Eye on Ethics
Hiring Former Clients: When the Best of Intentions Aren't Enough
Recently I testified in a complex licensing board hearing. My task was to serve as an expert witness in a case where the state licensing board alleged that a social work administrator violated the board's ethical standards. Specifically, the board alleged that the social worker—the director of a prominent mental health agency—failed to comply with prevailing ethical standards when she hired three former clients as agency employees.
The agency director's intentions seemed to me to be both admirable and noble. Her goal, she said, was to empower former clients who are functioning well and have much to offer current clients. She recognized that select former clients could provide current clients with unique empathy, based on their own experiences as clients, and serve as constructive role models. The former clients the director hired were, she said, "stable, clean, and sober" and were hired to provide peer support services to current clients. The new hires received training in how to serve as peer support professionals.
Problems arose when two other agency staffers (licensed social workers) who supported the concept of peer support specialists became concerned about what appeared to be ethics-related challenges. There were several issues. First, these social workers were concerned when they discovered that a new hire's former therapist at the agency was supervising the new hire. This appeared to be a conflict of interest and an inappropriate dual relationship. As I testified at the hearing, it could be ethically problematic if the new employee's current supervisor, who had been his therapist when the employee was a client, had to give the employee critical feedback or sanction the employee for poor work performance. Receiving this kind of negative feedback from one's former therapist could be devastating emotionally and undermine the benefits gained from their prior therapeutic relationship.
Second, the social workers who filed the complaint were concerned that the agency had not anticipated that a former client who had become an employee might need to become a client again if significant symptoms reemerged; this could pose an untenable problem with boundaries and conflicts of interest. The agency was located in a very rural section of the state; a former client who became an employee and then needed to obtain services as a client again could not be referred to another mental health agency in the community—there was no other agency within a 63-mile radius.
Further, the social workers who filed the complaint were concerned that agency administrators had not developed a policy concerning former clients' accessing their own clinical records once they became employees, or accessing the records of other individuals who were clients when the employees were clients. In one instance, one of the social workers testified, a former client who became a peer support specialist was concerned when he discovered that someone who was a client when he was a client had returned to the agency in a state of crisis. The record showed that the employee who had been a client accessed the returning client's clinical chart, without authorization, to find out about the returning client's new challenges. Also, according to the staffers who filed the licensing board complaint, the agency did not provide the new employees (the former clients) with sufficient training related to management of boundaries and confidential information.
Before filing their complaint, the social workers shared their concerns with the agency director and, according to licensing board documents, the director dismissed the staffers' concerns, informing them that she had "the situation under control." The social workers were very upset about the director's unwillingness to take assertive steps to address their ethics-related concerns and sought consultation with the state licensing board's administrator. The administrator told the staffers that if, in their judgment, the agency director was unwilling to address ethical issues that, if not resolved, could expose clients and the agency to risk, the social workers had a duty to file a complaint with the board. They reluctantly did so. The licensing board ultimately concluded that the agency director violated several of the state's ethical standards (although the decision was later reversed on appeal due to very technical legal considerations).
When I testified in this case, I made it clear that I supported the agency director's noble goals to empower former clients. I explained that a number of reputable social service programs nationally have hired former clients successfully, and that one of the principal hallmarks was agency administrators' careful attention to possible ethical issues. I explained that, ideally, agencies that consider hiring former clients would form a task force to identify pertinent ethical issues, draft comprehensive policies to address these issues, and provide in-depth training to current staffers and new hires to ensure that they fully grasp the nature of ethical challenges that may emerge when former clients are hired as staff.
Specifically, I stated that agencies that consider hiring former clients should develop policies and protocols to avoid inappropriate conflicts of interest and dual relationships (e.g., not having a former client's former therapist serve as the job supervisor when the former client is hired, and having ethically sensitive procedures in place if a former client who became a staff member needed to become a client again) and to protect confidential information (e.g., implementing policies that prohibit former clients who are hired as staff from accessing their own or other individuals' clinical records without proper authorization). Importantly, I cited the following two key standards in the NASW Code of Ethics that, in my view, obligate agency administrators to take these steps:
Standard 1.06[a]: Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients' interests primary and protects clients' interests to the greatest extent possible. In some cases, protecting clients' interests may require termination of the professional relationship with proper referral of the client.
Standard 1.06[c]: Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)
I felt badly for the agency director, who clearly meant well and had only good intentions. Unfortunately, sometimes, good intentions aren't enough.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He's the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.