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.
NASW-NYC Connections 
Please consider to “re-open the grandfather-in” which was briefly offerred for the LCSW eligibility. There was a small window of opportunity, and, for unforseen circumstances, several LMSW’s were unable to pursue the licence possibility at that time. For example, I received an MSSW in 1982. Several supervisors and other staff are no longer in the field (i.e., relocated, retired, deceased!). The dedicated professionals who remain, have extensive practice/work experience. We would like for NASW to re-activate this opportunity. Thank you for your consideration. Your feedback would be appreciated. Please contact me if I could be of assistance concerning this crucial proposal.
The licensing law created a grand parenting period of one year through September 2005, and NASW spent a great deal of time getting the word out to the field about this opportunity. Nevertheless, there were many who either did not learn about this or did not fully understand the need to apply for being grand parented at that time. As a result NASW lobbied to re-open the grand parenting period with the state legislature, but there was opposition to this. It is much easier to kill an initiative than to have one enacted, and grand parenting was not re-opened. We more recently tried a second time and it did not go anywhere. While we have been successful in getting some things enacted, including funding for loan forgiveness, there are times when the tide runs against us and we are not able to succeed, even with a strong voice on behalf of the profession.
licensing needs to be re-examine. it will a torn in the professions growth. I have a brochure developed by SED in the 80′. It explains certification of social workers. if you subsitute licensing for certification in this brochure it will remain 100% accurate. you need to ask yourself what is licensing really all about if not a institutional professional corporate attempt at segregation seperation and elitism boardering on institutional racism.
National NASW recently published a document titled “Institutional Racism and Social Work Practice: a Call to Action”, and many social workers, including many NASW leaders in NYC, have been taking training in addressing structural racism. This has opened many people up to seeing other sides of an issue, including licensing. This has not necessarily lead to being opposed to licensing but to looking at how to address its impact, as well as its benefits. The national publication can be accessed through our homepage, bottom left: http://www.naswnyc.org.
mental health clinics with top heavy administrative salaries is a major factor in the closing of clinics. selfishly many of these well salaried administrators rather close a clinic than to allow their rubber stamping boards hire new administrative teams at lower salaries and focus on the care givers and the community, Non for profits belong to the federal government and the people they serve. not rich administrators
I have been told that Medicaid will soon start limiting the annual number of therapy sessions covered to 20-something for mental health clients and 50-something for CD clients. This will make my clinic and many others unable to remain in business. Is this true?
There have been a great many changes in behavioral health and in medicaid, including a significant cut in funding, so it is not surprising that we will see cuts in client hours. Often times it is our members who are the first to inform us about changes and their implications. We need to know what you are experiencing on the front line; this is what enables us to take positions and develop our advocacy agenda. So thanks for raising this.
as an example of clinics w/ top heavy administrative salaries that went belly-up during the past 5 years I nominate Brooklyn Psychiatric Centers, Inc. This clinic workers were covered under 1199 SEIU and on at least 2 or 3 occassions the clinic was unable to meet their salary and benefit commitments to workers. In spite of the fact that LMSW and LCSW line worker salaries began at 39K and topped out around 44K (2000-2004), and COPS payments were at their highest. It appears that the top administrator(s) received 100K+ yearly and so that an extrapolation re:other administrators gives us an idea of the top heavy admin. salaries that may have impacted the agency’s insolvency.
As an LCSW who also spent over 25 years in administration and now teaches in social work grad education, I would ask all of you to hold off on the generalization and demonization of “well salaried administrators.” In all fields, ours included, there are those who are in fact as depicted by Mr. Lopez. However, the real problem is that our government financial support for all forms of social welfare services is meager and allocated grudgingly by both political parties. And most importantly this lack of generosity reflects the ongoing values and beliefs of our society (the tax payers) grounded on the most primitive of messages which is if you cannot be independent and take care of yourself, there’s something wrong with you. Remember the concept of “less eligibility” and the “moral hazard” of taking care of people in society? If the contracts provided by the government on all levels were generous and truly met the service needs of our client populations, administrators wouldn’t be turning themselves inside out to try to make a meal out of Stone Soup. We — all social workers working in all methods — are not the enemy in this . Our problem is that we’ve accepted the “do more with less” mentality and haven’t done our part to aggressively advocate as OWL has done. Remember what we did in the Progressive Era and in the 60’s. Where have we been since?
Listen, you are absolutely wrong for calling it generalizations. Top administrators and executives make way too large of a salary compared to their frontline workers. Therefore, please do not be remiss in acknowledging this reality. It’s real. The numbers will demonstrate this obvious reality. We social workers need more respect, money, and power. Administrators and top executives are always the individuals who are eager for power and money, and could care about the direct practice.
please do not speak for social work. the progressive era of the 60′ was not driven by social workers nor have we addressed the greed within our own institutions. the cops program of the 90′ as is parity today, an attempt to get extra funding into mental health, was invested on top heavy administrations that did not prepare for the new regulations of today which demand more with less. if we continue to misuse the crumbs that are distributed to the poor and their programs than we are in a cycle practicing our own version of the theory of limited goods. i expect more of this profession because of its origins and principles. let us not as a profession confuse truth to power with being idealistic and utopian. reality is we continue to miss the boat.
Thank you for your replies and efforts. We all have recognized years of experience. I have taken “pay deductions” over the years to remain committed to my initial goal(s).
When I went to the NASW private practioner’s meeting a few years ago, it was noted that LMSW’s were “not welcome” and “only The LCSW would be able to attend” those meetings.This is telling as it relates to “separation” within the social work mentality.
I was recently informed that it was mainly LCSW colleagues who “opposed” the re-opening of the “grand- parenting” of LMSW to LCSW to be extended or re-opened. Is this what our professional values and beliefs advocate for?
One way in which social workers are speaking up is through NASW-NYC’s political action committee, NYC-PACE. Elected officials are most open to hearing from social workers when they are preparing for elections, and PACE provides the opportunity for that. There is a lot of education going on, for everyone involved. Typically PACE meets on the 2nd Wednesday of each month at 6:15 PM. Call the office to confirm meeting dates at 212-668-0050, or to learn more about becoming involved in PACE.
Bob Schachter
I was an administration/macro social work student at the master’s level. I experienced marked prejudice from my colleagues as a student and later as a practitioner. I went on to study at the doctoral level, and became even more disillusioned about social work, partly because clinical work was considered “real” social work, while anything else was illegitimate. We could start our reforms by changing that attitude.
Licensure was a negotiated process meant to please everyone – it pleases no one. That people with master’s degrees need ongoing supervision ad nauseum makes us to be a para-profession, not a real one – and most people know it, and give us the appropriate amount of respect, which is to say very little. That LCSWs are the worst when it comes to this disrespect says a lot about our profession – or lack of one.
I have 15 years of providing assistance to people in changing their lives for the better, but I will never have enough supervised hours to qualify as an LCSW in New York, let alone get my “R”. I’d rather call myself a coach, which has no real certifications requirements to speak of, and make $25 an hour cash and call my own shots – not that I make that little. Or call myself a health care social worker – I provide a great deal of comfort and information to my clients, I refuse to call them patients, as they are people in need of help not necessarily people who are sick. We could continue reforms by defining who we are and what we do, rather than playing at those things which we are not.
Once again, in an effort to seem a serious profession, social work has done things that some imagine or perceive as serious, rather than simply BEING serious about what we do and how we do it. We might want to get over doing that, too.
Hi Everyone
Lets just stay focused on the real issue. There needs to be another grandparenting in for all of the hard working MSW’s. Many of us work for non profit organizations and service many and children and families that are at risk. We are paid little money but we still do our jobs because we care. In order for us to continue to do this work we need to be LMSW’s. If not many of us will loose our jobs.
Do what is right. If this is not done by July,2013, you think that the unemployment rate is high now, you ain’t seen nothing yet.
Remember Cathy Black that briefly worked for the NYC Board of Ed. She had Mr.Bloomberg call his friends at the NYC higher Education and requested Ms.Black ;be provided with a wavier/free pass. Ms.Black did not have any education or degrees in education, but they were getting the wavier for her. Why? The NYC higher education can do what they want when they want.
So why cant the MSW get a wavier/grand-parented in?
People need MSW’s. Mentally ill people need social workers. The “L” does not define the great work we are doing.
Thank you Sarita