Social workers in private practice: Why the AASW should be doing more for them

individual therapy1The world of work has changed significantly in the last 25 years. Permanent employment is declining and casual and part time work are on the rise. Outsourcing is fashionable, and markets (we are told) can deliver whatever we need. Trade unions are in retreat, real wages have flatlined, and our personal household debt, per capita, is amongst the highest in the world.

In this environment the ranks of the self-employed have risen, in our industry and others. There are now around 2,000 social workers in private practice across Australia, counseling, consulting, teaching and training. Needs must when the devil drives! We are all familiar with the alphabet soup of acronyms that are the sources of our income- DVA, MBS, NDIS, and EAP to name a few.

Whilst not telling the whole story of the rise in private practice, a cursory glance at MBS item number 80160, (individual focussed psychological strategies provided by a social worker) illustrates some of this growth in the mental health social work sector.

In the financial year 2007/2008, almost 71,000 services were provided, and this had more than trebled by 2015/16 to over 231,000 services, for which Medicare payed out approximately 18 million dollars. The strongest growth was in Victoria.

The story of how the AASW gained social work access to Medicare goes back to the 1990’s. In 1997 the Commonwealth Department of Health, as part of a mental health services reform process, held consultations with social work, nursing, psychology, occupational therapy and psychiatry, as well as consumers, to discuss the future of education and training of the professional mental health workforce.

The AASW was granted $50,000 by the Department of Health to develop standards of social work practice in mental health settings. When these competencies were published in 1999 they were groundbreaking, and remain the foundation document on which the AASW Practice Standards for Mental Health Social Workers is based. It is these standards that informed the mental health accreditation of social workers and their entry into the Better Access program in 2006.

It was also around this time too, that the AASW set recommended fees for its private practitioners. These fees were unfortunately set lower than Australian Psychological Society recommended fees for similar services- a mistake that would come back to haunt us, as Medicare used our own recommendations against us when setting MBS fees and rebates. Since then the AASW has made repeated representations to government (to no avail) to establish rebate parity with psychologists for similar services. On top of this social workers have suffered the further indignity of a Medicare rebate freeze since 2013.

Many social workers will remember the 2010 budget cuts that threatened social work clients access to Medicare rebates. The AASW led a strong political campaign, reminding the public at the time that more than one-third of social workers using Better Access were based in regional, rural and remote parts of Australia, more than 60% of them offer bulk-billing to at least some clients, and more than two-thirds of clients when surveyed, said they would be unable to access these services without Medicare funding. The direct action of the private practitioners forced the government to back down.

Private practitioners have become a cornerstone membership cohort within the AASW. In other parts of social work, membership penetration is usually no more than 25% to 30% of the maximum membership potential. But in private practice it is likely to be more than 90%. That constitutes a relationship of profound significance for both sides.

The AASW is not a trade union, but it should by necessity include some elements of industrial representation for its members in private practice. There is no alternative.- and private practitioners are doing it tough. Those of us working for an employer enjoy regular pay rises, but the self employed are forced to pass on rising costs to their clients or take a pay cut. And the current Federal Government is as mean spirited as they come in setting rates in ‘markets’ it has created in education, health and welfare.

Whilst the AASW cannot be faulted for its efforts in making representations to bureaucrats, these are not administrative issues, but politics pure and simple.

We have governments that are hostile to pay rises, and indifferent to the marginalized and the disadvantaged. ‘User pays’ and ‘outsourcing’ are their chief weapons. Political problems require political solutions. The AMA has no fear when it comes to political campaigns on behalf of its members. Go to their website and you will find a range of campaign resources related to the Medicare freeze, including templates that can be used to print a copy of the AMA’s Medicare Freeze poster in the tear off portion at the bottom of computer prescription forms. You will also find instructions on how to share campaign material on social media. The poster itself is highly emotive, featuring a distressed mother and a crying baby with some bold text stating- “The cost of running this practice will rise substantially between now and 2020. You will pay a new or higher copayment every time you visit you GP, every time you visit other medical specialists, every time you need a blood test, and every time you need an x-ray or other imaging. Tell your local MPs and election candidate you are not happy.”

There is an urgent need for a well resourced political campaign of this kind on behalf of social workers and their clients, perhaps in concert with the other allied health professions affected by the freeze. It is about time that every Coalition and independent MP heard from us.

 The AASW also need to think very seriously about the resources that private practitioners need in order to thrive in the current marketised environments. On top of their annual membership fees ($670 in 2016), mental health practitioners pay an additional $200 pa for their ongoing accreditation. Assuming 2,000 members, that amounts to $1,340,000 pa in regular fees and $400,000 pa for the accreditation surcharge. Add this up and it reveals that 20% of the members account for 45% of member revenue! Despite achieving their highest ever profit in 2016, and having a strong ratio of assets to liabilities, the AASW has introduced a 4% fee hike this year to both the full membership component ( to $697 pa) and the accredited mental health social worker fee (to $208 pa). It will be interesting to see how this hike is justified.

The $208 pa fee is levied only on the mental health accredited practitioners – and so ought to be applied exclusively towards capacity building for that group. This includes not only customized CPD, but also workshops to train our most experienced private practitioners so that they can pass on their knowledge and skills to fellow members. We can create a virtuous circle, skilling up our experienced members, on the proviso that they will offer some of their time in the following year or two, to teaching fellow members at subsidised rates. I am fed up with seeing non social workers advertising expensive training in our National Bulletin. Access to our members is a precious resource, and our motto must be ‘members first’.

Just as important is enabling those who want to take the next step beyond solo practice. Professor Ian Hickie, a National Mental Health Commissioner has called on PHN’s to deliver more appropriate, multidisciplinary care for those service users with complex and ongoing needs. Wholistic models of care are built in to the social work DNA. The AASW needs to be providing the skills and resources to help social workers build multidisciplinary practices that can bid for tenders to provide packages of care.

And last but not least, private practitioners need a professional networking platform on their smartphones linking them to fellow members in a community of practice. The small proportion of private practitioners who use AASW SWOT will agree with me on how clunky it is.

These urgent steps have not been taken because of a failure of governance. Private practitioners do not have a proper voice in the life of the AASW. They need a well-resourced policy development forum, a transparent conduit to the Board, and some measure of independence in running their own affairs.

 

 

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21 Responses to Social workers in private practice: Why the AASW should be doing more for them

  1. Mark Wilder says:

    Another well researched and presented piece Vittorio. Thank you for sharing your knowledge and insights. This piece shows me why you ought be voted-in so you might apply your knowledge and insight to benefit everyday AASW members.

  2. Fran Crawford says:

    Thank you for taking the time and trouble to research and articulate this piece. In an era of marketisation so important that social work is heard and able to engage the support of those we would serve.

  3. Thanks Vittorio for this important article and for your time and efforts in collating it all. It makes perfect sense and I felt less alone with some of my thoughts as an accredited mental health practitioner reading it.

  4. David Gould says:

    As a social worker, I am concerned that our profession have the best advocacy, that is fearless in the face of economic rationalism, and political realpolitik. The AMA is the example par excellence of robust advocacy for its members, and we need that in not only word, but action. Do social workers feel that they are being well served and represented? Do mental health social workers feel that they have the clinical support, respect and advocacy that they deserve? I am deeply concerned for better advocacy for our mental health and private practice social workers. I am also focused on our full fee paying members, and the need for them to feel listened to, to feel served by their professional association. There are according to the ABS 34,000 social workers in Australia (November 2015) and we have barely 10,000 members. Given that social workers all share many ethical and client focused values, what is stopping 24,000 plus social workers from joining the AASW?

    • Anonymous says:

      Interesting comment. In my experience, the AASW has always been conservative and catered to sectional interests within the profession. Sectional interests vary in terms of who can gain control. Sounds a bit like politics! Why people don’t belong is really straight forward – people behave according to their interests. I doubt that there is or ever has been a real consensus on what the values of the profession are. On the other hand, it could be argued that the AMA is one of the best organised and resourced unions in the country.

      • Kyp Kyprian Andrew says:

        dead right, we have become a profession of yes women and men to governments and their civil servants..in fact I think the governments see social workers a civil servants !!!
        fear of losing their jobs or funding comes into play…hence I enjoyed my private practice because I could take the system on without fear of my fellow workers losing funding .
        finally what is to stop the Profession calling itself Professional Social Workers and copyrighting the title for only those who ar a a member of AASW .

  5. Thank you Vittorio for voicing these concerns on behalf of all of us that work in private practice. I am an a keen reader of the comments on the SWOT blog but rarely contribute because it is so awkward to navigate.

  6. Jane Thomson says:

    Thanks Vittorio,
    You are brilliant and cogent political analyst. I so appreciate your blog. The concerns you raise are spot on.

    How do social workers articulate what they do as mental health social workers separately from what psychologists do? As a fragmented and unsupported section of the social work workforce (for all the reasons you analyse), how do they engage with public issues as well as private pain- the former being crucial? With you as President Vittorio, mental health social workers in private practice would be resourced to articulate a vision for their work which tackles the epidemic of mental illness which lies in our social, political and economic landscape. Thanks again.

  7. Thank you Vittorio for your excellent article. I concur with Mark Wilder. I have posted on the SWOT blog, knowing the AASW follow same and yet ACTion is not happening.

  8. Julie Richardson says:

    Thank you Vittorio, as a beginning practitioner, I am heartened that you have voiced your concerns for our profession.

  9. Elizabeth McEntyre says:

    Thank you Vittorio for such an insightful blog.

    As a Member of the Royal Australian & New Zealand College of Psychiatrists Aboriginal and Torres Strait Islander Mental Health Committee I attended the RANZCP 2017 Congress gathering this week in Adelaide. Psychology and psychological treatments were mentioned a number of times in presentations, including a Keynote Address. However, the role of mental health social work never rated at all. I would urge the AASW to connect with RANZCP in Melbourne to ensure that they know and understand the important role mental health social workers play with mental health recovery and how psychiatrists can tap into this resource.

  10. Skeptic says:

    The AASW should do more for Social Workers in private practice because the fees are more ridiculous than usual.
    Having had membership in the past, I’m yet to work out the incentives for paying such raging amounts..and that’s just for membership without the additional fees for private practice. In our current economic climate, more and more Social Workers may be considering private practice due to the instability of employment in state funded services due to constant funding cuts and downsizing. Positions once held by Social Workers are outsourced to CSWs of NGOs, who may or may not be required to have a TAFE acquired certificate in Mental Health. They have slowly crept over the boundaries and are now performing clinical duties. There’s quite an imbalance of the prerequisites in that instance.
    For the Social Workers being replaced by CSWs, or their position folded due to ‘transforming health’, they must have a spare $1000 to cover the AASW fee requirement. That’s just to apply. There’s a chance that the AASW will deny the application. To weigh up that potential loss with the needs of families.. if they did happen to have a little rainy day savings, it would be $1000 from the family budget. I wouldn’t think there are too many families able to gamble that.

    • Annoyed & Sceptical says:

      An interesting dialogue. I am wondering what percentage of Social Workers belong to the AASW and who is the major employer of Social Workers these days? I agree with my fellow sceptic about the cost of being a member, especially if you throw I the extra cost of Mental Health Accreditation. There is also the cost of the extra professional development needed to maintain the accreditation. There is no way that this is value for money, especially when there is a great difference between what Social Worker and say Clinical Psychologists (although no doubt Clinical Psychologists would disagree) are paid for pretty much the same job.
      I suspect that the greater number of Social Workers are in fact public servants and probably not members of the Association. I further suspect that is because the association does not represent their interests.
      If my workplace is anything to go by, Social Work is in real trouble, partly due to an irrelevant and toothless association. The issues are probably more industrial than anything else (wages and conditions). So please tell me again why we should be interested in such an association when it seems to be dominated by academics and management types who have little interest in the plight of workers at the coal face or indeed their clients. I also find the interest in policy fascinating. It would seem to me that politicians and managers like to have a policy on just about everything. This is often trotted out when there is a failing in the system or perhaps to blame some hapless worker for a systemic failure. Why then when the stocks of the profession are so low are we interested in policy? Please get real and get relevant.

      • vittorio1 says:

        Seems we agree that the AASW should be transparent about how expenditure is allocated- particularly to members who face additional fees.You will find if you read back through my material that I have long advocated for the AASW to work closely with trade unions where there is a shared membership.
        But I don’t understand your gripe about policy? What’s wrong about wanting to influence policy?
        We are now in a culture that has successfully discouraged a lot of collective action. Trade union membership and the membership of voluntary professional associations has drastically declined. But I believe that we must keep faith with the the professional project. Our independent code of ethics is our best defence against inequity, managerialism and the other blights of unfettered free markets.

        • Annoyed & Sceptical says:

          My issue with policy is probably as much based on personal experience as anything else. In my experience policy is often the domain of politicians and managers and often used to drive politically conservative or managerialist agendas. I don’t know if engaging in such activity is in our collective interests. It is more than likely a waste of time and energy. At worst policy can be used in a political process that is detrimental to us. In my view, too many social workers have been keen to get on board with these agendas. This in part explains why we have accepted quite a low fee structure or where Social Workers have engaged in policy work that has contributed to the demise of the profession in the public sector.
          I would still like to know what percentage of the profession is involved in the AASW and where the majority of Social Workers work these days.
          Whilst I agree with you about the code of ethics, I don’t see that the AASW has produced that much of relevance to the profession or it’s advancement as a whole (outside of representing sectional interests). I know that there is a growth in members who are private practitioners. The reason for this is obvious as is your interest in them as a politician. I do not think the organisation represents the interests of the vast majority. Maybe this should be a priority. Otherwise we as a profession are in danger of lurching into the area of pragmatic politics, void of the ethical considerations you mention.

          • vittorio1 says:

            I still don’t understand why you are giving me grief when I am advocating more progressive policies? Are you suggesting elections and policy debate are pointless? What activity do you think is in our collective interest?
            I am a very reluctant politician, but I won’t give up trying to persuade members that more progressive policies are in our collective interests. And I make no apology for advocating for private practitioners who have not had a pay rise for many years. The growth in private practice is due in large part to the way in which successive governments have decided to fund counselling. We find work where we can get it because we have bills to pay and need to put food on the table.
            The AASW keeps the components of our membership data a secret. I disagree with that. Sunlight is the best disinfectant.
            But I find your language divisive, insofar as it pits one membership group against another. We share a code of ethics and a commitment to social justice. I do not believe in the 51% ruling over the 49%. For me collectivity means- from each according to their abilities and to each according to their needs.

  11. Annoyed & Sceptical says:

    Sorry for pushing you into defence, I am not really intending to give you grief. I am not questioning your intentions. I just don’t agree with you and am truly concerned about the state of and the future for the profession.
    I am not in the position to answer the question you have posed about our collective interests. As you point out, it is difficult to get the necessary information. I will leave that to politicians (reluctant or otherwise).
    There are divisions within our profession – like it or not. Being as I am not a politician I am not seeking to exploit these, but I don’t like the idea of papering them over either. I think we have a way to go before we could truthfully talk of collective interests.
    What I object to here is more than a whiff of pragmatic politics – the sort of thing that has in my humble view got the AASW and the profession to the point where it has all but compromised itself out of existence. That is why the ethical base is so important, but it takes courage to run with this rather than compromise. No doubt one couldn’t win an election on this premise, hence my scepticism about politics.
    As far as progressive policies are concerned, who was it that went along with the current idea of the obviously underpaid idea of private practice. As you have pointed out, this has created a social work underclass. Was that seen as a progressive policy at the time? I dare say that the removal of indigenous children from their families was another progressive policy at that time in history, no doubt based on evidence of some sort.
    I am naturally wary of politicians and I am not alone in this belief. I also think there are very obvious flaws in what you are saying. Think about it if you will

    • vittorio1 says:

      Get involved. Get engaged. Stand for office. Put a name to your views and act on them. We will be remembered in the history of our profession for what we did, not what we said.

      • Annoyed & Sceptical says:

        In case you hadn’t noticed, I am engaged insofar as having a dialogue with you fits the bill. I could say don’t be patronising!
        You have a point about being remembered by what we do. Let me suggest to you that, at a rough guess you have some sort of socialist politics, although you are loathe to admit this because it won’t get you elected. As a politician then you have lurched down the liberal pathway with a mishmash of ideas that are inoffensive but largely ungrounded – perhaps along the lines of land rights for gay whales! I suspect like many social workers, you are in danger of compromising yourself out of existence
        I read the thing you wrote about ethics and you write very well. The problem is that pragmatic politics is devoid of ethics and full of justification. I think you are headed down that track.
        What is the problem with telling the truth? If you need to justify it in a political sense there is a politician in the UK who had a go on a socialist platform and almost pulled it off.
        In fact as a politician you will be remembered for what you say and what you do and the congruence of these things.
        Would I vote for you on the that premise – probably not. Will you be able to influence others to vote for you – probably yes. Will you win, which is the object you seek at considerable cost – well we will have to wait and see.

        • vittorio1 says:

          My apologies that I came across as patronising. I value and appreciate your engagement.
          I happily own up to being a socialist. I am also a member of the NSW Greens, and Dying with Dignity.
          If you don’t vote for me, you are unlikely to vote for the incumbents either- so why not stand yourself?

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