For legal-ish purposes, this does not, cannot, and should not be regarded as official ASWB content, promotion, or advertisment. I am simply a statistics enthusiast who is fueled by rage, spite, and the autistic urge to correct obviously stupid misconceptions.

Let’s start at the very beginning, it’s a very good place to start.

ASWB is the Association of Social Work Boards. They’re the people who provide exams for current available social work licenses in the United States (including the kind of independent territories) and Canada. Current exams are LBSW (licensed baccalaurate social worker), LMSW (licensed masters social worker), LGSW (licensed general social worker), and LCSW (licensed clinical social worker). LMSW and LGSW essentially represent the same educational and provisional license post-masters, while the convention is up to each region that licenses. LCSW also requires a masters, and supervised practice.

Many people have recently determined and furthered assertions on the biased nature of an exam. They will point toward frequent disparaties in demographics of those who pass on the first, second, and third attempt. (Note: after the third attempt of some exams, further supervised practice is required to reset the count.)

Common demographics that are mentioned:

• Age (typically comparing early vs late career change)
• Racial background
• Ethnic background
• Religious background
• General socioeconomic regional makeup (realtive population, income, and proportions of minority to majority makeup)
• If the test taker holds a BSW (bachelor of social work) or not

Before even attempting to address each variable, I opt to discuss the aim of licensing exams, general structure of exams, and outlined content comparison to actual content, as well as potential areas of concern within examination scoring/makeup.

The aim of licensing exams is to evaluate if minimum competencies spread over generally accepted areas of practice and course content are achieved at an acceptable level to obtain approval to bill insurance, gain hours toward independent licensure, and present yourself as a qualified provider of services rendered.

The general structure is including a predetermined number of questions that contribute toward the final score, frequently a set of field questions (ones that are being piloted for appropriateness of proposed changes), with general content areas being presented proportionally to posted percentages within the exam itself. This could be along the lines of: “25% of the exam will cover human growth and development” and so 25% of the questions are about human growth and development. Within these questions, test takers will anticipate content stated in an exam outline as being subcontent.

A potential area of concern is that, firstly, field questions could present challenges to providers in rural areas, or who work for agencies and organizations whose model of services is rigid, within doctrine, or even limit the population serviced. Secondly, within the test itself, there could exist an assumed perspective of social workers, meaning there could be skewed answers that align with those with little lived experience as a patient, per se, or even who have performed more macro level actives, for instance.

Where the factor of variables contributing breaks down is that the questions are meant to be aligned with competency areas clearly defined in accrediation criteria, such as CSWE competency areas. CSWE is the council on social work education, and sets standards of baseline competency areas, which broadly align with ASWB content areas/topics.

I’ll posit an assertion no one wants to say, but many statisticans acknowledge.

While discrepancies may exist among the demographics of those who pass, a test whose content is clearly stated and aligned with educational content can only reflect the quality of formal and informal education obtained, as standardized objectives preclude the existence of one experience being more appropriate than another.

It’s a lot of words, sure. But it’s not complex, even if it appears to be.

It is the academic and more neutral wording of conveying that the failure of the test takers falls distinctly on the shoulders of the educational program, to include the internships and provisional work experience acquired. Meaning, if more students from lower income areas do worse, the most plausible causality is the schools they were able to afford (or cost nonwithstanding) attending provided lower quality education. This can feasibly extend to an assumption that lower income areas provide highly limited areas of practice, and that perhaps the quality of supervision pales in holistic metrics.

This is not to forget the plethora of research existing that demonstrates passing an internship/practicum/field placement associated with course credit is a function of maintaining employment or simply following guidance more frequently than a measure of skills gained, learned, achieved, and any of the former being done competently.

As an aside: Many people who pursue clinical licenses have more likely than not obtained most of their experience that functionally parallels case management or peer support areas and difficulty of practice. This is often due to the associated risk. It’s much easier to allow an intern to perform tasks that carry less clinical weight and applicability, due to both the finite duration of the role, and also the chance that, as part of learning, there is an almost perfect chance that something easily avoidable will arise as a misstep.

As an example, my first full time clinical work may have been doing therapy with the aid of a manual, but it was just as well. I didn’t have a working concept of how to progressively introduce skills. Having a guide to suggest an order helped me conceptualize how build them off each other. The way we as therapists often create a style that works for us is to learn first a structured application and method. In practicing it, we may naturally develop nuances and stylistic flair. It’s easier to learn how to implement gradual and more technically minor changes, rather than going in with no concept of progession. Trust me, it also makes documentation that much smoother.

The flaw with this is that some organizations are not lead by people with clinical experience or some form of variable intervention application. This translates into locations using more practical self-help books as treatment. While there is a time and place to introduce self-help books and workbooks, these are not clinical therapy.

I won’t discourage people from seeking out structured group approaches. I know enough research is out there supporting the efficacy of having peers who specifically can be related to on the basis of shared or related mental health concerns.

After all, I have proudly participated in Celebrate Recovery to help be a leader. So I understand first-hand the value. But it also means I can personally attest to the distinction in services provided and level of support accessible through self-help groups, peer-led programs, and other forms of following steps or a guide to the letter. Again, nothing wrong in participating or engaging. Just to be clear, clinical psychotherapy is not going to feel, look, or function the exact same way, at least not by design.

And as we refer back to the metrics people posit as rationale people cannot pass a standardized assessment whose only aim is to assess for meeting basic competency standards, I want the clinicians and therapists reading this article to consider if your training was truly centered in clinical work.

I personally think it’s great even if your training was nowhere close to that.

The beauty of mental health professions is there’s a time and place for a client or patient to come and be wonderfully met where they are at through different types of help.

I personally cannot stand being a case manager.

That’s just me.

From the moment I meet someone to help, there’s a part of me that naturally gravitates toward asking diagnostic information. Regardless of how I ask, there’s this intrinsic quality of following the patient’s level of comfort and openness. Not to say case managers aren’t empathetic or attuned. Just that there’s a difference in assessing for which resources to recommend or how to best coordinate care, and, on the other side, assessing to see what is most reasonable to ask of a patient and subequently, what diagnosis makes sense for both us and the patient, on documentation. Again, there’s benefits and drawbacks to both. I know as a psychotherapist, I had to explain countless times that my role was not to help with a job search, budgeting, or housing. Sure, I can support the emotional toll or listen to your frustrations. But I wasn’t a case manager, so it just wasn’t my role to reasonably take on. I was happy to conference with the case manager and explain those needs. But that was the limit of my scope of care.

So, yeah, there is amazing benefit to having case management in your team.

Yet, as most people will find, the line in the sand is less about willingness or desire to provide skills and process emotions. Rather, there’s an interaction of scope – meaning in many places, case managers ethically are not allowed to even presume a diagnosis – and patient to provider ratio. I cannot express enough how grateful and impressed I always am at case managers. Having a roster of upwards of 80 people, who probably are near impossible to reach, paired with the benefit of likely being the resource who ensures benefits from the state are kept (health insurance, SNAP, etc.), will never not boggle my mind. I am duly impressed at each one of you, and glad a lot of people enjoy it.

And, as the metrics explain, a clinical exam is a function of clinical skills gained.

Just like I wouldn’t anticipate a writer could successfully write a math proof, or an economist reasonably explain mise en scene, I wouldn’t expect someone whose experience nestles in connecting people to external resources to feasibly understand how helping people through mainly internalized dilemmas works. It’s just different. I probably wouldn’t be able to reasonably pass a case management exam. Just couldn’t.

For the people who wonder about if religious affiliation matters…

It reallly doesn’t. Plenty of religious schools are good, plenty are awful, and plenty of secular/more public-education focused places can be terrible or good, as well. I have found that level of theological content in a program is not necessarily indicative of knowledge gained or skills learned. And, if you’re really concerned, many people choose a program that aligns with career goals. You probably won’t see a relgious-based provider working outside of distinctly marketed centers, agencies, or programs.

Besides, you often don’t have to use religion in your career, even if you know how. That’s the beauty of choice. Just because you can, doesn’t mean you will.

XOXO,

Dorothy B.