Developing a Simulation Model to Understand the Impact Licensing Exams Have on Scaling-up the Social Work Workforce

Background and purpose: Improving access to behavioral health services and maintaining service quality is a pervasive and complex challenge. Utah experiences a high degree of unmet behavioral health need and there has been mounting pressure for policy makers to address it. As such, during the most recent legislative session lawmakers modified various licensing requirements to reduce entrance barriers to behavioral health careers and increased supervision requirements to strengthen the quality of care. The intent is to expand the workforce and improve safety. We have partnered with the government office charged with creating these policy changes to design a simulation model to forecast the potential impact of these changes. The objective of this presentation is to explore the impact of removing the licensing exam requirement on the size of the clinical social work workforce.

Methods: We used system dynamics simulation modeling to address our objective. First, we conducted a literature review to identify factors related to entering and exiting the social work and broader behavioral health workforce. Next, we iteratively designed a preliminary module of a computational simulation model incorporating those key factors in partnership with state collaborators at the Office of Professional Licensure Review. Then, we collaborated with state partners to obtain data to operationalize the variables in the module. Finally, we explored three scenarios with the module: requiring the master’s and clinical exam, requiring only a clinical exam, and removing both exams.

Results: The simulation scenarios indicate that removing the master’s exam increases the size of the pool of Certified Social Workers (CSWs- Utah’s license designation permitting a social worker to provide clinical services under supervision). Removing both exams increases the pool of Licensed Clinical Social Workers (LCSWs – Utah’s license designation permitting a social worker to provide clinical services independently). Removing both exams also reduces the size of the CSW pool. Removing one or both exams incrementally increases the workforce and decreases burnout.

Conclusions and implications: Removing entrance exams requirements increases the size of the social work workforce and reduces burnout. However, increasing the size of the workforce quickly may have unintended consequences; the present model does not account for service quality or safety. Our next steps are to develop additional simulation modules that assess the impact these licensing changes and the growing workforce have on the safety of services looking at ethical violation data. Using simulation modeling is a useful approach to help law makers see the potential impact of policy changes on the behavioral health workforce.