In today’s episode, Part 2, Allan and I talk about Section 1.05, cultural competence and whether online communities fall under the ethical standard of cultural competence. Allan mentions the NASW 2016 Standards and Indicators for Cultural Competence. A few minutes later I mention the 2017 NASW, ASWB, CSWE, & CSWA Standards for Technology in Social Work Practice, and feedback that the Tech Standards and the 2018 Code of Ethics painted technology as problematic. Spoiler alert: Allan disagreed. All of the NASW Practice Standards & Guidelines can be found on the NASW website. We talk about section 1.04(e), knowing the laws in your jurisdiction and the one where your client lives and how that affects practicing across state lines with or without technology.
In Part 1, episode 113, we provided a historical overview of the NASW Code of Ethics and discusses why the NASW Code of Ethics was revised for 2018. Then, Allan and I talk about Section 1.03, Informed Consent, and specifically subsection “i” which has to do with electronic searches.
In Part 3, episode 115, we talk about 1.06(g) – professional affiliations, and the removal of the word “disability”. We talk about 1.15 – disruption in electronic communications. We end Part 3 with a discussion of resources for folks who want to learn more about the NASW Code of Ethics, and ethical issues in social work practice.
Bio
Allan Barsky, JD, MSW, PhD, is a professor at Florida Atlantic University where he teaches ethics, conflict resolution, addictions, generalist social work, and diversity-informed practice. His book credits include “Interprofessional Practice with Diverse Populations,” “Conflict Resolution for the Helping Professions” (Oxford University Press), “Clinicians in Court” (Guilford), and “Ethics & Values in Social Work” (Oxford). Dr. Barsky has chaired the NASW Code of Ethics Task Force and the NASW National Ethics Committee. He has taught internationally in Israel, the United Kingdom, Canada, the Netherlands, Switzerland, and Finland. For further information, please see www.barsky.orgTranscript
Introduction[00:13]
Jonathan Singer: Hey there podcast listener. Thanks for coming back for Part 2 of my discussion with Allan Barsky about the 2018 NASW Code of Ethics.
In Part 1 we talked about the history of the Code of Ethics and section 1.03(i) electronic searches.
In today’s episode, Part 2, we talk about Section 1.05, cultural competence and whether online communities fall under the ethical standard of cultural competence. Allan mentions the NASW 2016 Standards and Indicators for Cultural Competence. A few minutes later I mention the 2017 NASW, ASWB, CSWE, & CSWA Standards for Technology in Social Work Practice, and feedback that the Tech Standards and the 2018 Code of Ethics painted technology as problematic. Spoiler alert: Allan disagreed. All of the NASW Practice Standards & Guidelines can be found on the NASW website. We talk about section 1.04(e), knowing the laws in your jurisdiction and the one where your client lives and how that affects practicing across state lines with or without technology.
Interview
[02:00]
Jonathan Singer: I want to move on to Section 1.05 Cultural Awareness and Social Diversity. Section (b) says Social Workers should have a knowledge base of their client's culture and be able to demonstrate competence and provision of services that are sensitive to clients’ cultures and to differences among people and cultural groups. This sounds like something that Social Workers have been doing for a long time and so it's not necessarily a new idea, but people have talked about participation in online communities as being cultures, as having a different set of values and rules and expectations and norms. Was there any discussion in the revision about whether or not the Code of Ethics considers online communities or technology-mediated relationships as being client’s cultures?
Allan Barsky: So, in terms of what the internal discussions were, we were actually asked to sign an agreement that we would not share what those discussions were. So those were to be private, confidential discussions. What may be helpful for people is to look at there were Practice Standards, I think in 2016, on Cultural Competence. I'm not sure if they brought up the issue of whether or not a community that is online has its own culture. But if you look at the definition of culture, it's a group that has its own language, norms, values, etc. So certainly, various groups that are communicating online have different types of cultures, what's okay and what's not okay and many subcultures within. So, you couldn't say everybody on Facebook is the same culture. There may be some attributes that are familiar and common across many Facebook users but there's so many subgroups within Facebook as well. So, to me personally I would say that you could consider various online groups and various people who are connected through different types of digital communities that doesn't even have to be social networking but there may be some cultural aspects. I should clarify that even though I was on the Task Force I am not a spokesperson for NASW. I am not hired by them. I haven't been asked to speak on their behalf.
Jonathan Singer: Right. Which is a good clarifier and I appreciate that.
Allan Barsky: Did you want to go back to 1.05 (d)? Since we were talking about cultural issues, because [sub-section] (d) is the section that's amended.
Jonathan Singer: Yes, would be happy to.
Allan Barsky: So, one of the things that Social Workers have always been good at is doing a broad psychosocial assessment looking at all different areas of a person’s life: biologically, psychologically, socially, spiritually. We haven't always been good at assessing people in terms of their relationships with technology. And so, although this is a section on cultural awareness, competence, and technology, part of it is really just awareness that when you are doing work with people in terms of using technology, you should be aware of cultural, environmental, economic, ability and linguistic factors that affect the use of these services. So, for example, there's a number of people who are using text-based services and you need to have people who have a certain level of not just fluency in English or whatever language you're working in but also a level of literacy to be able to use your that technology. There's a lot of economic factors in terms of just access to different types of services. I know of entire programs that have stopped providing in-person services and everything is through technology, that's assuming that everybody has tablets or computers or they've got plans that allow them large amounts of data and things like that. So, we have to be aware of access issues for people on, economic issues and also in terms of ability issues. Now sometimes when you look at the code or you look at standards it seems to focus on the negatives but here it really talks about accessing all of these different factors and it may actually be that using technology is a great way to engage people with different abilities and different economic abilities as well. So, in terms of economics, the person who is working a nine to five job and can't afford to take off a couple of hours in the middle of the day might be able to connect with a Social Worker during lunch via technology and so it's actually more accessible means for the person as opposed to a less accessible means.
Jonathan Singer: Well, you know I appreciate you clarifying the tone of the Code of Ethics with regards to technology because there are places in there where it sounds like the Code is saying technology is bad.
Allan Barsky: Could you please point out a section where it actually says technology is bad? I think people came up with that critique and we tried to change any of that language because I think it's not even a choice between with technology or not with technology anymore because there is often a blending and so, we heard very loudly and tried to make sure that there wasn't a statement that said technology was riskier or technology was second rate. In fact, in many cases technology can be better. We do actually add language where people say well why do you have to add that language about technology because shouldn't we know it anyhow and one of the reasons that we added that language is because even though the existing Standard should have covered the issue we were finding a lot of problems with it. So, for example, in terms of use of respectful language, there's a number of places where we are talking about sexual relations or sexual harassment or respectful language. We made sure that we clarified that it's not just orally or in writing but it could also be digital communications which could include sending memes or pictures or electronic videos and people would say well why do you really need that? We have had a number of incidents, even on the NASW website, where people have been sending very vitriolic language and very insulting language to people that I don't think they would have said if we were having these conversations in person so we did it to try to highlight that really it is an educational tool, it's not changing the nature of the obligations but just being very clear about these types of standards, they apply whether it's with technology or without technology.
[09:01]
Jonathan Singer: So, you eluded to feedback that you received about specifically the technology practice standards is that correct?
Allan Barsky: Yeah, we got feedback to both the technology standards and also to the Code of Ethics.
Jonathan Singer: Oh, okay.
Allan Barsky: Both were set up for feedback from people. Also, I've been doing a number of presentations around the country including some at the Social Work and Social Work education conferences and people bring up these concerns so it's great that you could have these different dialogues with people.
[09:39]
Jonathan Singer: Yes, that's very strengths-based way of thinking about it. But you asked about sections where it sounded like there was an implication that technology was bad and that's kind of very absolute language but I want to point one out that to me speaks to that and I would love to hear what you have to say. So, under section 1.03 Informed Consent under letter (g), the last sentence says, "If clients do not wish to use services provided through technology Social Workers should help them identify alternate methods of service." In my mind, a more tech-friendly statement would have included a corollary which is and if clients do not wish to use services that are traditionally provided and would prefer technology then Social Workers should help them identify those technology-mediated services. So that's what I mean by saying, there are places where there is a tone that I'm reading and I will admit my bias that has places where it sounds like technology is the less favorable option and so you should always be able to find them the better option which would be the traditional services.
Allan Barsky: So, one of the things that we are trying to do with the Code of Ethics is to educate people and there's Social Workers with various levels of familiarity and comfort with technology and so if you look at the entirety of Informed Consent it does talk about, just in general, we should inform clients about the purposes of services, risks, etc. and clients have a right to ask questions and either consent to or reject different types of services. So, they could reject in-person services, I think you're right that we could have worded that section differently but what was decided was to leave the rest of the Standard intact and have a particular paragraph to just educate people about the use of technology. So yes, it could have talked about both directions. I'm not sure that it's saying that don't use technology because it's worse. I think it's just saying if you're using technology make sure you assess people's ability to use it and we do similar for whether it's technology-assisted or not technology assisted in earlier parts. And I would actually think that ten or twenty years from now, some of these sections on technology could probably be taken out completely because people would have found ways to make use of technology in a way that doesn't really separate out in person vs. technology so for a lot of people it still feels like it's something new or different but as we move along it's probably going to, we're probably going to incorporate things in a way that's more fluid.
[12:37]
Jonathan Singer: Which I think is also a nice thing to keep in mind and I appreciate you pointing out that, which is that the NASW Code of Ethics is a responsive document, a response to things that change in the society, and the ways that the Profession changed and so I think you're right, I think it would make sense to think that in twenty years from now some of the things are new will be just integrated into society. I don't know exactly what those will be, but it's nice to know that that's something that we can think forward to.
Allan Barsky: We're both Professors, I don't know if you've ever looked at some of your older syllabi and in older syllabi you sort of explained to people how to log on to Blackboard or Web CT whatever the online type of service was. We had provided a lot more information to students for how to use technology and now there's just sort of an assumption that people know how to log on and do all the basics. Now it's training people to do something at higher levels or newer types of technology.
Jonathan Singer: Yes, that's a great analogy. Absolutely true, and in fact, I found one of the trainings that I did back in my old agency in 1997 and I actually defined what a mouse was.
Allan Barsky: Probably had to put a picture of it too.
[13:55]
Jonathan Singer: I did. I know that there's some other things in the Code of Ethics that have changed around confidentiality and boundary issues and professional responsibility and I'm wondering if you could talk about some of those, particularly some that will change the way Social Workers think about practice or maybe practice. Could you address some of those changes?
Allan Barsky: Okay, so one change, it's only a couple of words, but they're very critical words 1.07c, when we're talking about confidentiality. So, the first part of it is the statement that we're to keep information confidential except for compelling professional reasons. And then it gives some possible exceptions to those and so the primary exception in the second sentence, "keeping information confidential does not apply when disclosure is necessary to prevent serious foreseeable imminent harm to client or others." Now it used to be serious foreseeable and imminent harm to the client or another identifiable person. We've taken out the term identifiable and just put in terms of others or other people because there are a number of states now that actually have in their laws duties to report or duties to protect whether or not the other people are identifiable.
So, if you look sort of historically, people will look back to the mid-1970's with the Tarasoff cases. Those were the first times ever that the court started to recognize that confidentiality is not absolute and that there are occasions when we have duties to third parties, people who aren't in the Social Work client relationship when their life or serious risk to their life or their body is at risk. So that was the first time, back in the 1970's and I think the language was trying to be fairly restrictive saying that if somebody threatens a specific person then that duty could be triggered, but if it’s not an identifiable person what could we do about it? Why should we limit confidentiality? So, there was a lot of concerns that if we had too many Social Workers or too many mental health professionals breaching people's confidentiality in order to protect other people then clients wouldn't come to us, they wouldn't trust us, they wouldn't open up with us, we wouldn't be able to build a positive working relationship with them.
Now, I still think it's important that Social Workers limit the types of disclosures and when that duty to protect or duty to report is triggered, but we've had a number of concerns in recent years where clients or others have made threats or it's been known that they are posing risks to others but it isn't necessarily an identifiable "other person." So if you were to work with somebody who was being radicalized by ISIS or by another terrorist organization and you knew that there was a threat to a school to a public gathering etc. but you didn't know which school or which specific people at that public gathering would be targeted, under the old framing of the Standard there wouldn't be an exception to confidentiality, so here you need to use your discretion in terms of what triggers that duty to report or duty to protect and what can you do in order to protect and at the same time minimize the breach of confidentiality. So just because there is a risk to another person of serious imminent harm, you may not need to disclose to others. If you are able use effective crisis management counseling, if you are able to develop a safety plan, if you are able to get the client's permission to share information with the potential victim, then you are not breaching confidentiality. But, if the client is posing a risk to others and working with the client in a collaborative way and obtaining consent is not possible then you have to think about okay when can we share information with others, the potential victim, the police other people in the community in order to make sure that we are protecting them from serious harm. So that's a change and everybody is going to have to know state by state what their laws say in terms of do they have a positive duty? do they have discretion? when is that discretion even met? So, we use the language of serious foreseeable and imminent harm.
The statues in different states and the licensing laws may use slightly different language or considerably different language. And one of the exceptions that I would bring up is the state of New Hampshire. I was presenting there and we were talking about imminent harm to the client or others and somebody said "Well what about property? What about buildings?" I said well I don't know of any legal responsibility to protect buildings from imminent harm, well we looked in their state laws and it was actually built into their state laws so think that's one of the things that we have to be aware of is that there's different legal duties that affects also what our ethical responsibilities are and you'd ask what would be different now than in the past, not just in terms of the Code of Ethics, but just in terms of our practices, there are far more Social Workers that are practicing across borders, and so if you are going to practice across state lines you need to know what the laws are, not just the licensing laws, but child protection laws and laws like what are the responsibilities of Social Workers and mental health professionals when there is serious foreseeable and imminent harm to the clients others or even to property.
[19:44]
Jonathan Singer: That's a really good point. And we know that you're not, that Social Workers are not, allowed to practice in other states where they are not licensed and I know that that is something that has come up a lot with online practice and you bring up a compelling reason why Social Workers should think twice before saying "Ehh, it'll be fine." Because there are these complex tangle of laws that can vary state by state. And things like protecting property is not something I've ever thought of. But, like you said, if it's in New Hampshire and you're practicing in Vermont and you don't know that then you're not meeting your professional responsibilities to understand the laws in that state.
Allan Barsky: Right, Right, having moved to Florida. Florida is a sort of an oddball state to compare it to some of the others. For instance, the courts here have decided the opposite of Tarasoff. The courts here, there's still a notion of illegitimacy of children for some purposes and if the child is born out of wedlock then the father is not required to be contacted for consent if there's going to be an adoption. How would you know that unless you really studied the laws in those particular states? I did want to clarify something that you said about Social Workers not being allowed to practice across state lines. So, there's a big "it depends." So, we're not allowed to practice across state lines in terms of types of services that require licensure. But we can practice across state lines if there are no requirements for licensure or no restricted practice. So lots of macro practice goes across state lines and there is no requirement for licensure in each and every state that you're practicing. You could provide coaching services, you could provide counseling that doesn't amount to therapy, you could do basic psychosocial assessments. You could not do diagnoses. If you look at 1.04 (e) that's one of the additions you need to know the laws of the jurisdiction of which you are present and also the laws of the jurisdiction where the client is located.
--End--
[21:59]
Jonathan Singer: Hey podcast listeners, it's me again. Did you enjoy it? Good. Well, if you haven't already listened to Part 1, please do that. And don’t forget to listen to Part 3. Part 1 is an overview and history of the NASW Code of Ethics, and a discussion of section 1.03(i) searching the web for information about your clients. In Part 3, episode 115, Allan and I talk about 1.06(g) – professional affiliations and the removal of the word “disability”. We talk about 1.15 – disruption in electronic communications. We end Part 3 with a discussion of resources for folks who want to learn more about the NASW Code of Ethics, and ethical issues in social work practice. Alright. I'm done!
Resources and References
- Barsky, A. E. (2017). Conflict resolution for the helping professions (3rd ed.). New York: Oxford University Press.
- Barsky, A. E. (2012). Clinicians in court: A guide to subpoenas, depositions, testifying, and everything else you need to know. New York: Guilford Press.
- Barsky, A. E. (2010). Ethics and values in social work: An integrated approach for a comprehensive curriculum. New York: Oxford University Press.
- Barsky, A. E. (2017). Social Work Practice and Technology: Ethical Issues and Policy Responses. Journal of Technology in Human Services, 35(1), 8–19. doi: 10.1080/15228835.2017.1277906
- Barsky, A. E. (2016). The Ethics of App-Assisted Family Mediation: The Ethics of App-Assisted Family Mediation. Conflict Resolution Quarterly, 34(1), 31–42. doi: 10.1002/crq.21168
- Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The Effectiveness of Telemental Health: A 2013 Review. Telemedicine Journal and E-Health, 19(6), 444–454. doi: 10.1089/tmj.2013.0075
- NASW Webinar on the 2018 Code of Ethics: https://naswwa.inreachce.com/Details?groupId=77263aba-2bf3-4da4-852e-51b56cf90067
- Reamer, F. (2013-06-11). The NASW Code of Ethics. Encyclopedia of Social Work. Retrieved 3 Jan. 2018, from http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-829.
APA (6th ed) citation for this podcast:
Singer, J. B. (Producer). (2018, January 5). #114 - 2018 NASW Code of Ethics (Part2): Interview with Allan Barsky, JD, MSW, PhD [Audio Podcast]. Social Work Podcast. Retrieved from http://www.socialworkpodcast.com/2018/01/Ethics2018-2.html
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