Confidentiality In Social Work Essay Topics

By: Rose M. Handon, BSW, MSA, LSW

Many professionals enter into the field of social work to help others grow and improve their life circumstances. Yet, when working with clients, social workers must maintain clear boundaries to assure professional integrity and responsibility. On any given social work credentialing board Web site, one will see frequent cases in which there have been complaints filed against social workers resulting in imposed fines, penalties, licensure sanction, suspension, or revocation. In some instances, workers have been imprisoned for misconduct for violation of confidentiality, falsification in record-keeping, malfeasance, and so forth. However, this article will explore the issue of client relationships and ethical boundaries for those working in social work, with a particular focus for those in child welfare.

    Dietz & Thompson (2004) offered, “The concern about appropriate boundaries is, at least in part, a concern about the effects of the power differential between client and professional. It is primarily a concern about boundary violations” (p. 2). Boundaries are “the limits that allow for a safe connection based on the client’s needs” (Peterson, 1992, p. 74). Yet, in retrospect, Reamer (2003) suggested that boundary violations and boundary crossings have to be examined in the context of the behavioral effects the behavior has caused for either the social worker or client. He posited a typology of five central themes in which boundary issues may arise: 1) intimate relationships, 2) pursuit of personal benefit, 3) emotional and dependency needs, 4) altruistic gestures, and 5) responses to unanticipated circumstances.

    In addition, the clinical issues of managing dual relationships and management of transference and countertransference are factors that cannot be ignored in this discussion. Workers in child welfare are often found in dual client relationships. According to the NASW Code of Ethics (1999), dual relationships occur “when social workers relate to clients in more than one relationship, whether professional, social, or business” (p. 9). Social workers must be knowledgeable and mindful of the NASW Code of Ethics (http://www.socialworkers.org/pubs/Code/code.asp), which provides a comprehensive and strategic outline of one’s professional standards and conduct in meeting the needs of those we serve.  

    Throughout one’s career, the question is often asked, “Why did you go into social work?” The answer invariably centers on an interest in wanting to help or improve the lives of others. In child welfare, we are often described as helpers, resource/change agents, do-gooders, motivators of change, child-snatchers, and other stereotypes. Inside our respective roles and responsibilities, to move a client forward, we must engage a client in the process of change.

    When working with clients, a major skill that social workers must utilize in facilitating the client’s growth or change process is to earn their trust, confidence, and respect. This is an integral part of the client engagement strategy, which must be established in the early phase of the relationship. For those in child welfare, this poses a great challenge, since there is an inherent right and governmental authority to remove children from their own homes, while continuing to work with families toward improved functioning, stabilization, and/or family reunification. Unfortunately, many professionals in our field have difficulties in the area of client rapport building. In an effort to meet the clients’ needs, workers may find themselves “befriending the client,” under the guise of helping.

    Throughout our profession, thousands of men and women work with vulnerable families and children. In the scope of delivering social services, we often hear stories that can “break one’s heart,” or cause one to be inadvertently  “sympathetic vs. empathetic” to the clients’ experiences and/or pain. Many of our clients have been subjected to abuse, neglect, or other forms of violence or maltreatment. Some report stories of abandonment, domestic violence, emotional abuse, or other wrenching experiences. Some even report having difficulty with intimacy as a result of their reported pain.  When social workers have not clearly identified and/or managed their emotional issues and baggage that they brought into the profession, the scope and nature of client/worker relationships can become quite blurry. Subsequently, instead of helping, the social worker may start the path of hurting the client while disclosing or sharing his or her own personal experiences.

     In child welfare, immediate supervisors must play a vital role in modeling, coaching, and engaging in frequent discussions with workers on topical issues of client engagement, rapport-building, and assurance of proper boundaries in the worker and client relationship. Social work schools, child welfare training, and other continuing education programs also have a responsibility in providing education and information on the management of client relationships and examination of ongoing ethical issues.

    The following behavioral factors may warrant or signal violations in the worker/client relationship:

Worker has given the client his/her personal e-mail, cell, home address or phone number, or may even disclose his/her MySpace or FaceBook account

Worker and client communicate with each other via texting via cell  on the worker’s personal and/or company cell phone

Worker is warm-natured and enjoys physical connectedness with clients, such as hugging or embracing upon contact, kissing, rubbing the shoulder, hands, or face to provide comfort and support to the client

Worker spends lengthy phone hours with the client during the work day or even on personal time

Worker may tend to dress provocatively on days when scheduled to see the client(s)

Worker tends to spend an inordinate amount of time with the client, both scheduled and unscheduled visits, in comparison to other clients

Worker talks frequently about the client, and may even openly share how much he or she likes, fantasizes, or can relate to the client

Worker may begin to spend frequent time with client at various restaurants, movie theaters, or other public places outside of the client’s home, or even at worker’s home, under the guise of a client visit

Worker freely shares and discusses his/her own personal experiences with the client

Worker spends his/her own personal funds to support clients’ needs, particularly if agency won’t pay for clients’ needs, while worker chooses to assume cost on his/her own

Worker engages in the use of drugs and/or alcohol with the client

Co-workers begin to talk about the worker and his/her relationship(s) with specific clients

Client’s own family and/or personal friends begin to talk about the amount of time worker spends with the client, and may even share such information with the agency

    The above is not an exhaustive list, but signals that the worker’s involvement with the client warrants further probe and attention. If the supervisor has a suspicion or concern, it’s important to document and confer with others in authority. In some instances, it may be a labor relations matter, or a training or coaching issue between the worker and supervisor.  

    There have been two distinct incidents in my career in which it was determined, following an internal investigation, that two different workers had grossly violated boundaries in the client/worker relationship. One case involved a worker being intimate with a parent during a weekend home visit, and a four-year-old child reported “daddy and caseworker” were kissing in father’s bedroom. The other involved a caseworker who had called off sick, and one of the caseworker’s clients called to report to the supervisor that the worker was not sick, but was instead at a client’s home getting “high.” In both instances, the workers were terminated from their jobs.

    Why might a caseworker risk contamination of the client engagement process or actual working relationship? There is no definitive or even easy answer. Erickson’s developmental stage of young adulthood, when there is a concentration on intimacy and expansion of one’s interpersonal relationships, might suggest that social workers between 22 and 25 years of age are vulnerable to such violations occurring while finding their personal and/or professional selves. Others may suggest that social workers’ use and/or abuse of power and authority may be a contributing factor while working with vulnerable clients who lack decision-making or empowerment skills. From others, it may be suggested there are always persons in any given profession who will violate the code of conduct rules and standards, despite any degree of training, supervision, or administrative oversight.

    As social workers, we have a responsibility to examine the issues of client relationships and ethical boundaries. This conversation merits discussion among our peers and other related professionals. In the age of increased litigation and constituent complaints, it is not a topic to be ignored. The personal and corporate costs and liabilities associated with claims of unethical behaviors have long lasting impact to those in the profession and for those who are served.

    Fortunately, ethics training for social workers must be taken in accordance with state licensure standards. This provides an opportunity to be mindful of our ethical obligations and boundaries in serving others throughout the field. Non-licensed employees are not exempt from the risk of assumed liabilities in child welfare or other social work settings. Both public and private organizations generally have ascribed core principles, ethical procedures, and guidance with regard to policy safeguards that govern the scope of responsibilities of employees in providing client services. This is intended to keep all safe.

    As individuals, let’s take the time to examine our own behaviors and interactions in the way we communicate with and relate to our clients. This includes verbal and nonverbal communication. Explore and determine whether your client engagement skills are healthy or unhealthy. Revisit the signals and warning list of possible risk factors provided earlier in this article. If you find yourself or others on the list, take any necessary action to correct the area(s) of concern.

    Always remain focused on meeting the needs of the client versus your own personal needs. Evaluate and pursue other avenues of support, which may include professional counseling, clinical supervision, and training. Finally, critically evaluate whether a career change might be necessary for the protection of self, clients, and agency employer.

References

Dietz, C., & Thompson, D. (2004). Rethinking boundaries: Ethical dilemmas in the social worker-client relationship. Journal of Progressive Human Services, 15 (2), 1-24. DOI: 10.1300/J059v15n02•01.

National Association of Social Workers. (1999). Code of ethics. Retrieved from http://www.socialworkers.org/pubs/Code/code.asp.

Peterson, M. R. (1992). At personal risk: Boundary violations in professional–client relationships. New York: W.W. Norton.

Reamer, F. G. (2003). Boundary issues in social work: Managing dual relationships. Social Work, 48 (1), 121-133. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/pdf?vid=15&hid=4&sid=84fd60ce-0dc4-46de-91e8-d035fafef8a5%40SRCSM1.

Rose Handon, BSW, MSA, LSW, has served in the field of child welfare for more than 30 years. She is a current state government policy administrator, and is a doctoral student at Walden University, School of Public Policy and Administration. She may be reached at rhand001@waldenu.edu.

by Kathryn S. Krase, Ph.D., J.D., MSW

Since your very first practice class in a social work program, you’ve probably been told a thousand and one times that you must keep client information confidential. “Don’t talk about clients with friends or family.” “Don’t discuss clients in the hallway or  elevator,” and so forth. And yet you are a mandated reporter, required by law to report suspicions of child abuse and neglect. Isn’t there a conflict here? The short answer is “yes,” but this article will spell out the long answer for you that finds that your legal obligation to report trumps your ethical responsibility to your client.

Responsibility to Keep Client Information Confidential

    Confidentiality means that information shared within a relationship will not be shared outside that relationship.  The expectation is that what a client tells a social worker, the social worker will not reveal to others. The purpose of client confidentiality is to encourage clients to share information that may be embarrassing, or even self-incriminating.  Through the sharing of such information, the social worker can help the client address an issue, concern, or problem the client may be experiencing. The social worker’s obligation to keep client information confidential is supported through state and federal law, but most often is discussed in reference to the NASW Code of Ethics.

    In the NASW Code of Ethics (NASW, 2008), Standard 1.07 outlines that social workers “should respect client’s right to privacy” (1.07[a]) by protecting “confidentiality of all information obtained in the course of professional service, except for compelling professional reasons” (1.07[b]).  So, is the legal requirement to report suspected child maltreatment a “compelling professional reason” to break client confidentiality? And the simple answer is “yes.”

    Although a social worker’s primary commitment is to his or her client, the Code outlines that social workers have a responsibility to the larger society as well.  In Standard 1.01, the Code acknowledges there are times when the social worker’s responsibility to society at large, or a specific legal obligation of the social worker, may supersede loyalty to a client.  The example of child abuse reporting is specifically highlighted in this standard.  

    So, the legal requirement of all social workers to report suspected child maltreatment trumps the responsibility to keep client confidences quiet. The NASW Code and related laws all find this to be so.

The Importance of Informed Consent

    Balancing the ethical responsibility to protect client confidentiality and the legal obligation to protect children from harm is difficult, even for social workers with decades of experience! So, how do you actually do this? First things first, you start at the beginning of the relationship with your client by incorporating a discussion of the limits to client confidentiality with your client through informed consent.

    Informed consent is the process through which social workers discuss with clients the nature of the social worker/client relationship. Through informed consent, the social worker and client outline what the client can expect from the professional relationship, as well as what the social worker expects from the client’s participation.   

    Informed consent often includes a discussion of basic protocols, such as how to make or cancel appointments, or the best way to contact the social worker. The process should also involve outlining what work will be done with and for the client, and what expectations there are for client involvement. Integral to the informed consent process is a discussion of client confidentiality.  

    Using simple language, appropriate to the developmental and language needs of the client, the social worker needs to explain to the client that he or she will generally keep information private, but that there are specific instances when the social worker is required to break client confidentiality. It is at this point that the social worker should highlight that if he or she suspects child maltreatment based on information received from the client, the social worker must break client confidentiality to make a report of the suspicion to child protective services.  

    It is important to clarify with the client that this means that the social worker may have to report suspected child abuse or neglect based on what the client says, even if the client is neither the victim nor the perpetrator. In other words, the social worker may (depending on the state where he or she resides*) have to make a report  involving people he or she has never met.

    In some agencies or practice settings, informed consent involves the client signing a form that acknowledges receipt of certain information. Although a written tool is a good idea, it is important that there be additional methods for ensuring informed consent.  

    In all cases, with or without written informed consent tools, the social worker and client should discuss, face-to-face, expectations for confidentiality and when confidentiality will be breached.  The social worker should use language the client can understand. So, the social worker can say that he or she will keep information “private” or “between the two of us.” But it is very important that the social worker make it clear that there may be times when the “private” information will be shared with others. Basic language can be used, such as, “I will have to share this private information if I think that you are going to hurt yourself, or hurt someone else, or if I think someone may be hurting you or someone else.”

    As with other forms of communication with clients, it is important to ensure that the client understands what you outline through informed consent. With child clients, or clients with impaired cognitive ability, you can start by asking them if they understand, but it is best to follow up. You can ask a question like, “If a boy told me that his mother was hurting him, would I keep that private?” And then explain who you would report to and why, highlighting that child protective services would then help protect that person from being hurt again.

    It is possible that by explaining to your client the limits of confidentiality, the client may choose not to disclose information that would warrant you to make a report to child protective services. It is important to remember that it is the client’s right to choose what information to share with you. That is part of the client’s right to “self-determination” (NASW Code, Standard 1.02).

    Informed consent is most often thought of in the context of the contracting stage with a client, which comes at the beginning of the professional relationship. To be effective, informed consent should be seen as an ongoing process. Informed consent can be integrated into each session with a client, or at regular/periodic intervals throughout a professional relationship. As the goals of the relationship change, informed consent should be revisited.  

Protecting Your Clients Even When Breaking Confidentiality

    Whereas it is clear that professional standards of conduct accept and expect a social worker to break client confidentiality to report suspicions of child maltreatment, the Code also highlights the social worker’s responsibility to minimize harm to a client from this kind of disclosure. Social workers are expected to provide the least amount of confidential client information necessary.  

    Even while making a report to child protective services, you should try to protect your client as much as possible.  If you make a report to child protective services about a client, you do not provide a complete bio-psycho-social assessment of your client. Instead, you provide the information necessary for fulfilling your legal obligation to report, as well as your ethical obligation to the larger society, while protecting as much of your client’s privacy as you can.

    The responsibility to keep client confidentiality while simultaneously adhering to the legal responsibility of social workers to protect children from maltreatment is an obvious conflict. However, a firm grounding of the professional relationship through thoughtful informed consent and attention to the responsibilities of the social worker to minimize harm to the client even after client confidentiality is breached show how such conflict can be effectively eased.

* For state specific information, visit the Child Welfare Information Gateway State Statute Search at: https://www.childwelfare.gov/systemwide/laws_policies/state/

References

National Association of Social Workers (2008). Code of Ethics.

Kathryn S. Krase, Ph.D., J.D., MSW, is an assistant professor of social work at Long Island University in Brooklyn, NY. She earned her Ph.D. in social work, her Juris Doctor, and her Master of Social Work from Fordham University. She has written and presented extensively on mandated reporting of suspected child abuse and neglect. She previously served as Associate Director of Fordham University’s Interdisciplinary Center for Family and Child, as well as Clinical Social Work Supervisor for the Family Defense Clinic at New York University Law School.

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