The clinical committee works to strengthen clinical social work practice in Nova Scotia by exploring the regulatory tools best positioned to:

  • serve and protect the public interest;
  • preserve the integrity of the clinical practice within the social work profession; and
  • maintain public confidence in the ability of the social work profession to regulate itself.

The clinical committee will establish a clear clinical scope of practice, assess risks to the public associated with that practice and develop recommendation and draft policy to assure that only those fully qualified are entitled to practice clinical social work in Nova Scotia are doing so. 

Committee members

  • Lida Abdulrahman
  • Jacquelyn Allan, PP
  • Kelly Breau, PP
  • Catrina Brown, PP
  • Patrick Daigle, PP
  • James Dubé, PP
  • Brandy Gryshik, PP (co-chair)
  • Robyn Hazard, RSW
  • Alex Hill, SWC
  • Jim Morton
  • Andrea Shaheen, PP (co-chair)
  • Alec Stratford, NSCSW ED/R
  • Errin Williams, PP

Messages for the clinical committee can be sent to [email protected]. Please include “For Clinical Committee” in the subject line.

Objectives 

  1. Identify clear scope of practice for clinical social work;
  2. Examine all risks to the public associated with the delivery of clinical social work services;
  3. Examine regulatory tools best position to mitigate risks;
  4. Develop a rationale, recommendations and proposed policy for the successful regulation of clinical social work in Nova Scotia 

Approved minutes

Plan

The Clinical Committee is committed to explore the following issues as they work towards the NSCSW’s objectives for this committee. 

  1. Exploring the key attributes that inform the professional identity of a clinical social work practice. Including an exploration of: 
    • Collective Confidence (holding a sense of collective identity and self-esteem; a clear and understood knowledge-claim for practice, including the production of knowledge)
      • Identify what knowledge, theory and skills should be integrated into clinical social work practice. 
      • Examine the history of social works relationship with assessment tools including the DSM V and the social determinants of mental health. 
      • Examining various practice frameworks that align with clinical social work. 
    • Relationships (including with other mental health professions; perceptions of trust by users of professional services, key stakeholders and other professions, and with each other in terms of congruent values shared by clinical social workers)
      • Explore how clinical social work is perceived by other professions. 
      • Examining what makes social work unique in the allied health professions. 
      • Examining international scopes of clinical social work practice. 
    • Public Awareness (a clear and well differentiated scope of practice, visibility in the public discourse for distinctive contributions a clear and understood knowledge-claim for practice, including the production of knowledge)
      • Identifying a clear scope of practice for clinical social work 
      • Develop an understating of the distinction between mental health and addiction related therapy and counselling 
  2. Examine all risks to the public associated with the delivery of clinical social work services. Including an exploration of:
    • Ethical Clinical Practice: Ethics are the foundational of social work practice, encompassing the values of our profession, articulating our central beliefs and creating the unique context for engaging in our work.
      • Explore the risk of scope creep and the erosion of social work roots and values in social justice.
      • Explore the delivery of clinical social work services through an anti-racist lens 
      • Explore the delivery of clinical social work practice through an intersectional lens
    • Professional Boundaries: Social work is a profession that highlights the importance of close and purposeful relationships with clients. These relationships play a crucial role in people’s lives, and directly affect their quality of life and general well-being. Within that important relationship, social workers are required to maintain professional boundaries with clients and to ensure that the professional relationship serves the needs of their clients.
      • Explore the risks of delivering Trauma Focused Therapy (Transference and Counter-Transference). 
      • Explore various cultural understandings of professional boundaries from Indigenous and Afrocentric worldviews. 
      • Explore the professional boundary issues related to the delivery of services to Youth, Children and families
      • Explore the impact of moral distress and moral injury on the delivery of clinical social work practice (risk to clinician. 
    • Clinical Assessments: Clinical assessments are an evaluation of a person’s social, cognitive, psychological (personality, emotions, beliefs, and attitudes), behavioural and social history and current condition in order to determine the presence of any mental health issues. 
      • Explore the risks of utilizing (or not) the DSM V as an assessment tool in clinical social work practice. 
      • Explore the risks of utilizing social determinant of mental health as an assessment tool in clinical social work practice 
      • Explore the use of psychoeducational assessment in clinical social work practice 
      • Explore the risks of conducting parental capacity assessments in clinical social work practice 
      • Explore the risks of conducting cultural assessments in clinical social work practice 
  3. Examine regulatory tools best position to mitigate risks: including an exploration of:
    • Title protection: distinct title of Registered Clinical Social Worker
      • Explore if a reserved title would afford a means for Nova Scotians to identify and distinguish clinical social work practice and if this is needed to clarify qualified practitioners of clinical social work
      • Explore if title protection best serves the public interest in describing the practitioner and the services being provided and distinguish the practitioner from others performing services outside the jurisdiction of the regulatory body. 
      • Examine if it is the public interest to maintain exclusive scopes of practice (e.g. bio-pyscho-social; psychotherapy, etc.) 
    • Entry to practice: an assessment process designed to ensure that only those who are qualified and meet a minimal standard are allowed entry to clinical social work.
      • Explore if establishing specific entry to practice requirements are needed to mitigate the risks.
      • Examine the role of training and education for clinical social work practice.   
      • Examine the role of clinical supervision and the possible requirement of clinical supervisors.
      • Examine the role of a clinical exam.
    • Standards of Practice detail the responsibilities of social workers to their clients, colleagues, employers, and society as a whole.
      • Explore the creation of clinical standards of practice, with: 
        • Commitments to anti-racism and accessibility 
        • Use of assessments
        • Use of documentations 

Backgrounder

The NSCSW Private Practice Committee was formed in June of 2017 to address issues with the by-laws regarding the registration of private practitioners. An agenda for the private practice committee was further defined by members at the 2018 AGM who passed a motion carried by the membership that 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 recommendation with detailed rationale to members at the next AGM in 2019.”

Recommendations of former Private Practice Committee

The Private Practice Committee made the following recommendations at the 2019 AGM:

  1. The committee has concluded that the current regulation of private practice is an over-regulation and is not in line with best practices or right touch regulation. In addition, the committee has determined that the assessment tools for assessing entry to private practice lack validity and reliability. Finally, current regulatory tools are sufficient in assuring that members competently and ethically deliver professional services. committee recommended that;

    “The prescribed requirement and qualifications for engaging in private practice should 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.”

    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 private practice.
  2. The committee also concluded that clinical social work is an advanced application of social work theory and methods to the treatment and enhancement of psychosocial function and ability, addressing emotional, relational and mental health challenges. It is based on theories of human development within a psychosocial context. Clinical social work services consist of evidence-based assessment, diagnosis; treatment, including psychotherapy and counselling; client-centered advocacy; consultation; and evaluation.

    The committee determined that there is a risk to the public if social workers are practicing clinically without minimal competencies to do so. They recommended that the NSCSW regulate clinical practice by creating a voluntary clinical registry. The committee recommended that entry to the registry would be acquired through: 
    • An MSW from an accredited school of social work;
    • A passing mark on the ASWB clinical exam; and
    • A minimal amount of supervised clinical practice experience.

Council decision

Council heard from many social workers at the 2019 AGM and determined that regulating clinical practice and moving away from private practice was in the best interest of the public. Council however believed that more exploration was needed regarding the best way to regulate clinical practice, and passed a motion to create a clinical committee to further explore the issue and develop recommendations and a rationale for clinical regulation.

Repositioning Social Work in Mental Health in Nova Scotia

The NSCSW released a major paper regarding mental health in Nova Scotia and has concluded that the delivery of mental health and addiction services are hampered by challenges within the larger public health system.

Part of the challenges faced in service delivery is the unquestioned hegemony of the bio-medical model within the delivery of mental health services. While the bio-medical model certainly has its place within mental health services, its dominance has also become cumbersome to many, as it does not capture the complexity of mental health needs. The bio-medical model, particularly in Nova Scotia, tends to be expert driven: the clinician determines diagnosis, treatment, and when you’re “well.” It is focused on individualized treatments and ultimately holds individuals for the structural conditions that contribute to their illness (this often leads to the criminalization of those with mental health concerns). It reduces mental health disorders to the simplest forms, creates standardized treatments, and is driven by symptoms rather than root causes. 

The paper articulates that the social work profession should be re-positioned within mental health and addiction services in order to deliver a bio-psycho-social model that understands that mental health is shaped by a person’s environment. To ensure that there is a system:

  • that understands that the process of healing should be relational, and recognizes that mental health services aren’t just supporting the person in the room, but that this person exists within a family, within a community, and within a society;
  • that recognizes that care is delivered through collaboration, and acknowledges that the client is the expert in their own lives, and both the practitioner and the client bring expert knowledge to therapeutic conversation; and
  • that shares the responsibility of creating a connected and supportive society, and demands that we bring a critical clinical focus to the work so that we are deconstructing social power and its effects on overall mental health. 

The paper makes 29 recommendations, including the recommendation to explore regulatory practices to determine what can be strengthened in order to ensure that there is a well-defined and clear scope of practice that includes critical clinical skill and family-centred practice that are grounded in a relational approach. This must include a recognition and definition of the scope of clinical social work skills.