Advances Vol. 3, No. 2


134

Correlates of MSW Students’ Perceptions of Preparedness
to Manage Risk and Personal Liability

Michael N. Kane

Abstract:Few studies in the discipline of social work have identified correlates of pre-
paredness to manage risk and personal liability among practitioners or students.
This study investigated predictors of MSW students’ perceptions of managing per-
sonal risk and liability (N=116). Four correlates were identified from the standard
regression model that accounts for 43% of the adjusted variance. These predictor
variables included: (a) concern and worry about lawsuits (Beta=-.458, p=.00), (b)
understanding the fit between client advocacy and managed care (Beta=.328,p=.00),
(c) understanding agency documentation requirements (Beta=-.164, p=.05), and (d)
perceptions of field preparation for documentation (Beta=.162, p=.05). Implications
are discussed.

Keywords: Risk management, documentation, career preparedness

Throughout the United States and the world, managed care and other
types of service delivery continue to change (Frazee, 1997). Much of this
change is a result of evolving models of managed care and privatization

(Berkman, 1996; Corcoran & Vandiver, 1996; Davis & Meier, 2000; Fletcher,
1999; Kane, Hamlin & Hawkins, 2000; Motenko et al., 1995; Oss, 1996; Perloff,
1998; Rose, 1996; Rosenberg, 1998; Vernon, 1998). These models were con-
ceived to provide effective intervention while controlling costs (Corcoran &
Vandiver, 1996; Davis & Meier, 2000). While these restrictive models of service
delivery have infiltrated most health, mental health, and social service venues
and have been a source of financial success, they have also been perceived as
a political and cultural failure (Robinson, 2001). Attitudes toward managed
care among consumers as well as practitioners of many disciplines are gener-
ally negative (Berger & Ai, 2000; Robinson, 2001; Yedidia, Gillespie & Moore,
2000).

It appears that these models of service delivery have focused primarily on
the cost of services. No doubt the cost of services is an important considera-
tion for practitioners, payers, clients, and organizations (Davis & Meier, 2000),
especially in an age of scarce resources.While practitioners may hold negative
attitudes toward these models, many practitioners work in managed care and

Michael N. Kane, Ph.D., M.S.W., M. Div. is Assistant Professor, School of Social Work, Florida Atlantic
University, Boca Raton, FL.

Copyright© 2002 Advances in SocialWorkVol. 3 No. 2 (Fall 2002) 134-145.
Indiana University School of SocialWork.



privatized venues. Consumers may also hold negative attitudes toward man-
aged care and privatization. However, consumers have more options. When
consumers perceive that they have received service that does not meet the
standard of care, they may increasingly opt for litigation. Practitioners are
acutely aware that they face the brunt of exposure to litigation and are
increasingly urged to seek legal counsel to ensure that they meet professional
standards of care (Bernstein & Hartsell, 2000; Houston-Vega, Nuehring, with
Daguio, 1997; Madden, 1998; Reamer, 1998; 2001). Also, professional schools
are adding content to address the management of personal risk and liability.
This exploratory study sought to investigate MSW students’ perceptions of
managing personal risk and liability. It also attempted to identify those vari-
ables that may be predictive for managing personal risk and liability among
MSW students.

HEALTH CARE CURRICULA, SOCIALWORK CURRICULA,
PRIVATIZATION, ANDMANAGED CARE

As a result of the pervasiveness of managed care and privatization, professional
education for most health and allied health disciplines has been altered (Berger
& Ali, 2000; Coggan, 1997; Fletcher, 1999). Medical schools have developed spe-
cific curricula that will responsibly prepare practitioners for current and future
service demands in managed care and privatized environments (Coggan, 1997;
Fletcher, 1999; Nordgren, 1996; Yedidia et al., 2000) as have schools of nursing
(Jacobson, 1998; Sherer, 1993). While perspectives may be discipline specific,
content includes clinical and ethical issues associated with managed care and
privatized environments, best-practices and clinical pathways, practice evalua-
tion methods, and risk management strategies (Coggan, 1997; Jacobson, 1998;
Sherer, 1993).

Social workers function in these same managed care and privatized environ-
ments. Many social workers have contributed to a growing body of literature
dealing specifically with these areas of concern. Some of this literature has inves-
tigated managed care operations and preferred practice models (Corcoran &
Vandiver, 1996; Kadushin, 1996; Mitchell, 1998; Poole, 1996) as well as reconciling
the profession’s code of ethics and managed care’s preferred methods of service
delivery (Madden, 1998; Reamer, 1998; 2001). Practitioners have contributed to
the profession’s knowledge base in the areas of client advocacy (Houston-Vega et
al., 1997; Sessions, 1998), appealing decisions of utilization reviewers (Callahan,
1998; Corcoran & Vandiver, 1996; Frager, 2000), confidentiality in current service
delivery environments (Bernstein & Hartsell, 2000; Reamer, 1998; 2001; Rock &
Congress, 1999), the fiduciary relationship (Bernstein & Hartsell, 2000; Houston-
Vega et al., 1997; Madden, 1998; Reamer, 1998), methods of client referrals
(Frager, 2000; Houston-Vega et al., 1997; Munson, 1998; Rock & Congress, 1999),
documentation requirements in current environments (Bernstein & Hartsell,
2000; Davidson & Davidson, 1998; Kane, Houston-Vega & Nuehring, 2002), and
evaluating relationships with reimbursement sources (Corcoran & Vandiver,
1996; Frager, 2000; Madden, 1998; Reamer, 1998;Watt & Kallmann, 1998).

135Kane/MANAGING RISK AND LIABILITY



136

There is also a growing body of social work education literature that focuses on
the skills and knowledge necessary in current service environments (Berger & Ali,
2000; Kadushin, 1997; Kane, in press; Kane, Hamlin & Green, 2001; Kane, Hamlin
& Hawkins, 2000; Kane, Houston-Vega & Nuehring, 2002; Rosenberg, 1998; Shera,
1996; Strom-Gottfried, 1997; Volland, Berkman, Stein & Vaghy, 1999). These
authors generally suggest that practitioners must possess the knowledge and
skills specific to managed care and privatized environments to competently pro-
vide service.

RISKMANAGEMENT AND PERSONAL LIABILITY

A common theme throughout most of this literature is the need for practitioners
to provide appropriate service that meets the standard of care. This literature
seeks to inform practitioners not only about the standard of care, but also about
substandard service delivery that may result in charges of malpractice or negli-
gence. There are several specific areas in the literature in which risk management
and personal liability are referenced, including practitioner education, over-diag-
nosis, agency protocols, documentation, reimbursement, and client advocacy
(Bernstein&Hartsell, 2000;Houston-Vega et al., 1997;Madden, 1998; Reamer, 1998).

It appears that organizations and reimbursement sources continue to shift the
bulk of responsibility for service decisions onto practitioners as they seek to
reduce organizational and payer risk and liability. Practitioners are required to
have a keen understanding of their fiduciary responsibilities in order to provide
appropriate service and manage risk and reduce personal liability (Callahan,
1998; Davidson & Davidson, 1998; Davis & Meier, 2000; Frager, 2000; Houston-
Vega et al., 1997; Kane et al., 2002; Kapp, 1999; Madden, 1998; Moline,Williams &
Austin, 1998; Reamer, 1998; 2001). Awareness of professional responsibility and
competent practice strategies may be important for reducing concern and worry
over potential liability and law suits (Houston-Vega et al., 1997; Kapp, 1999;
Madden, 1998; Moline et al., 1998; Reamer, 1998).

Professional social workers are formed through a specific educational program
that includes both classroom and field components. Both components provide
the essential knowledge and skill development necessary to prepare future prac-
titioners for competent and independent functioning. Of critical importance in
both classroom and field portions is the knowledge and skills associated with
documentation in practice (Kane, 2002).

As a method of risk management, documentation provides a record of the
encounter between client and provider. It serves as a protection to both clients
and providers (Houston-Vega et al., 1997; Kane et al., 2002; Madden, 1998; Moline
et al., 1998; Reamer, 1998; 2001). Professional organizations and state licensing
bodies require practitioners to document. Kapp (1999) suggests that documenta-
tion should be (1) accurate and truthful, (2) thorough and complete, (3) legible,
(4) timely, and (5) without editorializing comments. Documentationmay support
practitioners in allegations of substandard service delivery and provide detailed
information regarding how clients were best served.

Agencies and providers may depend on documentation for reimbursement
from third-party payers and other funding sources. These agencies and providers

ADVANCES IN SOCIALWORK



may have their own agendas regarding documentation and require specific infor-
mation to ensure organizational reimbursement.These agendas, whichmay center
on reimbursement, have the potential to become ethical and/or value conflicts
for professional social workers. In these cases, some practitioners may feel pres-
sured to “chart-to-the-negative,” over-diagnose, or mis-diagnose to ensure that
clients receive necessary services and/or the agency gets reimbursed (Houston-
Vega et al., 1997; Kane et al., 2002; Madden, 1998; Moline et al., 1998; Reamer,
1998; 2001). These pressures may be particularly powerful as practitioners inter-
act with utilization reviewers and other funding sources.

Social work practitioners are aware that they have a primary responsibility to
their clients’ welfare as informed by the profession’s Code of Ethics (Houston-
Vega et al., 1997; NASW, 1996; Reamer, 1998). This requires that they clearly under-
stand their responsibility to clients and develop ethical skills to advocate for
clients in current service delivery environments. Without this awareness, practi-
tioners are rendered vulnerable from a risk management perspective and clients
may receive inadequate service.

As noted previously, future practitioners may hold various attitudes toward
managed care and other restrictive models of service delivery. These attitudes
may influence their ability and willingness to navigate in these environments.
Future social workers will face clinical and ethical conundrums as they try to
obtain appropriate services for clients while managing risk and personal liability
(Berger & Ai, 2000; Kane, 2002; Reamer, 2001; Strom-Gottfried, 1997). The social
work literature reveals that educators and practitioners have investigated how
best to prepare practitioners for the demands of current and future social work
practice along with the necessary skills and knowledge critical to these environ-
ments. Yet, there is little empirical information that directly focuses on the pre-
dictors of managing risk and personal liability among future practitioners, espe-
cially in managed care and privatized environments.

This study investigated predictors of MSW students’ perceived ability to man-
age personal risk and liability. Through a literature review, several variables
appeared as potential factors that may predict an individual’s ability to manage
risk and personal liability. These variables include: professional experience in
managed care and privatized environments, occupational responsibilities, type
of agency at which the professional is employed, understanding agencies’ finan-
cial agendas, understanding agency documentation guidelines, awareness of eth-
ical and value conflicts such as over-diagnosis/mis-diagnosis, educational prepa-
ration for documentation, the skills of advocacy in current environments, preoc-
cupation with lawsuits, understanding gatekeeping and utilization review
processes, and field preparation for employment. These exploratory findingsmay
offer educators and curriculum planners information about students’ perceived
preparedness for future employment opportunities and practice competency.
This important information may assist students, employers, and educators in
providing services to clients that meet the standard of care and allow organiza-
tions and practitioners to effectively manage risk and personal liability. Finally,
this information may provide valuable content for curriculum development.

137Kane/MANAGING RISK AND LIABILITY



METHODOLOGY

Participants.A sample of students (n=116) was obtained from two Florida MSW
programs. Students currently enrolled in or who had completed at least one field
practicum andwere enrolled in clinical practice, advanced research, or field sem-
inar classes were asked to anonymously volunteer to complete an instrument.
Access to these students was based on instructor willingness to dedicate class
time to completing this instrument.

The typical respondent in this survey was female (84%), Anglo (49%), and had
some social work experience. Because of the diverse population of Florida,
respondents self-identified as Hispanic/Latino (19%), African-American (10%),
andWest Indian/Caribbean (15%). Themean age of respondents was 31.86 years,
with ages ranging from 22 to 51. Field sites were identified as public (41%), private
for-profit (17%), or private not-for-profit agencies (40%). Approximately 53% of
the sample indicated that they had two to five years of social work experience,
while 28%of the sample indicated that they had less than two years of experience.

Instrument. Kane, Houston-Vega, Tan and Hawkins (in press) developed an
instrument that contained nine variables that measured student preparedness
for managed care environments. The “Understanding agency financial agendas”
variable used six items to measure respondents’ understanding of how organiza-
tions use clients’ benefit packages for reimbursement. Specific items in this scale
investigated agencies’ concern for service reimbursement, service termination if
benefits are exhausted, and their preferences for serving clients who can pay for
services. The variable of “managing personal risk and liability” used six items to
determine whether respondents perceived that they had adequate knowledge
and skill to prevent a lawsuit. Specifically, items investigated respondents’ beliefs
about having the necessary skills to protect themselves from being sued and
avoid potential liability. “Understanding agency documentation requirements” is
a variable that uses four items to evaluate whether respondents are aware of spe-
cific documentation guidelines that are in place at agencies to shape profession-
al behavior. “Awareness of ethical conflicts surrounding over-diagnosis or mis-
diagnosis” measured the tension that may exist in practice that would encourage
a practitioner to “stretch the truth” to ensure agency reimbursement or service
authorization for clients. The variable “classroom preparation for documenta-
tion” used several items to measure perceptions about the level of preparedness
that respondents may feel as a result of their classroom education.
“Understanding the fit between client advocacy and managed care” was a vari-
able that evaluated respondents’ perceptions about their ability to navigate and
advocate for their clients in complicated and restrictive service environments. An
item in this variable is, “I believe I am capable of advocating for my clients in
managed care environments” (Kane, Houston-Vega, Tan & Hawkins, in press).
The variables of “worry and concern over lawsuits,” and "knowledge of utilization
review and gatekeeping" assess a respondent’s perceptions in these specific areas.
The variable of “field preparation for documentation” assesses respondents’ per-
ceptions of how well the field site prepares them tomanage risk and personal lia-
bility through documentation strategies. One item used in this variable is
“Documentation of my clinical work is a skill I learned mostly in my field place-

138 ADVANCES IN SOCIALWORK



ment” (Kane, Houston-Vega, Tan & Hawkins, in press). Respondents receive a
score for each variable scale. Values assigned by respondents for each variable
item are added together to obtain a variable score. There is no overall instrument
score. The variable of managing risk and personal liability was designated as the
study’s dependent variable for the purposes of multivariate analysis.

Reliability alpha coefficients were computed for each variable, including
agency financial agendas (α=.88), personal risk and liability (α=.84), agency doc-
umentation requirements (α=.79), ethical conflicts (α=.81), classroom prepara-
tion for documentation (α=.80), advocacy skills (α=.80), concern over lawsuits
(α=.76), knowledge of utilization review and gatekeeping (α=.58), and field prepa-
ration for documentation (α=.49). Normally, alpha scores above 0.7 are preferred.
Because of the exploratory nature of this research, two variables with lower alpha
scores were retained. Finally, Kane, Houston-Vega, Tan & Hawkins (in press)
reported face validity for this instrument.

To this instrument, demographic variables were added such as gender, age, eth-
nicity, social work experience, field experience, agency type, and future employ-
ment plans. The instrument was administered to all participants and took less
than 20minutes to complete. Prior to participant completion, the instrumentwas
piloted using practitioners and field supervisors.

Analysis: Univariate analysis included mean, standard deviation, minimum, and
maximum scores for each variable scale. To determine the strength of the rela-
tionship between each independent variable and the dependent variable, corre-
lation coefficients were computed. Finally, standardmultiple regressionwas used
for model building to identify those variables that were most predictive in under-
standing the dependent variable.

FINDINGS

Descriptive Analysis of theVariables

Overall, respondents indicated that they perceived themselves to be moderately
well prepared to manage risk and personal liability (Table 1). Most respondents
reported feeling moderately well equipped to understand agency financial agen-
das, understandingmanaged care gatekeeping and service authorization require-
ments, and advocating for clients in managed care environments. Most respon-
dents also believed that they had beenmoderately well prepared in the classroom
for documentation, moderately aware of ethical conflicts regarding over-diagno-
sis, and had a moderate concern and worry about lawsuits. Most MSW student
respondents strongly indicated that the field had prepared them to document
and that they understood agency documentation requirements. Table 1 provides
specific information regarding these variables.

Bivariate Analysis

Correlation coefficients (Table 2) were computed for the dependent variable
(managing risk and personal liability) and gender, age, MSW status (concentra-
tion or foundation year), ethnicity, field placement site, and career goal. None of
these coefficients were significant. Correlation coefficients were also computed
for the dependent variable and (a) understanding agency financial agendas, (b)

139Kane/MANAGING RISK AND LIABILITY



understanding agency documentation requirements, (c) awareness of ethical
conflicts/over-diagnosis, (d) classroom preparation for documentation, (e)
understanding advocacy for clients in managed care environments, (f) concern
and worry over law suits, (g) understanding managed care gatekeeping and serv-
ice authorization, and (h) field preparation for documentation. Three of these
variables were significantly correlated with the dependent variable: classroom
preparation for documentation, understanding advocacy for clients in managed
care environments, and concern and worry about lawsuits. Two other variables
approached significance (awareness of ethical conflicts/over-diagnosis and field
preparation for documentation). Finally, several variables, including concern and
worry about lawsuits, were negatively correlated with the dependent variable.
This finding suggests that the concern and worry about lawsuits variable is
reduced through managing risk and liability.

Multiple Regression Analysis

Standard regression analysis was initially performed using (a) understanding
agency financial agendas, (b) understanding agency documentation require-
ments, (c) awareness of ethical conflict/over-diagnosis, (d) classroom prepara-
tion for documentation, (e) understanding advocacy for clients in managed care
environments, (f) concern and worry over law suits, (g) understanding managed
care gatekeepingand service authorization, (h) fieldpreparation fordocumentation,
(i) age, and (j) field placement site. The initial solution yielded a model (R=.688,
Adjusted R2=.419, F=8.718, p=.000) with few significant predictive variables.

In further exploratory analysis, all items that were not significant in the initial
regression analysis were excluded from further model development. A final model
was selectedwhich accounted for 43.1%of the adjusted variance (F=21.994,p=.000)
using four independent variables. These variables included (a) concern and worry
about lawsuits (Beta=-.458, p=.00), (b) understanding the fit between client advo-
cacy andmanaged care (Beta=.328, p=.00), (c ) understanding agency documenta-
tion requirements (Beta=-.164, p=.05), and (d) perceptions of field preparation for
documentation (Beta=.162, p=.05). Table 3 contains further information.

140 ADVANCES IN SOCIALWORK

Variable Mean SD Min. Max.

Managing personal risk and liability 16.04 3.93 8 25

Understanding agency financial agendas 17.57 6.07 6 30

Understanding agency documentation requirements 15.52 3.63 4 20

Awareness of ethical conflicts/over-diagnosis 9.40 3.89 4 18

Classroom preparation for documentation 7.44 3.07 3 15

Understanding advocacy for clients in managed 12.85 3.39 6 20
care environments

Concern and worry about lawsuits 8.82 2.74 3 15

Understanding managed care gatekeeping and 9.58 2.41 5 15
service authorization

Field preparation for documentation 7.33 2.00 2 10

Table 1: Variable Descriptives



DISCUSSION AND IMPLICATIONS

Four variablesmade significant contributions to a regressionmodel and attempt-
ed to explain social work students’ perceptions ofmanaging risk and personal lia-
bility. These variables included (a) concern and worry about lawsuits, (b) under-
standing the fit between client advocacy and managed care, (c) understanding
agency documentation requirements, and (d) perceptions of field preparation for
documentation. It appears that respondents’ perceived that concern or worry
about potential lawsuits would be reduced by managing risk and personal liabil-
ity. In some sense, this worry or concern over the potential for litigation may fos-
ter an increased sensitivity among practitioners to provide services that meet or
exceed the recommended standard of care.While not the primary motivation for
the provision of appropriate service, awareness of personal liability may still be a
powerful incentive.

141Kane/MANAGING RISK AND LIABILITY

Variable Correlation Significance

Gender .033 .735

Age .070 .482

MSW status .108 .262

Ethnicity .006 .952

Field placement site -.030 .753

Career goal -.094 .330

Understanding agency financial agendas -.084 .378

Understanding agency documentation requirements -.061 .525

Awareness of ethical conflicts/over-diagnosis -.166 .080

Classroom preparation for documentation .357 .000

Understanding advocacy for clients in managed care .454 .000
environments

Concern and worry about lawsuits -.577 .000

Understanding managed care gatekeeping and -.050 .598
service authorization

Field preparation for documentation .172 .070

Table 2: Bivariate Analysis: Correlations to Perceptions of Managing Personal Risk and
Liability

B Beta t Sig.

Understanding agency documentation -.176 -.164 -1.926 .05
requirements

Understanding the fit between client advocacy .381 .328 4.166 .00
and managed care

Concern and worry about lawsuits -.658 -.458 -5.983 .00

Field preparation for documentation .317 .162 1.995 .05

Table 3: Final Regression Summary



142

The traditional social work role of client advocate was viewed by respondents as
being an important method of managing risk and personal liability. In managed
care and privatized environments, clients are frequently in need of scarce servic-
es. Social workers have been trained to navigate these complicated systems for
their clients and to advocate for scarce resources. This suggests that by ensuring
the primacy of clients’ needs, practitioners are aware that they are most appro-
priately upholding the standard of care. A practitioner’s best strategy from a risk
management perspective is to meet or exceed the standard of care (Houston-
Vega et al., 1997; Kapp, 1999; Madden, 1998; Moline et al., 1998; Reamer, 2001). In
addition, it seems reasonable to assume that clients who are cognizant that their
practitioner is also their advocate realize that their best interests are being upheld
by practitioners. Clients who feel that they have someone working on their behalf
are generally those who are less likely to choose litigation.

Respondents indicated that understanding agency documentation require-
ments was critical tomanaging risk and personal liability. This information is typ-
ically provided in both the classroom and field components of social work edu-
cation. As noted previously, documentation critical to protecting both client and
practitioner has repeatedly been cited in the literature, as it provides an accounting
of client-practitioner interaction and evidences whether the standard of care was
met (Corcoran & Vandiver, 1996; Houston-Vega et al., 1997; Kane, in press; Kane
et al., 2002; Madden, 1998; Moline et al., 1998; Reamer, 1998; 2001).

Finally, respondents perceived that the field component is critically important
for career preparation. This critical area in social work education assists students
to develop expertise and competence in many areas, especially in developing an
awareness of risk management strategies. These strategies may be learned from
the field supervisor who informs students about personal liability or through the
risk management strategies of the organization. Of critical importance in these
settings is the use of documentation. It appears that the experiential learning that
occurs in field education prepares students for documentation in compliance
with agency agendas.

While these contributing variables are important to understanding students’
perceived preparedness to manage risk and personal liability, the variables that
did not significantly contribute to the model are of equal interest. The following
variables were not significant predictors for the final model: gender, age, MSW
status, ethnicity, field placement site (private-for-profit, private-not-for-profit,
public), career goal (private practice, agency work, combination), or experience
in managed care and privatized environments. Of particular interest is the fact
that field placement site and experience (private for-profit, private not-for-profit,
public) were not contributors. It seemed logical to assume that experience and
field site might affect perceptions and suggests that future investigation is neces-
sary to verify these findings. Consistent with other literature, particularly among
medical educators and students, perceptions of knowledge and skill develop-
ment were not significantly influenced by either managed care or non-managed
care settings (Yedidia et al., 2000).

While negative attitudes toward service delivery models accomplish little, so
does excessive worry regarding potential litigation. While practitioners must

ADVANCES IN SOCIALWORK



ensure that they provide the best service possible, they must also develop an
awareness of potential risks and seek to avoid them. It is important for students
to develop not only the necessary knowledge and skills to protect themselves and
their clients in these environments, but also to develop attitudes that will ensure
that they capably advocate for vulnerable populations and options that will
enhance service delivery.

Developing curriculum to adequately prepare students for current service envi-
ronments continues to be a great challenge for professional educators (Berger &
Ai, 2000). Client advocacy, liability concerns, documentation requirements, and
field experience may be pivotal in preparing students to manage risk and per-
sonal liability.

LIMITATIONS AND SUGGESTIONS FOR FUTURE RESEARCH

This study used a purposive sample of 116 MSW respondents from two educa-
tional programs. While small samples from one educational program have been
used to investigate levels of student preparedness and satisfaction, in order to
assert generalizability and statistical power, larger and more representative sam-
ples of students from geographically diverse locations are necessary.

While this study relied on social work student respondents, further investiga-
tion is necessary. Curriculum development and knowledge generation will
require other information sources such as managed care organizations, service
environments, supervisors, educators, administrators, risk managers, and practi-
tioners.

References

Berger, C.S., & Ai, A. (2000). Managed care and its implications for social work curricula reform: Clinical
practice and field instruction. SocialWork in Health Care, 31(3), 83-106.

Berkman, B. (1996). The emerging health careworld: Implications for social work practice and education.
SocialWork, 41(5), 541-551.

Bernstein, B.E., & Hartsell, T.L. (2000). The portable ethicist for mental health professionals: An A-Z guide
to responsible practice. NewYork: JohnWiley & Sons.

Callahan, J. (1998). Documentation of client dangerousness in managed care environment. In G.
Schamess & A. Lightburn (Eds.).Humane managed care? (pp. 299-307).Washington, DC: NASW Press.

Coggan, P. (1997). Medical education and marketplace competition. Journal of the American Medical
Association, 277(13), 1037.

Corcoran, K., & Vandiver, V. (1996). Maneuvering the maze of managed care. NewYork: The Free Press.

Davidson, T., & Davidson, J.R. (1998). Confidentiality andmanaged care: Ethical and legal concerns. In G.
Schamess & A. Lightburn (Eds.).Humane managed care? (pp. 281-292).Washington, DC: NASW Press.

Davis, S.R., & Meier, S.T. (2000). The elements of managed care: A guide for helping professionals.
Stamford, CT: Brooks/Cole.

Fletcher, R.H. (1999). Who is responsible for the common good in a competitive market? Journal of the
American Medical Association, 281(12), 1127(1).

Frager, S. (2000). Managing managed care: Secrets from a former case manager. New York: JohnWiley &
Sons.

143Kane/MANAGING RISK AND LIABILITY



Frazee, V. (1997). It’s inevitable: Managed care is going global. Workforce, 76(1), G24-29.

Houston-Vega, M.K., Nuehring, E.M., with Daguio, E.R. (1997). Prudent practice—A guide for managing
malpractice risk.Washington, DC: NASW Press.

Jacobson, S.F. (1998). A faculty case management practice: Integrating teaching, service and research.
Nursing and Health Care Perspectives, 19(5), 220-223.

Kadushin, G. (1996). Adaptations of the traditional interview to the brief-treatment context. Families in
Society: The Journal of Contemporary Human Services, 79(4), 346-357.

Kadushin, G. (1997). Educating students for a changing health care environment: An examination of
health care practice course content. Health and SocialWork, 22(3), 211-222.

Kane, M.N. (In press). Are social work students prepared for documentation and liability in managed
care environments? The Clinical Supervisor.

Kane, M.N., Hamlin II, E.R., & Green, D. (2001). Perceptions of responsibility for the acquisition of skills
and knowledge in current service environments. Professional Development: The International Journal
of Continuing SocialWork Education, 4(1), 14-22.

Kane, M.N., Hamlin II, E.R., & Hawkins, W. (2000). Perceptions of field instructors: What skills are criti-
cally important inmanaged care and privatized environments? Advances in SocialWork, 1(2), 187-202.

Kane, M.N., Houston-Vega, M.K., & Nuehring, E.M. (2002). Documentation inmanaged care: Challenges
for social work education. Journal of Teaching in SocialWork.

Kane, M.N., Houston-Vega, M.K., Tan, P.P., & Hawkins, W.E. (In press). Investigating the factor structure
of an instrument to measure social work students’ preparedness for managed care environments.
SocialWork in Health Care.

Kapp, M.B. (1999). Geriatrics and the law: Understanding patient rights and professional responsibilities.
NewYork: Springer.

Madden, R.G. (1998). Legal issues in social work, counseling, and mental health. Thousand Oaks, CA:
Sage.

Mitchell, C.G. (1998). Perceptions of empathy and client satisfaction with managed behavioral health
care. SocialWork, 43(5), 404-411.

Moline, M.E., Williams, G.T., & Austin, K.M. (1998). Documenting psychotherapy– Essentials for mental
health practitioners. Thousand Oaks, CA: Sage.

Motenko, K., Allen, E., Agnelos, P., Block, L., DeVito, J., Duffy, A., Holton, L., Lambert, K., Parker, C., Ryan,
J., Schraft, D., & Swindell, J. (1995). Privatization and cutbacks: Social work and client impressions of
service delivery in Massachusetts. SocialWork, 40(4), 456-463.

Munson, C.E. (1998). Evolution and trends in the relationship between clinical social work practice and
managed care organizations. In G. Schamess & A. Lightburn (Eds.). Humane managed care? (pp. 308-
324).Washington, DC: NASW Press.

National Association of Social Workers (NASW). (1996). The NASW Code of Ethics. Washington, DC:
Author.

Nordgren, R. (1996). The effect of managed care on undergraduate medical education. Journal of the
American Medical Association, 275(13), 1053-1054.

Oss, M.E. (1996). Managed behavioral health care: A look at the numbers. Behavioral Health
Management, 16(3), 16-17.

Perloff, J.D. (1998). Medicaid managed care and urban poor people: Implications for social work. In G.
Shamess & A. Lightburn (Eds.). Humane managed care? (pp. 65-74).Washington, DC: NASW Press.

Poole, D.L. (1996). Keeping managed care in balance. Health and SocialWork, 21(3), 163-166.

Reamer, F.G. (1998). Managed care: Ethical considerations. In G. Shamess & A. Lightburn (Eds.).Humane
managed care? (pp. 293-298).Washington, DC: NASW Press.

Reamer, F.G. (2001). The social work ethics audit: A risk management tool.Washington, DC: NASW Press.

Robinson, J.C. (2001). The end of managed care. Journal of the American Medical Association, 285(20),
2622-2628.

144 ADVANCES IN SOCIALWORK



Rock, B., & Congress, E. (1999). The new confidentiality for the 21st century in a managed care environ-
ment. SocialWork, 44(13), 253-262.

Rose, S.J. (1996). Managing mental health:Whose responsibility? Health & SocialWork, 21(1), 76-80.

Rosenberg, G. (1998). Social work in health andmental healthmanaged care environment. In G. Shamess
& A. Lightburn (Eds.). Humane managed care? (pp. 3-22).Washington, DC: NASW Press.

Sessions, P. (1998). Managed care and the oppression of psychiatrically disturbed adolescents: A disturb-
ing example. In G. Shamess & A. Lightburn (Eds.).Humane managed care? (pp. 171-179).Washington,
DC: NASW Press.

Shera,W. (1996). Managed care and people with severe mental illness: Challenges and opportunities for
social work. Health and SocialWork, 21(3), 196-201.

Sherer, J.L. (1993). Will college nursing education include managed care? Hospitals & Health Networks,
67(13), 47.

Strom-Gottfried, K. (1997). The implications ofmanaged care for social work education. Journal of Social
Work Education, 33(1), 7-18.

Vernon, D.M. (1998). New opportunities for social work with state Medicaid managed care providers. In
G. Shamess & A. Lightburn (Eds.). Humane managed care? (pp. 401-406). Washington, DC: NASW
Press.

Volland, P.J., Berkman, B., Stein, G., &Vaghy, A. (1999). SocialWork Education for Practice in Health Care:
Final Report—A Project.NewYork: NewYork Academy of Medicine.

Watt, J.W., & Kallmann, G.L. (1998). Managing professional obligation undermanaged care: A social work
perspective. Family and Community Health, 21(2), 40-49.

Yedidia, M.J., Gillespie, C.C., & Moore, G.T. (2000). Specific clinical competencies for managing care:
Views of residency directors and managed care medical directors. Journal of the American Medical
Association, 284(9), 1093-1098.

Author’s Note:

Address correspondence to: Michael Kane, Ph.D., Florida Atlantic University School of Social Work, 777
Glades Road, Boca Raton, FL 33431, USA. E-mail: MNKane@aol.com.

145Kane/MANAGING RISK AND LIABILITY