Karen Harper-Dorton
Doug Horner
Bill Dahlheim
Kelley Skinner
John David Smith
Holly Whitlock
The WV Social Work Education ...
To review the major sections of the Social Work Code of
Ethics
To understand some of the legal precedents that
supercede t...
Introductions and Overview for the Day




Review legal issues, ethical responsibilities to
clients, colleagues, practic...
Ethics at Work









Decision-making model and value screen
Privacy and confidentiality
Conflict of interest, dua...
Case Examples
Case exercises
Post-test and feedback
Review legal issues,
ethical responsibilities to
clients, colleagues,
practice settings, social
work profession, and
broad...
Legal Precedents
DUTY TO WARN
CONFIDENTIALITY
MANDATED REPORTERS
MALPRACTICE
Legal Precedents
DEFAMATION
SOCIAL WORKER
PRIVILEGE
ENDING TREATMENT
RECORD KEEPING
Legal Issues
Disciplinary proceedings
What are some circumstances that call for
disciplinary proceedings by the SW
Board?
Legal Issues
What is the complaint process at your
organization?
What are the legal issues that you are
most concerned abo...
Legal Issues
Legal Issues
When Do Clients Tend to Sue?
Disappointed with outcome of the
intervention
Believe they have been exploited or used
financ...
What Constitutes Negligence,
Malpractice, and Liability?
Issues of “standard of care” – how would a
competent social worke...
Negligence
Defined as, “Performance outside of what
a reasonable professional in a similar
situation would do”. The four e...
Negligence
Was there a legal duty to the client?
Was there a breach of duty through
action/inaction?
Was harm or damage in...
Types of Negligence
Acts of Commission or
Malfeasance-did; should not
have
Acts of Omission or
Nonfeasance-should have
don...
AVOIDING
MALPRACTICE SUITS
Purpose: to minimize the
possibility of being named in a
lawsuit alleging professional
negligen...
Categories of Malpractice
Civil Lawsuits-potential monetary
damages
Criminal Complaints-potential criminal
sanctions such ...
In general, the plaintiff in a
successful malpractice suit must
prove four points.
The defendant (e.g., the social worker)...
Four points continued
The client suffered some injury or harm
(physical, financial, emotional, etc.)
The worker’s conduct ...
Risk Management
Licenses
Registrations in Order
Protocols for Emergency Situation
Insurance Coverage Paid
Maintenance and ...
Risk Management-cont.
Consultation with legal counsel
Second-Opinion Referrals
Ruling out Pathology
Psychological Testing
...
Ethical Decision-making
The Social Work Code of
Ethics
Ethical responsibilities to:
Clients
Colleagues
Practice Settings
As Professionals
The Profession
The Broader Society
Values and Ethics
 What is the difference?
Values and Ethics
Values are concerned with what is good and
desirable
Ethics deal with what is right and correct
Ethics a...
Values and Ethics
Social Work Values
1.
2.
3.
4.

All human beings deserve access to the resources they
need to deal with ...
Primary goal is to help people in need & address social
problems
Challenge social injustice
Respect dignity & worth of ...
Dual relationships
and NASW
position on Rural
Social Work
Dual Relationships
What are dual relationships?
The practice of assuming a second role with
a client
Examples?
Dual Relationships
The Code says…
“Social workers should not engage in a dual
or multiple relationships with clients or
fo...
Dual Relationships
When is a client not a client anymore?
Dual Relationships
and Rural Areas
Rural Policy Statement
Ethical practice in rural areas requires special
attention to th...
Dual Relationships
and Rural Areas
How do you keep professional and social
relationships separate or distinct?
What is the...
Dual Relationships
and Rural Areas
What do you do when you see a client at
the store?
What if a client wants to give you a...
Engaging in a
“Dual Relationship”
Entering a business relationship with a
current or former client
Participating in a roma...
Next…LUNCH!
Decision-Making
Model and Value
Screen
Ethical Rules Screen (ERS)
Examine the Code of Ethics to determine if any of
the Code rules are applicable. These rules ta...
Ethical Principles Screen (EPS)
1.
Protection
of life
2. Equality and
inequality
3. Autonomy and freedom
4. Least harm
5. ...
Values and Ethics


Managing Ethical Dilemmas
Right to life, health and well-being
Right of confidentiality
Right to life...
Values and Ethics
Right of self-determination
Right to basic well-being
Right to basic well-being
Laws, policies, arrangem...
Privacy and confidentiality
Conflict of interest, dual
relationships, sexual behavior
Informed consent and client selfdete...
Confidentiality




Safeguarding confidentiality involves respecting
client privacy, gathering information only for the
...
Confidentiality
Limits-Supervision and consultation
Client waivers of confidentiality
Danger to self or others
Suspicion o...
Failure to Maintain
“Confidentiality”
Often unintentional
Confidential nature of relationship and of the
information obtai...
Failing to Maintain “Accurate
and Complete Records”
Developing accurate assessments
Free of judgmental language and hear
s...


Informed Consent

Informed consent:
requires Social Workers to clearly communicate
to a client(s) the purpose of the se...
Legal Responsibility to Obtain
“Informed Consent”
Clients right to expect the same degree of
competence as that provided b...
Self Determination
What is this again?
Self Determination

Self determination is the right of individuals to
exercise freedom of choice in decision-making
Conduct of Colleagues
What should you do if you suspect that a
colleague is in violation of an ethical principle?

Always ...
Conduct of Colleagues
“Whistle-Blowing”
Reporting an ethical violation to outside authorities
When should this step be tak...
From: Gambrill (2002)
From: Gambrill (2002)
De-escalation and
Termination
De-escalation (handout)
What is it?
Decrease in intensity, magnitude or amount
What might it mean when engaging a
potentia...
Termination of
Services (handout)
When is it necessary to terminate
services?
Examples?
Ethics ii final version-2-16-07
Ethics ii final version-2-16-07
Ethics ii final version-2-16-07
Ethics ii final version-2-16-07
Ethics ii final version-2-16-07
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  • Handout Number of Ethical Violations Found; Gottfried, K.S. 2000. Ensuring ethical practice: an examination of NASW code violations 1986-1997. Social Work. 5(3), p. 253-54. Discuss implications
  • Handout-Legal precedents; discuss
    Handout-Tarasoff case-discuss in light of section 1.07, Code of Ethics
  • Discuss the differences between confidentiality and privilege-will be discussed on slides 22-23- Wigmore’s tests in relation to this
  • Use handout “Shaping Our Practice” handout to illustrate the vulnerabilities of social workers
  • Give handout
  • Focus on possible outcomes before proceeding in sensitive case situations. Provide extra attention to assessments for potentially suicidal clients. Address the responsibilities of mandated reporters.
  • Discuss examples of NASW practice standards
  • The law uses routinely the “reasonable person” standard
  • Breach of duty-the social worker has the duty to achieve a certain standard of care
  • 1969-1999-18.5% sexual improprieties; incorrect treatment-18.6-Reamer, 1995
  • Concerning the “standard of care” issue, the Code of Ethics serves as the basis for this. Also, NASW has practice standards for a variety of areas.
  • Typically, the courts look to the “reasonably foreseeable” standard. This focuses on what would a reasonable person be able to determine represented appropriate practice in a particular situation. The last point is the most critical-often difficult to “prove” i.e. suicide, client impact on 3rd. Party, etc.
  • Explain that the Code details the professional social workers responsibilities with reference to each of the groups listed here.
    Again have the participants find each section of the code that references each group. The idea is to get them generally familiar with what the code contains and how it is laid out.
  • Handout this position statement from Social Work Speaks. 2006-2009. NASW Press, Washington, DC.
  • Use rules screen first to deal with an ethical issue
  • Non-equal persons have the right to be treated differently?
    Treating people wrongly done not become right even when it is required and sanctioned by law—involuntary sterilization, discrimination, welfare raids, death penalty
  • Give handout
  • Dilemmas represent multiple and negative options-focus on principle of least harm.
    Both law and ethics are obligatory-the law may punish and ethics have civil and professional licensure implications.
  • Review subpoenas as coming from lawyers, not judges, and our responsibility to protect confidentiality when client has not agree to the release of information-careful of 3rd. Party releases
  • Ethics ii final version-2-16-07

    1. 1. Karen Harper-Dorton Doug Horner Bill Dahlheim Kelley Skinner John David Smith Holly Whitlock The WV Social Work Education Consortium-SWEC
    2. 2. To review the major sections of the Social Work Code of Ethics To understand some of the legal precedents that supercede the ethical standards and the tension between the two To learn a general decision-making model and an ethical screen as a guideline for ethical decision-making To apply ethical decision-making to a variety of practice situations To appreciate that in ethical decision-making there are often unclear parameters surrounding the decision
    3. 3. Introductions and Overview for the Day   Review legal issues, ethical responsibilities to clients, colleagues, practice settings, social work profession, and broader society Process of ethical decision-making BREAK!   Dual relationships and NASW position on rural social work Film: Subtle Boundary Issues (Hazeldan) LUNCH!
    4. 4. Ethics at Work       Decision-making model and value screen Privacy and confidentiality Conflict of interest, dual relationships, sexual behavior Informed consent and client self-determination Impairment, incompetence, and unethical conduct of colleagues Best practices: De-escalation and termination BREAK!
    5. 5. Case Examples Case exercises Post-test and feedback
    6. 6. Review legal issues, ethical responsibilities to clients, colleagues, practice settings, social work profession, and broader society
    7. 7. Legal Precedents DUTY TO WARN CONFIDENTIALITY MANDATED REPORTERS MALPRACTICE
    8. 8. Legal Precedents DEFAMATION SOCIAL WORKER PRIVILEGE ENDING TREATMENT RECORD KEEPING
    9. 9. Legal Issues Disciplinary proceedings What are some circumstances that call for disciplinary proceedings by the SW Board?
    10. 10. Legal Issues What is the complaint process at your organization? What are the legal issues that you are most concerned about in your practice? What protections/safeguards do you have in place or what preventative measures do you employ?
    11. 11. Legal Issues
    12. 12. Legal Issues
    13. 13. When Do Clients Tend to Sue? Disappointed with outcome of the intervention Believe they have been exploited or used financially, emotionally, or sexually Had a negative outcome and attributed it to the social worker’s incompetence or negligence Presented with a bill larger or much later than expected
    14. 14. What Constitutes Negligence, Malpractice, and Liability? Issues of “standard of care” – how would a competent social worker behave in a specific practice situation with children and families? Practice standards - predetermined best practice standards - see NASW lists
    15. 15. Negligence Defined as, “Performance outside of what a reasonable professional in a similar situation would do”. The four elements that would be considered by the courts:
    16. 16. Negligence Was there a legal duty to the client? Was there a breach of duty through action/inaction? Was harm or damage incurred by the client? Was there causal connection between the breach of duty and the resultant harm?
    17. 17. Types of Negligence Acts of Commission or Malfeasance-did; should not have Acts of Omission or Nonfeasance-should have done; did not
    18. 18. AVOIDING MALPRACTICE SUITS Purpose: to minimize the possibility of being named in a lawsuit alleging professional negligence or misconduct.
    19. 19. Categories of Malpractice Civil Lawsuits-potential monetary damages Criminal Complaints-potential criminal sanctions such as probation and jail Licensing Board Complaints-potential loss of license to practice for varying periods of time
    20. 20. In general, the plaintiff in a successful malpractice suit must prove four points. The defendant (e.g., the social worker) was obligated to provide the plaintiff with a particular standard of care or professional conduct. The worker was derelict because he or she breached that obligation (or duty) by some act or omission that had a foreseeable consequence.
    21. 21. Four points continued The client suffered some injury or harm (physical, financial, emotional, etc.) The worker’s conduct was a direct or proximate cause of the client’s injury or harm.
    22. 22. Risk Management Licenses Registrations in Order Protocols for Emergency Situation Insurance Coverage Paid Maintenance and Safeguarding Client Records Specialist Consultants Diagnosis and Treatment Frederick G. Reamer. 2001. The Social Work Ethics Audit: A Risk Management Tool. NASW Press. Tool.
    23. 23. Risk Management-cont. Consultation with legal counsel Second-Opinion Referrals Ruling out Pathology Psychological Testing Appropriateness of Psychotropic Medication Continuing Education
    24. 24. Ethical Decision-making The Social Work Code of Ethics
    25. 25. Ethical responsibilities to: Clients Colleagues Practice Settings As Professionals The Profession The Broader Society
    26. 26. Values and Ethics  What is the difference?
    27. 27. Values and Ethics Values are concerned with what is good and desirable Ethics deal with what is right and correct Ethics are rules of conduct to direct social workers in a manner consistent with the values of the profession
    28. 28. Values and Ethics Social Work Values 1. 2. 3. 4. All human beings deserve access to the resources they need to deal with life’s problems and to develop their potentialities All human beings have intrinsic worth and dignity The uniqueness and individuality of each person is of value. Given appropriate resources, human beings are capable of growth and change and should be supported in increasing their choices in solving their problems and directing their lives
    29. 29. Primary goal is to help people in need & address social problems Challenge social injustice Respect dignity & worth of the person Importance of human relationships Behave in a trustworthy manner Practice in the area of competence and continue professional development
    30. 30. Dual relationships and NASW position on Rural Social Work
    31. 31. Dual Relationships What are dual relationships? The practice of assuming a second role with a client Examples?
    32. 32. Dual Relationships The Code says… “Social workers should not engage in a dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client”
    33. 33. Dual Relationships When is a client not a client anymore?
    34. 34. Dual Relationships and Rural Areas Rural Policy Statement Ethical practice in rural areas requires special attention to the issue of dual relationships They are unavoidable and need to be managed
    35. 35. Dual Relationships and Rural Areas How do you keep professional and social relationships separate or distinct? What is the risk of working with someone that you know through community involvement? How do you handle confidentiality and conflict of interest?
    36. 36. Dual Relationships and Rural Areas What do you do when you see a client at the store? What if a client wants to give you a gift or wants to barter for services?
    37. 37. Engaging in a “Dual Relationship” Entering a business relationship with a current or former client Participating in a romantic or a sexual relationship with a current or former client Establishing dual relationships with instructor/students…in the field and in the classroom
    38. 38. Next…LUNCH!
    39. 39. Decision-Making Model and Value Screen
    40. 40. Ethical Rules Screen (ERS) Examine the Code of Ethics to determine if any of the Code rules are applicable. These rules take precedence over the worker’s personal value system. One or more of the Code rules apply: Follow the Code rules. The Code does not address the specific problem, or several Code rules provide conflicting guidance: Use the ethical principles screen. Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7th Edition, F. E. Peacock
    41. 41. Ethical Principles Screen (EPS) 1. Protection of life 2. Equality and inequality 3. Autonomy and freedom 4. Least harm 5. Quality of life 6. Privacy and confidentiality 7. Truthfulness and full disclosure Lowenberg, et al. 2005. Ethical Decisions for Social Work Practice, 7th Edition, F.E. Peacock.
    42. 42. Values and Ethics  Managing Ethical Dilemmas Right to life, health and well-being Right of confidentiality Right to life, health and well-being Right to privacy or self-determination
    43. 43. Values and Ethics Right of self-determination Right to basic well-being Right to basic well-being Laws, policies, arrangements of organizations
    44. 44. Privacy and confidentiality Conflict of interest, dual relationships, sexual behavior Informed consent and client selfdetermination Impairment, incompetence, and unethical conduct of colleagues
    45. 45. Confidentiality   Safeguarding confidentiality involves respecting client privacy, gathering information only for the purpose of providing effective services, and disclosing information only with client consent The Tarasoff case represents an example of the limits on confidentiality.
    46. 46. Confidentiality Limits-Supervision and consultation Client waivers of confidentiality Danger to self or others Suspicion of child or elder abuse Subpoenas and privileged communication
    47. 47. Failure to Maintain “Confidentiality” Often unintentional Confidential nature of relationship and of the information obtained in the relationship Exception found in the “Duty to Warn” *Threats of violence *Threat is imminent *Likelihood that threat will be carried out in foreseeable future *Victim(s) identified Method? Motive? Opportunity?
    48. 48. Failing to Maintain “Accurate and Complete Records” Developing accurate assessments Free of judgmental language and hear say Confidentiality guarded Records document the service and quality of care
    49. 49.  Informed Consent Informed consent: requires Social Workers to clearly communicate to a client(s) the purpose of the services, possible risks related to the service, limitations of the service, costs, alternatives to the service, clients’ right to refuse or withdraw consent, and the time frame covered by the consent
    50. 50. Legal Responsibility to Obtain “Informed Consent” Clients right to expect the same degree of competence as that provided by other practitioners Intended to guarantee clients’ freedom, privacy, and safety Including the use of audio or video taped client sessions for course requirements
    51. 51. Self Determination What is this again?
    52. 52. Self Determination Self determination is the right of individuals to exercise freedom of choice in decision-making
    53. 53. Conduct of Colleagues What should you do if you suspect that a colleague is in violation of an ethical principle? Always get the facts (evidence, harm) Options for next steps…See Code of Ethics-Section 2.11
    54. 54. Conduct of Colleagues “Whistle-Blowing” Reporting an ethical violation to outside authorities When should this step be taken?
    55. 55. From: Gambrill (2002)
    56. 56. From: Gambrill (2002)
    57. 57. De-escalation and Termination
    58. 58. De-escalation (handout) What is it? Decrease in intensity, magnitude or amount What might it mean when engaging a potentially violent child or parent? What methods/techniques do you employ?
    59. 59. Termination of Services (handout) When is it necessary to terminate services? Examples?
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