On Friday, the Association of Social Work Boards (ASWB) released a report detailing four years of data on its various exams. The report shows that white examinees were almost twice as likely as Black examinees to pass the ASWB Clinical Exam on their first attempt. This data supports the notion that license exams are more than passive recipients of existing inequities in training, and instead actively heighten racial disparities in the mental health work force.
Race is a major factor in ASWB Clinical Exam success
Our focus here will be on the ASWB Clinical Level Exam, as that is the exam used in most states for licensure as a social worker providing mental health care. As the report explains, the cleanest way to look at this data is by focusing on first-time examinees. And just… wow.
Chart by Ben Caldwell based on ASWB data. Mobile users may need to turn to landscape to see full chart.
If you are a white woman, your chances of passing the ASWB Clinical Exam on your first attempt are 84%. If you are a Black man, your chances of passing on your first attempt are just 37%. (For white examinees of all genders, the pass rate was 83%; for Black examinees, 44%.)
When you break down the data by race and age, rather than race and gender, Black men age 50 and over had a 22% pass rate on their first attempts, by far the lowest among age cohorts in specific racial groups. By contrast, those who identified as white and 30-39 passed on 86% of first attempts.
The exam seems to create additional disparity
Exam developers would likely argue that the social work exam, like similar exams for MFTs, counselors, and psychologists, simply reflects existing racial disparities in therapist education and training, rather than exacerbating those disparities. This data strongly suggests that argument is wrong, and that the testing process itself adds a major layer of inequity in the mental health workforce. While state processes differ, many states place the clinical social work exam after the completion of all other licensure requirements, including successful completion of a graduate degree and years of supervised experience. If those other processes themselves are inequitable, then the population that successfully completes those processes should be relatively well-equipped (and more similarly-equipped across racial groups than at the beginning of graduate education) to handle a testing process that simply receives those pre-existing differences. Instead, the differences in pass rate on the basis of race are staggering.
Like all mental health license exams, the ASWB Clinical Exam does not reflect clinical practice
This is a good time to point out again that, to my knowledge, no study has ever correlated mental health license exam performance with actual later safety in independent practice. That is the exact thing that license exams in mental health are supposed to assess.
Four-option multiple-choice tests without the benefit of consultation or other resources simply do not reflect mental health practice in any meaningful way. If I’m faced with a difficult issue in my clinical practice, I’m almost never under a short time constraint to address it on my own with no help from anywhere. Good practice suggests that I should slow down, do research, and consult. A multiple-choice, computer-based, solo exam appears to be a method of performing knowledge that meaningfully advantages people who identify as white over other racial groups.
Where to go from here
Considering what mental health license exams appear to do (creating a new layer of inequity) and what they don’t do (actually assuring safety in independent practice), it gets much harder to argue that such exams should exist at all. They work against the goal of diversifying the mental health work force, without a clear benefit. They’re security theater, designed to help professions look like they’re upholding high standards regardless of whether the exams actually have that effect.
I argued a few years ago that perhaps that’s enough reason for exams to exist. I was wrong. With this new data, it is no longer enough reason. License exams in mental health care are fundamentally, and perhaps irredeemably, flawed. They need to far better justify their existence, or they need to be done away with.
The entire ASWB report is worth reviewing. As alarming as this data is, good on ASWB for actually publishing it. All other mental health exam developers, including ASPPB, NBCC, AMFTRB, and the California BBS, should do the same.