Chaos Theory — Hope for Licensure Reform in the Post-9/11 Age?
Social Work Today
By Matthew Robb, MSW, LCSW-C
Vol. 4 No. 5 p. 17

Social workers have long bemoaned a fragmented licensure structure. Will urgency in the age of terrorism make a difference in the big picture?

Chaotic. Bewildering. A tangled, muddled mess.

That’s how social workers, from coast to coast, describe the regulatory architecture that shapes their professional lives.

On one level, social workers grumble about a Byzantine world of breathtaking inconsistency—of fragmentation, contradiction, and head-scratching perplexity that stymies even seasoned professionals. And then there’s that alphabet soup of nearly 40 professional designations—from LICSW and CAPSW to CSW-PIP and LMSW-AP—that only deepens perceptions of disarray. With regulatory players seemingly stuck in first gear and key issues going unresolved, it should not surprise to find practitioners howling in protest.

Just ask Dawn Hall Apgar, PhD, LSW, ACSW. As former president of the National Association of Social Workers’ (NASW) New Jersey chapter, Apgar has heard hundreds of exasperated social workers seethe, shout, and sob. She’s heard them equate state licensure boards to unresponsive fiefdoms ruled by myopic monarchs. She’s heard countless pleas for reform, followed by predictable echoes from Officialdom that reform takes time—lots of time.

But what really sharpened Apgar’s awareness were the aftershocks of September 11, 2001. That’s when she reportedly saw restrictive, convoluted licensure laws prevent New York social workers from providing needed follow-up care to World Trade Center families living in New Jersey. Today, she’s convinced more than ever: The system is broken. Real reform is needed now—before the next 9/11.

Apgar’s experience begs questions from her peers: If social workers are such savvy organizers and advocates, why is our regulatory system so splintered and inconsistent? Also, what progress is being made in standardizing, streamlining, and updating? And is there hope that we might attain the Holy Grail of reciprocity and/or national licensure?

We talked to those in the know. Their answers may surprise you.

A Bridge Too Far?
From her office at the New Jersey Institute of Technology, Apgar cuts to the heart of her argument: regulations that purportedly sow confusion, undermine credibility, and possibly slow disaster response.

“Why is it,” she asks, “that New Jersey requires 1,940 hours of supervised practice to qualify for clinical social work licensure but Pennsylvania wants more than 3,000 hours? How is it that clinical social workers are judged fully competent to practice in a town on one side of a bridge but not so once they cross that same bridge into another town, another state? And why is it that the CSW designation in New York State is a master’s-level clinical license while in New Jersey it’s a bachelor’s-level nonclinical license?

“In this region,” she continues, “it’s not uncommon for social workers—especially those working for agencies with satellite branches—to be licensed in two, three, or four states. This is cumbersome enough. But add to that the lack of uniformity over continuing education [CE] requirements and approval. Some states require 20 CE hours every two years. Others demand twice that amount. And while New Jersey automatically approves NASW-sponsored CE courses, some states do not. What this means is that the social worker hoping to count one CE course toward all of his or her licenses may have to seek preapproval from several state boards. That’s a waste of time and energy.”

Notes Apgar, “We take calls from confused consumers day in, day out. They know what a PhD psychologist is but can’t decipher social work designations that change from state to state.” The resulting hodgepodge, Apgar says, is a disservice to consumers, puts social workers at a competitive disadvantage, and further blurs our distorted public image.

She continues: “But we also constantly hear from social workers fed up with other ‘crazy’ licensure laws. With both Pennsylvania and New York just getting—or poised to get—licensure, everyone is scrambling around, wondering what new hoops they’re going to have to jump through.”

Apgar is too savvy to champion national licensure. Her wish is simpler: consistency—consistency in titles, requirements for supervision and work experience, and continuing education and even basic terminology. The end goal, she says, should be interstate portability—an open-doors policy made possible through reciprocity.

Regulations—confusing and fractious? Yes, indeed, says Debra Riggs, executive director of the NASW Virginia chapter. Riggs rattles off a raft of examples, including the case of neighboring Maryland demanding that all social workers be licensed—and recently tacking on tough new credentialing standards for clinical supervisors. In Virginia, meanwhile, “social workers don’t need a license at all, unless they are solo practitioners,” she says.

“I’m constantly answering questions from frustrated, stressed-out social workers who can’t decipher our arcane system,” says Riggs. “But it’s not just a matter of licensure complexity. It’s the entire bureaucracy that just wears you down. It shouldn’t be this way. We should have the same standards everywhere.”

Hurry Up and Wait
To underline perceptions of discontinuity, consider this: If Mila Tecala, ACSW, DCSW, were to relocate from Virginia to another state, it’s quite possible the state’s licensing board would respond: “You can’t practice here.”

Tecala, for the record, was the NASW National Social Worker of the Year (2002) and is a consultant to the Association of Social Work Boards (ASWB) and a gifted clinician of 32 years. Outlining her own case for reform, Tecala cites instances of social workers who relocate to other states only to stumble into regulatory roadblocks that impede or derail their careers. In some cases, state boards refuse to recognize their work experience, supervision, and/or education. But many new arrivals in California find the Golden State the least accommodating, as it no longer recognizes scores from the ASWB’s national licensure examination. Breaking from the pack, California instituted its own test in the late 1990s, asserting that it better reflected social work practice in California.

Furthermore, some state boards might require that even proficient clinicians like Tecala get additional clinical supervision—quite possibly from newly minted supervisors who possess but a fraction of their seasoning. Moreover, because Virginia long ago “grandparented” Tecala under its current system—without examination—another state board might require she pass the same examination for which she currently helps the ASWB write questions.

Comments Riggs, “I’ve seen people with 15 to 20 years of clinical social work experience arrive in Virginia only to be told by the state board, ‘You’ll need to get two years of supervision first.’ I’m talking about highly experienced social workers—and let’s remember: Virginia doesn’t even license most of its social workers.”

Says John D. Weaver, LCSW, BCD, ACSW, a long-term American Red Cross disaster responder and Pennsylvania Social Worker of the Year (2002), “These [disparate] regulations have been an ongoing problem for the Red Cross ever since disaster mental health started in 1992. Before the Red Cross can mobilize a response team, [organizers] must first examine state regulations to ensure Red Cross social workers can even contribute.”

Says Apgar, “I’m afraid it will take years to achieve meaningful reform—or possibly one huge national disaster.”

Eight-Hundred–Pound Gorillas & Shaky Tightropes
Don’t like the system? Blame the nation’s founding fathers, says Donna DeAngelis, LICSW, ACSW.

DeAngelis, executive director of the Virginia-based ASWB, notes that state licensure regulation is a secured constitutional right. Fundamentally altering the current arrangement would require that a silver-tongued reformer convince thousands of state legislators to pass a constitutional amendment that strips them of their regulatory power. Hence DeAngelis’ cautionary note regarding national licensure: Don’t hold your breath.

“Frankly,” DeAngelis says, “I could not agree more about the need for reciprocity, but the sweeping reforms that play well to social work audiences don’t get the same warm reception in legislative houses in Sacramento, Austin, Springfield, or Albany. States jealously guard their rights and interference from outsiders makes them see red.”

The paradox? The ASWB may seem an 800-pound gorilla on the national level, but its influence is peripheral, its power narrowly circumscribed. DeAngelis explains that the association’s roster is filled from the ranks of the nation’s social work boards and then connects the dots: “If we start doing things that our [voluntary] membership believes incompatible with our mission—or with their state rights—we will lose members.” Translation: The ASWB walks a shaky tightrope, forcing it to soft-pedal its Model Law—a blueprint for creating harmony from regulatory discord.

ASWB cannot lobby, twist arms, or pass decrees by fiat. The downside of low-key advocacy is glacial reform, meaning a timetable of years and decades, not weeks and months. “It’s not fast and it’s not perfect,” DeAngelis says. “But it’s the best we can do, and it’s not because we don’t care or that we don’t know there’s a problem out there.” Equating the regulatory system to a patchwork quilt, she adds, “We are trying to at least introduce a pattern into the patchwork.”

Notably, no other professionals—from physicians to physical therapists to psychologists—possess national licensure. Moreover, David Hamilton, PhD, CSW, executive secretary of the New York State Board of Social Work, comments that regulatory variation is par for the course in most every profession. He notes that states licensure of physical therapists is based on evolving educational requirements. While a therapist with a bachelor’s degree once satisfied licensure requirements, today the norm is the clinical doctorate.

Regulatory NIMBYism
So formidable are the constitutional issues that they tend to overshadow other sticking points to reform.

Says ASWB board member (and Oregonian) Roger Kryzanek, LCSW, “Before you could get the Oregon state legislature to consider adopting the ASWB Model Social Work Practice Act Law, you’d first have to get Oregon’s social work professionals to buy into the argument that we need regulation beyond what we currently have.” The ASWB may be selling, but many social workers simply aren’t in the buying mood.

Kryzanek’s point is sublime. Rather than monolithic, the social work profession is sharply divided at every level—political, economic, cultural, generational, geographic, occupational, philosophical, existential, and more. It’s not that we social workers are our own worst enemies; but we are advancing our own vested interests, and these interests are sometimes antagonistic.

With understatement, Riggs says, “It’s a challenge to sell a 20-year social worker on the notion that she’s not qualified—that she’s not professional enough.” Social workers opposed to stiffened standards can flex their political muscles. Edgy legislators fearing a backlash see wisdom in status-quo maintenance.

Yet, opposition comes from more than practitioners. It comes from agencies, taxpayers, politicians, and competing mental health providers. “In Virginia,” says Riggs, “the NASW has seen lots of resistance to upgrading our licensing regulations.” She notes that in rural areas, “agency directors may have excellent skills and experience but, lacking formal social work education, they are going to fight having to go back to school.” Progressive legislators—clashing with tight-fisted conservatives—may offer generous grandparent clauses, all for naught. In an era of skin-tight budgets and sharp competition, Riggs says, “agencies say they can’t afford or even find master’s- or clinical-level social workers—and they’re probably right.”

In the paradoxical world of regulation, then, what’s good for social work can also be very bad for social work.

Thus the ASWB’s delicate footwork.

Commenting on this push-pull dynamic, Hamilton notes that legislators must weigh the needs of “our powerful medical society, third-party payors, institutional providers, and lawmakers who want to protect New York State’s [legislative] heritage.” Hinting at yet another angle, The American Nurses Association opined on a proposed multistate nursing compact: “[W]e believe that the greater the number of nurses holding licenses in several states, the greater the potential revenue loss to state boards of nursing, potentially resulting in reduced nursing board services and/or increased licensure fees.”

Comments Janlee Wong, MSW, executive director of the NASW California chapter, “People don’t understand the difficulty in defining and legislating ‘clinical social work.’ It’s vague and general, so each state redefines it and makes its own requirements.”

In the final analysis, then, while regulators may be lightning rods for discontent, their perceived unresponsiveness and complacency can be traced to complex external forces. Whipsawed by often irreconcilable demands, powerful lobbies, and social workers advancing diametrically opposed agendas, they must maintain a difficult balancing act. Indeed, Hamilton challenges the notion of regulatory “disarray” and says variability in licensure merely reflects the complexity of society at large. Nevertheless, DeAngelis says lawmakers, regulators, and advocates have a strong record of surmounting key differences to move forward and serve the interests of consumers and social workers alike.

Reform on the Horizon?
So, how likely is regional or national licensure? On this matter, experts agree: Less than zero.

But DeAngelis reminds that national licensure isn’t the end all, be all of regulatory reform. She’s encouraged that the Model Law is helping stage regulators slowly—ever so slowly—converge toward common ground. Minds are opening, eyes are lifting, entrenched positions are softening. “No one has adopted the Model Law whole cloth,” she says, “but all jurisdictions use bits and pieces.” As laws inch toward uniformity, reciprocity (or its equivalent) becomes more likely, not less.

Tecala praises both the ASWB and NASW for leading the charge. “NASW has historically really fought hard on this licensure issue—in every state legislature.”

Kryzanek nods in agreement. “At ASWB, we talk about best practices in regulation and then the representatives go back to their home states and discuss ways of modifying existing standards. Progress in portability and uniformity is definitely being made. The outliers are disappearing over the long term.”

Kryzanek concedes the raw appeal of national licensure but adds that state control has its own logic, allowing a tailoring of laws to specific needs and also providing consumers with legal recourse.

Wong concurs: “A key issue is whether the social work practiced in rural Montana is the same practiced in San Francisco. We in California think it isn’t. When you work with different populations—rural farm vs. urban ghetto vs. Hopi Nation—how could it be the same?” A “one-size-fits-all” set of national standards, he says, would create its own problems, forcing states into rigid conformity and group-think—precisely what good social work is not about.

On the disaster response front, Hamilton notes that New York State has established Web- and print-based forums designed to keep licensed professionals abreast of response needs in the event of a future disaster. Apgar says her NASW New Jersey chapter has “really worked on strengthening our referral system through affiliation agreements with the major disaster service organizations.” And amid renewed threats from al-Qaeda, Weaver raises the idea of “national disaster reciprocity,” a system that would “waive more quickly and easily the licensure laws for people who are doing disaster relief work.”

Aware of the many challenges, DeAngelis nevertheless remains hopeful. She’s particularly excited about the ASWB’s just-launched “credentials registry,” which would position the ASWB as a national clearinghouse to speed and simplify licensure. “What our credentials registry means for the social worker,” she says, “is that, for a modest fee, ASWB will register all of their prima facie original documentation—college transcripts, supervisory evaluations, work experience, and CEs. Thereafter, when you relocate to another state, we can help fast track your application.” She says that “instantaneously” faxed official verification to state boards would eliminate needless delays and snail-mailed responses. Before this concept can become reality, however, more persuasion is needed. “We can’t get every state board to sign onto this fast-track process right away,” DeAngelis says. “They’re resistant to change. They don’t want to let go of their authority.”

Which leads to the final question: What can individual social workers do?

“The ASWB can’t be the tail that wags the dog,” Kryzanek says. “Social workers really need to get involved at every level.” Adds DeAngelis, “If social workers want change, they should lobby their legislatures and get involved with their local NASW chapters or with their clinical societies. Social workers have a proud history of organizing, lobbying, and advocating. Now is the time to redouble our efforts.”

Ultimately, the future of social work reform rests not in a dark legislative chamber but rather in each of our hands. Whatever direction it takes, reform begins with us.

— Matthew Robb, MSW, LCSW-C is a social worker and freelance writer residing in suburban Washington, DC.