Senator Eggman: title protection for social workers
VOTE HENNY
In Support of Title Protection for Social Workers in California
Author: Dr. Henny Kupferstein (she/her)
Re: Neurodiversity in Legislation
Dear Senator Susan Eggman,
Nationally, social workers make up more than ¼ of the entire job market. This is a job that is never going away in our society, whatever their credentialing requirements are. California is no different than the rest of the country in this respect. California is among the minority of US states; however, where the quality and job performances of the employed social workers is unregulated. This in turn, causes wide disparities in consumer services because anyone with a high-school diploma can end up with a social worker job. There is no professional standards requirement in California for social workers, i.e. no “title protection.”
As a benefit recipient, I have found this unbearable and inequitable. To change the situation given the large size of California and the diversity of people that need clinical social workers. Such population groups include 1 million veterans, 1 million autistic people, the ½-million elderly and disabled IHSS recipients. It is of gross concern that a social service worker who is not credentialed to review sensitive medical documentation, is serving as gatekeepers to funded programs.
The high turnover rate means that clients are not updated about who their point of contact is. Additionally, their service disruptions are correlated with increased hospital utilizations, and in the worst case scenario, a denial of services based on subjective denial of evidence of need. When social services workers pose as nationally recognized clinical providers, they do harm to public good. We have a conflict between state allocation of funds for infrastructure, administration, and salary, and the restriction of the funding of the supports they are meant to provide.
Title Protection is a humanistic solution that would stimulate greater competence and standards of care consistent with the intentional mitigation of inequitable barriers. Thinking bipartisanly, nobody would want an increased tax risk to secure an MSW job market. A republican opinion is to ask the employers, but not require them to pay the tuition or offset tuition through salary increases. A democratic opinion is to make supplementary funding available to the employers upon application, which is already possible under community development and county business grants. Especially in the commitment for diversity, equity and inclusion (DEI), we must continue to encourage divergent groups to act in service of their own demographic; by the people for the people. In the spirit of social work, the emancipated poor are best suited to service their similarly-situated community.
Part I: The National Standard
The national standard is that licensed [licensed clinical] social workers must meet the criteria set for them by their national association. However, in the State of California, the title ("i am a social worker") is not protected. This means that even if you achieved your licensure with your accrediting body, you still don't have exclusive rights to that title. Meaning, others who call themselves "social worker" are not necessarily peers or colleagues, because anyone who works in social services is allowed to call themselves a social worker in the state of California. A clinical social worker with a Masters Degree, also has required hours, an exam and then licensure. The BBS is in support of protecting the title, but in fact the title protection has never been passed into law.
Eggman’s legislative efforts
SB766 would prohibit an individual from representing themselves as a social worker, unless they possess certain academic qualifications. Today, we have a governor who is willing to sign a title protection bill. Only ¼ of the US does not have a formalized title protection for social workers, and that includes California. To date, 37 states have some form of title protection for social workers (NASW Connecticut Chapter, 2023) and it is only a matter of time until all will have it. Change is happening, as counties, municipalities, and private agencies are making efforts to use more generic terminology such as “mental health worker” or “case worker”.
Currently the bill is opposed by the (1) County Welfare Directors Association (CWDA), (2) SEIU union, the (3) California Association of Marriage and Family Therapists (CAMFT) and the (4) California Association for Licensed Professional Clinical Counselors (CALPCC). The opposition made arguments such that SB 766 would worsen the workforce crisis and that people would lose or be blocked from obtaining jobs. All of these arguments did not speak to the bill. The bill only focuses on what you can call someone, not who you can hire. Passing Title Protection for social workers, gives recipients a choice in who provides them with services. If a person would rather work with someone who has gone through rigorous education and training to become a Masters-level social worker, they would have a choice to work with that person.
Worsening the Workforce crisis
The statement that SB 766 would worsen the California workforce crisis at this time, is a baseless argument. The whole nation is dealing with a multitude of factors affecting different aspects of American workforce stability. One of the more complex factors is the pandemic factor. The exodus of the high profile silicon valley workers to Texas and elsewhere, a major contributing factor to California’s workforce shortage, clearly has been influenced by the pandemic factor, and not whether or not any of those workers are licensed workers. There is no evidence that social workers are exiting California, and no logical reason that if licensing became required for social workers in California, that a mass exodus of these workers would occur. As a matter of fact all 3 of California bordering states (Oregon, Arizona, and Nevada) require social workers to be licensed.
Current “social workers” losing their jobs
The argument that current social workers would lose their jobs is also a baseless argument. A very realistic implementation of the bill would include on-the-job training opportunities in addition to tuition waivers for any unlicensed social workers who are lacking sufficient formal educational degree backgrounds. Arrangements with community colleges and universities for evening and weekend classes are a common means for supporting career advancement for nontraditional students. Obviously, a grace period of time sufficient for current employees to complete the training is understood to be a part of the initiative.
Blocking job opportunities
Thirdly, the argument that requiring licensure for social workers would block job opportunities by narrowing the hiring field for employers and the employment field for LPCCs and LMFTs is also a baseless argument. Employers have the freedom, right, and responsibility to specify job requirements according to the products and the services they deliver to the community. That includes specifying that marriage and family therapists (LMFTs) or Licensed Professional Clinical Counselor (LPCCs) or psychotherapists meet the job requirements in an application. It also means that employers at their discretion, and as is commonly done across the country with social workers, can hire people under a probationary status without the requirements and then pay for them to get those requirements met, while on the job, such as a common occurrence where people with years of experience as a nurse want to change their careers and become a social worker.
We wondered if an underlying reason for the hesitation to pass Title Protection in California is that if these companies/non-profits do so, it means they would have to pay their employees more money due to having a more advanced degree and skill-set. This might speak to corporate greed. It’s about the bottom line with these companies. Still, unlicensed workers in CA get paid $10k more than licensed workers in NY. Technically, they are the highest paid unlicensed social services workers in the country.
The California Association for Licensed Professional Clinical Counselors (CALPCC) offered amendments exempting LMFTs and LPCCs from the bill, which was declined. Jonathan Goh (2022), wrote an excellent article for the NASW-CA news summarizing all the key points. But ultimately, what the fight has always been about is jobs. We always want to make sure the jobs that use the title of “social worker” are held by workers with the right education and training. In other words, those that have a BSW or MSW from an accredited school, and not a degree in psychology or counseling or art history for that matter (NASW-CA News).
AB 445 in 2003 was a relatively simple and straightforward bill that made it past the Assembly, but stalled in the Senate. This was largely due to the efforts of the County Welfare Directors Association. They claimed that the bill would incur significant costs to implement. Also, according to their perspective, without a grace period clause there was a possibility that many county workers would have to be laid off. So, any attempt in the future would have to address the cost issue and the workforce issue. Next was 2008 with AB 2753., an attempt to avoid counties and just focus on state employed social workers. This one proposed that the state cannot use the term “social worker” for any of its job classifications unless the person holding it has a BSW or MSW or DSW from an accredited school. It also included a grace period clause. A union, AFSCME Local 2620, came out in support.
2013 with AB 252 by Yamada and Eggman, were joint sponsors of the bill. It included a grace period clause but there was still opposition. SEIU Local 721 represented Los Angeles County workers including the vast majority of the non-degree social workers that “would be” affected by this bill; The grace period clause was not sufficient for them and the bill ultimately died in committee. Further analysis revealed that Governor Jerry Brown likely would have vetoed it, as he was not in favor of any title protection bill for any professional group. He believed that the market should decide that and not the legislature. This was confirmed in 2016 with AB 1279, title protection for music therapists in California. The bill made it all the way to the Governor’s desk where he promptly vetoed it as predicted.
Cost issue
The most vulnerable demographic is the 600,000 county-paid IHSS caregiver recipient. The welfare of the consumer-recipient and the safety measures for protection of the caregiver-provider is published in this public report, titled “The real cost of minimum wage caregivers' labor”.
[end of Part I]
Part II: positive outcomes of Title Protection
Regional Center
The second most vulnerable population are the Autistic consumers of the Regional Center through the Department of Developmental Services. The consumer must communicate with their “Service Coordinator” quarterly to negotiate services and support, despite the $15 billion from the budget to pay for these supports. Based on our 990 non profit audits of all 21 regional centers in California, less than 5% of their reported expenditures go toward the purchase of services for the consumer. Instead, the billions are funding the salary for their non-licensed service coordinators, which includes job perks such as group health insurance and tax-free home loans. As Regional Centers are non profits who are exempt from governance, they are least likely to be good stewards of public funds.
The BBS claimed that SB 766—Position of Oppose Unless Amended -- “This bill will result in job losses to psychotherapists throughout California as well as decreased access to mental health care in an already unsteady mental health infrastructure. They argue that “While the bill delays until 2029 the restriction for those in positions with “Social Work” titles, it does so for those who are employed in those positions before January 1, 2024. As a personal concern, I have no recourse to file a grievance with the BBS Consumer Affairs for an unlicensed worker, unless they are replicating the scope of practice of a licensed professional, and essentially “practicing without a license”.
Nearly half of the Consumer Affairs complaints investigated by BBS are referred to the Attorney General’s office for prosecution and arrest. It would be a public good initiative to disseminate information to those harmed by non-licensed social services workers to be better informed about their rights to file a complaint if a worker denies a services or makes subjective decisions about care; those are acts that replicate the services of a defined licensed professional, and the consequence should be an influx of ‘practicing without a license’ complaints.
Education
Social workers typically need a bachelor’s or master’s degree in social work from a program accredited by the Council on Social Work Education. They also may need a license; specific requirements vary by state. Clinical social workers need a master’s degree, supervised clinical experience, and a license from the state in which they practice.
If you are a California resident and your family earns $80,000 or less, you can attend one of the University of California (UC) colleges as an undergraduate tuition-free. According to the University of California, 55% of California students at the university pay no tuition. It costs the California government about $46 million of state funding to supplement tuition-free education for half of the enrolled students. More recently, AB19, allows for community colleges to cover tuition for all students, regardless of income.
If 37% of Californians already have their Bachelors degree, then their MSW cost is minimal. First, it would only cost $45,000 in tuition over the 2-3 years of the degree program. Graduate programs are designed for employed people to manage their studies simultaneously. If they are earning about $70,000 per year as an unlicensed social services worker, they would only need to spend 13% of their salary ($9,000 per year) for 5 years to acquire their credentials.
Cost Effectiveness
If California is so desperate for more social workers, the tuition will be waived for students through a variety of funding programs already in place. A typical MSW program lasts 2-3 years, and then a 3-year working internship is required. If the workplace has an onsite Licensed Clinical Social Worker, then the supervision converts to field hours toward licensure.
About 40% of Californian adults hold a bachelor's degree. If their $45,000 tuition is supplemented by the State, that would total to $630-billion per year. If we are waiving their tuition through existing programs, the State earns a major cost benefit. Nationally, the most common degree for social workers in the U.S. is a master's degree. However, in California, a worker with a “Social Worker” title, may or may not even have an associates or bachelors degree in social work.
The job market for licensed clinicians is steadily rising by 7% per year, and faster than the average job prospects for similar professions, then in order to anticipate the labor force by one year, it would cost $44-billion for 7% of 14 million bachelor’s holders (or, 980,000 people) to get their MSW. As AB19 only costs $46 million to educate about 1,000 students, it would be reasonable to add 7% of those graduates to the licensed clinical social worker labor pool, at a cost of $3-million to help 70 people earn their MSW without accusing and student loans.
We can also incentivize the employer to supplement the salary for workers who are earning their MSW while on the job. That would stimulate the state economy from tax withholdings of those already earning $70,000 a year. The workers will pay into their social security through these withholdings, guaranteeing a retirement with medicare.
Employer-sponsored education would be a perk for the business to advertise that they have certified staffers. If the company is a state funded program, the salary increase would have to be legislated, so that state workers will have greater resources to pay for their $45,00 education. If we choose to follow the national standard for specialized education, student loans would have to be forgiven for those who work in the social services sector, just as school teachers and clinical social workers can be debt-free if they work in less desirable markets for 5 years.
Economy
As of Nov 24, 2023, the average annual pay for a Licensed Social Worker in California is $71,786 a year. Just in case you need a simple salary calculator, that works out to be approximately $34.51 an hour. This is the equivalent of $1,380/week or $5,982/month.
In California, unlicensed social services worker pay rate is $34.51 per hour ($73437 per year), compared to the national average of $26.61, which is 30% higher than the certified professionals in the country. The average UNLICENSED SOCIAL WORKER SALARY in California, as of Nov 2023, is $35.31 an hour or $73437 per year. This data is sourced from ziprecruiter job postings and 3rd party sources. It is reasonable to assume that a worker shortage would lead to higher offerings on job advertisements.
Unlicensed workers in California make 4% more per hour than licensed workers in New York.
Bureau of Labor data data is based on tax paying employees with ‘social worker’ in their title, based on a monthly survey of 60,000 households in the country. When presented by the schools that advertise social degree program have a breakdown of salary by state reporting that the average salary for a social worker in New York, where the social worker in California, ($62,200) is still 23% lower than average salary of New York social workers, who earn an average of $76,350.
Census data reveals that California's population is at approximately 39.5 million people, with 37% of the population having a Bachelor’s degree or higher. Within 14 million housing units, and nearly 1 million employer-established businesses, California boasts a $91-thousand median household income, and a 60% employment rate. New York has 331-million people with 35.7 % education at a Bachelor’s degree or higher. In NY, there are 140-million housing units, 8 million businesses, also at 60% employment rates and a median household income of $74,755.
In 2002, New York’s title protection for social workers was expanded the profession’s, “scope of practice”, to allow unlicensed people to practice social work, but delineates that the licensed clinical standard of practice is protected for licensed social workers. In the history of this legislative change, we found that a trial attorney contested a social worker’s diagnosis of the defendant, and the court overruled his objection subject to title protection and competencies under the license. The legal decision states, “that in terms of clinical functions, the scope of practice of psychology and the scope of practice of licensed clinical social work, although described using some different words at times.” (2005)
Poll data
Should we require master's level entry into social work, or hire anyone with life experience? In New York, only professionals who are licensed are allowed to call themselves a social worker. In California, anyone who works for social services calls themselves a social worker. Is it time to protect the title in California to guarantee actual outcomes of engagement with publicly funded programs, or should we leave this field wide open to people who may never get back to you but are still paid a salary?
Yes, a social worker must have an MSW to be trusted to follow through on case management
82%
No, anyone who meets the job description of working in social services should be allowed to call themselves a social worker.
18%
Hospice Rhetoric
Opponents of title protection offered as an example of “How a title change mandate would impact these funding sources.” They argued that the rural hospice agency that funds “social worker” positions through Medicare has been interpreted to include those with mental health degrees (such as LMFTs, LPCCs, and even psychologists). We looked into the example of the ‘rural hospice’ agencies losing options for their providers in the event of title protection.
A factual review of how hospice helps people with their advance directives pass peacefully and in comfort in their place of choice, we found that 46 states started reporting the place of death by 2014 (CDC). The percentage of deaths that occurred in a hospital decreased 25.7%, from approximately half (50.2%) in 2000 to 37.3% in 2014. By contrast, the percentage of deaths that occurred in hospice and all other places increased 242.9%, from 3.5% in 2000 to 12.0% in 2014.
A sure model of hospice is where a licensed clinical social worker coordinates services per the advanced directive, and follows the standards of practice to ensure the patient does not die before services are in place. To oppose meaningful legislation by arguing that rural hospice agencies will be understaffed if there is a title protection place, is to argue that anyone with a high-school diploma is good enough for those dying in rural neighborhoods, whether they implement hospice in time or not. The surviving family would have no recourse of claims for wrongful death or interference with an advance directive, and consumer affairs will not investigate claims against unlicensed workers.
In 2010 New York had 81 hospice centers receiving medicare program payments for 32,147 people, who spent 2,358,641 in hospice before passing, but is average at a 74 Length of Stay (LOS) costing $345,206. New Yorkers get longer hospice stays, and .04% of the population is getting hospice. By Comparison, only .02% of Californias make it to hospice. In California, 87,548 patients who spent 5,608,689 days in hospice, with 65 LOS (average length of stay is a bit over 2 months), was costing $979,340.
Short hospice stay is a mark of patient dissatisfaction and lack of quality of service (Sedhom et al,. (2021). The fact that New York provides 14% longer stays in hospice indicates that title protection does convert to patient satisfaction. The benefits of hospice for patients with advanced cancer are well established. Short hospice length of service (LOS) is a marker of poor quality care and patient and family dissatisfaction.