Jan./Feb. 2007

Conducting an Ethics Audit
By Frederic G. Reamer, PhD
Social Work Today
Vol. 7 No. 1

In recent years, social workers have become more aware of ethical challenges and risks. Contemporary practitioners are familiar with a wide range of ethical issues related to client confidentiality and privacy, informed consent, self-determination, conflicts of interest, dual relationships, termination of services, and impaired professionals. Social work education, continuing education, and staff development now routinely include discussions of ethical dilemmas and ethics risk management.

Ethical standards in social work have matured. The profession has moved from relatively brief and simplistic ethical standards to more comprehensive and detailed guides. As a result, social workers are now expected to adhere to ambitious ethical standards set forth in pertinent codes of ethics, licensing, and other statutes and regulations. In light of these increasing demands, social workers should thoroughly examine their ethics-related practices, policies, and procedures to ensure compliance with prevailing standards.

One way to assess the adequacy of one’s ethics-related practices, policies, and procedures is to conduct an ethics audit. An ethics audit should focus on what is currently considered to be essential or core ethical issues in social work. Social work’s literature suggests two key knowledge areas that should form the foundation of the audit: (1) ethics-related risks in practice settings, based on empirical trend data gathered from actual ethics complaints (filed with state licensing boards and professional organizations, such as the National Association of Social Workers [NASW]), lawsuits filed against social workers that allege ethics-related negligence, and ethics committee and court findings and dispositions; and (2) current agency policies and procedures for handling ethical issues, dilemmas, and decisions. Based on these sources, social workers should audit their ethics-related policies, practices, and procedures related to a number of key risks: client rights; confidentiality and privacy; informed consent; service delivery; boundary issues and dual relationships; conflicts of interest; documentation; defamation of character; client records; supervision; staff development and training; consultation; client referral; fraud; termination of services and client abandonment; practitioner impairment; evaluation and research; and ethical decision making.*

Purpose of an Ethics Audit
The primary purpose of an ethics audit is to provide social workers with a practical way to:

• Identify pertinent ethical issues in their practice settings. What specific ethical risks do social workers face? Are there ethical issues that arise in the work that are unique to the client population, treatment approach, setting, program design, or staffing pattern?

• Review and assess the adequacy of their current practices. Has the practice setting addressed compelling ethical issues? How adequate are the current practices, policies, and procedures? What issues need to be addressed?

• Design a practical strategy to modify current practices as needed. What steps does the agency or practice need to take to protect clients, prevent disgruntled parties from filing ethics complaints with state licensing boards and professional organizations, and prevent ethics-related lawsuits? Who in the practice or agency should work to address these issues? What resources will they need? What timetable should they follow?

• Monitor the implementation of this quality assurance strategy. How can practitioners ensure that the implementation plan has been implemented effectively? What indicators can staff members use to assess the extent to which the audit goals have been met?

Steps in an Ethics Audit
Conducting an ethics audit involves several key steps:

1. In agency settings, a staff member should assume the role of chair of the ethics audit committee. Members should be appointed to the committee based on their demonstrated interest in the agency’s ethics-related policies, practices, and procedures. Ideally, the chair would have obtained formal education or training related to professional ethics. Independent practitioners may want to consult with knowledgeable colleagues or a peer consultation group.

2. The audit committee should identify specific ethics-related issues on which to focus. In some settings, the committee may decide to conduct a comprehensive ethics audit. In other agencies, the committee may focus on specific ethical issues that are especially important in those settings.

3. The ethics audit committee should decide what kind of information it will need to conduct the audit. Data may be gathered from documents (eg, informed consent forms, confidentiality guidelines, client rights statements) and interviews conducted with agency staff that address specific ethical issues. The committee should also review relevant codes of ethics and federal and state statutes and regulations.

4. Once the necessary data are gathered and reviewed, the audit committee should assess the risk level associated with each issue. Each issue should be assessed with respect to relevant agency policies and the procedures staffers follow. Policies may be codified in formal agency documents or memoranda. Procedures entail social workers’ actual handling of ethical issues in their relationships with clients, colleagues, and third parties. Each topic should be assigned one of four risk categories: no risk (current practices are acceptable); minimal risk (current practices are reasonably adequate; minor modifications would be useful); moderate risk (current practices are problematic; modifications are necessary to minimize risk); and high risk (current practices are seriously flawed; significant modifications are necessary to minimize risk).

5. Once an ethics audit has been completed, social workers need to take steps to make use of its findings. Social workers should develop an action plan for each risk area that warrants attention, beginning with high-risk issues, then moving on to moderate- and minimal-risk issues. The action plans should spell out specific measures that need to be taken to address the identified problem areas. Examples include updating confidentiality policies to reflect current laws and code of ethics standards, revising informed consent procedures and forms, and developing dual-relationship and conflict-of-interest guidelines.

6. The committee should identify which staff will be responsible for the various tasks and establish a timetable for completion of each and a mechanism to follow up on each task to ensure its completion and monitor its implementation.

7. The committee should document the complete audit process to demonstrate its good-faith effort to assess ethics-related policies and procedures. This documentation may be helpful in the event that someone raises questions about the adequacy of the agency’s ethics-related practices.

The maturation of ethical standards in social work has accelerated the need for social workers to examine more closely the ethical dimensions of their practice. The social work ethics audit is a process designed to help social workers assess ethical issues systematically and comprehensively. The concept of an ethics audit is consistent with social work’s enduring efforts to protect clients and others from harm. Such systematic attempts to highlight, address, and monitor the ethical dimensions of social work practice will, in the final analysis, strengthen the profession’s integrity.

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

* For a more detailed discussion of ethics audits in social work, see The Social Work Ethics Audit: A Risk Management Tool by Reamer, available through NASW Press.