A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

The need for explicit argumentation in ethical decision-making in social work

This article addresses the need for social workers' explicit argumentation in ethical decision-making, i.e. the justification offered in adopting a particular course of action with their clients. It is the main assumption of this article that social workers need to be aware and explicit of the personal and professional ideas, concepts, values, and assumptions that guide their practice. In the following sections we clarify central concepts such as argumentation and its explicitness, present a conceptual framework for analyzing ethical decisions in social work, illustrate its applicability on social work dilemmas, and discuss possible implications for social work practice and education. Finally, we recommend that social work education put emphasis on: (1) developing more awareness for inner deliberations and making these explicit and amenable for evaluation; and (2) developing specific skills for explicit argumentation in ethical decision-making.     

Social work and genetic testing: Ethical issues encountered in predictive testing for Huntington disease

Abstract

Recent advances in genetic technology, including the availability of presymptomatic genetic (ie. predictive) testing for untreatable late-onset conditions, have created a number of practice challenges for social workers. This article outlines the social worker's role in the internationally accepted protocol for provision of predictive testing for Huntington Disease (HD) and highlights some of the complex ethical, emotional and practical issues arising from predictive testing for HD and other similar disorders. For social workers in this field, attempts to deal with ethical dilemmas must rely both on the social work code of ethics and on reference to major principles of bioethics such as respect for autonomy, beneficence, non-maleficence and justice. It is acknowledged that in some situations involving a conflict of ethical principles there may be no ideal resolution.     

Supervising Social Workers in Involuntary Contexts: Some Considerations

ABSTRACT

This article outlines areas for reflection for those providing supervision to social workers working in involuntary and semivoluntary contexts. This includes clinical implications, impacts on social work identity, and potential impacts on the supervisory relationship itself. It suggests that there are some areas that could be considered for discussion and exploration that may be different in focus to other types of supervisory practice, encouraging supervisors to consider their own approach in response to the issues raised.

IMPLICATIONS

• Working in involuntary contexts raises specific challenges in relation to power and authority in practice, as well as a range of ethical dilemmas.

• Supervisors might wish to consider the issues raised with a view to exploring with their supervisees how working with involuntary clients changes their framework or approach.

     

Working with Women Associated with Bikie Gangs: Practice Dilemmas

Abstract

Much has been written about bikie gangs, but there is little about the women and children who are part of gang life. The present paper describes domestic violence agency social workers’ ethical practice dilemmas when assisting women who have left bikie gangs to search for a new, safer lifestyle away from the gang culture of drug use and violence, in particular sexual violence. The paper concludes with a discussion of the ethical processes and issues in resolving such practice dilemmas.     

Bringing Technology to School: An Online Resource Guide for the School Social Worker

SUMMARY

The Internet can assist social workers and other human service professionals to obtain information that may potentially benefit both themselves and their clients. There is little doubt among those who are familiar with the Internet that this electronic medium has revolutionized the way we communicate and access knowledge. This article provides school social workers and other human service professionals with links to resources that can be incorporated into practice by offering specific Web pages related to school social work practice.     

E-technology and Community Participation: Exploring the Ethical Implications for Community-based Social Workers

ABSTRACT

To date, much of the work on social work, ethics and technology has been focused on clinical social work and micromorality—the ethical practices of the worker and their clients in one-on-one or therapeutic group interactions. In contrast, this article foregrounds social workers engaged in community work and the ethical implications at a macromoral level. Central to community-based social work, also known as social development work, is the principle of participation. In observing the ways e-technology is affecting community participation, the focus is upon communicative and social technologies, rather than assistive technologies, or technology enabled assessment. The article explores the intersection of these three themes of community participation, technology, and ethics to examine the implications for social workers located in the complex context of community work.     

A comparative analysis of Norwegian and American social workers’ views about inclusion of religion and spirituality in social work

ABSTRACT

This article presents results from a comparative analysis of national surveys of Norwegian and American social workers’ views and practice with regard to inclusion of religion and spirituality in their professional work with clients. Findings include views about professional values, educational preparation, raising the topics of religion and spirituality with clients experiencing oppression, and use of related interventions. Overall, American social workers are more likely to address religion and spirituality than Norwegians. International comparative statistical and conceptual analyses consider influences of differences in practice settings, respondents’ age and length of experience, and cultural contexts.     

Recognising Strategy and Tactics in Constructing and Working with Involuntary Social Work Clients

ABSTRACT

This paper reports on the author’s academic work on working with involuntary clients, which began with a knowledge exchange project in Scotland. I reflect back on this work and use it as a way to explore subsequent reflections on the field. These move beyond consideration of the skills required to undertake such work through locating the category of involuntary clients within wider, yet contradictory, governmental discourses on client engagement. These are identified as the strategy that sets the context for such work. But the strategy is enacted through the day-to-day tactics of social workers on the ground; such tactics, enacted in everyday encounters, are constitutive of effective but also ineffective engagement with clients. The discussion goes on to problematise the distinction between voluntary and involuntary clients and to suggest that effective social work practice, whatever the nature of that involvement, requires that clients are recognised at an ethical and relational level.

IMPLICATIONS

• The term involuntary client(s) cannot be taken for granted but is constructed and needs to be understood in particular and often contradictory policy and professional contexts.

• Effective but also ineffective ways of working with involuntary clients go beyond the acquisition or demonstration of particular skills but are embodied in the everyday relational practices of social workers.

• Ethical engagement with involuntary clients proceeds from a sense of mutual recognition.

     

Self-care techniques for social workers: Achieving an ethical harmony between work and well-being

ABSTRACT

The prevalence of burnout in the field of social work is a significant challenge to staff retention. This paper addresses the necessity of self-care in the prevention and treatment of burnout amongst social workers. Self-care is important for social workers who wish to maintain healthy, balanced lives. It is also argued that social workers who do not practice self-care are not able to provide the best possible services to their clients. For these reasons, self-care is necessary both from an ethical and personal standpoint. Specific steps for developing an individualized self-care plan are presented. This begins with the creation of a self-inventoryutilizes the Holmes-Rahe Life Stress Inventory. This is followed by a sample of self-care techniques that social workers can use. The techniques are not meant to be an exhaustive list of all self-care practices, but rather a sample of practices from various areas of social worker’s lives to demonstrate the expansive and diverse nature of self-care.     

Social Work Roles in Drug Treatment with Youth

ABSTRACT

Social workers working with youth, who are prescribed psychotropic medication, are routinely faced with tasks pertaining to psychopharmacologic treatment. Little is known, however, about how these workers contribute to the medication treatment process or the impact of their contributions. The purpose of this national survey of social workers practicing with youth was to explore three areas: (1) the frequency of medication-related functions with adolescent clients; (2) the worker, client, and contextual factors associated with greater involvement; and (3) social workers' perceptions of the effects of greater involvement on treatment processes and outcomes. Our findings suggested that in relation to medication treatment, social workers more frequently interfaced with clients than physicians, and that various treatment context and individual factors are associated with greater involvement. Social workers also perceived their involvement as associated with some desirable treatment processes/outcomes, especially the inclusion of adolescents in decision-making.     

People with experience of long-term drug use and homelessness teaching with us: experts by experience participation in university social work education

ABSTRACT

Participation of experts by experience in university social work education is an important shaping factor for future social workers. This article presents two-year long experience in lecturing together with people who have had experience with long-term drug use, homelessness and have a lot of experience with being in a role of social work clients as well. The aim of the presented approach is to recognize their experience, opinions, and attitudes as an important source of knowledge in social work. Based on the research outcomes, the authors discuss topics such as: the role of experts, empowerment, breaking the stereotypes and ethical issues related to experts’ participation. They conclude with practical recommendations.     

Existential social work and the quest for existential meaning and well-being: A conceptual framework

ABSTRACT

The aim of this article is to conceptualize “existential social work.” A greater understanding of what existential social work means may enable social workers and those studying social work to see how its practice can reveal “the truth” about human existence and how they, as professionals, can enhance existential meaning and existential well-being among their clients. In such work, existential social workers have at their disposal tools such as the Frankl therapeutic approach to existential analysis (i.e., logotherapy) as well as spiritual-sensitive modalities (prayer and mindfulness). To interpret and understand apparent phenomena in the therapy is the ultimate goal with existential social work practices, thus providing clients with the opportunity to discover the meaning that exists in themselves. In addition, these practices pave the way for existential well-being.     

Narcissism and the Social Work Response

Abstract

This paper reflects on and discusses the relationship between social work knowledge and practice in the context of work with narcissistically-oriented clients. Two subtypes of narcissism postulated in the literature are discussed in relation to the pattern of narcissistic internal claims about self and associated relational expectations. Key messages for social workers are that greater knowledge of the dynamics of narcissism may lead to: accepting and adapting practice based on the idea that narcissistic dynamics have a certain intentionality; applying empowerment models more carefully with this group; better understanding of how to effectively engage clients without reinforcing strong narcissistic tendencies or “results”; and protection of social workers' wellbeing by being able to identify and understand how narcissistic dynamics impact in practice situations. Social workers are urged to critically reflect on and to develop deeper, social work-specific, understandings of personality psychology in the interests of greater practice effectiveness.     

Responses to Homelessness in Australian Cities: Social Worker Perspectives

Abstract

Responses to homelessness in Australia are provided by a range of government and nongovernment services. The present study examined the experiences of social workers within these diverse services. The article discusses how social workers make meaning of their professional identity and responses to homelessness in contemporary practice and policy settings. The findings of a qualitative study of 39 social workers employed in Adelaide, Melbourne, and Sydney are analysed from a social constructionist perspective. The practice dilemmas for social workers interviewed related to the dominating influence of the contemporary political and economic climate, the managerial requirement of organisations, and the personal and professional tensions these political and organisational contexts created.     

Morals,Ethics and practice — in search of social justice

Abstract

This paper reports a study of sources of influence on moral and ethical decision-making in social work practice. Practitioners from ten government and five non government agencies kept journals about the main moral issues they faced over a one-month period and were then interviewed about the nature of those issues, their resolution and the influences that shaped those resolutions. Practitioners' personal moral perspectives were found to be the main sources of influence on resolutions to a wide range of dilemmas and most of those resolutions did not conform to accepted social wok ethical practice principles. Even though the results of this study are drawn from a small sample, some implications are suggested for practitioner development, professional ethics and social work education.     

Religious Discrimination in Social Work

Abstract

Using quantitative and qualitative methods, this study explored perceptions of compliance with the ethical standards related to religion (N = 222). As posited, perceptions of ethical compliance were lower among social workers who affirmed a conservative or orthodox theological orientation compared to those who affirmed a liberal or progressive theology. Standards of particular concern were those related to (a) social work education about religious diversity and the oppression religious people encounter and (b) efforts to prevent and eliminate religious discrimination. In concert with these findings, qualitative analysis indicated two areas of major concern: institutional settings, such as academia, and colleagues. Respondents reported being demeaned, denigrated, ridiculed, and scorned by social work colleagues due to their religious beliefs, particularly in educational settings. Interestingly, 44% of both orthodox and progressive respondents knew of clients who had experienced discrimination due to their religious beliefs at the hands of social work colleagues.     

Reflective practice in a process for the re-approval of ASWs: An exploration of some inevitable resistance

In this article a mental health trainer and a group facilitator explore the background to developing a new protocol to manage the re-approval of mental health social workers in an inner London borough. The new procedure involved social workers attending a series of small group sessions in which they were invited to present and reflect on their work with clients. The dynamics of these sessions and particularly some of the transferential material between group members and facilitator are explored here. The significance for mental health social work, post-qualifying learning and the possibilities of reflective practice is considered.