Scopes of practice: A view from across the Tasman

A guest post by Justin Canty

John Darroch’s recent post  raises a number of crucial questions about the recently released Supplementary Order Paper (SOP) to the draft amendments to the Social Worker Registration Act. Within the SOP appears another ‘SoP’ – scopes of practice – as a method for identifying and circumscribing who and what is subject to the Act. In this contribution to the discussion, Justin Canty presents some further questions about the nature of scopes of practice and their application in the proposed amendments.

When I started work in Aotearoa New Zealand in 2007, I found myself surrounded by discussions of scopes of practice. Many mental health social workers were confronting the flow on effects from the HPCA Act and efforts by various professional groups to carve out ‘restricted practices’ which only that professional group performed. The core of the interprofessional tension in the mental health context was psychosocial interventions. Who “owned” those? Which profession could claim them as their sole province? This was of especial concern for social workers as the only profession working in mental health not covered by HPCAA.

Jumping forward a decade and a bit, we find ourselves in a new struggle over the uses of scopes of practice and being recognised for what we do as social workers.

Descriptive or Prescriptive?

The verb ‘scope’ suggests taking a broad view of something, encompassing its outer edges and boundaries. Professional scopes of practice commonly set out the role, actions, and procedures performed by a professional. This is a descriptive function. It allows for reasonable identification of the distinctive aspects of practice for that profession. Some of those actions, procedures, or processes may be undertaken by other professionals but the whole scope allows for description of the scope of professional practice for that profession. However, perhaps especially for social work, it is the whole of the scope that helps us recognise and articulate social work practice.

The Australian Association of Social Workers has a project underway on scopes of practice for social work. Current drafts include a general scope, with several scopes related to specific fields where social workers are engaged. The National Social Work Scope of Practice Strategy (AASW 2015) aims to promote social work practice and advocate for recognition of social workers engaged in the diverse range of settings in which they work. Each scope “provides an overview of the role, contribution and evidence informing social work practice in each relevant area.” (AASW 2015, p. 4). What this project offers is a vision of scopes of practice as a profession and practitioner led process for articulating practice into a scope.

The Accredited Mental Health Social Worker structure is a special case. It was developed to enable social workers in private practice to apply for a Medicare Provider Number, to enable clients to access Medicare subsidy[1] as part of increasing access to primary mental health care. Mental health social workers employed in the public system or employed by NGOs who are equally skilled and experienced are likely not to be accredited because they do not need it. The AMHSW scope of practice does not prevent social workers who are not AMHSWs from engaging in mental health social work. Eligibility to apply for accreditation requires at least two years supervised practice in mental health. If social work in mental health were restricted to AMHSWs then no-one would be able to gain the experience necessary to apply.

One important difference in the Australian context is there is no national registration of social workers and currently it is not on the political horizon. The AASW scopes and accreditation programmes are voluntary and non-binding on others’ practice. As is the case for ANZASW, not all social workers are members of the association and it has no regulatory or disciplinary role for non-members. The AASW Scope of Practice Project and the individual scopes developed so far are descriptive rather than prescriptive and include scopes of skills as well as scopes related to individual settings (AASW 2019).

Restricted Practices

Clearly, the legislation and the SWRB need to be able to determine who is subject to registration under the Act, both in terms of individuals and roles. While I was pleased to see a move away from the previous proposal, the detail in the SOP proposal for enlisting scopes of practice to this disciplinary purpose appears to go beyond the descriptive and ventures into prescriptive territory.

The Health Practitioners Competence Assurance Act, which has a parallel history with Social Workers Registration Act, also recognises scopes of practice developed by the professions. Within those scopes of practice are included restricted practices that may only be performed by a specified group of professionals. The key here is that restricted practices are a small component of scopes of practice. Some components within scopes of practice may not be restricted to individuals of that profession in that field. Scopes of practice and restricted practices are not coextensive.

The concern John raises is in his post is that the SOP appears to make scopes of practice in their entirety a statement of restricted practices. The SOP Section 8 seems to create an unwieldy and excessively burdensome structure using scopes of practice in a prescriptive and restrictive manner. The proposed structure for ‘specialist’ scopes of practice seems light years away from the realities of social work practice, social work careers, or the postqualifying education accessible to social workers wanting to extend their practice knowledge and skills.

Highly stratified professions are not useful templates for understanding or regulating social work practice. Medical specialisation in particular is not a suitable as a conceptual or comparative model to use as a template for social work practice. Even then, specialist consultants in specific areas don’t completely lose their capacity to do the basics of medicine. They might not be so practiced, but most psychiatrists would not be subject to disciplinary action for taking a person’s blood pressure …

Social work practice theory, skills, and knowledge are not siloed into discrete specialisations. If anything, social work specialises in working across fields and breaking down silos. Disciplinary uses of specialist scopes of practice in particular risk imposing an excessive restriction on a profession that in Aotearoa New Zealand is explicitly generalist. If its intent is not to do this, then the capacity for it to be interpreted as requiring retraining for social workers to shift between fields presents a clear need for further revisions so that it cannot be applied in this way.

There is a risk that enlisting scopes of practice to this purpose may constitute function creep and become overly constraining on the profession. The conflation or lack of clarity between of these two functions at the legislative drafting level is proving spectacularly unhelpful. These functions  need to be differentiated and the mechanisms to achieve them need to be fit for purpose. This risk is pronounced in relation to the proposal for specialist scopes of practice. I would advocate getting away from the term ‘specialist’ as this may encourage unhelpful comparison with medical specialisations. I prefer ‘specific’ as a descriptor and the AASW project refers to ‘individual’ scopes of practice.

It is essential to establish the distinction between scope of practice and restricted practices. The field of mental health and debate between professions over ‘psychosocial interventions’ is a perfect case study. Any time that one profession has attempted to establish this as a restricted practice it has been successfully challenged by others who also work competently in the field using psychosocial interventions.

Whose Scope of Practice?

The scope of practice approach has clear advantages over the previous proposal for identifying what roles and individuals may be subject to SWRA. I would not support a return to that previous proposal, as it removed power for articulating what social work is even further from social work practitioners and the profession.  The crux of the issue appears to be the ownership of the scope of practice and how it is used in the regulatory and disciplinary context.

Scopes of practice need to be developed and owned by the profession itself, not imposed.

One of the strengths of the AASW Scopes of Practice Project is that they are being developed in collaboration with practitioners in the fields whose practice the scope articulates. Currently, the social work profession has little input into the membership of SWRB and there is substantial disquiet in professional discussions about the lack of partnership with the profession in the drafting of the scopes of practice and their function within the legislation. Amy Ross picks up this point clearly in her argument on this blog that scopes of practice are an opportunity for ownership.

There are further discussions to be had on the post-qualifying education infrastructure that is currently missing. This should be developed before imposing heavy regulatory requirements on social workers that they have no hope of meeting.

Ultimately, the legislation needs to be able to recognise distinctively social work practice and exercising reasonable regulation in the interests of limiting malpractice. A scope of practice cannot perform the function of a statement of restricted practices and should not be enlisted to this end. Restricted practices may be identified within scopes of practice but a scope of practice cannot itself be a statement of restricted actions. Equally, the legislation will run afoul of our professional colleagues from other disciplines who undertake similar roles (notably in mental health but also community nurses, psychologists, and counsellors to name a few).

We need to be able to recognise and uphold the transferability of core social work skills between settings and the inherently cross-sector nature of effective social work practice in any scope of social work practice, whether that is general or for specific settings. My hope is that the generalist scope would form a broad foundation for articulating social work practice in any setting and that specific scopes are additive as a means to recognise further professional development in some areas without detracting from the foundational scope.

Dr Justin Canty is Lecturer in Social Work in the School of Social Sciences, University of Tasmania. He is a Registered Social Worker in Aotearoa New Zealand and has worked in professional and social work educator roles in Aotearoa New Zealand and Australia.

References:

Australian Association of Social Workers (2015)  Scope of Social Work Practice: National Strategy https://www.aasw.asn.au/document/item/8311

Australian Association of Social Workers (2019) The Scope of Social Work Practice [web page] https://www.aasw.asn.au/practitioner-resources/the-scope-of-social-work-practice

[1]   Australian federal government subsidy of doctor fees, extended to Allied Health Professionals as part of an initiative to increase access to mental health care.

Image credit | Mark爱生活

4 thoughts on “Scopes of practice: A view from across the Tasman

  1. Thanks for this helpful contribution Justin. The more I engage with the issues that John Darroch has raised, the more concerned I become about the current wording of the Bill with SOP amendations.

    You make a very useful distinction between the descriptive and restrictive function of scopes – and I think you are also right to identify that the turf stratification that can be applied to more distinct disciplinary groups under the umbrella of ‘health practice’ does not meet the needs of social work. Social work is (or should be) more about breaking, crossing or bridging silos than creating them for itself. It all gets potentially very unwieldy and bureaucratic.

    I feel we may be throwing the baby out with the bath water if the law is enacted in the proposed form. We tend to be very trusting = in the proposed law as it stands an awful lot of power is being vested in a politically appointed Board. The SWRB must consult with employers, organisations, and professional representatives in designing scopes and attaching qualifications to them but this body is being given wide discretion to decide the nature and degree of this consultation – how and who with.

    It is realistic to be concerned that the broader social justice and policy advocacy functions that go with the territory of social work in an unequal society will be reduced / back-grounded in a work-field knowledge and skills scoping process. Knowing and doing ‘what works’ in a given field is very likely to become central in the current context – all the usual stuff about credibility lent by association with psychological science approaches – focusing ‘in’ rather than ‘out’ to define problem causation and effective intervention.

    In other words there is a risk that the profession will be reduced / redefined by this process rather than strengthened and I fear that we have run too quickly to this way of solving the problems that were apparent in the first iteration of this Bill. Although time is short I think we should make every effort to ensure that we get this right.

  2. It is good to have informed discussion and different views on the difficult topic of ‘what is social work?’ and ‘how can social workers be safe?

    I have always been against both competency and registration as in my view, you could drive a tank through the holes ( and there were more important things to focus on, like the collapse of the welfare state….) Social workers need to practice safely, and this is best achieved by having good initial training, ongoing professional development, and excellent supervision. And the latter two are only achievable if your employer is committed to both. So it comes back to the employer again, which is why I didn’t object to the initial bill, where the employer has to employ a registered social worker if they want to employ a social worker. The reality is that the state calls the shots for the bulk of social work, one way or another. They either employ social workers directly, they fund the health system, or they have contracts with NGOs where they can say that a social worker should be employed. So if the state actually says, you will employ registered (ie trained) social workers AND you will fund ongoing training and supervision, that is likely to go some way to having safe social work practice. The other factor of course is enough time to do the job, and at last there seems to be an improvement in sight for Oranga Tamariki with this – again, state-controlled.

    While I am technically a registered social worker with an APC, I retired last year after 40 years as a social worker. I am sad that, for all the hype, there is less practical commitment to social justice than there was back in the 70s and 80s. I have heard the frustration of students who see the difference between what they are taught and what happens on the ground. I abandoned social work as a change agent at a macro level when we were so sadly lacking during the neo-liberal assault by the Labour then National governments in the 80s and 90s. I put my energy into the unions and community-led campaigns instead. And that is where social workers should be putting their energy into now. A definition of social work is doomed to failure, when you have mental health and Family Start workers doing the exactly the same job with different professional backgrounds.

  3. Nice summary Justin! It’s helpful to see comparisons with another area. I think the key is in how prescriptive these ‘scopes’ are – that’s my worry.

    My secondary worry, which you have touched on, is the makeup and power of the SWRB. Sure, they have to consult, but they don’t have to listen to us. They aren’t elected by us, they are appointed. This presents a worry. We have no say on whether they speak for us, there is zero democracy in this. They are literally appointed by whomever happens to be in government at the time when their terms are up. Perhaps if social workers trusted the SWRB a little more, then we would believe that our concerns during ‘consultation’ might be taken seriously.

    Added to this, there is little to no representation of the student voice on the Board, or in many of the professional organisations/unions involved in advocating for these changes. These changes will cause major disruption in terms of how and what one studies (and the cost). For a profession that prides itself on inclusivity, it is doing a very good job of shutting out some of the people likely to be most impacted in this.

    1. Thanks Eileen 🙂
      That sense of being ‘done to’ instead of ‘done with’ appears to be a common thread in the concerns associated with the legislation drafts and, as you identify, the relationship between the profession and the SWRB. Eerily parallel process to some of the experiences of people we’re often working with as social workers!

      There was a listening response to the problems that were identified in the previous draft by practitioners and professional leaders that would have effectively given power to employers to decide whether roles were social work independent of any professional or regulatory input. I would hope that the concerns being raised now about the uses of scopes of practice are also listened to, taken seriously, and that the potential for unintended interpretation or unintended consequences are resolved through further revisions.

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