The Private Practice committee formed in June of 2017 to address issues withthe bylaws regarding the registration of private practitioners. In addition, social work private practitioners and their clients have continued 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.
An agenda for the private practice committee was further defined at last year’s AGM, with a motion carried by the membership stated.
“the membership directs the College’s Private Practice Committee to continue further considerations for this by-law change to section 32 (1) b outlining the private practice requirements. As part of deliberations, the committee will bring a specific recommendations with detailed rationale to members at the next AGM in 2019.”
The committee has been hard at work reflecting, researching and discussing all of these issues with the goal of providing a rationale and recommendations back to the membership at this year’s AGM. Steps that the committee has currently taken have been to:
- Conduct an environmental scan of private practice and clinical social work regulations across Canada;
- Conduct a membership survey;
- explored relevant research on the topic.
The survey revealed that the current regulation on private practice is unclear and that members perceived private practice to be clinical practice. Further to this, an environmental scan revealed that Nova Scotia is the only province that regulates private practice as a specific area of practice, but that provinces such as British Columbia, Alberta, and Saskatchewan have specific regulation regarding clinical practice.
In the survey, there were certainly multiple perspectives on the issues. What the committee agreed is that the survey respondents believed the following.
- Having an MSW or PhD from an accredited school of social work is a necessary requirement for private practice.
- Five years of relevant social work experience is a necessary requirement for private practice.
- Supervision in an area of specialization is a necessary requirement for private practice.
- Conducting assessments for legal proceedings as a social worker requires an additional level of registration to protect the public.
- Clinical social work requires an additional level of registration to protect the public.
Further to this the committee reviewed the questions regarding specific regulations around clinical practice and agreed that survey that respondents believed the following:
- 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.
- The College should work to update the scope of practice so “Registered Clinical Social Workers” can legally diagnose using the DSM-5.
- The College should implement an exam to evaluate clinical competencies.
With this, the committee has continued to examine the core issues in order to weight out what regulations are necessary to protect the public and which are not. Using an approach framed in right touch regulation the committee is leaning towards making a recommendation that deregulates private practice, but that puts proportional regulation around clinical social work practice.
Over Regulating Private Practice
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 experiences to assess if social workers have the
The private practice committee believes that this is an over-regulation and not in line with best practices or right touch regulation. At this time the committee is leaning towards recommending that the prescribed requirement 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 codes of ethics are sufficient tools to regulate
The Question of Clinical Registration
However, the question of the regulation of clinical practice is something that the committee has continued to explore. The committee believes that clinical social practice is as 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. Through the use of evidence-based modalities, clinical social work applies assessments, interventions, and prevention practices to achieve optimum psychological and social functioning.
The committee believes there is a need to regulate clinical social work practice 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 works grounding principles provide a framework for a different worldview on mental health care. This worldview presents alternatives to service delivery beyond the medical model. Often these approaches involve a postmodern lens that is client and family-centered, 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 and 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 a tension between who they were trained to be and who they are forced to become in order to remain in the workforce.
This tension is often felt in Nova Scotia, social workers in mental health care settingshave expressed concerns to the Council of the College that it feels like social work is being pushed out of the mental health care system. In addition, private practitioners have expressed frustration with insurance companies who often do not cover the cost of social workers providing mental health care services. More and more the competencies required for clinical social work practice are 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 question such “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 works unique practice lens?” This erosion of professional identity can lead to ethical dilemmas, 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. That this process will more clearly define the professions role in Nova Scotia within the mental health care system strengthen our professional identity, strengthen ethical competent clinical practice and better protect the public.
Towards a Clinical Category of Registration.
Given the current situation in the Mental Health Care, the Private Practice committee is considering making the recommendation that the NSCSW regulate clinical social work practice by creating clinical category of registration. Instead of assessing and authorizing practice in each area of clinical specialization, the committee is considering recommending that the College set minimal requirements for clinical social practice.
The committee is considering recommending that the NSCSW set the minimums requirement of.
- An MSW from an accredited school of social work.
- A passing mark on the ASWB clinical exam.
- A minimal amount of supervised clincial practice experience.
Next steps (a discussion)
Given that the creation of a clinical category is to be decided by the membership at this year’s AGM, there is much to do and much to discuss with members. The Committee aims to complete the following tasks before a vote at this years AGM
- Complete a policy paper with more a detailed rationale for the recommendations.
- Develop proposed by-laws changes.
- Throughout the month of March (social work month!) travel the province to consult with members on these proposed changes.
We can begin the conversation today on this Blog Post. If you have questions, thoughts, ideas please post below.
We look forward to the engagement process !