How do we advise our clients when it impinges on areas beyond professional training?
One afternoon, Jane received a call from the mother of one of her clients, Qiu Min, who is a 15-year-old girl who struggles with depression. Her mother told her that Qiu Min had just revealed to her that she has been binging on food and purging, which are clear signs of an eating disorder. She confirmed this information with Qiu Min and they agreed to increase the frequency of our clinical sessions in order to address the eating disorder issues.
Jane has been practicing for six years. In university, she had read some literature and heard several presentations on the subject of eating disorders while attending one of the advanced clinical courses that provided an overview of treatment approaches. However, she has not had any formal postgraduate training in it.
Qiu Min continued to struggle with her eating disorder. Three months after her disclosure, she was suddenly hospitalized with symptoms of severe malnutrition.“I’m very troubled that your social worker, Jane, did not refer Qiu Min for specialized treatment right away,” expressed the hospital psychiatrist. “In my judgement, her current condition may have been prevented had Qiu Min been treated in an eating disorders clinic as soon as these symptoms surfaced.”
Qiu Min’s parents were deeply distressed and angry to learn that their daughter’s current crisis may have been prevented. They filed a complaint with the accreditation board against me, alleging incompetent practice.
I feel that some ethical guidelines useful for social workers handling “unusual” cases might include:
Senior Care Standards Officer
In my opinion, Jane should abide by the social work ethic of responsibility as professionals and be cautious of the services provided to Qiu Min as she is considered a minor. Jane was trying her best to help Qiu Min however, she did not realise her limitations as a social worker. Since she had done an advanced clinical courses on treatment of eating disorders in her university, she should have known that treatment of eating disorder should be managed and treated by psychiatrist that is out of her competency level to provide the service to her client. However, she could continue to provide emotional counseling to Qiu Min while she is seeking treatment at the hospital as a form of support system which is within her boundary of work.In addition, it would be helpful for Jane to consult her supervisor or seniors on managing of her clients when she received further request, information or progress of her clients during the sessions so that she could meet client or the family's expectations.
Ang Chai Hwee
Medicial Social Worker
Before making decisions on whether to conduct clinical sessions with Qiu Min, Jane could have considered several ethical guidelines.
Jane needed to recognise that professional responsibility takes precedence over personal aims and views. Social workers provide services and represent themselves competent only within the boundaries of their education, training, licence certification, consultation received, supervised experience or other relevant professional experience. In this case, she does not have formal postgraduate training on treating eating disorders. She based her limitations in knowledge of what she had learnt in literature/ university presentations/ clinical courses, to conclude that she had sufficient ability to intervene in Qiu Min’s medical condition.
With what Jane had learnt regarding eating disorders, she could have reflected on whether she was the best person to provide consultation/ counselling for Qiu Min. Suppose that she was aware that she was not the best person and yet went ahead with counselling Qiu Min, she would have disregarded the ethics of affirming the right to client self-determination by ensuring that client is both aware of and has assessed alternative options. Jane was to provide all relevant information about going to an eating disorders clinic for advice, so that Qiu Min could make an informed decision.
Suppose that Jane was unsure of whether she was the best person to work with Qiu Min, she could consult her own clinical supervisor about this case. This would be in line with the ethical guideline of social workers acting on the recognition that effective service depends on cooperation among professional disciplines and others with due regard to respective areas of competence. This was in regards to her supervisor having more years of seniority/ experience as well as the professionals who work with eating disorder clients.
Qiu Min suffered from depression as indicated in the abstract. I am unsure if it referred to clinical depression, but the fact that she also had binging on food and purging signs alongside with depression might indicate that Qiu Min was having a more serious medical condition than perceived by Jane. I am surprised that Jane did not seem to have approached her supervisor for advice, as it was not mentioned in the abstract.
Even as Qiu Min continued to struggle with the eating disorder and Jane did not see any improvement especially over a long period of 3 months, Jane’s inefficiency at practice (which would also be due to her lack of ethical guidelines and not perceiving this situation as a crisis) had resulted in harm to client in an increasing manner. According to the passage, it was even more difficult to treat Qiu Min’s medical condition which had worsened and could have been prevented.
Jane’s incompetency in practice had serious repercussions on Qiu Min’s health and psychological/ emotional conditions. Qiu Min’s family was also deeply distressed and they might even lose their daughter eventually. Ultimately, Jane had to face the consequences of making her own decisions without much consideration to conducting professional practice. In this case, she was alleged by Qiu Min’s family of incompetent practice through the Accreditation Board. Jane had risked losing her job, career path and reputation as a Social Worker. If this case was brought up to the media, Jane would face much shame and a bad name for the organisation she was working for.
Senior Social Worker
Clearly, social workers should offer professional services only when they have the proper education, training, knowledge, and skills. To do otherwise would be acting irresponsibly towards the client. A social worker should have at least the minimally acceptable competence to meet clients’ needs and perform the duties required by their employers.
The Singapore Association of Social Work, Code of Professional Ethics (D4) also states that “Social workers provide services and represent themselves competent only within the boundaries of their education, training, licence certification, consultation received, supervised experience or other relevant professional experience”.
It is important that a social worker whose experience and education have focused exclusively on one field should not hold themselves out as experts in another. A social worker trained in substance abuse treatment would not serve clients in a hospice program very well, nor should one who has minimal expertise related to research, program evaluation, and data analysis market themselves as a program evaluation expert.
Other times, these situations are less easily defined or solved. Some social workers may have reasonable expertise to provide services to clients but may not be the most qualified practitioners available. In places where there may be relatively few practitioners with specialized expertise, social workers practicing in them may feel some pressure to stretch the borders of their proficiency. It is up to a social worker to exercise careful judgment to ensure that potential clients are protected, and minimize the likelihood of disgruntled parties pointing blame at their professional competency, such as Qiu Min’s parents in Jane’s situation.
All professional social workers should constantly seek ways to strengthen and upgrade their knowledge and skills throughout their careers. Even the best undergraduate and graduate social work education programs can provide students with only foundation-level knowledge and skills and a moderate amount of advanced content. Seasoned and wise social workers recognize that continuing education is imperative to enhance their expertise and keep current with new developments. The amount of time social workers spend in formal education is a modest fraction of the time spent learning throughout their careers. During the course of their careers, social workers can expect to encounter new conceptual models and intervention approaches; practitioners must always be open to learning and continuously monitor emerging knowledge related to their areas of practice.
As the SASW Code of Ethics (D2) again says, “Social workers strive to remain proficient in professional practice and the performance of professional functions by critically examining and keeping current with emerging knowledge relevant to social work, reviewing regularly professional literature and participating in continuing education relevant to social work practice and social work ethics”.
One hallmark of professionalism is our willingness to gain the extraordinary knowledge and hone the skills required to perform our work. This applies equally to all diverse professions, including all types of social work too. At a minimum, this demanding process entails years of study, training, consultation, and supervision. Anything less falls short of the standards to which social workers are held and what clients have a right to expect.
Ideally, I should have explained to Qiu Min what the nature and extents of my expertise are, and provide an overview of other practitioners in the area with more knowledge of and capability to help her with her disorder. I need to explain my own strengths and limitations when it comes to meeting Qiu Min’s crucial needs. By encouraging her to ask questions, I could guide her to make a more informed decision about who would be the better practitioner to consult, and if possible refer her to my appropriate colleagues. As the Code of Ethics says, “Social workers should refer clients to other professionals when the other professionals’ specialized knowledge or expertise is needed to serve clients fully…”. This process is consistent with the critically important concept of informed consent, which is an essential element of our ethical social work practice.