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Karen Harper-Dorton Karen Harper-Dorton Doug HornerDoug HornerBill DahlheimBill Dahlheim
Kelley SkinnerKelley SkinnerJohn David SmithJohn David Smith
Holly WhitlockHolly WhitlockThe WV Social Work Education Consortium-SWECThe WV Social Work Education Consortium-SWEC
To review the major sections of the Social Work Code To review the major sections of the Social Work Code of Ethicsof EthicsTo understand some of the legal precedents that To understand some of the legal precedents that supercede the ethical standards and the tension supercede the ethical standards and the tension between the twobetween the twoTo learn a general decision-making model and an To learn a general decision-making model and an ethical screen as a guideline for ethical decision-makingethical screen as a guideline for ethical decision-makingTo apply ethical decision-making to a variety of practice To apply ethical decision-making to a variety of practice situationssituationsTo appreciate that in ethical decision-making there are To appreciate that in ethical decision-making there are often unclear parameters surrounding the decisionoften unclear parameters surrounding the decision
Introductions and Overview for the DayIntroductions and Overview for the Day Review legal issues, ethical responsibilities to Review legal issues, ethical responsibilities to
clients, colleagues, practice settings, social work clients, colleagues, practice settings, social work profession, and broader societyprofession, and broader society
Process of ethical decision-makingProcess of ethical decision-making
BREAK!BREAK! Dual relationships and NASW position on rural Dual relationships and NASW position on rural
social worksocial work Film: Film: Subtle Boundary IssuesSubtle Boundary Issues (Hazeldan) (Hazeldan)
LUNCH!LUNCH!
Ethics at WorkEthics at Work Decision-making model and value screenDecision-making model and value screen Privacy and confidentialityPrivacy and confidentiality Conflict of interest, dual relationships, sexual Conflict of interest, dual relationships, sexual
behaviorbehavior Informed consent and client self-determinationInformed consent and client self-determination Impairment, incompetence, and unethical conduct Impairment, incompetence, and unethical conduct
of colleaguesof colleagues Best practices: De-escalation and terminationBest practices: De-escalation and termination
BREAK!BREAK!
Case ExamplesCase Examples
Case exercisesCase exercises
Post-test and feedbackPost-test and feedback
ReviewReview legal issues, legal issues, ethical responsibilities to ethical responsibilities to
clients, colleagues, clients, colleagues, practice settings, social practice settings, social
work profession, and work profession, and broader societybroader society
Legal Legal PrecedentsPrecedents
DUTY TO WARNDUTY TO WARN
CONFIDENTIALITYCONFIDENTIALITY
MANDATED REPORTERSMANDATED REPORTERS
MALPRACTICEMALPRACTICE
Legal Legal PrecedentsPrecedents
DEFAMATIONDEFAMATION
SOCIAL WORKER SOCIAL WORKER PRIVILEGEPRIVILEGE
ENDING TREATMENTENDING TREATMENT
RECORD KEEPINGRECORD KEEPING
Legal IssuesLegal Issues
Disciplinary proceedingsDisciplinary proceedings
What are some circumstances that call for What are some circumstances that call for disciplinary proceedings by the SW disciplinary proceedings by the SW Board?Board?
Legal IssuesLegal IssuesWhat is the complaint process at your What is the complaint process at your organization?organization?
What are the legal issues that you are What are the legal issues that you are most concerned about in your practice? most concerned about in your practice? What protections/safeguards do you have What protections/safeguards do you have in place or what preventative measures do in place or what preventative measures do you employ?you employ?
Legal IssuesLegal Issues
Legal IssuesLegal Issues
When Do Clients Tend to When Do Clients Tend to Sue?Sue?
Disappointed with outcome of the Disappointed with outcome of the intervention intervention Believe they have been exploited or used Believe they have been exploited or used financially, emotionally, or sexuallyfinancially, emotionally, or sexuallyHad a negative outcome and attributed it Had a negative outcome and attributed it to the social worker’s incompetence or to the social worker’s incompetence or negligencenegligencePresented with a bill larger or much later Presented with a bill larger or much later than expectedthan expected
What Constitutes What Constitutes Negligence, Negligence,
Malpractice, and Malpractice, and Liability?Liability?
Issues of “standard of care” – how would a Issues of “standard of care” – how would a competent social worker behave in a competent social worker behave in a specific practice situation with children and specific practice situation with children and families?families?
Practice standards - predetermined best Practice standards - predetermined best practice standards - see NASW listspractice standards - see NASW lists
NegligenceNegligence
Defined as, “Performance outside of what Defined as, “Performance outside of what a reasonable professional in a similar a reasonable professional in a similar
situation would do”. The four elements situation would do”. The four elements that would be considered by the courts:that would be considered by the courts:
NegligenceNegligenceWas there a legal duty to the client?Was there a legal duty to the client?
Was there a breach of duty through Was there a breach of duty through action/inaction?action/inaction?
Was harm or damage incurred by the Was harm or damage incurred by the client?client?
Was there causal connection between the Was there causal connection between the breach of duty and the resultant harm?breach of duty and the resultant harm?
Types of Types of NegligenceNegligence
Acts of Commission or Acts of Commission or Malfeasance-did; should not haveMalfeasance-did; should not have
Acts of Omission or Nonfeasance-Acts of Omission or Nonfeasance-should have done; did notshould have done; did not
AVOIDING AVOIDING MALPRACTICE SUITSMALPRACTICE SUITS
Purpose: to minimize the Purpose: to minimize the possibility of being named in a possibility of being named in a lawsuit alleging professional lawsuit alleging professional negligence or misconduct.negligence or misconduct.
Categories of MalpracticeCategories of Malpractice
Civil Lawsuits-potential monetary Civil Lawsuits-potential monetary damagesdamages
Criminal Complaints-potential criminal Criminal Complaints-potential criminal sanctions such as probation and jailsanctions such as probation and jail
Licensing Board Complaints-potential loss Licensing Board Complaints-potential loss of license to practice for varying periods of of license to practice for varying periods of timetime
In general, the plaintiff In general, the plaintiff in a successful in a successful
malpractice suit must malpractice suit must prove four points.prove four points.
The defendant (e.g., the social worker) was The defendant (e.g., the social worker) was obligated to provide the plaintiff with a obligated to provide the plaintiff with a particular standard of care or professional particular standard of care or professional conduct.conduct.
The worker was derelict because he or she The worker was derelict because he or she breached that obligation (or duty) by some act breached that obligation (or duty) by some act or omission that had a foreseeable or omission that had a foreseeable consequence.consequence.
Four points Four points - continued- continued
The client suffered some injury or harm The client suffered some injury or harm (physical, financial, emotional, etc.)(physical, financial, emotional, etc.)
The worker’s conduct was a direct or proximate The worker’s conduct was a direct or proximate cause of the client’s injury or harm.cause of the client’s injury or harm.
Risk Risk ManagementManagement
LicensesLicensesRegistrations in OrderRegistrations in OrderProtocols for Emergency SituationProtocols for Emergency SituationInsurance Coverage PaidInsurance Coverage PaidMaintenance and Safeguarding Client Maintenance and Safeguarding Client RecordsRecordsSpecialist ConsultantsSpecialist ConsultantsDiagnosis and TreatmentDiagnosis and Treatment
Frederick G. Reamer. 2001. Frederick G. Reamer. 2001. The Social Work Ethics Audit: A Risk Management ToolThe Social Work Ethics Audit: A Risk Management Tool. NASW Press.. NASW Press.
Risk Management-Risk Management-cont.cont.
Consultation with legal counselConsultation with legal counsel
Second-Opinion ReferralsSecond-Opinion Referrals
Ruling out PathologyRuling out Pathology
Psychological TestingPsychological Testing
Appropriateness of Psychotropic Appropriateness of Psychotropic MedicationMedication
Continuing EducationContinuing Education
The Social Work The Social Work Code of EthicsCode of Ethics
Ethical Decision-makingEthical Decision-making
Ethical responsibilities to:
Clients
Colleagues
Practice Settings
As Professionals
The Profession
The Broader Society
Values and Values and EthicsEthics
What is the difference?What is the difference?
Values and Values and EthicsEthics
ValuesValues are concerned with what is are concerned with what is good good and and desirabledesirable
EthicsEthics deal with what is deal with what is rightright and and correctcorrect
EthicsEthics are rules of conduct to direct social are rules of conduct to direct social workers in a manner consistent with the workers in a manner consistent with the
values of the professionvalues of the profession
Values and Values and EthicsEthics
Social Work ValuesSocial Work Values
1.1. All human beings deserve All human beings deserve accessaccess to the to the resourcesresources they they need to deal with life’s problems and to develop their need to deal with life’s problems and to develop their potentialitiespotentialities
2.2. All human beings have intrinsic All human beings have intrinsic worth and dignityworth and dignity3.3. The The uniquenessuniqueness and individuality of each person is of and individuality of each person is of
value.value.4.4. Given appropriate resources, human beings are Given appropriate resources, human beings are capablecapable
of of growthgrowth and and changechange and should be supported in and should be supported in increasing their choices in solving their problems and increasing their choices in solving their problems and directing their livesdirecting their lives
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
Dual Dual relationships relationships
and NASW and NASW position on position on Rural Social Rural Social
WorkWork
Dual Dual RelationshipsRelationships
What are What are dual relationshipsdual relationships??
The practice of assuming a second role with The practice of assuming a second role with a clienta client
Examples?Examples?
Dual Dual RelationshipsRelationships
The Code says…The Code says…
““Social workers should not engage in a dual Social workers should not engage in a dual or multiple relationships with clients or or multiple relationships with clients or former clients in which there is a risk of former clients in which there is a risk of exploitation or potential harm to the client”exploitation or potential harm to the client”
Dual Dual RelationshipsRelationships
When is a client not a client anymore?When is a client not a client anymore?
Dual Dual Relationships Relationships and Rural Areasand Rural Areas
Rural Policy StatementRural Policy Statement
Ethical practice in rural areas requires special Ethical practice in rural areas requires special attention to the issue of dual relationshipsattention to the issue of dual relationships
They are They are unavoidableunavoidable and need to be and need to be managedmanaged
Dual Dual Relationships Relationships and Rural Areasand Rural Areas
How do you keep professional and social How do you keep professional and social relationships separate or distinct?relationships separate or distinct?What is the risk of working with someone What is the risk of working with someone that you know through community that you know through community involvement?involvement?How do you handle confidentiality and How do you handle confidentiality and conflict of interest?conflict of interest?
Dual Dual Relationships Relationships and Rural Areasand Rural Areas
What do you do when you see a client at What do you do when you see a client at the store?the store?What if a client wants to give you a gift or What if a client wants to give you a gift or wants to barter for services?wants to barter for services?
Engaging in a Engaging in a “Dual Relationship”“Dual Relationship”
Entering a business relationship with a Entering a business relationship with a current or former clientcurrent or former client
Participating in a romantic or a sexual Participating in a romantic or a sexual relationship with a current or former clientrelationship with a current or former client
Establishing dual relationships with Establishing dual relationships with instructor/students…in the field and in the instructor/students…in the field and in the classroomclassroom
Next…LUNCH!Next…LUNCH!
Decision-Decision-Making Model Making Model and Value and Value ScreenScreen
Ethical Rules Screen Ethical Rules Screen (ERS)(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:
The Code does not address the specific problem, or several Code rules provide conflicting guidance:
Follow the Code rules. Use the ethical principles screen.
Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7 th Edition, F. E. Peacock
Ethical Principles Screen Ethical Principles Screen (EPS)(EPS)
Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7 th Edition, F.E. Peacock.
7. Truthfulness and full disclosure
6. Privacy and confidentiality
5. Quality of life
4. Least harm
3. Autonomy and freedom
2. Equality and inequality
1. Protection
of life
Values and Values and EthicsEthics
Managing Ethical DilemmasManaging Ethical Dilemmas
Right to life, health and well-beingRight to life, health and well-being
Right of confidentialityRight of confidentiality
Right to life, health and well-beingRight to life, health and well-being
Right to privacy or self-determinationRight to privacy or self-determination
Values and Values and EthicsEthics
Right of self-determinationRight of self-determination
Right to basic well-beingRight to basic well-being
Right to basic well-beingRight to basic well-being
Laws, policies, arrangements of organizationsLaws, policies, arrangements of organizations
Major issues:Major issues:
Privacy and confidentialityPrivacy and confidentiality
Conflict of interest, dual Conflict of interest, dual relationships, sexual behaviorrelationships, sexual behavior
Informed consent and client self-Informed consent and client self-determinationdetermination
Impairment, incompetence, and Impairment, incompetence, and unethical conduct of colleaguesunethical conduct of colleagues
ConfidentialitConfidentialityy
Safeguarding confidentiality involves respecting Safeguarding confidentiality involves respecting client privacy, gathering information only for the client privacy, gathering information only for the purpose of providing effective services, and purpose of providing effective services, and disclosing information only with client consentdisclosing information only with client consent
The Tarasoff case represents an example of the limits on The Tarasoff case represents an example of the limits on confidentiality.confidentiality.
ConfidentialitConfidentialityy
Limits--Limits--
Supervision and consultationSupervision and consultation
Client waivers of confidentialityClient waivers of confidentiality
Danger to self or othersDanger to self or others
Suspicion of child or elder abuseSuspicion of child or elder abuse
Subpoenas and privileged communicationSubpoenas and privileged communication
Failure to Maintain Failure to Maintain “Confidentiality”“Confidentiality”Often unintentionalOften unintentionalConfidential nature of relationship and of the Confidential nature of relationship and of the information obtained in the relationshipinformation obtained in the relationshipException found in the “Duty to Warn”Exception found in the “Duty to Warn”*Threats of violence*Threats of violence*Threat is imminent*Threat is imminent*Likelihood that threat will be carried out in *Likelihood that threat will be carried out in foreseeable futureforeseeable future*Victim(s) identified*Victim(s) identified
Method? Motive? Opportunity?Method? Motive? Opportunity?
Failing to Maintain Failing to Maintain “Accurate and Complete “Accurate and Complete
Records”Records”
Developing accurate assessmentsDeveloping accurate assessments
Free of judgmental language and hear Free of judgmental language and hear saysay
Confidentiality guardedConfidentiality guarded
Records document the service and Records document the service and quality of carequality of care
Informed Informed ConsentConsent Informed consent:Informed consent:
requires Social Workers to clearly requires Social Workers to clearly communicate to a client(s) the purpose of the communicate to a client(s) the purpose of the services, possible risks related to the service, services, possible risks related to the service, limitations of the service, costs, alternatives to the limitations of the service, costs, alternatives to the service, clients’ right to refuse or withdraw service, clients’ right to refuse or withdraw consent, and the time frame covered by the consent, and the time frame covered by the consentconsent
Legal Responsibility to Legal Responsibility to Obtain “Informed Consent”Obtain “Informed Consent”
Clients right to expect the same degree of Clients right to expect the same degree of competence as that provided by other competence as that provided by other practitionerspractitioners
Intended to guarantee clients’ freedom, Intended to guarantee clients’ freedom, privacy, and safetyprivacy, and safety
Including the use of audio or video taped Including the use of audio or video taped client sessions for course requirements client sessions for course requirements
Self Self DeterminationDetermination
What is this again?What is this again?
Self Self DeterminationDetermination
Self determination Self determination is the right of individuals to is the right of individuals to exercise freedom of choice in decision-makingexercise freedom of choice in decision-making
Conduct of Conduct of ColleaguesColleagues
What should you do if you suspect that a What should you do if you suspect that a colleague is in violation of an ethical principle?colleague is in violation of an ethical principle?
Always get the facts (evidence, harm)Always get the facts (evidence, harm)
Options for next steps…See Code of Ethics-Section Options for next steps…See Code of Ethics-Section 2.112.11
Conduct of Conduct of ColleaguesColleagues
““Whistle-Blowing”Whistle-Blowing”
Reporting an ethical violation to outside authoritiesReporting an ethical violation to outside authorities
When should this step be taken?When should this step be taken?
From: Gambrill (2002)
From: Gambrill (2002)
De-escalation De-escalation and Terminationand Termination
De-escalation De-escalation (handout)(handout)
What is it? What is it?
Decrease in intensity, magnitude or amountDecrease in intensity, magnitude or amount
What might it mean when engaging a What might it mean when engaging a potentially violent child or parent?potentially violent child or parent?
What methods/techniques do you employ?What methods/techniques do you employ?
Termination of Termination of Services Services (handout)(handout)
When is it necessary to terminate When is it necessary to terminate services?services?
Examples?Examples?
