Expert answer:RE: SOCW6351: Assignment: Position Paper
Solved by verified expert:Dear students,For Week 9, you will be submitting a paper discussing a specific policy (i.e. state or federal level Law or Act) from the perspective of a population. Think of this assignment as a Testimonial where you, as the macro social worker is trying to persuade the audience on behalf of members identified from a specific population (i.e. pros and cons of the policy, recommendations, etc). This paper is essentially a written version of a speech, so you can use first person and case scenarios/anecdotes in order to persuade the reader. Even though the objective is persuasion, academic writing is still required. As such, provide in-text citations and a Reference page following APA 6th edition formatting. Be sure to review the course themes document posted in Doc Sharing to assist you in formulating this paper: identify the social problem; identify the population(s) affected; identify a specific policy (i.e. act or law) that exists in an effort to address the social problem; reflect on the social work values present.In an effort to assist you in this task, attached is a document with three brief writing samples. Please refer to these items for learning purposes only, do not duplicate or distribute: 6351_Week9Samples.pdf Sometimes, during heated discussions and debates about social policy, the underlying reasons for the policy go unnoticed. Advocates and policymakers may become so committed to their perspectives and to winning the debates that they lose focus on the larger context surrounding an issue. The purpose of policy is to improve the lives and well-being of individuals and groups in our society. As you assume the role of a social work policymaker, consider the importance of keeping the needs and experiences of vulnerable populations at the forefront of your mind in your advocacy efforts. This can help to assure effective policy practice.For this Assignment, you will analyze a state, federal, or global social welfare policy that affects an at-risk, marginalized, oppressed, underrepresented, or over looked group population. Finally, consider the impact of social policy from the perspective of the group you selected.Assignment (5-7 double-spaced pages, APA format four peer reviewed references and use reference included as one of references). In addition to a minimum of eight scholarly references, which may include electronic government documents and reputable websites, your paper should include:A description of the current policy approach for addressing the social issue you selectedA description of the current policy goals for addressing the social issue you selectedA description of the population the current policy approach coversAn explanation of the funding levels for the current policy approach and whether they are sufficient to address the issueAn explanation of how this policy may affect at-risk, marginalized, underrepresented, overlooked, or oppressed populations. Identify a specific at-risk population.An analysis of whether or not the policy meets the needs of the population groups most affected by the policy.Recommendations for alternative policies that would address the gaps identified in the policy. Please be specific in recommendations.ReferenceAcker, Gila M. (2010). How social workers cope with managed care. Administration in Social Work, 34(5), 405–422.Retrieved from Walden Library databases.
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Administration in Social Work
ISSN: 0364-3107 (Print) 1544-4376 (Online) Journal homepage: http://www.tandfonline.com/loi/wasw20
How Social Workers Cope with Managed Care
Gila M. Acker
To cite this article: Gila M. Acker (2010) How Social Workers Cope with Managed Care,
Administration in Social Work, 34:5, 405-422
To link to this article: http://dx.doi.org/10.1080/03643107.2010.518125
Published online: 09 Nov 2010.
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Date: 20 October 2017, At: 19:42
Administration in Social Work, 34:405–422, 2010
Copyright © Taylor & Francis Group, LLC
ISSN: 0364-3107 print/1544-4376 online
DOI: 10.1080/03643107.2010.518125
How Social Workers Cope
with Managed Care
GILA M. ACKER
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Department of Social Sciences, York College of The City University of New York,
Jamaica, New York, USA
The study reported in this paper examined the relationships
between social workers’ experiences when interfacing with managed care organizations, coping strategies, burnout, and somatic
symptoms associated with stress. A sample of 591 social workers completed questionnaires that included demographic questions
and measures of perceived competence in the context of managed care, coping strategies, burnout, and somatic symptoms.
Multiple regression analyses revealed that coping had statistically
significant correlations with several burnout dimensions and with
workers’ perceived competence in the context of managed care.
As coping provided the most comprehensive influence on workers’
psychological and somatic reactions associated with burnout, the
author suggests that agencies provide social workers with adequate
training to promote workers’ use of effective coping styles that are
appropriate when interfacing with managed care organizations.
KEYWORDS managed care, emotional exhaustion, depersonalization, personal accomplishment, somatic symptoms, perceived
competence in the context of managed care, coping strategies
INTRODUCTION
Social workers, along with other human service workers, have shown to be
vulnerable to work stresses characteristic of those occupations that involve
ongoing contacts with people. External and internal pressures including role conflict, overload, economic problems of the health and mental
health systems, and increased accountability to managed care organizations,
Address correspondence to Gila M. Acker, Department of Social Sciences, York College
of The City University of New York, Jamaica, NY 11451, USA. E-mail: acker@york.cuny.edu
405
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G. M. Acker
have created new pressures for service providers, including social workers (Cohen, 2003; Daniels, 2001; Hall & Keefe, 2000; Keefe & Hall, 1998).
Job stress is thought to be largely a function of conflicts within the work environment, such as when workers feel that they cannot master organizational
and work demands, and that their job activities are inappropriate and incongruent with their training and expertise (Acker, 2004; Al-Garni, 2003; Arches,
1997; Cohen, 2003; Hall & Keefe, 2000; Lambert, Pasupuleti, Cluse-Tolar,
Jennings & Baker, 2006; Lloyd, King & Chenoweth, 2002). Prolonged stress
is associated with chronic anxiety, psychosomatic illness, emotional fatigue,
frustration, irritability, and a variety of other emotional problems (Lloyd, King
& Chenoweth, 2002). Burnout is a syndrome composed of three dimensions
including emotional exhaustion, depersonalization, and reduced personal
accomplishment (Maslach, Jackson & Leiter, 1996). Burnout has serious
implications for both the worker and the organization including poor job
performance, absenteeism, psychosomatic illnesses, and turnover (MontesBerges & Augusto, 2007; Thoresen, Kaplan, Barsky, Warren & Chermont,
2003).
Addressing burnout can increase employees’ efficiency and effectiveness in today’s increasingly cost-prohibitive world of care. Although the
empirical literature has emphasized that the ways that workers cope with
job stressors may be more important than the amount of stress itself (Gellis,
2002; Latack, 1992), insufficient attention has been paid to how social workers cope with the new culture of mental health care (Cohen, 2003; Feldman,
2001; Gellis, 2002; Hall & Keefe, 2000). In this study, the negative outcomes of job stress, including the psychological and the psychosomatic
disturbances of social workers, were explored in relation to workers’ coping
strategies.
BURNOUT
Burnout is defined as a negative psychological experience that is a reaction of workers to job-related stress such as challenging organizational
demands, lack of autonomy, unsupportive work environment, and large
caseload size (Acker, 2003, 2004; Arches, 1997; Gellis, 2002; Maslach,
Jackson & Leiter, 1996; Pines, 1983; Rosenbaum, 1992). Burnout refers
to a cluster of physical and emotional symptoms, including emotional
exhaustion, a lacking sense of personal accomplishment, and depersonalization of clients. Burnout symptoms can also include common colds,
flu-like symptoms, gastroenteritis, headaches, fatigue, poor self-esteem, difficulty in interpersonal relationships, and substance abuse (Maslach, 1982;
Maslach, Jackson & Leiter, 1996; Mohren, Swaen, Kant, Van Schayck &
Galama, 2005). It is critical to recognize that social workers confronted
by the complex needs of clients and the organizational demands of cost
How Social Workers Cope with Managed Care
407
containment are at risk to experience the negative symptoms associated
with burnout.
Job resources like supervision and other supportive mechanisms
directed toward workers have been diminishing with the lack of funding
associated with social services (Acker, 2003, 2004; Adams, 2001; Pumariega,
Winters, & Huffine, 2003). Lack of social support is known to be another
stressor associated with burnout, as workers who feel professionally unsupported are more likely to develop negative attitudes toward their job (Acker,
2003; Pines, 1983; Um & Harrison, 1998; Winnbust, 1993).
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MANAGED CARE
During the past two decades, managed care has become the new approach
and organizing theme for the delivery of mental health care services in
the United States. It strives to provide efficient quality care at a lower cost
than that offered in the fee-for-service professional community. The emergence of managed care has created a new source of stress for social
workers and other helping professionals. Managed care’s cost containment
approach, which includes limited access to necessary services, strict practice
guidelines, reduced autonomy, and increased accountability, has created
new challenges for social workers, who used to enjoy much more professional freedom and opportunities for decision making (Cohen, 2003; Egan
& Kadushin, 2007; Feldman, 2001; Keefe & Hall, 1998; Lu, Miller & Chen,
2002; Mechanic, 2007).
The increased involvement of managed care has had vast implications
for the role of social workers in the mental health care field. Social workers who perform the largest portion of mental health work in the United
States have been required to alter their role from serving as clients’ advocates to balancing clients’ needs against the need for cost control. In their
new roles as gatekeepers and treatment providers, social workers must learn
new strategies and skills to reduce considerable cost-savings expenditures
when providing services to clients (Cohen, 2003). Skills that social workers
need in the managed care environment involve computers and technology,
documentation and paperwork, empirical validation of treatment methods,
knowledge of brief treatment methods, and a business orientation in managing services in a profitable way (Bolen & Hall, 2007; Feldman, 2001;
Lu, Miller & Chen, 2002). Building on the concept of competence, which
describes feelings of confidence about one’s abilities to master organizational and work demands (Hall & Keefe, 2000; Wagner & Morse, 1975;
White, 1967), several theorists argue that a person’s belief that he or she cannot perform well professionally increases their risk of becoming burned out
(Bandura, 1989; Cherniss, 1993; Harrison, 1980). Participating in managed
care is complicated, and those who are not apprised about the managed
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G. M. Acker
care world are likely to suffer stress and anxiety concerning their ability to
provide effective services in the context of managed care (Hall and Keefe,
2000; Spevack, 2009).
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COPING STRATEGIES
Coping strategies are defined as the cognitive and behavioral efforts that
people use to manage external and/or internal demands appraised as taxing or exceeding the person’s resources (Lazarus, 1993; Lazarus & Folkman,
1984; Sears, Urizar & Evans, 2000; Shikai, et al., 2007). Lazarus and Folkman
(1984) describe two major strategies for coping with stress: problem-focused
coping and emotion-focused coping. Problem-focused coping consists of
active behaviors and deliberate efforts to solve the situation, and the use
of social support, including collaborative efforts to educate and support
each other at the workplace (Brooks & Riley, 1996; Jenaro, Flores & Arias,
2007). Emotion-focused coping, on the other hand, is directed at regulating
emotional responses to a problem, such as using alcohol, drugs, excessive sleep, and denial and disengagement behaviors (Lazarus & Folkman,
1984; Jenaro, Flores & Arias, 2007; Shikai, et al., 2007). Previous studies
have found problem-focused coping to be effective for reducing stress in
the workplace (Gellis, 2002; Jenaro, Flores & Arias, 2007; Koeske, Kirk &
Koeske, 1993; Riolli, 2003). On the other hand, previous studies have found
emotion-focused coping to be related to negative psychological outcomes
such as higher levels of occupational stress (Gellis, 2002; Jenaro, Flores &
Arias, 2007; Thornton, 1992; Koeske, Kirk & Koeske, 1993).
A growing body of literature is stressing that personal resources (coping strategies) may help workers adjust to job demands, and diminish the
stress associated with a difficult and demanding job environment (Gellis,
2002; Jenaro, Flores & Arias, 2007; Latack, 1992). With the impact of managed care on the professional lives of social workers, such as increased
demands for new management activities and paperwork, cost containment,
and ongoing demonstration that continued treatment is needed (Rupert &
Baird, 2004), it is important to understand how workers cope with these
job situations. Types of coping strategies that workers use when interfacing with managed care are important to explore as they are likely to affect
work outcomes of social workers (i.e., burnout). Although managed care
has not suffered from any lack of attention from both the public and the
professional media, there is limited data to support the notion that social
workers feel that they are not competent and/or able to master the organizational demands associated with managed care (Feldman, 2001; Cohen,
2003; Hall & Keefe, 2000; Keefe & Hall, 1998; Shera, 1996; Stone, 1995).
There is also scarce data about how social workers cope when interfacing with managed care, and the impact of managed care on negative job
How Social Workers Cope with Managed Care
409
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outcomes such as burnout (Feldman, 2001; Cohen, 2003; Rupert & Baird,
2004).
The aim of the present study was to explore in more depth the professional lives of social workers heavily involved in managed care, and to
identify the coping strategies they find most useful in helping them to deal
more effectively with the job demands associated with managed care and
in reducing negative work outcomes. This study will add to the knowledge of how managed care impacts social workers, and how social workers
respond to the new demands and challenges associated with managed care.
The hypotheses of the study include:
1. Social workers who use problem-focused coping are more likely to feel
more competent in the context of managed care.
2. Social workers who use emotion-focused coping strategies are less likely
to feel competent in the context of managed care.
3. Social workers who use problem-focused coping strategies are less likely
to suffer from burnout, including emotional exhaustion, depersonalization, reduced personal accomplishment, and somatic symptoms.
4. Social workers who use emotion-focused coping strategies are more likely
to suffer from burnout, including emotional exhaustion, depersonalization, reduced personal accomplishment, and somatic symptoms.
MATERIALS AND METHODS
Procedure
The sample of this study, which was obtained from a professional list of
social workers practicing in New York State, consisted of 591 social workers. Self-administered and anonymous questionnaire packets were mailed to
1,000 randomly selected individuals from this list. The overall response rate
was 58%. The institutional review board of the university where the author
is employed approved the study.
Sample
Educational levels of respondents included 89% with master degrees in
social work, and 5% with doctoral degrees. The respondents were primarily
females (80%). The mean age was 51, ranging from 21 to 80. Seventy-one
percent were married or involved in long-term relationship with a partner;
28% were not married. The respondents were predominantly White (86%);
5% were African American or Black, 7% were Latino, and 1% were Asian.
The mean for years of experience in social work was 22 years, ranging
from 2 to 50 years of employment. The median for client contact hour per
week was 25. Forty-three percent were employed in outpatient mental health
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G. M. Acker
settings, 13% in community support systems, 23 % in private practice, 7% in
substance abuse rehabilitation settings, 8% in inpatient psychiatric settings,
and 6% in schools.
Measures
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PERCEIVED
COMPETENCE IN THE CONTEXT OF MANAGED CARE
(CMC)
In this study, perceived competence in the context of managed care was
defined as workers’ feelings of confidence about their abilities in mastering organizational and work demands associated with managed care.
The CMC developed by Hall and Keefe (2000) included 16 items ranging
from “1 = strongly disagree” to “4 = strongly agree.” Higher scores indicated a perception of greater competence in the context of managed care.
Example of items included: “Managed care allows me enough direction to
be effective in treating clients”; “Coordinating care under managed care conditions is easy once you understand the various managed care company
requirements”; and, “Managed care allows me enough freedom to be effective in treating clients.” Hall and Keefe (2000) demonstrated that the CMC
had adequate validity and reliability. In this study, the Cronbach’s alpha for
the CMC was .86.
PROBLEM-FOCUSED
COPING STRATEGIES
(PFCS)
Problem-focused coping strategies described assertive efforts of the individual to alter stressful situations. PFCS were measured by a 10-item scale
developed by Folkman and Lazarus (1988). Examples of items are: “Stood
my ground and fought for what I wanted”; “I expressed anger to the person(s) who caused the problem”; and, “Talked to someone who could do
something concrete about the problem.” Respondents were asked to rate
each item on a 4-point Likert-type scale for the extent to which they used
each strategy during stressful job encounters in the past (0 = did not use;
1 = used somewhat; 2 = used quite a bit; 3 = used a great deal). PFCS
are known to have both good reliability and validity (Carver, Scheier &
Weintraub, 1989; Folkman, Lazarus, Dunkel-Schetter, DeLongis & Gruen,
1986). Cronbach’s alpha for this study sample was .84.
EMOTION-FOCUSED
COPING STRATEGIES
(EFCS)
This 9-item scale (Folkman & Lazarus, 1988) described wishful thinking
and efforts to escape or avoid stressful job related situations. Examples of
items were: “wished that the situation would go away or somehow be over
with,” “didn’t let it get to me; refused to think about it too much,” and
“tried to make myself feel better by eating, drinking, smoking, using drugs,
How Social Workers Cope with Managed Care
411
or medications.” Respondents were asked to rate each item on a 4-point
Likert-type scale as described before. EFCS are known to have both good
reliability and validity (Carver, Scheier & Weintraub, 1989; Folkman et al.,
1986). Cronbach’s alpha for this study sample was .76.
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SOCIAL
SUPPORT AT THE WORKPLACE
This scale was adapted from the social support from supervisor and social
support from co-workers scales (Caplan, Cobb, French, van Harrison, &
Pinneau, 1980). The new scale comprised eight questions about the extent to
which people around the worker (the worker’s supervisor and co-workers)
provided support by listening and by being persons that the worker can
rely on for help. Examples of questions are: “How much does your supervisor go out of the way to do things to make your life easier?” and “How
much are other people at work willing to listen to your personal problems?”
Cronbach’s alpha for this study sample was .88.
BURNOUT
Emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were measured by a slightly modified version of the Maslach
Burnout Inventory (Maslach, Jackson, & Leiter, 1996). The EE subscale comprised nine items reflecting feelings of being emotionally overextended,
exhausted, physical exhaustion, and emptiness. Examples of items included:
“Working with people all day is really a strain for me” and “I feel frustrated by my job.” The four items of the DP subscale described an unfeeling
and impersonal response toward clients of one’s service. It included such
items as “I feel I treat some as if they were impersonal objects” and “I
don’t really care what happens to some clients.” The PA subscale consisted
of six items that describe feelings of competence and successful achievement in one’s work. Examples of items included: “accomplishing worthwhile
things at work” and “positively influencing my clients’ lives through work.”
Respondents were asked to rate each statement on a 7-point Likert-type
scale for frequency of agreement (0 = never, 1 = a few times a year or
less; 2 = once a month or less; 3 = a few times a month; 4 = once a
week; 5 = a few times a week; 6 = every day). Cronbach’s alpha coefficient for this study’s sample included .92 for EE, .78 for DP, and .77
for PA.
SOMATIC
SYMPTOMS
This measure included two scales based on previous research done by
Mohren and colleagues (2005) and Nakao, Tamiya and Yano (2005). The first
scale (12 items) measured flu-like symptoms (e.g., colds, sore throat, cough,
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G. M. Acker
and fever). The second scale (3 items) measured symptoms of gastroenteritis
(GA). Respondents were asked to rate each item on a 7-point Likert-type
scale in terms of how often they have been experiencing each of those
symptoms for the past six months (0 = never, 1 = rarely; 2 = sometimes;
3 = fairly often; 4 = often; 5 = very often; and, 6 = all or most of the time).
Cronbach’s alpha coefficient for this study’s sample included .85 for common
colds and flu-like symptoms, and .75 for symptoms of gastroenteritis.
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DATA ANALYSIS
Pearson product-moment correlation coefficient was used to investigat …
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