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ETH2228 - SECTION 5: KEY INFLUENCES ON ANY ETHICAL DECISION MAKING PROCESS

Values

Values are defined as:

“a concept that describes the beliefs of an individual or culture. A set of values may be placed into the notion of a value system. Values are considered subjective and vary across people and cultures. Types of values include ethical/moral values, doctrinal/ideological (political, religious) values, social values, and aesthetic values. It is debated whether some values are innate.” (Wikipedia)

The NASW Code of Ethics is based on some core values that define the social work profession: service, social justice, dignity, and worth of the person, importance of human relationships, integrity and competence. These values provide the framework for the principles behind the Code and as the Code states, are the ideals to which every social worker should strive. We have looked at these values in an earlier section, as we discussed some of the differences between the NASW Code of Ethics and the codes for ACA and AAMFT.

However, while these values are important in terms of defining who social workers are as professionals, in many circumstances they may conflict with each other. The same is true with values and directives from the codes of ethics for counselors and marriage and family therapists. Mental health clinicians will also find themselves at times in situations where their professional values may conflict with their employer’s values or interests, the clinician’s own personal values, or the client’s values.

Thus, a mental health clinician who wants to practice ethically will need strategies for resolving these conflicts and the ethical dilemmas that result from these competing value systems. Further on in this course several different decision making models for resolving ethical dilemmas will be presented.

Wallace and Pekel, the authors of one model taken from the business sector suggest that prior to starting the decision making process a value assessment should be done to determine the values held by the stakeholders. (Wallace, Doug, Pekel, Jon (2006). The Ten Step Method of Decisionmaking. Consultants of the Twin Cities-based Fulcrum Group; 651-714-9033; e-mail at jonpekel@atti.com. Retrieved 12/26/07 from http://www.authenticityconsulting.com/misc/long.pdf. )

Discussion of Values

To appropriately apply any ethical decision making model to an ethical dilemma, it is critical to have an understanding of the underlying values that may influence a professional’s ability to satisfactorily resolve the dilemma.

In The Ethical Decision-Making Manual for Helping Professionals, (Steinman, Richardson, McEnroe, 1998), the authors discuss what they refrer to as the “values trap,” which is a misunderstanding about personal, professional and religious beliefs and which of these values should guide a professional’s practice.

This manual offers definitions of these different values/codes/beliefs that should help practitioner’s distinguish between them and determine what values/codes should be guiding their professional practice:

- Religious beliefs – These can determine a person’s value system and moral standards and a sense of what is right and what is wrong. Because these religious convictions are handed down from a higher being for many they override any other authorities or values.
- Moral standards – These are codes of personal behavior that guide our everyday actions and how we relate to others and can be based on religious beliefs. If someone is seen as immoral it may be that they have different standards for moral behavior.
- Personal values – These are value systems that all peope have and which are used to determine what is and what is not important to them. Someone may be considered not to have any values just because their personal values may be different from our’s or society’s.
- Professional ethical code – These are the generally accepted standards of condut that guide the professional behavior of individuals in their working environment for how they relate to their clients, employer, co-workers, other professionals and within their own profession.

Being able to identify these values and understand the distinction between them will allow a social worker to avoid situations in which their own personal or religious values might conflict with those of their profession, client or employer.

Research done by David R. Hodge (Value Differences between Social Workers and Members of the Working Middle Classes, Social Work, Volume 48, Number 1, January 2003, Pages 107 – 119) illustrates just one difference in values between social workers and their clients and the need for all social workers to be aware of and understand the implications of these differences on their abilities to professionally serve their clients.

Hodge compares the political values of graduate level social workers, bachelor level social workers and their working and middle class clients. He found that graduate social workers typically have values to the left of their working and middle class clients and that the values of bachelor level social workers fall between that of graduate social workers and the working and middle class clients.

Marcia Abromson in her article, Reflections on knowing oneself ethically: Toward a working framework for social work practice (Families in Society: The Journal of Contemporary Human Services, April 1996, Pages 195 – 202) suggests that the focus should be on the ethical decision maker and, that to avoid any values conflicts, it is important for that person to be aware of not only their values but those of their client as well. Abromson concludes her article by stating:

“I believe that the character of the person who is making the decision determines the kind of ethical decision that is made and how that person follows through with his or her decision. Ethical self-knowledge prevents surprise when value conflicts occur. It provides a firmer footing for wrestling with the ethical dilemmas that occur so frequently in social work practice.”

Additionally, as stated in the earlier discussion about the NASW Code of Ethics, “the NASW Code of Ethics does not specify which values, principles, and standards are most important and ought to outweigh others in instances when they conflict.” There may be certain employment settings, such as those with a religious affiliation which may place a higher value on religious beliefs, or those in the area of corrections and criminal justice that will have policies and procedures where security is paramount and that will always conflict with certain aspects of the code.

A social worker, counselor, or marriage and family therapist who is aware of his or her own beliefs and values - whether they are professional, religious, personal or moral - and also aware of which among them are most highly valued, will have a better understanding of how to avoid or resolve this type of potential conflict with employers or clients as well as any other ethical dilemmas that they may face.

Ethical Self-Assessment

The following set of questions is adapted from questions posed in Abromson’s article and can be used as a tool to develop a level of self-awareness that can help guide ones application of any ethical decision making model.

1. What are the qualities of a good person?
2. What are the qualities of a competent therapist?
3. What are the qualities of a good employee?
4. What are the personal and professional standards to which I strive to meet or to hold myself accountable to?
5. When my roles as therapist, employee, moral person or upstanding member of society conflict, which role do I place first?
6. How important are the principles of autonomy (self-determination), beneficence (doing good), non-malfeasance (doing no harm) and justice to me, and which principle do I value most when they come into conflict?
7. When a client’s interests conflicts with the interests of society, how do I act and whose interests do I place first?
8. When faced with a shortage of resources, how would I decide to allocate them?

Values SCENARIO

Can Your Client Decide?
You are working with a family and your agency wants you to involve the client in deciding on the goals of care. You don’t believe that the client has the ability to make good decisions about what is best for her or her children. What do you do?


What is the ethical dilemma?
How do I fulfill my agency’s stated goal of involving clients in the decision making process around goals of care with a client who appears not to have the ability to make good decisions about what is best for her or her children?

What values or ethical perspectives should be considered (personal, societal, professional, client or agency)?
Part of the process the mental health clinician in this scenario should undertake is determining whether or not the client has the capacity to make decisions and to understand his or her own personal values. Do those values conflict with the client’s values? Are there cultural, class or religious differences between the client and worker?

Besides the clinician and the client, who else has a value or perspective on this situation that should be considered in resolving the ethical dilemma? Several examples are provided below of those people or entities that might have an interest in how this dilemma is resolved, and what some of their values might be.

Agency – The agency would value having employees sensitive to the values of the clients being served. The agency would value employees’ compliance with their professional codes and agency policies. The agency would value clients getting appropriate services. The agency would value the ability of employees to appropriately determine whether or not a client has the capacity to make decisions.

Professional organizations – Professional organizations would value members who abide by the professional code of ethics and who do not impose their personal values or beliefs on the people that they serve.

Client’s children – The children would value their relationship with their mother and family. The children would value receiving services that are appropriate to meeting their needs. The children would value clinicians who are sensitive to their cultural values.

Human Services – Human services would value a non-neglected and abusive environment for the children.

Courts – The courts would value appropriate determination of capacity.

What are the ethical standards (codes) that apply?

NASW Code of Ethics
1.01 Commitment to Clients
1.02 Self-Determination
1.03 Informed Consent (a) (b) (c) (d)
1.06 Conflicts of Interest (a)
1.14 Clients Who Lack Decision-Making Capacity
2.05 Consultation (a)
3.09 Commitments to Employers (a)(b)(c)(d)

AAMFT Code of Ethics Provisions that Apply
(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.1, 1.2, 1.8, 1.10

ACA Code of Ethics Provisions that Apply
(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, A1c, A2a, A2d, A4a, B5a, B5b, B5c

Review Questions

How are values defined?

Why is it important for a social worker to understand their own values?

How might a social worker’s or counselor’s values conflict with their employer’s?

Which values are most important according to the NASW Code of Ethics?

How do a social worker’s personal values affect his or her ability be culturally competent?

Beyond the NASW Code of Ethics, what other sources of information should be used by social workers to help guide their ethical thinking?

Cultural Competence and Self-Awareness

According to Social Work Speaks, (2006-2009), social workers have an ethical responsibility to be culturally competent practitioners as suggested by the NASW Code of Ethics. While the codes of ethics for counselors and marriage and family therapists do not cover cultural competence in as much detail as the NASW code, in their very first sections, both codes address the idea of cultural competence with the concept of non-discrimination, as shown below:

ACA code: Standard of Practice One (SP-1): Nondiscrimination. Counselors respect diversity and must not discriminate against clients because of age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status. (See A.2.a.)

AAMFT code: 1.1. Marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, or sexual orientation.

NASW defines cultural competence as: “a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals and enables the system, agency, or professionals to work effectively in cross-cultural situations.

The word ‘culture’ is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic and religious, or social group. The word ‘competence’ is used because it implies having the capacity to function effectively” (pg. 80)

It also states that one aspect of being culturally competent is the need for social workers to be aware of their own values so that those values do not interfere with their work as a professional, “Social workers’ self-awareness of their own cultures is as fundamental to practice as the informed assumptions about clients’ cultural background and experiences.” (pg 79)

It goes on to say: “Cultural competence requires social workers to examine their own cultural backgrounds and identities while seeking out the necessary knowledge, skills, and values that can enhance the delivery of services to people with varying cultural experiences associated with their race, ethnicity, gender, class, sexual orientation, religion, age or disability.” (pg 81)

Why is Cultural Competency Critical to Ethical Practice?

Derald Wing Sue and David Sue in their book, Counseling the Culturally Diverse: Theory and Practice (2008) state,…while mental health providers could be well intentioned in their desire to help clients of color, the goals and process of counseling and psychotherapy were often antagonistic to the life experience and cultural values of their clients. Without awareness and knowledge of race, culture, and ethnicity, counselors and other helping professionals could unwittingly engage in cultural oppression.” (pg 23)

The first provisions of all three of the codes of ethics governing mental health clinicians speak of respect for the client and that the client’s interests are paramount, and for that reason, unless a mental health clinician is culturally competent in their practice, they will not be able to meet the expectations of these provisions in their codes of ethics.

Sue states that the definition of cultural competence is applied on two levels, the person/individual and the organizational/system. He defines cultural competence as:

“Cultural Competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems. Multicultural counseling competence is defined as the counselor’s acquisition of awareness, knowledge and skills needed to function effectively in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds), and on a organizational/societal level, advocating effectively to develop new theories, practices, policies, and organizational structures that are more responsive to all groups.” (pg 46)

Sue states that a culturally competent therapist is working toward three competencies:

1. Awareness of one’s own assumptions, values and biases
2. Understanding the worldview of culturally diverse clients
3. Developing appropriate intervention strategies and techniques (pg 44 – 45)

He goes on to provide more detail about what each of these competencies entail. He describes three levels of cultural competence, shown on the following pages.

“Multicultural Counseling Competencies"


Level I. Cultural Competence: Awareness
1. Moved from being culturally unaware to being aware and sensitive to own cultural heritage and to valuing and respecting differences.
2. Aware of own values and biases and of how they may affect diverse clients.
3. Comfortable with differences that exist between themselves and their clients in terms of race, gender, sexual orientation, and other sociodemographic variables. Differences are not seen as deviant.
4. Sensitive to circumstances (personal biases; stage of racial, gender and sexual orientation identity; sociopolitical influences, etc.) that may dictate referral of clients to members of their own sociodemographic group or to different therapists in general.
5. Aware of their own racist, sexist, heterosexist, or other detrimental attitudes, beliefs and feelings.

Level II. Cultural Competence: Knowledge
1. Knowledgeable and informed on a number of culturally diverse groups, especially groups therapists work with.
2. Knowledgeable about the sociopolitical system’s operations in the United States with respect to its treatment of marginalized groups in society.
3. Possess specific knowledge and understanding of the generic characteristics of counseling and therapy.
4. Knowledgeable of institutional barriers that prevent some diverse clients from using mental health services.

Level III. Cultural Competence: Skills
1. Able to generate a wide variety of verbal and nonverbal helping responses.
2. Able to communicate (send and receive both verbal and nonverbal messages) accurately and appropriately.
3. Able to exercise institutional and intervention skills on behalf of their client when appropriate.
4. Able to anticipate impact of their helping styles, and limitations they possess on culturally diverse clients.
5. Able to play helping roles characterized by an active systemic focus, which leads to environmental interventions. Not restricted by the conventional counselor/therapist mode of operation.”

Sue goes on to state that skills should include alternatives to the traditional one-to-one therapy and could include such approaches as:
“- Having a more active helping style
- Working outside the office (home, institution, or community)
- Being focused on changing environmental conditions as opposed to changing the client
- Viewing the client as encountering problems rather than having a problem
- Being oriented toward prevention rather than remediation
- Shouldering increased responsibility for determining the course and outcome of the helping process.” (pgs. 47-48)

Sue, Derald Wing and Sue, David. (2008). Counseling the Culturally Diverse: Theory and Practice. John Wiley and Sons, Inc., Hoboken

NASW Standards for Cultural Competence in Social Work Practice

Not only has the NASW code been most fully developed in terms of addressing issues of cultural competence, it is also supplemented by the Standards for Cultural Competence in Social Work Practice, which we will spend some time examining here:

Standard 1. Ethics and Values—Social workers shall function in accordance with the values, ethics, and standards of the profession, recognizing how personal and professional values may conflict with or accommodate the needs of diverse clients.

Standard 2. Self-Awareness—Social workers shall seek to develop an understanding of their own personal, cultural values and beliefs as one way of appreciating the importance of multicultural identities in the lives of people.

Standard 3. Cross-Cultural Knowledge—Social workers shall have and continue to develop specialized knowledge and understanding about the history, traditions, values, family systems, and artistic expressions of major client groups that they serve.

Standard 4. Cross-Cultural Skills—Social workers shall use appropriate methodological approaches, skills, and techniques that reflect the workers’ understanding of the role of culture in the helping process.

Standard 5. Service Delivery—Social workers shall be knowledgeable about and skillful in the use of services available in the community and broader society and be able to make appropriate referrals for their diverse clients.

Standard 6. Empowerment and Advocacy—Social workers shall be aware of the effect of social policies and programs on diverse client populations, advocating for and with clients whenever appropriate.

Standard 7. Diverse Workforce—Social workers shall support and advocate for recruitment, admissions and hiring, and retention efforts in social work programs and agencies that ensure diversity within the profession.

Standard 8. Professional Education—Social workers shall advocate for and participate in educational and training programs that help advance cultural competence within the profession.

Standard 9. Language Diversity—Social workers shall seek to provide or advocate for the provision of information, referrals, and services in the language appropriate to the client, which may include use of interpreters.

Standard 10. Cross-Cultural Leadership—Social workers shall be able to communicate information about diverse client groups to other professionals.

In addition to these standards, several provisions of the NASW Code of Ethics specifically apply to Cultural Competence and Social Diversity:

1.05 Cultural Competence and Social Diversity
(a) Social workers should understand culture and function in human behavior and society, recognizing the strengths that exist in all cultures.
(b) Social workers should have a knowledge base of their clients’ cultures and be able to demonstrate competence in the provision of services that are sensitive to clients’ culture and to differences among people and cultural groups.
(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion and mental or physical disability.

Examples of the Importance of Being Culturally Competent

Following are just a couple examples – the meaning of yes, eye contact, smiling and gift giving - of gestures or types of communications that are very common interactions that occur between mental health clinicians and their clients – sometimes in the initial interaction between the two. If misinterpreted or not handled appropriately these simple mistakes could seriously impact the relationship between the clinician and client and the ability of the clinician to put the client’s interests first.

The Meaning of Gestures

Roger Axtell in his book Gesture: the Do’s and Taboos of Body Language Around the World, (John Wiley and Sons, Inc., New York, 1998) clearly illustrate how critical it is for social workers to have a basic understanding of the cultures of the people they serve.

Just considering such a simple thing as how a social worker makes eye contact or interprets the eye contact with his or her clients can have an impact on the therapeutic relationship with that client. Several examples regarding eye contact from Axtell’s book make this point:

- Hispanic women may hold eye contact longer
- Americans, Canadians, British, Eastern Europeans and Jewish cultures favor face-to-face relations
- In some regions of Africa it is not permissible for a child to look an adult in the eye
- For Native Americans it is not polite to look a senior person straight in the eye and respect is shown by avoiding eye contact
- In Japan, Korea and Thailand it is considered rude to stare and prolonged eye contact is even intimidating
- In Saudi Arabia one is expected to maintain strong eye contact
- In Taiwan and Hong Kong, repeatedly blinking the eyes at someone is considered impolite. (page 67-68)

The “Ultimate Gesture”

Axtell also refers to the “ultimate gesture” – a gesture that is universally understood – smiling. However, he then goes on to point out that even smiling is complicated:

- Some people are physically incapable of smiling because the muscles it takes to smile are physically impaired
- Others may smile at strange times, such as in Singapore, Malaysia and the Philippines, people try to hide their embarrassment by smiling or laughing
- And still others are trained not to smile under certain conditions, such as Japanese who will not smile for official government photos such as for a driver’s license in case smiling might be interpreted as being too frivolous; and
- In the Korean culture, excessive smiling is a sign of shallowness or thoughtfulness. (pg 118-119)

Gift Giving

The NASW Code of Ethics standard for Conflicts of Interest (1.06) (b) states:
“social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political or business interests.”

Simply interpreted, this provision could mean that social workers should not accept gifts from their clients. Depending on the nature and value of the gift and goals of therapy, many agencies have policies that will prohibit and/or dictate the type and under what circumstances a gift may be accepted.

The AAMFT Code is a bit more specific regarding the acceptance of gifts:
“Marriage and family therapists do not give or receive from clients (a) gifts of substantial value or (b) gifts that impair the integrity or efficacy of the therapeutic relationship.” (3.10)

The ACA Code of Ethics has a different approach to gift giving and actually builds into the code an acknowledgement of the various views that different cultures might have on gift giving:

“Counselors understand the challenges of accepting gifts from clients and recognize that in some cultures, small gifts are a token of respect and showing gratitude. When determining whether or not to accept a gift from clients, counselors take into account the therapeutic relationship, the monetary value of the gift, a client’s motivation for giving the gift, and the counselor’s motivation for wanting or declining the gift.” (A10.e. Receiving Gifts)

Axtell points out that several cultures, such as the Japanese and Middle Easterners place a high value on gift giving. Other Asian cultures, including Koreans, Taiwanese, Chinese and Malaysians, amongst others, also incorporate gift giving as part of their culture. (pg118) Assuring that there is no conflict of interest while at the same time, using appropriate methodological approaches, skills, and techniques will require that a social worker or counselor become familiar with the history, traditions, values, family systems, and artistic expressions of the major client groups that they serve and understand the role of culture in the helping process.

The Meaning of "Yes" and Informed Consent

Rena Gropper, in her book Culture and the Clinical Encounter: An Intercultural Sensitizer for the Health Professions (Intercultural Press, Inc., Yarmouth, Maine, 1996) illustrates how silence and the word yes can have different meanings for different cultures:

“Silence and the word "yes" lead to numerous misunderstandings. Neither necessarily signifies agreement. Silence can mean ‘I do not agree with what you are saying, but I am too polite to say so.’ "Yes" can mean ‘I am listening but not promising or agreeing.’ ‘I do not understand what you are saying, but I acknowledge you are trying to tell me something, and I am grateful for that’ is another possibility.”

Different cultural meanings of "yes" or silence can provide challenges for mental health clinicians seeking informed consent from clients. The NASW Code of Ethics provides guidance for social workers in these situations, but to know whether or not "yes" means "yes" a social worker must be familiar with the its cultural context. The standards of the NASW Code of Ethics that would apply to obtaining a valid informed consent are:

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 service, risks related to the service, limits to service 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.

(b) In instances where clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients’ comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter and/or translator whenever possible.

(c) In instances where clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission from an appropriate third party, informing clients consistent with their level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.

(d) In instances where clients are receiving services involuntarily, social workers should provide information about the nature and extent of services, and of the extent of clients’ right to refuse service.

(e) Social workers who provide services via electronic mediums (such as computers, telephone, radio, and television) should inform recipients of the limitations and risk associated with such services.

(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.

For a more comprehensive overview of the complexities of ethical decision making in situations of cultural diversity, you may wish to view yourceus.com's course, Cultural Diversity, Value Conflict and Ethical Decision Making: An Overview for Mental Clinicians.

Strategies for Ethical Advocacy

In their article, Expanding the Boundaries of Ethics Education: Preparing Social Workers for Ethical Advocacy in an Organizational Setting, Dodd and Jansson suggest that to be effective, social workers must go beyond the theoretical applications presented in the literature on ethical decision making and figure out how to be part of the ethical deliberations. These authors suggest that beyond the identification of values, the recognition of ethical issues, and the application of a decision making process, social workers need to become ethical advocates.

They use the example of hospital social workers to illustrate the power imbalance that can exist between different professions. In this instance they discuss social workers and doctors in a hospital setting where doctors historically dominate, and point out the need for social workers to understand that imbalance and how best to use it.

For example, while a doctor may not necessarily recognize the value of the social worker’s input, they would pay attention to concern’s expressed by a patient, so the social worker may focus his or her attention on helping the patient and the patient’s family communicate effectively with the doctor. Examples of ethical advocacy at the organizational level might involve “seeking written protocols, seeking multidisciplinary training sessions, and educating physicians about the social worker’s potential role in multidisciplinary deliberations.”

The authors conclude that social workers will encounter organizational and professional barriers to their participation in ethical deliberations and that they must be ethically assertive and develop and utilize strategies to break through those barriers if they are to be effective.

Dodd, Sarah-Jane, Jansson, Bruce, Expanding the Boundaries of Ethics Education: Preparing Social Workers for Ethical Advocacy in an Organizational Setting, Journal of Social Work Education, Vo. 40, No. 3 (Fall 2004), Council of Social Work Education, pgs. 455 – 465.

SCENARIO

More Services are Needed

Because of the structure of your program, you have only a limited amount of time to work with your clients. This limited amount of time does not give you enough time to do the work you know you need to do with each client to provide good service. What do you do?

Identify the ethical dilemma.
How do I fulfill my ethical obligations to my clients when there are restrictions on the amount of services that can be provided?

What are the ethical standards (codes), laws or cases that apply?

The relevant code sections are noted on the following page.

NASW Code of Ethics
1.01 Commitment to Clients
1.13 Payment for Services (a)
1.15 Interruption of Services
1.16 Termination of Services (a) (b) (c) (e)
2.05 Consultation (a)
3.07 Administration (a) (b) (d)
3.09 Commitments to Employers (a) (b) (c) (d) (g)
5.01 Integrity of the Profession (a)
6.01 Social Welfare
6.04 Social and Political Action (a) (b)

AAMFT Code of Ethics Provisions that Apply
(Please link to the AAMFT Code of Ethics for the specifics of the identified sections of the Code that apply – AAMFT Code of Ethics) 1.1, 1.2, 1.9, 1.10, 1.11, 6.1, 7.1, 7.2, 7.3, 7.5, 7.6

ACA Code of Ethics Provisions that Apply
(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, A10b, A10d, A11a, A11d, D1g, D1h

What are the organizational and or professional barriers that may interfere with the social worker’s or counselor’s participation in the decision making process?

This scenario is clearly one in which the mental health clinician may need to take on the role of advocate for their clients. Decisions about the amount of services that can be provided may happen at a much different organizational levels than where the clinician normally works. An advocacy role may be needed both inside and outside of the agency.

For example, decisions about the amount of services that can be offered may happen at the time that an annual budget is prepared for the organization. Additionally, this annual budget may be based on the amount of funding that is available at the state level to pay for the services, so program funding decisions may be made as part of the state’s legislative budget process or at the executive department level in setting rates for the reimbursement of services.

For clinicians who do not typically function outside of the direct client relationship, it is important that they develop the skills and strategies to be effective advocates if they are to be in compliance with their codes of ethics and to effectively serve their clients.

Review Questions

Why did the NASW develop their Standards for Cultural Competence in Social Work Practice?

Why is cultural competency critical to ethical practice?

Why might it be wrong for a social worker or counselor to accept a gift from a client? When might it be OK?

What are some of the challenges in getting informed consent from a person whose culture might have a different meaning for the word “yes”?

What are some steps a social worker might take to make sure that they are involved within their organization’s discussions about ethical issues?

In which society might even Axtell’s “ultimate gesture” not really be “ultimate”?

What are some of the alternative skills that Sue suggests are necessary for practicing with cultural competence and why?



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