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Thank you for the excellent work of the taskforce on the NASW STANDARDS FOR PRACTICE IN SERIOUS ILLNESS: PALLIATIVE AND HOSPICE SOCIAL WORK updates. The updated information on cultural competence and cultural humility is important to the work of hospice and palliative care social works and an excellent addition to the standards.
As a recently retired hospice and bereavement social worker with 20 years of experience in the field, I ask how we recognize and support the application of clinical social work for hospice social workers who come to the job with LCSWs, or for LSWs who undergo clinical supervision as part of their practice experience in ways that honor the holistic underpinnings of the hospice and palliative models of care as distinct from the traditional western biomedical focus, but also honors the experience and expertise of hospice social workers in the eyes of state licensing boards. While individual states have different credentialing requirements that are beyond the scope of this task forces work, I am requesting that you consider how the standards can begin to address this difficult topic.
I am one of many social workers who obtained their clinical licensure through clinical supervision in the hospice setting. Current changes to state licensing practices have made obtaining clinical licensure as a hospice social worker more difficult, with indication that the word “psychotherapy” needs to be in the job description. With a recognition that psychotherapy may not be part of the scope of practice of all hospice social workers, we risk losing qualified, dedicated social workers from the hospice and palliative care setting if they are unable to obtain clinical licensure after years of clinical supervision. Under clinical supervision, LSW’s are qualitied and can provide clinical levels of support, including psychotherapy in both hospice and bereavement. The American Psychiatric Association¹ and the American Psychological Association² indicate that psychotherapy may address emotional distress or emotional changes related to grief, medical illness, or the death of a loved one.
Palliative care Licensed Clinical Social Workers are now able to bill Medicare for psychotherapy services provided to patients with co-occurring behavioral health diagnosis or emergent issues. In the hospice setting, an LCSW or LSW under clinical supervision is qualified to provide psychotherapeutic support for end-of-life issues. Anxiety, sadness, and depression can be part of the existential experience of palliative care and hospice patients. End-of life decisions, crisis intervention, coping with changes in the family system, redefining hope, and undertaking life-review can all be clinical psychotherapeutic interventions provided by qualified social workers.
With respect for maintaining a holistic approach to hospice and palliative care social work that keeps us distinct from private practice guidelines, we run the risk of losing qualified professionals if they are unable to obtain clinical licensure within the hospice and palliative care setting. As we advocate for a holistic approach to total pain, we need to recognize that qualified hospice social workers provide psychotherapeutic support to seriously and terminally ill patients and families, as well as bereaved family members.
I request in addition to the excellent work already done by the taskforce to consider if wording to support the clinical work that can and does occur in the hospice and palliative care settings be included in the updated standards. I suggest areas where wording to support the clinical and at times, psychotherapeutic work being provided could be included are in NCP Domains, 4, 5, and 7, under grief and bereavement support on page 17, under professional growth on pages 33 and 34, documentation/demonstration of skills on pages 39 and 40, or supervision on page 47.
As hospice and palliative care social workers continue to work at the top of their licensure, considerations for discussing the psychotherapeutic work that takes place in the hospice, bereavement, and palliative care settings from qualified staff in the updated standards could be a step in supporting hospice and palliative care social workers with obtaining clinical licensure in an increasingly difficult licensure landscape.
Thank you for your excellent work and consideration for the suggestions in this comment.
Sincerely,
Joan A. Ordille, DSW, LCSW
New Jersey
¹American Psychiatric Association (2023). What is Psychotherapy? at https://www.psychiatry.org/patients-families/psychotherapy
²American Psychological Association (2023). Understanding psychotherapy and how it works Learn how to choose a psychologist, how therapy works, how long it lasts, and what should and shouldn’t happen during psychotherapy at https://www.apa.org/topics/psychotherapy/understanding
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