New licensed clinical social workers often arrive with strong clinical foundations, but behavioral health leaders say the harder lessons come after licensure: judging what matters most, knowing when to escalate, and working inside the systems that shape care.
Becker’s asked three behavioral health leaders — all licensed clinical social workers themselves — where new LCSWs most need support on day one. Their answers point less to gaps in clinical knowledge and more to the skills that come with real-world practice. These include tying evidence-based practice to measurement-based care, assessing risk quickly in fast-paced integrated settings, building a broader intervention toolbox and continuing to seek supervision after earning independence.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What skills are new LCSWs missing on day 1?
Tammer Attallah. Executive Clinical Director of the Behavioral Health Clinical Program at Intermountain Health (Salt Lake City):
One of the biggest gaps I see is not clinical skill, per se. Many new LCSWs enter the workforce with strong foundational knowledge and a genuine desire to provide evidence-based practice. The challenge is that many have not yet learned how to connect evidence-based practice with measurement-based care and system design.
Too often, new clinicians think of evidence-based practice as selecting the right therapeutic intervention. But evidence-based care requires more than that. It also requires knowing whether treatment is actually working. That means routinely measuring outcomes, incorporating patient-reported measures and using data to guide clinical decisions in partnership with the patient.
What I wish more new LCSWs would ask prior to day one (within the interview) is not simply, “What model of care do you use?” but rather, “How do you support clinicians in delivering evidence-based care?” Do you have ways to collect outcomes from patients? Are measures integrated into workflow? Do clinicians receive actionable data they can use during treatment? What technology exists to reduce administrative burden so more time can be spent with patients?
At Intermountain, for example, we view measurement-based care as the operationalization of evidence-based practice. Although we still have work to do, it is not enough to believe an intervention works. We need systems that help clinicians understand whether it is working for the person sitting in front of them. That requires infrastructure, outcome measurement tools, clinical decision support and workflows that are easy for both clinicians and patients to use.
The future of behavioral health depends not only on preparing excellent clinicians, but also on preparing them to evaluate and thrive within healthcare systems that make high-quality, evidence-based care possible. The most successful therapists are the ones who learn to ask not only how they will treat patients, but how the organization will support them in delivering the best care possible.
Teresa Lopez. Director of Behavioral Health Integration at Huntsman Mental Health Institute (Salt Lake City):
In integrated behavioral health, the biggest gap I see isn’t necessarily clinical knowledge — it’s the ability to translate that knowledge into the pace and complexity of a healthcare setting on day one. New LCSWs often need development in concise clinical assessment, risk stratification and safety planning, interdisciplinary collaboration, and knowing when and how to escalate concerns.
They also need stronger skills around documentation, measurement-based care and understanding how behavioral health fits into the broader patient journey — not just treating the behavioral health diagnosis in isolation.
And perhaps most importantly, we need clinicians who are comfortable with ambiguity. Our patients rarely present with one neatly defined problem. They may have medical complexity, behavioral health needs, social drivers, family dynamics and access barriers happening simultaneously. The ability to quickly identify what matters most, develop a focused intervention, collaborate across disciplines and connect the patient to the right level of care is something that generally develops with experience rather than coming directly out of graduate school.
I don’t view that as a failure of new LCSWs. It’s an opportunity for healthcare organizations and academic programs to work together to better bridge the transition from classroom learning to real-world integrated behavioral healthcare.
Tina Niziurski. Director of Social Work at Children’s Healthcare of Atlanta:
The year was 2007. I had just passed my LCSW exam. I showed up to work the next day elated to receive my new badge with the new letters behind my name. After the excitement wore off, I took a moment to reflect on what this really meant. I could practice independently. I could start my own private practice if I wanted to. The big question was: Did I really have all the skills that I needed as a new LCSW? The reality is that, despite the significant academic and clinical preparation new LCSWs receive, they often need additional support in several areas of real-world practice.
Clinical assessment and clinical judgment
Many new LCSWs are great at collecting the facts, but struggle with deciphering which information is truly important, and how to convert this information into a viable clinical formulation. Risk assessment and safety planning can often be areas of weakness if the new LCSW has not previously worked in a crisis-type setting. Knowing what is emergent versus what can wait is imperative when working with clients experiencing mental health concerns.
Intervention toolbox
Clinical social work is more than just one intervention. I have interviewed many new LCSWs for social work and therapy roles, and, when asked which therapeutic interventions they utilize, the answer is often cognitive behavioral therapy (CBT). While CBT is a great intervention for anxiety, depression and other diagnoses, having a “toolbox” with several interventions is always best practice, as is knowing which intervention is best based on the client’s diagnosis and presenting concern.
Ethical decision-making and supervision
Lastly, the area of ethical decision-making and the use of appropriate supervision is often not emphasized enough once an individual becomes an LCSW. We must recognize ethical dilemmas before they become crises. Truly understanding confidentiality, boundaries, informed consent, conflicts of interest and professional competence should be at the top of our minds daily. Becoming an LCSW does not mean that supervision is no longer needed. We need to be comfortable saying, “I don’t know; I need to consult.”
Becoming an LCSW marks the beginning of professional independence but does not mark the end of learning. As I always tell my supervisees and mentees, if you ever get to a place in your career where you think you know it all, it is time to take a step back and reflect.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
