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Practicing During a Pandemic — The Role of Social Work Regulators
Jay Miller, PhD, MSW, CSW

These are unprecedented times. The COVID-19 pandemic has fundamentally changed every facet of our lives—the way we communicate, the way we socialize, the way we think.

And, for social workers, it has radically changed the way we practice.

As is the case with most professional disciplines, social work practitioners are being tasked with ensuring that clients continue to receive exemplary services in increasingly restrictive environments. Evolving policy edicts from local, state, and federal governments compound these tasks. Indeed, the contemporary social work practice landscape is one the likes of which most social workers have never seen.

Against this backdrop, practitioners need flexibility in providing services and obtaining and maintaining credentials necessary to perform those services—all while maintaining ethical standards. Regulatory entities in general, and those involved with social work services specifically, must take action to provide regulatory clarity and relief.

However, this can be complicated. In a social work regulatory culture rife with a dizzying array of myths, misnomers, and misconceptions, assessing and making necessary changes to practice regulations is not always straightforward. This article provides a contextual clarification of professional regulation and six recommendations for these challenging times.

Regulatory Context
Compared with other professions, the regulation of professional social work practice is a relatively new phenomenon. Interestingly, Puerto Rico was among the first to regulate practice in the 1930s. Some two decades later, California became the first state to mandate licensing for social work clinicians.

In the 1970s, NASW issued a statement promoting the regulation of social work. For many, it was widely promoted that regulation would improve the quality of services provided by social workers. By 1988, all but eight states offered some type of social work licensure or registration. Today, social work practice is regulated in all 50 U.S. states, the District of Columbia, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and all 10 Canadian provinces.

Regulatory Framework
To fully grasp the role of regulators, it is necessary to understand the overarching framework in which regulation occurs.

No overarching national entity oversees social work practice. The Constitution of the United States grants states the right to regulate professional practices, such as social work. As a result, practice protocols and guidelines vary widely across states. While some states regulate social work practice via licensing at multiple practice and educational levels, other states only license at one level.

Board structure and composition also varies. Some states operate via composite boards, which entail several different professional disciplines (e.g., social work, professional counselors, and marriage and family therapists). Others solely oversee the practice of social work. Criteria such as number of board members, appointment processes, and member terms differ by state.

Research on social work licensing reveals that practitioners often confuse state regulatory boards with the Association for Social Work Boards (ASWB). A nonprofit independent organization, ASWB develops, manages, and administers social work licensing exams. ASWB comprises member jurisdictions (e.g., state boards) and provides support and services to social work regulators.

Regulatory Functions
The essential function of regulators is very simple: to protect the public. Ultimately, state regulatory boards are tasked with ensuring that the public receives social work services from appropriately credentialed social work providers. These credentials, such as licenses, are connected to certain levels of education and training, which qualify the individuals to provide the specified service.

Of course, with that protection comes the need to oversee disciplinary issues. In an effort to ensure public protection, state boards often receive, investigate, and take disciplinary actions regarding complaints against social workers. Disciplinary scenarios run the gamut: dual relationships, fraudulent billing, unauthorized practice, and the like. Though not always popular, discipline is a necessary regulatory function.

Regulatory Roles and Responsibilities
Undeniably, this crisis is a trying time for social work regulators. Affording social workers (and their organizations) the flexibility needed, while also upholding ethical practice standards, can be challenging. Additionally, because of evolving reimbursement standards related to COVID-19, social work regulators may be pressured to relax standards in a way that is unsafe (and, thus, unethical) for social work practitioners and their clients.

The following are six recommendations are for regulators, and those affected, currently assessing regulatory approaches to deal with the impact of coronavirus on the social work practice landscape.

• Reframe regulatory purposes. For regulators, protecting the public is paramount. Traditionally, that function has been tantamount to ensuring that clients do not receive inept social work services. However, there is a somewhat nuanced complementary view, particularly relevant in times like these: regulators have the responsibility to ensure that clients receive needed social work services. This view expands the concept of protecting the public, to include a notion of serving the public. Within this reframe, protecting the public and serving the public are not mutually exclusive. Regulators have a responsibility to ensure that the public, which includes clients, can access adequate social work services. Regulations promulgated by boards should reflect that responsibility.

• Communicate clear, concise, and coordinated messages. Uncertainty and confusion are rampant in this crisis. Clear, concise communication can assuage that uncertainty and provide needed clarity. Information about practice regulations, particularly new, altered, or waived requirements, needs to be communicated in a consistent, coordinated fashion. Dissemination initiatives that encompass a wide array of media platforms (e.g., social media outlets, video messages) are imperative. Ensure that all communication clearly explicates scope, applicable practitioner groups, and timeframes (e.g., start/end dates) for any rule or regulation changes.

• Be creative and flexible. On March 13, the federal government declared a national emergency. As of March 17, nearly all states had declared a state of emergency. A host of other states and U.S. cities have declared public health emergencies. In most instances, these proclamations give regulatory boards immense latitude in promulgating emergency regulations and memoranda to ensure licensees can ethically deliver services. Even if temporary, boards should leverage these declarations to make necessary regulatory provisions. These provisions may include expanding telehealth parameters, shifting to virtual training/supervision modalities, or allowing for the issuance of provisional/temporary licenses, among others. Notably, both regulators and practice organizations should consult legal counsel related to interpreting emergency provisions.

• Think systemically. When taking regulatory action related to COVID-19, remember that every aspect of social work practice will be impacted by this pandemic. Be attentive to the entire regulatory continuum. For example, licensees may have trouble accessing required continuing education or meeting nonvirtual clinical supervision requirements; those who fall ill may need additional time for renewals. While some issues may receive a lot of attention (e.g., telehealth), regulators should be mindful of other practice dynamics impacted and proactively promulgate regulatory guidance associated with those issues.

• Enlist help and collaborate. No social work entity is in this alone in grappling with this pandemic. Regulators should engage with other social work associations and organizations to both inform and communicate regulatory changes during this time. For instance, state boards can consult with membership organizations, such as NASW, the Clinical Social Work Association, etc., to glean information about proposed regulatory changes. This collaboration may be particularly helpful for composite boards. As well, ASWB can provide examples about approaches that other states have taken to address common practices issues impacted by COVID-19. Ensure that education stakeholders, such as the Council of Social Work Education, National Association of Deans and Directors, Association of Baccalaureate Social Work Program Directors, and other state associations are included in discussions and communications associated with regulatory changes.

• Act now. Many social work practitioners are panicking—perhaps understandably so. Some feel trapped in the proverbial “damned if I do/don’t” scenario. On one hand, they do not want to abandon or inappropriately terminate services with clients; on the other, regulatory restrictions may impact their ability to continue services without putting their own health and well-being at risk. Regulation stakeholders must take swift, decisive action to support licensees in safely delivering services.

Now, and for the foreseeable future, social workers will play an integral role in addressing this pandemic. Social work regulators must lead the way in ensuring practitioners have the requisite information and flexibility to proffer services consistent with meeting the needs of the time. After all, our citizens—the people regulators are tasked to protect—are depending on it.

— Jay Miller, PhD, MSW, CSW, is the dean, Dorothy A. Miller research professor in social work education, and director of The Self-Care Lab in the College of Social Work at the University of Kentucky. Miller also serves as Chairperson of the Kentucky Board of Social Work.