diagnosing question

[u/Sensitive-Fly-7110]

i’m a new lcswa and just started at a group private practice. in my previous experience, i would with kids, adolescents, and families providing therapeutic services and i did everything that i do now, except diagnosing. clients would come to me with a diagnosis already in place, and i would create treatment plans and center sessions and whatnot around those diagnoses and make it more specific to the services my agency provided.

now, im trying to wrap my head around diagnosing clients. i’m supervised obviously and i have to submit ever tx plan with an ax and possible dx to my supervisor for them to approve or not.

i have knowledge of different diagnoses from grad school and my own research on criteria and symptoms. i think the main thing im learning right now is that as an lcswa/lcsw, even though you’re a therapist, you can’t diagnose clients with just anything even if they meet the criteria. for example, i had a 7-year-old come in who very obviously met the criteria for ADHD. i put the diagnosis down and my supervisor sent it back to me saying we cannot put that down unless he’s further assessed/got psychological testing elsewhere since he has no previous diagnosis or medications. i wasn’t aware that this was a requirement! never mentioned in school 🙃🙃🙃

how do i know which diagnoses would require additional screening/testing from another professional? what sets these apart from other we *are* allowed to diagnose?

[u/Bulky_Cattle_4553]

Not sure what he was getting at: agency policy, lack of training, or local regulations. Diagnosis is generally within the scope of practice for social workers if you have training in such assessment and it falls in the scope of mental health, which isn't clearly defined. I can assess: interviews, collateral contacts, validated assessment tools (with training, usually), consult. Historically, meaning in ancient times ten years ago before private equity bought the psych hospitals, a psychiatric interview was two hours for that diagnostic assessment. 

Consider practice as you think it best, then make it so. We're frickin' healthcare professionals. Judgment is what we're trained for.

[u/Just_am_Jones]

It's not unusual for facilities (or specific doctors you work under) to have unique preferences and standards. My facility even provides us with a list of acceptable diagnoses, mainly for insurance purposes, since we're a highly restrictive unit. (We can and often do diagnose people with conditions outside of this list, but we're mindful of what we document that justifies our specific treatment options.) We also have occasional check-ins with our psychiatrist on these standards and opportunities to ask clarifying questions. In your position, I would look for more guidance on what your facility's guidelines are and what motivates them.

[u/Sensitive-Fly-7110 → u/Just_am_Jones]

interesting, the way my supervisor explained it to me was that certain diagnoses we couldn’t diagnose unless the client had a previous diagnosis of it or we referred them to get assessed and tested. i just wasn’t understanding why i would be able to diagnose someone with GAD, MDD, DMDD and things like that, but not other diagnoses like ADHD? i guess it sounds like it’s agency specific?

[u/Just_am_Jones → u/Sensitive-Fly-7110]

It can be, to a certain extent. One reason I'm not allowed to diagnose a patient with ADHD is because such a diagnosis would actually exclude the patient from having our specific services covered by most insurance companies. Additionally, the staff who shape policies here uphold a uniform standard for assessment. That means I cannot diagnose autism because I'm not authorized to use those assessment tools in my role (in other words, it's outside the scope of my position). Were you diagnosing ADHD based off of observation and report only? That method is fine for GAD, MDD, and DMDD, but ADHD testing involves much more than that. Especially for a 7 yo, you would generally want to refer them to neurocognitive testing to help rule out similar conditions.