Supervised versus Independent Practice: All practitioners are required to have supervised practice experience as a part of their educational process. In addition, many professions require a specified number of hours of supervised practice after coursework is completed, or after graduation, before a license is granted to practice that profession. Sometimes this is considered part of the degree program; sometimes it is considered part of the “apprenticeship” in a profession. Once the license is granted, some professions continue to require some level of supervision for certain services, while others are permitted to practice independently, either as soon as they are initially licensed, or following the specified period of supervised practice. If licensure laws permit a profession to provide services “autonomously” or “directly to the public,” we considered this to be independent practice. Some of these distinctions are summarized in the tables, while others are too complex or subtle to summarize in a table, and are discussed in the next section.
We present our findings in six areas: 1) scope of practice laws; 2) training and supervision requirements; 3) supervised practice 4) potential effects of licensure laws on reimbursement; 5) evidence and effects of a “guild” environment, or competition among the professions; and, 6) descriptions of initiatives or legal language from specific states that show promise for addressing rural access issues.
Throughout our findings sections, we use a number of professional titles generically although there is actually substantial variation throughout states. For example, in Table 2 we used the title “licensed clinical social worker” to describe those MSW or DSW-level practitioners who have undergone clinical training and typically practice independently. However, in some states these professionals are actually licensed as “independent social workers,” “certified social workers,” or some other title. Similarly, in Table 3 we use the title “licensed professional counselor” when, in fact, states use many different titles to describe this type of mental health practitioner, including “licensed clinical professional counselor” or “licensed mental health worker.” Consequently, the reader should view our use of these generic licensure titles as describing a commonality of function and should not conclude that there is uniformity in the titles used for each profession across the states.
Scope of Practice Tables 1 through 6 present our findings on the scope of practice for each of the four professions included in this paper. Three mental health services are presented in detail for