Revisions to the clinical scope proposal

The Clinical Committee is pleased to distribute a revised proposal on the regulation of clinical social work for discussion at next week’s Special General Meeting, on Thursday May 12, 2022.

It should be noted that the committee spent much time debating adding diagnosis to the clinical social work scope of practice, and originally landed on applying and critiquing the use of diagnostic impressions. This was done because of the ethical consideration and critiques of the DSM, as well as the recognition that diagnosing is a controlled act in Nova Scotia; adding diagnosis to the scope of practice would require legislative change to the Social Workers Act, which is much more of a challenge to achieve as the Government of Nova Scotia would have to write and pass new legislation.

In April a legal review on the proposal was conducted, and it was determined that legally there is no substantial difference between diagnosis and diagnostic impressions. This means that adding diagnostic impression to the scope of practice would also require legislative change. Participants in the April member consultations also noted that not being able to sign their name to assessments for clients who required diagnoses created a barrier for clients to access services.

The debate regarding social workers’ relationship to the DSM and its overall usefulness will remain a central one in the application of ethical clinical social work practice. The professional paradigms of social work clearly emphasize the social context and conditions of people’s lives, human strengths, and collaborative approaches. However, social workers, especially those working within mainstream institutions such as government-based services and hospitals, are expected to conform to the dominant bio-medical paradigm which relies on the DSM. It is therefore crucial that clinical social workers have working knowledge of the DSM to be able to apply and critique its uses while providing support for an individual in the context of their lives.

Given this, the clinical committee has made two changes to the proposal on clinical regulation: 

  1. The first is regarding the abilities a clinical social worker must have. The proposal now recommends that: “Clinical social workers must have the abilities to complete assessments on human struggle and suffering throughout the stages of life using theories of human behaviour shaped by family, social, economic, cultural, spiritual, and political structures. Clinical social workers use a person-in-environment lens to apply and critique a diagnosis in solidarity with clients.”
  2. The second is for council to seek legislative changes to the Social Workers Act to add a clinical scope of practice. 

We look forward to conversation at the Special General Meeting next week.

Warm regards, 
Alec Stratford, RSW
NSCSW Executive Director/Registrar