Ethical Decision-Making and Child Welfare Practice in Social Work

Ethical Decision-Making in Clinical Practice

The first step in ethical decision-making is identifying the ethical issue present in the clinical situation. It is important to determine whether a moral issue exists before making any decision. Based on the identified ethical issues, one can then proceed with decision-making while ensuring no ethical codes are violated. The next step involves identifying the individuals, groups, and organizations affected by the moral decision. Determining who is impacted ensures the social worker understands how decisions affect each party. The third step is identifying possible courses of action along with the potential benefits and risks of each. For every action considered, the social worker must assess its impact on the client and whether it helps or poses risks.

Before implementing a decision, the social worker should consider relevant ethical theories, codes of ethics, and social work practice principles. If the worker determines they cannot arrive at a clearly ethical decision alone, they should consult with colleagues. The following step is making and documenting the decision, including how it was reached. Documentation allows the worker to reference their reasoning later or share it with others should questions arise. Finally, the decision should be monitored and evaluated to ensure follow-up occurs and that no negative consequences emerge.

The situation resolved satisfactorily. The ethical dilemma centered on whether to use information indirectly acquired about a client's drug use without direct evidence to support a report. Another social worker had shared details about a client — changing the name and identifying information — but enough similarities existed that the worker suspected the client in question was their own. Reporting the client would have resulted in her children being separated from their mother and the family being broken apart. The agency supported the worker by outlining the consequences of reporting the mother's drug use versus helping her stop. Informing the client that the worker was aware of her drug use prompted a change in behavior, and mandating occasional drug tests proved effective. For further context on navigating such dilemmas, see the National Association of Social Workers code of ethics guidelines.

Competency-Based Assessment: Report Content and Information Sources

When completing a competency-based assessment report, the practitioner should include information such as the diagnosis made, the onset of the condition, the presenting symptoms and behaviors, and the likely differential diagnosis (Gray & Zide, 2016). The diagnosis should align with the DSM-5 criteria for the particular symptoms and behaviors presented by the client. Using the DSM-5 ensures there is credible, standardized evidence to support the diagnosis and allows readers to reference the manual directly. Everyone reading the report must understand that the diagnosis is grounded in the presenting symptoms. Since the client faces legal charges, the practitioner should also demonstrate how the diagnosis may impair the client — causing them to act in ways they are unaware of or cannot control. The timeframe for the onset of the condition is vital in determining whether an intellectual developmental disorder is present. According to Gray and Zide (2016), including the timeframe demonstrates when the disorder began; the practitioner would indicate childhood-onset if the disorder started before the client was ten years old, or adolescent-onset if symptoms appeared after that age.

The goal is to establish when the symptoms first presented and whether they emerged during the developmental period. Intellectual developmental disorders are understood to occur during this period; therefore, documenting the onset assists in demonstrating whether the client's development was impaired.

The symptoms or behaviors presented by the client are also important because they illustrate how a person with the disorder typically behaves. In a legal context, these behaviors could be used to show that the client acted — or broke the law — because of the disorder, without awareness that they were doing something wrong. The diagnostic symptoms can be compared to those exhibited by the client to determine whether they are consistent. The report will also include information about how a person with the disorder would behave and interact with others. The differential diagnosis section offers information on other disorders that could be confused with the primary diagnosis. The report presents data to show why the differential diagnosis does not apply, for example because the client lacks one symptom required by the DSM-5 for that alternative diagnosis. Clearly including the differential diagnosis gives readers the information needed to support the primary diagnosis and prevents diagnostic confusion.

Supplemental sources of information would include parents, caregivers, teachers, police officers, and the client. A comprehensive assessment cannot rely on a single source. Parents can provide information about when they first noticed negative behaviors and about the child's upbringing, helping to determine whether anything may have impaired mental development. If the client was in foster care, caregivers from the formative years should be interviewed for any information relevant to the diagnosis. Teachers can provide insight into the client's behavior at school and how they interact with peers, which helps establish when the disorder may have begun. Police officers can describe the crime committed and the client's behavior at the time, which assists in determining whether those behaviors are consistent with the suspected intellectual developmental disorder. The client's diagnosis might be correct even if the crime they committed is not directly related to the disorder — this distinction must be carefully analyzed in the assessment report.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). American Psychiatric Association.

Burke, J. D., & Romano-Verthelyi, A. M. (2018). Oppositional defiant disorder. In Developmental Pathways to Disruptive, Impulse-Control and Conduct Disorders (pp. 21–52). Elsevier. https://doi.org/10.1016/B978-0-12-811323-3.00002-X

Eskander, N. (2020). The psychosocial outcome of conduct and oppositional defiant disorder in children with attention deficit hyperactivity disorder. Cureus, 12(8). https://doi.org/10.7759/cureus.9521

Gray, S. W., & Zide, M. R. (2016). Empowerment series: Psychopathology: A competency-based assessment model for social workers (4th ed.). Cengage Learning.

LAW, P. (1980). Adoption Assistance and Child Welfare Act of 1980. Public Law, 96, 272.

Palacios, J., Adroher, S., Brodzinsky, D. M., Grotevant, H. D., Johnson, D. E., Juffer, F., Martínez-Mora, L., Muhamedrahimov, R. J., Selwyn, J., & Simmonds, J. (2019). Adoption in the service of child protection: An international interdisciplinary perspective. Psychology, Public Policy, and Law, 25(2), 57. https://doi.org/10.1037/law0000192