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RISE Article 4 -- Ethics
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“Ethics -- A Client who is also a Social Worker" and
“Ethics -- Burned Out and At Risk”
* Both of these articles are combined to offer 1 CE Credit
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Ethical Dilemma of the Month

Response to Member re Unethical Behavior of a Client Who Is Also a Social Worker

An NASW member requested Office of Ethics and Professional Review (OEPR) comment on the following situation:

A female client who is also a social worker has revealed that she has engaged in dual relationships with her own clients. In one instance, the social worker client hired a former client as a secretary. In another, she invited a client to attend a professional social work seminar and gave the client a ride to the seminar. The social worker client also recently revealed to the caller that she had engaged in a romantic relationship with a former client as well. The caller wanted to know what his responsibilities are in relation to his social worker client’s apparently unethical behavior.

 

Response:

Before turning to the substance of this inquiry, please be reminded that there are no hard and fast ethical “rules” governing a professional social worker’s conduct in a professional setting. There are only guidelines. An excerpt from the Purpose section of the NASW Code of Ethics states:

“The Code offers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations. Specific applications of the Code must take into account the context in which it is being considered and the possibility of conflicts among the Code's values, principles, and standards. Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional.”

Nevertheless, there are specific standards of the code that seem related to the situation as posed, that might inform the decision-making process in this instance. In addition, there are certain questions that might be asked to help determine what seems to be the wisest course of action. Please note that the questions included here are not exhaustive in nature. The may well be others that could and should be considered.

The ethical dilemma: The most obvious standard in the code pertains to dual relationships (1.06 c). However, before reviewing that standard, it is important to first identify what the ethical dilemma actually is in this instance. To be an ethical dilemma, there must at least be two conflicting or competing elements. These can be competing ethical standards, principles, values, a conflict between agency policy and an ethical standard, etc. At the outset the dilemma in this instance could be defined as consisting of a conflict between two ethical standards. These two standards from the NASW Code of Ethics are presented next:

“2.11 Unethical Conduct of Colleagues. (a) Social workers should take adequate measures to discourage, prevent, expose, and correct the unethical conduct of colleagues.”

and

“1.07 Privacy and Confidentiality. (a) Social workers should respect clients' right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply.”

Relevant questions:
  1. Does a social workers responsibility to address unethical conduct in a colleague also pertain to misconduct by a social worker that is revealed in the context of therapy?
  2. Is the responsibility to uphold the standards of the profession superceded by the social worker client’s right to confidentiality?
  3. What standard of the Code of Ethics is the social worker client’s conduct allegedly violating?

The last question relates to the standard in the Code mentioned earlier (1.06c). That section of the Code reads:

“1.06 Conflicts of Interest. (c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)”

Relevant Questions:
  1. Would there be any risk of exploitation or harm to the clients of this social worker (i.e., the clients of the client of the caller) in any or all of the three situations described?
  2. Were the dual relationships unavoidable in any or all of these three instances?
  3. What would constitute clear, appropriate and culturally sensitive boundaries?
  4. Does there appear to be a pattern of misconduct by the social worker client involving dual relationships and possibly sexual misconduct?
  5. Would this alleged misconduct, if true, place more than one person at risk?
  6. Does the placing of many people being seen by the social worker client at risk fall within the responsibility of the social worker clinician to the larger society?

This last question raises the issue of the social worker clinician’s responsibility to the broader society. Standard 6.01 of the Code of Ethics reads:

“6.01 Social Welfare. Social workers should promote the general welfare of society, from local to global levels, and the development of people, their communities, and their environments. Social workers should advocate for living conditions conducive to the fulfillment of basic human needs and should promote social, economic, political, and cultural values and institutions that are compatible with the realization of social justice.”

Relevant Questions:
  1. In the situation the caller described, just what is the social worker’s responsibility to the broader society?
  2. Does the social worker’s responsibility to the larger society as well as his responsibility to prevent a colleague’s misconduct take precedence over his responsibility to protect his client’s confidentiality?
  3. If so, does this mean he has an obligation to report the alleged misconduct?
  4. To whom would the report be made?

This last question returns the discussion to standard 2.11 of the Code, Unethical Conduct of Colleagues, sections b, c and d. Those sections read:

2.11 Unethical Conduct of Colleagues.

(b) Social workers should be knowledgeable about established policies and procedures for handling concerns about colleagues' unethical behavior. Social workers should be familiar with national, state, and local procedures for handling ethics complaints. These include policies and procedures created by NASW, licensing and regulatory bodies, employers, agencies, and other professional organizations.

(c) Social workers who believe that a colleague has acted unethically should seek resolution by discussing their concerns with the colleague when feasible and when such discussion is likely to be productive.

(d) When necessary, social workers who believe that a colleague has acted unethically should take action through appropriate formal channels (such as contacting a state licensing board or regulatory body, an NASW committee on inquiry, or other professional ethics committees).

Comment: These sections seem quite clear as to the options for where the social worker would make a report concerning alleged unethical behavior. The dilemma was originally posited as a conflict between this obligation to act regarding a colleague’s unethical behavior and that same colleague’s right to confidentiality as a client.

There are many other questions and considerations, which might apply to this situation, depending on other factors that, may or may not be operative. Some of the questions included here may not apply in this instance or may have already been answered in the description of the problem. A useful format for problem-solving an ethical dilemma can be found on this web page as well.


NASW Insurance Trust Practice Pointers

Burned Out—and at Risk

 

Phyllis has been a Child Protective Services caseworker for the past four years.  Although she initially took pride in her work and proficiency, her upbeat attitude eventually soured amid mounting caseloads, alarming employee turnover, media exposés of alleged agency gaffes, and spotty communication between supervisors and frontline workers. For months, Phyllis suppressed her growing discontent and shouldered on.  During an annual retreat, however, she finally unveiled her frustration in a teary outburst. The department, she said, was a shambles, her  supervisors were disconnected from day-to-day issues, and she felt pulled in seven directions. While her venting proved momentarily helpful, Phyllis’frustration quickly sharpened as institutional problems deepened. She became distracted, moody, forgetful— culminating two weeks later in a glaring administrative oversight that led to the injury of a 6-year-old client. Two days after this event, Phyllis, then on sick leave, tuned her television to the local evening news and saw a “Special Report.” The topic? Incompetent social workers. The subject of investigation? Phyllis. 

 

 

While many of the nation’s social workers feel overburdened and underappreciated from time to time, burnout is another matter. Burnout is a serious issue whose endpoint can entail mental confusion, psychosocial distress, and physical collapse. 

 

Burnout is pervasive. Enter the words “social work” and “burnout” into an Internet search engine and you’ll be rewarded with thousands of hits, a sober reminder of the significant stresses inherent in our profession, particularly among CPS workers. According to experts, the causes of burnout are varied, including heavy caseloads, unrealistic timeframes, low pay, lack of appreciation, and adverse working conditions without foreseeable relief. 

 

Burnout may be intolerable, but the consequences of burnout (or any other form of professional impairment) have no legal defense and social workers accused of impairment are at risk of malpractice action.  The paradox is that while some social workers are at higher risk of burnout, they still have an absolute responsibility to protect their clients from others—and from themselves. It therefore follows that social workers like Phyllis—including supervisors, managers and administrators—must take  preventive measures and be attuned to the early warning signs of burnout. In risk management, the weakest link can jeopardize the organization, its clients, and tarnish its reputation indefinitely. 

 

Signs of Burnout:

According to psychologist Christina Maslach, Ph.D. a pioneering researcher on occupational burnout and designer of the Maslach Burnout Inventory (MBI), burnout is not a telltale sign of personal weakness or bad attitude. Instead, it arises chiefly due to a mismatched fit between worker and job.  The greater the mismatch, the greater the potential for burnout. Symptoms of burnout span a continuum and can be easily overlooked in the earliest stages. According to researchers, burnout impacts: 1

 

  • Thinking. Burnout can lead to confusion; impaired judgment and decision-making; forgetfulness; and decreased ability to identify alternatives, prioritize tasks, and evaluate one’s own performance
  • Mood. Burnout can cause emotional exhaustion; loss of a sense of personal accomplishment and merit; depersonalization and alienation; depression; and easy excitability, anger, and irritability
  • Somatic functioning. Burnout can lower energy level, change appetite and sleeping, and cause gastrointestinal problems, hypochondriacal complaints, and exhaustion
  • Behavioral functioning. Burnout can cause increased or decreased activity level; extreme fatigue; excessive isolation from coworkers, family and clients; disorganization; misplacing of items; and impaired competence on the job.

 

Maslach and numerous other researchers have isolated the worker-job mismatches that give rise to job burnout, among them: overwhelming  workloads,  subordination of client and employee needs, depersonalized office culture and loss of camaraderie, inequitable treatment leading to  erosion of trust, and conflict between personal values and work assignments.

 

“Emotional Exhaustion”

According to University of Michigan social work professor Siri Jayaratne, burnout among social workers is a very real phenomenon. 

 

“We’ve done five national surveys of burnout among social workers and it’s clear that burnout is a problem,” he says.  “Our data tell us that protective service workers are at highest risk, while private practitioners are generally at the other end of the spectrum.” That said, Jayaratne notes that the term  burnout is so widely used and misused that its meaning is often clouded. “People often talk about feeling ‘burned out,’ but researchers obviously have very different definitions of it. My sense is that, when people refer to burnout, they are uniformally addressing a feeling of pure emotional exhaustion—a feeling of ‘I just can’t take it anymore.’”

 

Jayaratne believes that many sources of social worker burnout are preventable and that  early detection is imperative. “Our data generally shows that organizational structures tend to be a major cause of occupational burnout and that  the presence of support within organizations— including clarity of information and having staff available to assist in activities when needed—can greatly facilitate coping. Organizations must treat burnout as a priority; otherwise it’s just a case of blaming the victim.”

 

Periodic Audits

Reflecting on 20 years of research on social worker issues, Jayaratne comments, “A healthy employee leads to a healthy organization. Conversely,  when burnout occurs, ultimately service declines.” As burnout negatively impacts the social worker, his or her clients, and the organization at   large, the systemic problem of burnout requires a systemic solution.

 

Says Jayaratne, “Administrators and managers should continually assess the organizational climate. My impression is that there is a lot of tweaking that can be done that doesn’t require a major organizational overhaul. No  organization can adopt a generic solution, but each should conduct a periodic audit to identify problem areas and possible solutions.”

 

Assessing  the conventional approach to burnout, Jayaratne says, “I think teaching stress management and time management skills is only part of the solution—perhaps a small part. If the context of the organizational structure doesn’t change, burnout will recur.” The bottomline? Managers and  administrators should strive to create a more humane, less adverse working environment. The problem, he says, is sometimes one of feasibility.  Some agencies have notoriously difficult missions—missions that do not lend  themselves to much tweaking. 

 

“We are in an environment where everyone feels overloaded,” Jayaratne says.  “Even if there’s a desire to provide needed services to social workers, the question sometimes is: Is there the time or resources to provide it? If I go to my supervisor once a week for support, that may be fine. But if I go to her three times a week, will she consider me a lousy worker? It’s tough. Sometimes there are clear answers. But sometimes social workers are faced with a very difficult situation.”

 

NASW Code of Ethics:

In 1996, the National Association of Social Workers updated the NASW Code of Ethics to cover issues of professional impairment (section 4.05). With regard to burnout, the Code says:

  • Social workers should not allow personal problems, psychosocial distress, or mental health difficulties to interfere with their professional judgment, performance, or responsibilities to clients
  • Social workers who experience these problems should “immediately seek consultation and take appropriate remedial action” by seeking  professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others”
  • Social workers with direct knowledge of another social worker’s impairment should, when feasible, consult with and assist the social  worker in taking remedial action.

 

Prevention & Resources

According to Prudent Practice: A Guide for Managing Malpractice Risk, social workers who suspect they might be undergoing a process of  burnout are advised to undertake preventive measures— measures to safeguard themselves and their clients, 2 among them:

  • Listen to concerns of colleagues, family, and friends
  • Conduct periodic self-assessments
  • Reduce isolation by maintaining regular supervision and network with colleagues
  • Take needed “mental health days” and use stress-reduction techniques
  • Arrange for reassignment at work, take leave, and seek appropriate professional help, as needed.

 

Impaired social workers such as Phyllis in our example above should not attempt to go it alone. Going it alone along the road to burnout imperils the social worker, the organization, and his or her clients.  

 

It is important to seek out needed resources to help deal with this insidious phenomenon. This might include making use of a host of NASW chapter programs and special programs of state professional regulatory boards. 3

 

The good news? Help is available for social workers experiencing burnout. The first steps require us to recognize that a problem exists—and then  to seek appropriate help. In short, social workers should heed the age-old maxim: know thyself.

 

Sources:

1.     Institute for the Studies of Destructive Behavior & Los Angeles Suicide Prevention Center, 1988

2.     Prudent Practice: A Guide for Managing Malpractice Risk, 1997, Mary Kay Houston-Vega, Elane M. Nuehring, and Elisabeth R. Daguio

3.     Prudent Practice: A Guide for Managing Malpractice Risk, 1997, Mary Kay Houston-Vega, Elane M. Nuehring, and Elisabeth R. Daguio

4.      NASW Code of Ethics, approved by the 1996 NASW Delegate Assembly and revised by the 1999 NASW Delegate Assembly

 

 

Practice Pointers is a service of:

The NASW Insurance Trust

750 First Street, NW, Suite 725

Washington, DC 20002-4241

www.NASWInsuranceTrust.org

Matthew Robb, MSW, writes for the NASW Insurance Trust. Names and case examples depicted in Practice Pointers articles are fictitious. Any resemblance to persons living  or dead is coincidental.


 

 

 

 

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