Treating Trauma in Children

Effects of Trauma

Part A

SECTION 1: READ & REVIEW

The Council on Social Work (CSWE) and the NASW Code of Ethics encourages social workers to apply ethical principles to their professional practice. You will read and review both.

The Council on Social Work (CSWE) and the National Association of Social Workers (NASW) Code of Ethics are similar in their goals for the social work profession. The CSWE focuses on the competencies a social worker must possess to perform their duties ethically and professionally. At the same time, the NASW Code of Ethics pushes for ethical principles in the performance of social work. They both encourage social workers to use ethical principles and have similar codes and competencies. The goal is to guide the social worker in professional conduct so they can satisfactorily attend to their clients. In the performance of their duties, social workers need guidance to ensure they make decisions and appropriately conduct themselves. Ethics is vital in the social work profession because it guides social workers on how to conduct themselves and handle various clients. The CSWE and the NASW mandate social workers to remain ethical in their client interactions by providing guidelines that should always be observed (National Association of Social Workers, 1996). The NASW offers a set of standards that should guide social workers in their practice. The focus of the CSWE and NASW is to inform the social worker on what is required of them and how they can perform their duties without discrimination, favoritism, or mistreatment of clients. As indicated in the NASW Code of Ethics, a social worker should only offer services they have competency on. Competency is the main focus of the CSWE, where social workers are required to have specific competencies before they can be accredited to offer services to clients.

SECTION 2: RESPONSE QUESTIONS TO COMPLETE

QUESTION 1: NASW Code of Ethics

In 7 sentences describe your current level of familiarity with the NASW Code of Ethics.

The NASW Code of Ethics applies to all social workers and social work students (NASW Code of Ethics, 2017). Their professional functions, work settings, or the populations they serve do not matter, and social workers must always ensure they perform their work following ethical guidelines. The Code of ethics might look stringent, but it is meant to guide the social worker to ensure they attend to their client appropriately. The Code is divided into six primary ethical standards focused on social workers’ moral responsibility to clients, colleagues, in practice settings, as professionals, the social work profession, and the broader society (NASW Code of Ethics, 2017). Social workers can use the Code to guide their decision-making when dealing with diverse clients. Social workers can refer to the NASW Code of Ethics whenever an ethical issue arises to determine how they can handle it or conduct themselves. However, the Code does not offer a set of rules that inform how social workers should act in all situations. Therefore, social workers must rely on logic and apply the Code based on the considered context.

QUESTION 2: Rest’s Model and Ethical Decision-Making Process

a. Reflection on Rest’s Model Component 1: Moral Sensitivity

Moral sensitivity is demonstrated when the author notes that “to infer that her impairment would interfere with her work as a professional social worker could be seen as prejudiced toward persons with a mental illness.” The statement demonstrates moral sensitivity in that the author considers the other person and their needs and rights, not just his need to seem right (Garrigan et al., 2018). The author did not have any right to disclose Mary’s mental illness because they did not have information on her progress in dealing with her illness. Sensitivity is demonstrated when the author indicates they cannot claim that her impairment would interfere with her professional work because they do not have all the information regarding the case. Mary’s need to work as a professional social worker is considered by understanding that her illness cannot interfere with her work performance.

b. Reflection on Rest’s Model Component 2: Moral Judgment

“Social workers should protect the confidentiality of all information obtained during professional service, except for compelling professional reasons. The general expectation that social workers will keep the information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person.” Disclosing the information about Mary would be breaking the privacy and confidentiality code since there was no imminent harm to any client (Zook, 2001). There was no way to argue that there was severe, foreseeable, and imminent harm to a client because the author did not have much information regarding Mary’s illness. The encounter with Mary was brief and involved only admitting her to a mental health facility. Also, she was voluntarily admitted to the facility, demonstrating her willingness to deal with her mental illness.

c. Reflection on Rest’s Model Component 3: Moral Motivation

“The Code is not a clear set of rules. Rather, it gives guidance to social workers. While it is instructive, the Code does not specify what course of action is best in all instances.” (Zook, 2001) In the situation with Mary, there is no clear course of action offered by the NASW Code of Ethics, making it tricky to determine what is right in such a scenario. However, the author notes that it is best to use professional judgement to make an ethical decision in such cases. The ethical intention was to determine the best course of action by analyzing the different codes that can apply to the case. Demonstrating how they fit together and how they conflict with each other demonstrates the difficulty of the situation. Understanding Mary’s situation and knowing she was working towards her mental health illness was an essential guide in determining the best action.

d.: Reflection on Rest’s Model Component 4: Moral Character

“There seemed to be no ideal course of action in this situation. I did not know how to predict what would happen if I talked with Mary. It is conceivable that I would have a colleague who was less than happy with my reminding her of her illness. Confidential information would be divulged if I did intervene by reporting to persons responsible for hiring. I could be identified as practicing discrimination toward persons with a mental illness. If I did not intervene, and she was hired, harm could come to clients.” Here the author shows the various actions they could take and the consequences of the actions. When making an ethical decision, consideration should be given to the different actions that can be taken and their impact. However, when making an ethical decision, we should be prepared to face the consequences and challenges of the decisions. Therefore, the author should pick what feels right and offer justification for their decision. Social workers should ensure the safety of their clients, and the best action would be to intervene, ensuring that Mary offers a response to the hiring team on her mental illness and steps taken to manage the illness. Accommodations can be made to help her cope with her illness as she performs her work.

QUESTION 3: Your Refection on the Scenario

Part 1: Issues

What are the facts?

The author briefly interacted with a client when they worked at Adult Hospital. During the interaction, they admitted Mary, a social worker with an MSW, who had voluntarily brought herself to the facility. Mary had been diagnosed with schizophrenia, undifferentiated type, and had been in and out of psychiatric hospitals for years. A couple of years later, the author was now working at Children Agency, and Mary came for a job interview. The author was not responsible for making employment decisions.

Is there a legal issue?

There is no legal issue in the case because Mary was never referred to the Adult Hospital by a police officer. When Mary was admitted to the facility, it was a voluntary admission with no court documents. Also, Mary has not committed any crime by applying for a job she is qualified to perform. There would only be a legal issue if Mary had committed a crime or broken any law. Being treated for a mental health illness is not breaking the law.

What is the specific law?

Mary did not commit any crime or break the law. The issue presented in the case is a moral issue on the author’s part (Zook, 2001). The information the author has regarding Mary was confidential. The author had briefly attended to Mary a couple of years back, and they met her again when she was being interviewed for a position in the same place the author worked. Applying for a job after being diagnosed or treated for a mental health condition does not mean a law is broken. However, discriminating against people due to their mental health conditions can be illegal.

Is there an ethical issue?

Yes, there is an ethical issue. The ethical issue in question focuses on the capability of Mary to perform her duties without being affected by her mental illness. The author is concerned about her ability to perform her duties based on her past mental health illness. However, the concern faced by the author is how to handle the situation since they have interacted with Mary and are aware of her condition. The author points out that disclosing Mary’s illness would amount to breaking confidentiality, and keeping quiet could result in Mary harming a client.

What is the ethical issue?

The ethical issue faced by the author is whether they should disclose Mary’s past mental illness to their supervisor. Revealing the information might be wrong on the author’s part because they only interacted with Mary for a brief moment. The little information they have about Mary was from a couple of years back, and she might have been healed, or her condition might be in remission. Confidentiality will be broken if they reveal Mary’s admission information to their supervisor. Failure to inform their supervisor could result in Mary mishandling or harming a client due to her condition.

Is there a moral issue?

A moral issue focuses on right and wrong. The author notes that whatever decision they make, there is a right and wrong aspect. Therefore, they are faced with a challenge in that they are wondering what they should do. Whatever decision the author makes, it is correct, and it is still wrong. However, failure to report Mary’s past could be catastrophic, especially when she gets hired. The moral thing to do would be to let Mary disclose the information herself to the supervisor when she is ready.

What is the moral issue? (Respectful treatment, supporting the common good, preserving individuals’ dignity, justice)

Preserving individuals’ dignity is the moral issue of the case. The author is torn between letting their supervisor know about Mary’s past illness and admission to Adult Hospital and letting Mary reveal the information when she is ready (Zook, 2001). When she is prepared, it is vital to let Mary inform the supervisor about her mental health condition. The information the author knows regarding Mary should remain confidential because Mary was never her client, and the author doesn’t know much about her current condition. When the time is right, Mary will reveal her past if and when she decides to.

Part 2: Impacts

Who might be impacted?

The children served by the agency might be affected in case Mary’s illness does not remain in remission. Because Mary will be interacting and dealing with clients, they will be most impacted since she might find it challenging to handle their needs. The agency might be affected, too, because Mary would struggle to attend to her clients. Colleagues who work with Mary will be affected by her illness since they will have to take on the case she manages when she cannot accomplish her tasks. The community served by the agency will be impacted since Mary cannot deliver services to them when she is required to.

How might they be impacted?

A reduced focus will impact the clients’ needs because Mary would be struggling with her mental health needs. If Mary needs to visit her psychiatrist and clients wait to see her, the clients might not get the service they need. The agency is impacted by client complaints or increased missed workdays by Mary. While her sickness might be in remission, the certainty of it staying in remission is unknown. Therefore, the agency will find that clients have not been attended to and might begin to raise complaints.

How serious would the impact be?

While the seriousness of the impact might not be known for sure, we can posit that clients will stay longer in the system considering the agency handles children and foster care for the children. Case initiation and completion will take longer than expected since Mary is not entirely focused on the cases. Other social workers’ workload would increase because they have to take on Mary’s cases, reducing their concentration and focus on the cases. Increased workload reduces a person’s attention span, meaning clients will not receive adequate services.

Part 3: Options

What are your options?

The first option is to reveal Mary’s illness anonymously. Letting the supervisor know about her illness is vital because they can make an informed decision. The negative side of this decision is that we would be revealing confidential information about Mary, and maybe her illness has been cured or well managed. Another option could be to talk with the admitting psychiatrist at the Adult Hospital and find out how Mary progressed with her treatment. Since we have interacted with her in the past and already have privileged information, it would not be difficult for them to share it.

What options did you eliminate based upon your own ethics?

The option of sharing confidential information anonymously was eliminated. The reason has been that we would still be doing an unethical thing by revealing confidential information. There is a high chance that it would be discovered I am the one who shared the information, especially if Mary is still hired and she recalls we have met at the Adult Hospital. Ethically, it is wrong to share confidential information, and it would demonstrate my work ethic to my superiors. People would assume I could do the same with other clients.

What options did the author of the article consider?

The first option was to talk with Mary and find out about her illness (Zook, 2001). However, there is a likelihood she might be unhappy with the talk because of being reminded of her illness. The second option was to inform the supervisor about Mary’s illness. Doing so would disclose confidential information, and that would be ethically wrong. The last option was not intervening and letting Mary be hired. The challenge with this option is that harm could come to clients due to Mary’s illness.

Did the author eliminate or favor any options? If so, what options and what was the rational for eliminating or favoring?

The author did not eliminate or favor any of the options they noted. They seemed to be in a predicament as to what to do since all the options seemed right and wrong. There was no ideal answer, and they could not avoid the situation, which is the nature of ethical decision-making. Pointing out the positive and negative aspects of the option allows the author to determine the best course of action to take. However, in Mary’s case, there was no clear option, and all three seemed suited for the case.

Part 4: Evaluation of Options

Which options do you believe would:

Do the most good and least harm

The option that would be best for the situation is talking to Mary and trying to find out more information about her mental health. The author could approach her in a friendly manner and introduce himself to her reminding her where they had met in the past. With such an approach, Mary would connect with the author since they shared a past, and she could reveal more information regarding her illness. Mary would not feel attacked without questioning her illness, and their work relationship would not be impacted. The key is to take cues from Mary regarding what she wants to talk about regarding her condition.

Treat everyone fairly and with dignity

Talking with Mary is the best option for treating everyone fairly and with dignity. When the author talks to Mary and reminds her about her illness, they would not be disclosing any confidential information to anyone else. Even if Mary takes it the wrong way, the author can know they did not bring up something that s not true, and they did not allow harm to come to clients without trying to assist. Mary’s dignity would remain intact because her past illness has not been disclosed to others in the organization, and it cannot be used to discriminate against her. No ethical rule would be broken, and the author cannot be questioned later for doing any harm.

Maintain the clinical role

The clinical role of a social worker is to treat clients and colleagues professionally when interacting with them. Therefore, the option that maintains a clinical role is talking to Mary. The discussion would let Mary know the author cares for her and is merely looking out for the best interests of the clients and agency. Being an MSW social worker, Mary should understand why you have to talk to her and why you chose that option instead of revealing her confidential information. If she doesn’t, the author can know they tried to do what was right and have to live with the consequences.

Promote the good of the profession

Talking to Mary is still the best way to promote the profession’s good. Going straight to the supervisor demonstrates the author’s lack of care for confidential information. The supervisor might wonder if the author could do the same with other clients. Failure to intervene and harm occurring to clients would be wrong for the agency and the profession. Therefore, there is only one option left: to talk with Mary and air the concerns.

Part 5: Your Strategy

Define your strategy to addressing this situation if you were the author

The strategy for addressing the situation would focus on preserving the dignity of Mary and upholding professional ethics. Looking at the case from that perspective allows the author to determine the best course of action and the consequences of their actions. Having a colleague who is unhappy because they were reminded of the past illness is something the author can live with, and it could remind Mary that she needs to ensure she takes care of her mental health. The author should understand that there is never a good ethical decision, and no matter the option they select, they will have to live with the decision. Ethical decisions are never easy, forcing the author to weigh all options before concluding what they will do.

Part 6: Greatest Struggles

Define your greatest struggles with the case:

The greatest struggle was trying to come up with a decision that would be suitable for all involved. However, realizing no option could make everyone happy makes the decision difficult. Attempting to make sense of the available options and mapping them to the NASW Code of Ethics presented an even more significant challenge. I realized that the Code offers a guideline, and, in some cases, one is required to use professional judgement. While the options seemed viable, selecting the best one comes to choosing the one that will have the least harm to the profession and clients.

Part 7: Managing Self

How well did you manage if a clear right or wrong could not be identified?

It was not easy managing the case when no clear right or wrong was identified. The options have to be considered based on the expected outcomes and consequences. From there, one can determine what works best and what they can live with. Making a proper analysis allows one to choose the lesser of two evils. The analysis gives the possible outcomes and ensures all possible scenarios are determined before making a decision. Sadly, the social worker has to stick to their decision no matter the consequences.