasive and significant safety risks that social workers encounter on the job. Between 2011 and 2013, there were nearly 25,000 assaults annually, with almost 75 percent occurring in healthcare and social service settings (Harrell, 2011). In the last few years alone, we have witnessed the murders of five social workers while they were on the job. Thousands of others have experienced assault-related physical injuries with lifelong repercussions. Clients, too, suffer secondary trauma when there is violence in the service setting. Numerous states, including California, New Jersey, Washington, and Kentucky, have adopted safety guidelines for social workers and other social services professionals. In 2013, Massachusetts became the first state to pass social worker safety legislation. NASW has in the past two Congresses worked to enact legislation to promote social worker safety which would establish a grant program to provide for safety measures such as GPS equipment, security systems, self-defense training, and conflict prevention, among other measures.
The current federal and state regulatory landscape is another impediment to a strong workforce. Federally, CSWs face two challenges. First, their scope of practice in the Social Security Act, the “diagnosis and treatment of mental illness”, does not reflect the scope of practice for today’s social workers. This includes providing services to people who, although not mentally ill, are experiencing major challenges (such as a physical illness or family crisis) for which they need the support of a CSW. Second, CSWs are only reimbursed at 75 percent of the Medicare physician fee schedule. They are the lowest paid mental health providers in Medicare. With reimbursement rate reductions implemented in Medicare for CY 2021, the reimbursement level is even lower. Appropriate reimbursement would help to address the poor compensation of social workers.
At the state level, there is currently no permanent interstate licensure portability. CSWs must seek and pay for a separate license for every state in which they wish to practice, which can take months for states to process and represent a significant expense for an already undercompensated profession. Telehealth expansion, especially during COVID-19, has created major new opportunities for interstate practice. Larger federal investments in promoting portability, especially for professions providing critically important mental and behavioral health and social care services, should be a priority.
NASW calls on national leaders to:
- Facilitate and fund interstate licensure portability for clinical social workers (CSWs).
- Make permanent the telehealth expansion under COVID-19, including removing site and geographic restrictions, enabling the use of audio-only devices and payment parity with in-person payment rates.
- Provide student loan debt relief for social workers including the Public Service Loan Forgiveness (PSLF), federal loan cancellation, and others.
- Pass the Employer Participation in Repayment Act (S. 460/H.R. 1043 in the 116th Congress) which allows employers to make nontaxable payments up to $5,250 toward employees’ student loans.
- Pass the Improving Access to Mental Health Act (S. 782/H.R. 1533 in the 116th Congress, lead Senate sponsors social worker Debbie Stabenow and John Barrasso and House lead and social worker Barbara Lee) to enable CSWs participating in Medicare to bill independently to provide Health and Behavior Assessment and Intervention services and services to skilled nursing facility residents, and to increase their reimbursement rate.
- Pass the Protecting Social Workers and Health Professionals from Workplace Violence Act (S. 2880/H.R. 5138 in the 116th Congress, lead Senate sponsors social worker Kyrsten Sinema and Lisa Murkowski and House leads Julia Brownley and Elise Stefanik) to promote safety on the job.
- Pass the Dorothy I. Height and Whitney M. Young, Jr., Social Work Reinvestment Act (H.R. 1532 in the 116th Congress, lead House sponsor social worker Barbara Lee) to support the social work workforce.
- Invest in programs to strengthen the social work workforce (Title IV-E, Health Resources and Services Administration [HRSA])
- Expand Title IV-E education partnerships.
- Establish targeted student loans and loan forgiveness for public child welfare service.
- Offer loan forgiveness on all federally subsidized loans for BSW or MSW graduates who are employed in public child welfare.
- Increase funding to Historically Black Colleges and Universities, Tribal Colleges and Universities, and other minority-serving institutions to further diversify the social work workforce.