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| From February 2000 NASW NEWS Copyright ©2000, National Association of Social Workers, Inc. |
The recent NASW News article "Survey Records Subpoenaed in Suit" was the impetus for this letter. It comes after years of concern over the professional integrity of NASW, related to the portrayal of the managed care industry.
After years of direct clinical practice, I made a decision to work in the managed care field, and have since worked for several companies. Through this work, I have promoted the field of social work, educated other professionals and communities on the benefits of using social work over other clinical modalities for behavioral health treatment and helped to improve the access and quality of behavioral health care for insured members.
As an industry, managed care provides thousands of jobs for social workers at salaries well above the inadequate industry norms. Managed care provider networks have created a system in which social work is the treatment modality of choice, thus significantly supplementing the income of thousands upon thousands in private practice. Managed care companies have also provided an opportunity for social workers such as myself to play key managerial roles in the industry, which has provided the opportunity to further educate and promote the profession.
I would hope that one goal of a professional organization would be to adequately represent the members. I'm sorry to report that you have significantly let me down, and likely the thousands of social workers employed by managed care companies and paying dues to NASW.
Lawrence M. Gleit, LCSW
Clinton, N.J.
I was pleased to see the notice that NASW is involved with an effort to put a single-payer health insurance plan in place.
With the absurd mess that is managed care now familiar to everyone, the country may be ready for it. Of course, it will be necessary to withstand the selfish advertising that the insurance and pharmaceutical companies will use against it.
Politicians and other leaders speaking for the single- payer approach will need the services of a sort of truth squad. The popularity of the single- payer system in Canada, despite anecdotal complaints, can be cited. We need to know a lot more about what other western democracies (and Japan?) do with their systems and how satisfied with them their people are.
We are the richest nation in the world, and yet we have the poorest health care for most people. Meanwhile, the insurance companies become obscenely wealthy.
Michael Ehrlich
New York, N.Y.
The one sure way to enforce state and federal standards vis-a-vis nursing home care is to put a patient advocate in every nursing home ["Elder Abuse Is a Crisis, Groups Say," January]. This advocate would have to be carefully screened to make sure that he or she had no connection with the nursing home.
I have been a nursing home consultant for almost three decades. I have seen state and federal agencies that have oversight responsibility for nursing homes do cursory examinations and rarely talk to patients.
New laws seem to have little impact on the way nursing homes operate. Well-meaning community advocates run into a brick wall when they try to move nursing homes to create a more humane environment for patients. It may seem far-fetched and costly to put a patient advocate in every nursing home, but who has a better idea?
Murray C. Schwartz, MSW, ACSW
Huntingdon Valley, Pa.
The only true thing about "informed consent" is that clients are informed that either they allow all information they are asked for to be shared with countless people (inside and outside the helping professions) or they will not obtain services.
How much sense does it make for managed care to ask most detailed questions after a first session or even before? For most clients, a first session is an anxiety-ridden situation and should be used to allay fears and begin to form a relationship between client and therapist.
How long will we live with "medically necessary" intervention and psychiatric diagnoses? How many of our clients fit into the threadbare and shopworn DSM IV 300.4 and 300.24, which seem to describe none of my patients?
Hedi McKinley, CSW
Albany, N.Y.
I commend John O'Neill's comprehensive piece on the complexities of maintaining client confidentiality in a managed care climate ["Trading Future Privacy for Services Today," January].
I take comfort that I practice in a setting in which only authorized clinicians have access to sensitive client records. Sadly, this no longer balances the external intrusions that threaten quality care.
We should also note that severely ill clients may lack the energy and concentration required to advocate for themselves.
All clinicians, administrators and educators are challenged to operationalize our Code of Ethics in this era. The News story is a thoughtful step toward that goal.
Sue Matorin, ACSW
New York, N.Y.
The undercover work of Terrance Johnson ["Advocacy Takes a New Tack," September 1999] should not be admired for being mired in deception of others. Deception is a form of lying, and lying in research is wrong. Attempting to couch the exercise in the language of research doesn't change the morality of the act. This only makes the act all the more egregious because it tries for a moral justification when none is entitled.
Perhaps Johnson didn't know any better, and if he didn't, there is a case to be made that he his education failed him. Certainly the dean and faculty at the University of Pennsylvania had to know this project was wrong from the start. They had simply to ask themselves if they thought this project would meet the approval of the Office of Institutional Research. I think we can assume they did not ask because they knew what the answer would be.
Did Johnson and others at Penn think they could replicate the Rosehan Study without incident? Surely, they didn't think that consent would just clutter up things and interfere with some more noble purpose.
As we enter the millennium, let us hope for a moral compass that works.
D. A. Albers, Ph.D., ACSW
Lexington, Ky.
Editor's Note: The story reported social worker Terrance Johnson's undercover work for a CBS "60 Minutes II" documentary on patient abuse in psychiatric hospitals. His participation was referred to once as a "research opportunity," which we printed in quotation marks, when Johnson was recruited to assist CBS. As far as we know, however, the investigative report was not considered a bona fide research project or study.
Letters are published as space permits and may be edited for clarity and length. Submissions may not necessarily be published or responded to; receipt is not acknowledged. Unsigned letters, form letters and ccs to third parties are not published. Mail to: Managing Editor, NASW News, 750 First St., N.E., Suite 700, Washington, DC 20002. E-mail — plain (ascii) text only — to: naswnews@naswdc.org
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Copyright NASW Press, 1998 |
