Private thoughts and public actions:: A commentary on articles dealing with ethical issues in evaluation

This commentary represents a personal reaction to seven articles on ethical issues in evaluation. The author of the commentary begins with two assumptions: (1) Professional evaluators might not have the vocabulary and constructs to analyze their thoughts and actions in ethical terms, and (2) professional evaluators have often confronted troubling situations that probably contain ethical issues embedded within them. Consequently, she queries the seven articles individually and collectively in terms of the following questions: 1. What is the range of ethical problems I might encounter as an evaluator; and how do I recognize the ethical characteristics of professional dilemmas? 2. How do I describe troubling evaluation problems I have encountered that seem to have an ethical component? 3. What are some approaches I have used or might use in thinking about a proper course of action? 4. How do I know if, in a given situation, I have behaved ethically? 5. Where do we go from here?     

Gamesmanship for internal evaluators: Knowing when to “hold 'em” and when to “fold 'em”

This article discusses the ethical conflicts between an internal evaluator's altruistic social reform motivation and an organization's practical survival motivation. The internal evaluator might encounter (a) pressure to downplay negative and emphasize positive findings; (b) reinforcement for nonthreatening, routine evaluation activities; (c) greater interest in making the evaluation unit visible than in using evaluation results; or (d) reduced access to privileged information.     

Road signs in ethical quicksand

This commentary highlights some of the major moral and ethical dilemmas illustrated by authors in this special issue. From an ethical viewpoint, the complexity of evaluation activities is likened to “quicksand” terrain in which directional or warning signs should be erected to aid personal choices when such issues are encountered. However, even previous training and personal introspection are inadequate to completely avoid, circumvent, or handle a specific situation because of its complexity and the competing values inherent in ethical choices.     

Exploring Three Functions in Child Custody Evaluation for the Relocation Case: Prediction,Investigation, and Making Recommendations for a Long-Distance Parenting Plan

SUMMARY

The psycho-legal dilemmas posed by child custody relocation cases are discussed in terms of the four decisional alternatives facing the court and evaluator. Different legal contexts for relocation are reviewed in terms of their implications for the custody evaluation. Complexities involved in the evaluator's function of making predictions for the court are presented. The need to conduct careful investigation on both risk and pragmatic factors is highlighted by case illustrations. The obstacles of crafting of long distance parenting plans that will be in the best interests of the child are presented as governed by the goal of harm mitigation.     

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.     

The evaluation and monitoring of a Medicaid second surgical opinion program.

The evaluation of newly implemented and controversial programs often present real problems for the evaluator. When a program is accompanied by a legislatively mandated evaluation, the issues become even more acute. The evaluator, wanting to impact on policy, must strike a balance between the adherence to principles of scientific inquiry, yet be responsive to the needs of policymakers. This paper describes the evaluation and follow-up monitoring of a recently established second opinion program for Medicaid recipients. The program was to terminate in 17 months unless extended by the Wisconsin Legislature. The evaluation found, among other things, marked reductions in the use of surgical services after implementation of the second opinion program. Based in large part on the evaluation, the program was extended with a provision for continued monitoring. The paper discusses the factors that contributed to the evaluation having a major impact on the decision to extend the program.     

Working with Domestic Violence: Ethical Dilemmas in Five Theoretical Approaches

Therapists working with domestic violence are trained in many different theoretical models, each based on different values and assumptions. Each model raises different ethical dilemmas. In this paper, five theoretical approaches are evaluated in relation to the ethical principles of: respect for clients' autonomy; beneficence; non‐maleficence; and justice. The inverse relationship between respect for autonomy and beneficence and non‐maleficence is discussed. The hierarchical asymmetry involved in the therapeutic relationship is also explored.     

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication

Abstract

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.     

Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents

SUMMARY

This paper will focus on ethical dilemmas that arise in the treatment of adolescents with gender dysphoria. We will begin with a discussion of ethical and legal issues pertinent to the treatment of any adolescent, and then proceed to the gender dysphoric adolescent, since there is a great deal of overlap between the two areas. The authors re-view legal decisions, the existing data on adolescent decision-making, and ethical principles that may help the clinician in resolving some very complex situations. Utilizing case vignettes of three gender dysphoric adolescents, the authors provide a pragmatic illustration of the ethical dilemmas involved in evaluation and treatment of these youth. It is the authors' belief that treatment interventions should be based on respect for the adolescent's autonomy and confidentiality where he or she is deemed competent to make decisions.     

ETHICAL DILEMMAS IN FAMILY THERAPY

A review of the literature in the area of ethical dilemmas facing family therapists revealed that there were a number of issues facing family therapists which are not included in the Principles for Family Therapists (1984) of the American Association for Marriage and Family Therapy. Seventy-five family therapists from across the nation responded to a questionnaire which asked what ethical dilemmas they face and how helpful the ethical guidelines are with these dilemmas. Results indicate that family therapists are encountering dilemmas which are not included in the Principles, significantly more often than those that are included. The ethical principles were found to be helpful for those ethical dilemmas attended to by the Principles.     

Analysis approaches to community evaluation

Analysis approaches to the evaluation of community interventions must be sensitive to a wide variety of analytic contaminants that may bias the statistical assessment of changes in outcome measures. These contaminants include model misspecifications related to failures to control for community-specific time trends, temporal autocorrelated errors in equations, spatial autocorrelated errors among geographic units, and other failures of unit independence otherwise indexed by estimated intraclass correlations. Although an enormous amount of progress has been made toward the solution of many of these analytic problems over the past years, the contemporary evaluator of community interventions is left with a number of unenviable design and analysis choices; choices that inevitably force an assessment of the relative threats of different sources of error to the internal and external validity of the evaluation. This article describes the choices made for the evaluation of the Community Trial Project outcome data.     

Assessing competency-based evaluation course impacts: A mixed methods case study

The contexts in which evaluators develop and apply their expertise are increasingly complex; evaluator education needs to provide robust opportunities to support and assess the progressive, lifelong development of relevant knowledge and skills. This mixed methods case study begins to address the dearth of empirical evidence assessing the impacts and learner experiences of competency-based approaches to evaluator education. A decade-in-the-making doctoral evaluation course based on the Canadian Evaluation Society’s Competencies for Canadian Evaluation Practice created an opportune study setting. We applied a systems perspective to Stufflebeam’s Context, Input, Process, and Product (CIPP) model to frame the case study analysis and presentation of the complex impacts generated by pre/post course competency self-assessments and reflections, integrated with an end-of-course focus group. Seven insights shed new light on the effective course design and implementation features for developing intended and unintended evaluator competencies. We conclude with a discussion of the theoretical, practical, and methodological implications for effective competency-based evaluator education.

• •Keywords: Case study; Competency-based approach; Evaluator education; Mixed methods research

     

The care manager’s dilemma: balancing human rights with risk management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such ‘care recipients’ from the criminal justice system to a disability sector that values a social model of disability and philosophies of autonomy, choice and normalisation. This research identified dilemmas faced by care managers legally responsible for care recipients. Care managers experienced: tension between imperatives of risk management, rehabilitation and human rights; role ambiguity between ‘custodian’ or ‘therapist’; philosophical incongruity within their services; and ethical dilemmas over decisions to lengthen care orders. The changing care recipient population has intensified these dilemmas: services must now adapt to the needs of young, street-wise people with alcohol and drug problems and histories of criminal behaviour. The article makes recommendations about how these dilemmas can be addressed.     

INTERNET: A Framework for Analyzing Online Human Service Practices

SUMMARY

The Internet and related electronic communication technologies are used by human service professionals for many functions ranging from the storage and transmission of sensitive medical information to online counseling. Yet, there are many aspects of telecommunications law that work against privacy and thus the potential for ethical dilemmas has increased. This paper explores and discusses the complex reasons contributing to these ethical dilemmas. The article also presents a human service oriented framework, INTERNET, for analyzing and resolving these dilemmas.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

Trustworthiness in evaluation practice: an emphasis on the relational

As canons for trustworthiness developed explicitly in the discourse of qualitative inquiry, the emphasis was on procedural matters rather than fundamentally relational ones. A nod was made to the relational in such strategies as “member checks” but the issues of how the evaluator actually relates to participants and to the larger communities of practice and discourse—matters subsumed under moral principles and ethical standards—were often marginalized. This chapter posits that the first consideration in designing and conducting rigorous evaluation inquiry, and in critiquing the results of any research, should be the study's trustworthiness. Judging a study's trustworthiness, however, should focus on much more than procedural matters; it should also rely on moral principles and ethical standards which specifically address how we relate to an evaluation's participants. Central to these considerations are cross-cultural sensibilities about the nuanced meanings associated with any principles and standards. The chapter provides a theoretical framework for this position and offers two illustrative examples in the form of dialogues.     

Ethical problems in program evaluation: Advice for trapped evaluators

This paper argues that ethical problems in program evaluation are increased when conflicting or incompatible evaluation models are applied concurrently. Three models are illustrated: an Amelioration Model, generating better information for a program's own decision makers; an Accountability Model, focusing on public data disclosure and citizen participation in evaluation; and an Advocacy Model, in which the evaluation is designed to advance the program's interests in the competition for resources. Ethical problems inherent in each model, and arising from combining models are presented, along with case examples and discussion. The authors suggest several directions that program evaluators can consider to reduce their vulnerability to ethical problems.     

You got a problem with that? Exploring evaluators' disagreements about ethics

A random sample of American Evaluation Association (AEA) members were surveyed for their reactions to three case scenarios--informed consent, impartial reporting, and stakeholder involvement--in which an evaluator acts in a way that could be deemed ethically problematic. Significant disagreement among respondents was found for each of the scenarios, in terms of respondents' views of whether the evaluator had behaved unethically. Respondents' explanations of their judgments support the notion that general guidelines for professional behavior (such as AEA's Guiding Principles for Evaluators) can encompass sharply conflicting interpretations of how evaluators should behave in specific situations. Respondents employed in private business/consulting were less likely than those in other settings to believe that the scenarios portrayed unethical behavior by the evaluator, a finding that underscores the importance of taking contextual variables into account when analyzing evaluators' ethical perceptions. The need for increased dialogue among evaluators who represent varied perspectives on ethical issues is addressed.     

Decision-making capacity: the core of self-neglect

Self-neglect in the elderly is a pervasive public health issue that affects 1.2 million elderly each year. In working with self-neglect cases, ethical issues are often raised that challenge all professionals. Professional and family's wishes to remove obstacles to the wellbeing of an elderly may be directly in opposition to the individual's wishes. The core of many ethical dilemmas resides in the question of the individual decision-making capacity. Issues surrounding decision-making capacity are complex with many confounding factors. Through case-discussion, fundamental ethical issues of decision-making capacity relating to self-neglect will be explored and strategies will be offered to resolve these dilemmas.