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Eye on Ethics

Virtuous Virtual Social Work
By Frederic G. Reamer, PhD
May 2020

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
The word virtue is linked to the Latin virtutem, which refers to moral perfection, moral strength, and high character. To be virtuous is to have high moral standards. And that’s exactly what social workers must pursue as they move at a rapid pace toward the use of virtual tools to help people in need.

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.

Informed Consent
The advent of distance counseling and other remote social services delivered electronically has enhanced social workers’ ethical duty to ensure that clients fully understand the nature of these services and their potential benefits and risks. Obtaining clients’ truly informed consent can be especially difficult when social workers never meet clients in person nor have the opportunity to speak with clients about informed consent.

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
The rapid emergence of online and digital technology used by social workers to deliver services has added a new layer of challenging privacy and confidentiality issues to those practitioners ordinarily consider. Social workers must ensure that they are using state-of-the-art encryption in order to protect clients. Also, social workers who offer video counseling services must recognize that they have much less control over confidentiality than when they provide traditional office-based services. For example, a client receiving video counseling services may invite a family member or acquaintance to sit in on a session—outside of camera range—without the social worker’s knowledge or consent.

Boundaries and Dual Relationships
Social workers’ use of technology to serve clients has created novel boundary issues. For example, many social workers receive requests from current and former clients asking to be social networking “friends.” Electronic contact with clients and former clients on social networking sites can lead to boundary confusion. Electronic message exchanges between social workers and clients that occur outside of normal business hours, especially if the social worker uses a personal social networking site or e-mail address, may confuse practitioner-client boundaries. Social workers who choose not to accept a client’s “friend” request on a social networking site to maintain clear boundaries may inadvertently cause the client to feel a deep sense of rejection. Social workers should anticipate this possibility and explain to clients how they handle clients’ Facebook requests.

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.

Practitioner Competence
To practice ethically, social workers who use digital and other technology must seek training and continuing education focused explicitly on the use of technology to deliver services, including developing protocols for screening potential clients, obtaining clients’ informed consent, assessing clients’ clinical needs, maintaining confidentiality, implementing distance interventions and services, maintaining clear boundaries, managing documentation and electronic records, and terminating services. Such knowledge and skills include knowing how to communicate effectively while using the technology to provide social work services; handle emergency situations from a remote location; apply the laws of both the social worker’s and client’s locations; be sensitive to the client’s culture, including the client’s cultural community and linguistic, social, and economic environment; attend to clients’ unique needs and challenges; ensure that the technology is in working order to provide effective services and avoid disruption; keep abreast of the changing landscape of technology; and adapt accordingly.

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.