Maryland and the District of Columbia share more than just a border. They also share challenges with every U.S. jurisdiction in fulfilling their missions despite the adverse circumstances caused by the COVID-19 pandemic. Like many other ASWB member boards, the social work regulators in these two jurisdictions have worked with emergency legal provisions related to electronic practice, licensing out-of-state social workers, and continuing education—all while figuring out how to work and meet when gathering in person is impossible. The lessons learned may mean long-term changes for the regulation of social work in these two jurisdictions.
Practice by social workers licensed outside the jurisdiction and the electronic practice solution
Temporary legal provisions in both Maryland and the District of Columbia allow electronic practice as a way of providing social work services, recognizing the necessity of continuity of care for residents who were receiving social work services elsewhere.
Before the pandemic, the District of Columbia had no laws addressing electronic practice. In response to the pandemic, however, the jurisdiction published guidance. “Telehealth services are viewed as another tool to be used by healthcare providers, similar to an x‐ray machine or MRI, and not as a new type of healthcare practice,” the guidance document says. It emphasizes the importance of continuing to practice according to acceptable standards of care: “Telehealth services can be utilized by any practitioner, for any services, assuming such services are provided in accordance with acceptable standards of care.”
Allowing electronic practice was one solution in D.C. Mayor Muriel Bowser’s March administrative order to meet the need for health care providers in the District. The order cites a number of findings, including the loss of health care workers who must self-quarantine after infection or exposure, the willingness of qualified health care providers from other areas to practice in D.C., and the immediate need for licensed providers that could not be met through the typical licensure process because of the time involved. The order waives licensure requirements for providers licensed in good standing outside of the District who provide electronic services to existing clients or work in a D.C. licensed facility.
Maryland’s board received many requests from social workers asking permission to practice electronically in the state. “Social workers from Virginia, D.C., Delaware, and Pennsylvania contacted our board staff,” says Stan Weinstein, executive director of the Maryland Board of Social Work Examiners. “We wanted to facilitate this to enable continuity of care.” Maryland statute allows a social worker licensed outside the state to apply for endorsement and practice in the state for six months while completing the application process. The board waived the fees usually required in this circumstance and assigned one staff member to handle these applications so they could be quickly approved. “Approximately 260 out-of-state social workers have applied so far,” Weinstein says. Other ways Maryland eased rules for electronic practice during the public health crisis were to allow audio-only telehealth and to offer enforcement discretion that loosens HIPAA rules in the provision of electronic services. Finally, Maryland is allowing Masters social workers to practice electronically under the supervision of a clinically licensed social worker during the emergency.
Continuing education and online learning
Just as schools and universities suddenly had to shift to online learning as the pandemic led to stay at home orders, providers of continuing education have also switched to virtual training. Previously, Maryland and the District of Columbia had policies requiring in-person training to complete a portion of the CE credit needed for license renewal; both have now established temporary policies allowing social workers to complete all training online.
Weinstein explained that in Maryland, “our Continuing Education Committee voted to permit online courses that are live, interactive, and in real time as a substitute.” The committee then took the additional step of contacting program sponsors and encouraging them to shift to the new format. Committee members also handled emails and calls from licensees needing help with meeting the CE requirement.
Mavis Azariah Armattoe, who serves as health licensing specialist for the District of Columbia Board of Social Work, says that the District also changed its CE requirement. “The board drafted a guidance policy … for the waiver of the requirement for in-person continuing education credit,” she says. The guidance means that D.C. social workers may complete their required CE online.
Responding to exam administration challenges
The reduced ability of Pearson Vue to schedule ASWB social work licensing exam administration appointments proved another major challenge for regulators in both Maryland and Washington, D.C. Weinstein says the Maryland board discussed and then rejected the possibility of issuing temporary or provisional licenses. “While being empathetic to the plight of [people in] this situation,” Weinstein says, “the board felt what ASWB, in consultation with CSWE and NASW, determined—this may be a short-term solution with long-term consequences, and it did not support our mission of protecting the public.”
The District of Columbia board put a hold on issuing exam approvals during the test center closure and is now discussing whether to permanently change the approval period from 120 to 180 days, says Armattoe.
Providing regulatory services
Many of the changes needed as the pandemic began to affect U.S. social work regulation were logistical. Armattoe counts the process of moving the D.C. board staff to remote work and conducting the board’s meetings virtually among some of the greatest challenges her board faced.
Weinstein credits the flexibility of board members and staff for the Maryland board’s ability to continue to serve the citizens of Maryland. He says staff have prepared to renew the licenses of 7,000 social workers and approve the licenses of 1,200 new graduates. “Staff responded to thousands of emails, particularly in the first six weeks, usually within two days,” he says. He also gives kudos to the board’s continuing education unit, its compliance and investigation unit, its licensing unit, its IT unit, its board counsel, and its fiscal officer.
Changes required to meet the needs of social workers and regulatory boards in response to the public health emergency may persist even after the pandemic has passed. In the District of Columbia, Armattoe says, “The board will continue to address the telehealth requirements and whether or not this will be implemented in social work regulation.”
Weinstein agrees that the use of technology in practice is “here to stay.” He also believes that changes to the way regulatory services are delivered using technology will outlast the pandemic. Though using technology in doing his board’s work will enhance services, he says, cross-training and collaboration between board leadership and staff will continue to be necessary. And he reminds other regulatory board administrators of the benefits of working with ASWB. “Collaboration with ASWB can be very supportive,” Weinstein says. “It was beneficial to discuss issues with other board administrators through ASWB.”
Visit the Regulatory Provisions tab on the ASWB and COVID-19 page to learn more about the emergency provisions in place in member jurisdictions.