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Ethical Issues in Substance Abuse Recovery Group

NASW member requested Office of Ethics and Professional Review comment on the following situation:

I run a recovery group for teenagers who have had problems in the past with drugs and/or alcohol. We normally meet in the group meeting room at my agency. As a treat for the members who have remained sober/drug free for the last six months, I would like to take the group out for pizza at the local pizzeria. We would go during the regular meeting time. Is there a problem with this plan ethically? My supervisor at the agency seems to think there may be.

Response:
There are no hard and fast ethical "rules” governing a professional social worker’s conduct in a professional setting. There are only guidelines. An excerpt from the Purpose section of the NASW Code of Ethics states:

"The Code offers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations. Specific applications of the Code must take into account the context in which it is being considered and the possibility of conflicts among the Code’s values, principles, and standards. Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional.”

Nevertheless, there are specific sections of the code that seem related to the situation as posed, that might inform the decision-making process in this instance. In addition, there are certain questions that might be asked to help determine what seems to be the wisest course of action. Please note that the questions included here are not exhaustive in nature. The may well be others that could and should be considered.

The most obvious section of the code pertains to dual relationships (see excerpt 1.06 c).

1.06 Conflicts of Interest
(c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)

Relevant Questions:
1. Is this situation avoidable?

2. What would this activity accomplish that cannot be accomplished in the normal setting?

3. Does the situation place the client at risk of harm (no matter how slight)?

4. Can clear appropriate boundaries be set and enforced not only with the client but also with others who might be present?

5. The last question brings up the issue of privacy and confidentiality. An excerpt from section 1.07 of the Code:

1.07 Privacy and Confidentiality
(a) Social workers should respect clients’ right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply.

(b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client.

(e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients’ right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker-client relationship and as needed throughout the course of the relationship.

Relevant Questions:
1. Should the fact that the client is in a school support group be treated as confidential? If not, why not (specifically refer to section 1.07 e, excerpted above)?

2. Is appearing in public with a client in and of itself a breach of confidentiality, even if it could be reasonably argued that appearing in public with the client does not constitute a dual relationship?

3. If the answer to #2 is yes, would this required a signed consent by the student or the legal guardian? (See Code section 1.03 Informed Consent, excerpted below)

4. How would the professional respond to questions such as, "I saw you and a group of kids at the pizzeria yesterday. How do you know Mary (one of the kids)?”

Question #3 raises the issue of informed consent, see Code section 1.03 Informed Consent, excerpted below:

1.03 Informed Consent
(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should 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 provide clients with an opportunity to ask questions.

(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission from an appropriate third party, informing clients consistent with the clients’ level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.

(d) In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients’ right to refuse service.

Relevant Questions:
1. Does state law allow these students to give their own consent for services? [The letter states that parents have signed permission slips]

2. If the answer to #1 is no, or if some or all of the students are under the legal age of consent in that state, have the legal guardians consented to the planned activity?

3. Is taking clients to a different and public location within the scope of providing services to clients only in the context of a professional relationship?

4. Is the planned activity mandatory? If yes, was this covered in the initial intake process for the group? If not, what will the clients, who do not wish to participate in the activity, do during the time they would normally meet with the rest of the group?

There are many other questions and considerations which might apply to this situation, depending on other factors that may or may not be operative. Some of the questions included here may not apply in this instance or may have already been answered in the description of the problem. A useful format for problem-solving an ethical dilemma is Essential Steps in Ethical Problem-Solving.

 


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National Association of Social Workers - Massachusetts Chapter
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