Eye on Ethics

Ethical Challenges and Coronavirus
By Frederic G. Reamer, PhD
March 2020

Decades from now, social workers are likely to recall 2020 as the year their lives were transformed by COVID-19, aka coronavirus. With little notice, legions of social workers suddenly found themselves facing unprecedented roadblocks in their effort to serve their clients. In-person meetings were cancelled. Both clients and social workers scrambled to fashion new ways of connecting remotely. Within minutes of declarations of a public health emergency, I began receiving frantic telephone calls, e-mails, and text messages from social workers throughout the United States who sought clarification about the rules: Am I allowed to use my personal smartphone to talk with clients? How about using FaceTime, Google Hangouts, Google Voice, Zoom, GoToMeeting, Facebook Messenger, Skype, and WhatsApp? What’s HIPAA-compliant and what’s not? Are the major insurance companies authorizing social workers to use these digital tools? Can I serve clients who live in other states where I’m not licensed? These are reasonable and understandable questions, of course.

Ethics Challenges in the Digital World
Well-informed social workers know that the relatively recent revision of the NASW Code of Ethics (effective January 1, 2018) added new standards obligating practitioners to use state-of-the art, encrypted technology when serving clients, in order to protect clients’ privacy and confidentiality. According to the code’s new standards, “Social workers should take reasonable steps to protect the confidentiality of electronic communications, including information provided to clients or third parties. Social workers should use applicable safeguards (such as encryption, firewalls, and passwords) when using electronic communications such as e-mail, online posts, online chat sessions, mobile communication, and text messages” (standard 1.07[m]). Further, the new, comprehensive Technology Standards in Social Work Practice adopted jointly by NASW, the Association of Social Work Boards, the Council on Social Work Education (CSWE), and the Clinical Social Work Association includes similar explicit guidance.

Before March 17, 2020, social workers whose services are governed by HIPAA were required to use software and digital platforms that meet very strict regulations issued under HIPAA, as amended by the Health Information Technology for Economic and Clinical Health, or HITECH, Act, to protect the privacy and security of protected health information. Many of the popular digital applications that allow for video chat and text message exchanges do not meet these strict standards. To comply with federal law, social workers have had to subscribe to one or more HIPAA-compliant software platforms and smartphone applications.

COVID-19 changed all that, at least for now. On March 17, 2020, the federal Office for Civil Rights (OCR)—the agency responsible for enforcing HIPAA compliance—issued a notice that was music to the ears of many social workers who have been concerned about meeting the needs of their clients. The official message to health and behavioral health professionals from the OCR director was clear: “We are empowering medical providers to serve patients wherever they are during this national public health emergency. We are especially concerned about reaching those most at risk, including older persons and persons with disabilities.” According to the official OCR notice, “OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” This new federal policy is entirely consistent with the mandate in the NASW Code of Ethics: “Social workers should provide appropriate professional services in public emergencies to the greatest extent possible” (standard 6.03).

The daunting coronavirus has taught social workers yet another valuable lesson about professional ethics. While some ethical standards are carved in stone (e.g., do not engage in a sexual relationship with a client; do not falsify clinical notes or billing records), others evolve over time. When the task force that I chaired drafted the 1996 NASW Code of Ethics, we never imagined a need for standards governing social workers’ use of smartphone or internet technology that would enable them to serve clients they never meet in person and who live in other states or nations. At that time, this technology did not exist; now it does. Add to that the unique challenges associated with an international pandemic and we have a sudden, unanticipated need to develop new ethical norms and guidelines.

The Role of Social Work Advocacy
One of social work’s principal virtues is that it is the one human service profession whose code of ethics highlights explicitly practitioners’ moral duty to address pertinent social policy and social justice issues, in addition to addressing ethical issues associated with the delivery of services to individual clients. According to the NASW Code of Ethics, “Social workers should engage in social and political action that seeks to ensure that all people have equal access to the resources, employment, services, and opportunities they require to meet their basic human needs and to develop fully. Social workers should be aware of the impact of the political arena on practice and should advocate for changes in policy and legislation to improve social conditions in order to meet basic human needs and promote social justice” (standard 6.04[a]).

All social workers were introduced to policy practice and advocacy concepts and skills during their professional education. Following CSWE accreditation standards, typical curricula teach students how to use critical thinking skills to analyze, develop, implement, and evaluate social policies. Key elements, with particular application to COVID-19, include the following:

• Conduct a needs assessment. Using research skills, gather data on the nature and extent of local needs. Which individuals, groups, neighborhoods, and regions are most likely to be affected by COVID-19? What are the most pressing challenges, for example, related to health and behavioral health services, housing assistance, employment assistance, food, and day care?

• Determine what barriers may prevent people from accessing needed benefits and services. These may include meeting eligibility criteria; accessing federal, state, and local funds; overcoming language barriers; and addressing disabilities that limit people’s access to services.

• Analyze the strengths and limitations of existing and proposed policies, including administrative and legislative policies. How might policies designed to address COVID-19 be helpful or harmful? To what extent do they align with social work values? How might the policies be improved?

• Engage in advocacy to support policy initiatives. Typical advocacy includes reviewing pending legislation and contacting key administrators and legislators. Examples include the following:

- Review bills that have been introduced in Congress (House and Senate) and your state legislature that address emergency funding during the coronavirus crisis. These bills may address allocation of funds for testing, paid sick leave, housing assistance (mortgage and rent assistance), and unemployment benefits, among other issues.

- Share your opinions on these bills with your Congressional and local representatives. Their contact information is available online.

- Contact your local NASW chapter and other local or national organizations to find out what advocacy efforts may be available related to COVID-19. Participate, if you are able.

- Consult the NASW website, which includes updated information on social work’s role during the coronavirus crisis, including advocacy opportunities.

• Evaluate the impact of policies. What data can be collected to assess the impact of policies once they are implemented? How might these data be used to modify policies, as needed?

This is not the first time social workers have been called into action during a widespread crisis. Social workers, and the social work profession, have played a pivotal role during world wars, the Great Depression, the HIV/AIDS crisis, Hurricane Katrina, and many other national and local emergencies. Our profession is uniquely positioned to address both the individual needs of vulnerable people and the public policy issues that surround these crises. That is what social work is all about. The daunting COVID-19 crisis is yet another in a series of significant challenges. Our venerable ethical standards help guide the way.

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