Eye on Ethics
Virtuous Virtual Social Work
The social work careers all of us planned on no longer exist, at least for now. COVID-19 has made sure of that. Hospice social workers communicate with patients and their loved ones on smartphones. School social workers and students connect with each other on their respective laptops and tablets. Social workers in independent practice are scrambling to learn the art of video counseling. Agency administrators are convening staff meetings on cloud-based platforms.
Virtual social work is here. Some social workers embrace opportunities to deliver services to clients remotely. Even before the onset of the coronavirus, growing numbers of practitioners converted all or segments of their practice to online and digital delivery. Many social workers appreciate their ability to enhance clients’ access to services using electronic tools. They believe that distance counseling services offer a number of compelling advantages. During national health crises that limit clients’ and practitioners’ mobility, social workers can use technology to serve clients without risking contagion. Also, some individuals who want social services live in remote geographic areas and would have great difficulty traveling to a social worker’s office.
Additionally, clients with physical disabilities can use distance counseling options without enduring the logistical challenges and discomfort involved in arranging transportation and traveling significant distances. Individuals with overwhelming anxiety can access help from home that they might not seek otherwise. People who are profoundly concerned about protecting their privacy can receive counseling without risking exposure in a social worker’s waiting room. The around-the-clock availability of services, given the options people have to connect remotely with a social worker somewhere in the world almost immediately any time of day or night, either online or by smartphone, also enhances practitioners’ ability to help people in crisis.
At the same time, many seasoned social workers have serious reservations about these options that facilitate remote delivery of services. These practitioners worry that the expanding use of digital and other distance service-delivery options dilutes the meaning of therapeutic relationship and alliance that requires in-person contact. They believe that services provided remotely greatly increase the likelihood that social workers will miss important clinical cues—for example, tears welling up in a client’s eyes, joyful facial expressions, or a client’s grimace or squirm in response to the social worker’s probing question or comment.
Putting Virtue in Virtual Social Work
In recent years, the social work profession has made great strides in its attempt to create sound, unprecedented ethical standards guiding practitioners’ use of a wide range of technological tools to serve clients virtually. These are reflected in the recently updated NASW Code of Ethics and new technology standards adopted jointly by the NASW, Association of Social Work Boards, Council on Social Work Education, and Clinical Social Work Association. Key concepts concern longstanding social work values related to informed consent, privacy and confidentiality, boundaries and dual relationships, and practitioner competence.
To protect clients when providing services virtually, social workers must adhere to widely accepted informed consent standards. First, coercion and undue influence must not have played a role in the client’s decision; practitioners must ensure that clients do not feel pressured to grant consent to services provided remotely. Second, a client must be mentally capable of providing consent to the receipt of services remotely. Social workers should assess clients’ ability to reason and make informed choices, comprehend relevant facts and retain this information, appreciate current circumstances, and communicate their wishes.
Third, consent forms and procedures must be valid. Typical elements include details of the nature and purpose of a service; advantages and disadvantages of an intervention; substantial or possible risks to clients, if any (including risks uniquely associated with online and distance social work services); alternatives to the proposed use of technology to deliver services; and anticipated costs for clients. All of this information should be presented to clients in clear, understandable language and in a manner that encourages clients to ask questions for clarification. Fourth, a client must have the right to refuse or withdraw consent. Social workers should be prepared for the possibility that clients will exercise these rights, particularly with respect to the delivery of online and distance social work services.
Privacy and Confidentiality
Boundaries and Dual Relationships
Also, clients who are able to access social workers’ publicly available social networking sites may learn a great deal of personal information about their social worker (such as information about the social worker’s personal and family relationships, social and religious activities, and political views); this may introduce complex boundary challenges in the practitioner-client relationship. Also, clients’ postings on their own social networking sites may lead to inadvertent or harmful disclosure of private and confidential details—for example, sensitive information shared by others in group therapy sessions.
Social workers have always grasped the importance of virtue as a core element of professional practice. The burgeoning of technological innovations, including the delivery of online and distance services, has added to the challenges of contemporary social work practice. Understanding and adhering to the profession’s time-tested values and ethical standards is one sure way to ensure that virtual social work is virtuous.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.