Reamer, F. G. (2023). Risk management in the behavioral health professions: A practical guide to preventing malpractice and licensing-board complaints. Columbia University Press.
Reviewed by Jeffrey Steen, PhD, LCSW
International Journal of Social Work Values and Ethics • Volume 20(2), Copyright 2023 by IFSW
This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of IFSW.
While most social workers are eager to assume clinical roles, there is less enthusiasm about the rules and regulations which influence their practice. A lack of knowledge and ability to implement appropriate standards of care may seriously endanger clients, colleagues, and organizations. And, while lawsuits and license board complaints are not common, social workers’ negligent or intentional ethical lapses may invite repercussions which make them unable to continue delivering services. In his latest book, Dr. Reamer presents risk management issues of great relevance to a variety of behavioral health professionals, including social workers.
After a legacy of publications about social work values and ethics, the author’s latest text is informed by his rich history as a practitioner, educator, researcher, and expert witness. This book examines in careful detail numerous issues related to risk management, including confidentiality, supervision of staff and clients, deception and fraud, consultation, and referrals. Reviews of legal histories, rules and regulations, professional standards, findings from peer-reviewed literature, and case materials are incorporated into each chapter, critical content that frames ethical decision-making and promotes best practices. Importantly, strategies for reducing risk are frequently provided and can readily guide therapeutic processes.
While an array of topics are discussed, social workers may find a few sections particularly valuable. For instance, the author presents difficult confidentiality concerns that routinely appear in practice settings, such as discerning when to disclose information to protect third parties, managing information-sharing within families, and understanding the nuances of privileged communication. While considering the challenges they present, recommendations for mitigating confidentiality-related risks are also offered, including developing a clear informed consent process, distributing policies explaining communication practices, and establishing protocol to support the safeguarding of client records. Readers will also benefit from suggestions addressing common missteps in treatment, namely violation of client rights, unprofessional boundaries, inaccurate assessment, inappropriate utilization of interventions, and negligent interruption or termination of services. Social workers will also appreciate the sample forms in the appendices, which are examples of releases of information, policies for private psychotherapy services, and consents for remote treatment. In regards to this latter issue, Dr. Reamer’s often-cited expertise in technology and social work practice is infused throughout the book, information which is only cursorily considered in many counseling publications. Future editions of this text will want to attend to the latest technology-related developments in clinical work, including advances in virtual reality and artificial intelligence. Increased consideration of ethical issues related to community-based social work practice, rather than privileging private practice settings, would also expand the book’s scope and usefulness.
A more recent revision to the NASW Code of Ethics presents social workers’ ethical responsibilities as professionals with recommendations specifically related to impaired practitioners. Dr. Reamer dedicates an entire chapter to this issue of emerging significance, describing the forms of distress that may impact social workers’ professional judgment and performance. These considerations are consistent with published findings from a study of over 6,000 licensed social workers, recently conducted by a group of my colleagues, in which we found that professionals’ problems with physical and mental health, substance misuse, and exposure to Adverse Childhood Experiences influenced their decisions to enter the field and impact their work, particularly their clinical practice. Acknowledging the need for more universal protocols to prevent and respond to these needs, the text recommends approaches for identifying and documenting these issues and supporting impaired practitioners through a process of rehabilitation. In this post-COVID era, social workers’ heightened physical and behavioral health problems will need to be better understood and addressed, to support their wellbeing and their capacity to work most effectively with clients.
Social work educational programs, to their great detriment, include minimal curricular content on ethics and risk management. Rather than a standalone course, this information when made available to students is typically done so piecemeal, included in classes throughout the curriculum and without a unified approach or textbook to engender critical thinking, ethical decision-making, and implementation of clinical strategies which reflect these priorities. The lack of attention to the ethics of clinical social work puts students at risk for malpractice throughout their careers. This limited approach to the training of new professionals – and concerns about supports for social workers’ ongoing development—support the necessity of Dr. Reamer’s latest publication. Offering expert advisement, this resource has the potential to enrich direct practice courses in behavioral health training programs, continuing education sessions, supervisory relationships, and therapeutic processes, equipping social workers to provide sound clinical care in an increasingly complex service delivery environment.