The Children’s Institute, Inc. (CII) is a premier agency providing pro bono emergency intervention services primarily designed for child victims of family violence. Since its inception, the CII at the Compton city location, south of Los Angeles, has rendered children services to over 27,000 affected minors in the county (Children’s Institute, Inc. 1).
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The services provided include counseling to enable vulnerable children to recover from trauma, empowerment of caregivers, and social support, among others. The CII’s vision is founded on a three-R model, i.e., “recovery, resiliency, and readiness” (Children’s Institute, Inc. 3). It aspires to help affected minors heal from trauma, foster resiliency, and prepare them for a prosperous academic and social future. This essay examines the CII’s operations in the context of social work values and the administrative and micro-level steps for resolving any conflict between the CII’s policies and professional values.
Policies/Operations Reflecting the Value-based of the Social Work Profession
The professional code of ethics prescribes three core value bases that represent the social work profession, i.e., human rights, social justice, and professional integrity (British Association of Social Work [BASW] 10). Upholding human rights means “respect for the inherent worth and dignity” of all individuals while social justice entails promoting equity, fairness, and diversity (BASW 16). The professional integrity theme requires social workers to preserve professional values in their conduct and practice.
One way in which the CII’s operations reflect the value-base of the social work profession is through its focus on the whole child or the entire family. A core principle of the human rights value base is the treatment of a person as a whole. The holistic approach entails the recognition of the whole individual in the context of his or her family, community, or natural settings (BASW 15). This means that social work interventions should consider all facets of an individual’s life. CII’s operations aim at three agency outcomes, namely, recovery, resiliency, and readiness (Children’s Institute, Inc. 3). This family-centered approach is formulated to treat the whole child or family. It supports recovery from unpleasant childhood experiences, resiliency and prevention, and preparedness for academic and social success.
The agency uses an integrated service model encompassing clinical services for trauma victims, child/youth development services (resiliency), family support (parenting education), and early childhood services. It provides family support through ‘Project Fatherhood’, child prepares for kindergarten, evidence-based mental health services for vulnerable groups, and youth development to improve social skills. These services reflect the principle of treating each individual as a whole, which underlies the human rights value base.
Policies/Operations Conflicting the Value-based of the Social Work Profession
However, this disclosure excludes psychotherapy notes documenting the details of a counseling session. The provisions of the confidentiality policy give psychologists the right to disclose psychotherapy notes to the patient. In other words, the psychologist decides whether to release this information, which is kept separate from the PHI record, to the patient. Therefore, the policy, in this respect, raises an ethical dilemma relating to professional accountability and confidentiality.
Social workers are required to be accountable for their actions and decisions and rationalize their clinical judgments. Psychotherapy notes contain the therapist’s impressions about the client; they form the basis for selecting a particular treatment/intervention. Under the HIPAA rule, patients can access their PHI records; however, this right of access does not cover psychotherapy notes, which are accorded protection that is more stringent. Therefore, a psychologist may deny patient access to this information, resulting in an ethical conflict with the professional accountability principle.
Administrative-level Steps for Resolving the Conflict
In CII, balancing between the issues of confidentiality and professional values on accountability would require a series of administrative-level actions. One administrative-level step that could be taken to resolve the identified ethical conflict is by holding regular administrative meetings to brief staff on PHI privacy issues and how to navigate through the ethical dilemma related to confidentiality and professional practice. A series of meetings will allow the CII staff to share the ethical conflicts experienced and devise ways of handling privacy matters without subjugating professional accountability.
Another step that the CII could take to address the ethical conflict is through educational programs. The understanding of possible privacy issues is a prerequisite for ethical decision-making. A training program involving educational workshops will help impart ethical decision-making skills to the CII’s staff. In particular, the administrators will learn how to identify and resolve ethical issues related to PHI privacy without appearing to derelict their professional responsibility. Further, the training will communicate the organizational policy on confidentiality and relate it to the requirements of the HIPAA act. Additional educational workshops will train the CII employees on ethical considerations relevant to patient confidentiality.
An employee assistance program could help develop staff capacity to balance between confidentiality and the professional accountability obligation. Such programs should focus on supporting new CII volunteers, such as psychologists participating in its early childhood services and youth development programs, to understand the organizational policy on confidentiality. Moreover, the assistance programs will educate staff on the PHI disclosure and reporting procedures in the event of a breach.
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Micro-level Steps for Resolving/Minimizing the Conflict
Another individual-level action involves helping others in identifying solutions to ethical conflicts related to the privacy issue. This action will enable one become familiar with the resolution of ethical issues related to confidential information. In addition, it will broaden one’s understanding of the ethical reasoning behind information disclosure as well as how to balance between confidentiality requirements and professional accountability for mutually acceptable outcomes.
British Association of Social Work [BASW]. The Code of Ethics for Social Work: Statement of Principles, 2012. PDF file.
Children’s Institute, Inc. Impact Report, 2015. PDF file.