The LMSW, the Monthly Phone Call, and the Grant-Funded Group
Daniela holds an LMSW and works at a nonprofit outpatient clinic. Her assigned supervisor, Marcus, holds an LMSW-AP and has put her in charge of a weekly psychotherapy group for adults with PTSD and asked her to complete intake diagnoses so the clinic can bill insurance. Marcus moved to El Paso six months ago. They now speak by phone for 45 minutes once a month, and Daniela emails him her progress notes, which he signs and returns. Daniela has logged roughly 1,400 supervised hours toward the LCSW. Yesterday the billing manager told her the group cannot pause because a state grant depends on attendance numbers, and that 'everyone here signs off on each other's stuff anyway.'
1. Do Daniela's hours under Marcus count toward the LCSW? Explain what is and is not creditable and what she must change.
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Two independent problems, and either one defeats the hours.
1. Supervisor qualification. The LCSW requires supervised clinical experience under a supervisor holding the Board's clinical supervisor credential. An LMSW-AP is an advanced non-clinical license; it authorizes independent administrative and macro practice, not clinical supervision. Marcus's signature cannot convert clinical hours into creditable ones.
2. Format of supervision. One 45-minute phone call per month, plus emailed notes for signature, is not ongoing, documented, interactive clinical supervision. Board rules contemplate regular scheduled contact with review of the supervisee's clinical work, not retrospective sign-off on notes the supervisee has already written.
Practical consequence. Daniela should not assume the 1,400 hours are banked. She should (a) obtain a qualified clinical supervisor, (b) ask the Board in writing how any pre-qualification hours are treated rather than guessing, and (c) keep her own contemporaneous log of hours, dates, and supervision content. Continuing to log hours she knows are deficient creates a credibility problem later, at the LCSW application stage and if a complaint is ever filed.
2. What should Daniela do this week about the group, the intake diagnoses, and the billing manager's pressure?
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Scope analysis first. An LMSW may deliver clinical services - including psychotherapy and diagnosis - only while under qualifying clinical supervision. Leading a trauma group and assigning DSM diagnoses for reimbursement without a qualified clinical supervisor is outside the LMSW scope, regardless of what the employer directs.
Do not simply walk out. Abruptly dropping a therapy group is client abandonment. She should:
- Put the concern in writing to the clinical director: the supervisor is not clinically qualified, the supervision format is deficient, and she cannot sign diagnoses she is not clinically supervised to formulate.
- Request a contracted qualified clinical supervisor or reassignment of the group to an LCSW.
- Ask for a written interim plan for group coverage.
- Decline to author diagnoses for billing that she is not supervised to support; a diagnosis written to satisfy a grant is both a scope problem and a potential fraud problem. 'Everyone signs off on each other's stuff' describes a supervision system that does not exist.
If the agency will not correct it, she should consult a licensure attorney and the Board about her options while arranging an orderly client transition. Grant pressure is not a defense to practicing outside her license.