Title of Regulation: 18VAC140-20. Regulations Governing the Practice of Social Work (amending 18VAC140-20-10, 18VAC140-20-110).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 22, 2017.

Agency Contact: Jaime Hoyle, Executive Director, Board of Social Work, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4406, FAX (804) 527-4435, or email jaime.hoyle@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the Board of Social Work with the authority to promulgate regulations that are reasonable and necessary to administer effectively the regulatory system.

Purpose: The purpose of adding "psychosocial intervention" is to broaden the definition of clinical social work to be more inclusive of those therapeutic modalities that expand beyond the strict definition of psychotherapy. The addition of the term is intended to update the current definition of clinical social work services to more accurately reflect the scope of practice for clinical social workers.

The addition of requirements for documentation of a licensure or certification in another jurisdiction and a report from the U.S. Department of Health and Human Services National Practitioner Data Bank (NPDB) will provide the board with important information about possible discipline in another state or malpractice action against an applicant for reinstatement whose license has been lapsed for more than one year.

The purpose of specifying an amount of supervision during the 360 hours of supervised practice is intended to ensure that a person who has not been practicing is now competent to resume active practice with clients. A supervisor would be required to have specific oversight for the person seeking reinstatement or reactivation, so the board can have some assurance that a client's health, safety, and welfare is protected when in the care of a supervisee.

Specifying an amount of supervision for applicants for reinstatement or reactivation who have not been actively practicing is intended to clarify the intent in requiring supervised practice for at least 360 hours in the 12 months immediately preceding licensure in Virginia. Currently, regulations provide no definitive guidance on how much supervision is required during the 360 hours. In the proposed regulations, the board has specified a minimum of 60 hours of face-to-face direct client contact and nine hours of face-to-face supervision during the 360 hours. Since the proposed amendments only require active practice or supervised hours of practice for those who have been lapsed or inactive for 10 or more years, there is a heightened necessary for more specificity about the supervised practice to ensure safety and competency when a full license is granted.

Substance: The proposed changes (i) amend the definition of clinical social work services to include psychosocial interventions, (ii) require applicants for reinstatement to provide verification of licensure in another state, if applicable, and a report from NPDB, and (iii) amend 18VAC140-20-110 to specify an amount of supervision that is required for a person who has not actively practiced for 10 or more years and applies to reinstate or reactivate his license.

Issues: The primary advantage to the public is more explicit rule about supervision for applicants whose licenses have been lapsed or inactive. There are no disadvantages to the public. There are no advantages and disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Social Work (Board) proposes to amend its main regulation to: 1) update definitions, 2) require applicants for reinstatement of licensure to provide proof of licensure in another state, if they have been licensed in another state, and a report from the U.S. Department of Health and Human Services' National Practitioner Data Bank (NPDB) and 3) specify the nature of supervision that is required for individuals who are seeking reinstatement and whose licenses have lapsed for 10 or more years.

Result of Analysis. Benefits likely outweigh costs for all proposed changes.

Estimated Economic Impact. Description: This chapter "establishes qualification for licensure, sets a schedule and fee for renewal and establishes the standard of practice for licensure of social workers."¹

Current regulation defines "clinical social work services" as: "the application of social work principles and methods in performing assessments and diagnoses based on a recognized manual of mental and emotional disorders or recognized system of problem definition, preventive and early intervention services and treatment services, including but not limited to, psychotherapy and counseling for mental disorders, substance abuse, marriage and family dysfunction, and problems caused by social and psychological stress or health impairment." The Board now proposes to add "psychosocial interventions"² to the treatment services in this definition. Board staff reports that this change is being proposed to make this definition more reflective of the current scope of practice. No affected entity is likely to incur costs on account of this change. To the extent that it may clarify scope of practice, this change will benefit interested parties who read this regulation.

This regulation currently requires individuals who are applying for reinstatement of licensure more than one year after licensure expiration to provide documentation of having completed continuing education hours during the time their license had lapsed up to a maximum of four years. Such individuals are also required to provide proof of competency by documenting either: 1) active practice in another United States jurisdiction for at least 24 of the 60 months immediately preceding licensure application, 2) active practice in an exempt setting for at least 24 of the 60 months immediately preceding licensure application or 3) practice under supervision for at least 360 hours in the 12 months immediately preceding licensure application.

The Board now proposes to additionally require that individuals who are applying to reinstate their license provide documentation of any other license or certificate held in another political jurisdiction and a current NPDB report. The Board also proposes to limit the requirement that these individuals provide proof of continuing or supervised practice (as laid out above) to only those individuals whose Virginia licenses had been lapsed for 10 years or more.

Requiring documentation of licensure in other jurisdictions and a NPDB report will increase costs for applicants for reinstatement; Board staff reports that political jurisdictions (including Virginia) charge a fee, typically $25 or less, for licensure verification and that the cost of a NPDB report is $6. These costs are likely outweighed by the benefit that would likely accrue to the citizens of Virginia because these documents allow the Board to check for disciplinary actions or malpractice claims that applicants may have been subject to.

Board staff reports that the Board proposes to limit the requirement that individuals provide proof of continuing or supervised practice to only those individuals whose licenses have lapsed for 10 years or more in order to reduce the burden of reinstatement costs on individuals who likely have not been out of practice long enough to place doubt on their ability to practice competently. Social workers whose licenses have been lapsed for between one and nine years, and who do not meet the active practice criteria to show continued competency, will likely save time costs, and may save the cost of paying for supervision, on account of this change.

Current regulation requires that individuals reinstating lapsed licenses, and who must undertake supervised practice, complete at least 360 hours of practice under supervision; current regulation does not, however, specify the parameters of that supervision. The Board now proposes to require that these supervised practice hours include at least 60 hours of face-to-face direct client contact and nine hours of face-to-face contact with the supervisor. Board staff reports that these face-to-face requirements are proportional to the requirements for initial licensure. Board staff further reports that the Board does not anticipate any supervisee incurring additional costs on account of these changes. These changes will provide the benefit of clarity for individuals who may have been confused about what is required under supervised practice.

Businesses and Entities Affected. These proposed regulatory changes will affect all clinical social workers as well as all individuals who apply for reinstatement of licensure. Board staff reports that the Board currently licenses 6,458 clinical social workers. Board staff does not have an estimate of the number of individuals who might be affected by the changes to rules for reinstatement.

Localities Particularly Affected. No locality should be particularly affected by these proposed regulatory changes.

Projected Impact on Employment. These proposed regulatory changes are unlikely to significantly affect employment in the Commonwealth.

Effects on the Use and Value of Private Property. These proposed regulatory changes are unlikely to affect the use or value of private property in the Commonwealth.

Real Estate Development Costs. These proposed regulatory changes are unlikely to affect real estate development costs in the Commonwealth.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. Individuals seeking reinstatement of Virginia licensure, who plan to practice as individual proprietors or in a small practice setting, will likely incur some additional costs on account of being required to provide a current NPDB reports and proof of licensure or certification in other political jurisdictions.

Alternative Method that Minimizes Adverse Impact. There are likely no alternative methods that would both meet the Board's aims and further lower costs for applicants.

Adverse Impacts:

Businesses. Individuals seeking reinstatement of Virginia licensure, who plan to practice as independently rather than seeking employment in another business, will likely incur some additional costs on account of being required to provide a current NPDB reports and proof of licensure or certification in other political jurisdictions.

Localities. No localities are likely to incur costs on account of these proposed regulatory changes.

Other Entities. These proposed regulatory changes are unlikely to adversely affect other entities in the Commonwealth.

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¹ The Chapter description, as well as more information on this Chapter, can be found at: http://townhall.virginia.gov/l/ViewChapter.cfm?ChapterID=1157.

² Medical-dictionary.com defines psychosocial intervention as a nonpharmacologic maneuver intended to alter a patient's environment or reaction to lessen the impact of a mental disorder.

Agency's Response to Economic Impact Analysis: The Board of Social Work concurs with the analysis of the Department of Planning and Budget.

Summary:

The proposed changes (i) amend the definition of clinical social work services to include psychosocial interventions, (ii) require applicants for reinstatement to provide verification of licensure in another state, if applicable, and a report from the U.S. Department of Health and Human Services National Practitioner Data Bank, and (iii) specify the amount of supervision required for a person who has not actively practiced for 10 or more years and who applies to reinstate or reactivate his license.

Part I
General Provisions

18VAC140-20-10. Definitions.

A. The following words and terms when used in this chapter shall have the meanings ascribed to them in § 54.1-3700 of the Code of Virginia:

Board

Casework

Casework management and supportive services

Clinical social worker

Practice of social work

Social worker

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Accredited school of social work" means a school of social work accredited by the Council on Social Work Education.

"Active practice" means post-licensure practice at the level of licensure for which an applicant is seeking licensure in Virginia and shall include at least 360 hours of practice in a 12-month period.

"Ancillary services" means activities such as case management, recordkeeping, referral, and coordination of services.

"Clinical course of study" means graduate course work that includes specialized advanced courses in human behavior and the social environment, social justice and policy, psychopathology and diversity issues; research; clinical practice with individuals, families, and groups; and a clinical practicum that focuses on diagnostic, prevention and treatment services.

"Clinical social work services" include the application of social work principles and methods in performing assessments and diagnoses based on a recognized manual of mental and emotional disorders or recognized system of problem definition, preventive and early intervention services, and treatment services, including but not limited to psychosocial interventions, psychotherapy, and counseling for mental disorders, substance abuse, marriage and family dysfunction, and problems caused by social and psychological stress or health impairment.

"Exempt practice" is that which meets the conditions of exemption from the requirements of licensure as defined in § 54.1-3701 of the Code of Virginia.

"Face-to-face supervision" means the physical presence of the individuals involved in the supervisory relationship during either individual or group supervision or the use of technology that provides real-time, visual contact among the individuals involved.

"Nonexempt practice" is that which does not meet the conditions of exemption from the requirements of licensure as defined in § 54.1-3701 of the Code of Virginia.

"Supervisee" means an individual who has submitted a supervisory contract and has received board approval to provide clinical services in social work under supervision.

"Supervision" means a professional relationship between a supervisor and supervisee in which the supervisor directs, monitors and evaluates the supervisee's social work practice while promoting development of the supervisee's knowledge, skills and abilities to provide social work services in an ethical and competent manner.

18VAC140-20-110. Late renewal; reinstatement; reactivation.

A. A social worker or clinical social worker whose license has expired may renew that license within one year after its expiration date by:

1. Providing evidence of having met all applicable continuing education requirements.

2. Paying the penalty for late renewal and the renewal fee as prescribed in 18VAC140-20-30.

B. A social worker or clinical social worker who fails to renew the license after one year and who wishes to resume practice shall apply for reinstatement and pay the reinstatement fee, which shall consist of the application processing fee and the penalty fee for late renewal, as set forth in 18VAC140-20-30. An applicant for reinstatement shall also provide documentation:

1. Documentation of having completed all applicable continued competency hours equal to the number of years the license has lapsed, not to exceed four years;

2. Documentation of any other health or mental health licensure or certification held in another United States jurisdiction, if applicable; and

3. A current report from the U.S. Department of Health and Human Services National Practitioner Data Bank.

An C. In addition to requirements set forth in subsection B of this section, an applicant for reinstatement whose license has been lapsed for 10 or more years shall also provide evidence of competency to practice by documenting:

1. Active practice in another United States jurisdiction for at least 24 out of the past 60 months immediately preceding application;

2. Active practice in an exempt setting for at least 24 out of the past 60 months immediately preceding application; or

3. Practice as a supervisee under supervision for at least 360 hours in the 12 months immediately preceding reinstatement of licensure in Virginia. The supervised practice shall include a minimum of 60 hours of face-to-face direct client contact and nine hours of face-to-face supervision.

C. D. A social worker or clinical social worker wishing to reactivate an inactive license shall submit the difference between the renewal fee for active licensure minus any fee already paid and the fee for inactive licensure renewal and document completion of continued competency hours equal to the number of years the license has been inactive, not to exceed four years. An applicant for reactivation who has been inactive for four 10 or more years shall also provide evidence of competency to practice by documenting:

1. Active practice in another United States jurisdiction for at least 24 out of the past 60 months immediately preceding application;

2. Active practice in an exempt setting for at least 24 out of the past 60 months immediately preceding application; or

3. Practice as a supervisee under supervision for at least 360 hours in the 12 months immediately preceding reactivation of licensure in Virginia. The supervised practice shall include a minimum of 60 hours of face-to-face direct client contact and nine hours of face-to-face supervision.