This document presents three ethical dilemmas involving social workers: 1. A social worker must decide whether to report newborns to welfare recipients as required by new regulations or ignore the rule due to concerns it could deny services to those children. 2. A social worker trained paraprofessionals to provide culturally competent counseling but new rules prohibit unlicensed people from counseling. A complaint was filed against the social worker. 3. Social workers contracted with a hospital after their positions were eliminated. They now experience conflicts referring patients to the hospital's home services agency versus others. The hospital argues this creates conflicts of interest.

1. Ethical Practice:
For each of the ethical dilemmas outlined in Box 2.10, consider
whether you would consult with colleagues. If so, what
questions would you ask?
Case #1.
A social worker employed in a county social services
department as an eligibility worker has learned that local
welfare reforms direct that she report any new children born to
current welfare recipients. She fears that the new reporting
requirement could prevent children born into welfare families
from receiving income supports later in their lives. The worker
is aware of the requirement that social workers should comply
with the law. However, she is convinced that reporting
newborns might preclude future essential services. The social
worker also believes that the new regulations will create a new
class of citizens (children born to welfare mothers) that might
be discriminated against in various ways. She feels caught
between complying with the law and ignoring the law to prevent
what she views as likely injustice.
What is/are the ethical dilemma(s) facing the social worker?
Are these legitimate concerns? Why or why not?
As the social worker in this county agency, how would you
respond in this situation? What A are your possible courses of
action?
Case #2.
A clinical social worker in a remote community trains
paraprofessionals to do mental health counseling with members
of their Asian, Pacific Islander, and Central American

2. communities. She believes that well-trained paraprofessionals
familiar with community members’ cultures and languages
could broaden mental health services by bringing cultural depth
in service to those communities. Months after those she trained
began providing services, the state department that licenses her
agency adopted new policies prohibiting unlicensed social
workers from providing mental health counseling services. A
regional department representative reports that he is considering
filing a complaint against the social worker for facilitating the
unauthorized practice of social work.
What do you see as the ethical dilemma here for the social
worker? For the state department representative?
Which action would provide the best services to the clients?
Why do you think so?
As the social worker at the agency, what would you do to
protect your paraprofessionals and the services they provide to
your clients?
As a state department representative (which may well be social
worker too), on what ethical grounds can you feel justified in
enforcing the law?
Is there a win-win solution to this dilemma? What do you think
it might be?
Case #3.
When a nonprofit hospital downsized, all social work positions
were eliminated. The social workers were transferred to an
affiliated home health care agency. The hospital then offered to
contract with the home health social workers for the same work
they had done previously for the hospital. At times, the social
workers who do both hospital and home-based work experience

3. conflicts of interest when faced with the need to refer hospital
patients to home-based services. The social workers understand
that they should not exclusively refer to the hospital’s home
health care agency and that self-determination requires that
patients have information about a range of available,
appropriate services. But from the patient’s perspective, they
also see that it would often be more desirable to be able to
continue to work with the social worker who had been assigned
during the hospitalization period. The hospital’s risk
management officer has argued, however, that when patients
choose their home health care agency, the same social worker
should not continue to work with the patient because of the
appearance of conflict of interest—that is, the social worker
would receive compensation for services because of a referral
he or she made.
If a patient chooses to continue with her hospital social worker
as her home health social worker, is there really a conflict of
interest for the social worker? If so, what do you believe the
conflict to be?
What underlying social work values may be jeopardized in the
above working arrangement?
Are there any standards of practice being violated in this
working arrangement as set forth by the NASW
Code of Ethics
? Which one(s)