Clinical Registration

Right-touch regulation of social work practice

BY NSCSW PRIVATE PRACTICE COMMITTEE

The Private Practice Committee formed in June of 2017 to address issues with the bylaws regarding the registration of private practitioners. The committee has been hard at work reflecting, researching and discussing these issues with the goal of providing a rationale and recommendations back to the membership at this year’s AGM.

A membership survey revealed that the current regulation on private practice is unclear and that members perceived private practice to be clinical practice. An environmental scan of private practice and clinical social work regulations across Canada also revealed that Nova Scotia is the only province that regulates private practice as a specific area of practice; however, provinces such as British Columbia, Alberta, and Saskatchewan have specific regulation regarding clinical practice.

SURVEY RESULTS

The survey revealed multiple perspectives on the issues, but the committee found beliefs shared by most respondents:

1. Having an MSW or PhD from an accredited school of social work is a necessary requirement for private practice.

2. Five years of relevant social work experience is a necessary requirement for private practice.

3. Supervision in an area of specialization is a necessary requirement for private practice.

4. Conducting assessments for legal proceedings as a social worker requires an additional level of registration to protect the public.

5. Clinical social work requires an additional level of registration to protect the public.

The committee reviewed the questions regarding specific regulations around clinical practice and agreed that survey respondents also believed the following:

1. The College should work to gain title protection of the title “Registered Clinical Social Worker” – this would mean a specific registration would be required to hold this title.

2. The College should work to update the scope of practice so “Registered Clinical Social Workers” can legally diagnose using the DSM-5.

3. The College should implement an exam to evaluate clinical competencies.

The committee has continued to examine the core issues, to weigh out which regulations are necessary to protect the public and which are not. The committee is considering a recommendation to deregulate private practice and put proportional regulation around clinical social work practice.

OVER-REGULATED PRIVATE PRACTICE

Right-touch regulation is an approach of looking for responses that are proportionate to the level of risk.

Currently, private practice is defined in the Social Workers Act as being “self-employed” which does not inherently mean clinical practice. The College’s Board of Examiners reviews applications for private practice by examining resumes, letters of reference, and years of experience, to assess if social workers have the competencies to provide social work services in the area of specialization that they’ve applied for. As social work has a large scope of practice, it’s problematic to define what competencies are needed in each area of social work; each area of practice is going to be contextual and relevant to the place of employment, clientele, and community.

The private practice committee believes that this is an over-regulation and not in line with best practices for right-touch regulation. The committee is now leaning towards recommending that the prescribed requirements and qualifications for engaging in private practice would be that a Registered Social Worker or Social Worker Candidate must be a member in good standing, and only engage in private practice in the area where they are competent to provide the social work service. The opinion is that the current entry to practice requirements, including completing an accredited social work degree coupled with a declaration to adhere to the Standards of Practice and Code of Ethics are sufficient tools to regulate private practice.

CONSIDERING CLINICAL REGISTRATION

The committee has continued to explore the question of clinical practice regulation. Clinical social work practice is an advanced area of social work that focuses on the individual

and their relationship to the social, economic and political structures that impact mental health, emotional, and other behavioural functioning. Using evidence-based modalities, clinical social work applies assessments, interventions, and prevention practices to achieve optimum psychological and social functioning.

There is a need to regulate clinical social workpractice, in order to protect the public.

CURRENT STATE OF MENTAL HEALTH CARE

Currently, mental health care in Nova Scotia’s is embedded in a worldview that predominantly sees mental health as an “illness,” a psychiatric condition that occurs largely out of the blue in individuals who are genetically vulnerable, are uncontrollable and lifelong. This worldview flows from the medical model which diagnoses and treats symptoms for those who are severely ill. This model is problematic as it drives political decisions towards stacking resources into hospitals and emergency rooms as opposed to communities. This approach is not supported by recent research, which tells a more complex story of mental health.

Social work’s grounding principles provide a framework for a different worldview on mental health care. This worldview presents alternatives to service delivery beyond the medical model. These approaches often involve a postmodern lens that is client and family-centred; is built to avoid having the deficit-based, problem-saturated, and pathologizing language of the medical model; and is rooted in strengths-based approaches to practice. These approaches work to ensure that clients’ voices and stories are valued above all else.

SOCIAL WORK & MENTAL HEALTH CARE

Since the late 1980s, social workers have felt a split between traditional social work values and medical model values. Social workers often feel tension between who they were trained to be and who they are forced to become in order to remain in the workforce.

Private practitioners and their clients continue to face barriers in ensuring coverage of social work services through insurance companies. Parallel to these concerns, members working through the public mental health systems have expressed distress about the current direction of mental health care in Nova Scotia and the role of social work within this system. The competencies required for clinical social work practice are increasingly being defined through the lens of the medical model rather than the values of the profession.

This creates challenges for the development of the social work professional identity within the mental health care setting. It often leads to internal tension and questions: “What is the role of social work in mental health care?” “How do our professional values fit and guide our actions within this setting?” and “How do we best collaborate with other health professions through social work’s unique practice lens?” This erosion of professional identity can lead to ethical dilemmas and burnout, which ultimately puts the public at risk.

The committee believes that social work professionals are best situated to define the minimal competencies required to practice as a clinical social worker. This process will more clearly define the profession’s role in Nova Scotia within the mental health care system, strengthen our professional identity, strengthen ethical and competent clinical practice and better protect the public.

TOWARDS A CLINICAL CATEGORY OF REGISTRATION

Given the current situation in mental health care, the Private Practice Committee is considering a recommendation that the NSCSW regulate clinical social work practice by creating a clinical category of registration, and setting minimal requirements for clinical social practice rather than assessing and authorizing practice in each area of clinical specialization.

The committee is considering recommending that the NSCSW set the minimum requirement of:

1. An MSW from an accredited school of social work.

2. A passing mark on the ASWB clinical exam.

3. A minimal amount of supervised clinical practice experience.

NEXT STEPS

There is much to do and much to discuss with members before the creation of a clinical category is decided by the membership at this year’s AGM. The committee aims to complete the following tasks before a vote at the AGM:

1. Complete a policy paper with more a detailed rationale for the recommendations.

2. Develop proposed by-law changes.

3. Travel the province during National Social Work Month to consult with members on these proposed changes.