Ethics—Summer Institute on Aging

1. Ethics—Summer Institute on Aging June 9, 2011 Jennifer Powell, MSW, JD Mercury Education and Training Services

2. Good Morning!

3. Overview • Ethics in General • Ethical issue when working with the elderly

4. Attitude is important…

6. Social Workers: • Believe in human potential. • Believe in the dignity and worth of every person. • Believe that a person is better than their worst behavior or their greatest need.

7. Social Work’s Basic Mission • Enhance human well-being and help meet the basic needs of all people (particularly those that are vulnerable, oppressed, and living in poverty • Focus is on individuals’ well-being in a social context • Attend to the environmental forces that create or contribute to and affect problems in living

8. Define ethics: • Social Work Dictionary says: Ethics is a system of moral principles and perceptions about right vs. wrong and the resulting philosophy or conduct that is practiced by a group or profession

9. Social Work definition of ethical behavior: • Ethical conduct follows the NASW Code of Ethics, providing the highest and most skillful levels of service to clients, relating to colleagues, professionals, all people and society in an honorable manner.

10. Core Values of Social Work Practice • The mission of the social work profession is rooted in a set of core values. These core values, embraced by social workers throughout the profession’s history, are the foundation of social work’s unique purpose and perspective: • service • social justice • dignity and worth of the person • importance of human relationships • integrity • competence

11. The NASW Code of Ethics: Four Components • Preamble: mission and core values • Purpose: overview of Code • Ethical Principals: broad ethical mandates • Ethical Standards: specific ethical standards to guide conduct and serve as a basis for professional review

12. Social Workers Ethical Responsibilities Social Workers have ethical responsibilities to: • Clients • Colleagues • In practice settings • As professionals • To the social work profession

13. How should social workers view clients? NASW Code of Ethics says… • 1.01 Commitment to Clients • Social workers’ primary responsibility is to promote the well­being of clients. In general, clients’ interests are primary. • Simply put, clients need to be able to trust us. We need to be competent and caring.

14. 16 ethical responsibilities to clients • 1.01 Commitment to Clients • 1.02 Self Determination • 1.03 Informed Consent • 1.04 Competence • 1.05 Cultural Competence and Social Diversity • 1.06 Conflicts of Interest • 1.07 Privacy and Confidentiality • 1.08 Access to Records

15. 16 responsibilities, continued • 1.09 Sexual relationships • 1.10 Physical contact • 1.11 Sexual harassment • 1.12 Derogatory language • 1.13 Payment for Services • 1.14 Clients who lack decision-making capacity • 1.15 Interruption of Services • 1.16 Termination of Services

16. A Guide for Social Work Decisions • Social Workers make ethical decisions on a regular basis. The Code of Ethics: • 1. Is a valuable reference tool for making decisions that have ethical considerations • 2. Is a guide that references the majority of ethical considerations that social workers encounter • 3. Does not address every conceivable situation that a social worker might encounter

17. Guide to Using the Code • NASW recommends the following steps: • Reference the key words or concepts related to the ethical concern • Read the identified standards in the Code and determine which apply • Consider other relevant resources

18. Examples:

19. Examples:

20. Examples:

21. Using the Index… • Consider the keyword that describe a situation: burnout, competence, impairment…. More than one standard might apply…

22. Identifying the Appropriate Standard • The same subject matter is addressed in relation to different practice and professional contexts… Competence (Sections 1.04, 4.01) Impairment (Sections 2.02, 4.05)

23. Other considerations and Resources: • Legal issues • Employer policy and procedures • Professional Consultation and supervision • Clinical Standards of Practice/Best Practices (https://www.socialworkers.org/aging.asp) • Professional literature, research

24. Regulating the practice of social work • State Practice acts • Limit the practice of the profession to those approved by the state’s board • May limit the use of a specific title to those certified by the state’s board • May also recognize different levels of social work practice, i.e. LSW, LGSW, LCSW

25. Regulating the Practice of Social Work • Regulation is usually based on three different competencies: • 1. Level of education • 2. Experience • 3. Passing an examination • May also require continued oversight and regulation, i.e. continuing education

26. Regulating Social Workers in West Virginia • Why do we care about the NASW Code of Ethics? • Is adhering to the NASW Code of Ethics just recommended or is it required?

27. It is required!WV CSR 25-1-4 • WV is one of 20 + states that incorporate the NASW Code of Ethics into its regulations governing social work practice. • 4.1 West Virginia Board of Social Work Examiners adopts the National Association of Social Workers Code of Ethics, in the version effective January 1, 1997, and incorporates it by reference. • 4.2 The Board may take disciplinary action against a licensee who fails to comply with this Code of Ethics

28. WV Board of Social Work Examiners • Types of Proceeding you might face: Administrative, also known as disciplinary or ethics • Entity: WV Board of Social Work Examiners www.wvsocialworkboard.org Consequence: loss of social work license Source of authority: WV Code 30-30-1, et.seq. WV CSR 25-1-1, et. Seq. NASW Code of ethics

29. NASW and the WV Board of Social Work Examiners Review WV Code 30-30-1, et. Seq. and WV CSR 25-1-1, et. Seq. NASW Code of Ethics—guide for ethical behavior WV Board of Social Work Examiners is the entity authorized to regulate, correct and punish unethical social workers

30. The WV Board of Social Work Examiners • The WV Board of Social Work Examiners was created by legislation in 1986. • The purpose of this legislation is to protect the public by setting standards of qualification, education, training and experience for those who seek to engage in the practice of social work and to promote high standards of professional performance for those engaged in the profession of social work.

31. WV Code 30-30-7 Grounds for disciplinary proceedings Ex: Felony conviction, gross negligence, false representation to the Board Consequences for unethical conduct Refuse to issue or renew your license, revoke or suspend your license Due process protections—is a social work license “property?” What protections/notice/opportunity to be heard are you given?

32. WV Code 30-30-8 • The WV Board of Social Work examiners may: • Refuse to issue a license • Refuse to renew a license • May suspend a license • May revoke an existing license

33. WV Code 30-30-8 Disciplinary Proceedings Notice Right to Counsel Right to Cross Examine Witnesses Right to present evidence on own behalf Board can issue subpoenas to secure attendance of a witness or documentary evidence

34. WV CSR 25-1-10 Regulations Adds a level of detail about administrative proceedings Explains complaint, investigation, and hearing process Details possible consequences and powers of Board to sanction social workers

35. WV CSR 25-1-10 The Board may impose any of the following sanctions, singly or in combination, after finding that a license holder has engaged in professional misconduct:        10.6.1.  Refuse to renew a license;        10.6.2.  Suspend an existing license for a set period of time and/or impose requirements for reinstatement or renewal of a license;        10.6.3.  Revoke an existing license;        10.6.4.  Enter into a consent decree, consent agreement, agreed settlement, default or stipulation or other informal disposition;        10.6.5.  Issue a public reprimand

36. WV CSR 25-1-10, continued • 10.6.6  Impose a period of probation and requirements for the lifting of probation, including meeting continuing education requirements, mandatory supervision by a licensed social worker, peer or professional counseling, a medical, psychological or clinical social work evaluation, or other reasonable requirement, singly or in combination, that the Board considers sufficient to protect the public;        10.6.7.  Levy fines not to exceed one thousand dollars ($1,000) per day per offense; and,        10.6.8.  Assess fees to recover administrative costs incurred by the Board for disciplinary actions taken.

37. This begs the question.. • What is professional misconduct? In other words, why would the Board be disciplining a social worker?

38. 10.1.  Professional misconduct is: • 10.1.1.  Conviction of a felony; • 10.1.2.  Inability to perform the functions of his or her professional duty by reasons of illness or impairment; • 10.1.3.  Gross negligence in the practice of social work; • 10.1.4.  Assisting or participating with a person who falsely represents himself or herself as a licensed social worker;10.1.5.  Failure to renew a license after expiration or revocation of a license with continued representation that he or she is duly licensed;

39. Professional Misconduct: • 10.1.6.  Obtaining or attempting to obtain a license or renewal of a license by bribery, theft or false representation;10.1.7.  Knowingly making a false statement on a form or written statement submitted to the Board;10.1.8.  Failure to comply with the Code of Ethics of the National Association of Social Workers; 10.1.9.  Failure to report knowledge of professional misconduct by a licensee.  

40. Private Credentialing and discipline • Council on Social Work Education (CSWE) and National Association of Social Workers (NASW) • These additional credentials are powerful and respected and indicate a level of education, training and certification (ACSW—Academy of Certified Social Workers) • NASW has mechanism for resolving complaints against its members and can punish its members for unethical conduct, including stripping their membership in NASW, strip any private credentials from NASW, require member to take continuing education, and can publish information about social workers who engage in unethical practice.

41. Sanctions by NASW • Can include: • Notifying the licensing board, your employer, and publishing your ethical misdeeds in the NASW newsletter • NASW sanctions are listed publicly for a maximum of 10 years and are placed on the NASW website • NASW can strip you of your membership in NASW

42. Ethical problems may lead to employment problems • Your employment may be terminated. • You may lose your job if your license is revoked or suspended. • Lose of license could prevent a social worker from successfully seeking and obtaining employment • Employers may require NASW membership or a specialty certification/professional liability insurance • Review and findings in any professional disciplinary system could result in a loss of employment

43. Things to consider: • 1. What types of misconduct do social workers engage in that will likely result in them having ethics charged filed against them? • 2. When are clients particularly motivated to file ethics complaints?

44. NASW says… • Most frequent types of claims against individual social workers: • 1. Incorrect treatment—service provided was wrong for client’s problem. • 2. Sexual misconduct—from suggestive statements to physical contact (whether consensual or forced) • 3. Breach of confidentiality—disclosure of information without client’s consent • 4. Suicide or attempted suicide by client

45. Red Flag Areas: • When are clients most likely to file an ethics complaint or lawsuit? • 1. When they are disappointed with their outcomes; their expectations were not met. • 2. When they believe that their social worker is incompetent or negligent • 3. When they feel that they have been financially, emotionally or sexually exploited • 4. When they are billed incorrectly or later than expected.

46. Ethics and Aging…. • Check your own values and biases about aging. • Respect and promote older clients’ rights to dignity and self-determination. • Apply ethical principals carefully when working with clients with limited decision-making capacity. • Respect diversity among older clients (class, gender, sexual orientation, culture, religion)

47. Aging, Ethics and Assessments • Be mindful of potential sensory, language or cognitive limitations of some older adults. • Assess: health status, cognitive functioning, mental health status, and social functioning. • Assess caregivers’ needs and levels of stress.

48. The Aging Process Look at functionality, not chronological age. Chronological age=number of years lived. Functional age=defined by mental and physical abilities (work, physical activity) Frailty=impaired strength, endurance and balance.

49. Themes of Older Adulthood • Retirement • Independent Living • Mentoring, passing down wisdom • Maintaining health • Social involvement vs. isolation • Developing new opportunities or maintaining current activities

50. Myths about aging • That certain health problems must be “accepted” • Depression is a normal part of aging • Older adults have no interest in sex • Older adults are unable to learn new things (i.e. technology)