Colleagues,
I hope this letter finds you well. I write today to advocate for and educate Social Workers regarding the “Social Work Compact.” Social workers are often tireless advocates for the people we serve but too often lack the same ability to organize, educate, and advocate effectively for ourselves in our profession. The work, while both worthwhile and necessary, is often a heavy burden to bear, full of decisions that deeply impact the lives of those we serve. As social workers, state and federal mandates govern whether we repeat or report what we hear and observe. These rules outline the limits of confidentiality and Duty to Warn, protecting not just our clients but us as Social Workers. Rules so critical to the effective practice of our profession need to be managed carefully and thoughtfully.
Often, our positions require us to make difficult decisions and recommendations daily. The accuracy and outcome of our assessments can mean the difference between life and death, abuse or safety, homelessness or shelter, food or hunger, incarceration or freedom, and the right to bear arms or have them removed based on mental fitness. Currently, there is proposed legislation in 25 states to create a multistate practice license, known as a “Social Work Compact.” An Interstate Compact such as this is a permanent commitment to a set of rules that will impact how interstate practice is conducted.
According to the current model language of proposed legislation in several states, social workers would be responsible for knowing all the specifics of legal confidentiality for any state in which a client lives. This especially impacts sensitive issues such as Duty to Warn, and the privacy of certain trigger issues in those states. For example, some states allow abortions, or gender reassignment, whereas others do not. Some states have Second Amendment red flag laws and other yellow flag laws. In some states, parents are allowed full access to a minor client’s records while in other states access is limited based on a minor reaching a certain age. In addition to the legal and ethical considerations, other aspects of the compact are not fully established, such as how much the interstate license will cost or how the revenue generated will be used. In addition, those seeking the interstate license must be willing to submit biometric data into a national database affecting personal privacy and data privacy and security.
There are other practical considerations: A social worker who holds a multistate license and submits CEUs one or two days late could end up with between one and twenty-five disciplinary actions based on the number of states that enact and participate in the interstate compact. It is possible that a disciplinary action issued by one state, even for an infraction as small as a late CEU completion, could end in several dozen disciplinary actions and an encumbered license. This small initial incident could then trickle down into increasingly larger problems. For example, when a social worker fills out any application for renewal of license or expansion of their practice, they could be denied based on several disciplinary actions that originated from one incident. Further, the social worker’s malpractice insurance company could decline to renew a policy, leaving them uninsured and thus unable to legally practice.
I often say that grace is in the gray. But here, the devil is in the details. Initially, I supported the idea of a multistate license to remove barriers to service. However, a careful review of the compact has led to concerns that it will exponentially increase the risk and responsibilities of social workers who are already overburdened, under-supported, and often underpaid. As social workers, we must value ourselves and the work we do. We deserve further clarification before legislators enact laws on behalf of our profession. To be clear, language is important and ambiguity could cause daily ethical and legal dilemmas, create opportunities for predatory for-profit companies, worsen standards of care, and increase caseloads. As practitioners, it is possible that we would need several sets of Consent to Treatment, state by state, to inform about the limits of confidentiality. There is currently no infrastructure to assist clinicians practicing across state lines in getting crisis services or safety checks for clients who live out of the clinician’s state. Calling 911 or your local police department will not help a client who resides in a different state than you do.
It is time to put our skills of advocacy and care to use on our behalf. We owe it to ourselves to review the language of this compact and ask critical questions. We need to inform and advocate for ourselves and not blindly accept the first draft of the model legislation. Thus far; I have seen only the benefits of this interstate compact presented by our professional organizations; not the risks. It is a one-sided Pro/Con list.
Social workers do important work, and by taking the time to consider and act on these issues we can ensure our profession continues to grow in a way that benefits people - not politicians who may have other priorities. We need to approach this very serious change with vision, foresight, and awareness of all implications before the compact is enacted.
Timing is everything: considering the toxic political climate and the upcoming Presidential election there is no need to rush into this compact. There are options to consider. Perhaps a test group of Licensed Social Workers who are unable to practice due to having an active-duty spouse who is reassigned to another state could help highlight strengths and weaknesses in the compact through a test group. Many successful corporations use a phased approach to change, another concept that might help positively introduce the multistate license and yield data about what works and what does not.
We are ethically and legally bound to be able to share the limits of confidentiality with clients and provide good care. As such, we have a right to push for answers and more clarity so we are not caught off guard by things that have not been thought through, built, or adequately tested while we are trying to serve others..
Respectfully,
Alexandra Burke, LCSW
Editor: Rebecca Cavanaugh Barger
© Alexandra Burke 2024 -
Please feel free to share and reproduce this to help advocate and inform other social workers. If you want to learn more I encourage you to review the language and then contact your state representative and senator to express your opinion as a double stakeholder; a voter and a social worker.
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