In the following case scenario Linda Brown commits multiple ethical violations. Read each section of the scenario and then review the NASW, ACA or AAMFT codes to identify the violations. See how many violations fo the code you can find. The applicable sections of the code that appear to have been violated are listed at the end of the case scenario according to each section. Participants who are governed by another code of ethics may wish to download that code and refer to it throughout this course.

If you like, you may print each of the sections. In this way you will have available the sections of the scenario when you reach the end of the chapter. Simply click on the "Print this Page" button on the right side of each page.

How Many Mistakes Does Linda Brown Make?

Section 1

Mary was treated at Rural Town Medical Center in Smalltown, ID for Severe Post-Partum Depression on an in-patient basis from April 2 - April 5, 1994. Upon Mary’s discharge, Prozac was prescribed and she was advised to also seek therapy.

On April 9, 1994 Mary began treating with Linda Brown, a licensed social worker/counselor in Greentown, Idaho, which was the closest therapist to where she lived in Redville, Idaho.

During her first office visit with Ms. Brown, Mary, her brother and her husband went to Greentown and met with Ms. Brown for about 3 hours. Ms. Brown did not do a detailed intake. She did not provide information about confidentiality or release of information and she did not do an appropriate assessment of Mary’s presenting symptoms or diagnosis. Ms. Brown reviewed with Mary what Mary hoped to accomplish in treatment. The remainder of the visits occurred in a second floor bedroom in the home of Ms. Brown’s daughter, which was located closer to Redville, where Mary lived.

Section 2

When Ms. Brown first began treating Mary, she advised Mary that her doctor at Rural Town Medical Center put her on Prozac to help address the depression. It is unclear whether Ms. Brown prompted Mary to end Prozac or whether Mary stopped on her own, however Ms. Brown referred Mary to Barbie Smith, an herbalist and licensed Advanced Registered Nurse Practitioner in Largertown, Idaho. Ms. Brown contacted Ms. Smith to make the referral without first getting written permission from Mary. Ms. Brown did not provide Mary with any other referrals, and did not refer Mary to her prescribing physician or any physician regarding the discontinuation of the Prozac. Ms. Brown felt that Ms. Smith had the knowledge and expertise necessary to assist Mary in weaning off Prozac.

Section 3

Ms. Smith met with Mary only one time and discussed the weaning off process from the Prozac and incorporating St. John’s Wart into her diet as a replacement for the Prozac. Mary discontinued the Prozac and started the St. John’s Wart as she was directed by Ms. Smith.

Neither Ms. Smith nor Ms. Brown monitored the weaning off Prozac process, nor did they confer with each other, despite the fact that they were both aware that Mary was taking St. John’s Wart that she was receiving through the mail. Neither did they recommend that she see her physician.

Section 4

Ms. Brown continued to treat Mary from April through August, but failed to recognize the severe and presenting symptoms of Mary’s Post-Partum Depression. On at least one occasion during treatment, Mary discussed certain suicidal ideations she was experiencing. On her own, in August, Mary ended treatment with Ms. Brown. Just prior to the ending of treatment, Mary had started to see another physician and psychiatric nurse in Bigtown, Idaho. Upon commencing treatment with her new physician, Mary was admitted for inpatient psychiatric care, which she continued to receive for almost a month. Before ending treatment with Ms. Brown, Mary had asked that her medical records be sent to her home.

Section 5

While Mary was hospitalized, her husband contacted Ms. Brown and talked for an hour with her about Mary’s treatment. Ms. Brown had not obtained permission from Mary to speak with her husband.

Section 6

When she was released from inpatient care, Mary had access to the medical records she had requested from Ms. Brown. These records contained the treatment records from the hospital where she delivered her baby and from her inpatient hospitalization from April 2 – 5 in 1994. There were no treatment records or even a summary of the treatment she received from Ms. Brown. There was, however, a copy of a letter from Ms. Brown to an attorney regarding another patient in her practice.

Section 1
NASW Code of Ethics Violations

1.02 Self-determination
Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.

1.03 Informed Consent
(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.

(f) Social workers should obtain clients’ informed consent before audio-taping or videotaping clients, or permitting third party observation of clients who are receiving services.

1.06 Conflicts of Interest
(d) When social workers provide services to two or more people who have a relationship with each other (for example, couples, family members), social workers should clarify with all parties which individuals will be considered clients and the nature of social workers’ professional obligations to the various individuals who are receiving services. Social workers who anticipate a conflict of interest among the individuals who are receiving services, or who anticipate having to perform in potentially conflicting roles (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients), should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.

1.07 Privacy and Confidentiality
(b) Social workers may disclose confidential information when appropriate with a valid consent from a client, or a person legally authorized to consent on behalf of a client.

(c) Social workers should protect the confidentiality of all information obtained in the course of professional service, except for compelling professional reasons. The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person. In all instances, social workers should disclose the least amount of confidential information necessary to achieve the desired purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed.

(d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent.

(e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients' right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker-client relationship and as needed throughout the course of the relationship.

(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements.

3.06 Client Transfer
(a) When an individual who is receiving services from another agency or colleague contacts a social worker for services, the social worker should carefully consider the client’s needs before agreeing to provide services. To minimize possible confusion and conflict, social workers should discuss with potential clients the nature of their clients’ current relationship with other service providers and the implications, including possible benefits or risks, of entering into a relationship with a new service provider.

(b) If a new client has been served by another agency or colleague, social workers should discuss with the client whether consultation with the previous service provider is in the client’s best interest.

4.01 Competence
(a) Social workers should accept responsibility or employment only on the basis of existing competence or the intention to acquire the necessary competence.

AAMFT Code of Ethics Violations

(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.2, 1.3, 1.13, 2.1, 2.2, 3.6

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the Code that apply – ACA Code of Ethics) A1a, A2a, A2b, A3, A7, B1a, B1b, B1c, B1d, B3c, B4b

Section 2
NASW Code of Ethics Violations

1.02 Self-determination
1.04 Competence
(a) Social workers should provide services and represent themselves as competent only within the boundaries of their education, training, license, certification, consultation received, supervised experience, or other relevant professional experience.

(b) Social workers should provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques.

1.07 Privacy and Confidentiality
(b) Social workers may disclose confidential information when appropriate with a valid consent from a client, or a person legally authorized to consent on behalf of a client.

(q) Social workers should not disclose identifying information when discussing clients with consultants, unless the client has consented to disclosure of confidential information or there is a compelling need for such disclosure.

2.06 Referral for Service
(a) Social worker should refer clients to other professionals when other professionals’ specialized knowledge or expertise is needed to serve clients fully, or when social workers believe that they are not being effective or making reasonable progress with clients and additional service is required.

(b)Social workers who refer clients to other professionals should take appropriate steps to facilitate an orderly transfer of responsibility. Social workers who refer clients to other professionals should disclose, with clients’ consent, all pertinent information to the new service providers.

AAMFT Code of Ethics Violations

(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.2, 2.2, 2.6, 3.6, 3.7, 3.11

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the code that apply – ACA Code of Ethics) A1c, A2a, A11d, B1c, B6f, C1, C2a, C2b, C2e, D1a, D1b

Section 3
NASW Code of Ethics Violations

2.03 Interdisciplinary Collaboration
(a) Social workers who are members of an interdisciplinary team should participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the social work profession. Professional and ethical obligations of the interdisciplinary team as a whole and of its individual members should be clearly established.

2.05 Consultations
(a) Social workers should seek advice and counsel of colleagues whenever such consultation is in the best interest of clients.

2.06 Referral for Services
(a) Social worker should refer clients to other professionals when other professionals’ specialized knowledge or expertise is needed to serve clients fully, or when social workers believe that they are not being effective or making reasonable progress with clients and additional service is required.

4.01 Competence
(a) Social workers should accept responsibility or employment only on the basis of existing competence or the intention to acquire the necessary competence.

(b) Social workers should strive to become and remain proficient in professional practice and the performance of professional functions. Social workers should critically examine, and keep current with, emerging knowledge relevant to social work. Social workers should routinely review professional literature and participate in continuing education relevant to social work practice and social work ethics.

(c) Social workers should base practice on recognized knowledge, including empirically based knowledge, relevant to social work and social work ethics.

AAMFT Code of Ethics Violations

(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.2, 1.9, 1.10, 3.7, 3.11

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the Code that apply – ACA Code of Ethics) A2b, A11d, C2a, C2b, C2d, C2e, D1a, D1c

Section 4
NASW Code of Ethics Violations

1.04 Competence
1.07 Privacy and Confidentiality
(l) Social workers should protect the confidentiality of clients’ written and 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.

(n) Social workers should transfer or dispose of clients’ records in a manner that protects clients’ confidentiality and is consistent with state statutes governing records and social work licensure.

1.08 Access to Records
(a) Social workers should provide clients with reasonable access to records concerning the clients. Social workers who are concerned that clients’ access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit client access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both the clients’ request and the rationale for withholding some or all of the record should be documented in the clients’ file.

(b) When providing clients with access to their records, social workers should take steps to protect the confidentiality of other individuals identified or discussed in such records.

AAMFT Code of Ethics Violations

(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.9, 1.10, 1.11, 2.1, 2.2

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the Code that apply – ACA Code of Ethics) A3, A11a, A11d, B6d, B6e, C2e, D1c

Section 5
NASW Code of Ethics Violations

1.07 Privacy and Confidentiality
(b) Social workers may disclose confidential information when appropriate with a valid consent from a client, or a person legally authorized to consent on behalf of a client.

(d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences and, when feasible, before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent.

(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements.

(g) Social workers should inform clients involved in family, couples, marital, or group counseling of the social worker’s, employer’s, and agency’s policy concerning the social worker’s disclosure of confidential information among the parties involved in the counseling.

AAMFT Code of Ethics Violations

(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.2, 1.9, 1.10, 1.13, 2.1, 1.1, 3.2

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the Code that apply – ACA Code of Ethics) B1c, B4b

Section 6
NASW Code of Ethics Violations

1.04 Competence
1.07 Privacy and Confidentiality
(n) Social workers should transfer or dispose of clients’ records in a manner that protects clients’ confidentiality and is consistent with state statutes governing records and social work licensure.

1.08 Access to Records
(a) Social workers should provide clients with reasonable access to records concerning them. Social workers who are concerned that clients’ access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Social workers should limit clients’ access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both clients’ request and the rationale for withholding some or all of the record should be documented in the clients’ file.

3.04 Client Records
(a) Social workers should take reasonable steps to ensure that documentation in records is accurate and reflective of the services provided.

(b) Social workers should include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future.

(c) Social workers’ documentation should protect clients’ privacy to the extent that is possible and appropriate, and should include only information that is directly relevant to the delivery of services.

(d) Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statutes or relevant contracts.

AAMFT Code of Ethics Violations
(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.2, 2.2, 2.4, 3.1, 3.2, 3.6

ACA Code of Ethics Violations

(Please link to the ACA Code of Ethics for the specifics of the identified sections of the Code that apply – ACA Code of Ethics) A1b, A2a, A2b, A11d, B1c, B6a, B6d, B6g, C1

Review Questions

What are the parts of the NASW Code of Ethics, ACA Code or AAMFT Code that apply to informed consent and how were they violated in this scenario?

What are the parts of the NASW Code of Ethics, ACA Code or AAMFT Code that apply to record keeping and how should have the records been treated in this scenario?

Was the transfer or referral of Mary to Ms. Brown handled appropriately? Was the referral of Mary to the herbalist/nurse practitioner handled appropriately? Which parts of the codes apply to these referrals/transfers?

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