Counselor, Social Worker & Marriage and Family Therapist Board 77 South High Street, 24th Floor, Room 2468 Columbus, Ohio 43215-6171 614-466-0912 & Fax 614-728-7790 http://cswmft.ohio.gov & cswmft.info@cswb.ohio.gov To: Rep. Keith Faber, Chairman, Finance Subcommittee on State Government and Agency Review From: Brian Carnahan, Executive Director Re: Supplemental Budget Questions Date: 2/28/2017 1. What is your department s primary purpose and objectives? The Board s primary purpose is to ensure public protection through the application of laws and rules concerning the practice of Counseling, Social Work, and Marriage and Family Therapy. Customers are the residents of Ohio who are served by the Board through the public protections provided. The Board s customers also include the applicants and licensees who receive application, renewal, continuing education, and ethics consultation services from Board staff. The Board licenses and investigates persons who practice Counseling, Social Work, and Marriage and Family Therapy. The Board conducts additional activities such as auditing licensees, reviewing continuing education programs and providers, answering inquiries from the public and licensees regarding ethics, answering questions regarding applying for licensure, supporting a web site, and publishing a newsletter. In the current fiscal year, the Board is focusing on the following: Reviewing and approving applicants for examination and licensure efficiently; More effectively using the current legacy licensing system while waiting to adopt the new licensing system; Identifying and implementing a replacement for the Board s current document management system; Increasing consistency between Professional Standards Committees; Increase use of the web site, social media, and related tools in communications and application processing; Limiting rule changes to ensure licensees have sufficient time to become familiar with rule changes; Increasing the number of licensees in practice in Ohio through raising student awareness of counseling, social work and marriage and family therapy through presentations and distribution of the Board s licensure brochure; Protecting the public through responsive and effective investigations; Increasing consumer and licensee awareness of the Board s role through use of web-based resources; Addressing emerging issues such as teletherapy/e-therapy, license mobility/portability, and the impact on scope of practice when integrating mental health and medical services; Improving the Continuing Education program approval and audit processes by implementing changes resulting from a survey of Social Workers. Page 1 of 6
The Board s primary priority is to continue providing its current services. There are no activities of the Board that can be reduced without negatively impacting the licensure and renewal processes or public protection functions. The Board has over 37,000 licensees and registrants. Regulation of these licensees to protect the citizens of Ohio is the primary purpose of the Board. Without the funding to maintain the Board s activities, new licensees will have delays in obtaining jobs and mental health services will be impacted when there are not sufficient licensed professionals to provide services. Demand for the Board s services is not diminishing. The Counselor, Social Work and Marriage and Family Therapy education programs are seeing steady increases in students. Licensees continue to maintain their licensure beyond traditional retirement age. Should the funding be awarded for additional priorities, the Board would like to expand its use of technology. With an investment in the appropriate tools, the staff can provide ethics and application training more effectively by reducing travel time by conducting webinars. 2. What is your department s past and anticipated workload, the number of staff required to complete that workload, and the department s total number of staff? Also provide a breakdown of how many staff work in administration, customer service, or in the field. The Board has a staff of 13 full time employees, which includes an Executive Director, a Deputy Director, two Investigators, an Administrative Assistant, five Application Coordinators, who process new applications for the three professions, a Renewal Coordinator, and two additional positions, one dedicated to audits and another to public inquiries and customer service. Our staff manages the licensing process for all three professions; Board investigators investigate complaints that arise out of all three professions; the renewal coordinator is responsible for the renewal of licenses for all three professions, while the remaining staff work with all three professions. Several staff members assume multiple roles. For example, the staff member who reviews continuing education program and provider applications also handles many administrative duties such as payroll and tracking financial expenditures; the auditor coordinator also acts as the Board s web master; the Marriage and Family Therapist application coordinator acts as the board compliance officer, while also managing the document imaging process; the Deputy Director manages the investigation team while also conducting investigations and overseeing Counselor licensure. The Board s workload in 2016, as discussed below, is illustrative of past years workload. The Board issued 3,518 new professional licenses (this figure excludes trainees and other registrants): Licensed Professional Counselor 760 Licensed Professional Clinical Counselor 598 Social Worker Assistant 59 Licensed Social Worker 1251 Licensed Independent Social Worker 780 Licensed Marriage and Family Therapist 43 Licensed Independent Marriage and Family Therapist 27 Staff completed continuing education audits of 2,278 licenses. Generally, 10% of renewing licensees are subject to a random audit. Of the audits conducted, 339 were considered failed the audits, requiring corrective action by the licensee, of which 195 resulted in caution letters to the licensee, while another 144 licensees were required to pay an audit failure fee. Forty-nine audits, down from 60 in FY 2015, were referred to the investigation team for follow up. Page 2 of 6
The Board processed 1,502 applications for continuing professional education program approval and reviewed 2,178 requests for post program approval for individual licensees seeking approval of a continuing education program for their license renewal. The Board currently has 584 active continuing professional education provider individuals or organizations of which 246 renewed in FY 2016 (two year approvals) and 32 new providers were approved for one year. In fiscal year 2016, the Board opened 281 new investigative cases. Approximately 20 cases were carried over from fiscal year 2015. The Board is experiencing an increase in the complexity of the complaints it investigates. In comparison with the prior Fiscal Year, discipline related actions increased across all categories by nearly 30%. CSW entered into 45 consent agreements. 29 of the consent agreements were for discipline and 16 were for counseling endorsement licensing. Of the 29 disciplinary consent agreements, 6 resulted in the surrender of their license and 11 resulted in suspensions. The Board revoked 22 licenses, 21 of which were revoked through the Goldman process. 19 of the revoked licenses were for audit failures. 3. Please identify the rules adopted by your department and explain how these rules are consistent with the legislative mandate of the department as expressed in the statutes that created and empowered the department? The Board s rules are published in Chapter 4757 of the Ohio Administrative Code. These rules respond to the Board s mandate as established in Ohio Revised Code Chapter 4757. 4. Does your department s jurisdiction or any of its programs overlap or duplicate those of other departments? If so, what is the extent to which your department coordinates with those other departments and the extent to which the department s programs could be consolidated with the programs of other state departments? The Board s jurisdiction does not overlap with any other board, agency, or department with respect to the specific requirements for the licensure of Social Workers, Counselors, and Marriage and Family Therapists. The Board does coordinate with other Boards and Agencies with respect to peripheral issues such as licensee scope of practice questions, joint licensees, access to Medicaid funding, and similar issues. 5. Is your department necessary to protect the health, safety, or welfare of the public? If so, how? The CSWMFT Board is necessary to protect the public. Persons lacking appropriate qualifications to engage in the professions regulated by the Board can cause mental, emotional, and physical harm. Remaining cognizant of the fact that many persons who may have been harmed elect not to file a formal complaint, the types of complaints (e.g., child custody related issues, inappropriate relationships, poor recordkeeping, inappropriate termination of services) received by the Board suggest that it fulfills a critical mission. In addition to investigating complaints, the investigative team responds to a significant number of inquiries regarding the laws and ethics surrounding the professions regulated by the Board. Providing this customer service helps to eliminate ethical lapses which could result in harm to clients, leading to discipline and possible job loss. 6. What is the amount of regulation exercised by your department compared to such regulation, if any, in other states? All states impose some form of licensure and/or registration for the professions regulated by the Board. The regulations imposed in Ohio do not differ substantially from those in other states. All states require a Page 3 of 6
particular level of education and training, passage of an examination, and training supervision. Laws and rules regarding ethics are relatively uniform across the United States. Nonetheless, in writing rules to implement ORC Chapter 4757, the Board takes into account the needs of Ohio s citizens and licensed professionals. 7. Describe the general costs and impact of your department s activities on Ohio s businesses and individuals. The costs imposed by the Board are paid by those persons seeking licensure. The overall economic impact is limited, but the Board is mindful that any dollar paid by an applicant or licensee is one that he or she cannot put to a different use of his or her own choosing. The Board has issued licenses since 1986. As of this date, the Board has not raised license application or renewal fees, demonstrating good economic stewardship and growth in the professions regulated. Owing to increasing IT and related operating costs, the Board does anticipate seeking a fee increase during FY 2017/2018. 8. Identify and explain your customer service standards and what methods you use to monitor or improve customer service at your agency. Because the Board works directly with persons seeking a license which will allow them to seek employment, the Board maintains very high standards of customer service. The submission and processing of applications and issuance of licenses is daily monitored. The Board has a customer service policy (attached) as required by ORC Section 121.91. The policy is updated regularly and maintained with the policies that staff are required to annually acknowledge. 9. Please provide an assessment of the authority of your department regarding fees, inspections, enforcement, and penalties. The Board has an appropriate level of authority to fulfill its statutory responsibilities. 10. Has your department s operation been impeded or enhanced by existing statutes and procedures and by budgetary, resource, and personnel practices? If so, which sections? The Board can identify no specific recent statutes that have impeded or enhanced its operation. 11. Has your department recommended statutory changes to the general assembly that would benefit the public as opposed to the persons regulated by the department? If so, have those policies been adopted and implemented? The Board has not recommended any statutory changes that would specifically impact the public as opposed to persons regulated by the Board. 12. Has your department required or requested any persons it regulates to report to it the impact of department rules and decisions on the public as they affect service costs and service delivery? The Board has requested no such report. Nonetheless, the Board has conducted in the last two years a survey of Social Workers which helped to provide information that is being used to assess continuing education requirements. Additionally, the Board maintains a customer service survey online which is used by licensees and applicants to provide feedback. Through its newsletter and other publications, the Board encourages feedback that will help it refine its rules and procedures. Page 4 of 6
13. Describe how your department encouraged public participation in its rule-making and decisionmaking? Before any rule filings the Board has considered the draft rules in several board meetings, providing licensees and stakeholders another opportunity to comment. Draft proposed rule changes are publicized using social media and the Board newsletter well in advance of the formal filing of rules. Draft proposed rules are also posted to the Board web site before beginning the official rule filing process. Through the newsletter, licensees and stakeholders are encouraged to comment. Finally, the Board, in accordance with statute, holds a public hearing. 14. What is the process for formal public complaints that are filed with the department? And how are they resolved? Formal complaints are directed to the attention of the Executive Director. Based on an assessment of the complaint, the Executive Director will follow up accordingly with the involved staff person(s). A complaint about the Executive Director would be forwarded to the Board Chairperson for review and action. 15. Does federal law require that Ohio perform some or all of the tasks of your agency? If so, what functions are required and how are they met? Federal law dictates a limited number of Board activities. The Board must report to the National Practitioner s Database any person formally disciplined by the Board. These reports are submitted to the federal database when formal discipline results from an investigation. 16. Please describe in detail how any state regulation or rule, of your department, exceeds or differs from any similar federal requirements with a similar impact. Occupational licensing is generally a responsibility of state and local jurisdictions. The Board is not aware of any similar federal requirements regarding the licensure of Social Workers, Counselors, or Marriage and Family Therapists. 17. Please identify the department s practices and methods to comply with public records requests; any methods to make your records more generally available or online; the number of public records disputes during the last 2 years and the top 3 record types that are requested by the public. The Board follows all State laws regarding public record requests. It is the policy of the Board to fully and promptly fulfill all requests that comply with Ohio laws. Information regarding the license status of individual licensees is available through the online license look up maintained by DAS. The Board publishes to its web site statistics regarding the number and types of licensees, as well as meeting notices and minutes for all public meetings. The Board does not specifically track requests; almost all requests are fulfilled. The Board averages two to four requests per month. The majority of record requests involve providing contact information for categories of licensure. Such requests are generally made by entities seeking to market continuing education or researchers interested in surveying licensees. The only requests for records denied are those requests that seek records the Board does not maintain or that cannot be legally fulfilled, such as information regarding complaints, which is confidential under existing law. In most instances, we are able to suggest similar records which can be used to fulfill the request. A recent example is a researcher seeking a list of all licensees receiving training supervision toward independent licensure. Because the Board does not require registration of such training, it suggested the alternative of a list of all licensees holding a dependent license, providing the researcher the opportunity to send a survey. Page 5 of 6
Requests that cannot be fulfilled internally, for example those requests seeking thousands of records, are sent to the Ohio Data Network for completion. If your department issues licenses, please answer the following: 1. Are such licenses required by federal law and, if so, what law(s)? Licenses issued by the Board are not required by federal law. 2. What is the extent to which licensing ensures that practitioners have occupational skill sets or competencies that correlate with a public interest? What is the impact that those criteria have on applicants for a license, particularly those with moderate and low incomes, seeking to enter the occupation or profession? Owing to the prevalence of accrediting bodies for the institutions that train the professionals licensed by the Board, the public can be satisfied that the education and training requirements imposed in statute and rule ensure that appropriately educated persons obtain a license. Low to moderate income persons are barred from entry to the professions to the degree that college and university coursework for any type of degree can be involve a significant financial investment. The Board would be happy to work with the General Assembly and stakeholders to explore how to ensure the costs to enter these important professions are appropriate. 3. What is the extent to which the requirement for the license stimulates or restricts competition, affects consumer choice, and affects the cost of services? The Board actively considers the requirements its sets in implementing the law and the impact such requirements have on persons seeking a career in one the professions it regulates. There is a shortage of persons qualified to provide mental health services, therefore, the Board has no interest in unduly restricting access to licensure. Competition is limited for the services of Social Workers, Counselors, and Marriage and Family Therapists in that a specific program of education and training must be completed before a license can be issued. Owing to the nature of the professions licensed, and the scope of practice in which a licensee can engage, it would be difficult to identify any substitutes for the education and training currently required. Persons seeking to enter the professions licensed by CSWMFT can access a number of programs throughout the State and online to earn a degree that could qualify them to practice one of the professions. Page 6 of 6