Clinical social workers have practiced in governmental and voluntary agencies and, since the time of pioneer social worker Mary Richmond, in private practice. In 1961, NASW defined private practice as a setting for the delivery of clinical social work services and published its first Handbook on the Private Practice of Social Work in 1967.
Clinical practice continues to be an integral part of the services delivered in agency settings. At the same time, an increasing number of clinical practitioners have been moving into independent private practice, which further attests to the commitment of trained and experienced professionals to the direct treatment of individuals, families, and groups. This development, encompassing solo and group practice as well as other arrangements, is in addition to the practice of clinical social work in traditional voluntary and governmental agency settings.
Many states require the legal regulation of social work practice; some states require a special license for practitioners of clinical social work as well as those in independent private practice. Generally, certification for clinical social work requires a master’s degree in social work plus at least two years’ experience as well as an examination.
Given the variations among the states regarding legal regulation and the needs of clinical social work practitioners, NASW has taken appropriate responsibility for establishing standards of practice for all clinical social workers in all settings. These standards are to be considered desirable for all clinical social workers and are designed to do the following:
Clinical social work shares with all social work practice the goal of enhancement and maintenance of psychosocial functioning of individuals, families, and small groups. Clinical social work practice is the professional application of social work theory and methods to the treatment and prevention of psychosocial dysfunction, disability, or impairment, including emotional and mental disorders. It is based on knowledge of one or more theories of human development within a psychosocial context.In May 1961, the NASW Board of Directors endorsed the following definition of private practitioners of social work:The perspective of person-in-situation is central to clinical social work practice. Clinical social work includes interventions directed to interpersonal interactions, intrapsychic dynamics, and life-support and management issues. Clinical social work services consist of assessment; diagnosis; treatment, including psychotherapy and counseling; client-centered advocacy; consultation; and evaluation. The process of clinical social work is undertaken within the objectives of social work and the principles and values contained in the NASW Code of Ethics.
Private practitioners are social workers who, wholly or in part, practice social work outside a governmental or duly incorporated voluntary agency, who have responsibility for their own practice and set up conditions of exchange with their clients, and identify themselves as social work practitioners in offering services.
All clinical social workers shall be willing to have judgments and decisions reviewed by knowledgeable peers in a formal process. When requested by a client, the clinical social worker will provide information about how to file a complaint charging unethical behavior.
1. Social, psychological, and health factors and their interplay on psychosocial functioning, such as these:The clinical social worker shall have available a variety of appropriate social work therapeutic intervention techniques that he or she uses selectively, depending on the client’s needs and capacity for change.2. Community resources
- theories of personality and behavior,
- social-cultural influences,
- environmental influences,
- physical health, and
- impairment and disability, including mental and emotional conditions.
3. Specific practice skills, including the ability to
- available social resources in the community and their operation and how to use them in the client’s behalf and
- how to identify appropriate services and negotiate a referral.
4. Knowledge about and skills in using research to evaluate the effectiveness of a service.
- establish a relationship of mutual acceptance and trust,
- obtain, analyze, classify, and interpret social and personal data, including assessment and diagnosis,
- establish compatible goals of service with the client,
- bring about changes in behavior (thinking, feeling, or doing) or in the situation in accordance with the goals of service.
When knowledge and skills are acquired, other than those specific to social work, the practitioner is responsible for obtaining the appropriate training and certification. Clinical social workers shall maintain and enhance their skills through appropriate forms of professional development and continuing education (see NASW Standards for Continuing Professional Education) and are personally accountable for all aspects of their professional behavior and decisions.
Clinical social workers shall limit their practice to those clients whom they have the skills and resources to serve. However, they shall be aware of and seek to ameliorate any of their attitudes and practices that may interfere with their ability to offer competent and equitable service. They have a professional responsibility to help a client establish contact with other appropriate resources when they cannot meet the needs for service of a particular client.
If the clinical social worker is unable to schedule a timely appointment for an initial assessment, he or she may screen the client by telephone to determine the urgency of the client’s situation. The well-being of the client is the key factor in all decisions. In emergency situations in which the clinical social worker cannot be available to a new client, every effort should be made to find an appropriate source of immediate help.
On occasion, a client may decide to terminate treatment before a clinician judges the client to be ready. When the clinical social worker is sure that the termination is premature but the client persists in his or her decision, it is the clinician’s responsibility to refer the client to another appropriate treatment resource or, failing that, to help the client terminate treatment as constructively as possible, leaving the door open for the client to reapply for service at another time.
When a client is being served by other agencies, the clinical social worker shall maintain collaborative contacts as necessary with the other providers to ensure the coordination of services and the client’s receipt of optimal benefits from the various services.
When the client is involved with more than one clinician, collaborative consultation shall be maintained as necessary to ensure delineation of the specific areas of responsibility. The clinician shall not share information about a client without the client’s informed consent. (See Standard 6 for an elaboration of confidentiality.)
In establishing an office, the clinical social worker shall be aware that some clients may have or develop physical handicaps. Thus, the clinical social worker shall make every attempt to ensure that offices are free of impediments to mobility and that helping devices are available for sensorially impaired clients. The office’s accessibility by public transportation, when it is available, also should be a consideration.
The beginning clinical social worker requires regular case-consultation supervision. For the first two years of professional experience, at least one hour of supervision should be provided for every fifteen hours of face-to-face contact with clients. After the first two years, the ratio may be reduced to a minimum of one hour of case consultation supervision for every thirty hours of face-to-face contact with clients. In some situations, additional consultation will be sought by the clinician, because of complex issues involving a client, or suggested by the consultant, because of difficulties the consultant perceives in the clinician’s handling of a situation.
Clinicians with five years or more of experience should utilize consultation on an as-needed, self-determined basis. Although clinicians who are in independent practice shall utilize more case consultation when they first begin practicing, they should maintain consultative arrangements throughout the time they are in practice. Clinical social workers shall be knowledgeable about how and when to utilize the expertise of other professional disciplines in the area of medical problems, including pharmacology, and be alert to the effects of prescription drugs on a client so they can provide feedback to the client’s physician.
The clinical social worker should ensure that appropriate insurance is maintained: agency liability, personal professional liability, premises protection, and other protective policies.
Clinical social workers shall establish a fee structure when in independent private practice or utilize the fee structure of the agency in which they are working. All fees and procedures for payment shall be discussed with the client at the beginning of treatment; to minimize misunderstanding, it is useful to present these policies in writing as well. This discussion should include the use of insurance reimbursement and how it will be handled; charges for missed or canceled appointments, vacations, and collateral contacts; and any other financial issues. Clinical social workers shall not refuse service to clients solely because the clients are not covered by insurance.
Billing procedures shall be included in the original discussion and clients’ accounts shall be maintained according to acceptable accounting methods, with all bills and receipts provided on a regular and timely schedule. Clinical social workers shall discuss overdue accounts with clients and make every effort to avoid accrual of debt. When it is clear to a client and clinician that, for whatever reason, the client can no longer afford to pay for treatment, a mutually acceptable alternative plan for compensation or an orderly and appropriate termination or referral shall be instituted. Nothing in this standard shall be construed to rule out an individual clinician’s decision to provide services on a pro bono basis.
When all efforts to collect an overdue account from a client have failed, the client should be informed that unpaid accounts may be turned over to a collection agency or small claims court or that other types of legal action will be taken. If there is a dispute over charges, the clinical social worker should make every effort to resolve it without damaging the therapeutic relationship.
Waiting rooms and offices should be kept clean, and the environment should be properly maintained to ensure a reasonable degree of comfort. Interviewing rooms should ensure privacy and be free of distractions. Steps should be taken to assure the client’s and the social worker’s personal security.
Although advertising in various media was thought to be questionable professional practice in the past, recent judicial decisions, Federal Trade Commission rulings as well as current professional practices have made such advertising acceptable. The advertisement must be factual and should avoid false promises of cures.
The content of the advertisement should include the private practitioner’s or agency’s name and professional credentials and the address and telephone number or other contact information. It might also include the type of services provided (e.g., individual, family, or group therapy; alcoholism counseling; divorce mediation; and so forth) and the type of problems that are dealt with (e.g. marital distress, parent-child conflicts, eating disorders).
The NASW standards for the independent practice of clinical social work are those required for inclusion in the NASW Register of Clinical Social Workers:
Clinical social workers who are employed by agencies and have an independent private practice should not refer agency clients to themselves unless they have made a specific agreement with the agency and have offered alternative options to the clients. Agencies have the responsibility to establish written, reasonable guidelines or policies about secondary employment (see NASW Standards for Social Work Personnel Practices). When an agency does not have clear written policies, the clinical social worker may cite the relevant NASW standards.
When a clinical social worker leaves an agency to establish an independent private practice, he or she must take great care to explain fully the options available to clients. Clients in treatment may be offered various options after consultation with the agency. These options include (1) transferring to another staff member in the agency, (2) continuing with the same clinician in an independent setting, (3) transferring to another agency or to a different private practitioner, or (4) terminating treatment. The overriding principle is the client’s right to self-determination and freedom of choice. That is, the client’s best interests must always be paramount in these decisions.
Gary
M. Wilson
Licensed Clinical Social
Worker