Eye on Ethics

Developing a Social Media Ethics Policy
By Frederic G. Reamer, PhD
July 1, 2011

Raise your hand if you are a clinical social worker who does not have a Facebook profile, has never exchanged e-mail or text messages with a client, and has never used a Web-based search engine such as Google to seek information about a client.

Two years ago when I posed this question to social work audiences, many hands went up. Now very few social workers raise their hand. In what seems like the blink of an eye, the social work profession has moved from paper and verbal communication with clients to all manner of electronic communications. Today’s clients may send social workers e-mail or text messages to change appointment times or plea for help with a sudden crisis. Social workers may use Google or another search engine to perform an informal background check on a new client. Clients may send social workers electronic messages asking to be a Facebook friend.

Ethical Challenges
In addition to the complex clinical ramifications of social workers’ decisions about interacting with clients electronically, these novel forms of communication are fraught with ethical challenges. Clients who discover that their social worker conducted a Google search on them may feel overexposed and that their privacy has been invaded. Social workers who interact with clients via Facebook may unwittingly violate ethical standards concerning boundaries and dual relationships. Practitioners who exchange clinically relevant e-mail messages with clients may have difficulty protecting clients’ confidentiality.

Ethical challenges created by new technology in the human services are not new. In the 1970s, when the contemporary bioethics and professional ethics fields emerged, practitioners and scholars wrestled with a wide range of ethical dilemmas that were a direct result of new technology, especially in healthcare.

For instance, the technology that enabled surgeons to transplant organs brought with it complex ethical issues. When only one heart or kidney was available on any given day or night, healthcare professionals had to make extraordinarily difficult moral judgments about who ought to receive the organ. When ventilator technology in healthcare was revolutionized in the 1970s, healthcare professionals suddenly needed to make difficult ethical decisions about end-of-life care and termination of life support. The advent of revolutionary genetic engineering technology decades ago triggered complicated moral judgments about the very creation of life.

Thus challenges facing today’s social workers resulting from the invention of various forms of social media are simply the latest chapter in professionals’ efforts to use new technology ethically.

Developing a Social Media Ethics Policy
Social workers are quickly discovering that a social media policy reflecting current ethical standards can simultaneously protect clients and practitioners. A carefully constructed social media policy that social workers share with their clients can prevent confusion and minimize the likelihood of ethics-related problems concerning boundaries, dual relationships, informed consent, confidentiality, privacy, and documentation. Ideally, a comprehensive social media ethics policy should address the most common forms of electronic communication used by clients and social workers: social networking sites, search engines, e-mail and text messages, location-based services, and consumer review sites. (For a useful model, visit the website www.drkkolmes.com.)

• Social networking sites: Social workers sometimes receive electronic requests from clients who want to be ‘’friends” or contacts on social networking sites such as Facebook and LinkedIn. I have consulted on several cases where social workers learned painful lessons after the fact about boundary, dual relationship, confidentiality, privacy, informed consent, and documentation problems that can arise if they interact with clients on such networking sites.

Although some social workers—a distinct minority, it appears—seem comfortable with these electronic relationships with clients, most agree that a social media policy should inform clients that their social worker does not interact with clients as electronic friends or contacts on social networking sites. Clients should understand the difference between a Facebook page that a clinical group practice might maintain to provide information to the public and clients and a Facebook profile, which is for personal purposes.

• Search engines: The National Association of Social Workers Code of Ethics states, “Social workers should respect clients’ right to privacy” (standard 1.07[a]). When the current code of ethics was ratified in 1996, the committee that drafted it (which I chaired) never imagined that this standard could possibly be applied to social workers’ use of electronic search engines, which did not yet exist.

Today, however, social workers must decide whether it is ethical to conduct electronic searches about their clients. To respect clients’ privacy, an ethics-based social media policy should explain to clients that their social worker will not conduct electronic searches about them unless there is, for example, a genuine emergency where information obtained electronically might protect the client from harm. 

• E-mail and text messaging: Social workers who correspond with clients via e-mail or text messages about sensitive, clinically relevant information may expose a client to confidentiality and privacy breaches. E-mail correspondence and text messages are not 100% secure. Further, informal e-mail and text message exchanges, especially during what are customarily nonworking hours, may confuse clients about the boundaries in their relationship with social workers. A social media policy should explain to clients that social workers limit such electronic messages to appointment scheduling and other routine correspondence. Clients should understand that e-mail and text message communications may not be secure and that any electronic messages may become part of the clinical record.

• Location-based services: Many clients use location-based services such as Foursquare, Loopt, and Gowalla to enable friends and acquaintances to follow their itinerary via their mobile telephones. A social media policy should inform clients that their use of location-based services, especially if their mobile telephones are GPS enabled, may inform friends and acquaintances that they are visiting a therapist, thus jeopardizing their privacy.

• Consumer review sites: Some clients choose to post publicly available comments on Web-based business review sites such as Healthgrades, Yahoo!, and Yelp about the clinical social workers from whom they receive therapeutic services. A social media policy should alert clients that posting comments on these websites with identifying information would compromise their privacy and confidentiality.

Most contemporary social workers completed their formal education and entered the profession before currently available social media were invented. Until relatively recently, electronic communication with clients meant telephone calls using landline equipment. Today, however, the social media revolution that has permeated clients’ and practitioners’ lives has introduced a wide range of clinical and, especially, ethical challenges. To ensure compliance with prevailing ethical standards related to boundaries, dual relationships, confidentiality, privacy, informed consent, and documentation, prudent social workers should develop comprehensive social media policies and review them with clients.

— 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.