The NASW Code of Ethics Applied: ConfidentialityAuthor: Nancy M. Levine, LICSW, Chair, NASW Ethics Hotline Committee
FOCUS Newsletter - September 1996
What do you tell your clients when you make agreements for service? Do you give them assurances of confidentiality and soothe their anxieties by reminding them that everything they tell you is confidential between the two of you? Do you promise to stick by your client through thick and thin until they are ready to leave you? Have you ever found yourself in a disagreement with your clients with regard to any of your administrative policies, such as cancellation payment policies, and found yourself saying "but I told you that the first time we met"?
If your answer to any of these questions is "yes" then beware! You may be having a problem with informed consent. Informed consent is not simply a legalistic maneuver designed to protect us from litigious clients. It is part of the foundation for sound clinical and ethical practice.
The Ethics Hotline receives numerous calls from Social Workers who find themselves in the midst of some very thorny predicaments. Although confidentiality is a cornerstone of practice, it cannot be promised to any client unconditionally. Duty to warn standards and mandated reporter status, for instance, make such promises impossible to keep. The following suggestions are made based on the hundreds of calls the Hotline has received in the years since its inception. They are neither complete nor hard-and-fast rules, but hopefully some reminders that will help you to integrate the ethical, clinical and legal factors involved in superior practice.
1. Provide your client with a written statement of your policies. Relying on memory (your own, to cover all topics with each new client, and the client's, under the stress and anxiety of initial contact and potentially conflictual material) is simply asking for omission or misunderstandings down the road. Certainly the written statement does not replace a verbal discussion of these issues, but at least when conflicts do arise, there will be written documentation of your prior agreement.
2. Keep abreast of legal statutes affecting practice. For instance, knowledge or strong suspicion of child or elder abuse must be reported to DSS no matter how much you worry about the effect such a report may have on your relationship with your client. There is, however, no mandated reporting of spousal abuse. Duty-to-warn standards also supersede confidentiality. In cases where you are told of a plan to harm another individual, you may be required to break confidentiality in order to protect the intended victim.
3. Distinguish between individual and clinic confidentiality. If you are working in an agency setting, you may want to state clearly the parameters of confidentiality, i.e.: supervision/consultation arrangements, multiple workers collaborating on one case, etc.
4. Records must be thoughtfully kept. They must provide important information for the social worker and the agency, and yet be in the best interests of the client. While the United States Supreme Court has recently ruled to protect confidentiality of written psychotherapy notes, one must find and walk the fine line between recording accurately the type and progress of social work services, and making the client vulnerable to the exposure of harmful or embarrassing material should a record be required to be given over to a court proceeding. You may not, under any circumstances, keep separate records.
The Ethics Hotline is a Chapter service available to all NASW members and can be reached by calling the NASW office. Committee members will take your call, present the situation confidentially to the entire Committee and consult back with you regarding the Committee's interpretation of the sections of the Code of Ethics relevant to your situation. Meeting with the Committee for a roundtable discussion is also an option.
Think you are in an ethical dilemma? Please feel free to consult your colleagues in the NASW Ethics Hotline, at (617) 227-9635. Leave your name and phone numbers where you can be reached with the operator. Your call will be returned within 24 hours by a member of the Committee.
Essential Steps for Ethical Problem-Solving
Ethical Issues in Substance Abuse Recovery GroupEthics in Schools: How School Culture Impacts Social Work Practice Confidentiality
Ethical Conflict Among SystemsTowards a New Ethical Consciousness
Ethical Issues Across the Fields of Practice
Confidentiality in Social Work Practice: Challenges and Ethical Dilemmas (Part I)
Confidentiality in Social Work Practice: Challenges and Ethical Dilemmas (Part II)The New NASW Code of Ethics Can Be Your Ally: Part IThe New NASW Code of Ethics Can Be Your Ally: Part II
Ethical Challenges for Social Workers in Substance Abuse: Ethical Lapse and RelapseThe New NASW Code of EthicsResolving Ethical DilemmasAgency EthicsDuty to WarnThe NASW Code of Ethics Applied: Confidentiality
About the Ethics Hotline: Have an Ethical Dilemma? Contact the Ethics Hotline.Essential Steps in Ethical Problem SolvingTips for Resolving Ethical Dilemmas*