3. To review the major sections of the Social Work Code of
Ethics
To understand some of the legal precedents that
supercede the ethical standards and the tension
between the two
To learn a general decision-making model and an
ethical screen as a guideline for ethical decision-making
To apply ethical decision-making to a variety of practice
situations
To appreciate that in ethical decision-making there are
often unclear parameters surrounding the decision
4. Introductions and Overview for the Day
Review legal issues, ethical responsibilities to
clients, colleagues, practice settings, social work
profession, and broader society
Process of ethical decision-making
BREAK!
Dual relationships and NASW position on rural
social work
Film: Subtle Boundary Issues (Hazeldan)
LUNCH!
5. Ethics at Work
Decision-making model and value screen
Privacy and confidentiality
Conflict of interest, dual relationships, sexual
behavior
Informed consent and client self-determination
Impairment, incompetence, and unethical conduct
of colleagues
Best practices: De-escalation and termination
BREAK!
12. Legal Issues
What is the complaint process at your
organization?
What are the legal issues that you are
most concerned about in your practice?
What protections/safeguards do you have
in place or what preventative measures do
you employ?
15. When Do Clients Tend to Sue?
Disappointed with outcome of the
intervention
Believe they have been exploited or used
financially, emotionally, or sexually
Had a negative outcome and attributed it
to the social worker’s incompetence or
negligence
Presented with a bill larger or much later
than expected
16. What Constitutes Negligence,
Malpractice, and Liability?
Issues of “standard of care” – how would a
competent social worker behave in a
specific practice situation with children and
families?
Practice standards - predetermined best
practice standards - see NASW lists
17. Negligence
Defined as, “Performance outside of what
a reasonable professional in a similar
situation would do”. The four elements
that would be considered by the courts:
18. Negligence
Was there a legal duty to the client?
Was there a breach of duty through
action/inaction?
Was harm or damage incurred by the
client?
Was there causal connection between the
breach of duty and the resultant harm?
19. Types of Negligence
Acts of Commission or
Malfeasance-did; should not
have
Acts of Omission or
Nonfeasance-should have
done; did not
21. Categories of Malpractice
Civil Lawsuits-potential monetary
damages
Criminal Complaints-potential criminal
sanctions such as probation and jail
Licensing Board Complaints-potential loss
of license to practice for varying periods of
time
22. In general, the plaintiff in a
successful malpractice suit must
prove four points.
The defendant (e.g., the social worker) was
obligated to provide the plaintiff with a
particular standard of care or professional
conduct.
The worker was derelict because he or she
breached that obligation (or duty) by some
act or omission that had a foreseeable
consequence.
23. Four points continued
The client suffered some injury or harm
(physical, financial, emotional, etc.)
The worker’s conduct was a direct or proximate
cause of the client’s injury or harm.
24. Risk Management
Licenses
Registrations in Order
Protocols for Emergency Situation
Insurance Coverage Paid
Maintenance and Safeguarding Client
Records
Specialist Consultants
Diagnosis and Treatment
Frederick G. Reamer. 2001. The Social Work Ethics Audit: A Risk Management Tool. NASW Press.
Tool.
25. Risk Management-cont.
Consultation with legal counsel
Second-Opinion Referrals
Ruling out Pathology
Psychological Testing
Appropriateness of Psychotropic
Medication
Continuing Education
29. Values and Ethics
Values are concerned with what is good and
desirable
Ethics deal with what is right and correct
Ethics are rules of conduct to direct social
workers in a manner consistent with the
values of the profession
30. Values and Ethics
Social Work Values
1.
2.
3.
4.
All human beings deserve access to the resources they
need to deal with life’s problems and to develop their
potentialities
All human beings have intrinsic worth and dignity
The uniqueness and individuality of each person is of
value.
Given appropriate resources, human beings are capable
of growth and change and should be supported in
increasing their choices in solving their problems and
directing their lives
31. Primary goal is to help people in need & address social
problems
Challenge social injustice
Respect dignity & worth of the person
Importance of human relationships
Behave in a trustworthy manner
Practice in the area of competence and continue
professional development
33. Dual Relationships
What are dual relationships?
The practice of assuming a second role with
a client
Examples?
34. Dual Relationships
The Code says…
“Social workers should not engage in a dual
or multiple relationships with clients or
former clients in which there is a risk of
exploitation or potential harm to the client”
36. Dual Relationships
and Rural Areas
Rural Policy Statement
Ethical practice in rural areas requires special
attention to the issue of dual relationships
They are unavoidable and need to be
managed
37. Dual Relationships
and Rural Areas
How do you keep professional and social
relationships separate or distinct?
What is the risk of working with someone
that you know through community
involvement?
How do you handle confidentiality and
conflict of interest?
38. Dual Relationships
and Rural Areas
What do you do when you see a client at
the store?
What if a client wants to give you a gift or
wants to barter for services?
39. Engaging in a
“Dual Relationship”
Entering a business relationship with a
current or former client
Participating in a romantic or a sexual
relationship with a current or former client
Establishing dual relationships with
instructor/students…in the field and in the
classroom
42. Ethical Rules Screen (ERS)
Examine the Code of Ethics to determine if any of
the Code rules are applicable. These rules take
precedence over the worker’s personal value system.
One or more of the
Code rules apply:
Follow the Code rules.
The Code does not address
the specific problem, or
several Code rules provide
conflicting guidance:
Use the ethical principles screen.
Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7th Edition, F. E. Peacock
43. Ethical Principles Screen (EPS)
1.
Protection
of life
2. Equality and
inequality
3. Autonomy and freedom
4. Least harm
5. Quality of life
6. Privacy and confidentiality
7. Truthfulness and full disclosure
Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7th Edition, F.E. Peacock.
44.
45. Values and Ethics
Managing Ethical Dilemmas
Right to life, health and well-being
Right of confidentiality
Right to life, health and well-being
Right to privacy or self-determination
46. Values and Ethics
Right of self-determination
Right to basic well-being
Right to basic well-being
Laws, policies, arrangements of organizations
47. Privacy and confidentiality
Conflict of interest, dual
relationships, sexual behavior
Informed consent and client selfdetermination
Impairment, incompetence, and
unethical conduct of colleagues
48. Confidentiality
Safeguarding confidentiality involves respecting
client privacy, gathering information only for the
purpose of providing effective services, and
disclosing information only with client consent
The Tarasoff case represents an example of the limits on
confidentiality.
50. Failure to Maintain
“Confidentiality”
Often unintentional
Confidential nature of relationship and of the
information obtained in the relationship
Exception found in the “Duty to Warn”
*Threats of violence
*Threat is imminent
*Likelihood that threat will be carried out in
foreseeable future
*Victim(s) identified
Method? Motive? Opportunity?
51. Failing to Maintain “Accurate
and Complete Records”
Developing accurate assessments
Free of judgmental language and hear
say
Confidentiality guarded
Records document the service and
quality of care
52.
Informed Consent
Informed consent:
requires Social Workers to clearly communicate
to a client(s) the purpose of the services, possible
risks related to the service, limitations of the
service, costs, alternatives to the service, clients’
right to refuse or withdraw consent, and the time
frame covered by the consent
53. Legal Responsibility to Obtain
“Informed Consent”
Clients right to expect the same degree of
competence as that provided by other
practitioners
Intended to guarantee clients’ freedom,
privacy, and safety
Including the use of audio or video taped
client sessions for course requirements
56. Conduct of Colleagues
What should you do if you suspect that a
colleague is in violation of an ethical principle?
Always get the facts (evidence, harm)
Options for next steps…See Code of Ethics-Section
2.11
61. De-escalation (handout)
What is it?
Decrease in intensity, magnitude or amount
What might it mean when engaging a
potentially violent child or parent?
What methods/techniques do you employ?
Handout Number of Ethical Violations Found; Gottfried, K.S. 2000. Ensuring ethical practice: an examination of NASW code violations 1986-1997. Social Work. 5(3), p. 253-54. Discuss implications
Handout-Legal precedents; discuss
Handout-Tarasoff case-discuss in light of section 1.07, Code of Ethics
Discuss the differences between confidentiality and privilege-will be discussed on slides 22-23- Wigmore’s tests in relation to this
Use handout “Shaping Our Practice” handout to illustrate the vulnerabilities of social workers
Give handout
Focus on possible outcomes before proceeding in sensitive case situations. Provide extra attention to assessments for potentially suicidal clients. Address the responsibilities of mandated reporters.
Discuss examples of NASW practice standards
The law uses routinely the “reasonable person” standard
Breach of duty-the social worker has the duty to achieve a certain standard of care
1969-1999-18.5% sexual improprieties; incorrect treatment-18.6-Reamer, 1995
Concerning the “standard of care” issue, the Code of Ethics serves as the basis for this. Also, NASW has practice standards for a variety of areas.
Typically, the courts look to the “reasonably foreseeable” standard. This focuses on what would a reasonable person be able to determine represented appropriate practice in a particular situation. The last point is the most critical-often difficult to “prove” i.e. suicide, client impact on 3rd. Party, etc.
Explain that the Code details the professional social workers responsibilities with reference to each of the groups listed here.
Again have the participants find each section of the code that references each group. The idea is to get them generally familiar with what the code contains and how it is laid out.
Handout this position statement from Social Work Speaks. 2006-2009. NASW Press, Washington, DC.
Use rules screen first to deal with an ethical issue
Non-equal persons have the right to be treated differently?
Treating people wrongly done not become right even when it is required and sanctioned by law—involuntary sterilization, discrimination, welfare raids, death penalty
Give handout
Dilemmas represent multiple and negative options-focus on principle of least harm.
Both law and ethics are obligatory-the law may punish and ethics have civil and professional licensure implications.
Review subpoenas as coming from lawyers, not judges, and our responsibility to protect confidentiality when client has not agree to the release of information-careful of 3rd. Party releases