SWK 511 Class Three Copyright c 2012 BrooksCo

The Helping Process Phase I: Exploration, engagement, assessment, and planning Phase II: Implementation and goal attainment Phase III: Termination

Phase I: Exploration, engagement, assessment, and planning • • • Exploration of the problem Establishing rapport Multidimensional assessment Mutually negotiating goals Making referrals EPAS 2. 1. 10. A, EPAS 2. 1. 10 b

Interviewing Process • Physical conditions ▫ ▫ ▫ ▫ Adequate ventilation and light Comfortable room temperature Ample space Attractive furnishings and décor Chairs that adequately support the back Privacy appropriate to the cultural beliefs of the client Freedom from distraction Open space between participants • Structure of interviews ▫ Maintain flexibility EPAS 2. 1. 10 a

Interviewing Process • Establishing rapport ▫ ▫ Starting where the client is-motivational congruence Awareness of cultural norms and biases Use of verbal and non-verbal cues that convey attentiveness Use of an interpreter • The exploration process ▫ Furthering responses, paraphrasing, empathic responding ▫ Exploring expectations ▫ Eliciting explicit information EPAS 2. 1. 4. b , 2. 1. 10. a

Interviewing Process • • Focusing in depth Employing outlines Assessing emotional functioning Exploring cognitive functioning Exploring substance abuse, violence, and sexual violence Negotiating goals and a contract Ending interviews Goal attainment EPAS 2. 1. 10. c, 2. 1. 3. b

Phase II: Implementation and goal attainment • • • Enhancing self-efficacy Monitoring progress Barriers to goal accomplishment Relational reactions Enhancing clients’ self-awareness Use of self EPAS 2. 1. 10, 2. 1. 1. b

Phase III: Termination • Assessing that goals have been satisfactorily attained • Helping client to develop strategies to maintain change past termination • Successfully terminating the helping relationship • Planning change maintenance strategies

Social Work Values & Ethics

NASW Core Values Copyright (c) 2012 Brooks/Cole, a division of Thomson Learning, Inc. • All human beings deserve access to the resources they need to deal with life’s problems and to develop to their fullest potential ▫ Commitment to help securing resources ▫ Development and implementation of policies to help fulfill unmet needs ▫ Self-examination of personal values and biases that may serve as obstacles EPAS 2. 1. 1 a & 2. 1. 1 b

NASW Core Values • Social workers respect the inherent dignity and worth of the person. Social workers recognize the central importance of human relationships ▫ Belief in the intrinsic importance of all people regardless of past or present behaviors, beliefs, way of life or social status ▫ Respect, acceptance, and trust are paramount to establishing a helping relationship ▫ Affirm the individuality of all people ▫ Understand personal judgmental tendencies EPAS 2. 1. 1 b, 2. 1. 2 a

NASW Core Values • The value of integrity means that social workers behave in a trustworthy manner ▫ Social workers act honestly, encourage ethical practices, and take responsibility for their own ethical conduct ▫ Accurately represent self and credentials ▫ Treat fellow professionals with respect EPAS 2. 1. 1 f, 2. 1. 2 a

NASW Core Values • The value of competence requires that social workers practice only within their scope of knowledge and ability ▫ ▫ ▫ Take responsibility for knowing personal limits Seek knowledge and experience needed to develop expertise Utilize supervision Be a lifelong learner and stay abreast of practice-related research Be alert to personal events or problems that may impact professional competence EPAS 2. 1. 1 f, 2. 1. 1 e, 2. 1. 1 b

Challenges in Embracing the Profession’s Values • Worker’s inability to conform to profession’s values ▫ Explore through supervision or therapy ▫ Opt to transfer case ▫ If transfer is not an option seek intensive assistance • Differences in cultural norms and values ▫ Practice “moderate universalism”

Ethics • The intersection of laws and ethics ▫ See Figure 4 -1 • Key ethical principles ▫ ▫ Self-determination (case examples 21 -25) Providing informed consent Preserving professional boundaries Safeguarding confidentiality EPAS 2. 1. 2 b, 2. 1. 1 c, 2. 1. 1 d

Figure 4 -1: The Relationship of Law and Ethics

Ethics Copyright (c) 2012 Brooks/Cole, a division of Thomson Learning, Inc. • What are the limits of confidentiality? ▫ ▫ ▫ Supervision and consultation Client waivers Danger to self or others Suspicion of child or elder abuse Subpoenas and privileged communication Confidentiality in various types of recording EPAS 2. 1. 1 f

The Ethics of Practice With Minors • Minors’ rights are limited by laws and policies, differences in maturity and decision-making capacity • Parents may retain the right to review a child’s treatment record and be informed of issues child raises in therapy • Rights are dependent on the particular service setting and presenting problem (i. e. substance abuse services, treatment for sexually transmitted diseases) EPAS 2. 1. 2 c

Understanding and Resolving Ethical Dilemmas • Rights to life, health, well-being, and necessities of life take precedence over confidentiality • One’s individual rights to well-being takes precedent over another’s right to privacy, freedom, or self-determination • Right to self-determination takes precedence over own right to basic well-being • Right to well-being may override laws and policies EPAS 2. 1. 2 c

Steps for Ethical Decision Making • • • Identify the dilemma; gather information Determine core principles and competing issues Review the relevant codes of ethics Review applicable laws, policies, and regulations Consult with supervisors, colleagues, and legal experts Consider possible courses of action and examine consequences Decide on a course of action Develop strategy for implementing Evaluate process and results EPAS 2. 1. 2 d, 2. 1. 1 f

Ethical “Hierarchy” Examine Code for applicable rules; these rules take precedence over the worker’s values One or more rules applies No rule applies OR rules provide conflicting guidance Follow Code rule Principles Screen Dolgoff, Lowenberg & Harrington, 2005

Ethical “Hierarchy” Principles Screen Truthfulness/ Full disclosure Privacy/ confidentiality Quality of life Least harm Self-determination Equality/inequality: Those without power Protection of life: Duty to warn/protect Dolgoff, Lowenberg & Harrington, 2005

Ethical “Hierarchy” Principles Screen 1. 2. 3. 4. 5. 6. 7. Protection of life: Duty to warn and protect Equality/inequality: Those without power Autonomy and freedom: Self determination Least harm Quality of life Privacy and confidentiality Truthfulness and full disclosure Dolgoff, Lowenberg & Harrington, 2005

Liability • Faulty assessment, diagnosis or treatment ▫ Lack of referrals to medical evaluations ▫ Over-assumption that the problem is psychological or socially based • Fraud ▫ Reducing diagnoses to “protect” clients ▫ Specifying an illness when one is not present • Boundary violations (dual relationships) ▫ Sexual relationships (most prevalent, 1/5 of all complaints) ▫ Financial relationships (accepting gifts)

Liability (Contd) • Malpractice – Professional negligence (act of commission or omission that harms the client) or misconduct. Points to prove are: ▫ ▫ The social worker had a professional duty The social worker was remiss in the performance of that duty Harm occurred that can be measured A link between what the social worker did (or didn’t) and the harm that client suffered • Liabilities ▫ Direct liability: Harm has resulted in a supervisor’s acts of commission or omission (i. e. assigned duties without adequate training or experience) ▫ Vicarious liability (respondeat superior): Harm has resulted in a supervisor’s responsibility for a supervisee’s actions during the course of employment, training or field instruction

Privacy, Confidentiality & Privilege • Privacy: Basic rights of individuals to decide how information will be shared • Confidentiality: Obligation of social worker to not divulge information obtained during the course of a professional relationship without permission; exceptions: ▫ ▫ ▫ Consent Information in lectures and writings if identity is disguised Circumstances as defined by law (duty to protect, duty to warn) • Privilege: Legal right that prevents confidential information from being disclosed ▫ Client is “holder of privilege” ▫ Exception if minor or incompetent, then parent/guardian is holder ▫ Limits defined by state law

Confidentiality (contd) • Court Decisions ▫ Tarasoff v. Regents (1976) – Ruled by Supreme Court of CA stated that, under certain circumstances, psychotherapists whose clients tell them that they intend to harm someone are obliged to warn the intended victim (Duty To Warn) ▫ Jaffe v. Redmond (1996) – United States Supreme Court ruled that conversations between clinical social worker and their clients are protected from disclosure in Federal trials; the Court extended privilege to all levels of social work

Internet Resources • Ethical decision making and field work http: //www. socialworker. com/ethicaldecision. htm • NASW Code of Ethics http: //www. naswdc. org/pubs/code/ • IFSW Code of Ethics http: //www. ifsw. org/en/p 38000324. html • Various Codes of Ethics http: //ethics. iit. edu/codes/ • HIPAA http: //www. hhs. gov/ocr/privacy/