Legal and ethical issues are an integral component within the practice of social work. In this particular case the client expresses difficulty with being away from home for the first time in her life and has some issues coping with her current life situation. As far as ethical dilemmas present in this case, the social worker is presented with upholding the ethical responsibility of the Duty to Protect.
On the topic of the general discussion of law, which impacts practice in this case, it must be noted that the state mandatory reporting laws that require social workers to report suspected child abuse don’t apply to this case. However, it is my responsibility to uphold the regulations of HIPAA in regards to the client’s patient health records. As a result of some of the clients issues mentioned in the bio-psychosocial assessment it was a necessary requirement to assess the client’s health through the patient health questionnaire. First, the mandatory reporting law of suspected child abuse does not apply as well because the client is not a minor, is living away from home on a college campus and no forms of child abuse are suspected through the presenting problems.
Second, a matter of civil law that should be addressed is the client’s involvement in underage drinking. During the bio-psychosocial assessment the client stated that if having a bad week or experiencing stress she has no interest in drinking. This is a matter of civil law because the legal drinking age is twenty-one. Although, the clients usage of alcohol may not occur on a consistent basis it was disclosed that she has participated in drinking while away at school. This presents an issue of a duty to protect the client in situations where the client may be putting herself at risk for increasing her usage of alcohol due to her issues with being away from home. A study conducted by Dodd et al. found that, “The practice of high-risk drinking may be regarded as the most serious health problem faced by U.S. colleges and universities…This pattern of high-risk drinking results in serious negative consequences for college students including unintentional injuries, risky sexual behavior, violence, academic difficulties and trouble with the law.” Therefore, during treatment with the client it is necessary to discuss risk factors of underage drinking and the affects that can potentially put her or others at risk that she may not be equipped to handle. It is also important to warn and remind the client of her family’s history through her fathers past battle with alcohol abuse.
When it comes to the discussion of relevant ethical issues applicable to this case according to the NASW Code of Ethics, confidentiality is a major part of this case. The text states, “From a practical standpoint, confidentiality is a sine qua non of the helping process. Without the assurance of confidentiality, it is unlikely that clients would risk disclosing private aspects of their lives that if revealed, could cause shame or damage to their reputations” (Hepworth et al., pg. 74). As a young adult, the client has taken it upon herself to seek help for her issues with adjusting to her new life away from home and within this experience she has shared vulnerable aspects of her past and present life. From the beginning, it was made clear to her that details that were shared within our discussions and meeting would be held confidential. Additionally, a key ethical principle that has the potential to become an ethical dilemma is the ethical value of the clients right to self-determination. As previously stated in the general discussion of laws, I have the responsibility of the duty to protect by warning the client of the dangers of underage drinking. However, the client also has the right to make her own decisions but as her social worker I could take this opportunity to intervene by providing the client with agreed upon resolutions to the presenting problem.
In this case, one ethical dilemma that must be identified is the ethical responsibility of the duty to protect. As evidenced by the suicide risk assessment checklist the clients results indicate a low risk however she presents other concerns as a result of having no support system away on the college campus, occasional alcohol usage, decrease in appetite and sleep pattern. The presenting problems create a greater concern that opposes the results of the risk assessment tool. In a study conducted on Homesickness and adjustment in university students, it indicates, “university students living away from home suggest that homesickness is most commonly associated with anxiety, depression, and loneliness. Intense homesickness is particularly problematic when it exacerbates preexisting mood and anxiety disorders or precipitates new mental health or physical health problems, such as insomnia, appetite changes, gastrointestinal upset, and even immune deficiencies and diabetes” (Thurber & Walton, 2012). According to the assessment results of a low risk of the suicide assessment, the client has verbally expressed a recent loss of a boyfriend, lack of support system away from home and insecure attachment to parental figures, which may eventually cause the client to self-harm or encourage the threat of suicide due to her unhappiness.
With the knowledge that these issues have an affect on the college experience, mental and emotional state it is important to handle this dilemma by educating the client of her risks during the beginning stages of treatment and to remind her that I have the responsibility of the duty to protect and intervene if I suspect that she will put her personal safety in danger. According to the text, as a social worker it is required that we know when the risk is sufficient enough to warrant breaking the clients confidence. At this point, I don’t believe that the client presents a risk high enough to break confidentiality but it is necessary to take preventive measures with the client.
Ethical decision-making is yet another integral component of the practice of social work. According to Marian Mattison (2000), “Ethical decisions involve not only distinguishing right from wrong, but also addressing the more troubling good/good or bad/bad variety of deliberations”. During this decision making process we must take the time to thoroughly examine benefits through in depth contemplation and consulting with colleagues in the practice of social work. Furthermore, there are steps involved in the ethical decision making process. First, it is required that we identify the problem or dilemma and we do this by gathering relevant information about the situation from a number of perspectives and include the client in this process. Second, the core principles and competing issues should be evaluated. Third, the NASW Code of Ethics that applies to the case must be considered. The question that one must answer is whether the code of ethics fit within the case. Fourth, take the time to consult with colleagues, supervisors or legal professionals. Fifth, consider the possible courses of action and the consequences of all options considered. Sixth, make a decision on the course of action by weighing the information gathered and the impact of other choices involved. Seventh, develop a strategy for effectively implementing the decision. Last step in the process is to evaluate the process and results to determine if the intended outcome was met and consider future modifications of the process.
In taking the time to reflect on this case, realistically it should be understood that homesickness is a real issue for first-year college students and is an adjustment that make take months to become comfortable with. Thurber and Walton support this view by stating, “The transition from living at home to living away from home represents a significant transition for first-year college students. For many students, the experience is a stimulating adventure, both socially and intellectually. For other students, the experience is overwhelming and distressing” (Thurber & Walton, 2012). With this in mind, I can be sensitive to the fact that this was a new experience for this client and she may not have been equipped with the coping skills, confidence in self or independence to handle the transition. Which brings me to the discussion of potential personal biases affecting practice in this case would be the age of client in comparison to the social worker and my opposing beliefs regarding gender roles and expectations. First, the client whom is 19 years old is experiencing her first journey in life away from home. As a social worker, my personal bias could be that she is just going through a phase that she may soon outgrow. As well as knowing that the client is inexperienced in life may cause one to have less patience or adopt the thought that this issue as not as a big of a deal as the client believes. I could adopt the belief that the client will eventually get used to being away from home as she gets older and no longer experience the same issues. Second, as the social worker I could have an issue with her cultural background and her parents opposing views of gender roles and expectations. Because her parents hold the belief that girls should begin working and stay at home rather than seeking higher education, issues of cultural competency must be considered. It becomes necessary to fully understand her parent’s cultural background so that I don’t offend her familial values in the therapeutic process.
On the topic of consultation and supervision, it is understood that this time should be used to present case situations with supervisors or consultants for the purpose of addressing the needs of the client. However, it is also understood that the sharing of certain details personal information can occur under exceptional circumstances. Consultation and supervision should be used for the purpose of better serving the client, which also requires that those involved, client and social worker sign binding agreements that would prevent them from misusing confidential information (Hepworth et al, pg. 75). According to the NASW Code of Ethics, it is required that social workers involved in providing supervision or consultation should have the necessary knowledge and skill to supervise/consult on a professional level and only has the right to do so within their scope of practice. Overall, because the purpose of consultation and supervision is to enhance the delivery of services clients will agree to the disclosure of information when the purpose is made clear up front.