Agencies and Social Work Licensing: A Perspective on Exemptions Coming to an End
Robert Schachter, DSW, LMSW
A version of this article was published in the May Issue of the New York Non-Profit Press. For the Chapter’s last update on licensing and back ground relating to the article, click here.
On July 1, 2013, 13 months from now, exemptions from the social work licensing law for state agencies and their non-profit providers are slated to end. As reported in this issue of the New York Non-profit Press, six state agencies are calling for exemptions in various forms to be continued, most probably, indefinitely. Only the State Health Department expressed no need for continuing exemptions.
There is no guarantee that the State legislature will grant further exemptions. The last time they extended exemptions, key legislators expressed frustration about doing so and were concerned that agencies were not doing enough to come into compliance with the law. The unknown at this time is what their ultimate position will be in the next legislative session.
The purpose of licensing is to protect the public. Consumer protection is based on assuring that those who deliver a service have the requisite knowledge, theory, skills and values required to provide services. This is what is embedded in the licensing of social workers, the primary foundation being a degree from a graduate school of social work. Licensing recognizes that not just anyone can do social work.
Prior to licensing becoming state law, a key legislator responsible for oversight of the licensed professions in New York questioned the need for social workers to be licensed. He said that in engineering and architecture, a building could collapse if it was not designed properly. He wanted to know if social work met the criteria of the work being “a matter of life and death”.
Social workers across every service delivery system can explain that social work is a matter of life and death. As one hospital social worker told us, it is a matter of life and death every day, all day long. When we discussed this with this legislator, he stopped us in mid-sentence and emphatically acknowledged that he got the point.
Representatives of state agencies make a number of assertions as to why the social work licensing statute should not be applied to their sectors. At the top of the list is the cost of employing licensed social workers and the need to replace staff who are doing social work that do not have the license. The other assertion is that multidisciplinary teams and multiple layers of oversight reduce the need for licensed professionals. They also assert that licensing was not actually intended for agencies but became law to address social workers in private practice.
Over the next year there will be multiple deliberations as to whether exemptions from the social work licensing statute should be allowed to end, which will happen if the legislature does nothing, or whether exemptions should be continued.
It would be very helpful to all concerned if the issues are as clear as possible. The realities in front of us are complex and filled with dilemmas. Sorting them out is the job in front of us.
Here are a few thoughts in response to three of the central issues raised by the state agencies, based on what we have been hearing among our members. While most of our members are in direct practice, there are a substantial number running agencies and programs, as well. We hear from a broad range of our constituents.
The claim that multidisciplinary teams and multiple layers of oversight reduce the need for licensed professionals
There is a broad consensus in the profession about the value of multidisciplinary teams, and multiple layers of oversight are essential. Nevertheless, social work often takes place out of the direct sight of others. The worker-client encounter is a matter of primary importance. How a relationship is initiated, the quality of the assessment or diagnosis, and subsequent engagement determines the outcome. This is why one form of accountability relates to the qualifications of the worker, and licensing reflects what is considered to be minimum qualifications.
Integral to oversight is who is doing supervision. Supervision is the first layer of oversight as well as providing opportunities for training, often specific to very challenging cases. We should be concerned when someone with less education and training is in a position to supervise someone with more. The social work profession also has concerns about someone from outside of social work supervising a licensed social worker. The licensing statute permits psychiatrists and licensed psychologists to provide supervision, but some of the agency reports reflect that other staff provide supervision.
The claim that social work licensing was not intended for agencies but designed for private practice
When licensing was passed into law, the legislature was interested, among other things, in preventing unqualified individuals from going into private practice in New York. Nevertheless, the social work profession and members of the legislature were to a great extent interested in strengthening the capacity of the human service workforce to serve our most vulnerable populations.
There continues to be a concern that licensed social workers are needed in aging, child welfare, as well as behavioral health, health and homeless services, and other systems, as well. When agency reports cite that licensing was not designed for agency practice, it suggests that some modifications to the licensing law need to be considered. It is not a rationale that the law should be discarded.
The claim that replacing unlicensed staff will be costly
The reality is that cost tends to drive just about everything. Estimates from agencies run from several million dollars upward to $100 million a year. These are formidable sums. However, it should be noted that money tends to appear for public safety when it has to do with preventing terrorism, responding to disasters or to putting people in jail. As a society we don’t adequately value the public safety issues involved in providing quality health and human services.
The cost projections may be overstated, given difficulties in estimating the number of staff who would be practicing without a license after July 1, 2013. In the next 15 months, we would all do well to zero in more precisely on just what agency staff are doing so that we can more accurately sort out who needs to have a license and who does not.. While the agency reports provide more detail on the human services work force than we have seen in the past, greater clarification is still needed in order to make decisions.
One of the first places to start is by clarifying how many social workers with masters degrees are employed who do not have the license. Understanding why they do not have it and addressing this seems opportune. There are also many functions that do not require a license, yet questions exist as to whether the State agencies inadvertently included this work as being restricted to licensed social workers. This needs clarification.
Another issue related to funding is assuring that licensed social workers are available for reimbursement from third party insurers, whether from government or managed care companies. This relates to behavioral health but also the possibility of reimbursement for services such as care coordination. Projections on this would further understanding of the need for licensing.
The State Education Department is expected to issue a report on social work licensing and exemptions before July 1. We can expect that this report will initiate the discussion in the 2013 legislature at that time.
The time could be ripe for all stakeholders, social workers, agencies (which are often run by social workers), the graduates schools, the State Education Department and legislators to collaborate to assure that the workforce of the future is as good as it can possibly be.