NASW Social Work Talks - EP36: Social Work Practice Mobility

Episode Date: August 27, 2019

NASW CEO Angelo McClain, PhD, LICSW, speaks with Mary Jo Monahan, CEO of the Association of Social Work Boards (ASWB) about efforts to increase social work practice mobility. See show the notes for resources and a transcript. And if you like this episode, please leave us a review in iTunes!

Welcome to NASW Social Work Talks podcast. Today, we have a special program on social work license mobility. NASW Executive Director Angelo McLean will be having a conversation with Mary Jo Monahan, Chief Executive Officer of the Association of Social Work Boards. Let's turn the conversation over to Angelo McLean. Welcome to Social Work Talks, Mary Jo. Well, thank you very much for inviting us. We're very happy to be here, Angelo. We're excited to have this discussion, this important topic on licensed mobility. NESW is the largest social work organization in the nation, representing the interest of over 750,000 social workers, including over 200,000 clinical social workers. Mary Jo, can you please tell us about ASWB? The Association of Social Work Boards is the nonprofit organization composed of and actually owned by 64 social work regulatory boards and colleges in all 50 U.S. states, the District of Columbia, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and all 10 Canadian provinces. ASWB is the only nonprofit organization dedicated to social work regulation.

Our mission is to provide support and services to the social work regulatory community to advance safe, competent, and ethical practices to strengthen public protection. Currently, I've got some numbers for you. there are 480,026 licensed social workers in the United States and 53,465 licensed social workers in Canada, for a grand total of 533,671 licensed social workers in North America. As you can see, our two organizations have a lot in common. ASWB owns and maintains the social work licensing examinations that are used to test the social worker's competence to practice ethically and safely. Many of your members who are licensed have taken this exam as part of the requirements to become licensed. And you're really doing a lot to not only help advance the profession,

but really to protect the public and make sure that a good ethical social work practice is occurring across the country and beyond into Canada and other parts of North America. You know, NESW, we're hearing from many of our members who are clinical social workers that they, like many other clinicians, such as psychologists, would like to be able to more readily practice in multiple states or territories. It is a reality of modern life, as we know, that professionals are more mobile. further technology is changing the way clinicians work with teletherapy gaining momentum policymakers and the public also want to significantly increase access to mental health services

what can be done to advance the shared interest of social workers policymakers and the public in promoting access and what can be done to advance the needs of the profession for mobility Well, that was a great question because you really laid out the case for mobility in the question. And it was also a great way to bring in the macro perspective. I believe that the best way to advance the shared interests of social workers, policymakers, and the public is through collaboration, beginning with a shared understanding of the issues so that a solution can be determined that makes the most sense to those impacted. I'm sure you remember our discussion at the CSWE roundtable meeting back in, I think it was December of 2014, about the collective impact model. Do you remember that one?

This is what we use at ASWB as the strategic organizing model that expresses the conditions of success that ASWB has adopted for our mobility strategy. Briefly, and I'm sure you memorized this, the five conditions are, one, having a common agenda, which we do, using common progress measures, engaging in mutually reinforcing activities, that's the part where we all work together, excellent communication, and leadership by backbone organizations. I believe this podcast and our upcoming video series of conversations about licensing and regulation is a great example of collective impact, and we are all in this together. Many NESW members are aware of the compacts that are being implemented for physicians, nurses, psychologists, and physical therapists, which make it easier for those professions to practice across state borders. Mary Jo, what is ASWB's plan to make it easier for social workers to practice electronically and across state borders, and how is ASWB advancing this effort?

ASWB has been exploring social work practice mobility and portability for the past five years in great depth. We have carefully evaluated and researched the issues, And along the way, we have developed tools to assist social workers in dealing with electronic practice, as well as we've worked with social work regulators on mobility and portability issues. When we look at electronic social work practice specifically, we need to remember that safe, competent, and ethical practice is the standard for all of social work practice, no matter what form of delivery the social worker is engaged in. That was the findings of the group of social work regulators and practitioners from around the world who joined in 2015 to write and publish the Model Regulatory Standards for Technology and Social Work Practice. ASWB is grateful to Dr. Frederick Reamer, who you all know, who chaired this task force. This publication is available to download from the ASWB website and offers guidance to social work regulators as they amend rules and regulations related to the evolving practice of electronic social work practice. As you know, Dr. Reamer also chaired the collaborative group of social workers who came together in 2016 to update the NASW technology in social work practice standards.

What we did, we accomplished writing a 60-page guide on how to use technology in an ethical, safe, and competent manner. This helpful publication is available on both the ASWB and NASW websites. The important document that has framed ASWB's mobility strategy is the ASWB Model Social Work Practice Act. This document is updated every year to keep pace with changes in regulations and social work practice. I know that many of your NASW state exec directors are familiar with this document and refer to it in their advocacy efforts as they work with their licensing boards. One of the directives in the Social Work Model Act is that social workers must be licensed in every state in which they practice, either physically or through electronic means.

And that's a backbone of the Social Practice Act. This is true for other health care professionals as well, nurses, doctors, and pharmacists. And this is the crux of the mobility strategy, and the implementation of this directive is through what we're calling licensure by endorsement. Licensure by endorsement allows a state licensing board to recognize a social worker's existing license when issuing a new one. This reduces the burden on the social worker to provide supporting documentation and expedites the licensing process. They don't have to go through it all over again because they've already been licensed. ASW believes that this model is the key to social work practice mobility. This is the model that pharmacy adopted many, many years ago, and it has worked quite well for that profession.

It is simple and does not require additional bureaucratic steps as the compact models do. Here's the endorsement model in a nutshell. Endorsement refers to the process of a state granting a license to an applicant who is already licensed in good standing, and they issue, they endorse the license at the equivalent designation in their own jurisdiction. As I said, the endorsement model recognizes the due diligence of the jurisdictions that previously licensed the social worker. An endorsing applicant does not have to undergo significant additional training, work experience,

examination or assessment, except to fulfill jurisdiction-specific requirements, if there are some extra requirements there. The licensure process for endorsing applicants is often expedited for these reasons. It's not going to take as long as when you got your initial license. Basically, the substantially equivalent requirements are the following. As a licensed social worker, you must have a social work degree from a CSWE-accredited program, a passing score on the equivalent ASWB exam, equivalent supervision hours, and no discipline against the license. The licensure by endorsement model is predicated on the various states

trusting that the state that issued the initial license did their due diligence already in assessing the licensee's requirements. And the new state that the social work wants to practice in is respecting the work of the issuing state. This is a big change, and for our members, but it will eliminate barriers to obtaining a second or a third license for the licensee, as well as for the state board. It greatly streamlines the process for all licensees, regulatory boards, and most importantly, the public. Okay. So, Mary Jo, you're explaining that ASWB's strategy for social work mobility is through licensor endorsement. And some folks in the field have said, you know, we think this should be the compact model.

Could you speak a little bit to the advantages of the endorsement model? Sure. I'd be glad to. And as I said, we've been studying this issue very diligently for the past five years. And our membership has embraced this licensure by endorsement model because it makes most sense to them. And after all, they are the regulators. So state-based regulation of the professions actually comes from the concept of federalism as set down in the 10th Amendment of the U.S. Constitution. So that's where it is in law. In 1889, the U.S. Supreme Court case of Dent v. State of West Virginia upheld physician licensing and recognized the state's rights to use regulation to protect public health and safety. So that's where it's been around a long time, and it's embedded in the Constitution.

This recognition of states' rights is the organizing model for the U.S. system of each state having its own authority to regulate the professions within its borders. Some social workers have suggested that we move to a federal license for convenience for them. But until the Tenth Amendment changes, I don't see that in our New Year future, and I hope we're not going to change the Tenth Amendment. Unlike the compact models used by nursing and medicine, the endorsement model can be administered independently by the states. Additional legislation is not needed, and states and territories do not have to wait for a compact to exist.

they can use it with the endorsement language already in their laws. One drawback to a compact model is that professionals licensed through a compact model may find their license status in jeopardy if a state withdraws from the compact or is terminated from a compact. In an endorsement model, a license remains valid as long as the licensed professional is in good standing in the state or territory where the license is issued. And if you have multiple licenses, you have to maintain that status in all of the states in which you're licensed. There are some negatives to compacts that you should also be aware of. Compact models require

an additional layer of bureaucratic structure that has to pay for itself. No taxpayer's money go into these models. So it has to pay through licensure fees. Most likely, these costs will be passed on to either the states and their boards will have to pay these costs, or it'll be passed on to the licensees. So one thing you said there that I wanted to dig into a little bit, that endorsement doesn't require additional legislation. So are existing licensing laws permissive of the endorsement model? Yes, we actually have, there are 30 states that already have this in, and we've had our members check this out over the last two years, and 30 of them are ready to go. And we're working very closely with the others to get the model very clearly

stated as licensure by endorsement. Some are using other terms like reciprocity that doesn't quite get what we're going after. So there are 30 states who are allowed to do the endorsement model or there are 30 states that are doing the endorsement model? That's a good question. Most jurisdictions have, as I said, 30 states have provision in their statutes by licensure by endorsement for licensure by endorsement and what we're doing is working with them to help them implement what's in their statutes in a more streamlined manner by our members have agreed on the four requirements that i stated earlier about having if you've been licensed and you met the requirements that i discussed earlier and your license is in good standing their process of

looking through your application will be expedited and it'll be much easier because they're not having you go through the process all over again as it has been. So this is the good news in social work that we're in the implementation phase and that as social workers are requesting or trying to apply for a second license or a third license, they're finding the process easier. We just did some research on how many licenses do social workers actually hold. And we had a group of 7,000 social workers who responded to our survey. And what we found is most social workers have one license, possibly two. Max is three at this time. Yeah. Well, let me add one more thing. You can go to our mobility website for the most up-to-date information regarding endorsement at moving

social work.org. ASWB, again, is working with the remaining states to review their laws and rules to include a real clear statement on licensure through endorsement and also set up their processes so that we can be expediting licenses. But, again, we were interested to find out that, yes, we're on the move, but not a lot of movement as yet. So we're moving in the right direction with endorsement, but there's some things that could happen to accelerate that? Because I'm wondering what it will take to get all states to adopt the endorsement model.

Well, I'm a little curious why you believe this effort should be accelerated, because it actually is going quite well. It's going forward in a measured, common-sense manner, which is what we need so it doesn't get. We have to think about unintended consequences first and then think it through, which is why it does take long. And also, you know, any kind of change in government and licensure as government takes a while. There needs to be a reasonable approach to ensure that the mandate of regulation, public protection, remains at the forefront of our efforts. There are some examples of where the efforts have received some political interest and pressure, including streamlining licensure for military spouses in many of our states are implementing

processes for that the recent endorsement as you know for all licensed professionals in arizona that was speeded up and then the new telehealth language that was just i think last month introduced into florida so all of these changes are happening and at aswb we're staying on top of them to see how it uh they um work with our model um but as as you've said and and i know we agree on this this is an important effort and therefore should be implemented thoughtfully and by evaluating the realities of each individual state as well yeah i thanks for all this terrific uh information uh in in in a model that like you say can be implemented across all the states and territories. I'm wondering what would be the cost for social

workers under the endorsement model, given that they would need to likely pay for the application in the second state or the transferring state and the continuing education and renewal costs in each state? The costs for licensed social workers would be determined by each state in which they choose to become licensed and and the states have different fees that that they charge and it's really important that you go up on either our website and and find and go to the state that you want to move to to find out what those fees are the reality is is that regulation must pay for itself and in most states taxpayer money is not used to support licensing so the boards have to generate fees to be able to stay in business.

So at this time, social workers will have to pay the fees charged by each state they choose to be licensed in. Social workers choosing to become licensed in multiple states are responsible to understand the laws and regulation in each state in which they are licensed. We all know that. For example, in terms of public protection and client safety, it's important for social workers to know the available resources for clients in the state if especially if they're practicing electronically they need to know in case of a crisis how

they can continue to serve their client and get their client the help that they need in their state where they aren't so there are also limits in each state regarding scopes of practice so the social worker needs to know the scope of practice in every state in which she or he works so in terms of practicing safely and ethically, cost should only be one part of the decision to obtain multiple licenses. Client safety really should be the most important deciding factor. What are the obstacles to achieving greater mobility and how might we pursue making more progress? Well, I sort of answered that earlier when you said about accelerating our efforts.

We feel that it's actually going forward in a measured common sense and smart regulatory manner. We talked about having a reasonable approach that keeps public protection up front. and also I gave some examples of efforts that we're already working very closely with NASW on and that we continue to work together on this and keep each other informed. Okay. I'm going to ask a specific question that I know some of our members would probably want me to ask, and that is when we think about the different states and the variation between the licensing requirements, say for instance the number of hours required for supervision how does that get sort of rectified in the endorsement model i've got to tell you that that's probably one of the things that we

spent the most time on looking at the variations in in the regulatory standards throughout the state very early on we realized that we have a patchwork quilt of regulation out there and that states had spent many years perfecting the excellence in their state, but what had happened was they got farther and farther away from the Model Act. So the first years of our efforts on mobility was to ask our states to go back to the Model Act so that we could have more commonality across the different states. And they have been opening up their practice acts to make changes in it so that there is much more commonality and adherence to the Model Social Work Practice Act, which we wrote back in 1996. As I mentioned earlier, licensure by endorsement allows a state

or provisional licensing board to recognize the social worker's existing license in issuing a new one. And that's the key there. They're already licensed. Supervision issues then become a on issue when states allow an existing licensee in good standing as, well, the existing license in good standing as the only necessary proof that a licensed social worker is qualified. That's really what the endorsement is. Further, as I mentioned, we studied issues related to mobility for five years and really found that when our states went back to the model law, the vast majority of states had substantially similar requirements for initial licensure in terms of the education, the experience,

and the examination, the three E's that we talk about. In our licensure through endorsement plan, we have simplified the challenge of dealing with this one I know you know about because I talk about it often, with the almost 64 different titles for licensed social workers throughout the United States and Canada. We do not expect states to change the titles that they have in their laws. That would freak everybody out. So we're not asking for that. But merely to crosswalk their titles into these three equivalent categories of licensure that the states have. Bachelor of Social Work, Master of Social Work, or Clinical Social Work. So whatever your title is in the one state if it's equivalent to a clinical social work in the new state that you

go to you get the title that they have so you may have two different titles for a license in florida and a license in nebraska but they're equivalent and when you practice in the this when you're practicing in one state you need to use the right title that you have there but the end result is going to be there may be social workers with three different titles if they're practicing in three different states okay um so thanks for that uh clarification and uh i'm i'm i hear a lot from our members who want to get involved in in help uh move the mobility uh issue move it forward and i'm wondering uh what would be your advice to our members who want to get involved and help aswb move things forward with the endorsement model?

I believe that the most important thing a social worker who's one of your members can do to move mobility forward is to first understand the regulations in their state and understand the regulations in any state that they're interested in moving to. And once they understand those regulations, they may find, in particular the application process, they may find that it's much easier than it was when they initially got licensed, especially if it was years ago, because things have changed. I think it's important for your members to attend regulatory board meetings to become better informed about how regulation works. There's a lot of myths and misunderstandings out there. But those meetings are open to the public?

Absolutely, they're open to the public. Most of the meeting is, in some states, everything is open to the public. In some states, when they are having a discipline hearing, they close that. But I was in Florida, and our discipline hearings were open to the public. And social work educators brought their students to the meetings, and it's a great, great way to help students understand that our goal is to get them licensed and have them live licensed. I would like to do a shout out to your members to consider becoming a regulator and serving on your state board. I think it's a wonderfully way for social workers to give back into the profession, but also to really live our social work values of integrity and social justice by protecting the public. Most importantly, maintain your license in good standing. Go to our website, movingsocialwork.org, for regular updates. And we have a section on there that we want to know your story. And if you just click on the Take Action tab, you can tell us your story.

And we like positive stories as well as the ones that are negative out there. So tell us your story. And ESW chapters have, for many, many years, been partners with regulatory boards and particularly in helping getting legislation passed. I'm wondering how ASWB and NASW can work together to get licensure by endorsement regulations passed. Great question, and that's part of why we're here. I would encourage the NASW state chapters to work closely with the state regulatory boards because that's where the action really is at the state level.

You and I, ASWB and NASW National, can provide support through national information and national meetings. However, the real work, as I said, occurs at the state level. We see more positive outcomes for regulation when the state board is supported by the NASW state chapter. sometimes misunderstanding or lack of communication or lack of respect from the two groups leads only to public and legislative confusion and that doesn't help any of us social work is a profession affecting public health safety and welfare it's regulated in the same way that medicine and nursing are regulation is your assurance that the professionals who provide care or assistance, are competent to practice, and will interact with clients in an ethical

and safe manner. And I believe those are the values of both ASWB and NASW. Regulation is also your assurance that clients have recourse through the state board of social work if a social worker does step outside the bounds of ethical and safe practice. It's less than one percent, but anyone who harms a client, I believe, needs to be held accountable, and that that's also part of our social justice values. The mission of these regulatory boards is protection of the public, and that public includes anyone who's a recipient of social work services. Before we end the podcast, Mary Jo, I wanted to give you an opportunity, if there's any sort of main points or any points that you made that you would want to underscore.

keep yourself informed about regulation if you're a licensed social worker no matter what your license is that is a wonderful support for you that shows that you are a professional but it also is a message to the public that you have been vetted that you have met standards of care that we we agree are important to safe competent and ethical practice and wherever you're you're providing your your social work services whether it's electronically or it's in one or two states keep your high ideals there so that we can all be proud of our profession i'm extremely proud of our profession and i'm extremely proud that we have the social work regulatory community that includes all of us it includes the three pillars it includes the regulators and that we all for

the most part work together quite well yes well thank you very much mary jo for uh joining me on this podcast today and thank you for sharing that knowledge and my takeaway is really you know we can achieve social work mobility through the endorsement model and it's something that you're asking that we all get behind and that we work across the country to get endorsement in place where we can have greater mobility for social workers. Thank you very much for this, and I look forward to us continuing to collaborate on this and many other initiatives. Yeah, I guess we're stuck with each other, aren't we? I wouldn't say stuck. We are blessed to be able to work together. Absolutely. Thank you very much again. Yes. You have been listening to NASW Social Work

Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies. You can learn more at www.socialworkers.org. Don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode.