by Allan Barsky, PhD, JD, MSW
March 2020—As the saying goes, “Extraordinary times call for extraordinary measures.” In light of the COVID-19 pandemic, we are certainly in extraordinary times. As social workers, we are facing a myriad of challenges. Many of us are working in organizations that have temporarily closed or are replacing in-person meetings with clients to telephone and digital communication. Some of us are in working organizations that are being overwhelmed with client concerns, ranging from anxiety about the pandemic, to unemployment and financial concerns, to difficulties with access to COVID-19 testing and healthcare services for themselves and their loved ones. All of us are working in environments of uncertainty, stress, and yes, also opportunities — opportunities to promote health, well being, social justice, empowerment, and a stronger sense of community.
Social workers possess many important methods and skills to help clients and communities to cope and thrive in times of crisis and transition. We can provide moral and instrumental support, access to services, advocacy to address client needs, therapy to help clients deal with anxiety and trauma, community organization, and a myriad of other methods of helping. But what are our ethical obligations when we are not able to provide services in our usual ways, particularly, the ways that are authorized by our codes of ethics, agency policies, and regulatory laws? Under what circumstances, if any, is it ethical for social workers to breach particular ethical standards, agency policies, or regulatory laws? And if we do breach any of these guidelines, what can we do to minimize the risk of harm to our clients, ourselves, and our practice settings?
Examples of Exceptions
Consider the issues that arise when social workers are suddenly forced to provide services through technology when, traditionally, they have provided these services in person. An agency may have been directed to stop in-person services as part of the national and global efforts to reduce the spread of COVID-19. Despite the honorable purpose of this directive, it puts social workers in challenging situations. Our Code of Ethics says that we should not provide services unless we are competent to do so (NASW Code of Ethics, s.1.04)—yet, social workers who have not been trained in using videoconferencing and other communication technologies for working with clients are abruptly being required to do so. If the workers had time and other resources, they could learn best practices and skills for using these technologies (cf., National Technology Standards). But they do not have time. If they do not use the technologies right away, they may be violating ethical standards by abandoning clients in need (s.1.17(b)).
Consider another challenge: maintaining confidentiality (s.1.07). Some forms of communication technology have strong protections to ensure that communications with and about clients are kept confidential (e.g., encryption, firewalls to prevent unauthorized access, and strong passwords or double authentication methods). Some agencies and social workers have access to these forms of technology, so using this technology is relatively safe. Other agencies and social workers may need to rely upon Apple FaceTime, messaging apps, Skype, or other communication programs that are not specifically designed for health and mental health care communications. If these agencies and workers do not use these easily accessible apps, however, they may also be abandoning clients in need. Workers need to consider what types of technology are accessible to particular clients. A client may not have access to the types of technology that provide for secure communications. Remember, also, workers need to engage clients in informed consent regarding changes in the way we practice (s.1.03). This may include discussing transitions from in-person to distance communication. What types of communication technology are available? What are the pros and cons of each type of technology? Which type does the client prefer? How can the worker and client minimize any risks (e.g., using a computer or phone in a private room, without others present)?
Now, consider the ethical obligation to maintain clear and appropriate boundaries (s.1.06(c)). Some employers are asking social workers to use their personal devices and accounts to communicate with clients. Some social workers are providing services in evenings, on weekends, and other hours that may not ordinarily be authorized by their agencies. Some social workers may be going beyond their normal professional roles to assist clients through particular crises, for instance, by providing clients with computers or tablets from their offices (with agency consent) to ensure clients are not cut off from work, school, health, or social service providers. Each of these examples is a boundary crossing (acting outside one’s usual scope of one’s professional role), but not necessarily a boundary violation. When engaging in boundary crossings, social workers should use risk reduction strategies to ensure clients are well served and to protect clients and others from potential harm. When extending hours of availability to clients, for instance, workers should still set appropriate boundaries. For instance, they could inform clients that they will be available during the week until 8 p.m., but if urgent concerns arise afterward, the client should contact 911 or other emergency services. The following section provides additional risk reduction methods for various circumstances.
Acting Prudently in Exceptional Circumstances
In each of the aforementioned scenarios, social workers are responding to extraordinary circumstances. Normal practices may not be feasible. Normal practices may also be detrimental. This does not mean, however, that workers should simply ignore their ethical, legal, and agency obligations. It is still important to act prudently and professionally. In particular, workers should strive to maintain the ethical principles of service, respect for the dignity and worth of all people, professional competence, integrity, human relationships, and social justice.
Ideally, social workers should identify solutions that meet client needs and also comply with their obligations. The legal obligations under HIPAA, for instance, have been eased temporarily to allow social workers and other health professionals to use communication apps that are not otherwise HIPAA compliant (see National Law Review). The regulators recognized that social workers and other health care professionals may need to use FaceTime, Google Hangouts, and other apps that are easily accessible to the people they serve. Still, if it is feasible for social workers to use HIPAA-compliant apps, they should do so. And if workers need to use non-HIPAA-compliant apps in the short-term, it would still be prudent to consider how to gain access to HIPAA-compliant apps in the longer term. Some videoconferencing apps, such as doxy.me, are free, HIPAA-compliant, and relatively easy to learn and use.
In terms of using personal devices for work purposes, social workers should consider whether this is necessary or whether there are other alternatives that maintain professional boundaries. For instance, could the agency allow workers to take computers or other technology home from the usual workplace? If workers are using personal devices to communicate with and about clients, they should also consider risk reduction methods. For instance, even when workers are using their personal computers, they should (ideally) log into and use their work email, videoconferencing apps, shared documents, text messaging, and other distance technologies. When using their own telephones, they could download an app that provides them with a secondary phone number that may be used for work purposes. This would enable workers to provide clients with a work number, rather than a home number. For those workers who have an old-fashioned land-line at work, the land-line number could be forwarded to the new work number on their phones.
Regarding competence to communicate with clients through technology, social workers may need to start by doing the best they can. They may not be as skilled at videoconferencing as they are at in-person communication with clients. Still, they can learn as they go along. If the workers have time, they could consult literature and online videos that demonstrate effective use of communication technologies. For those just struggling to deal with client crises and urgent concerns, there may not be time. Social workers may also consult and observe other workers who have already developed higher skills with various communication technologies.
Whenever possible, make sure that your employing agency modifies its policies to allow for changes in practices to meet the needs of clients and workers under the current conditions. The changes may be documented in relatively informal memos, giving workers guidance and protection as they venture into new territory with technology and clients. Policy changes could also be included on agency websites and on client consent forms.
When in doubt about how to proceed in these extraordinary times, consult with your supervisors, executive directors, attorneys, NASW’s consultation hotline, professional licensing body, or other experts. You may also need to consult with your professional liability insurance companies to ensure that your new practices are covered (particularly online services and teletherapy).
Avoid isolation. Ethics is a team sport. We can all learn from and support one another.
On a completely different note, please consider the use of the recently popularized term, social distancing. Health care experts and government officials have been encouraging people to use social distancing to reduce the spread of COVID-19, or at least to slow down the spread. The term social distancing is unfortunate and perhaps misleading. Perhaps we should be speaking of physical distancing rather than social distancing. The intent of the social distancing directives have been to encourage people to remain physically apart from one another (e.g., avoiding large congregations of people, keeping a distance of 6 feet apart from others, staying home unless necessary to go into a public place). People need social connection, social support, social interaction, and social group activities. Each of these can be done at a safe distance, including through the use of telephones, online games, videoconferencing, social media, and other technology.
Thanks for all the extraordinary things you are doing to take care of yourselves, your social networks, and the clients you serve.
Allan Barsky, PhD, JD, MSW, is Professor of Social Work at Florida Atlantic University and author of Social Work Values and Ethics (Oxford University Press).
The views expressed in this article do not necessarily represent the views of any of the organizations to which the author is affiliated, or the views of The New Social Worker magazine or White Hat Communications.