Self-employment and private practice as a social work endeavor.
Thoughts on the history of SW in the market place 2005-2018
RUMINATIONS ON THE CONNECTION BETWEEN SOCIAL WORK AND PRIVATE PRACTICE 2005-2018.
THERE MAY BE SOME HISTORICAL INACCURACIES - BUT INCONSEQUENTIAL.
When the AASW endorsed and promoted the acceptance of SWs in the Medical allied health professional programs for mental health, I suspect the then AASW Board did not realise the consequences for future engagement with SWs.
Up until 2005 there were many social workers, members and non-members of the ASSW, who were working in what is collectively called “self-employment” settings. These SWs attended to short to medium term contracts, worked as sessional counsellors for EAP groups , and a myriad other consultancies and settings which may or may not be regarded as primary “social work” type settings. These were a minority cohort, and as yet had no collective voice. In 2005 social workers were introduced to a model of intervention that has its roots in what we sometimes loosely call “the medical model”. Self-employment (the AASW’s preferred words at that time) became dominated by the paradigm of “private practice”. The words invoke a sense of medical specialists and elitism, and have never sat well in generic social work in Australia. The private practice model revolved around fee taking (i.e. rebates and payment gap fees), a strange thing in social work practice and probably the first thing a social worker has to get used to when transitioning from the public or gov sector to the private market sector. Its not easy. Social workers in private practice (SWPP) had to get used to developing business plans. This sort of social work practice essentially became small business practice. Again, not a comfortable zone for generic social work theory. Some (or many) social workers already in sole practice “self-employment” noticed around mid 2005 a marked change in referral pathways. G.P.s in particular would start asking whether the SWer was registered as a provider of the Medicare Enhanced Primary Care (EPC) program (a precursor to Better Access). If not, more often than not, the SWer lost the potential referral. Needless to say, many then sought membership with the AASW in order to get the accreditation as Mental Health Social Workers (MHSWers] to enter the Medicare EPC program. Most, if not all, of these first wave MHSWs were senior in the profession, had become jaded by their work settings or needed a career change after many years in organisational settings, and accepted this opportunity for another beginning. As time went on the MHSW space was taken up by many who used it as a part of their “self-employment” mix.
Up until 2010 there were around 1100 SWs in self-employment, with a significant portion of that work being private practice. The majority of SWs were more likely to be workers in NGO, community-based and government settings. They were statistically more likely to be employed in a waged (often permanent employee) or on specified long contracts. SWs working in organisational settings typically had the mission statements, protocols, work procedures, team activity and support, and other group focussed assets that go with human service organisations. The AASW largely did not have to become too much involved with any particular individual type (modality) of social work activity., and could concentrate on the regulation of SW, education standards, complaints about ethical behaviours and the pursuit of social justice. Because there was less of a focus on the worker as an individual, the requirement to provide resources for individuals was a rather exotic and rare thing.
I recall that between - say -1990 and 2010, SWs in PP had no specific reason (significant imperative) to be a part of the AASW, and if they were members then they did not call upon the AASW much for assistance and support, unless there was an ethical complaint. The AASW remained largely an “arm’s length” association by default, with various complicated relationships with State branches. It wasn’t a union and rarely needed to be directly representational. There was lesser need for political advocacy for its members. Graduate SWs were still finding jobs as bona fide SWs in settings that were looking for certain skill-sets.
Around 2010 the AASW seemed to have lost its way and lost the trust of more members than it may care to know. (I interviewed senior SWs in Tasmania around this time). While trying to revamp its structure and probably the constitution (I cant remember) there was an apparent major major major dispute in its own ranks at board level that turned out to be very damaging to the rank and file. Many SWers became aware that there was/had been some sort of dispute that was bleeding the AASW of its resources and that the rank and file were being kept rather ignorant of the facts behind the fracas. The result seemed to be an incredible amount of infighting and – as pointed out to me by a very senior SWer in my area – a lot of navel-gazing.
Outside of the AASW a momentous political change had been taking shape. The Howard years meant that (what we name as) the “neo-liberal” agenda led to the formidably dominating concept of competitive tendering. This rolled out in to all human service organisational sectors. It sowed the seeds of competition and fragmentation. (I am not arguing whether this is good or bad.) Over time it meant much more uncertainty about security of employment. More SWs were doing more of what we call “self employment”. They, more often than before, had to cobble together employment opportunities, and give up any sense of permanence in employment. SWs were actually experiencing work conditions that were more like the common lot of the workforce culture across Australia. This meant that more SWs were more likely to have to take on smaller quantities of fragmented contracted work, or seek out individualised expressions of their professional work without the convenience of support structures that are common to NGOs et al.
Since around 2014 we have seen a rapid change in the National landscape of educational training. The SW enterprise is now hard pressed to maintain its identity as a profession. I have recently looked and listened in vain for media recognition of positive SW activity, and I have noticed that job advertisements will say anything but “social worker position”. Therefore…more SWs out of work, with typically SW opportunities taken over by underqualified mickey mouse qualified semi-professionals. No wonder SWers have to consider “self-employment” as a path forward in their careers (and to pay their mortgages)! Some of these SWs began to develop innovative ways of work. These pathways are what we recognise as businesses. They required that SWs have ABN numbers. These SWs became “sole traders” or set up companies that delivered – among other innovative endeavors - counselling and related consultancy services.
The AASW originally provided the structure of accreditation that enabled - and still enables - MHSWs to be regarded a legitimate providers of mental health services. I contend that SW is losing professional ground in the fields of direct practice in counselling and mental health counselling. MHSW accreditation may well be the only platform to “hold the line” aganst the unfair erosion of perceived SW expertise in mental health interventions in this current national political environment. In my capacity as a past chair of MHSWiPP and SWiPP, I have heard of many places where previously respected SW professional roles and opportunities have been seriously eroded or even culled. Many social workers in organisational settings felt these shifts and sometimes even got to observe them, but were largely powerless to effect any significant change of attitude in their own organisations because of the hierarchal structures and entrenched interests of other professions within these organisations. Those is self-employment also noted these shifts and changes and, because it is a more direct competitive environment, have been somewhat more savvy in marketing the expertise of SWers and MHSWers.
With regard to MHSW, the average age of SWers entering MHSW seems to be broadening towards a younger cohort. It is becoming a viable platform for SWs. Some of these SWs have embraced the entrepreneurial spirit and have developed and grown successful businesses.
The AASW has a challenge before it. The general impetus of social work does not easily accommodate the market place, although the funding for nearly all SW activity comes from the taxation of the outputs of that same system. SW is driven more by social humanism than liberal humanism. The marketplace in a capitalist culture rewards individual effort and has little interest in equality. This is difficult for SW as a profession. I have to wonder if the AASW has an unspoken reluctance to embrace and support MHSW and PPSW because of an almost visceral reaction to this political culture. The political culture is often called neo-liberalism, although I think that is a catch-all pejorative that remains unnuanced in much SW theory. Most of the one fifth of AASW membership ( n.b. this does not equate to saying one fifth of all social workers – that would be wrong) that are Acc MHSWs will be in this private practice mode within this neoliberal environment, or they will be considering becoming a PP in their future career. They must be supported by the peak professional body that they subscribe to.
The point is – SWs are in this culture and are deriving income to feed their families and pay their mortgages from the bounty of this culture. If many of these SWs are going to be sole practitioners (sole traders!), then they will have to be supported by the AASW in new ways that have not been tested in the past. If new ways do not evolve, and if the AASW remains at an arm’s length from this same rank and file that pay their subs to be members, then trouble is afoot. PP in SW has become more assertive and confident, and very very aware of the competitive environment they inhabit. If there is no turn around in relations with the AASW , I can foresee a tipping point where cooperation and respect turns irreversibly into unexpected antagonism.
The sheer frustration of members trying to get support from the AASW is palpable. This is most evident on commentary made on I.T. platforms, and I can confirm that many non-members in Tasmania do not see the AASW as particularly relevant (except if you want registration as a MHSWer!). Members of the old MHSWiPP and the new SWiPP feel most strongly that the AASW has not been able to, or been inclined to, engage with the level of political and community advocacy activity that is necessary for SWs in PP to remain recognised as professionally legitimate. Nearly everything the AASW does in our cause feels like “catch up”; not quite there; not quite early enough to catch the change in the air. It does not help that staff turnover leaves the AASW with a deficit of longitudinal knowledge and skill: therefore the loss of a crucible of wisdom in relation to SWs and PP.
We need a collective culture at the operational level, with a real collaborative style. In past years at the front end of SWiPP, I have noted a lot of talk-support, but a real lack of action-support. It is true that the AASW is not as well staffed as – say – the APS, but that is no excuse for not engaging in new and smarter ways. And yes there are smarter ways. We also need a collective culture at board level that is willing and able to accommodate and celebrate PP and ensure that directives and policies have the capacity to protect and promote this reasonable SW practice.
We certainly need a AAW front desk with the staffing that is dedicated to supporting and advocating for SWs in PP.