May/June 2008

The Challenge of Electronic Communication
By Frederic G. Reamer, PhD
Social Work Today
Vol. 8 No. 3

When social work began as a profession in the late 19th century, the telephone was a relatively new invention. Only a handful of years before social work’s formal inauguration, Alexander Graham Bell placed the first telephone call to Thomas Watson. Social work’s earliest practitioners grew to depend on the telephone, then the only electronic tool available to them, as a vital part of their efforts to plan and deliver services to clients.

During those early years, what social worker could have possibly forecast the range of electronic tools that are now considered essential in contemporary social work practice? Social workers in hospitals, substance abuse treatment programs, private practices, nursing homes, hospice programs, community mental health centers, schools, correctional facilities, and a wide range of other settings regularly depend on electronics to carry out their professional duties. Social work clinicians, case managers, supervisors, community organizers, agency administrators, policy analysts, researchers, and educators can hardly imagine professional life without cell phones, fax machines, e-mail, and the Internet.

Clinicians routinely fax documents to colleagues in other agencies to coordinate services for clients and plan their discharge from programs. Social workers in home-based service programs would find it hard to live without cell phones to help them keep in touch with their agencies and clients. Social work administrators would be hamstrung if they had to function without e-mail and electronic spreadsheets. The work of case managers and crisis information specialists would be stymied if they did not have access to up-to-date, Web-based information about community resources.

Virtually no social worker would want to return to the electronically primitive days of the late 19th century despite widespread laments about how oversaturated and overwhelmed contemporary practitioners are by electronic communications. Most social workers have come to accept the trade-offs involved in their dependence on electronic tools, recognizing that, despite the drawbacks, they enhance and facilitate the delivery of services.

Novel Ethical Challenges
Among the chronic challenges involved in the use of electronic communications in social work are daunting ethical issues, such as the following:

• Althea was a social worker in private practice in a small, rural community. Her client needed to be admitted to a psychiatric hospital. Althea faxed a summary of the client’s clinical profile to the hospital admissions department of the hospital—or so she thought. Unfortunately, Althea misdialed the last digit of the hospital’s fax number. The sensitive document, which included details about the client’s psychiatric diagnoses and substance abuse history, was faxed inadvertently to a local car repair shop’s fax machine, which had a similar phone number. A mechanic at the shop retrieved Althea’s fax. The mechanic was the client’s former brother-in-law, and the client and the mechanic’s sister were divorced and in the midst of a bitter child custody dispute. The mechanic shared the sensitive document with his sister.

• Danielle was employed as a supervisor by a family service agency that provided home-based intervention for families in crisis. Danielle occasionally used e-mail to consult with colleagues about her cases. On one occasion, Danielle included identifying information and sensitive details about one of her clients in her response to an e-mail message she received from a colleague. Danielle inadvertently clicked on “reply to all” when she responded to the message, sending her message to several people who should not have had access to those confidential details.

• Lawrence was a clinical social worker who developed a Web site to promote his counseling services. Lawrence provided Internet-based counseling to clients who lived hundreds of miles away. He did not meet most of his clients in person. One of Lawrence’s clients sent him several troubling e-mail messages consistent with suicidal ideation and gesturing. Lawrence did not have information about emergency contacts in the client’s home community.

Evolving Ethical Standards
As electronic tools in social work practice have proliferated, the profession has had to create ethical guidelines to keep pace with these developments. These guidelines are designed to do the following:

• Avoid ethical mistakes. Social workers need to take careful steps to, for example, avoid faxing documents or e-mailing sensitive information to the wrong destination. They also need to protect clients’ privacy when using cell phones in public settings and audiotaping clients during clinical sessions.

• Prevent ethical misconduct. Social workers must use electronic tools responsibly. They should not promote electronic services that endanger clients (such as Internet-based counseling that does not include adequate clinical protections and safeguards) or compromise clients’ privacy for social workers’ self-serving purposes (for example, using e-mail or cell phone text messages to cultivate an inappropriate personal relationship with a client).

• Enhance social workers’ management of ethical dilemmas involving electronic communications. Examples include social workers’ decisions about whether to give at-risk clients their personal cell phone numbers for use in an emergency, whether to engage in clinically relevant e-mail communications with a client who will be traveling abroad for an extended period of time, and how to protect clients’ privacy when videotaping them for educational or training purposes.

Unlike its predecessors, the current National Association of Social Workers Code of Ethics includes explicit ethical standards to help social workers avoid ethical mistakes, prevent misconduct, and manage ethical dilemmas involving electronic communication:

• Social workers who provide services via electronic media (such as computer, telephone, radio, and television) should inform recipients of the limitations and risks associated with such services. (standard 1.03[e])

• Social workers should obtain clients’ informed consent before audiotaping or videotaping clients or permitting observation of services to clients by a third party. (standard 1.03[f])

• Social workers should protect the confidentiality of clients’ ... electronic records and other sensitive information. Social workers should take reasonable steps to ensure that clients’ records are stored in a secure location and that clients’ records are not available to others who are not authorized to have access. (standard 1.07 [l])

• Social workers should take precautions to ensure and maintain the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology. Disclosure of identifying information should be avoided whenever possible. (standard 1.07[m])

Social work practice has changed dramatically since its earliest days. Among the most remarkable changes are those involving the development and proliferation of electronic tools. Fortunately, the profession’s ethical standards have evolved to help practitioners manage these challenges.

— 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.