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Client or former client? Implications of ex-client definition on social work practice.



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The study discussed in this article investigated the effect of the variation in individual worker definition of "former client" in relationship to workers' perceptions of appropriate professional behaviors during the provision of social work services. A random sample of 654 social workers who possessed MSW (MicroSoft Word) See Microsoft Word.  degrees, provided direct services to clients, and were members of NASW NASW National Association of Science Writers
NASW National Association of Social Workers (Washington, DC)
NASW National Association of Social Workers
NASW National Association for Social Work (UK) 
 were surveyed regarding their perceptions of appropriate behavior in seven practice domains: peripheral professional advice, concrete assistance, multiple or dual relationships, sexual and intimate relations, confidentiality and privacy, social relationships, and religion and prayer in practice. Variations in practice behavior perceptions were analyzed an·a·lyze  
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.

2. Chemistry To make a chemical analysis of.

3.
 in relationship to the worker's definition of an "ex-client." The overall findings suggest that there is a definite lack of consensus regarding the definition of a former client, and that this may affect practice standards and variations in views of appropriate professional behavior.

Key words: client definition; ethics ethics, in philosophy, the study and evaluation of human conduct in the light of moral principles. Moral principles may be viewed either as the standard of conduct that individuals have constructed for themselves or as the body of obligations and duties that a ; practice standards; professional behaviors

The social work profession is rooted in a set of core values and ethical principles that have much to say about obligations and responsibilities to clients (Gambrill & Pruger, 1997; Levy, 1993; Lowenberg & Dolgoff, 1988; Reamer reamer

Rotary cutting tool of cylindrical or conical shape, used for enlarging and finishing to accurate dimensions holes that have been drilled, bored, or cored. A reamer cannot be used to start a hole.
, 1995, 1998). The NASW Code of Ethics (2000) states that "'clients' is used inclusively to refer to individuals, families, groups, organizations, and communities" (p. 1). Social workers tend to apply this term broadly to refer to those who are receiving some type of service from the worker. However, the clarity of this definition becomes more ambiguous when considering the complexities of a seemingly seem·ing  
adj.
Apparent; ostensible.

n.
Outward appearance; semblance.



seeming·ly adv.
 simple question: When, if ever, does an individual cease to be a client? The answer to this question has important and broad implications affecting practice standards and variations in views of appropriate professional behavior.

The NASW Code of Ethics (2000) advances no definition of "former client" or "ex-client," although the terms are used implicitly or explicitly in several places (Sec. 1.07 (c), (n), and (o)). At times the terms client and former client appear to refer to the same individual and are used somewhat interchangeably, as in the statement, "Social workers should not engage in sexual activities or sexual contact with former clients because of potential for harm to the client" (p. 13).

The literature suggests three possible positions regarding the definition of former client, with many of these references found largely in the context of sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life. . The three positions are as follows: (1) There is no such entity as ex-client in that once a person is a client, he or she always remains a client in the context of professional relationships and responsibilities; (2) a specified time period after termination of services defines a transition from client to ex-client; and (3) a client ceases to be a client at the point of termination of services. Each perspective is based on assumptions and values that may affect interactions with clients.

Perspectives on Ex-Client Definition

Once a Client, Always a Client

Many of the arguments in support of the principle of once a client, always a client are grounded in concepts of power and the principle of "do no harm." Some authors argued that the very nature of the relationship between clients and social workers provides a context for ongoing professional responsibility (Epstein, 1994; Gabbard, 1994). Others asserted that there are posttermination ethical responsibilities, such as privacy and confidentiality, that should continue in perpetuity Of endless duration; not subject to termination.

The phrase in perpetuity is often used in the grant of an Easement to a utility company.


in perpetuity adj. forever, as in one's right to keep the profits from the land in perpetuity.
 (NASW, 2000, Sec 1.07 (r); Reamer, 1998; Silbertrust, 1993). The concept of transference also is used to support this view. For example, Epstein (1994) noted that "it should be remembered that in the unconscious mind, time has no relevance" (p. 133). Therefore, the nature of the professional relationship continues even after services have terminated and time has passed. Herman, Gartell, Olarte, Feldstein, and Localio (1987) concluded after a nationwide survey of psychiatrists This list includes notable psychiatrists.

Individuals listed below are all physicians, and are board certified by the American Board of Psychiatry and Neurology, or are members of the American Psychiatric Association, or the Royal College of Psychiatrists in the United Kingdom, or
 that "neither transference nor the real inequality inequality, in mathematics, statement that a mathematical expression is less than or greater than some other expression; an inequality is not as specific as an equation, but it does contain information about the expressions involved.  in the power relationship ends with the termination of therapy" (p. 168). Others have also documented the persistence of the effect of transference (Buckley, Karasu, & Charles, 1981; Gabbard, 1994; Luborsky, Diguer, & Barber, 1994).

Perhaps the most compelling argument in favor of the once a client, always a client definition is the fact that clients often return for social work services when new or recurring re·cur  
intr.v. re·curred, re·cur·ring, re·curs
1. To happen, come up, or show up again or repeatedly.

2. To return to one's attention or memory.

3. To return in thought or discourse.
 problems arise. In this context clients are viewed as being "active" or "nonactive" rather than taking on the status of ex-client. In a survey of former clients, Silbertrust (1993) found that 69 percent of the respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy.  had some posttermination contact with their therapists, with only 14 percent indicating that under no circumstances would they contact their therapists in the future. Similarly, Hartlaub, Martin, and Rhine (1986) found that two-thirds of successfully analyzed patients had contact with their analysts within three years of termination. These data suggest that posttermination contact may be the rule rather than the exception. Implicit in Adj. 1. implicit in - in the nature of something though not readily apparent; "shortcomings inherent in our approach"; "an underlying meaning"
underlying, inherent
 these studies is the notion that the perception of the client is that he or she can return for services when the need and desire are present.

Trends in managed care are also important determinants in services delivery to clients (Reamer, 1997; Strom-Gottfried & Corcoran, 1998). Managed care firms often promote episodic episodic

sporadic; occurring in episodes. e. falling a paroxymal disorder described in Cavalier King Charles spaniels in which affected dogs, starting at an early age, experience episodes of extensor rigidity, possibly brought on by stress. e.
 versus long-term treatment with a primary provider to encourage continuity and reduce costs. It may then be perceived that a social worker who has once provided a client with services is also a potential provider of future services over time and on an ongoing basis. Therefore, those with this perspective believe that the nature of the social worker-client relationship continues indefinitely in·def·i·nite  
adj.
Not definite, especially:
a. Unclear; vague.

b. Lacking precise limits: an indefinite leave of absence.

c.
.

After Specified Time Limit

Some professional organizations take a somewhat less absolutist position regarding the definition of an ex-client and define the category as one based on some time period defining a transition from client to ex-client (American Association for Marriage and Family Therapy, 1991; American Counseling Association, 1995; British Association for Counseling, 1996). Time frames ranging from immediately on termination of services to several years beyond are used to define former client and what is acceptable contact after the conclusion of services. Regretfully re·gret·ful  
adj.
Full of regret; sorrowful or sorry.



re·gretful·ly adv.

re·gret
, most of the literature addressing posttermination relationships does so in the context of sexual behavior (Bernsen, Tabachnick, & Keith-Spiegel, 1994; Sloan, Edmond, Rubin, & Doughty, 1998). For example, the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association (1995) require that a two-year period elapse e·lapse  
intr.v. e·lapsed, e·laps·ing, e·laps·es
To slip by; pass: Weeks elapsed before we could start renovating.

n.
 before psychologists may have sexual contact with former clients. Implications for professional behaviors can be suggested that, if one can at some point in time be allowed to have sexual contact with a former client, other types of interactions and relationships may also be appropriate (dual relationships, business associations, and so forth).

The NASW Code of Ethics (2000) uses prohibitory ACTION, PROHIBITORY, civil law. An action instituted to avoid a sale on account of some Vice or defect in the thing sold which readers it either absolutely useless, or its use so inconvenient and, imperfect, that it must be, supposed the buyer would not have purchased it, had he known of  language regarding sexual activity with clients and former clients, but states in the same section that social workers who do engage in sexual behavior with former clients as a result of extraordinary circumstances bear the full burden of "demonstrating that the former client has not been exploited, coerced, or manipulated intentionally in·ten·tion·al  
adj.
1. Done deliberately; intended: an intentional slight. See Synonyms at voluntary.

2. Having to do with intention.
 or unintentionally" (Sec. 107 (c)). However, little guidance is given to social workers regarding any other posttermination contact with former clients. Although there is variation in the time frames and characteristics used to define a former client, the concept that a client can become a former client and, thus, different parameters of interaction and behavior apply, is supported by this position.

At Termination of Services

This position is based on the concept of mutually agreed on contracts that end after an agreed upon Adj. 1. agreed upon - constituted or contracted by stipulation or agreement; "stipulatory obligations"
stipulatory

noncontroversial, uncontroversial - not likely to arouse controversy
 time period. Clients enter into service contracts with a variety of professionals (for example, lawyers and real estate agents) and are permitted to revoke To annul or make void by recalling or taking back; to cancel, rescind, repeal, or reverse.


revoke v. to annul or cancel an act, particularly a statement, document, or promise, as if it no longer existed.
 the agreement at any time. In most agreements, once the contractual obligations are fulfilled ful·fill also ful·fil  
tr.v. ful·filled, ful·fill·ing, ful·fills also ful·fils
1. To bring into actuality; effect: fulfilled their promises.

2.
, there are no ongoing responsibilities. This position argues that considerable attention is given in social work training regarding termination with clients. The Social Work Dictionary (Barker barker

a term for an animal that does not usually bark which makes a violent respiratory effort, often during a convulsion, accompanied by a sound which roughly resembles a dog's bark.
, 1999) defines termination as:

The conclusion of the social worker-client intervention process; a systematic procedure for disengaging dis·en·gage  
v. dis·en·gaged, dis·en·gag·ing, dis·en·gag·es

v.tr.
1. To release from something that holds fast, connects, or entangles. See Synonyms at extricate.

2.
 the working relationship. It occurs when goals are reached, when the specified time for working has ended, or when the client is no longer interested in continuing. (p. 483)

The NASW Code of Ethics (2000) encourages adequate preparation for termination with clients (Sec.1.16). There is a clear implication that an ending of some sort is occurring.

Another argument for this position focuses on the differences in client definitions that can emerge when there is consideration of such issues as the differing nature and context of the services provided; the size and definition of the client system; and the length, frequency, and time limitations of the contact (Herlihy & Corey, 1992). For example, professionals in the role of consultants providing one-time evaluations may not view themselves as entering a contractual obligation that involves ongoing professional responsibilities.

Client Definition Implications

What is apparent in the literature is the missing voice of the social work profession. The definition of ex-client has been addressed in passing in psychology and psychiatry psychiatry (səkī`ətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. , but no research exists, to the best of our knowledge, on the relationship between such definitions by the worker and the professional behavior of social workers with clients. Because perceptions often guide our behavior and definitional vacuums are typically filled by selfpronouncements, this research attempts to bridge a critical gap in the social work practice literature.

The research reported here identifies the current lack of consensus in the social work profession regarding the definition of ex-client and hypothesizes that the absence of a consistent definition has a significant effect on what social workers perceive as appropriate professional behavior during the provision of services to clients. Suggestions regarding possible strategies to further explore this important issue also are provided.

Method

Sample and Design

The study population consisted of 58,056 NASW members listed in the Membership Directory who possessed an MSW degree and identified themselves as being in direct practice. A random sample of 1,200 members meeting these criteria were mailed a 10-page questionnaire with a cover letter, commitment postcard, and return envelope. If the commitment postcard was not returned within three weeks, a second questionnaire, cover letter, and return envelope were mailed to the respondents. This procedure resulted in the return of 654 usable questionnaires (57.2 percent).

The mean age of respondents was 45.8 years, and 79.5 percent of the sample was female. Close to one-third (28.9 percent) earned an annual income between $35,000 and $45,000, whereas almost another third (29.9 percent) earned between $25,000 and $35,000. More than two-thirds of the respondents (67.7 percent) were married. The sample was predominantly pre·dom·i·nant  
adj.
1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant.

2.
 white (90.6 percent). The majority of the respondents worked in either the public (28.3 percent) or the private nonprofit A corporation or an association that conducts business for the benefit of the general public without shareholders and without a profit motive.

Nonprofits are also called not-for-profit corporations. Nonprofit corporations are created according to state law.
 (33.3 percent) sector, and 27.4 percent were in private practice. The study sample compared well with the NASW membership as described by Gibelman and Schervich (1993). These authors noted that the median age of NASW members was between 41 and 45 years, including the younger BSW BSW Bachelor of Social Work (degree)
BSW Bundesverband Solarwirtschaft (German Solar Industry Association)
BSW BrettspielWelt (online gaming site)
BSW Biblical Studies on the Web
 members. Women composed 75.7 percent of the membership and 88.5 percent were white. However, the study sample had a somewhat lower representation of workers in the public sector (28.3 percent) and the private nonprofits (33.3 percent) compared with 38.7 percent and 39. 1 percent, respectively, in NASW. These differences may at least in part be attributed to the fact that the NASW statistics include BSW practitioners, whereas this study sample deals only with MSW workers.

Study Variables

The critical predictor variable Noun 1. predictor variable - a variable that can be used to predict the value of another variable (as in statistical regression)
variable quantity, variable - a quantity that can assume any of a set of values
 in this analysis references the definition of former client or ex-client. In this study we did not provide a definition of client or ex-client. Rather, we simply asked the following question:

Practitioners have different views on the definition of an ex-client or former client. When would you consider someone to whom you have provided services to be an ex-client?

(1) at the time services are terminated

(2) once a client, always a client

(3) other (specify)

We used this technique in the questionnaire because, as noted before, the NASW Code of Ethics (2000) does not define client or ex-client. This strategy not only presented the respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests.  with the extreme positions with regard to the definition of ex-client but also offered the option of a middle-ground response that they could specify individually.

Jayaratne, Croxton, and Mattison (1997) reported on a national study of practice behaviors and beliefs of direct practice social workers. Using information from this survey tool, which identified various categories of behavior related to ethics and standards of practice, information from a literature review of other professions regarding ethical practice issues (Borys & Pope, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987), and feedback from both the state chapter and the national office of the NASW Committee on Inquiry cases, seven practice domains were identified for consideration in this study. A questionnaire was developed that contained a series of items referencing behaviors between workers and their clients. The questions asked the respondents to state the degree to which they considered the stated behaviors to be appropriate or inappropriate professional conduct, but did not ask if they actually performed the behaviors. The response patterns revealed the degree of acceptance or rejection of the identi fied behaviors as appropriate conduct for social workers.

Thus, the dependent variables in this study constitute seven different constructed scales of these practice standard domains (Jayaratne et al., 1997). A principal components factor analysis with varimax rotation was used for this purpose. Only items uniquely loading with a factor coefficient coefficient /co·ef·fi·cient/ (ko?ah-fish´int)
1. an expression of the change or effect produced by variation in certain factors, or of the ratio between two different quantities.

2.
 of .40 or better were included in a scale. The emerging scales were peripheral professional advice; concrete assistance; multiple or dual relationships; sexual and intimate relations; confidentiality and privacy; social relationships; and religion and prayer in practice. Responses were based on a five-point scale, with 1 = "very appropriate" and 5 = "not at all appropriate." Thus, in all instances the higher the score, the more inappropriate the behaviors represented in the scale.

Results

Demographic Characteristics

Four demographic characteristics were examined in relation to the respondents' definition of a former or ex-client, given that prior research had indicated that these particular domains may have an effect on practice behaviors: gender, income, auspices aus·pi·ces 1  
n.
Plural of auspex.


auspices
Noun, pl

under the auspices of with the support and approval of [Latin auspicium augury from birds]

Noun
, and age (see Table 1). Age was grouped above and below the mean age of 45.8 years for this analysis. Although race or ethnicity ethnicity Vox populi Racial status–ie, African American, Asian, Caucasian, Hispanic  may be an important and significant explanatory ex·plan·a·to·ry  
adj.
Serving or intended to explain: an explanatory paragraph.



ex·plan
 variable, we did not conduct any race and ethnicity contrasts given the small number of ethnic minority respondents (61 across all ethnic minority groups in the study sample).

Only auspices emerged as significant between the two groups. Respondents in the private practice arena were far more likely to believe in the principle of once a client, always a client, whereas those in the public sector were more likely to report that clients become former clients at the point of termination of services. This finding could be explained by both the nature and character of services generally provided by the workers in these two contexts of practice. Public sector social workers compared with private practitioners are far more likely to engage in legally defined time-limited services and to provide concrete services, to see clients who by definition are transitory and temporary in character, and to have clients who are more likely to be involuntary involuntary adj. or adv. without intent, will, or choice. Participation in a crime is involuntary if forced by immediate threat to life or health of oneself or one's loved ones, and will result in dismissal or acquittal.


INVOLUNTARY.
.

The majority of respondents chose one of the two discrete definitions of ex-client that were provided rather than opting to write an individual definition. The respondents were almost equally split in their definition of former or ex-client, with 46.8 percent indicating once a client, always a client, and 40.9 percent indicating one becomes an ex-client at the time of termination. The remaining 12.1 percent, a little over 80 respondents, indicated various time periods ranging from six months to 10 years. The small numbers in these distinct categories precluded analyses related to these subsets of time periods.

Table 2 presents the different scales, constituent items, and alpha coefficients for internal reliability. Although the vast majority of respondents considered most of the questionable practice behaviors inappropriate professional conduct, a significant number of respondents were uncertain. For example, although 70.0 percent of the respondents considered it inappropriate to have as a client someone with whom you have another relationship, 20.1 percent were uncertain, and nearly 10 percent thought it was appropriate. Similarly, whereas nearly 49 percent of the respondents considered it inappropriate for social workers to pray with their clients, nearly a one-third were uncertain, and 21.4 percent considered this appropriate conduct. Thus, these illustrative il·lus·tra·tive  
adj.
Acting or serving as an illustration.



il·lustra·tive·ly adv.

Adj. 1.
 response patterns clearly demonstrate considerable disagreement and uncertainty within the profession about many aspects of professional conduct.

Table 3 presents t tests comparing the mean scores of the two termination groups on the practice standards measures. It is clear that the definition of former client had a significant and consistent relationship to the judgment of whether specific sets of behaviors are considered appropriate professional conduct. In all instances, the practitioners who believed in the definition of once a client, always a client were significantly more conservative in judging the appropriateness of the measured behaviors.

Table 4 presents a regression analysis In statistics, a mathematical method of modeling the relationships among three or more variables. It is used to predict the value of one variable given the values of the others. For example, a model might estimate sales based on age and gender. , where the demographic characteristics were entered first into the equation as control variables. The termination criterion emerged as a significant predictor in all instances but social relationships. Furthermore, with the exception of the social relationships scale, the definition of ex-client was the strongest predictor across all of the practice behavior dimensions. On the other hand, the small amount of variance explained suggests that the model used in this analysis is incomplete, and some important factors have been left out of the study.

Discussion

When the data are examined more closely, subtle yet potentially important patterns emerge. Practice setting, or auspices, provides a clue to the acceptance of certain behaviors. We found that workers in the public sector (who were more likely to define someone as an ex-client at the point of service termination compared with their colleagues in other settings) were significantly more likely to consider appropriate the provision of concrete assistance and a breach of confidentiality. One could perhaps explain the issue of concrete assistance by virtue of the fact that much of public sector work consists of providing discrete services and support. The public sector provider is less likely to engage in long-term treatment. Rather, these workers are more likely to provide clients with specific resources (money and goods, for example) and are also more likely to refer clients to other service providers. On the other hand, explaining why these workers would condone condone v. 1) to forgive, support, and/or overlook moral or legal failures of another without protest, with the result that it appears that such breaches of moral or legal duties are acceptable.  the breaching of confidentiality is less evident. A somewhat negative and unlikely perspective would suggest that these workers show little professional consideration or regard for their public sector clients. A more positive view would be that these workers are attempting to build a supportive client environment, one that would enhance the well-being of the client, even at the risk of violating client confidentiality The examples and perspective in this article or section may not represent a worldwide view of the subject.
Please [ improve this article] or discuss the issue on the talk page.
. This perspective is based on the fact that the scale items were constructed within the context of the client's best interest (see Table 2). Yet another explanation may be that these workers are forced to engage in these behaviors by virtue of existing rules and regulations. However, this does not answer the question of why such behavior would be condoned by the worker, given professional guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
 about confidentiality.

We also found that the public sector workers differed significantly from private practitioners in approving multiple or dual relationships with clients. We can only speculate, but this may truly be a function of the context of practice. Private practitioners (who were far more likely to define clients as once a client, always a client) are more likely to work with their clients for longer periods of time and are more likely to deal with problems of a more psychological or intimate nature compared with public sector workers. The very nature of the connection that typifies a private practitioner as "therapist" conjures an image of an intense and highly personal client--worker relationship. Any behavior that would impair im·pair  
tr.v. im·paired, im·pair·ing, im·pairs
To cause to diminish, as in strength, value, or quality: an injury that impaired my hearing; a severe storm impairing communications.
 or damage this relationship may be viewed as taboo, something that not only would harm the therapeutic alliance but also could result in the loss of a client. The fact that the nonprofit sector workers did not differ significantly from either the private or the public sector workers further rein forces this argument. Practitioners in these settings are more likely to see a far more diverse array of clients and hence engage in a broader spectrum of interventions.

The findings on age differences indicated that younger workers were less likely to condone behaviors related to dual relationships, intimacy, and social relationships with clients than their older counterparts. This could be viewed as "wisdom of youth," where the younger workers are not only sensitive to their own vulnerabilities but perhaps more attuned at·tune  
tr.v. at·tuned, at·tun·ing, at·tunes
1. To bring into a harmonious or responsive relationship: an industry that is not attuned to market demands.

2.
 to the potential dangers associated with such behaviors. They may simply be afraid of engaging in behaviors that appear to have potential impropriety. It is also possible that the younger workers have had greater exposure to content on professional ethics professional ethics,
n the rules governing the conduct, transactions, and relationships within a profession and among its publics.

professional ethics liability,
n 1.
 by virtue of the relatively recent Council on Social Work Education The Council on Social Work Education (CSWE) is the national association for social work education in the United States of America.

The CSWE sets and maintains standards of courses and accreditation of bachelor's degree's and Master's degree programs in social work.
 (1994) standard on the infusion of content on values and ethics in the curriculum. The more experienced older workers may perceive such situations as less pertinent to them, and therefore view themselves as unlikely to engage in these behaviors. But their positive responses in this regard may be guided by experience and the belief that such relationships are inevitable. It is not uncommon, for example, to note that rural practitioners find themselves in unenviable and unavoidable dual relationship situations purely as a function of the context of practice. However, whether this justifies dual relationships remains a question in need of an answer.

Overall, the data suggest that certain behaviors may be questionable in the larger scheme of professional conduct and ethical behavior and are influenced both by the auspices of practice and the age of the practitioner. Although it could be argued that age is correlated cor·re·late  
v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates

v.tr.
1. To put or bring into causal, complementary, parallel, or reciprocal relation.

2.
 with auspices to some extent, with older workers more likely to be found in private practice, the results point to independent effects. Both younger workers and private practitioners were more likely to disapprove dis·ap·prove  
v. dis·ap·proved, dis·ap·prov·ing, dis·ap·proves

v.tr.
1. To have an unfavorable opinion of; condemn.

2. To refuse to approve; reject.

v.intr.
 of dual relationships compared with public sector workers and older practitioners. Thus, it would appear that something other than auspices and age played a critical role with regard to the approval of engaging in these boundary behaviors.

Our findings underscore The underscore character (_) is often used to make file, field and variable names more readable when blank spaces are not allowed. For example, NOVEL_1A.DOC, FIRST_NAME and Start_Routine.

(character) underscore - _, ASCII 95.
 the importance of defining when a client is no longer a client. The profession trains social workers in the process of termination but fails to clarify the nature or the client-worker relationship after termination. The result is a confused practitioner. We contend that defining when a client is no longer a client is of paramount importance in professional conduct and workers' judgment about a variety of behaviors that are arguably ar·gu·a·ble  
adj.
1. Open to argument: an arguable question, still unresolved.

2. That can be argued plausibly; defensible in argument: three arguable points of law.
 on the boundaries of appropriateness. This lack of agreement on the definition of an ex-client is found across all demographic contexts. Neither age, experience, practice setting, nor gender explained the variation. The lack of a universally accepted definition may place the client, the practitioner, and the profession at risk. Many of the concepts, guidelines, and prohibitions explicated in the NASW Code of Ethics (2000) rely on an understanding of the meaning of client. The absence of an agreed on definition results in practitioners operating under varyin g assumptions, that is, their own constructed definitions. Thus, both practice behaviors and judgments about ethical conduct may be compromised. The process of adjudication The legal process of resolving a dispute. The formal giving or pronouncing of a judgment or decree in a court proceeding; also the judgment or decision given. The entry of a decree by a court in respect to the parties in a case.  of cases by state and national committees on inquiry, licensing boards, and courts of law may be clouded and confused.

This study raises several issues for further research and exploration. The applicability of definitions and standards of practice must be examined in the context of practice and the scope of services delivery. Consideration should be given to whether all or some of the standards are universally applicable across all settings and client systems. Also, we know very little about what clients themselves think about their own relationship with a worker. When do they consider a "worker no longer their worker"? Furthermore, the advent of managed care and time-limited services within prescribed pre·scribe  
v. pre·scribed, pre·scrib·ing, pre·scribes

v.tr.
1. To set down as a rule or guide; enjoin. See Synonyms at dictate.

2. To order the use of (a medicine or other treatment).
 parameters may further muddy the situation and increase the need for more specific contracting with clients to clarify the nature and duration of the relationship. Finally, whereas our study focused only on direct services providers, interesting and parallel questions emerge if the practice of community organizers and administrators were to be examined.

The complex question of "Who is an ex-client?" needs to be addressed by the social work profession. Rather than leave decisions to others outside the profession, we need to take the initiative to engage in a substantive dialog to clarify and reach consensus regarding an ex-client definition. We do no service by operating out of our own individual assumptions about definitions that profoundly affect practice behaviors. We suggest that we owe a duty to our clients, our profession, and ourselves to address this lingering lin·ger  
v. lin·gered, lin·ger·ing, lin·gers

v.intr.
1. To be slow in leaving, especially out of reluctance; tarry. See Synonyms at stay1.

2.
 question and improve consistency in implementing our professional ethical standards.

References

American Association for Marriage and Family Therapy. (1991). AAMFT code of ethical principles for marriage and family therapist. Washington, DC: Author.

American Counseling Association. (1995). ACA ACA - Application Control Architecture  code of ethics and standards of practice. Alexandria, VA: Author.

American Psychological Association. (1995). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

Barker, R. L. (1999). Social work dictionary (4th ed). Washington, DC: NASW Press.

Bernsen, A., Tabachnick, B. G., & Keith-Spieigel, P. (1994). National survey of social worker's sexual attraction Noun 1. sexual attraction - attractiveness on the basis of sexual desire
attractiveness, attraction - the quality of arousing interest; being attractive or something that attracts; "her personality held a strange attraction for him"
 to their clients: Results, implications, and comparison to psychologists. Ethics and Behavior, 4, 369-388.

Borys, D. S., & Pope, K. S. (1989). Dual relationships between therapists and clients: A national study of psychologists, psychiatrists and social workers. Professional Psychology: Research and Practice, 20, 283-293.

British Association for Counseling. (1996). BAC BAC
abbr.
blood alcohol concentration
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Table 1

Comparison of Termination Criterion, by Demographic Characteristics

                              At Service                 Always a
                              Termination                 Client
Criterion                N             %          N          %

Gender
  Male                  52            48.1       56         51.9
  Female               208            45.9      245         54.1
Income ($)
  25,000 or less        42            51.2       40         48.8
  25,001-35,000         82            50.0       82         50.0
  35,001-45,000         69            42.3       94         57.7
  45,001 or more        70            45.2       85         54.8
Auspices
 Public                 88            55.4       70         44.3
 Private practice       51            33.1      103         66.9
 Nonprofit              86            45.5      103         54.5
Age
 Less than or equal
 to 45.8 years         128            46.9      145         53.1
 More than 45.8 years  135            46.4      156         53.6



Criterion              [chi square]

Gender                     0.175
  Male
  Female
Income ($)                 2.787
  25,000 or less
  25,001-35,000
  35,001-45,000
  45,001 or more
Auspices                  16.114 (*)
 Public
 Private practice
 Nonprofit
Age                        0.014
 Less than or equal
 to 45.8 years
 More than 45.8 years

(*)p< .0005.
Table 2

Distribution of Respondents (and %) across Scale Items

                                          Scale Scores
                                    1-2                    3
Criterion                    N         %         N         %

Peripheral professional
advice ([alpha] = .75)

  Give medical advice to
    clients other than
    referring to a
    physician                44        6.9       79       12.4
  Give legal advice to a
    client other than
    referring to a lawyer    41        6.4       69       10.7
  Give financial
    investment advice to
    your clients             13        2.0       32        5.0

Concrete assistance
([alpha] = .79)

  Loan your car
    to a client              11        1.7        7        1.1
  Give a ride to a client   153       24.0      172       26.3
  Help a client with a
    move or other
    big chore                59        9.3       66       10.4
  Loan tools or
    equipment to a client    47        7.4      108       17.1
  Pay for a client's
    lunch with your
    own money                87       13.6      144       22.5

Multiple or dual
relationships
([alpha] = .75)

  Accept business
    associates or
    coworkers as clients     55        8.5       81       12.6
  Have clients with whom
    you have another
    relationship             63        9.9      128       20.1
  Accept relatives or
    friends as clients       27        4.2       34        5.3

Sexual and intimate
relations ([alpha] = .86)

  Go out on a date
    with an ex-client        11        1.7       20        3.1
  Have sex with a client's
    relative or other
    individual with whom
    the client has a close
    personal relationship     8        1.3        7        1.1
  End a professional
    relationship with a
    client in order
    to have a personal
    relationship             24        3.7       35        5.4
  Kiss a client
    on the lips              10        1.6        2        0.3
  Kiss a client on
    the cheek                47        7.4       76       11.9
  Have sex with
    an ex-client             14        2.2       13        2.0

Confidentiality and
privacy ([alpha] = .60)

  Share confidential
    information about
    client with relatives
    without client's
    consent when you
    thought it was
    in the client's
    best interest?           75       11.8       71       11.2
  Share confidential
    information about
    client with others
    (not family
    relatives) without
    client's consent when
    you thought it was
    in the client's best
    interest?                81       12.7       88       13.8

Social relationships
([alpha] = .70)

  Accept a client's
    invitation to a party
    or special event
    (e.g., wedding?)        113       17.5      242       37.5
  Participate in
    recreational or
    social activities
    with your clients?      107       16.8       86       13.5
  Look after a client's
    belongings (house,
    pets, etc.) for
    a while?                 12        1.9       25        3.9
  Ask favors from a
    client (e.g.,
    a ride home)?            12        1.9       33        5.1
  Invite a client to
    your home for a
    social event?            19        3.0       29        4.5

Religion and prayer in
practice ([alpha] = .80)

  Discuss your
    religious beliefs
    with your clients?      105       16.5      163       25.5
  Pray with clients
    during sessions
    at their request?       138       21.4      191       29.8
  Use the "serenity
    prayer" as part of
    your treatment
    program?                243       38.2      195       30.7
  Recommend a religious
    form of healing?         57        8.9      106       16.6
  Initiate or recommend
    the "laying on
    hands" as a
    healing technique?       32        5.1       74       11.7
  Request a client to
    pray with you
    during a treatment
    session?                 20        3.2       41        6.4

                                Scale Scores
                                    4-5
Criterion                    N         %

Peripheral professional
advice ([alpha] = .75)

  Give medical advice to
    clients other than
    referring to a
    physician               517       80.7
  Give legal advice to a
    client other than
    referring to a lawyer   535       82.9
  Give financial
    investment advice to
    your clients            596       93.0

Concrete assistance
([alpha] = .79)

  Loan your car
    to a client             624       97.2
  Give a ride to a client   312       49.7
  Help a client with a
    move or other
    big chore               509       80.3
  Loan tools or
    equipment to a client   478       75.5
  Pay for a client's
    lunch with your
    own money               410       63.9

Multiple or dual
relationships
([alpha] = .75)

  Accept business
    associates or
    coworkers as clients    508       78.9
  Have clients with whom
    you have another
    relationship            447       70.0
  Accept relatives or
    friends as clients      576       90.5

Sexual and intimate
relations ([alpha] = .86)

  Go out on a date
    with an ex-client       611       95.2
  Have sex with a client's
    relative or other
    individual with whom
    the client has a close
    personal relationship   623       97.6
  End a professional
    relationship with a
    client in order
    to have a personal
    relationship            584       90.9
  Kiss a client
    on the lips             630       98.1
  Kiss a client on
    the cheek               514       80.7
  Have sex with
    an ex-client            611       95.8

Confidentiality and
privacy ([alpha] = .60)

  Share confidential
    information about
    client with relatives
    without client's
    consent when you
    thought it was
    in the client's
    best interest?          489       77.0
  Share confidential
    information about
    client with others
    (not family
    relatives) without
    client's consent when
    you thought it was
    in the client's best
    interest?               469       73.5

Social relationships
([alpha] = .70)

  Accept a client's
    invitation to a party
    or special event
    (e.g., wedding?)        291       45.0
  Participate in
    recreational or
    social activities
    with your clients?      445       69.7
  Look after a client's
    belongings (house,
    pets, etc.) for
    a while?                603       94.2
  Ask favors from a
    client (e.g.,
    a ride home)?           596       93.0
  Invite a client to
    your home for a
    social event?           593       92.5

Religion and prayer in
practice ([alpha] = .80)

  Discuss your
    religious beliefs
    with your clients?      371       58.0
  Pray with clients
    during sessions
    at their request?       312       48.8
  Use the "serenity
    prayer" as part of
    your treatment
    program?                198       31.1
  Recommend a religious
    form of healing?        475       74.5
  Initiate or recommend
    the "laying on
    hands" as a
    healing technique?      528       83.2
  Request a client to
    pray with you
    during a treatment
    session?                577       90.4
Table 3

Comparison of Mean Scores on the Standards Measures, by Service
Termination

Criterion                  n     M     SD   t value    p

Peripheral professional
advice
  At service termination  259  4.413  0.82   -2.36   .05
  Always a client         297  4.562  0.68
Concrete assistance
  At service termination  253  3.823  0.89   -5.81   .0001
  Always a client         293  4.221  0.70
Multiple or dual
relationships
  At service termination  257  4.107  0.92   -7.33   .0001
  Always a client         295  4.580  0.59
Sexual and intimate
relations
  At service termination  255  4.503  0.63   -3.46   .001
  Always a client         295  4.661  0.43
Confidentiality and
privacy
  At service termination  261  4.052  1.09   -2.77   .01
  Always a client         299  4.289  0.94
Social relationships
  At service termination  263  4.123  0.83   -5.44   .0001
  Always a client         300  4.451  0.60
Religion and prayer in
practice
  At service termination  255  3.823  0.89   -3.55   .0001
  Always a client         295  4.071  0.71
Table 4

Regression Analyses on Standards Measures, by Demographics and
Termination Point

Criterion                         [beta]    f value    p    [R.sup.2]

Peripheral professional advice
  Age                              .06       1.443    NS       .01
  Gender                           .01      (5,483)
  Income                           .04
  Auspices                        -.03
  Termination point                .09 (*)
Concrete assistance
  Age                              .03       8.346   .0001     .07
  Gender                           .03      (5,475)
  Income                           .07
  Auspices                         .12 (*)
  Termination point                .24 (*)
Multiple or dual relationships
  Age                             -.10 (*)  12.943   .0001     .11
  Gender                           .05      (5,480)
  Income                           .07
  Auspices                         .11 (*)
  Termination point                .29 (*)
Sexual or intimate relations
  Age                             -.15 (*)   4.371   .001      .03
  Gender                           .04      (5,480)
  Income                           .04
  Auspices                        -.01
  Termination point                .14 (*)
Confidentiality and privacy
  Age                             -.01       3.852   .005      .03
  Gender                           .12      (5,487)
  Income                           .05
  Auspices                         .11 (*)
  Termination point                .13 (*)
Social relationships
  Age                              .19 (*)   4.999   .0005     .04
  Gender                           .13 (*)  (5,481)
  Income                          -.01
  Auspices                         .02
  Termination point               -.04
Religion and prayer in practice
  Age                              .01       3.861   .005      .03
  Gender                           .09      (5,480)
  Income                           .08
  Auspices                        -.02
  Termination point                .14 (*)

NOTE: NS = nonsignificant.

(*)[beta]values are significant at < .05 or higher.
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Date:Jan 1, 2002
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