January/February 2011 Issue

Pause Before Posting — Using Social Media Responsibly
By Matthew Robb, MSW, LCSW-C
Social Work Today
Vol. 11 No. 1 P. 8

Social workers using social media such as blogs, Facebook, message boards, or Twitter must think carefully about how their postings could affect their clients and their careers.

On issues ranging from domestic violence and homophobia to racism and the insidious disease of breast cancer, a young MSW social worker blogs incisively about the African American experience. Her commentary is powerful, her passion palpable and persuasive. When she writes, readers take notice.

But in a mid-September 2010 post, her hue and cry turned ice cold. Riffing on Tyler Perry’s 2010 movie For Colored Girls, this erstwhile champion inexplicably bellowed into cyberspace: “Once again stop singing the ‘woe is me, I am a black woman, they hate me’ drama. The first step you can make is stop bitchin’ and do something. It is everybody else fault that things are wrong in your life? [sic]”

Undeterred, she fired a second volley: “Some of you may question why I am focusing on the black woman? Well, I am a black woman and no offense I do not care about the social issues of the white, Asian, Latino, or other woman. Their issues are irrelevant to me….”

And so it goes—the wild world of desktop publishing.

Going Rogue
From the outset, let’s be clear: Our profession has leveraged social media to astonishing effect. Social media give us a no-cost, readily accessible, grassroots-to-global platform to alert, educate, mobilize, and improve the world around us. Social media arguably constitute one of the most important cultural milestones in the last half-century.

But the problem is equally clear: When social workers misuse these tools, they can irreparably harm clients, sabotage their own careers, and cast a long shadow over our profession.

The social worker cited above isn’t alone. As the digital age unfolds, concerned ethicists fear they are witnessing the emergence of a new breed of social worker—the renegade blogger—whose stealthy, unethical disclosures and intemperate rantings suggest a new normal. The implications are chilling.

For this article, Social Work Today asked 11 social workers, social work students, and legal/technology experts to discuss ethics and the responsible use of blogs, YouTube, Twitter, Facebook, and message boards. On two key points they agreed: Now more than ever, helping professionals need a road map to help navigate the sometimes foggy intersection of ethics and social media. But they also came down hard—very hard—on those who flout the NASW Code of Ethics and go rogue.

Consider the following bloggers:

• Since January 2009, one social worker (a self-described Capricorn) has been blogging the intimate details of her clients’ lives, including an incident in which an ostensibly intoxicated baby was placed in her office after a “drug raid.”

• One month prior to referencing a patient who “could only be described as a little meth-y,” an Oregon-based medical social worker wrote, “Same problem as usual … how to talk about some of my experiences without breaching patient confidentiality.”

• Affixed to this “youngish” social worker’s blog is a disclaimer attesting to “altered names, places, and other identifying information … to protect [client] privacy.” The postings that follow reveal excruciating details about the social worker’s foster care clients.

Frederic G. Reamer, PhD, a prominent ethicist and professor of social work at Rhode Island College, has written extensively on social media. His analysis is as textured as his bottom line is clear: When social workers contemplate ways to evade, finesse, or otherwise wiggle around the Code of Ethics, they are on the slippery slope to professional misconduct.

“As a general guide,” Reamer says, “social workers who use social media need to think very carefully before they post anything. We must adhere not just to the letter of the code but also to its spirit. Sliding underneath the code by doing something technically permissible or debatable does not mean you are acting ethically or that your actions are not potentially harmful.”

Despite continuing education requirements, many social workers cling to the belief that state licensing boards and the NASW Code of Ethics give a green light to the sharing of client information, provided identifying information is not disclosed.

Not so, says NASW General Counsel Carolyn Polowy. “Maintaining strict confidentiality is at the heart of social work. Even in instances of formal, closed-door clinical supervision, social workers must obtain written client permission before discussing the case—and even then, identifying details are omitted,” she says.

“On this matter,” Polowy continues, “the code is unambiguous. We must respect the inherent dignity and worth of the individual as sacrosanct. Sharing personal information is anything but respecting the client’s dignity. Why would anyone even want to give the appearance of compromising social work’s core values?”

Underscoring Reamer’s cautionary tone, Polowy says social workers who exploit seemingly gray areas in the code—or emerging frontiers in our profession—may be unwittingly exposing clients, coworkers, supervisors, and agencies to malpractice claims or potential ethics violations. Suffice it to say, social workers who plead ignorance of the NASW Code of Ethics before an NASW ethics committee have a weak defense.

“From a client’s perspective,” says University of Maryland adjunct professor Fran Forstenzer, MSW, LCSW-C, “blogging about patients without permission is a violation of trust and risks contaminating the therapeutic process.

“As a client,” she continues, “I think it would be horrible to think of oneself being talked about in a public arena. We need to remember that the authors who present clinical cases in our texts either have signed permission statements or they are making up vignettes whole cloth.”

Forstenzer asks, if a social worker truly believes his client would not object to being the subject of a blog or a message board post, why all the secrecy? “I don’t think it is appropriate or wise to talk about patients online, no matter how the demographics are disguised. We have very little privacy left to us. The therapy relationship is precious and personal and our last hope to believe that we can talk openly and honestly with another human being,” she says.

Is Anyone Really Anonymous?
Like burglars, even the sneakiest renegade blogger leaves a trail. Using a basic Web 2.0 tool kit and information gleaned from a single posting, this writer managed to quickly uncover the identity of one of the bloggers cited above—full name, city of residence, current and former employers, college and high school attended, even online résumé and photograph. One can only imagine a client stumbling on this trail.

How else might a renegade blogger be exposed? Perhaps estranged friends, alienated coworkers, and former lovers embroiled in divorce or custody suits; freelance geeks who hack “secure” sites; or consulting firms that specialize in uncovering anonymous bloggers and Internet forum posters.

Polowy notes investigators could ask during discovery in a professional liability lawsuit whether the social worker ever blogged about clients or client situations. An answer of “yes” casts doubt on the therapist’s ability to maintain confidentiality, she says.

“Social workers should stick to their professional standards and realize people are always trackable,” cautions Joe Caruso, CEO of New York-based Global Digital Forensics, an international consulting firm. “People who blog anonymously have a false feeling of security, as do those on Facebook, Twitter, and message boards.” Subpoenaed accounts, he says, “can be tracked back to the poster.” Nor is it hard to imagine a day when a gifted cryptogeek manages to crack the code of a major blog-hosting site and render the entire blogosphere transparent.

In mid-July, 2010, alarms sounded when a massive Facebook leak spilled into cyberspace “private details” of an estimated 100 million users. Before the social media giant could staunch the leak, an estimated 1,000 users worldwide had downloaded the information. And this latest breach occurred after a highly publicized security “fix.”

Privacy experts raise similar questions about Twitter. In mid-April 2010, the Library of Congress announced it would begin digitally archiving every single tweet (microblog) since Twitter’s 2006 launch, joining some 165 terabytes of information already “harvested” by government officials for reasons that are still unclear. Notably, this is the same Library of Congress whose security is so slipshod that in 2007 officials could not account for nearly 13% of its 130 million-item collection, according to a Washington Post report.

James Merrow, executive director of the Maryland Board of Social Work Examiners, points to a case of a social worker who denied an inappropriate relationship with a client. “We investigated and found evidence on Facebook affirming the allegations,” he says. It was bad enough that the social worker lost her license, but she also suffered the ignominy of seeing the ruling published in the board’s mass-circulation newsletter.

Elizabeth H, an MSW student, has strong opinions on the security risks of social media. On Facebook, she comments, “I did everything right, including the tightest privacy settings to limit what people had access to. All it took was a keylogger [spy software program] and everything about me was exposed.”

In a flash, Elizabeth’s friends were bombarded with messages beseeching their immediate financial help so she could attend a best friend’s funeral. After frantically putting out fires for the next 30 days, the grad student vowed never again.

“As an aspiring social worker, I cannot conceive of using Facebook, not with all the privacy issues we’ve seen recently,” Elizabeth allows. “When you put personal information about yourself online, you don’t always get to choose your audience and can’t always prevent inappropriate disclosure by accident—by a second or third party. I can imagine working with teenagers to promote healthy lifestyle decisions, yet there posted by a friend on Facebook are pictures of you at a crazy party. I don’t want to undermine the work I do with clients. A client intent on pleasing people may represent themselves in a very different way after seeing something you posted. The social media are amazing, but privacy to a social worker and privacy to a Facebook designer are two very different things.

“Social media tools,” she adds, “are so pervasive now that many people don’t even think of it as publishing.”

University of Texas MSW student Cheryl Jones made the hard decision to delete her Facebook account in October 2010. “I don’t think you can so neatly compartmentalize your professional and personal lives,” she says. Jones says few of her fellow students agree with her hard-line position, “but for me it’s better to eliminate any possibility of misunderstanding.

“A few of my fellow students,” she continues, “have posted things on Facebook like, ‘It’s been a terrible day!’ or ‘My client gave me a really hard time,’ but I think that’s a dangerous line to walk. I mean, where does it stop? I feel those private conversations should stay in the agency and only benefit the client.”

Carrie Rheingans, an MSW/MPH student at the University of Michigan, calls herself a “huge proponent” of social media. Still, she says, “Sometimes people don’t think of the implications of what they post. A medical doctor in India posted online photographs of a mastectomy surgery, probably without the patient knowing about it. Another person posted photos of a youth HIV group. Those are huge violations of HIPAA.”

At the University of Wisconsin at Green Bay, training manager Tammy Snortum, MSSW, notes her team is preparing training modules on social media ethics. While more direction from national experts is welcome, she says, “we need to have conversations with those in the field to come to an understanding about the ethical dilemmas they are facing before creating a framework to provide guidance.”

University of Maryland professor Tanya Sharpe, PhD, MSW, agrees: “We’re quickly moving to a place where we need an open discussion about policy guidelines and then incorporate that into the Code of Ethics.” In the meantime, she says, “social workers in doubt should refer back to the Code of Ethics to keep them grounded.”

Melinda Lewis, LMSW, a macro social worker and MSW instructor at the University of Kansas, counts herself among social media’s most ardent enthusiasts. For her, the defining standard is using social media intelligently, sensitively, and always responsibly.

“As a community organizer,” Lewis says, “I see a reverse danger of people being so afraid of sharing too much via social media that they artificially and unnecessary place barriers between themselves and clients. From a community organizing perspective, detaching yourself from the community is detrimental, as it may prevent needed transformation.

“Social workers,” she says, “have been venting about clients in elevators and in lunchrooms for decades, and to me it is as abhorrent then as today. Social media certainly have not created these ethical dilemmas, but they do highlight the ethical dilemmas that have always been there—and remain with us today.”

Ultimately, Lewis notes, “the onus is on the social worker to construct boundaries that protect, respect, and honor our clients.”

— Matthew Robb, MSW, LCSW-C, is a social worker and freelance writer residing in suburban Washington, DC.

Tips for Responsible Use of Social Media

Social Work Today asked our panel to share their wisdom about the responsible and ethical use of social media. Here are some of their observations:

• Blog about your passion but brace for heat: In 2008, a Milwaukee social worker noted his online political commentary “seems to bring out the devil in quite a few other bloggers.” Consider the vitriol from one: “You make me physically ill. I seriously and sincerely hope you are violently victimized by one of these bastards you keep defending. You deserve it.”

• Protect yourself: It’s true our digital age offers no guaranteed safe harbor, but do not make yourself an easy target. Use Facebook Places, Foursquare, and similar apps wisely, says University of Texas social work student Cheryl Jones.

• Googling clients; clients Googling you: In a recent news story, a client described being Googled by her therapist as feeling “close to rape.” As far as clients Googling social workers, our panel says it goes with the territory. “Given the intimacy of the clinical setting or the issues attendant in community organizing, what client wouldn’t be interested in learning more?” asks Jones. As always, focus on healthy boundaries.

• Clients blogging about therapy: Social workers exercise no editorial control over clients, Fran Forstenzer, MSW, LCSW-C, notes.

• Be consistent when blogging: “I would be devastated if my social worker were sympathetic to my beliefs in therapy yet espoused something quite different in cyberspace,” says grad student Elizabeth H. “It would undermine the therapeutic relationship.”

• Clients asking to “friend” you: If you’re doing direct social work, don’t friend on Facebook. Says Dennis Shelby, PhD, of the Chicago-based Institute for Clinical Social Work, “I would politely decline and discuss it in the next session.” Macro social worker Melinda Lewis, LMSW, accepts friend requests from students but always keeps her audience in mind when posting.

• “Friending” clients: Our panel speaks as one: Don’t start down that slippery slope.

• “Liking” groups or causes: Lewis politely declines these requests. Sure, you admire “Students for Saving Gaia,” but how do you feel about “Concerned Americans Against Birth Control”?

• Whistleblowing: The NASW Code of Ethics outlines proper handling of such sensitive issues, notes University of Maryland professor, Tanya Sharpe, PhD, MSW. As slow or frustrating as this path might be, first go through proper channels.

• Be culturally sensitive: “Remember the digital divide,” reminds University of Michigan student Carrie Rheingans. “Many clients are not on the Internet and aren’t computer savvy.”

— MR