Eye on Ethics

When Bad Things Happen to Good Social Workers: The Perils of Ethics Mistakes
By Frederic G. Reamer, PhD
November 30, 2011

Nearly 30 years ago Rabbi Harold Kushner published the influential book Why Bad Things Happen to Good People. I think of the book’s title frequently when I consult with social workers who have been accused of using poor ethics judgment.

The Nature of Ethics Mistakes
Most social workers who find themselves in the midst of ethics-related controversies have not engaged in serious misconduct, such as becoming involved sexually with a client or billing insurance companies for services they never provided. Rather, ethical issues in social work often take the form of what can only be described as mistakes made by talented, conscientious, and dedicated practitioners. These are not complex ethical dilemmas involving conflicts among professional duties, such as choosing between a client’s right to confidentiality and the disclosure of confidential information without a client’s consent to protect a third party from harm. Instead, these are situations where good social workers slip on the proverbial banana peel and violate ethical standards. Here are several examples:

• An independent social worker provided counseling services to a woman who struggled with chronic depression. The client was laid off from her job and lost her healthcare coverage. The social worker agreed to hire the client to clean her home as a way to help her financially. Several weeks later, the client was hospitalized following a suicide attempt. During her hospital stay, the client disclosed to the hospital’s psychologist that she had cleaned her social worker’s home. The psychologist was concerned that the client and the social worker were involved in an enmeshed relationship and reported the alleged boundary violation to the social work licensing board.

• A clinical social worker expanded his practice to include cybertherapy, that is, counseling services provided online (using live Internet chat and e-mail) to clients throughout the United States. The social worker did not realize that the state in which one of his clients lived required out-of-state social workers who deliver online clinical services to be licensed in the client’s state. One of the social worker’s clients was dissatisfied with the services he received. The client contacted the licensing board, which initiated disciplinary proceedings against the social worker for practicing in the client’s state without a license.

• A clinical social worker at a community mental health center provided counseling services to a father who struggled with bipolar disorder and alcoholism. In addition to documenting her counseling sessions in the agency’s clinical record, the social worker maintained a separate set of personal notes pertaining to her work with the client. In the personal notes, the social worker included very sensitive details about the client’s life that she did not feel comfortable including in the agency’s formal record, which other staffers could access. The client and his estranged wife were in the midst of a contentious custody dispute regarding their two young children. The wife’s attorney subpoenaed the social worker’s records, including the practitioner’s personal notes. The social worker did not realize the laws in her state did not protect clinical social workers’ personal notes about clients.

• A social worker who directed a substance abuse treatment program hired a former client who applied for a case management position. The former client had been clean and sober for nearly three years, ever since he stopped receiving services at the agency. Ethical problems arose when the former client became an employee; soon after he was hired, the former client inappropriately accessed confidential records of two current clients who had also been clients when he was a client. In addition, when he was hired, the former client was supervised by his former therapist, who had been promoted to the position of case management program director. These confidentiality and boundary problems led to considerable controversy at the agency.

Preventing Ethics Mistakes
Many ethics mistakes in social work are preventable. Perhaps the best prevention is vigilance in the form of social workers’ constant awareness of potential ethical missteps. Among the most common risk areas are client confidentiality and privacy, boundaries and dual relationships, conflicts of interest, informed consent, documentation, and termination of services.

• Confidentiality and privacy:Social workers face countless situations that require careful management of confidential and private information. Social workers must be familiar with ethical standards and laws related to, for example, disclosure of confidential information without client consent to protect third parties; disclosure to law enforcement officials and media representatives; release of information related to sensitive information, such as HIV/AIDS and substance abuse; disclosure of information about deceased clients; release of information about minors to parents and guardians; sharing of information among clients’ family members; protection of electronic communications, including e-mail, text messages, Facebook posts, and other social media; protection of client confidentiality in the event of the social worker’s retirement, disability, employment termination, or death; disclosures to third-party payers; and disclosures in public or semipublic areas to consultants, during teaching or training, and during legal proceedings.

• Boundaries and dual relationships:Social workers should be careful to maintain clear and appropriate boundaries in relationships with clients. Major risks are associated with social workers’ friendships with former clients; encountering clients in public settings; attending clients’ social, religious, and life cycle events; accepting gifts from clients; performing favors for clients; bartering with clients for goods or services; managing relationships with clients in small or rural communities; disclosing personal information to clients; and hiring former clients.

• Informed consent: Social workers should adhere to widely held standards regarding clients’ informed consent to services and release of information. These standards include ensuring that clients’ consent has not been coerced, clients are mentally capable of providing consent, clients provide proper written and verbal consent, and clients’ consent is based on clear and thorough information.

• Nontraditional services:Social workers who contemplate using nontraditional or unorthodox interventions should exercise extraordinarily careful judgment and take responsible steps to protect clients from harm. Social workers should seek skilled consultation and be certain that the professional literature and experienced colleagues support their use of nontraditional or unorthodox interventions.

• Documentation:Skilled documentation is a vitally important risk management tool. In addition to enhancing the quality of services social workers provide to clients, careful documentation provides essential evidence of social workers’ efforts to manage ethics-related risks. Among the most common mistakes social workers make is the failure to document the steps they took to manage difficult ethical judgments (for example, consulting colleagues and the NASW Code of Ethics). Also, social workers sometimes include too much detail in a client’s record, do not use precise wording, or fail to document in a timely fashion. Documentation errors can expose social workers to considerable risk if questions are raised about their ethical judgment.

• Termination of services: Social workers expose themselves to allegations of client abandonment when they terminate services improperly. Social workers should be careful to follow widely used protocols when they terminate services, especially if they do so against a client’s wishes (for example, consulting with colleagues about a termination decision, giving clients as much advance warning as possible, providing clients with referral options and information about how to handle emergencies).

Ethical challenges in social work are inevitable. To prevent ethics mistakes, social workers should acquaint themselves with the most common ethical risks and implement comprehensive risk management protocols.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.