Observations About the Post-Pandemic World – A Licensure Board Perspective

Now that we are 4 years past the onset of the global pandemic, it is time to step back as those with an interest in licensing and consider the changes we have experienced. Some of these may continue to evolve and become permanent aspects of licensure. Others may eventually disappear as we transition back to prior practices and standards following evaluation and experience with the temporary changes. Regardless, we have experienced significant change. The pandemic will be viewed as an inflection point in world history, but also that of licensure. In considering occupational licensure, the pandemic helped to accelerate emerging trends as well as foster new trends. The observations below are largely anecdotal, and not all licensure boards and their staff, nor licensed professionals, will necessarily have experienced these. However, I believe these observations are reflective of our recent and current environment.  

Telehealth has been a growing means of delivering services. At the onset of the pandemic, many Ohio licensees were surprised to find that the Ohio Counselor, Social Worker, and Marriage and Family Therapist (CSWMFT) Board had an “electronic service delivery” rule for about a decade prior to the pandemic. However, use of telehealth was not yet widely adopted. Telehealth helped to meet many needs during the pandemic. Used appropriately, it can be a significant factor in delivering services; however, there is a certain “unreality” of telehealth that can lead to ethical issues. This is particularly the case when either the clinician or client treat the interaction like their personal communications using technology.   

The discussion of racial issues that emerged with the death of George Floyd resulted in questions about licensure qualifications, exams, and how boards license. Many boards have continued to explore these issues as a board and with stakeholders. Attention will likely continue to be placed on disparities we witness in both occupational matters and access to services.   

Like telehealth, the pandemic accelerated recognition of workforce issues. It became clear that even without the pandemic, behavioral health care faces issues with recruitment and retention. Exacerbating this issue is the desire to reduce costs through paraprofessionals. Many states are implementing legislation or programs intended to increase the numbers of those entering the behavioral health fields.    

Related to the workforce development issue is an increased mobility imperative based on the growing realization that, at times, too many barriers exist to qualified professionals working in other states. This has led to the introduction and adoption of compacts. States such as Ohio, Arizona, Utah, and a growing list of others have passed reciprocity or “universal” licensure bills or changed regulations. These changes require recognition of similar licenses in good standing in the state with the universal licensure law. Generally, this means that the state with the reciprocity law does not review the education or related qualifications of out-of-state licensees but rather confirms candidates have a license in good standing in another state, have no disqualifying background check issues, and have passed a national examination.  

Different approaches to criminal background issues are being implemented, often through “fresh start” legislation. An example of this is House Bill 263, passed in Ohio in 2020. This law requires licensing boards to establish a list of disqualifying offenses. At the same time, it directs boards to not disqualify an applicant if certain offenses occurred 5 or more years ago. Similar legislation has been passed in other states. These laws can help applicants with convictions but can also change the dynamics under which licensing occurs, with boards having less authority to question the risk an applicant may pose.  

Customer service demands seem—anecdotally—to have changed over the last few years. There is a sense of urgency, as if many people are trying to “catch up” from the pandemic. This may partially relate to the level of technology adopted both shortly before and during the pandemic. Submitting applications and service requests online can make it appear as if there is no human role in processing online submissions. The reality is that technology is often a substitute for paper but not people. Many state licensure processes still rely heavily on licensure staff. This often means someone is manually reviewing a transcript, score report, or other submission. Although the use of artificial intelligence is increasing, it will take some time to emerge in licensing.   

Ohio’s experience suggests more complex complaints have emerged over the last few years as well as more nuisance complaints. The changes in both the number and type of complaints cannot be directly attributed to the pandemic, so we continue to explore the reasons behind these changes. Some relate to changes in how complaints are submitted using an online portal, other complaints may relate to generational changes in the professions, as more experienced professionals exit the field and are set to be replaced by licensees with different interests and values.   

In this article, I have outlined some of the changes that have occurred because of the pandemic. Some of these, such as changes to telehealth, were emerging at the start of the pandemic, but accelerated. What has become obvious is that we are in a time of change. In future issues, I will be exploring some of the questions I am left with in considering what is next for counseling licensure and regulation. Exploring questions about the Counseling Compact and reciprocity, emerging ethics issues, evolving licensure standards, and workforce development will help us better plan for the future.

Brian Carnahan is Executive Director of the State of Ohio Counselor, Social Worker, & Marriage and Family Therapist Board. Formerly a compliance manager in the affordable housing industry, he regularly publishes articles on a variety of topics, including licensure, regulatory affairs, affordable housing, and adoption. Brian can be reached via e-mail at brian.carnahan@cswb.ohio.gov.