STATE OF WEST VIRGINIA

PRELIMINARY PERFORMANCE REVIEW OF THE BOARD OF SOCIAL WORK EXAMINERS

OFFICE OF LEGISLATIVE AUDITOR
Performance Evaluation and Research Division
Building 1, Room W-314
State Capitol Complex

CHARLESTON, WEST VIRGINIA 25305
(304) 347-4890
Background

The Board of Social Work Examiners (BSWE) was created in 1984. Its mandate is stated in §30-30 of the West Virginia Code. There are seven members on the board. Six are mandated licensed social workers; the seventh is a citizen representative. All seven members are appointed by the Governor for terms of three years. The BSWE is separate from any other agency and is self-sufficient. Table 1 shows the Boardıs operating revenues and expenditures for the past three years. The Board is budgeted solely from fees and fines collected from its licensees and continuing education providers. There are fewer licensees scheduled for renewal in even years, therefore, revenue from even years, such as 1996, will be less than in odd years.

Table 1
Board of Social Work Examiners
Operating Revenues & Expenditures
Beginning Operating Balance Revenue Expenditures Ending Operating Balance
FY 1997 $73,210 $103,144 $118,853 $57,501
FY 1996 $81,598 $76,434 $84,821 $73,211
FY 1995 $40,853 $131,339 $90,595 $81,597

The Board met often from July 1994 to December 1997. In calendar year 1997, the Board met every month. In 1996 there were eight meetings, and in 1995 nine meetings. On only one occasion (in 1995) the Board did not have a quorum. Executive sessions have occurred three times. (See Appendix A)

From July 1994 to February 1998 the Board received fifty complaints. Out of the total number of complaints 25 were classified as unsubstantiated. Two of these were sent letters of caution. Ten complaint cases are open at this time. Three complaints were not against any particular social worker, rather they were general complaints and were not treated as unsubstantiated. Five fraudulent licenses or practicing without a license were reported to county prosecuting attorneys and to the Disciplinary Action Reporting System, issued by the American Association of State Social Work Boards. One license has been suspended. Four licenses were surrendered, one of these to avoid a hearing and the other three were non-compliant temporary licensees.

As of June 1997 there were 4,273 West Virginia social workers. They are licensed at different levels as Table 2 illustrates, with temporary licenses being the lowest level.

Table 2
Number of West Virginia Licensed Social Workers
by License Level
License Level FY 1995 FY 1996 FY 1997
Temporary 1646 1632 1402
Social Worker 1841 1856 1998
Graduate Social Worker 182 174 201
Certified Social Worker 630 612 545
Independent Clinical Social Worker 93 102 127
Totals 4392 4376 4273

There were 1,402 temporary licensees in fiscal year 1997. This represents one-third of the total number of licensees. Temporary licenses were created to address a statewide shortage in individuals with social work degrees. Temporary licensees generally have little social work experience and their education training is in a non-social work field, as opposed to formal training in an accredited college social work program. They are required to be employed for four years as a social worker under the supervision of a certified social worker, attend 80 hours of continuing education compared to 50 for regular social workers, and pass the BSWE exam before they can receive a social work license.

The Board received approval of new rules from the 1998 Legislature to phase out temporary licenses. After July 1, 2000, those graduating with a non-social work degree will not be eligible for a temporary license. Temporary licenses will continue to be issued to those who graduate prior to July 1, 2000 with a degree in a non-social work field. The Department of Health and Human Resources will be exempt from this provision because of the difficulty in hiring professional social workers. However, these licensees will not be able to work for any other agency.

ISSUE AREA 1: The Board of Social Work Examiners Can Improve Its Effectiveness By Monitoring Compliance to Standards.

The Board of Social Work Examiners (BSWE) was created to protect the public from unqualified and unscrupulous social workers. The Board accomplishes this by establishing standards of qualification, education, training, experience, and promoting standards of professional conduct. This preliminary review evaluated the Board's performance in important areas of operation. These areas are:

1) the licensing process of social workers;
2) the licensing process of continuing education providers;
3) the complaint process;
4) accessibility to the public;
5) travel reimbursement; and
6) filing of financial disclosure statements.

This first issue area discusses items number one and two, while items three through six are discussed in issue area two. Overall, the BSWE has been effective to some extent. The Board is reasonably accessible to the public, and it has addressed 50 complaints over the past four years. However, its effectiveness can be improved in the licensing process through monitoring the compliance of licensees and monitoring the performance of continuing education providers.

Monitoring Compliance Will Improve the Board's Effectiveness

The Board's ultimate objective is to protect the public who are served by social workers. It is difficult to measure public protection to determine the Board's effectiveness. However, it is reasonable to assume that to some extent the goal of protecting the public will be achieved if an adequate compliant process is in place, and standards for education, training, experience, and professional conduct are established and complied with. In this issue, the Legislative Auditor concludes that the Board has established standards as required by law, however, the Board does not know to what extent its standards are being complied with.

Each person who seeks to become a licensed social worker must file an application with the BSWE. The application requires the applicant to submit the following:

An official college transcript verifying the degree received.
Three professional references.
A completed question and answer sheet, with one question asking if the applicant has been convicted of a felony.

The Board's procedural rules (§25-2-3.5) state that "The Board will review all sections of the application on a random basis...." In a written statement, the Board indicated that it does not randomly verify application information.{1} The Board verifies application data only in cases where the information provided appears suspicious or if the Board becomes aware that an applicant's application is false. Also, the Board's staff cross checks out-of-state applicant names to the Disciplinary Action Reporting System, issued by the American Association of State Social Work Boards. This report has 48 social work licensing boards participating and lists social workers who have had sanctions brought against them. There is another safeguard in that some social services organizations require a criminal background check as part of their hiring process. The Board needs to examine ways to verify an applicant's response to criminal behavior in cases where the employer does not do a criminal background check.

Without verifying application information, the Board runs the risk of licensing individuals that are unqualified or have questionable professional integrity. The fact is that people will falsify information or violate the standards. In one case, the Board became aware that a licensee falsified a school transcript. In another case, it was brought to the Board's attention that a licensee was convicted of a felony several months after becoming licensed.{2} Verifying information not only identifies individuals who should not be licensed, it also gives the Board a measure of the rate of compliance to its standards. This will give the Board an indication of whether or not there is a need for greater scrutiny of licensees, such as taking a larger sample of applications. Furthermore, randomly verifying information will give a signal to all licensees that the licensing process is not entirely based on the honor system. When it becomes common knowledge that the Board verifies information, it should improve compliance with standards which in turn leads to greater protection for the public.

Continuing Education is Not Verified and Continuing Education Provider's Performance Is Not Evaluated

Each licensed social worker must complete 50 hours (80 hours for temporary licensees) of continuing education every two years. Continuing social work education consists of programs designed to enhance social work practice, skills, values, knowledge and social work ethical considerations. These courses must be offered by Board-approved continuing education providers. Of the 50 hours of continuing education, up to 20 hours can be earned in Individual Professional Activities. These are educational activities which can be self-directed and are not specifically offered through a Board-approved program.

In order for a license to be renewed, licensees must report to the Board all continuing education taken within the two-year license period. The Board requires that continuing education be reported on a Continuing Education Recording Form. The form requires the licensee to indicate the name of the course, the date and location of the course, the number of hours received, the name and license number of the provider, and licensee identification information. Licensees are not required to submit verification of attendance, certificates, or written reports, although the Board instructs them to maintain this information in their files for possible monitoring of their records.

According to legislative rules (§25-1-9.8):

The Board may monitor and evaluate continuing education providers and the continuing education records of individual licensees to determine compliance with these rules.

Although the Board may monitor licensee records to verify continuing education, this is not being done on a random or routine basis. Furthermore, the Board indicates in its rules the types of documents it could request if it decided to audit a licensee's continuing education or professional activities, but the Board does not inform licensees of all the documents it could request. The Board indicated that there are ways to verify this information if there is any question about the hours completed, but "the Board has not been able to randomly monitor continuing education because of limited staff time, but will consider ways that this might be done." Professional activities that are used towards continuing education are also not monitored. The Board indicated that licensees are required to submit a "grade report" or college transcript for professional activities, however, the Board will seek to monitor licensees' Individual Professional Activities on a random basis.

The lack of verification of continuing education through random checks allows false claims to go undetected. Furthermore, when the social work community has the impression that continuing education is not verified at all by the Board, it is reasonable to assume that an incentive will develop to report false information. Part of the process of protecting the public is promoting enhancements of professional skills. If continuing education is not being taken in the required amount, then the enhancement of skills will not occur. Although it is good that the Board has means to verify continuing education, these means should be used to increase the Board's effectiveness. When social workers know that their continuing education could be audited, compliance with this requirement will improve.

Continuing Education Providers not Evaluated

The Board has established a Continuing Education committee consisting of volunteers in the social work field to coordinate continuing education activities, and to recommend to the Board approval or disapproval of providers. The Continuing Education committee investigates an organization's application to become a Board-approved ongoing or individually approved continuing education provider. An approved ongoing provider may offer numerous training programs a year. Also, ongoing providers do not have to be re-certified once they receive approval. Individually approved providers seek approval to offer only one event, and each new training session must be approved.

Legislative rules (§25-1-9) establish the requirements for approved providers. Some of the requirements providers must document are:

A licensed social worker holding a degree in social work is to be responsible for coordinating the training program.
A system for maintaining records must be in place, including licensee's attendance.
A method for the selection and evaluation of qualified instructors.
Indicate the competency of the instructor.
Identify the means and results of program content evaluation by participants.

Judging from the minutes, the Continuing Education committee provides a thorough review to ensure each application is complete and meets the criteria. The committee often disapproves an application because of inadequate documentation, or withholds a decision pending additional information.

However, providers of continuing education are not evaluated for their performance after receiving Board approval. Since ongoing providers are not re-certified, years could go by where poorly performed courses are offered. The Board does require ongoing providers to submit, twice a year, a report of all events they offered. This report, however, simply lists the title of the courses, the dates and location, and the number of credit hours. If there are complaints brought against a provider, the Board indicated that it will request records from the provider. When random checks of provider performance becomes a common practice of the Board, providers will become more responsive to the quality of their programs.

Positive Changes Made by the Board During This Review

During this review the Board began implementing changes in response to the findings of this report. The Board indicated that it will change the guidelines it sends to licensees to inform them that the Board will be monitoring licensee's professional activities and continuing education. Also, all the types of documents that are listed in the rules that the Board may request are stated in a policy statement. In a policy statement attached to the new guidelines issued to all licensed social workers, effective April 1, 1998, the Board stated:

This Policy Statement is to inform you that the Board will begin doing random audits of licensees' individual continuing education training records EFFECTIVE IMMEDIATELY. Therefore, it is most important that you maintain; Certificates of Attendance, receipts for registration fees, verification of attendance from provider representatives, program notes, or other proof of attendance. The Board will submit a "Continuing Education Training Monitoring Request" to approximately twenty licensed social workers per month.

Prior to the beginning of this review, the Board had proposed amendments to its legislative rules. These rules were passed by the 1998 Legislature. One of the amendments requires continuing education providers to provide documentation of satisfactory performance every two years in order to maintain their certification. This re-certification process will be a monitoring tool for the Board to evaluate provider performance. It will also make providers more sensitive to quality continuing education.

Conclusions

Overall, the Board of Social Work Examiners operates well. The recommendations of this report serve to improve the Board's effectiveness. The licensing process has relied to a great extent on the honor system. This does not mean that the system is ineffective. To some extent, the Board has been effective. Standards have been established and complaints are being addressed. It is likely that many social workers are complying with the standards even in an honor system if only to maintain their employment or out of personal integrity. However, monitoring compliance will detect violations or poor performance which would likely have gone undetected. Furthermore, once regular monitoring of compliance becomes common knowledge, there will be greater diligence on the part of social workers that will enhance compliance. Improved compliance will lead to greater protection of the public. The Legislative Auditor commends the Board's response to the findings prior to the completion of this review.

Recommendation 1

The Board should check application information on a random basis as required by its Procedural Rules. The Board also should examine ways to verify an applicant's response to criminal behavior in cases where the employer does not require a criminal background check in its hiring process.

Recommendation 2

The Board should randomly request additional information from licensees to verify professional activities and continuing education, as allowed by rule. The Board should also inform licensees of all the documents listed in the Legislative rules that they should maintain in their records for monitoring purposes.

Recommendation 3

The Board should randomly monitor continuing education providers for the quality of continuing education, as allowed by rule.

ISSUE AREA 2: The BSWE Has Satisfactorily Complied With Important Statutory Requirements.

The Board was examined in four areas that are important in operating effectively or that are required by statute. These areas are as follows:

The Complaint Process.
Travel Reimbursement.
Accessibility to the Public.
Submission of Financial Disclosure Statements.

The Legislative Auditor finds that the Board has given adequate attention to these areas of operation.

The Complaint Process

The general provisions for boards of examinations (§30-1-8) require that no license can be denied, suspended or revoked without a prior hearing before the Board. The BSWE has established a procedure in its legislative rules (§25-1-10) that provides due process to individuals who face charges that could result in disciplinary actions leading to the suspension or revocation of their license. This procedure is also important in protecting the public. From July 1994 through February 1998 fifty complaints were logged by the Board's staff. Table 3 shows major categories of complaints or the resulting disciplinary actions.

Table 3
Complaints by Category
Revoked 0
Suspended License 1
General Complaints (Not Against Individuals) 3
Fraudulent License/Practice without License 5
Surrendered License due to inactivity of licensee 4
Surrendered License due to falsification 2
Open Cases 10
Unsubstantiated 25
Total 50

Upon receiving a complaint, the Board will send a letter of acknowledgment to the complainant. The person who the complaint is against (respondent) receives an uncensored copy of the complaint and is asked to provide a written response to the Board in fifteen days. A Board member will be assigned to investigate the complaint to determine if it is substantiated. If the complaint is determined unsubstantiated, a letter is sent to the complainant indicating the Board's determination. Twenty-five of the complaints were found to be unsubstantiated.

If a complaint is substantiated, the Board works to resolve the dispute through a consent agreement rather than a formal hearing. A consent agreement is a formal written document that states a resolution that both parties must agree to by their signatures and the signatures of Board members. The consent agreement could contain resolutions involving revocation or suspension of a person's license, or some other disciplinary action.{3} If the respondent does not agree to the Board's disciplinary action, the respondent has the right to a formal hearing before a licensed hearing examiner. A decision is recommended by the hearing examiner. The Board can accept, amend or reject this decision. Respondents also have the option of appealing decisions to the circuit court.

One case went before a hearing examiner who recommended three years suspension of the person's license. The Board, however, modified the suspension to one year. The hearing examiner concluded that testimony in the case revealed that a dual relationship developed between the client and the social worker.{4} The dual relationship subjected the licensee, the client, and the client's family to potential harm. The instances of potential harm were cited as: 1) failure to inform a supervisor of two occasions when the client threatened to shoot himself; 2) the licensee engaged in target practice with the client; and 3) the licensee undermined the therapeutic process when the licensee drank alcohol with the client and gave him drugs with the knowledge that he was a substance abuser.

In another case, it was brought to the Board's attention that a licensee was convicted of a felony several months after becoming licensed. The licensee was convicted of possessing and distributing "LSD," and received five years probation and was fined $5,000. The Board requested the licensee to surrender his license. In another case, a licensee surrendered his license to avoid a hearing. Five licensees have been reported to prosecuting attorneys because of practicing without a license or practicing with a fraudulent license.

There are ten open cases, two of which are currently scheduled for hearings. One of these cases involves a social worker who began having a sexual relationship with a former client. In the consent agreement, the Board determined that the dual relationship had risk of exploitation or potential harm to the former client. The respondent did not sign the consent agreement leading to the scheduled hearing. If the social worker had agreed to the consent agreement she would have had her license suspended for six months and be put on a probationary period where she would be supervised by another social worker for two years. Further conditions of the consent agreement were that the social worker would not manage clients whose issues were of sexual orientation nature and the social worker would have to complete 45 hours of continuing education units in areas of dual relationships.

There were six surrendered licenses, two of which were Board requested. The Board has submitted the names of five licensees to the American Association of State Social Work Boards (AASSWB) for inclusion in its Disciplinary Action Reporting System. This report is a listing of individuals in 48 participating entities (U.S. Virgin Island reports) who have had disciplinary actions brought against them. All five reports made to the AASSWB were for fraudulent licenses or regarding someone practicing without a license.

The Board issued a letter of caution in another case. In this instance, the relationship was the request of a client to have her social worker take custody of her child. The social worker was also a licensed foster parent. The social worker made adjustments to have the client phased out from her care. This social worker was found to have made appropriate efforts to separate herself from her client. In addition to the efforts to separate herself, she appropriately took into consideration the best interests of the client and the child as section 1.06 of the Code of Ethics calls for. No action was taken against the worker because the Board felt the worker only needed to be cautioned.

The Board is responding to complaints and is disciplining licensees. Responding to complaints and disciplining licensees facilitates the mandate of protecting the public from inappropriate actions by social workers.

Travel Reimbursement

The Legislative Auditor compared dates of travel reimbursement claims with dates of Board meetings and attendance. There is no indication of fraudulent travel reimbursement claims. However, documentation of some travel to conferences and speaking should be improved. Checking dates of meetings against dates for which reimbursement is claimed is one way of improving documentation. Filing brochures from attended conferences with registration confirmation lists would also provide adequate documentation, as well as evidence that a Board member was a listed speaker at an event.

Accessibility to the Public

Accessibility is necessary for complaints to be filed by the public. It is possible that some individuals in various parts of the State are not aware of whom to call with a complaint about a social worker. The Board is accessible to the public through the Government section of the Kanawha-Putnam telephone directory, through agencies where social workers are employed, through the WV Capitol directory, and through the web site of the American Association of State Social Work Boards. Other large cities of the State do not have the Board listed in their government section; these cities include Beckley, Clarksburg, Huntington, Martinsburg, Parkersburg and Wheeling. The Board is encouraged to put its listing in these telephone directories so that regions of the State are encompassed and more citizens are able to locate the Board. Recent legislation encourages all Boards to list their address and telephone number in the Government section of telephone directories other than the required Charleston area telephone directory.

Financial Disclosure Statement West Virginia Code §6B-2-6a2 requires Board members to file financial disclosure forms with the Ethics Commission. All members of the Board have filed their financial disclosure statements with the Ethics Commission for FY 1997. These statements are due by February 1, 1998.

Recommendation 4

The Board should improve its documentation of travel reimbursement by maintaining documents of attendance at conferences and speaking engagements.

Recommendation 5

Although the Board is in compliance with H.B. 4021 by having its telephone number listed in the Charleston area telephone book, it is encouraged by the same legislation to list in other cities as possible, or obtain an "800" number.

FOOTNOTES********************************

{1} The Board did agree that verifying application information was important, and it will discuss ways to immediately begin random verification.
{2} The licensee was convicted of possessing and distributing "LSD," and received five years probation and was fined $5,000.
{3} On July 1, 1998 when the Board's new rules come into effect, the Board will be able to impose fines on licensees as a disciplinary sanction in addition to suspending or revoking a license. Also, the Board will have authority to hire an investigator to scrutinize complaints.
{4} The National Association of Social Workers' Code of Ethics states that "Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client." Dual relationships occur when social workers relate to clients in more than one relationship, professional, social or business.