States Struggle With Varying Regulations

— Heidi Sfiligoj, News Staff


woman crossing state line with licenseAs social work has risen in status among the professions, it has become increasingly evident that state regulations simultaneously provide support for and impose limitations on professional social work practice. NASW state chapters face diverse challenges in working with state legislators and professional boards on issues regarding licensure and title protection.

Licensing regulations impact social workers but are not designed for social workers. The purpose of a license is to protect the public by ensuring that the licensee has met fundamental levels of education, examination, supervision, practice experience and ongoing professional development.

The Association of Social Work Boards (ASWB) develops and maintains a social work licensing examination used in most states and acts as a resource for information on the legal regulation of social work. In 1997, ASWB adopted the Model Social Work Practice Act, a document that aims to set out a "best practices" scenario for licensure law.

"We don't lobby for its implementation, but simply offer it as a resource for regulatory boards to refer to when considering changes to laws or regulations," said Troy Elliott, communications director for ASWB. A major reason for the creation of the model law was to encourage standardization across borders.

State borders

It can be difficult for social workers who are licensed in one state to work in another state because a state social work license is issued by and useful only in the jurisdiction where the holder plans to practice. At national and state levels, NASW staff working on the Social Work Reinvestment Initiative (SWRI) have registered member comments regarding the need for reciprocal agreements in state licensure laws.

Elizabeth Franklin, project manager for the Reinvestment Initiative, noted that our increasingly mobile society and the rise of e-therapy indicate that state restrictions add to the problem of recruitment and retention in the field. Pending before Congress, the Social Work Reinvestment Act states: "The Commission shall study state-level social work licensure policies and reciprocity agreements for providing services across state lines."

"If the regulatory systems were more similar, social workers would likely find it easier to move from one state to another and easier to maintain licensure in multiple states," said Elliott. "However, the U.S. Constitution reserves the right to regulate professions with the individual states, so states can't be 'forced' to implement reciprocity. There does need to be some balance, or a better balance. Obviously, greater uniformity would benefit consumers and social workers, but states also need to have the ability to craft regulations that meet the needs of the public the individual governments aim to protect."

According to Wendy Rae Hill, director of government relations and political affairs for NASW's California Chapter, her state's rigorous licensing system makes it hard for social workers from other states to be recognized in California. The California Board of Behavioral Sciences licenses social workers in the state and creates and administers the test they are required to take.

"If we were to offer reciprocity, many would believe it is unfair, since the board believes California has more requirements than other states," said Hill. "So, if you are licensed elsewhere and move to California, you have to have all the requirements, meaning licensed clinical social workers in other states have had to go back go graduate school to take some classes and do more clinical hours." Hill says the California Chapter's members are divided over the reciprocity issue.

After Hurricane Katrina wreaked havoc on Gulf Coast states in 2005, health professionals from outside those states had a hard time providing services to victims there because they were unable to quickly and clearly obtain authorization to practice within the affected states. To address this issue, the Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) was promulgated in 2006. The objective of UEVHPA is to allow volunteers with appropriate skills and expertise to provide services in a state with an emergency as if they are licensed in that state.

Protecting social worker

Title protection refers to regulatory safeguards that restrict use of the term "social worker" by other human services professionals who may be trained in different disciplines. As many NASW members have reported, in some settings the term "social worker" is used as a job title even though the position qualifications do not require the educational preparation.

There is some debate about whether the social worker title should be connected to a license or degree. In certain states, one cannot call herself or himself a social worker until being licensed, and a license cannot be obtained without first having the degree. In other states, the title is not restricted at all or is simply connected to having a social work degree.

"We did not feel that licensure should be mandated [in order] to be called a social worker because a license is not mandated for direct practice in Pennsylvania," said Jenna Mehnert, executive director of the Pennsylvania Chapter, which recently secured title protection. "There is a very large segment of the social work profession that does not hold a license, and not allowing them to be 'social workers' would hurt, not help, the profession." Mehnert does believe that title protection helps the profession and the public. "Individuals have a right to know the qualifications of the professionals working with them, and the lack of title protection meant that anyone could use our title," she said.

Missouri has had title protection since 1990. In Missouri, a degree from an accredited social work program is required before one can call herself or himself a social worker. However, Tamitha R. Price, executive director of the chapter, believes practice protection is the most important. "In 2003, Missouri decided that we have to educate the public on what a social worker does and the skills they should have. It was important to make sure that the people who obtain a degree from the social work programs have the right skills to protect the practice," she said. "The most important thing is to protect the degree, since the general public believes that people who graduate from these programs have a certain set of skills. Your licensure hones those skills, but it doesn't give you them."

In California, the State Personnel Board agreed to voluntarily delete the state service classification that was titled "social worker" but did not require a social work degree. This was done through negotiations and without moving legislation. There are now no state service jobs titled "social worker" that do not mandate a professional social work degree.

Challenges in New York. New York City and state are also struggling with a number of issues. There, one can obtain an LMSW by graduating from a master's program and passing a national test from the ASWB. An LCSW can be obtained after passing the national exam and three years of appropriate supervised experience in diagnosis, treatment planning, and psychotherapy.

The term "scope of practice" is generally used to differentiate between what is the appropriate domain of the licensed professional. In New York, as with most states, there are additional requirements of training and supervision, as well as a separate test before the license allows the provision of diagnostic and psychotherapy services.

Since the license went into effect in September 2004, social workers have been getting their LMSW and then going on to get their LCSW. However, in June 2008, the state education department, which is responsible for administering licenses in New York, clarified that social workers could not obtain their LCSW by going into private practice and hiring their own supervision. "That got lots of reaction," said Robert S. Schachter, executive director of the New York City Chapter. "Many believed that was permissible." New Yorkers are now exploring whether people in private practice can be given amnesty.

It is hard for social workers to obtain their LCSW by working in an agency, Schachter says, since many agencies do not have the ability to provide supervision due to budget cuts.

The education department has also acknowledged that the setting one receives supervision in must be permitted to do psychotherapy. It has found that few settings are authorized to do psychotherapy and is looking at what kind of regulatory or legislative changes are necessary to allow more settings to qualify. "Those who want to be the career path to get an LCSW are finding it difficult," said Schachter. "They have to find an agency that can provide supervision as well as one that is authorized to do psychotherapy. We're worried about the impact these issues will have on the social work workforce."

Schachter says another obstacle for social workers in New York is the corporate practices law, which bars corporations, including many non-profits, from employing licensed professionals unless the law explicitly gives them an exemption. According to the law, there should be no authority higher than the licensed professional. "There needs to be an exemption in the law that allows non-profit corporations to employ LCSWs and LMSWs," said Schachter.

According to Steve Karp, executive director of the Connecticut chapter, which is introducing a multi-level licensure law for introduction into the 2009 legislature, drawing up licensure laws can be tricky. "Drafting language is very difficult as one wants to minimize the law of unintended consequences," he said. "In licensing social workers, we need to be careful not to put our profession out of the running for certain jobs."

As a professional association, NASW supports licensure for social workers. Consistent with the NASW Code of Ethics, licensure regulations provide consumers with a layer of protection and recourse in the event that there is a complaint of misconduct. Consequently, NASW supports title protection as equally important ensuring that both social workers and constituents have the same right of recourse in the event of misrepresentation.