Summary

Issue for Discussion

The purpose of this item is to discuss with the Professional Practice Committee proposed amendments to Part 74 of the Regulations of the Commissioner of Education in regard to the experience required for licensure as a licensed clinical social worker (LCSW) in New York.

Reason(s) for Consideration

             
              For information and advice.

Proposed Handling

This item is being shared for informational purposes. Discussion and potential emergency action on proposed amendments to the regulations will take place at the June 2010 meeting of the Board of Regents.

Procedural History

Chapter 420 of the Laws of 2002 amended Article 154 of the Education Law, effective September 1, 2004, making social work a practice-protected profession.  Prior to Chapter 420, social work was a title-protected profession only.  The new statute established two levels of social work practice, licensed master social work (“LMSW”) and licensed clinical social work (“LCSW”), and prescribed requirements for licensure in each of these two new professions.

In June 2004, the Board of Regents adopted regulations for licensure in the field of social work. Subsequently, the Legislature enacted Chapter 230 of the Laws of 2004, which changed a number of the licensure requirements.  In February 2005, the Board of Regents adopted changes in the Commissioner’s regulations to conform them to the legislative amendments, including those relating to experience requirements for licensure as an LCSW.

The Office of the Professions and the State Board for Social Work have been engaged in ongoing discussions regarding the requirements for licensure and the practice of the professions of LMSW and LCSW. In working with stakeholders, we have reached agreement on the need to change the experience requirements to reflect current practice in New York and to be more consistent with the licensing requirements in other jurisdictions. The Committee is being asked to provide guidance for the development of regulations to implement such changes.

Background Information

Section 7704(2) of the Education Law requires an applicant seeking licensure as an LCSW to complete three years of full-time supervised post-graduate clinical social work experience in diagnosis, psychotherapy and assessment-based treatment planning, or its part-time equivalent obtained over a period of not more than six years. The current regulations define full-time experience as an average of 20 client contact hours per week in diagnosis, psychotherapy, and assessment-based treatment planning for three years under a qualified supervisor; the part-time equivalent is defined as the same total number of client contact hours (2,880) over a period of not more than six years under a qualified supervisor.

The law defines a qualified supervisor as a licensed clinical social worker, licensed psychologist who is competent in psychotherapy, or licensed physician who is competent in psychiatry. The current regulations define acceptable supervision as at least four hours of in-person clinical supervision each month, provided that at least two hours of such supervision be individual supervision.

Since 2008, the Office of the Professions has been working with service providers, professional associations, State agencies, the Legislature and others to identify issues related to the social work licensing requirements.  We will discuss with the Committee the following concepts, each of which addresses an area of concern:

• Reducing the client contact hours to reflect current practice. The experience requirements that were adopted in 2004, establishing a minimum of 2,880 client contact hours in diagnosis, psychotherapy, and assessment-based treatment planning, are the most demanding in the country and do not fully reflect the current practice  of clinical social work. Decades ago, a client received discrete mental health treatment, typically in 45-minute sessions for months or years. Today, psychotherapy treatment is often provided in shorter sessions and in a shorter period of time, and is frequently provided in conjunction with other health care services. Based on discussions with the field, we are developing proposed regulations to reduce the number of client contact hours required for licensure from 2,880 to 2,000, which equates to approximately 70 percent of the number of client contact hours currently required. New York would still have among the highest requirements for clinical hours, ensuring client safety.

• Adjusting the hours of required supervision to conform to the proposed revisions to the number of required client contact hours.  Under the current regulations, an LMSW must receive an average of four hours per month of in-person clinical supervision. Clinical supervision includes a review of the LMSW’s cases and evaluation by the supervisor of the LMSW’s work. This is in addition to general supervision which ensures appropriate services and patient care. We will propose adjusting the hours of clinical supervision from the current 144 hours of required in-person supervision over a period of three years (with at least 72 hours of individual supervision) to a minimum of 100 hours of in-person individual and/or group supervision over three years. This reduction of 70 percent is consistent with the proposed reduction in the number of client contact hours that would be required for licensure and would provide needed flexibility to the service provider agencies while continuing to assure appropriate oversight of the LMSW, who may only practice clinical social work under appropriate supervision.

• Including in regulations specific language identifying acceptable settings for experience in accordance with the existing laws. The Education Law allows an LMSW to practice in a range of settings under supervision. We will develop regulations to clarify the acceptable settings, which include a professional corporation, professional limited liability company, registered limited liability partnership, sole proprietorship, or professional partnership; a hospital or clinic that is authorized under Article 28 of the Public Health Law; a program or facility that is approved under the Mental Hygiene Law; a program or facility authorized under the federal law; or an entity that is defined as exempt from the licensing laws or otherwise authorized by law.

• Simplifying the process by which an LCSW may qualify for third-party reimbursement for psychotherapy services. The Insurance Law authorizes the Department to issue the “R” privilege to an LCSW who completes three additional years of experience in diagnosis and psychotherapy. We will propose regulations to require the LCSW to collaborate with a qualified, licensed professional – as defined in the Insurance Law – in order to qualify for the privilege. We will also propose to increase the one-time fee for the privilege, from $85 to $100, similar to the fee for other privileges issued by the Department. The changes will simplify the process by which an LCSW can demonstrate advanced training in psychotherapy, in order to qualify for private, third-party reimbursement of psychotherapy services.

• Offering prospective review of setting and supervisor for an LMSW practicing clinical social work under supervision. Since the 2004 implementation of the law, the State Board has seen many applicants who completed experience under a supervisor who is not qualified or in a setting that is not authorized, rendering that experience invalid for meeting their experience requirement for licensure. We will propose regulations that allow an LMSW to submit to the State Board a plan for supervised experience, so that the LMSW, as well as the supervisor and clients, are assured of the acceptability of the setting and supervisor. The proposed review will change the Board’s review from a retrospective to a prospective process, so there will be no change in workload and, in fact, may expedite the final approval of an applicant’s experience.

Timetable for Implementation

The conceptual changes have been shared with the Legislature and stakeholders for informal comments and feedback. It is possible that the Legislature will choose to amend Article 154 by clarifying the experience requirements for licensure. The State Board will review draft regulations, based on the comments of the Professional Practice Committee and stakeholders. We will return to the Committee in June 2010 with proposed emergency regulations addressing the issues identified above.