Representation Matters: A Case for an Equitable Clinical Exam
Students tend to feel more comfortable working with clinicians who reflect their own cultural and racial experiences; however, the licensing system is making it more difficult for clinicians of color to enter the profession. A recent report has illuminated the innate racial inequity in the social work licensing exams.
In August, the Association of Social Work Boards (ASWB) published its annual report, which analyzes the pass rate for their clinical exams. We have two main takeaways from the 2022 report: first, more people are interested in pursuing clinical social work; and second, there exists a jarring demographic disparity between those who pass the exam and those who don’t.
This licensure exam is a requirement for all clinicians who wish to work within schools. Between 2011 and 2021, the number of exams proctored nearly doubled, indicating that more and more psychology master’s students wanted to delve into social work and school-based work upon graduation. While this rate might seem encouraging on its own, it becomes worrisome when the racial demographics of the pass rates are broken down. The overall pass rate is 88%; White examinees have a higher pass rate of 91%, while Asian test takers had an 80% pass rate, Latino test takers had a 77% pass rate, indigenous test takers had a 74% pass rate, and Black examinees had a shocking pass rate of 57%. The numbers speak for themselves; this is not a fair exam.
If the license exam for school-based work is so difficult to pass for Black, indigenous, and people of color (BIPOC) clinicians, then many of them who DO want to work with students will be discouraged from doing so. According to the National Center for Education Statistics, social workers in schools have to work with an average of about 700 students per clinician. Though the nationally recommended ratio is 250 students per clinician, this metric does not take into account the differing prevalence rates of mental illness among BIPOC communities and communities of low socioeconomic status. Because of this disparity, Counselors for America (CFA) recommends a ratio of 110 students per clinician to make sure that all students’ needs are adequately met. The need for school-based clinicians is painfully evident; most students are not receiving the care they deserve from people who are able to both understand and validate their experiences.
The ASWB exam is in dire need of reexamination and thorough revision to ensure that BIPOC clinicians’ lived experiences are taken into account in the writing of the exam. All clinicians should be validated in their willingness to go into school-based work. Our Executive Director, Maurissa Szilagi LCSW, Ed.M., provided us with insight into the inherent inequities of the exam. Most clinicians need to pay upwards of $2000 to take the exam; this includes exam fees, test prep tutoring rates, and licensure fees. Maurissa spent about 200 hours across 2 months preparing for this exam, all while taking care of her newborn. This amount of preparation is excessive and inaccessible, all for an exam that does not accurately reflect the lived experiences of clinicians in the answers to the test. Maurissa and other clinicians have realized that the ASWB exam is made for competent test takers with access to the extra resources required to take it; good clinicians without access to time and funds are seriously disadvantaged.
We are interested in how the new master plan for mental health care by California Governor Gavin Newsom will contribute to this systemic change. This announcement states that this “plan for kids’ mental health invests $4.7 billion to reimagine mental health and substance use services and adds 40,000 new mental health workers.” $1.4 billion of this funding is allocated towards diversifying the clinical workforce in schools; hopefully, some of this will be used to tangibly change the licensure exam.
At CFA, we want to further challenge and dismantle this racially biased system by investing in culturally responsive therapists who respectively hail from ALL different types of backgrounds and experiences, especially to provide more comprehensive mental health care for students in underserved communities. We also plan to fund licensure supervisors who will be able to meaningfully contribute to BIPOC clinicians’ experiences with school-based work to affirm the decision to work in that field. CFA will also provide funding for test prep resources for clinicians who are planning on taking the exam for the purpose of entering school-based health centers.
While CFA will do its part to alleviate financial and time-based burdens from those who want to pursue school-based clinical work, we applaud the National Association of Social Workers and the California Association of Marriage and Family Therapists for working to ensure that the exam and preparation processes are more accessible and fairer for prospective clinicians. At the end of the day, clinicians work with people, not paper. The fight for representation and racial diversity starts in our schools, and the clinicians we implement should reflect the needs of our students.
This article was co-authored by Prachi Naik, Founder and CEO; and Anisha Patwardhan, Media Strategist.
Sources:
“ASWB Social Work Licensing Exam Pass Rate Data Confirm Concern over Racial Disparities.” NASW - National Association of Social Workers, August 11, 2022. https://www.socialworkers.org/News/News-Releases/ID/2531/ASWB-social-work-licensing-exam-pass-rate-data-confirm-concern-over-racial-disparities.
“Governor Newsom Unveils New Plan to Transform Kids' Mental Health.” Office of Governor Gavin Newsom. California Governor, August 18, 2022. https://www.gov.ca.gov/2022/08/18/governor-newsom-unveils-new-plan-to-transform-kids-mental-health/.
“Contributing to the Conversation.” Association of Social Work Boards, August 8, 2022. https://www.aswb.org/exam/contributing-to-the-conversation/.
“Mental Health Staff in Public Schools, by School Racial and Ethnic Composition.” National Center for Education Statistics. Accessed August 25, 2022. https://nces.ed.gov/pubs2019/2019020/index.asp.
“Racism, Racial Trauma, and Access to Mental Health Care for BIPOC.” CAMFT. Accessed August 26, 2022. https://www.camft.org/Membership/About-Us/Social-Policy-and-Public-Statements/Racism-Racial-Trauma-Access-Menta-Health-Care-for-BIPOC.