January/February 2016 Issue

Eye On Ethics: To Post or Not to Post — Ethical Challenges in a Digital World
By Frederic G. Reamer, PhD
Social Work Today
Vol. 16 No. 1 P. 10

Harris N. was a clinical social worker at a substance abuse treatment program that served adults. Mr. N., who was in recovery himself, specialized in the treatment of individuals with trauma histories who struggled with serious mental health challenges as well as addiction.

In his personal life, Mr. N. was actively involved in his church and many local faith-based activities, including a large online community that offers spiritual guidance, prayer, and support for people in recovery. He believed strongly that for many clients, faith can enhance their ability to cope with addiction and mental illness.

One of Mr. N.'s clients, Jack S., was diagnosed with a serious form of cancer. The client's medical prognosis was poor. Mr. N., who believed in the healing power of prayer, posted a request to his online faith-based community: "One of my long-term clients has been diagnosed with brain cancer. His doctors are not optimistic. I have known Jack for many years. He's a fighter. Jack is a Vietnam War vet and has struggled with addictions since his time in the service. He has already survived a battle with liver disease and hepatitis. With your help, I think Jack can make it. Please pray for him."

One of Mr. N.'s colleagues at the substance abuse treatment program was a member of the online faith-based community to which Mr. N. belonged. The colleague read Mr. N.'s online post and was very concerned that Mr. N. may have breached Jack's privacy. The colleague was distressed about the number of personal details about Jack's life (including his military service in Vietnam, addiction history, and very specific health-related details) that might enable a reader to identify him.

The colleague printed out the posting and shared it with the agency's clinical supervisor for her opinion. The clinical supervisor, also a social worker, was deeply concerned about Mr. N.'s judgment. In the supervisor's opinion, Mr. N.'s online comments and prayer request were unprofessional and violated standards in the NASW Code of Ethics. In particular, the supervisor believed Mr. N.'s online posting violated standards pertaining to clients' right to privacy (standard 1.07[a]) and a social workers' duty to maintain clear boundaries between their private conduct and professional responsibilities (standard 4.03).

The supervisor was also concerned that Mr. N.'s online posting may have violated state law pertaining to clients' privacy and confidentiality rights and strict provisions in the U.S. Code of Federal Regulations concerning practitioners' duty to protect confidential information pertaining to substance abuse treatment (42 CFR Part 2, "Confidentiality of Alcohol and Drug Abuse Patient Records").

Mr. N.'s supervisor consulted with the agency director. Together they decided that Mr. N. must be suspended from his job for two months, during which he needed to obtain additional training in ethical standards related to client privacy and confidentiality and professional boundaries. When the supervisor and agency administrator spoke with Mr. N., Mr. N. was very remorseful and acknowledged his lapse in judgment. Mr. N., who was otherwise considered a valuable and skilled employee, was devastated.

In this digital world social workers now have many opportunities to exercise judgment about their online conduct. Most contemporary social workers concluded their formal social work education before the advent of Facebook, Google, Bing, LinkedIn, Twitter, Skype, Instagram, Snapchat, and other digital applications. Now, of course, this technology is pervasive in both professionals' and clients' lives, thus requiring social workers to be mindful of a wide range of novel ethical challenges.

Emerging Ethical Risks
Ethical risks in our digital world occur in three principal ways. First, social workers may be naïve about the risks associated with online and other postings using digital technology. They may be using sophisticated digital technology but may not fully understand how encryption works, technological features, or the possibility of privacy and confidentiality breaches. These social workers may post comments online without realizing who may have access to them or may be careless about including identifying information that compromises clients' privacy.

In contrast, social workers sometimes face circumstances that require careful ethical decisions about online postings and other digital communications. These practitioners may be fully aware of the risks and unlikely to make naïve mistakes, but still must make thoughtful and calculated judgments about their digital behavior. Increasing numbers of social workers are providing online and digital services to clients and professionally relevant information to the general public. What practitioners refer to as e-mail therapy, text therapy, avatar therapy, video counseling, online psychoeducation and assessment, and other services using sophisticated online technology and smartphone apps are proliferating, with mixed reviews regarding their effectiveness and adherence to widely embraced ethical standards. Proponents argue that these technologically-based options expand social work's reach, particularly to people who may be reluctant to obtain traditional social work services or meet with practitioners in their offices, live in remote locations, or are so disabled that traveling to a social worker's office would be difficult. Critics claim that so-called distance services severely compromise the quality of social work and dilute the meaning and impact of relationship that is an essential element of meaningful social worker-client connections.

Recognizing the complexity of this debate, it is nonetheless clear that social workers' use of online and other digital technology to provide constructive services is here to stay. Thus, it is incumbent upon social workers to be thoroughly familiar with their duty to respect client privacy and confidentiality and the steps they need to take to ensure compliance with the profession's ethical standards. This includes exercising sound judgment about encryption, the content of online postings and other digital communications with and about clients, and informing clients about the potential benefits and risks of online postings and digital communications.

Sadly, in addition to potential ethical mistakes and the need for careful judgment about whether and how to use online and digital technology for professional purposes, a relatively small number of social workers have used this technology to engage in gross misconduct. In recent years, I have consulted on several disturbing cases in which seasoned social workers were convicted in criminal court as a result of their online conduct that involved inappropriate intimate relationships with current clients. Clearly the technology that has the impressive potential to enhance social workers' ability to assist vulnerable people also has a dark side.

In a number of key respects, today's social work is a far cry from the profession for which many of us signed up. Many of us could not have imagined that today's online and digital tools would ever exist. But here they are. Our duty is to recognize and reflect on the complex and unprecedented ethical challenges that accompany them.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He's the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.