The Association of Social Work Board’s (ASWB) release of their long-requested report on licensure exam passage rates has prompted industry outrage. Professional response has been fierce with calls for action by every sector, especially for social work regulatory boards across the states and territories to stop giving and requiring licensure exams.The report’s appearance forced me to pause, especially as a clinical social worker with 40 years committed to patient and professional empowerment. Add my roles as a former ASWB clinical exam item-writer, social work educator, and clinical supervisor to the mix, and know I’ve engaged in my share of introspective reflection.
Systemic racism has long been attributed to standardized tests across education levels, academic programs, and professional licensure and credentialing entities. The National Education Association calls for more authentic means of assessment, viewing the exams as “instruments of racism and a biased system”. Ibram X. Kendi states,” The tests have failed time and again to achieve their intended purposes: measuring intelligence and predicting future academic and professional success. The tests, not the black test-takers, have been underachieving”. Students who are English Language Learners (ELL), persons with disabilities, and Black males are all identified among persons least likely to receive a passing score.
Social work is not alone in its outcry over licensure exams passage rates and the associated disparities. There are countless studies, including a recent release by the American Bar Association in May 2022. The report revealed how Whites pass the Bar exam as first-time test takers (and within two years of graduation) at higher rates than graduates from other racial and ethnic groups.
Other Causal Explanations
A flurry of literature, reports, and dialogues have focused on other causal factors. These span themes of the quality of academic and professional education, age of the test taker, availability and quality of social work licensure supervision, and opportunities to actively use the knowledge-base on the job; the impact of life stressors, test-taking anxiety, exam preparation and over-preparation have also been explored, as well as the item-writing process itself.
The American Health Information Management Association (AHIMA) conducted a literature review on factors impacting exam passage that spanned professions (e.g., medicine, medical technologists, nursing, physical therapy). While race, age, disabilities and gender were addressed, also highlighted were availability of child care during field practicums, distance education degree programs compared to those in-person, access to quality prep courses, and receiving necessary disability accommodations.
The quality and equity of social work supervision received is a topic that touches me deeply. We have a workforce to grow, and supervision leverages a sustainable, diverse, clinical workforce. I cringe when hearing about negative and disparate supervision experiences from potential supervisees. Too often their processes lack attention to the clinical nuances of practice, such as differential diagnosis, or ethical dilemmas and decision-making. Too often they lack reflective discussions on why one intervention versus another was used for particular clients or patients. Too often I hear about inconsistent supervision scheduling where cancellation of required weekly standing sessions is more norm than exception. This devalues the supervisee and does little to ensure their successful completion of required supervision hours. Far too often I hear of supervisee exploitation, where excessive fees are charged with poor quality in return. These actions leave supervisees not benefitting from the consistent support to empower learning, promote clinical savvy, or support exam passage.
The Ultimate Dilemma
What should happen next? Herein lies the $64 M question. Social work is a regulated profession, the primary purpose of which, is protection and safety of the public; the secondary purpose is to protect the profession. Yet, I’m confident most have met individuals who are expert test takers, but less than effective practitioners. Is exam passage necessary? If yes, what becomes the best method to “test” that an individual has the level of didactic knowledge, critical thinking, and professional maturity required to intervene as an independent clinician? If no, are other licensure requirements alone sufficient to denote competency to practice in a state, such as graduating from an accredited school of social work, fulfilling the requisite practicum hours, completion of a requisite number of clinical (direct) and work (indirect) hours, plus a set number of supervision hours? How should the minimum standard for clinical practice be defined by state boards, considering the different requirements across them?
From a liability standpoint, standardized exams have allegedly provided an objective measure of the minimum standard of practice expected for that licensure/credential. Protecting patient’s from harm has been a priority of licensure, but what of practitioner harm? From an ethical standpoint, conclusive data shows standardized exams in their current form, obstruct access to (independent) licensure, especially for persons of color, certain ethnic groups, and those with disabilities, among others. Practitioner harm and trauma become direct outcomes when these individuals are unable to pass the exam; professional reputation and financial status are impacted through loss of promotions or jobs, as well as dollars spent on prep courses and repeated exam application. This action fails to ensure attainment of a diverse workforce that can provide the concordant care warranted across patient populations.
From social work’s lens, if the ASWB exam is removed, what will replace it? That premise is a central consideration. Some states, as Illinois, charted that course prior to the ASWB report; the LSW no longer requires a person take an ASWB exam. Other states are considering their next steps. Social work strives to identify and fix systems that are broken. If the licensure exam process is broken, then we are beholden to fix it.
The National Association of Social Workers (NASW) released their formal response, emphasizing concern over racial disparities and need to address the “systemic racism within the profession”. Further statements have appeared from the Social Work Hospice and Palliative Care Network, and are expected from other groups, including the National Association of Black Social Workers.
Whatever happens next, one action is certain; strategic, coordinated, and equitable action is mandated. That action must ensure social work’s professional path is not laden with the same disparities and obstacles faced by populations served by the profession itself.
This Blog post was first published in, Ellen's Interprofessional Insights, and appears with permission.