Ethics Alive! A Text in the Night

By: Allan Barsky, JD, MSW, Ph.D.

Jace is a social work student interning at an agency that serves recent retirees. In an effort to reduce costs and maintain services, the agency cuts its use of landline telephones and asks workers and students to use their cell phones. Jace does not think it is appropriate for the agency to ask students to use their personal cell phones for work purposes.

Still, she agrees because everyone at the agency seems to be complying without raising much of a fuss. One night, around 3 a.m., Jace is awakened by her cell phone. She picks it up and sees a text message from a client, Ramon. The message says, “My life is worthless. Nobody cares about me. I’m going to end it all.” Jace feels panic and wonders what to do. If she does not respond, Ramon may commit suicide, and Jace will have foregone any chance to save his life. If she does respond, will she be able to do so in a competent manner, without the benefit of supervision? If she takes time to contact her supervisor for advice, how will her supervisor react to being woken up in the middle of the night? How might the delay in contacting the client affect the risk that Ramon will commit suicide? Jace thinks about calling 911, but wonders if she should call Ramon first to see if she can handle the situation without breaching his confidentiality.

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Although the names and other facts of this case are fictional, it is based on actual situations. As the use of cell phones, e-mail, texting, social networking, and other technology grows, social workers are facing many challenges about the appropriate use and limits on use of such technologies. Unfortunately, many agencies are embracing new forms of communication technology without providing workers with sufficient ethical guidance and training. Workers, including new social workers, may need to raise concerns with their supervisors and administrators in order to pre-empt the type of situation faced by Jace.

When an employer asks social workers to use personal cell phones for work purposes, a number of legal and ethical concerns arise:

Does an employer have a right to ask social workers to use personal cell phones for work purposes, and if so, does state law require employers pay workers for use of their cell phones?

Is an employer allowed to require social workers to answer phone calls or texts outside of business hours (including after work, or while the worker is on vacation)?

If a social worker responds to a client’s call or text outside of regular working hours, is the agency legally and ethically responsible for the worker’s conduct (e.g., responsible to pay the worker for her time, responsible for providing supervision, and legally accountable for any malpractice that may occur)?

If a social worker does not respond to a client’s call or text outside of work hours, is the social worker liable for malpractice or state licensing sanctions?

When answering a cell phone, what steps should the social worker take to ensure confidentiality is maintained throughout the call?

As with many legal and ethical questions, the answers depend on the particular situation, including the general employment laws of the state and any regulatory provisions for the agency and social worker. Let us first focus on the ideal. If an agency expects social workers to use cell phones (or other technology) to communicate with clients, then the agency should provide the technology. As a matter of fairness (if not a matter of law), employers should pay for the tools that employees require in order to fulfill their work obligations.

For social workers, another concern is professional boundaries. The NASW Code of Ethics (COE, 106(c)) states that social workers should maintain appropriate boundaries with clients. Providing clients with the worker’s personal cell phone number might violate such boundaries. Ordinarily, social workers make themselves available to clients during regular work hours. If clients have emergencies outside such hours, then the client should be directed to emergency services (e.g., 911 or a crisis center). Ramon, faced with a crisis in the middle of the night, made use of Jace’s cell phone because it was available. If Jace and the agency had set clearer boundaries, then Ramon might have used more appropriate services.

Unfortunately, many (or all) of us are not living in the ideal world. What if we have an employer who asks us to use personal cell phones for work purposes? Actually, I am in exactly this situation. I am a professor, and my university has asked professors to relinquish our landline phones to help address the budget cuts. If students want to contact me, they may e-mail, or they may contact a secretary who will e-mail me. If I want students to call me directly, I need to use my personal cell phone. I could refuse to use my cell phone for work purposes, but for now, I have decided that I will use it. Providing students with my cell phone number is useful to them and me. The cell phone provides students with easier access than the alternatives, and allows me to respond to students in a timely manner.

Do I think my university should compensate me for using my personal cell phone? Yes. Would I prefer that the university provide me with a separate work cell phone? Yes. Still, it is not in the university’s budget, and I have decided that this is not a battle that I want to pursue at this time. (Perhaps our faculty union will address it in upcoming negotiations.) Accepting that I will use my cell phone for work purposes is not the end of the story. I also need to identify risks and determine how I will manage those risks.

In general, BSW and MSW students are not as vulnerable as clients in typical social work settings. Most calls relate to academic issues, not personal issues and crises. Still, I inform my students—in writing at the beginning of each term—that I have a number of restrictions on the use of my cell phone. First, students are permitted to call me only during regular business hours (9 a.m. to 5 p.m. from Monday to Friday, exclusive of holidays). Second, although students are not permitted to send text messages, they may send e-mails to my work e-mail address. I let students know that although the cell phone is my cell phone and I have a password for some protection, I cannot guarantee that information left on the cell phone can be kept confidential. I encourage students to leave brief messages and to avoid sharing information that is of a sensitive nature. My e-mail is somewhat more secure, but I cannot guarantee confidentiality over e-mail (e.g., my employer may have access to my work e-mails).

For emergencies, I inform students to call 911 or other emergency services. One reason is that I may not be available to respond to an emergency. More importantly, my role is to teach and facilitate learning, not to provide therapy or intervene in crisis situations. If I am aware of a student in a crisis or emergency situation, my university has protocols about reporting such situations to appropriate authorities (e.g., university counseling services and the dean of students).

As with the “informed consent” process with clients, my students need to know the extent of confidentiality when they share information with me (COE, s.1.03; 1.07). Also, they need to know the boundaries for communication with me. The professor-student relationship has certain parallels with the social worker-client relationship, so I want to model good practice.

Although I am willing (albeit reluctantly) to use my cell phone for work purposes with my university, I would advocate much more strongly against using cell phones for clinical social work practice (practice with individuals, families, or groups). The risks are simply too high—in terms of protection of client confidentiality, maintaining appropriate professional boundaries, and ensuring that clients make use of appropriate services when they are in a crisis situation. Accordingly, if an agency wants social workers to use cell phones for work purposes, then I would suggest the following policies:

The agency should provide workers with cell phones that are to be used solely for work purposes.

Clients should be informed about the policy on contacting workers via cell phones at the outset of services: what times the client may call, how long the social worker has to respond to a call, what types of messages should or should not be left on the cell phone, and limits on confidentiality when using cell phones.

Clients should be provided with information about crisis services they may contact should the need arise.

Clients should be provided with information on whether they can send text messages, and under what circumstances (e.g., only to set or change appointment times, and not to discuss any clinical issues).

Some agencies may decide to turn off functions such as text messaging or voice mail, so that messages cannot be left.

Social work agencies may have very good reasons for using cell phones, texting, and other technologies with clients. Still, they need to address risks in a professional and strategic manner. As you and your agencies review procedures and policies, identify relevant Web sites and articles, such as those listed below. Learn from their experience.

And now for the surprise ending to our case scenario: Jace decides to contact 911 and share Ramon’s cell phone number. Emergency services identify where Ramon lives and send a crisis unit to his address. Ramon is alive and well, although quite perturbed about being awakened in the middle of the night. Ramon was not suicidal. He simply lost his cell phone. An unidentified person was playing a prank by texting suicide notes to people in his address list.

Additional Reading

American Telemedicine Association, State Telemedicine Policy Center (2012). Available at http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3604.

Boschen, M. J., & Casey, L. M. (2008). The use of mobile telephones as adjuncts to cognitive behavioral psychotherapy. Professional Psychology: Research and Practice, 39 (5).

Boschen, M. J. (2009). Mobile Telephones and Psychotherapy: I Capability and Applicability. The Behavior Therapist, 168-173, Retrieved from http://www98.griffith.edu.au/dspace/bitstream/handle/10072/29570/59553_2.pdf?sequence=1.

Morgan, S. (2012). Social workers, smartphones and electronic health information. National Association of Social Workers, Legal Defense Fund, Legal Issue of the Month. Available at https://www.socialworkers.org/ldf/legal_issue/2012/May2012.asp.

National Association of Social Workers (2005). NASW & ASWB standards for technology and social work practice. Available at https://www.socialworkers.org/practice/standards/NASWTechnologyStandards.pdf.

Dr. Allan Barsky is Professor of Social Work at Florida Atlantic University and 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 (Brooks/Cole), and Clinicians in Court (Guilford Press). The views expressed in this article do not necessarily reflect the view of any of the organizations with which Dr. Barsky is affiliated.