FOR CLINICAL social workers in volved in providing direct interve tion to patients or clients of health, men tal health, and human services, this is the age of accountability. Demands for ac countability that affect clinical social workers (as well as other mental health professionals) are both internal and ex ternal. The internal demands emanate from standards, guidelines, and ethical principles, promulgated by the profes sion and internalized by the individual practitioner. External accountability demands come from clients, purchasers and third-party payors, and legal and regulatory bodies. Because each of these entities has a different concern, conse quently the accountability requirements each one imposes also is different. Although many recent requirements for accountability are external, they are con sistent with the traditional commitment of social work to be responsible for its professional activities and the outcomes. This commitment is reflected in the codes of ethics, standards for profes sional behavior, practice texts, and posi tion papers that describe clinical social work activities.1 The commitment of the profession to accountability has come from philosoph ical and ethical considerations primarily, which have been part of the growth of social work and individuation process, and which help form the consciences of social workers as they become socialized to the values of the profession. The authors have found that for more ex perienced practitioners, the pressure to be accountable comes primarily from the internal checks and balances. Two external factors—(1) the increase in consumer advocacy within the client population and (2) the growing commer cialization of practice—have contributed significantly to the recent and dramatic increase in emphasis on accountability in clinical practice. These factors have helped to create a new climate in which practitioners are asked to articulate and Shelomo Osman Sharon A. Shueman
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