Social Work Values and Ethics: Analysis of Privacy Issues in Adolescent Clients

Abstract

Social Workers often run into situations that involve ethical problem-solving to resolve difficult dilemmas involving their clients, agency, or standards. Specifically, a wide range of confidentiality and privacy issues are continually presented to clinicians on a daily basis.

Upon reflection of scenario #3, assessment of methodology available, and research of current trends in solving ethical dilemmas, it was determined Frederic Reamer's methodology would provide a solid foundation for this ethics application paper. For the purposes of this report, the primary focus was given to applying Frederick Reamer's (1999) principles and steps to resolving ethical dilemmas along with the NASW Code of Ethics (2017).

This paper delivers a concentrated look at problem-solving for a dilemma involving confidentiality and privacy as it relates to a minor's treatment plan.

Scenario 3: A social worker provides counseling for a 15-year-old boy ("Jim") with depression. One day he comes to his counseling session with blurred eyes and slurred speech. The boy admitted to the social worker that he was under the influence and that his new friends had introduced him to ecstasy and crystal meth. The boy is worried about his drug use. The social worker offers to enroll him in the state-funded program for adolescents with both mental illness and substance abuse issues. The boy agreed to participate but refused to let the social worker tell his parents about his drug problem. The social worker was unsure whether she was allowed to provide the boy with drug counseling without informing his parents and obtaining their consent.

Conflicts in Confidentiality and Privacy

For over twenty years, social workers have looked to Frederic G. Reamer's (1999) Social Work Values and Ethics for guidance in ethical decision-making and practical information regarding professional conduct. Reamer founded his ethical decision-making model from Alan Gewirth's guidelines in Reason and Morality (1978) to provide a hierarchy based on the fundamental right of all human beings to freedom and well-being.

According to Rothman (2013), Reamer created six principles to help social workers resolve conflict when presented with an ethical dilemma: Principle 1 Rules against basic harm to an individual's existence and preside over rules against harms such as lying or revealing confidential information or threats. Principle 2 An individual's right to basic well-being takes priority over another individual's right to freedom. Principle 3 An individual's right to self-determination presides over his or her right to basic well-being. This gives rise to concerns because the opportunity for self-harm is present, provided harm may not occur to others. Principle 4 The duty to obey laws, rules, and regulations to which one has willingly and knowingly consented, and this duty overrides one's right to conduct themselves in a manner that conflicts with these laws and rules. Principle 5 In cases of conflict, individuals' rights to well-being may override laws, rules, and regulations. Here the obligation of obeying laws, rules, and regulations is not absolute but has limits and, in some cases, allows rules to be broken. Principle 6 The responsibility to prevent basic harm and to promote public goods such as housing, education, and public assistance over the right to complete control over one's property.

Reamer (2002) acknowledges within the six actions, not all possible ethical dilemmas may be resolved, but at least the provided applications generally yield success in ethical decision-making for most social workers. To date, Reamer's principles are consistent with the NASW Code of Ethics, but he does not clearly identify this aspect in his works (Rothman, 2013).

The following steps to identifying a resolution are recommended by Reamer (1999: 76-66): determine the conflict, identify who is affected, gather information (Use the NASW Code, seek input from others, review policies and laws, research and determine ethical obligations), identify possible solutions and/or consequences, implement solutions and document the process, monitor and evaluate the decision, restructure as needed.

I used Reamer's recommended steps in identifying a resolution for working with Jim and obtaining counseling and treatment. The ethical dilemma presented entailed whether to disclose confidential information to Jim's parents when Jim had requested confidentiality and privacy. Those affected by this ethical situation include Jim, his parents, the friends supplying the drugs, the agency, and the state-funded program.

When encountering difficult ethical choices pertaining to a minor client's right to confidentiality—and social workers' corresponding duty to share information with parents—I turned to federal laws, state laws, NASW, and agency policy to establish a foundation for direction. Becoming familiar with state laws and regulations that focus directly or indirectly on minors' confidentiality rights is essential as they take precedence over Federal laws. State laws and regulations differ significantly as a function of local history, culture, public attitudes, court opinions, political climate, and legislative debate (Reamer, 2002). For example, some states have laws permitting social workers to use their professional judgment when deciding whether or not to inform parents about their children's drug or alcohol problems and requests for treatment. In these states, such as Pennsylvania, I was permitted to exercise my professional discretion when determining whether a disclosure to Jim's parents was in Jim's best interest or that it would be harmful to my efforts to get help for Jim's problems. However, in other states, the law prohibits my disclosure of confidential information to Jim's parents without Jim's explicit consent in an effort to encourage minors, such as Jim, with substance abuse problems to seek treatment, Reamer Eye on Ethics (2002).

I also determined Jim was my primary client and not his parents. It may seem obvious that Jim is the client, but since he is a minor, his parents may actually be the clients to whom I am most obligated. In Pennsylvania, a minor over the age of 14 has established limited confidentially as it pertains to sharing information with parents and consents to outpatient treatment. In this case, the state-funded program was for local outpatient treatment and was protected under PA Act 147.

Along with confidentiality, Jim's welfare and rights are a top priority throughout the decision-making process. Because of Jim's age, I need to clarify the implications of his consent to counseling and ensure that Jim is sufficiently involved in the informed consent process. The NASW ethical codes address the necessity to provide disclosure statements at the beginning of counseling (NASW, 2017). In this case, I gave a disclosure statement to both Jim and his parents, and since informed consent is an ongoing process, it is essential that the counseling relationship continually addressed confidentiality with all parties.

I was able to establish that self-harm and harm to others were not an imminent issue as Jim was actively seeking treatment and taking responsibility for his actions. This reinforced my decision to allow for a state-funded program to be initiated without parental consent.

I was also fortunate to have a mentor and colleague who had experienced similar situations in the past. After consultation and review of pertinent information, it was determined that Jim had recognized his shortcomings and was actively seeking the proper treatment options available without the use of his parent's insurance.

I brought forth this ethical issue for debate during a weekly agency in-house meeting. After much debate, it was reinforced that Jim reinforced that he could be in charge of his treatment and that his privacy was protected. In addition to consulting relevant ethics standards, laws, and regulations, social workers employed in agencies typically consult supervisors and administrators to review internal policies regarding the disclosure of confidential information to parents. Some agencies have drafted extensive policies concerning the disclosure of confidential information to parents that are based on relevant ethics standards, laws, and regulations. In this case, it was determined that until Jim proved otherwise, it was in his best interest to begin treatment without the parent's consent. Simultaneously I brought forth and educated Jim on confidentiality issues and reminded him that if at any point he was not compliant, there would be an understanding that his parents would be informed and brought in for more intensive treatment and parental approval as warranted.

There is no simple answer to my ethical obligations in this circumstance. On the one hand, Jim has a right (although somewhat limited) to confidentiality and outpatient treatment without parental consent. I also appreciate and recognize that minor clients, like Jim, need to be able to trust me. Otherwise, Jim may be reluctant to share clinically relevant information. I also understand that many parents believe they have a right to know about major risks their children face and believe that their children's clinicians have a duty to share critical information involving their children's safety.

I have learned from experience in hospital settings the importance of documentation. In the event that outside parties raise questions about my judgment, I want to be able to establish the thought processes, assessments, and evaluations that went into the treatment plan and the documented backing of my agency to my decision-making process. I also appreciate and fully understand the need to document consultations and decisions carefully to protect my clients, as well as myself and my agency. There is also the importance of documenting the

References

1. National Association of Social Workers. (August 2017). Code of ethics. Retrieved July 1, 2018, from http://www.socialworkers.org/pubs/Code/code.asp
2. Reamer, F. G. (2002). Eye on Ethics: Making Difficult Decisions [Eye on Ethics]. Social Work Today, pp. 2, 22–23.
3. Reamer, F. G. (1999). Social work values and ethics. New York: Columbia University Press.
4. Rothman, J. (n.d.). From the Front Lines: Student Cases in Social Work Ethics (4th Edition) (Connecting Core Competencies): Juliet C. Rothman: 9780205866410: Amazon.com: Books. Retrieved from https://www.amazon.com/Front-Lines-Student-Connecting-Competencies/dp/0205866417
5. Rothman, Juliet C. From the Front Lines: Student Cases in Social Work Ethics, (Connecting Core Competencies) (Page17-18). Pearson Education. Kindle Edition
6. Gewirth, A. (1978). Reason and Morality. Chicago, IL: Univ. of Chicago Pr.
7. (PDF) Methodologies for ethical decision making in Social Work. Available from: https://www.researchgate.net/publication/318852875_Methodologies for ethical decision making in Social Work [accessed Jul 01, 2018].    

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