Eye on Ethics
The Limits of Professional Competence
A social worker in private practice provided clinical services primarily to children and adolescents. The social worker had considerable expertise in behavior management, depression, anxiety, and substance abuse.
One afternoon the social worker received a call from the mother of one of her clients, a 15-year-old girl who struggled with depression. The mother told the social worker that her daughter just disclosed to her that she has been binging on food and purging, clear signs of an eating disorder. The social worker scheduled an appointment to meet with her teen client, who then confirmed she was binging and purging. They agreed to increase the frequency of their clinical sessions in order to address the eating disorder issues.
The social worker, who had been in clinical practice for six years, did not have any formal postgraduate training in the treatment of eating disorders. She had read some literature and heard several presentations on the subject while in graduate school during one of her advanced clinical courses that provided an overview of treatment approaches for a variety of clinical phenomena.
The teen continued to struggle with her eating disorder and, three months after her disclosure, was suddenly hospitalized with symptoms of severe malnutrition. The hospital psychiatrist told the teen’s parents that she was very troubled the social worker had not referred their daughter for specialized treatment of her eating disorder. The psychiatrist said that, in her judgment, the current crisis may have been prevented had the teen been treated in an eating disorders clinic as soon as her symptoms surfaced.
The teen’s parents were deeply distressed to learn their daughter’s current crisis may have been prevented. They were angry that the social worker had not referred their daughter for more specialized treatment. After some discussion with an attorney, the parents filed a licensing board complaint against the social worker alleging incompetent practice. The parents also considered filing a negligence lawsuit against the social worker.
Understanding the Limits of Competence
• “Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience” (standard 1.04[a]).
• “Social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques” (standard 1.04[b]).
In some instances social workers obviously should not hold themselves out as experts, for example, when a social worker whose education and experience have focused exclusively on substance abuse treatment considers applying for a job as a social worker in a hospice program. Clients in the hospice program would not be well served by a social worker who has no formal education, training, or experience in the hospice field. Similarly, a social worker who has minimal expertise related to research, program evaluation, and data analysis should not market himself or herself to local agencies as a program evaluation expert.
However, other circumstances are less clear. On occasion social workers may have reasonable expertise to provide services to clients but may not be the most qualified practitioners available. In some rural communities, for example, there may be relatively few practitioners with specialized expertise; social workers in those communities may feel some pressure to stretch the borders of their proficiency. In these instances social workers must exercise careful judgment to ensure that potential clients are protected and, as well, to minimize the likelihood that disgruntled parties will allege the social workers engaged in incompetent and unethical practice.
Ideally, social workers should always explain to potential clients the nature and extent of their expertise, provide an overview of practitioners in the area who may have more expertise, explain their own strengths and limitations with regard to meeting the clients’ needs, encourage the clients to ask questions, and then encourage clients to make an informed decision about which practitioner would be most appropriate. When appropriate, social workers should refer potential clients to colleagues who are better able to meet their needs. As the Code of Ethics says, “Social workers should refer clients to other professionals when the other professionals’ specialized knowledge or expertise is needed to serve clients fully…” (standard 2.06[a]). This process is consistent with the critically important concept of informed consent, which is an essential element of ethical social work practice.
Like all professionals, social workers should constantly seek ways to strengthen and upgrade their knowledge and skills throughout their careers. Even the best undergraduate and graduate social work education programs can provide students with only foundation-level knowledge and skills and a moderate amount of advanced content. Seasoned and wise social workers recognize that continuing education is imperative to enhance their expertise and keep current with new developments. The amount of time social workers spend in formal education is a modest fraction of the time spent learning throughout their careers. During the course of their careers, social workers can expect to encounter new conceptual models and intervention approaches; practitioners must always be open to learning and continuously monitor emerging knowledge related to their areas of practice. The Code of Ethics says, “Social workers should strive to become and remain proficient in professional practice and the performance of professional functions. Social workers should critically examine and keep current with emerging knowledge relevant to social work. Social workers should routinely review the professional literature and participate in continuing education relevant to social work practice and social work ethics” (standard 4.01[b]).
One hallmark of professionalism is the willingness to gain the extraordinary knowledge and hone the skills required to perform one’s duties. This applies equally to professions as diverse as social work, medicine, dentistry, engineering, accounting, and nursing. At a minimum, this demanding process entails years of study, training, consultation, and supervision. Anything less falls short of the standards to which social workers are held and what clients have a right to expect.
— 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.