A Piece of Good News but Major Challenges in Social Work in New York Today
• More Social Workers Obtaining Their LCSW
• A Sea Change In How Social Workers Are Employed In Mental Health Clinics
• Governor’s Medicaid Redesign Team Could Create Challenges Relating to Reimbursement and the Future of Licensing.
Three of the biggest issues in social work now are licensing, employment, and reimbursement. Here is a brief update. I welcome your thoughts and response, and feel free to add to this discussion.
Number of New Clinical Licenses Issued
As challenging as licensing has been for many in the field, there is some good news. For several years after licensing went into effect, a relatively small number of social workers were able to obtain the LCSW. NASW worked closely with the State Education Department (SED) to understand the issues involved, including the criteria on whether a setting was qualified to offer psychotherapy.
Ultimately, SED revised the regulations relating to the LCSW, and the number of hours required for the LCSW was reduced by one-third, as was the hours for supervision. Data available on SED’s website shows that through 2010 the number of social workers obtaining the LCSW in a year (statewide) more than doubled, from around 400 a year for several years to over 1,000. That is a significant increase.
Another issue relating to licensing is the pass rate for the exam. NASW-NYC is convening a workgroup of the board of directors to examine options for the Chapter to assist social workers who are finding the exam to be especially challenging.
NASW is continuing to work with SED to monitor the impact of licensing on the profession.
Scarcity of Job Openings
On the employment front, it is distressing how few job openings there appear to be. There was a time not too long ago that you could open the New York Times classifieds and see a full page of job notices for social workers. The listings now, more likely to be on the internet, are nowhere what they once were. This reflects the economy and the political environment in the country overall, where the ideological disdain for government programming by many in elected office has a direct impact on the services social workers provide and the communities that we work with.
It is possible that this will change, but this is not on the horizon as of now. One can only hope that popular movements around the country such as Occupy Wall Street will help shift public opinion, but much more will be needed to bring about change.
A Sea Change in How Social Workers are Employed in Mental Health Clinics
Another development that we are monitoring relates to social workers in mental health clinics being employed solely on the basis of the time they see clients. In other words, instead of being paid by the hour, payment is based only on seeing a client and what is billable. If a client does not show up, there is no payment. Along with this is reduced or no benefits, no leave time for vacation or sick days, nor time for paperwork.
Agency administrators have shared that they face stark choices. Given the level of reimbursement for services, they say that they can either close their doors or cut personnel expenses. We were told that other programs outside of clinics have not been affected. We are also told that clinics are able to continue to offer supervision and remain as routes toward obtaining the LCSW.
One of the hallmarks of working in human services, historically, has been the benefits and leave time. NASW members are telling us that this “fee-for-service” employment model is spreading.
NASW is currently examining what is driving this within some clinics yet not in others, and we are looking to understand whether salaries have increased to compensate for cutbacks elsewhere.
Governor Cuomo’s Medicaid Redesign Team (MRT) Looking at Reimbursement for Managed Medicaid Behavioral Health and the Future of Licensing
Governor Cuomo’s Medicaid Redesign Team has been examining many changes to health and behavioral health with an eye toward integration of the two systems. Last year, several billion dollars in savings were identified, and costs remain a factor.
There could be opportunities for social work emerging from the Team’s recommendation, such as the need for care coordination across systems and transitions of care. There could also be an opportunity given the recognition for effective assessments and assuring that clients obtaining the appropriate level of care.
One question is related to the focus on the increased utilization of peer counselors in behavioral health. As valuable as peer services may be, will this result in unlicensed people being allowed to engage in professional services? In addition, a workgroup of the MRT has been given for consideration a proposal to extend the exemptions agencies now have from complying with social work licensing requirements. The exemptions currently go through 2013.
We are also concerned that the movement toward managed care for behavioral health will result in agencies being reimbursed only for services provided by LCSWs. Historically, Medicaid reimbursement to agencies has been possible for services provided under supervision, whether by a LMSW or an intern. On the other hand, managed care companies have not tended to reimburse for clinical services of the LMSW or interns. It is doubtful that there are enough LCSWs available to meet the need, which would create waiting lists for clients, and a significant pathway for LMSWs to become LCSWs could dry up if this were to be the outcome.
NASW will be watching these developments very closely in the months to come and making its voice heard.
Social workers have always worked under difficult circumstances while achieving very positive outcomes. Nevertheless, there is a tremendous amount needing to be done. This is a time when the profession needs to work together as never before, and NASW needs to be sustained by its members in order to be the voice for the profession on these matters.
Let us know what you are experiencing by commenting below.