Ethical Principles and Responsibilities

Question 1 (ia-01, version 2, tests IA-1: Confidentiality and where it stops, including privacy law)

A social worker in private practice receives a subpoena from a lawyer who represents a client's former spouse. It asks for the client's full treatment record for a custody hearing. The client has not signed a release. What should the social worker do FIRST?

1. Consult a lawyer about whether the subpoena is valid.
   Why: Legal advice is a sound step and often comes soon after. But the privilege belongs to the client, so the first thing any lawyer will need to know is what the client wants.
2. Contact the client to talk through the subpoena. KEYED AS BEST ANSWER (B)
   Why: Best first step. The client should know about the request and decide whether to consent. The client or the client's lawyer can ask the court to block or narrow the subpoena. A subpoena has to be answered, but it is not a judge's order to release the record. Rules on privilege vary by state.
3. Write to the court to claim privilege for the client.
   Why: Claiming privilege is the right response when the client does not consent. The social worker does not yet know that. The client may want the record released.
4. Review the record to see which parts are relevant.
   Why: Sorting the record comes later, once it is clear that something may be shared. Then the social worker shares only what is needed.

Sources cited: NASW Code of Ethics, 1.07(b), 1.07(j); Jaffee v. Redmond, 518 U.S. 1, 1996

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Question 2 (ia-02, version 3, tests IA-2: Legal and ethical duties to clients, colleagues, the profession and society)

A social worker at a community clinic is worried about a social work colleague. The colleague has twice mentioned drinking heavily to cope with a divorce, and yesterday missed two client sessions. The colleague does not seem intoxicated at work. What should the social worker do FIRST?

1. Consult the clinic director about what has been seen.
   Why: Going to the director is the likely next step if the colleague does not take adequate action. It is one of the proper channels the Code names. It is not the first step when a direct talk is feasible and no one is in immediate danger.
2. Review the agency policy on impaired staff members.
   Why: Knowing the policy is useful, but it does not help the colleague or the clients. The Code already says where to start.
3. Speak with the colleague in private about the concern. KEYED AS BEST ANSWER (C)
   Why: Best first step. A social worker with direct knowledge that a social work colleague's impairment is affecting practice should consult with that colleague when feasible and help them take corrective action. Some states add reporting duties for impaired professionals.
4. Keep dated notes on the colleague's behavior to share later.
   Why: Clients are already affected, since sessions were missed. Collecting more evidence leaves clients at risk and leaves the colleague without help.

Sources cited: NASW Code of Ethics, 2.08(a), 2.08(b)

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Question 3 (ia-03, version 3, tests IA-3: Spotting an ethical dilemma and working it through)

A social worker sees two adult siblings as separate clients. In session, one sibling says they plan to sell the family home without telling the other, who lives there. The second sibling's main treatment goal is keeping stable housing. The social worker cannot see how to serve both fairly. What should the social worker do FIRST?

1. Consult a supervisor about serving both siblings. KEYED AS BEST ANSWER (A)
   Why: Best first step. The social worker has a real conflict between duties to two clients and does not know how to resolve it. The Code says to seek consultation in that spot, and to take reasonable steps to resolve a conflict of interest in a way that protects clients.
2. Refer the first sibling to another social worker.
   Why: A referral may turn out to be the answer, and the Code allows ending a relationship with a proper referral to resolve a conflict. It is a big step to take alone. It should follow consultation and involve the client.
3. Urge the first sibling to tell the other about the plan.
   Why: This pushes one client to act so that the social worker's own problem goes away. It puts the social worker's needs ahead of that client's right to decide.
4. Help the second sibling prepare a backup housing plan.
   Why: This uses what one client said in confidence to steer the other client's treatment. It is a quiet breach of the first sibling's confidentiality.

Sources cited: NASW Code of Ethics, Purpose; 1.06(a); 2.05(a)

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Question 4 (ia-04, version 3, tests IA-4: Getting informed consent the right way)

A new adult client at an outpatient clinic speaks Spanish and only a few words of English. The clinic's consent form is printed in English. The client says "OK" and reaches for a pen. What should the social worker do FIRST?

1. Ask a bilingual front desk worker to go over the form.
   Why: Speaking two languages is not the same as being trained to interpret. Consent terms may be explained wrongly, and a front desk worker is not part of the client's care, so the client's privacy is also at stake.
2. Ask the client's adult daughter in the waiting room to interpret.
   Why: A family member is a poor interpreter, even an adult. Accuracy suffers, the client may hold back private matters, and the client loses the chance to decide what the family knows.
3. Use a machine translation app to read the form in Spanish.
   Why: An app cannot check that the client understood or answer the client's questions, and machine translation of consent wording is unreliable.
4. Arrange a trained interpreter to go over the form. KEYED AS BEST ANSWER (D)
   Why: Best first step. When a client has trouble with the language used in the practice setting, the social worker must take steps to make sure the client understands. The Code names a detailed spoken explanation or a qualified interpreter or translator.

Sources cited: NASW Code of Ethics, 1.03(a), 1.03(b)

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Question 5 (ia-05, version 3, tests IA-5: The profession's core values and ethical principles)

A social worker at a housing agency sees that applicants who use wheelchairs often give up, because the intake office is up a flight of stairs. The social worker has helped a few of them by meeting at a nearby library. Which action BEST reflects the professional value of social justice?

1. Ask agency leaders to move intake to an accessible space. KEYED AS BEST ANSWER (A)
   Why: Best answer. Social justice means challenging unfair conditions and working for equal access to services. Removing the barrier gives every applicant the same way in.
2. Set up a standing weekly intake hour at the library.
   Why: This helps more people than one-off meetings, but it keeps a separate and smaller door for people with disabilities: one hour a week, somewhere else. The barrier itself stays.
3. Offer intake by phone or video to those who need it.
   Why: A useful stopgap, and worth doing while the space is fixed. It is still a separate route that depends on having a phone or internet, and the barrier stays in place.
4. List other accessible housing agencies on the website.
   Why: This sends people with disabilities elsewhere and accepts that this agency is closed to them.

Sources cited: NASW Code of Ethics, Ethical Principles: Social Justice; 6.04(a)

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Question 6 (ia-06, version 2, tests IA-6: Burnout, secondary trauma and compassion fatigue)

A social worker has counseled survivors of sexual assault for three years. Lately the social worker has nightmares about clients' stories, startles easily, and avoids streets that clients have described. The work still feels meaningful, and the caseload has not grown. Which term BEST describes this reaction?

1. Burnout from the demands of the job
   Why: Burnout builds from workload and workplace strain. It shows up as exhaustion, a detached attitude and feeling ineffective. Here the work still feels meaningful, the caseload is the same, and the signs look like a trauma reaction.
2. Moral distress over limits on care
   Why: Moral distress comes from knowing the right thing to do while rules or lack of resources block it. Nothing in the vignette describes being blocked from giving good care.
3. Secondary traumatic stress from the work KEYED AS BEST ANSWER (C)
   Why: Best answer. Nightmares, being easily startled and avoiding reminders are trauma-like signs that come from exposure to other people's trauma. Many texts treat compassion fatigue as the wider term that includes this.

Sources cited: Figley, Compassion Fatigue, 1995, secondary traumatic stress; Maslach Burnout Inventory, three dimensions of burnout

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Question 7 (ia-07, version 3, tests IA-7: Self-care as part of the job)

A child welfare social worker has started to dread going to work and feels numb during home visits. This month the social worker forgot two scheduled visits with families. What should the social worker do FIRST?

1. Ask the supervisor for a smaller caseload for a month.
   Why: A lighter caseload may be part of the answer. Asking for one fix before the supervisor knows the whole problem skips the assessment, and it leaves out the missed visits.
2. Tell the supervisor what has been happening at work. KEYED AS BEST ANSWER (B)
   Why: Best first step. The social worker's distress is already affecting families. When that happens, the Code calls for seeking consultation right away and taking corrective action. The agency also needs to know about the missed visits so that families are covered.
3. Call the employee assistance program to start counseling.
   Why: Counseling is one of the corrective steps the Code names, and it may be part of the plan. In child welfare, a missed visit can leave a child unsafe, so the agency has to know first.
4. Think over which cases have felt the hardest lately.
   Why: Reflection is healthy, and the Code treats self-care as part of ethical practice. Thinking alone does not deal with the effect on families that has already happened.

Sources cited: NASW Code of Ethics, Purpose (self-care); 4.05(a), 4.05(b)

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Question 8 (ia-08, version 2, tests IA-8: Staying current through training, supervision and consultation)

A social worker licensed for 15 years uses a treatment method learned in graduate school. At a staff meeting, a colleague describes newer research showing that a different method works better for the clients the social worker sees most. What should the social worker do FIRST?

1. Sign up for a certification course in the other method.
   Why: Training is needed before using a new method, but this commits time and money before the social worker has checked what the research really shows.
2. Try the other method with one client under supervision.
   Why: Supervision helps, but using a method on a client before learning it puts that client at risk. New approaches come after study and training.
3. Review outcome data for current clients before deciding.
   Why: The social worker's own outcome data is worth knowing. It says nothing about whether the other method would do better.
4. Read the studies and judge how well they fit the caseload. KEYED AS BEST ANSWER (D)
   Why: Best first step. Staying proficient means keeping up with the professional literature and looking at it critically. A second-hand report at a meeting is a reason to read the research, and the reading tells the social worker whether training is the next step.

Sources cited: NASW Code of Ethics, 1.04(b); 4.01(b), 4.01(c)

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Confidentiality: the default and its limits

• The default is to keep client information private and to share it only with valid consent (NASW 1.07(a), 1.07(b) and 1.07(c)).
• Talk about the limits of confidentiality early, before the client shares something you cannot keep private, and again when needed (NASW 1.07(e)).
• NASW 1.07(c) allows disclosure without consent when it is needed to prevent serious, foreseeable and imminent harm to the client or to others. The standard permits disclosure. It does not require it.
• When you do disclose, share the least information that does the job, and tell the client first when that is possible (NASW 1.07(c) and 1.07(d)).
• State law adds its own rules. Duty to warn or protect, and mandated reporting of abuse, vary by state. The exam tests the general principle.
• In couples, family and group work, ask everyone to agree to keep what is said private, and say plainly that you cannot guarantee the others will (NASW 1.07(f)).

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Privilege, subpoenas and court orders

• Confidentiality is your ethical duty. Privilege is the client's legal right to keep treatment information out of court. The client holds it and usually decides whether to waive it. A guardian may decide for a minor, and some courts set it aside when the client's mental health is part of the case. Rules vary by state.
• A subpoena is a demand to respond. It is not the same as a judge's order to release the record. Do not ignore it and do not just comply.
• First steps with a subpoena: tell the client, find out what the client wants, claim privilege on the client's behalf if there is no consent, and get legal advice.
• If a court orders disclosure and it could harm the client, ask the court to withdraw or narrow the order, or to keep the record sealed (NASW 1.07(j)).
• In Jaffee v. Redmond (1996), the U.S. Supreme Court recognized a psychotherapist privilege in federal courts. It covers confidential talks with licensed social workers in the course of psychotherapy. State rules on privilege vary.

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HIPAA in one screen

• HIPAA is the U.S. federal law that protects health information. Protected health information (PHI) is health information that can be tied to a person.
• Providers may use PHI for treatment, payment and health care operations without a separate signed authorization. Most other uses need one.
• Minimum necessary: share only what the purpose requires. This limit does not apply to sharing with another provider for treatment, or to sharing with the client.
• Psychotherapy notes are a clinician's private notes about session content, kept apart from the main record. They get extra protection and usually need their own authorization to release.
• Clients have a right to see and get copies of their records, with narrow exceptions. Under HIPAA that right does not reach psychotherapy notes.
• When state law gives the client more protection than HIPAA, follow the stricter rule. Details: the HHS HIPAA Privacy Rule pages.

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Records, payers, minors and other confidentiality details

• Clients should have reasonable access to their own records. If you think seeing part of the record could seriously harm the client, help them understand it, and limit access only in rare cases with strong evidence. Write down the request and your reasons (NASW 1.08).
• Do not share confidential information with an insurer or other payer unless the client has agreed (NASW 1.07(h)).
• Protect electronic records and messages with reasonable safeguards, such as encryption and passwords, and tell clients about a breach in a timely way (NASW 1.07(l), 1.07(m) and 1.07(n)).
• Confidentiality continues after a client dies (NASW 1.07(w)).
• With minors, parents or guardians usually give consent and may have a legal right to information. Explain to the young person and the family, at the start, what will and will not be shared. The rules vary by state.

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Informed consent

• Consent is a conversation, not a form. The client must understand, agree freely, and be able to make the decision.
• Use plain language. Cover the purpose of the service, risks, limits set by an insurer or other payer, costs, alternatives, the right to refuse or stop, and how long the consent lasts (NASW 1.03(a)).
• If the client cannot read the form or does not share your language, give a detailed spoken explanation or bring in a qualified interpreter or translator (NASW 1.03(b)). Family members, and children above all, are poor choices as interpreters.
• If the client lacks the capacity to consent, get permission from the proper third party, such as a guardian, and still explain things to the client at their level and seek their agreement, called assent (NASW 1.03(c)).
• Clients who are required to attend still have rights. Tell them what the service involves and how far their right to refuse goes (NASW 1.03(d)).
• Get consent before recording a session or letting someone observe it (NASW 1.03(h)), and before using technology to provide services (NASW 1.03(f)).

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Duties to clients, colleagues, the profession and society

• Clients come first. Their interests are primary, with narrow exceptions for legal duties and for the safety of others (NASW 1.01).
• Practice only within what your education, training and supervised experience support (NASW 1.04).
• Colleagues: treat them with respect and consult them for the client's benefit. If a colleague's impairment or incompetence is affecting practice, talk with the colleague first when that is feasible, then go through proper channels if they do not act (NASW 2.08 and 2.09).
• If you believe a colleague acted unethically, raise it with the colleague when that is feasible and likely to help. If not, use formal channels such as the licensing board or an NASW ethics committee (NASW 2.10).
• Profession: be honest, keep high standards, and add to what the profession knows (NASW 4.04 and 5.01).
• Society: work for the general welfare, fair access to resources, and policies that meet basic human needs (NASW 6.01 and 6.04).

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The six core values

• Service: helping people in need comes before self-interest.
• Social justice: challenge unfair treatment and push for equal access and opportunity.
• Dignity and worth of the person: respect each person and their right to make their own choices.
• Importance of human relationships: relationships are a main route to change.
• Integrity: act in a trustworthy way.
• Competence: practice within your abilities and keep building them.
• Exam use: when a question names a value, pick the action that carries out that value, not just any helpful action.

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Is it really an ethical dilemma?

• An ethical dilemma is a real conflict between two duties or values, where meeting one means falling short on the other. Feeling uneasy is not, by itself, a dilemma.
• If one option breaks both the law and the Code and another breaks neither, it is not a dilemma. When the law, the Code or agency policy point different ways, that is a real dilemma: consult before acting.
• The Code does not rank its values or give a formula. It tells you to use judgment and to consult: supervisors, colleagues, an agency ethics committee, or a lawyer.
• On the exam, when the social worker is unsure and nobody is in immediate danger, look for the answer that gathers more information or seeks supervision before acting. Supervision is not a magic answer, though. If there is a direct step the social worker can take, such as talking with the client or the colleague, that usually comes first. When the conflict is between two clients, or the social worker cannot see a fair path, consultation comes first.
• Write down what you weighed, whom you consulted, and why you chose as you did.

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Burnout, secondary traumatic stress, compassion fatigue

• Burnout builds slowly from workload and workplace conditions. Signs: exhaustion, a cynical or detached attitude, and feeling ineffective. It can happen in any job.
• Secondary traumatic stress comes from exposure to other people's trauma. It looks like a trauma reaction: unwanted images, avoiding reminders, feeling on edge. It can come on quickly.
• Vicarious trauma is a slower shift in how the helper sees the world, such as feeling that nowhere is safe, after long work with trauma survivors.
• Compassion fatigue is often used as the wider term for the cost of caring. Many texts describe it as secondary traumatic stress combined with burnout.", "Moral distress is different again: the strain of knowing the right thing to do for a client while rules, limits or lack of resources keep you from doing it.
• To tell them apart on the exam, ask what the cause is (workload, or trauma exposure) and what the signs look like (worn out, or trauma-like).

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Self-care and impairment

• The Code's Purpose section, as amended in 2021, calls professional self-care paramount for competent and ethical practice. The Integrity principle adds that social workers should take care of themselves professionally and personally. Self-care is part of the job.
• Agencies share the duty. The Purpose section also encourages organizations to support self-care through their policies and practices.
• Do not let personal problems, distress, substance use or mental health difficulties get in the way of your judgment or your clients' interests (NASW 4.05(a)).
• If they do get in the way, act right away: seek consultation and take corrective steps, such as getting professional help, changing your workload, or stopping practice (NASW 4.05(b)).
• Exam pattern: when the social worker's own state is already affecting clients, the first move is consultation or supervision, not a private wellness plan.

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Staying current

• Become proficient and stay that way. Read the professional literature and take continuing education (NASW 4.01(b)).
• Base practice on recognized knowledge, including research (NASW 4.01(c)).
• Use a new method only after proper study, training, consultation and supervision (NASW 1.04(b)).
• Supervision teaches and oversees your work. Consultation is advice from a peer or expert that you may accept or decline. Both count as professional development.
• Licensing boards set continuing education rules for renewal, and those rules vary by state.
• Administrators and supervisors should arrange continuing education and staff development for the people they are responsible for (NASW 3.08).

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Part 4. Step-by-step figure: Working through an ethical dilemma

1. Name the conflict. Say which duties or values are pulling against each other, such as confidentiality against safety. Check that it is a true conflict and not just discomfort.
2. See who is affected. List the people and groups with something at stake: the client, family members, the agency, the public.
3. Check the rules. Read the relevant NASW standards, the law in your state, and agency policy. If they all point the same way, follow them. If they point different ways, you have a real dilemma, so keep going.
4. Consult. Talk it through with a supervisor, an experienced colleague, an ethics committee, or a lawyer. Protect the client's identity where you can.
5. Weigh the options and choose. Think through what each option would do to each person. Favor the choice that protects safety and the client's rights with the least harm.
6. Document and follow up. Record what you considered, whom you consulted, and why you chose as you did. Then check how it turned out.

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