Professional Values, Ethics, and Professional Relationships
Weaknesses of problem oriented record
it partializes or over-simplifies problems and assessments; de-emphasize strengths and resources of clients; focuses on biomedical rather than psychosocial concerns; and, disregards the complexities of service.
Access to records
limit access to records only if it could cause harm to the client. Must document reason for withholding as well as any client requests for records clients should always sign a release of info before discussing cases with anyone, including other mental health professionals
Time series recording
most closely associated with behavioral intervention and single subject designs where time series records document and measure specific behaviors. IT also provides information on movement toward goals and objectives. Data is collected and displayed visually on a graph and can be analyzed either statistically or visually
Role of UR social worker
obtains authorization for recommended outpatient services, schedules initial appointments to obtain services, vouchers, and prescriptions
Subpoena
provide only the information required to provide. If testifying on behalf of a client, the request to testify needs to be in writing
Court-order
provide only the information required to release to the judge *Clients permission FIRST. ALWAYS try to get the client's written permission first before releasing any client records
Utilization review
provides a gatekeeping function that determines whether a recommended medical treatment or procedure is medically necessary and should receive insurance reimbursement The goal is to decrease medical costs while providing quality medical care this function is essential for discharge planning and continuity of care, and marketing as benefits can be denied
Ethical codes
standards of moral conduct for a society or subgroup, such as social workers. A code of ethics for a profession contains standards of conduct subscribed to by members of a profession. These codes reflect concerns and define basic principles that "ought to guide" professional activities.
There are five social work values that Hepworth and Larson describe as the cardinal values of social work. They are as follows:
1. People should have *access to the resources* they need to meet life's challenges and difficulties as well as access to opportunities to realize their potentials throughout their lives. 2. Every person has *intrinsic or inherent worth*. Related concepts include: unconditional positive regard, acceptance, nonjudgemental attitude and respect 3. Intertwined with acceptance and a non-judgmental attitude is the value that *every person is unique and that social workers should prize and affirm the individuality of people with whom they work*. Prejudice attitudes result in a loss of opportunity for the affirmation of individual self-worth. 4. People have *the right to freedom* in so far that they do no infringe on the rights of others; transactions with people in the course of seeking and utilizing resources should enhance their independence and self-determination. 5. An affirmation of client strengths and problem-solving abilities supports *self determination*. To implement these values the following are needed: commitment to value, knowledge of the skill in employing resources and willingness to develop, actively support, and implement policies and programs that effectively meet human needs
Social workers must evaluate ethical practice based on 3 considerations:
1. their professional moral judgement (does it make the worker uncomfortable) 2. legal aspects (are there laws governing it) 3. ethical implications (do ethical principles to which we abide apply)
Q: When conducting SUPERVISION for social work LICENSURE, the requirement for ACCEPTABLE SUPERVISORY SESSIONS SHOULD CONTAIN: A. supervision sessions that are practice oriented and well documented are required B. group supervision without practice application is acceptable C. teaching without practice application is acceptable D. direct case presentations only
A.
Q: The social work supervisor, in reviewing a supervisee's recorded case file makes this comment about the case recording method being used: "This type of case recording STRESSES THE INDIVIDUAL SOCIAL WORKER'S INTERPRETATION AND TENDS TO BE VERY LONG and not uniformed in its presentation; that is probably why it is rarely used today". WHAT RECORDING method was used? A. diagnostic summary recording B. problem-oriented recording C. SOAP note D. current process recording
A. Answer on pg 63
Q: Which of the following is considered AN UNACCEPTABLE FORM OF ADVERTISING? A. personal information about the social worker B. professional information about the social worker C. classified advertisement D. phone directory advertisement
A. -personal info is considered unacceptable Answer on pg 50
Q: A BOY (9 YEARS-OLD) tells the social worker during a session that a RELATIVE HAS SEXUALLY ABUSE HIM. The boy IMMEDIATELY BREAKS INTO TEARS AND FEAR THE SOCIAL WORKER WILL REPORT IT. The FIRST RESPONSE of the worker should be to: A. calm the child and ask for further clarification of the abusive information B. explain to the child that the social worker has no choice and it must be reported immediately C. tell the child that it is for the best in the long run and he must trust the worker D. explain the legal requirements and what will probably happen to the child as a result of current abuse
A. -the case will have to be reported if abuse report is verified Answer on pg 50
Q: In developing an ADVERTISEMENT FOR GROUP THERAPY SESSIONS, a social worker in private practice can include all of the following EXCEPT: A. recommendations from former clients B. professional qualifications C. academic degrees D. policy on accepting third party payments
A. -the others are acceptable Answer on pg 51
Q: A social work SUPERVISOR WHO PRACTICES AS A GENERALIST IS CORRECTLY described as: A. a social work expert in all areas of social work B. a practitioner who practices across specialization lines of the fields of practice, population groups and problems C. a practitioner who is considered interested in all forms of medical social work practice D. a practitioner who specializes in family therapy but practices all types of social work practice
B.
Q: In a multi-disciplinary organization, the BEST WAY for a supervisor to OBTAIN DESIRED OUTCOME is to: A. review salaries after establishing criteria for doing so B. meet with individual employees to establish rapport C. establish a motivational incentive system D. clearly establish goals and organizational objectives
B. -everyone is from a different discipline with a different perspective
Q: If a SUPERVISOR BELIEVES A SUPERVISEE'S CASE IS BEING HANDLED POORLY, the supervisor should FIRST: A. discuss it immediately with the client B. discuss it immediately with the supervisee C. report it to ethics committee D. set up an appointment with the client involved
B. -talk it over with the supervisee first
Q: A social worker that works primarily with the elderly REFERS A CHILD TO ANOTHER SOCIAL WORKER IN HER OFFICE. In exchange the referring social worker is GIVEN A 10% FINDER'S FEE. This referral process is considered: A. accepted ethical behavior B. unacceptable ethical behavior C. acceptable if limited to 10% of fee D. acceptable if agreeable by both social workers
B. -this is considered a Split-fee, which is not an acceptable practice procedure Answer on pg 48
Q: SUPERVISION has generally been related to social work practice PRIMARILY AS MEANS OF: A. in-service education B. measuring worker effectiveness C. ensuring the delivery of ethical, quality, and efficient social work services D. social control
C.
Q: If an ATTORNEY REQUESTS THE RECORD OF A CLIENT and the social worker has RECEIVED VERBAL OKAY TO RELEASE THE RECORD FROM THE CLIENT, the SOCIAL WORKER SHOULD: A. release the record as requested B. wait until the record is subpoenaed to court C. get the client's consent in writing D. assert professional privilege and refuse to release the record as you believe it might be harmful to your client's case
C. -always get the client's consent in writing Answer on pg 50
Q: While in therapy with a social worker, a client reveals that SHE IS PLANNING TO PHYSICALLY HARM ANOTHER CLIENT. The other client is also BEING TREATED BY THE SAME SOCIAL WORKER. What is the BEST ETHICAL COURSE OF ACTION for the social worker? A. first, the social worker should alert his/her supervisor B. the social worker can do nothing because he/she is bound by client confidentiality C. the social worker should first warn the other client D. the social worker should first tell the police of the client's intentions to harm another client
C. -duty to warn the other individual is first Answer on pg 48
Q: A BREACH OF ETHICAL CONDUCT MAY EXIST when a social worker: A. uses a client's first name B. exchanges information about local restaurants in the area C. exchanges social work sessions for yard work to be completed by the client D. discusses what happened at a local sporting event
C. -exchanging services are not considered acceptable practice Answer on pg 51
Q: J., a 28-YEAR-OLD MALE CLIENT, DISCLOSES to his social worker in the second interview that he HAS HAD A SEXUAL RELATIONSHIP WITH HIS PREVIOUS SOCIAL WORKER. He states that he is no longer in therapy with her but that he still sees her ON OCCASION IN A NONPROFESSIONAL SENSE. The current social workers BEST ETHICAL COURSE OF ACTION IS: A. report the other social worker to the governing board of social workers B. do nothing in terms of reporting it, and respect client confidentiality C. explain the options available to your client if he chooses to report it D. give the client the number of the licensing board and ask him to call
C. -explain options to your client and let him decide what he wants to do Answer on pg 48
Q: In a social service agency, the DESIGNING OF TRAINING PROGRAMS and the IMPLEMENTATION OF STAFF DEVELOPMENT RESTS WITH THE: A. support staff B. general administration C. supervisor D. company executive officer
C. -person who serves in this role is expected to do this
Q: While working with a 20-YEAR-OLD CLIENT you discover that her UNCLE SEXUALLY ABUSED HER FOR THE LAST FIVE YEARS. She is concerned HE WILL DO IT TO HER NEPHEW AS WELL. As a social worker YOU ARE ETHICALLY BOUND TO: A. report the case of sexual abuse because it first occurred when she was minor B. report the case of sexual abuse because it is currently going on C. do no report current case, only report this case if you feel a child is currently in danger D. urge the client to confront the abuser so it won't happen to someone else
C. -report if you believe a child is in danger Pg 49
Q: If a WOMAN ADMITS during a counseling session that her HUSBAND IS ABUSING HER, the social worker is OBLIGATED TO DO the following: A. report the incident to the proper authority with or without client permission B. report the incident with client permission only C. assist the woman to become aware of services available to her in regard to the abuse D. nothing is required of the social worker, it is up to the woman to ask
C. -reporting is not warranted Answer on pg 50
Q: A clinical social worker wants to hire a bookkeeper to file insurance reimbursement. One of the APPLICANTS TURNS OUT TO BE A FORMER CLIENT. Since therapy WAS TERMINATED OVER A YEAR AGO, the social worker decides to HIRE THE CLIENT. This situation is: A. ethical since termination of therapy was over a year ago B. ethics is not an issue when the applicant is competent, she should be hired C. this could be unethical because hiring a former client would create the potential for a dual relationship D. not to hire the applicant would be seen as discrimination
C. -there is no time limit. Once a client, always a client Pg 49
Q: A female social worker has been treating A MALE CLIENT FOR SEVERAL WEEKS when she realizes that she is ATTRACTED TO HER CLIENT. At times she finds herself wondering WHAT IT WOULD BE LIKE TO BE WITH HIM outside of the therapy session. She discusses this with her supervisor. Her supervisor's FIRST COURSE OF ACTION SHOULD BE TO: A. find out if this has happened before B. advise the social worker that this is unethical and must be stopped at once C. explore the situation with the social worker D. refer the client to a different therapist
C. -thinking is not unethical, acting on your thoughts is!!! pg 49
Spouse Abuse
Can happen across all ages, income levels, races, etc. There is a great deal of mutual abuse and the severity of abuse incidents often increases. Most abuse is in the form of psychological abuse and exploitation and begins with emotional abuse. Many of those who participate in abuse- grew up in abusive environments
Confidentiality & privilege therapy
Confidentiality refers to therapy content. it is an ethical responsibility and must be provided to all clients and research participants. Names of clients should not be given out. Privilege is a legal term similar to confidentiality although this term applies specifically to the courts and other legal proceedings. Only laws establish privilege. *Privilege was traditionally held only be the client- not be the therapist*. Parents or legal guardians and emancipated minors are considered to possess privilege. The legally incompetent and minors (non-emancipated) do not. Social workers are recognized as professionals whose discussions with clients are protected from disclosure in *Federal* trials. State requirements can differ. Remember: records can and are often subpoenaed in a court of law. Documentation should reflect this awareness
Q: A YOUNG BOY (AGE 14) states in session that he HAS WITNESSED A CRIME. He is frightened because some OLDER BOYS BEAT UP ANOTHER BOY after selling him drugs in his neighborhood. He FEELS HE SHOULD TELL THE POLICE but he is afraid to do so. The social worker's BEST ETHICAL COURSE OF ACTION is to: A. encourage the boy to contact the police B. inform the boy that confidentiality must be broken and report it C. contact the boy's parents and tell them what happened D. explore the situation further, helping the boy to discuss available options
D. Pg 49
Q: If a social worker BELIEVES SHE CANNOT HELP A CLIENT, the BEST COURSE OF ACTION IS: A. disengage from the client B. consult a colleague C. obtain the education/skills needed to help the client D. refer the client to another clinician who can provide the needed service
D. -always practice in your scope of expertise and *when unable to assist, always refer* Answer on pg 50
Q: While in their second session, A WOMAN WHO IS HAVING DIFFICULTY CONTROLLING HER CHILDREN, asks the worker is she has any children? The BEST RESPONSE IS: A. "I am not allowed to discuss my personal life with you" B. "No, it is your children we are discussing" C. Avoid the question and redirect it back as "It sounds like your children are causing you concern." D. "Yes. I have children, tell me why you want to know."
D. -answer the question, but always relate any further comment back to the client. Always remember self disclosure is for the benefit of the client Answer on pg 50
Q: A supervisor HEARS A SUPERVISEE TELLING A CLIENT in the lobby that they MUST ARRIVE TO APPOINTMENTS ON TIME or they WILL NO LONGER BE TREATED. The supervisor should FIRST: A. ignore it and allow the conversation to continue B. immediately confront the supervisee and let them know this is inappropriate C. do nothing as this may be a legitimate interchange D. later in the day discuss your concerns with the supervisee
D. -clarify first and address
Q:As a social worker, you are about to finish a session with a FATHER AND SON. As you are preparing to close the session, you NOTICE THAT THE CHILD HAS A CIGARETTE BURN ON HIS ARM. The FIRST COURSE OF ACTION FOR THE SOCIAL WORKER would be: A. contact Child Protective Services about potential abuse B. ask the father how the injury occurred C. wait til the next session to explore the situation D. ask the child in private how the burn occurred
D. -if confronted, the father may feel pressured to lie about the injury. The ideal situation is to ask the child alone. If that was not a choice, it would be better to either extend the session and discuss it or consider making it an agenda item at the next meeting or try to contact the child setting up a meeting without the father Pg 49
Q: Supervisors are EXPECTED TO PROVIDE A VARIETY OF SERVICES FOR THOSE THEY SUPERVISE, services included generally consist of all of the following EXCEPT: A. education B. assistance with reinterpretation C. active problem solving D. parental guidance when warranted
D. -never do D
What is the difference between supervision and consultation?
In consultation, recommendations are voluntarily followed and clinical suggestions can either be accepted or rejected. In consultation, the relationship is not regulated by legal statute (although, must adhere to ethical standards). The consultant provides expert advice but the legal responsibility lies with the social worker completing the task. Consultation is limited in authority and often does not meet requirements for credentialing bodies or insurance companies. *In clinical supervision, the supervisee must be aware of the different methods of record keeping often used by social workers and all professional records need to be accountable and accurate.
Questions to help evaluate whether there is a risk of abuse
Is there is a history of previous spouse or significant other hitting? Are they pathologically jealous? Does his/her personality change to violent when drinking alcohol? What is his/her family like? How does he/she react to your success? Does he/she try to isolate you? Has he/she ever hit you?
Reporting procedures
Laws vary bx the states; however, the following is accepted unless otherwise stated: physical abuse or emotional neglect to a minor child under the age of 18 must be reported no matter who the perpetrator suspected to be. Parental support and permission are required for treatment to minors under the age of 18, specific exceptions have been made in certain areas (ie., abortion, birth control, etc.)
The purpose of ethical codes is to:
Provide standards of practice to aid professionals when approaching areas of conflict Assist in clarifying professionals when approaching areas of conflict Give society some guarantee that professionals will demonstrate a sensible regard for mores and expectations of the society Give professionals themselves grounds for safeguarding their freedom and integrity
SOAP notes
S: subjective, the therapist writes what they see as the patient's reason for coming in etc., subjective information from patient and family O: objective, only measurable criteria is discussed, direct quotes are often used here, objective information from tests and observation. A: assessment, this section involves what is believed to be the underlying problem and diagnosis if applicable. what does the therapist see as happening? P: plan, involves what you want to happen to the individual and how treatment objectives will be conducted and obtained. In this section, problems are to be resolved or stabilized. If they cannot be addressed, referrals and future plans are specified (e.g., alternate plans or referrals to community agencies)
Ethical pricinples
Service- help people in need and address social problems Social justice- challenge social justice Dignity and worth of the person- respect each individual Importance of human relationships- recognize the importance of social relationships Integrity- behave in a trustworthy manner Competence- practice within your area of competence and seek to further enhance skills
Advertising
as a questionable area for social workers "good professional taste" is considered acceptable. Testimonials and case examples are not recommended and considered unacceptable and unprofessional; however, the usage has increased as a marketing strategy. Never use *personal* info about a social worker to market services
Setting boundaries
boundaries for treatment are simply stated friendships and sexual relationships with past or current clients are prohibited Sexual relationships, in particular, are subject to severe legal penalties. The best rule is "once a client, always a client" It is the social worker's responsibility to set clear appropriate and culturally sensitive boundaries with any client served
Dual and Multiple relationships
hiring or employing previous clients is discouraged. When doing this a dual relationship would result that could create an environment for exploitation and would be considered unethical. Multiple relationships can become unethical and need to be recognized and managed accordingly.
Is first responsibility to your client or your colleague?
client first, ALWAYS
When documenting in the record, the social worker should:
identify, describe and assess the client situation describe the purpose and the process of the service being provided outline service goals, plans, and activities evaluate the process and outcome of their activities with and on behalf of clients
Diagnostic recording
different from process recording in that the emphasis was on individual characteristics and psychosocial causes.
Weakness to Computerized and standardized records
difficulty and concern about maintaining confidentiality with this type of record system
Co-optation
entails "using" or "including" the person who opposes you or your program goals in completing "your" agenda. This helps to "reduce opposition" to getting group or program goals accomplished
Billing and fee for service
fees should be fair and reasonable and consideration given to client's ability to pay Address and explore options before discharging a client because of an INABILITY to PAY Pro bono services are permitted and encouraged by the NASW code of ethics
Commitment to clients
first duty to client unless violates responsibility to larger society or legal sanctions. (e.g., client has abused a child, danger to self or others) Client's rights/prerogatives (client self-determination always comes first unless danger to self or others) Informed consent: confidentiality and privacy needs to be ensured, be clear and always protect this right with informed consent or clear verbal instructions, etc.
Weakness of diagnostic recording
hard to find important information and often highlighted only what the diagnostician saw as important-leaving out other areas.
Ledgers and narrative records
have a long hx of use in social work practice. This type of record-keeping just stored facts by listing needs and services provided.
Problem Oriented record (POR)
highly focused record on specific client problems based on the notion of worker accountability in relation to the problem being treated. Problems are identified, services are planned and delivered and problems are resolved. It contains a database (face sheet information), a problem list (where problems are listed, each problem is ranked and checked off when completed), documentation includes: initial plans (the steps that will be taken to resolve the problems) and the progress note (which includes *SOAP* format for recording client progress). This is *NOT process recording*
When making referrals, take into account the following perspectives:
the reason a referral is made. How will the client benefit from this additional service; and how will the social worker handle the termination or continuation of practice once the referral has been made? What will be needed to make an appropriate referral? Specification of the problem, availability of the types and requirements of resources to address it; and how to actually make the referral. How to make the referral. How will the info be made to the source and how will the client get there? How will confidentiality be handled? Has a written or informed consent been obtained? How will the info handled from service to service ensure high degrees of professionalism and service effectiveness? **When referring to another social worker, it is best to provide a client with at least two choices; but if based on expertise etc., one choice is considered acceptable *Remember consider the client's: 1. financial needs, 2. social worker degree of competence, 3. social worker clinical orientation, 4. cultural match with the client and 5. must abide by professional ethical code
Supervision
the relationship between supervisor and supervisee that promotes the development of responsibility, skill, knowledge, attitudes and ethical standards in the practice of clinical social work. The *top* priority of supervision is accountability for client care within the parameters and ethical standards of the social work profession. The supervisor should point out inappropriate work performance when it occurs, and needs to remain flexible to alternate perspectives that differ from what the supervisor thinks it should be.
Important professional/legal considerations
the right of the "least restrictive alternative" if client is involuntarily admitted must receive treatment treatment must be cure or improvement oriented
Confidentiality and privacy
these need to be ensured for service provision always get informed consent client must have right to due process and signed consent clients have right to privacy clients can sue if used in published case description without permission- if case is identifiable
Malpractice
this is injurious or unprofessional treatment of a client by a clinician Usually it is covered under tort law. It is basically *professional misconduct*
Weakness of time series recording
this method can lack agency support because it stresses client's behaviors rather than aspects of the situation and often needs supplementation
NASW Code of Ethics
used as the foundation of practice provides a guideline for ethical practice and is divided into 6 sections. NASW holds and updates this and therefore set and ensure ethical practice standards for social workers. The social work state licensing boards establish the minimum criteria or standards for competence for practice in the state
Gifts
when accepting gifts, good or services from a client the social worker accepts the responsibility of defending the action if need be If held to a "jury of your peers" would other professionals say they would do the same? is the gift for the benefit of the client? Would others think so? Is there a money value attached? Are there cultural or relationship issues supporting taking the gift? Is it kept in your office? Can you defend your actions?
Disclosing client information
when to disclose info: if danger to self or others and in cases of suspected child/elderly abuse (if a client of a social worker has the "intent" to harm another client of the social worker, the worker must breach confidentiality).