Issue Paper on Social Work Licensing in New York State
Requirements for Obtaining the LCSW: A Need for Modification
History of Clinical Social Work
The social work profession, which celebrated its 100th anniversary in 1998 of the founding of the first school of social work, has been engaged in clinical practice for over 80 years. During this time, clinical social work has been practiced in a wide array of service programs, including, but not limited to mental health, hospitals, community health, aging services, addictions, developmental disabilities, children’s and family services, criminal justice, employee assistance programs, and public schools.
The Profession’s Definition of Clinical Social Work
NASW, which is the largest association of professional social workers in the world, describes clinical social work as follows: “Clinical social work shares with all social work practice the goal of enhancement and maintenance of psychosocial functioning of individuals, families and small groups. Clinical social work practice is the professional application of social work theory and methods to the treatment and prevention of psychosocial dysfunction, disability, or impairment, including emotional and mental disorder. It is based on knowledge of one or more theories of human development within a psychosocial context. Clinical social work services consist of assessment; diagnosis; treatment, including psychotherapy and counseling; client-centered advocacy; consultation; and evaluation. The process of clinical social work is undertaken within the objectives of social work and the principles and values contained in the NASW Code of Ethics” (NASW, 1999).
The Original Requirements for the LCSW in New York
With the passage of the Social Work Licensing Law in 2002, New York State recognized clinical social work as an advanced form of social work practice. The requirements for obtaining the LCSW were defined as having three years of “clinical practice experience”, under appropriate supervision, and the passing of an exam in clinical practice. One year later, amendments to the licensing statute were passed with the intention of addressing a limited number of technical issues associated with the original legislation. This included, for example, inserting a date for ending the grand parenting period for automatically granting a license to qualifying social workers. This date had originally been omitted. The amendment also included a narrowing of the requirement to qualify for the LCSW to diagnosis, treatment planning and psychotherapy. The broader experience of “clinical practice experience” was removed. NASW-NYC recognizes that this amendment was in actuality far more than a technical modification of the original statute in relation to qualifying experience, and this has had major unanticipated outcomes.
Significant Limitations of the LCSW Today
The State Education Department’s Office of the Professions, which has administrative oversight for social work licensing, narrowly defined what experience qualifies for obtaining the LCSW based on the amendments to the statute. It has also determined that the settings in which the experience for the LCSW is obtained must be limited to settings that are legally authorized to do psychotherapy. As a result of this, hundreds of settings where clinical social work has historically been practiced in New York are not authorized to engage in clinical practice as defined by the LCSW in law. Consequently, clinical practice experience obtained in these settings is not acceptable to fulfill the requirements for obtaining the LCSW.
Clinical Practice Across Service Settings
While diagnosis, treatment planning and psychotherapy are important clinical social work functions requiring advanced skill, they should not be singled out as the requirements for obtaining the LCSW to the exclusion of other forms of clinical social work practice. All forms of clinical social work require advanced experience and skill, especially for serving clients with complex, life determining needs.
People who receive services in aging, health care, and child welfare programs, for example, frequently come for concrete service needs and in the process of assisting them, social workers find that they have multiple, complex problems in addition to the primary issue being addressed. Regardless of setting, social workers are frequently called upon to deal with the effect of depression, anxieties, personality disorders, traumas, and addictions, as well as complicating factors associated with sudden or chronic illness, domestic violence, disabilities, lack of resources, or stressful experiences resulting from bias and discrimination.
Success in service delivery frequently requires the availability of experienced, seasoned social workers bringing clinical theory, skill and judgment to assess the interplay of the unique needs of a program’s clients, and to assure that brief, crisis, short and longer term interventions match actual needs and capacities. In addition, since clients frequently receive essential support and services from more than one program, care coordination and advocacy are valuable components of clinical social work practice. The full array of these capacities is often determinative of successful outcomes, not only in relationship to a program’s formal goals, which may be limited, but to successful outcomes for the client, overall. These features are the hallmark of clinical social work practice.
Consequences of the Narrow Definition of the LCSW
1. Workforce Shortages
As a result of the current limitations on the LCSW, NASW-NYC believes that a shortage of clinical social workers is developing. As social workers discover that they are not able to receive their experience to qualify for the LCSW in numerous settings where clinical social work has traditionally been practiced, many are forgoing making their careers in these settings. Given the type of support and services that clients require, they are going to be the most seriously affected by this developing shortage.
2. Eligibility for Reimbursement for Services
The federal Medicare program requires providers of services to hold the highest license available to a profession within a state. When licensing first went into effect in 2004, over 1,800 social workers in New York State who had previously been Medicare providers, were disenrolled as providers because they did not qualify for the LCSW. It underscores the importance of licensing in relationship to reimbursement. Currently, support is mounting for Congress to expand Medicare to reimburse for geriatric care coordination for the increasing number of elderly in need of many forms of health care. Few gerontological social workers today are able to qualify for the LCSW, the license required for this important form of reimbursement. Broadening the experience requirement for the LCSW would significantly remedy this problem.
Medicaid reimbursement is also an important consideration. Currently many agencies that rely upon Medicaid reimbursement for services are exempt from the requirements of the licensing law, including whether a social worker has the LCSW or not, but these exemptions are time limited. These exemptions will expire in June, 2010. Even if these exemptions are extended for a few more years as agencies are requesting, Medicaid will require the LCSW once this exemption period expires. Agencies report that they will not have a sufficient number of LCSW when this occurs, but broadening the experience requirement for the LCSW will help them increase this availability.
NASW-NYC urges the New York State legislature, the State Education Department, and the Governor to amend the social work licensing statute to broaden the experience requirement for obtaining the LCSW.