Chapter 4 Notes: Operationalizing Social Work Values and Ethics
Chapter 4 Overview
Social work practice is guided by knowledge, skills, values, and ethics.
Values and ethics can sometimes conflict, creating dilemmas.
The chapter provides guidance on resolving these dilemmas.
It also challenges you to analyze your personal values and assess their compatibility with social work values.
By completing the chapter, you will:
Understand core social work values and their practical application.
Develop self-awareness and professional competence by examining tensions between personal and professional values.
Identify the roles ethics play in guiding professional practice.
Learn about the NASW Code of Ethics structure and standards.
Become familiar with core ethical issues: self-determination, informed consent, professional boundaries, and confidentiality.
Know the steps for resolving ethical dilemmas and their application to cases.
Understand the complexities of applying ethical standards to clients who are minors.
EPAS Competencies
This chapter provides information to meet the following EPAS competencies:
Competency 1: Demonstrate Ethical and Professional Behavior
Competency 2: Engage Antiracism, Diversity, Equity, and Inclusion in Practice
The Interaction Between Personal and Professional Values
Values are preferred conceptions or philosophies about how things ought to be; they reflect the ideas, beliefs, and behaviors that are most important to people.
Values can be enduring and widely shared, or vary by culture, setting, and context.
The profession of social work has its own values.
Social workers must be aware of their personal values and how they align or clash with professional values.
Clients also have personal values that may conflict with the social worker's or the profession's values.
Larger society has values articulated through cultural norms, policies, laws, and public opinion that can differ from those of the individual worker, clients, and the profession.
Becoming a social worker means agreeing to promote and abide by the profession's values, regardless of personal values.
Deferring personal interests to professional obligations can be challenging but is done to serve those who rely on social workers.
Self-awareness is the first step in resolving potential conflicts.
The Cardinal Values of Social Work
The National Association of Social Workers (NASW) Code of Ethics articulates the core values and ethical principles of the profession:
Service
All human beings deserve access to resources to deal with life's problems and develop their full potential.
Social workers elevate service to others above self-interest.
They use their knowledge and capacities to help people in need and address social problems through paid work, volunteerism, and pro bono services.
Social Justice
The profession prioritizes working for social justice and social change, focusing on issues like poverty, unemployment, discrimination, and other forms of social injustice.
Social workers promote sensitivity to oppression and cultural and ethnic diversity.
They strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision-making for all people.
Dignity and Worth
Social workers believe in the inherent dignity and worth of others.
They treat each person with care and respect, mindful of individual differences and cultural and ethnic diversity.
They seek to resolve conflicts between clients' and systems' interests ethically and socially responsibly.
Human Relationships
Social workers view interpersonal relationships as essential for well-being and as an important vehicle for change.
This affects how social workers relate to others and improve the well-being of client systems.
Integrity
Professional social workers behave in a trustworthy manner.
They treat clients and colleagues fairly and respectfully.
They are honest and promote responsible and ethical practices.
Competence
Social workers practice only within their areas of ability and continually develop and enhance their expertise.
They take responsibility for assuring their competence is not diminished by personal problems, substance use, or other difficulties.
They should act when confronted with incompetent, unethical, or impaired practice by other professionals.
Ethical Dilemmas: social workers must be aware of situations in which they might experience difficulties.
Valuing Service
A social worker's primary goal is to help people in need and to address social problems.
A historic and defining feature of social work is the profession's focus on individual well-being in a social context.
Attending to the environmental forces that "create, contribute to, and address problems in living" is an essential part of social work theory and practice (NASW, 2021, p. 1).
To embrace these values, social workers:
Believe people have the right to resources
Work to assure that adequate resources are available and accessible
Help secure needed resources
Develop policies and programs to fill unmet needs
The United States has a long history of valuing self-sufficiency, productivity, hard work, and morality which is then reflected in policies and programs with little regard for people judged unworthy of services.
As a result, many basic services (such as food and health care) that are considered fundamental rights in other countries are not universally available in the United States leading to real and perceived scarcity of resources.
Social workers in broker roles may experience overt or covert pressure to ration services or judge a client's worthiness for a given service.
Service Scenario 1: A client with a chronic psychiatric disorder repeatedly loses his glasses and requests funds to purchase new ones.
Service Scenario 2: A terminally ill client requests assistance to pursue death with dignity through assisted suicide, which is legal in their state.
Service Scenario 3: A social worker is overwhelmed with work when advocating for change because the broadband service in the rural county is very weak, expensive, and unpredictable.
Valuing Social Justice
Social workers challenge social injustice.
Injustice can present itself in many forms: oppressive policies and social structures, bureaucratic hurdles, judgmental services, inadequate resources, and the marginalization of vulnerable populations.
The profession's social change efforts target poverty, unemployment, discrimination, and other forms of injustice above all others.
Social workers promote awareness of oppression and cultural and ethnic diversity, ensuring access to information, services, resources, equality of opportunity, and meaningful participation in decision-making.
Responding to clients' rights and needs speaks to the importance of social workers' altruism and dedication to serve others, acting beyond the worker's personal needs or interests.
It also indicates the important role of macro practice and systems change skills to disrupt oppressive practices.
Social Justice Scenario 1: You and your coworkers have taken part in several marches to support the Black Lives Matter move-ment, antipoverty initiatives, and PRIDE parades.
Social Justice Scenario 2: A military mental health provider treats a client with mild trauma symptoms that wants to be sent home from deployment.
Social Justice Scenario 3: A social worker conducts a home study for an overweight, older couple interested in adoption and wonders if the screening criteria are biased.
Valuing the Person’s Dignity and Worth
Social workers respect the inherent dignity and worth of the person (NASW, 2021).
Respect for clients means that social workers believe that all people have intrinsic importance, whatever their past or present behavior, beliefs, way of life, or social status.
Understanding these qualities is essential in involving clients as partners in change.
These values embody several related concepts, sometimes referred to as "unconditional positive regard," "nonpossessive warmth," "acceptance," and "affirmation."
The value that every person is unique intersects with the right to service and commitment to justice.
Social workers should affirm the individuality of all whom they serve, entering that individual's world and understanding how that person experiences life.
Labels-such as "autistic," "unwed mother," "sorority girl," or "little old lady" perpetuate stereotypes because they obscure the individual characteristics of the people assigned to those labels.
Whether the preconceptions are positive or negative, professionals who hold them may fail to effectively engage with the person behind the label.
They may overlook needs or capacities, and, as a result, their assessments, goals, and interventions will be distorted.
Respect, curiosity, and nonjudgmental interactions are vital in helping build trust and mobilize capacities that are essential to change and to well-being.
As a professional, you may inevitably confront the challenge of maintaining your own values without imposing them on your clients (Doherty, 1995).
A first step toward resolving this issue is reflecting on and addressing your own judgments and first impressions.
Dignity and Worth Scenario 1: The client is a 35-year-old married man who was convicted for secretly videotaping women in restrooms.
Dignity and Worth Scenario 2: A low-income family spent a settlement check on a large television and gambling at a local casino.
Dignity and Worth Scenario 3: A 10-year-old boy demonstrates strangling cats and dogs with toys during play therapy.
Valuing Human Relationships
Social workers recognize the central importance of human relationships (NASW, 2021, p. 5).
Like dignity and worth, this value also recognizes that respect is an essential element of the helping relationship.
Before people risk sharing personal problems and expressing deep emotions, they must first feel fully accepted and trust the helpful intent of their service providers.
Research affirms the importance of this value in findings that relationship factors such as warmth, empathy, encouragement, and acceptance account for 30% of change in the therapeutic process (Hubble et al., 1999).
When asked to rank the factors they perceived as contributing to change, 35% of therapists selected the therapeutic relationship, again underscoring the importance of fostering strong rapport.
It is difficult to build a therapeutic alliance with clients who feel ashamed, inadequate, or powerless in seeking assistance.
The worker's role is not to judge whether people are to blame for their problems. Rather, our role is to seek to understand clients' difficulties and assets and assist them in accessing solutions.
Human Relationships Scenario 1: A Chinese student wants to major in history, but her parents insist she study business.
Human Relationships Scenario 2: A client was admitted to a domestic violence shelter following an attack by her husband.
Human Relationships Scenario 3: A Latinx outreach worker has a Caucasian client who blames her difficulty finding a job on "all these illegals."
Human Relationships Scenario 4: A high school senior is told by her parents that she is needed at home to care for her younger siblings and assist in her family's ministry.
Valuing Integrity
The value of integrity means that professional social workers behave in a trustworthy manner.
Integrity has several dimensions:
Wholeness or compatibility with a person's essential character.
Consistency in one's words and actions.
Steadfastness, where integrity is demonstrated despite the circumstances (Banks, 2010).
As an ethical principle, integrity means that social workers act honestly, encourage ethical practices in their agencies, and take responsibility for their own ethical conduct (Reamer, 2018).
Practically, this means that social workers present themselves and their credentials accurately, avoid misrepresentation, and do not associate with fraud and deception.
Trustworthiness is also related to worker well-being, and it asserts that social workers take care of themselves personally and professionally (NASW, 2021).
Integrity also refers to the ways social workers treat their colleagues.
Professionals are expected to treat one another with respect, avoid involving clients in professional disputes, and be forthright in their dealings.
Challenges can arise when pressures from colleagues or organizations create ethical dilemmas.
Professionals experience moral distress when institutional constraints prevent them from acting congruently with their ethics codes and values (Mänttäri-van der Kuip, 2019; Papouli, 2019).
Moral courage is the ability to act on behalf of principles, despite possible harms or pressures to do otherwise (Strom-Gottfried, 2019).
Moral courage is visible when people have "the capacity to overcome the fear of shame and humiliation in order to admit one's mistakes, to confess a wrong, to reject evil conformity, to renounce injustice, and also to defy immoral or imprudent orders" (Miller, 2000, p. 254).
Integrity Scenario 1: The agency has no protective equipment, and the administration insists on regular (in-person) meetings because the reimbursement for phone services was too low.
Integrity Scenario 2: The supervisor wants to discuss cases over lunch to save time in busy schedules, but it is impossible to have a private space or avoid discussing details of the cases.
Integrity Scenario 3: A roommate graduated from the social work program last year and is supposed to receive weekly supervision as a condition of their beginning license.
Valuing Competence
The value of competence requires that social workers practice only within their areas of ability and continually develop and enhance their professional expertise.
Professionals take responsibility for knowing their own limits and seeking out the knowledge
The commitment to utilizing evidence-based practices means that professionals must be lifelong learners, staying abreast of practice-related research findings, discarding ineffective or harmful practices, and tailoring interventions to the clients' unique circumstances (Gambrill, 2007).
The NASW Code of Ethics also includes cultural competence among its expectations for social workers
Self-regulation requires social workers to be alert to events or problems that affect professional competence.
Countertransference and transference can constructively or harmfully affect the helping process. It is important to be alert to such reactions and use supervisory sessions to examine and address their impact.
Supervision is an essential element in professional development and ongoing competence.
Competence Scenario 1: The director of a financially strapped counseling center assigned you to a trauma-informed interventions unit with children but, you have never studied or worked with children, especially those at risk.
Competence Scenario 2: You've found yourself attracted to one someone on your caseload.
Competence Scenario 3: You encounter a woman from the Ukraine whose dialect you are unfamiliar with, a Muslim woman reluctant to disrobe for the physical exam, and a Korean family at odds over the placement of their teenager's newborn infant.
Challenges in Embracing the Profession's Values
Uneasy or negative feelings may arise, which is not unusual.
It can be challenging to look beyond differences, our comfort zones, distressing case information, or bureaucratic systems to suspend judgment and work for change.
By focusing intentionally on the person within the troubling behavior or role, you can move beyond initial reactions and see others in full perspective.
Skilled mentors, teachers, or colleagues can help probe your reactions, encourage reflection, share divergent perspectives, and promote accountability to change.
Talk with other professionals about the value conflicts they initially experienced, and how they managed them. What value challenges still arise and what techniques do they use to stay resilient, self-aware, and client centered?
Acceptance is conveyed by listening attentively, responding sensitively to others' messages, and using facial expressions, voice intonations, and gestures that convey interest and concern.
Reaching beyond preconceptions or superficial interactions to understand others fosters humility, builds alliances, and increases appreciation for the life journeys.
If personal change is not possible or timely, or if the situation is exceptional, the social worker and their supervisor should explore the possibility of transferring the case to another practitioner who can effectively engage with the client or the necessary systems.
It is vital to clarify that the transfer is because clients deserve the best service possible, and the particular social worker cannot provide that service.
Practitioners who are consistently unable to accept clients' differences or carry out their roles in a professional manner owe it to themselves and to future clients to reflect seriously on their suitability for the social work field.
Values, Ethics, and Culture
Cultural values shift and evolve over time, and social workers' systems change efforts may appropriately target stances that harm or disenfranchise certain groups
How can social workers ensure that their efforts are proper and congruent with the desires of the particular cultural group and not a misguided effort born of paternalism and ethnocentrism?
Are ethics fixed guidelines that should be applied universally (a deontological perspective)?
Are they flexible, depending on the place and population to which they are applied (a relativist position)?
Do ethics depend on the worker having honorable personal characteristics, such as honesty, kindness, or integrity (virtue ethics)?
Striving for cultural humility, curiosity, and lifelong learning are vital first steps to bridge competing values and norms (Barsky, 2019; Maschi & Liebowitz, 2018).
Social workers must be aware of their values and those of their colleagues and clients and engage in ongoing education and conversation.
This approach encourages exploration and discourse in order to determine where the ethical tensions reside and how much of an impediment they are to the helping process.
Ethics
Codes of ethics are the embodiment of a profession's values and set forth principles and standards for behavior.
Codes can be issued by employers, regulatory bodies, and professional associations.
In each jurisdiction, the code reflects values and standards that embody the history, culture, and context in which it is written.
The NASW Code of Ethics addresses a range of responsibilities that social workers have as professionals to their clients, their colleagues, their employers, their profession, and society.
Four primary areas of ethical responsibility for social workers are: self-determination, informed consent, maintenance of client-social worker boundaries, and confidentiality.
The Intersection of Laws and Ethics
The practice of social work is governed by policies, laws, and regulations established by court cases, Congress, state legislatures, licensure boards, or regulatory agencies.
Competent practice requires social workers to be aware of the laws and regulations that govern the profession and apply to their area of practice and the populations they serve, and, also knowledge of both the applicable ethical principles and the relevant laws.
Even with this knowledge, dilemmas may persist.
Case Example: Alice is a 38-year-old woman who discloses that she is HIV positive but is unwilling to tell her husband of her status because then the affair would be revealed, and she fears losing him and her two young daughters.
Figure 4-1 The Relationship of Law and Ethics
Key Ethical Principles
The NASW Code of Ethics contains 171 standards, addressing a variety of ethical issues.
Four key areas of immediate relevance to direct practitioners are:
Self-Determination
Biestek (1957) defined self-determination as "the practical recognition of the right and need of clients to freedom in making their own choices and decisions" (p. 103).
This also embodies the perspective that individuals have the capacity to grow, change, and develop solutions to their difficulties, as well as the right and capacity to responsibly exercise free choice.
As enablers of change, social workers facilitate clients' quests to view their problems realistically, consider various solutions and their consequences, implement change-oriented strategies, understand themselves and others more fully, gain awareness of previously unrecognized strengths and opportunities for growth, and tackle obstacles to change and growth.
Just as fostering self-determination enhances client autonomy, exhibiting paternalism (preventing self-determination based on a judgment of the client's own good) infringes on autonomy.
Even when clients have reduced ability for self-determination, social workers should act to ensure that they exercise their capacities to the fullest feasible extent.
Self-Determination Scenario 1: Two clients who are in their 90s reside in the same facility and are sexually involved with each other.
Self-Determination Scenario 2: A 15-year-old who is four months pregnant has contacted you several times in regard to planning for her child but is habituated to heroin.
Self-Determination Scenario 3: An elderly man is disheveled and thin, and the house is unclean, piled high with old newspapers and magazines, and occupied by more than a dozen cats.
Self-Determination Scenario 4: A young woman to receive training as a beautician in a local technical college, a vocation in which she expressed intense interest but tells you that she wants to discontinue the program and go into nursing.
Providing Informed Consent
In essence, informed consent requires that social workers use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent.
Social workers should obtain client consent before conducting an electronic search on the client when using technology to provide social worker services.
Timely and understandable informed consent sets the stage for social work services by acquainting the client with expectations for the process and limits on client privacy.
It should be an active and ongoing part of the helping process.
Social workers should utilize interpreters and multiple communication methods as appropriate for persons with hearing, literacy, or language difficulties.
Preserving Professional Boundaries
The term boundaries refers to norms of separation that are maintained between the social worker and the client in an effort to preserve the working relationship.
Boundaries help clarify that the client-social worker relationship is not a social one.
When clients can trust that boundaries exist and will be maintained by the social worker, they are more able to focus on the issues for which they are seeking help.
The NASW Code of Ethics addresses boundaries through several provisions: (1) should not take unfair advantage of any professional relationship (2) should not engage in dual or multiple relationships (3) should not engage in physical contact or sexual activities with clients.
Not all encounters with clients outside the helping relationship are unethical.
Safeguarding Confidentiality
Confidentiality is essential to the helping process. Without the assurance of confidentiality, it is unlikely that I anyone seeking services would risk disclosing private aspects of their lives.
Social workers are bound by the NASW Code of Ethics to safeguard their clients' confidentiality.
People commonly reveal information that is shocking, moving, humorous, bizarre, or titillating so To fulfill your responsibility in maintaining privacy, you must guard against disclosing information in inappropriate situations.
There are advantages exist in electronic provision of services through a video software, websites, online groups, and so on but challenges to maintaining client privacy are evident.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established federal standards to protect the privacy of personal health information but also recognizes the validity of professional standards.
The Family Educational Rights and Privacy Act (FERPA) is another significant privacy law that resembles HIPAA in empowering individuals to control their personal information.
What Are the Limits on Confidentiality?
Although social workers are expected to safeguard the information they collect in the course of their professional duties, there are several situations in which helping professionals are allowed or are compelled to share case information such as: seeking supervision or consultation, waives confidentiality, presents a danger to self or others, reporting suspicions of child or elder maltreatment, and presented with a subpoena or court order.
Supervision and Consultation are situations but the client has a right to be informed that such disclosures may occur, and practitioners seeking supervision have a responsibility to fully conceal the identity of the client.
Client Waivers of Confidentiality is important that case data be provided only with the written, informed consent of clients, as this releases the practitioner and the agency from liability in disclosing the requested information.
Danger to Self or Others (Tarasoff case) If the worker perceives a serious, foreseeable, and imminent threat to an identifiable potential victim, the social worker should (1) act to warn the victim(s) or (2) take other precautions (such as notifying police or placing the client in a secure facility) to protect the public from harm.
Suspicion of Child or Elder Abuse also prioritize the client's right to confidentiality because all 50 states have statutes making it mandatory for professionals to report suspected or known child abuse.
Subpoenas and Privileged Communicaiton are also constraints on the client's right to confidentiality in that this right does not necessarily extend into courts of law.
Confidentiality in Various Types of Recording entail the process of following specified guidelines to ensure maximal confidentiality through case record keeping, and precaution for recordings of client interactions.
The Ethics of Practice with Minors
A particular challenge in social work practice is interpreting ethical standards as they apply to clients under the age of 18 but their rights are limited by laws and policies, by differences in maturity and decision-making capacity, and by their very dependence on adults as their caretakers.
Minors' rights are also affected by the service setting and by their presenting problems.
As such, parents may retain the right to review a child's treatment record and to be kept informed of issues the child raises in therapy.
Understanding and Resolving Ethical Dilemmas
Ethical dilemmas help assure that all perspectives are carefully considered and opportunities for positive outcomes are maximized (Strom-Gottfried, 2019).
Steps in Ethical Decision-Making
Social workers encounter many situations that inevitably involve uncertainty and ambiguity.
Dilemmas are difficult because they pit competing goods or rights against each other.
Recommendations include:(1) Identify the problem, (2) Determine the core principles,(3) Review the relevant codes of ethics, (4) Review the applicable laws and regulations, (5) Consult with colleagues,(6) Consider the possible and probable courses of action,(7) Decide on a course of action,(8) Develop a strategy for effectively implementing your decision,(9) Evaluate the process and the results.
These procedures need not be followed in the order listed even decisions that must be made on the spot with little planning or consultation can be evaluated after the fact using this model.
Applying the Ethical Decision-Making Model
To apply this model, let's use the case of Alice that the social worker has a loyalty to Alice's needs and wishes but also a responsibility to prevent her from harming another person (her husband).
Several provisions in the NASW Code of Ethics (2017) speak to this dilemma that: (1) social workers should protect the confidentiality unless serious harm results (2) If social workers plan to disclose inform clients and review circumstances where information may be requested.
It is important to know how the social worker handled informed consent, and if the agency was alread aware of laws and had incorporated them into policies.
Supervisory guidance is essential through assistance from supervisor or consultations from medical or legal experts.
Options for Actions incude honor Alice's wishes, educating her about the virus, offer to assist in telling her husband, or reporting.
Ethical decisions require the social worker to look a the advantages from each party and act according to ethical standars.
Self-awareness and self-evaluation in one important for a competent ethics practise.
Summary
This chapter introduced the ethics and the values that support the social work profession and highlighted the ways these values may create conflicts in professional practice.
It provided guidelines for supporting self-determination, respecting confidentiality, obtaining informed consent, maintaining boundaries, and resolving ethical dilemmas.
The chapter suggested steps to aid in resolving ethical dilemmas and applied these steps to a case in which self-determination and client confidentiality conflicted with another's safety.
Throughout, the chapter considered the importance of self-understanding and self-regulation so that social workers learn to be intentional in their statements and actions and assure that clients' needs and the working relationship are given precedence.