(September 2004)

As the licensing law goes into effect this month (September, 2004), following a lengthy period during which social workers have learned about what is being required of them, a degree of uncertainty remains.

Perhaps nowhere is this uncertainty greater than for social work employers, program directors, and supervisors. And, it follows, if there is confusion at this level of organizational life, social workers who are planning their careers cannot be very clear either.

Assuming that everyone who has been eligible to be grand-parented into the LMSW (Licensed Master Social Worker) and the LCSW (Licensed Clinical Social Worker) already understands what the requirements and procedures are, there is a new set of issues that have risen to the surface for those social workers who are not eligible to be grand-parented. This relates to the experience requirements for the LCSW and which settings provide that experience.

For many social work graduates, obtaining the LMSW will be the terminal license for one’s career. It will not be necessary for many social workers to obtain the LCSW. Anyone planning to practice as community organizers, planners, administrators, researchers, or policy advocates will not need to obtain a LCSW.

And many social workers planning to work in a broad array of settings as direct practitioners will not need an LCSW to practice. LMSW’s can do psychosocial assessments and engage in a wide range of interventions, with individuals, families and groups. This includes doing counseling.

Programs that Employ LCSW’s

Only LCSW’s, or LMSW’s who are supervised by LCSW’s, licensed psychologists or psychiatrists, will be able to do diagnoses, treatment planning or psychotherapy. A major question, then, is which programs will need to employ LCSW’s. Mental health programs that require these three functions will need to.

But will other settings require social workers to have LCSW’s or LMSW’s working under supervision? According to several social work program directors and clinicians interviewed for this article, the answer may not be cut and dry.

LCSW’s in Child Welfare

A social work manager who oversees both mental health and child welfare programs said that her foster care and PINS diversion programs involve the key functions that fall under the scope of practice for the LCSW and that any LMSW working within these settings will be able to qualify for the LCSW, as long as they are properly supervised.

She explained that her foster care program works with young men of color in late adolescence. Many enter the program with psychiatric diagnoses. She said that staff needs to make decisions about additional interventions about people who are often quite fragile. A mistake could throw someone into a psychotic state. She said that while technically these types of programs do not require a LCSW or a LMSW under supervision, her program would require it.

Similarly, she said that in her PINS diversion program, the nature of the work is complex, requiring a good level of clinical skill. This social work manager explained that when a mother who brings her 14 year old, out of control son to court for placement, the judge may very well send the child into the care of a MSW level social worker in a PINS diversion program.

She said that each case involves understanding a family, evaluating siblings and parents. This may require determining whether a child who is not attending school is “school phobic”, whether another sibling who is sleeping all day is “drugging”, or determining why a three year old is not talking. She said that the social worker would need to do diagnoses.

Differing Views on What is Clinical Practice

Social work directors in several hospitals each said that the work that their staff do is highly clinical, even if it is brief work. They each said that they believed that MSW’s who work in their settings would obtain work experience that will qualify them for obtaining the LCSW.

The director at one hospital said that she has been following the licensing law and the regulations very closely. She said that one must be scrupulous in adhering to the requirements of the law. At the same time, she said that she did not think that it would be necessary to define LCSW practice too narrowly, given the complex, clinical nature of the work with people who are hospitalized.

There are different views as to what constitutes clinical practice in the profession. One social worker who has been in private practice for most of her career pointed out that, in her opinion, social workers in hospitals who do discharge planning could not be engaged in doing diagnoses, treatment planning or psychotherapy. But others have a different understanding.

Psychotherapy - A Range of Perspectives

The definition of psychotherapy is spelled out in the licensing law as follows: “Psychotherapy is the use of verbal methods in interpersonal relationships with the intent of assisting a person or persons to modify attitudes and behavior which are intellectually, socially, or emotionally maladaptive.”

Psychotherapy is also described in the law as ranging from brief, short term and crisis oriented to long term. What constitutes psychotherapy is not defined by its duration nor by any one specific approach.

Accessing Information and Applications

Information about all of the requirements of the licensing law and application forms can be obtained on the website of the New York State Education Department’s Office of the Professions. Go to http://www.op.nysed.gov/lcsw.htm.

The Prevalence of the 45-Minute Hour 

(Click here to read the State Education Department clarification on 45 Minute Contact Hour)

One of the questions that NASW-NYC has explored with the State Board for Social Work, which is located within the Office of the Professions, is the definition of a client contact hour. According to the information on the State website, a client contact hour is defined as 45 minutes. This is the definition in the insurance law for the “P” and the “R”, but the social work licensing regulations appear to be silent about the length of a client contact hour as it relates to qualifying for the LCSW.

In order to qualify for the LCSW within three years, one must have 20 client contact hours per week over 48 weeks each year.

NASW is seeking clarification on whether or not the 45-minute hour is the applicable definition for the LCSW. This is important because what might be referred to as the “45-minute hour” is probably not the prevailing length of client contact in agency settings. As much as 85% of social work practice occurs within facilities.

One social worker told NASW-NYC

that, in her program, 45 minutes may well be the average amount of time that they see a client, with some contacts going well over that amount of time. Another social worker said that with managed care, mental health settings are requiring social workers to see more clients each day, thereby reducing the time with each individual.

A third social worker said that it is appropriate to require 45 minutes, asking how can anything of value happen in less time? This social worker hoped that the licensing law would result in changes within agency settings.

In fact, many social work leaders over the years have had the vision that social work licensing would induce changes in the way services are delivered in the State. Beyond assuring greater contact with clients, social workers have hoped that licensing would result in higher salaries and an increase in the availability of supervision. These would be outstanding outcomes. Whether these outcomes will result from licensing relates to the very limited availability of funding for all of human services in the State and the Nation, and the primacy of managed care and its control over reimbursement.

Public Agencies and the LCSW

Several weeks ago NASW-NYC received an email from a social worker in a major public agency inquiring about the impact of the requirements of the LCSW on that agency. The agency has been seeking to employ more professional social workers over the years and to expand its capacity to provide mental health services. Questions were raised as to whether the requirements for the LCSW were going to have an adverse effect on the agency’s ability to recruit and retain LCSW’s or LMSW’s seeking the LCSW. NASW-NYC has scheduled a meeting with the agency’s deputy commissioner to discuss their concerns in depth.

NASW-NYC Moving Forward

NASW-NYC will be setting up a task force to monitor the implementation of the licensing law, to provide members with information, and to engage in advocacy for modifying the law if and when the need arises.

Overall, NASW-NYC’s objectives will be threefold: 1) to assure that appropriate standards are maintained for effective practice, 2) that licensing is accessible to the diverse range of members of the profession, and 3) that quality services are available across all communities in New York City. NASW-NYC is the one organization that is uniquely positioned for finding the optimal balance among these three objectives. Ultimately, it is the licensing law that must strike this balance.

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