by Allan Barsky, JD, MSW, Ph.D.
The term “app” refers to any software or digital program that has been designed for a particular application or purpose. People may use apps on computers, smartphones, tablets, watches, and other electronic devices. Within social work, an app could be used to help clients with exercise, addiction, depression, problem solving, motivation, and a whole host of other functions. Your client has dementia? There’s an app for that. You want to help clients manage stress by raising their mindfulness? There’s an app for that. You are working with a high-conflict divorce situation in which clients need an intermediary to help them communicate? There’s an app for that, too.
Nancy Smyth’s “Social Work Apps” board on Pinterest lists more than 150 apps and 1,000+ followers (https://www.pinterest.com/njsmyth/social-work-apps). And this site presents just a small slice of the apps that may be used with social work clients. Various social agencies, hospitals, private practitioners, computer scientists, and entrepreneurs are developing apps for a broad array of biopsychosocial-spiritual issues. So with this grand proliferation of apps, perhaps it is time to think about the ethical implications for social workers and the people they serve. In particular, this article explores ethical issues pertaining to client self-determination, informed consent, professional competence, confidentiality, client safety, and risk management.
Consider the following scenario: Gail’s husband Herb has dementia. Gail is concerned that Herb sometimes wanders out of the house and gets lost. Shandra, a social worker, does a quick Google search and finds a tracking app that can be used to monitor a person’s movements via GPS (global positioning system). Gail thinks this is a wonderful idea.
Self Determination and Informed Consent
In terms of self-determination (NASW Code of Ethics, S.1.02), one could argue that clients should be allowed to use whatever apps they want. Given his dementia, Herb lacks decision-making capacity. Gail (as next of kin) may make decisions on his behalf. The principle of informed consent (S.1.03), however, suggests that social workers have a duty to explain the nature and consequences of any interventions they are considering. In this case example, Shandra would need to be able to explain how the app works, what are its advantages, what are its risks, and how trustworthy is the information she is relying upon. Unfortunately, many apps have not been tested with particular client populations. Among those apps that have been tested, the testing may have been conducted by those who are developing and selling the product. Remember, the primary goal of a for-profit business is to make money, not to serve vulnerable client populations in the most effective manner possible. Further, research on some apps may be limited to an evaluation of customer satisfaction, self-reported benefits, or general testimonials.
Before recommending use of a particular app, social workers should use the same due diligence that would be appropriate for selecting any social work intervention. Rather than considering just one option (discovered randomly on the Internet), Shandra should investigate various options through a thorough literature search. If there is insufficient research evidence to recommend a particular app, Shandra needs to inform Gail, “Although this product may look promising, I was unable to find any solid research on how well it works for people with dementia.”
Identify Risks in Using Apps
Gail asks, “This tracking app seems so simple. What could possibly go wrong?” Shandra could then discuss the possible risks with Gail. For instance, how does the company ensure privacy? Could unauthorized persons hack into the app to follow Herb? How durable is the tracking device? If Gail is still inclined to use the app, Shandra should also help her manage the risks identified. For instance, what if Herb does not want to use the tracking device and decides to throw it away? Shandra could discuss how to present the tracking device idea to Herb in a positive manner and try to secure his permission to use it (which not only reduces the risk of losing the device, but also shows respect for Herb’s dignity and worth). They could also discuss having a trial period in which they test whether the device works in the manner intended.
HIPAA, Privacy, and Other Legal Issues
Creating and using apps with clients opens up a range of legal issues. If the social worker is providing health services or is working within a healthcare facility, then the social worker may need to comply with HIPAA, the Health Insurance Portability and Accountability Act. Does the app comply with HIPAA’s provisions for confidentiality and privacy of information? If the social worker is using a device to help with medication, nutrition, or related medical services, then it may need to comply with the Food, Drugs, and Cosmetics Act. If the device transmits information through wireless communications, then it may need to comply with regulations of the Federal Communications Commission. Does the FBI or Homeland Security have the right to access information that is transmitted electronically?
In addition to federal laws, there could be state laws regulating various devices or types of interventions. Social workers may need legal advice to help them determine whether and how particular laws affect their planned use of particular apps and electronic devices.
Some apps may be low-risk in terms of legal and ethical issues. For instance, an app that provides a listing of AA meetings is not likely to be risky, as long as the listing is accurate and the social worker reminds clients that they are responsible for checking whether a particular meeting is appropriate for them. An app that monitors people with suicidal ideation, however, presents higher levels of risk and requires greater care on the part of the social worker. If the app links suicidal clients with crisis intervention services, for example, the social worker should ensure that the services are provided on a 24/7 basis and that the service providers are adequately trained and certified.
Weigh Pros and Cons for Ethical App Use
The point of this article is not to scare social workers away from using apps with clients, but rather to encourage them to be aware of the need for a solid understanding of how the apps work and whether they can be used in a safe, ethical manner. Apps have the potential to enhance social work services. Still, workers need to consider what types of help are best provided face-to-face between a social worker and client, and which services can be moderated effectively through the use of apps and electronic devices.
Remember, also, that social workers do not need to be passive users or consumers of apps. They can also work with computer scientists and other experts to develop and improve apps for the benefits of the people they serve.
Dr. Allan Barsky is Professor of Social Work at Florida Atlantic University and former Chair of the National Ethics Committee of the National Association of Social Workers. He is the author of Ethics and Values in Social Work (Oxford University Press), Conflict Resolution for the Helping Professions (Oxford University Press), and Clinicians in Court (Guilford Press). The views expressed in this article do not necessarily reflect the views of any of the organizations with which Dr. Barsky is affiliated.