A Review of the Board of Examiners for Social Workers and Marriage and Family Therapists
Executive Summary
Introduction
PEER reviewed the Mississippi Board of Examiners for Social Workers and Marriage and Family Therapists (hereafter referred to as “the board”). PEER conducted the review pursuant to the authority granted by MISS. CODE ANN. Section 5-3-57 et seq. (1972). This review is a “cycle review,” which is not driven by specific complaints or allegations of misconduct.
PEER first established the public need for regulation of these professions, then evaluated how well the board carries out its two primary regulatory functions to protect the public: licensing social workers and marriage and family therapists and handling complaints/investigations.
PEER also reviewed the board’s monitoring of licensees’ fulfillment of continuing education requirements and the board’s financial management practices.
Background
The Legislature created the Board of Examiners for Social Workers and Marriage and Family Therapists in 1997 to protect the public by licensing and regulating social workers and marriage and family therapists. The board licenses and regulates three levels of social workers (i. e., social workers, master social workers, and certified social workers), as well as marriage and family therapists. The typical regulatory functions of licensure and enforcement of applicable laws, rules, and regulations provide a safeguard against public risk. Without the safeguards of licensure and enforcement in place, the likelihood of untrained or unethical social workers and marriage and family therapists placing the public at risk could occur.
The board is composed of ten members--six social workers and four marriage and family therapists. The Governor appoints six members of the board (four social workers and two marriage and family therapists) and the Lieutenant Governor appoints four members (two social workers and two marriage and family therapists).
The board currently employs a full-time Executive Director and two full-time administrative assistants. The board contracts for investigations of complaints against practitioners and for temporary office staff during license renewal periods. Additionally, the board retains legal assistance from a representative of the Attorney General’s office, who attends board meetings and assists with administrative hearings.
The board is a special fund agency, with revenues generated from fees charged for license application and renewal. FY 2006 revenues were $196,482 and FY 2006 expenditures were $211,831. (The board had a carryover cash balance from FY 2005; therefore, the board had no deficit in FY 2006.)
Conclusions
Overlap in the Scope of the Social Work and Marriage and Family Therapy Professions
The scopes of practice of social workers and marriage and family therapists are so broadly defined in state law that they often overlap with each other and, in some cases, may conflict with state law regarding the practice of other professions (e. g., the practice of psychology).
The statutory definitions of scopes of practice for social workers and marriage and family therapists (in MISS. CODE ANN. Section 73-53-3 and Section 73-54-5 [1972]) are sufficiently broad to encompass the scopes of practice of other social service professions. The types of services social workers and marriage and family therapists may provide in Mississippi overlap in some areas (e.g., treatment/counseling) and are imprecisely defined in state law. The statutory definitions and rules of the board regarding scopes of practice of these two professions may even contradict other provisions of state law. For example, the board’s rules and regulations allow a licensed certified social worker to use “interventive methodologies such as psychotherapy and a variety of psychotherapeutic techniques” and the definition of marriage and family therapy in MISS. CODE ANN. Section 73-54-5 (b) (1972) includes “the professional application of psychotherapeutic and family systems theories and techniques.” Yet CODE Section 73-54-9 (3) expressly prohibits marriage and family therapists from engaging in the practice of psychology. Because “psychotherapy” and “psychotherapeutic techniques” are arguably part of the practice of psychology, the statutes seem to contradict each other and the public could be confused about what type of practitioner to engage for treatment.
Potential for Compromised Independence of the Process for Nominating Board Members
State law requires the Governor and Lieutenant Governor to make appointments to the Board of Examiners for Social Workers and Marriage and Family Therapists from nominations provided by the statewide professional associations for social workers and marriage and family therapists. When the associations’ officers also serve as members of the board, the opportunity exists for the independence of the nominating process to be compromised.
When vacancies occur on the board, MISS. CODE ANN. Section 73-53-8 (1972) requires that the Mississippi Chapter of the National Association of Social Workers (NASW) and the Mississippi Association for Marriage and Family Therapy (MAMFT) provide nominations to the Governor and Lieutenant Governor.
Currently, three members of the board serve or have formerly served in leadership positions in their respective statewide associations. Even if none of these board members ever participated in the nomination process through their statewide professional associations, if no prohibition (i. e., in statute or in the board’s rules) exists against board members participating in the nominating process to fill board vacancies, in the future the potential exists for persons serving on the board to suggest nominations that would perpetuate their regulatory philosophies.
Needed Improvements in the Licensure Process
Applications for Licensure
Because state law does not specifically authorize the board to perform background checks on applicants for licensure, the board accepts applicants’ self-reporting of criminal history rather than initially utilizing background check resources available in the state. Also, although the law requires applicants for licensure in both professions to have “good moral character,” neither state law nor the board’s rules and regulations have formal, written criteria for this requirement.
The licensure prerequisites for social workers and marriage and family therapists, set in MISS. CODE ANN. Sections 73-53-13 and 73-54-13 (1972), do not include a requirement for the board to conduct background checks on licensure applicants, but do state that both social workers and marriage and family therapy applicants must be “of good moral character.” Also, CODE Section 73-53-13 specifically requires that social workers must have an “absence of conviction of a felony related to the practice of social work for the last ten years.” In determining whether applicants have a criminal history that would preclude them from licensure, the board accepts applicants’ sworn self-reporting rather than initially utilizing background check resources. Relying on self-reporting of criminal history potentially allows applicants with serious criminal histories to be licensed. These licensees would be obvious threats to public safety.
Also, although state law requires applicants for licensure in both professions to have “good moral character,” neither state law nor the board’s rules and regulations have formal, written criteria for this requirement. Thus the potential exists for the board to judge applicants’ adherence to this requirement inconsistently or that an unsuitable applicant could inadvertently become licensed.
Experience Requirements for Licensure
The board’s requirements regarding evaluation of the supervised experience may not ensure that social worker and marriage and family therapist licensure applicants have acquired the experience needed for the practice of their professions.
Applicants for both social worker and marriage and family therapist licensure must fulfill requirements for supervised experience prior to licensure. State law sets the general supervised experience requirements for both professions and the board sets additional requirements.
The forms that that the board requires supervisors to use in evaluating social worker and marriage and family therapist licensees have not been proven to contain the objective criteria necessary to demonstrate competence in supervised experience. Thus the board cannot ensure that these licensees have acquired the necessary experience required to practice their professions independently. Also, the board does not require supervisors to conduct practice evaluations (or other training) to assure inter-rater reliability1 in evaluating applicants’ supervised experience prior to licensure. When inter-rater reliability among supervisor evaluations is not tested, the opportunity exists for supervisors to evaluate supervisees in an inconsistent manner, which could result in arbitrary and capricious treatment of potential licensees.
Maintaining Licensure Information
The board does not maintain an accurate database of licensee information, which could allow individuals without a current license to continue to practice and put the public at risk.
PEER found inaccuracies in the licensee database of the Board of Examiners for Social Workers and Marriage and Family Therapists. The status of selected licensees shown in the database did not accurately reflect their actual status (e. g., some records showed licenses as “active” when they were not).
Poor records management of a regulatory board hinders the board’s ability to perform its regulatory function to protect the public from unlicensed, insufficiently trained and unethical social workers and marriage and family therapists.
Issues Regarding Continuing Education of Licensees
Continuing Education for Social Workers
Because state law does not require social workers to complete continuing education in order to renew their licenses, the board cannot enforce its rules requiring such and cannot ensure that social workers stay abreast of the most recent research and techniques of their profession.
Neither MISS. CODE ANN. §73-53-15 (1972), which governs license renewal for social workers, nor any other CODE section requires social workers to participate in continuing education activities. However, Rules and Regulations Regarding Social Workers and Marriage and Family Therapists requires social workers to complete four social work units (i. e., forty hours of continuing education) for each renewal period. When licensees do not submit the required number of continuing education hours, the rules and regulations call for disciplinary actions to be taken against licensees. However, because the requirements are not in law, the board cannot legally enforce them.
Continuing Education for Marriage and Family Therapists
Rather than verifying continuing education annually for all licensed marriage and family therapists, the board’s policy is that it may randomly audit a percentage of licensees’ continuing education hours. The board is not consistently conducting these random audits, and when it does, it conducts them after licenses have been renewed. Thus the board does not ensure that all licensed marriage and family therapists receive the necessary continuing education to remain professionally competent prior to having their licenses renewed.
MISS. CODE ANN. Section 73-54-27 (5) (1972) requires that marriage and family therapists participate in continuing education “in order to renew a license.” The implementation of the statutory requirement is the responsibility of the board. The board requires that marriage and family therapists complete thirty-five hours of continuing education every two years, four hours of which must be in professional ethics. However, the board does not require proof/documentation of completed continuing education hours prior to renewal of a license. The board’s policy that it may randomly audit a percentage of licensees’ continuing education (which, in practice, is done for a small percentage of licenses after renewal) does not ensure that all marriage and family therapists have completed the number of continuing education hours required by the board so that they may stay abreast of professional developments in their field.
Inadequacies in Complaints and Disciplinary Processes
Deficiencies in Management of Complaints Process
The Board of Examiners for Social Workers and Marriage and Family Therapists does not have an effective system for managing complaints filed against social workers and marriage and family therapists. The board does not maintain a master record or log of complaints containing all legally required information, as well as the current status of the complaints. Minutes do not contain a complete record of the board’s actions taken on complaints. Individual complaint files do not consistently contain complete documentation, including a record of actions taken on that individual complaint, copies of letters that should have been sent to complainants and licensees according to the board’s rules and regulations, or an explanation of the reasons for actions taken. Also, the board does not establish a timeline or milestones for resolution of complaints.
The board’s complaint log does not contain the case description and status/disposition of a complaint, even though MISS. CODE ANN. Section 73-53-19 (1972) and the board’s own rules and regulations require that this information be logged. Because the board does not maintain a complete complaint log, it is unable to monitor effectively the status of complaints.
Concerning the board’s final action on complaints, MISS. CODE ANN. Section 25-41-11 (1972) requires that all public bodies keep minutes and that these minutes reflect the final actions taken by these bodies. PEER reviewed board minutes for the period August 4, 1997, to April 2007 to determine the official disposition of the seventy-two official complaints submitted to the board from its inception through April 2007. There was no information in the board minutes concerning the status of twenty-eight of the seventy-two complaints.
PEER also found that the board does not ensure that all complaint files contain documentation of the history and disposition of each individual complaint. Because the board does not consistently maintain a record of actions taken on complaints, including a brief explanation of the reasons for the action taken, in the complaint files and does not establish a timeline or milestones for resolution of complaints, PEER could not evaluate the timeliness of the board’s complaints process. However, from the records that the board maintains, PEER concluded that nineteen complaint cases are over five years old, which calls into question the board’s management of its complaints process.
Publication of Licensee and Disciplinary Action Information
The board has not complied with state law requiring annual publication of names of social worker licensees and those licensees who had license revocations or suspensions within the preceding year.
MISS. CODE ANN. § 73-53-27 (5) (1972) requires that the board annually publish the names of all social worker licensees and those who have had license revocations or suspensions that year. The law does not specifically require the board to publish this information on marriage and family therapists. Although the board reports disciplinary sanctions regarding social worker licensees to the Association of Social Work Boards (ASWB) and that body subsequently reports such to the National Practitioners Database, the general public does not have access to these databases. Without such information, a person unknowingly could obtain services from licensed professionals who have had sanctions against them, thereby placing themselves at an increased risk of harm.
Rules and Regulations Governing Standards of Conduct
Although the board has created a unified set of rules and regulations governing standards of conduct for both social workers and marriage and family therapists, several of these standards are unenforceable due to lack of statutory authority and vagueness.
PEER extends a strict construction to the provisions of law dealing with the regulation of both social workers and family and marriage therapists. Courts in Mississippi have consistently held that statutes regulating professionals are penal in nature and should be construed strictly against the state. Although it is reasonable for a unified board to attempt to consolidate the rules and regulations governing the profession’s standards of conduct, current law does not fully support the board in these efforts.
The standards of conduct that have been adopted by the board requiring reporting of violations by a licensee lack statutory authority. The board’s rules and regulations contain violations that are not found in either the statute for social workers or the statute for marriage and family therapists. While the enforceability of these standards has not been challenged to date, a court could find that the board lacks authority to enforce these additional standards of conduct against either social workers or marriage and family therapists. The board has adopted one standard of conduct that, while enforceable against marriage and family therapists through incorporation of their national association’s code of ethics, is not enforceable against social workers. The law has not been amended to include this specific standard of conduct and therefore social workers should not be disciplined for failure to comply with this standard. Also, by adopting the code of ethics for the National Association of Social Workers, the board has implemented standards of conduct that are vague and unenforceable because they cannot be easily defined in court or by a social worker in the course of practice.
Problems with Financial Management
The board has not implemented internal controls recommended by the State Auditor to improve cash receipts accounting, controls over the bank clearing account, and timely deposits of cash receipts into the bank clearing account and State Treasury.
To ensure fiscal accountability within smaller agencies of state government, the State Auditor performs limited internal control and compliance reviews. The reviews evaluate an agency’s compliance with state laws, its own internal controls, state policies and procedures, and its own policies and procedures. Following completion of the fieldwork, the State Auditor issues a management report to the agency’s management containing findings of deficiencies or noncompliance, if any, and recommendations for improving the agency’s internal controls.
The State Auditor completed a limited internal control and compliance review of the Board of Examiners for Social Workers and Marriage and Family Therapists in 2003, reporting the results on May 15, 2003. In his June 6, 2003, written response to the State Auditor, the board’s Executive Director described actions that the board’s staff would take to implement the State Auditor’s recommendations and improve the board’s internal control environment. Although the board and staff have taken steps to improve some of the internal control deficiencies identified by the State Auditor, the board has not fully implemented all of the actions contained in its written response to the State Auditor, as described below:
Recommendations
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1Inter-rater reliability is the extent to which two or more individuals (i. e., coders or raters) agree. Inter-rater reliability addresses the consistency of the implementation of a rating system.