Authored by Stephanie Hicks Pass*,
Abstract
Novice chemical dependency workers often find themselves facing ethical issues with little formal supervision available to them. They have to rely on their prior training, their professional Code of Ethics and their practice knowledge, however, novice helpers often do not have enough practice knowledge to feel comfortable in their skills. This novel framework is a tool designed for newly graduated professionals to add to their arsenal in toolkit to utilize in resolving ethical issues in the practice arena.
Keywords:Ethics; Ethical dilemmas; Ethical frameworks; Value conflicts
Introduction
Working in chemical dependency treatment is a challenging yet rewarding profession. We do recognize, however, that there are some unique characteristics involved in working with the chemical dependency population that makes the work especially challenging for inexperienced workers or workers who have transitioned from other fields. Sometimes clinicians find themselves involved in ethical quandaries with little guidance on how to handle these issues from their supervisors. Oftentimes, in many settings they may be the only mental health (social worker or counselor or chemical dependency counselor) on the unit surrounded by medical workers. Chemical dependency treatment is often a team effort of nursing staff, technicians, medical doctors and chemical dependency counselors. These chemical dependency counselors also come from a variety of fields themselves, social work, counseling, pastoral counseling, marriage and family therapy and licensed chemical dependency counselors. At master’s level education, the Occupation handbook states that of the social work profession 116,780 of them specialize in chemical dependency treatment, it goes further to state there are 319,400 bachelors level chemical dependency counselors in the US in 2019 and that the field is growing employment area [1]. This is an exciting and marketable field of employment for social workers at all levels.
However, while working in a team environment brings a unique set of challenges as well. Sometimes, the chemical dependency clinician is working solitarily alongside medical workers. Medical workers, such as nurses or technicians and doctors often operate under differing sets of goals and codes of ethics, thus, when the ethical dilemmas arise, the social worker is sometimes left to resolve it alone. It is in this environment the social worker is expected to offer support to the client, offer insight to client and client’s family, locate resources, advocate inside and outside the agency. The social worker is expected to function within the constraints of the client’s financial limitations, insurance limitations, agency limitations and client’s personal desires, while operating under the highest level of professional integrity possible.
But, how do social workers make these ethical decisions? Do they rely exclusively on the professional Code of Ethics? On personal judgment? On agency policy? On a framework given to them during their school years? Or a blend of all of these? While there has been research exploring ethical resolutions, only a handful of researchers has looked at how social workers actually come to their solutions. Holland TP [1], explored how social workers came to decisions when faced with dilemmas and they found that social workers tended to focus on three main bipolar dimensions: “ the focus of decisions, ranging from emphasis on goals or ends to emphasis on means or principles; the interpersonal orientation, ranging from independence and autonomy to mutuality and community; and the locus of authority, ranging from internalized to externalized. “and further, many of the social workers reported feelings of loneliness or isolation in their internal struggles with ethical issues. Even more concerning, few self-reported relying on the professional Code of Ethics, relying rather on their own decision making processes. This is where simple ethical making frameworks can be of assistance and vital for novice social workers entering the field.
The following novel framework has been created to assist inexperienced or newly graduated clinical workers (or perhaps experienced ones as well) in resolving ethical quandaries. It is designed to be utilized when there are no reliable supervisors to turn to at the moment, or when there is no time to go searching for supervision. It is designed to be ingrained into the thought processes so the clinician can just automatically go down the checklist and resolve the problem independently when necessary.
To best utilize this framework, let’s explore the kinds of ethical issues that clinicians may find themselves encountering most frequently. For Licensed Professional counselors a 28 states survey of state licensing boards found that the most commonly reported offenses include: failure to maintain continuing education units, dual relationships and unprofessional conduct, with the runners up including professional misrepresentation and non-counseling related crimes [2]. For social workers, the most commonly reported offenses include boundary violations (sexual relations with clients), dual relationships and poor practice [3]. It is fairly obvious that most of these offenses could have been avoided with proper usage of ethical framework and good decision making skills.
So, let’s take a look at the framework.
Table 1:
The actual framework is fairly simple, purposely. It is meant to be easy to remember and ingrain into a novice social worker thought process. But, to really learn the process of utilizing the framework, let’s explore it further. We will break each section down piece by piece.
Steps for Resolving Value Conflicts and Ethical Dilemmas Expanded
Step 1: Identify the issue and your own personal feelings about the issue: What is the conflict you are experiencing on a personal level? Identify what your thoughts are first on the issue. Then, put that aside for a moment, because, quite honestly, this is not about you. You need to meet the client where they are at, so let’s focus on them.
Step 2: Identify who exactly is the client/s? Is the client the family, an individual in the family, the agency, a community? You need to know clearly who the client is to identify the steps of action to take to assist them.
Step 3: Think about what exactly you, as a helper, owe the client: To do this you must first identify what is your role in your agency, in your profession and in your personal set of values. What does your role allow you to do in the professional setting? What can you legally do? What do you morally feel is the correct thing to do? What does your profession call for you to think about?
Step 4: Identify what is the actual conflict? Identify exactly what the conflict is to begin with. Is it a problem with agency policy not meeting client need? Is it client need overstepping a personal boundary? Is it a legal issue? Is the conflict within your own set of values, the agency policy the agency culture, the law, or with the profession itself?
Step 5: Identify resolution options: What are the various options you can consider? What are the potential outcomes? Who could possibly be harmed or who can benefit? What steps do you need to take to mitigate harm? Are the options just and fair? Would you take the same measures for other clients as you are doing for this one? Or are you showing favoritism?
Lastly, here are some last minute questions before closing the case.
At the end of this what are your CURRENT personal feelings about the issue?
Have they changed any?
(Now, again, ignore those feelings and focus on the client needs.)
Remember, who is the client and what is your professional role?
What does your role allow you to actually do?
Now, are you are ready to move forward with a solution? Why or why not?
In utilizing this framework to resolve ethical dilemmas such as conflicts of interest or dual relationships, one can avoid the potential misconduct allegations and investigations with potentially career ending consequences. This framework guides the clinician in how to identify the actual problem, identify who is the actual client and what the clinicians responsibility is to the client, and it further explores the clinicians own personal feelings and values on the issue while it guides them on how to focus on the client and their responsibility to the client.
Conclusion
By getting back to the basics in this framework, and allowing the social work, or other chemical dependency clinician, to focus on the basics of the “who, what, when, where and how” of their work they can begin resolving the ethical conflict more clearly and independently when necessary. While this framework is designed for the novice social worker, it can be utilized by other social service helper to resolve ethical dilemmas in the any practice environment. It is the hope of this author that this simple framework will be utilized by novice helpers in other settings to avoid ethical dilemmas. This simply designed set of steps that can be applied in a variety of situations that remind us, as professionals, to remain professional in our decision making at all times and keep our personal values out of the equation.
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