Social Work in the Digital Age: Ethics and Risk Management Challenges

Editor’s note: This text-based course is an edited transcript of the webinar, Social Work in the Digital Age: Ethics and Risk Management Challenges, presented by Frederic G. Reamer, PhD.

Learning Outcomes

After this course, participants will be able to:

• Identify ethics and risk management issues related to online and distance social work.
• Apply relevant ethics and practice standards related to online and distance social work.
• Use policies and protocols designed to protect clients and prevent litigation and ethics complaints.

  Introduction

Social work in the digital age is a timely subject regarding ethics and risk management challenges. I spend time serving as a formal consultant in lawsuits filed against social workers for malpractice or negligence. In recent years, more of those cases have involved digital technology. Social workers are using technology to accomplish three things: 

• Social workers use technology to serve clients remotely, and sometimes these are clients social workers never meet in-person.
• Social workers who are using technology to communicate with clients. 
• The ways in which we are using technology to manage and store and locate sensitive information and that might be in the form of electronic health records (EHRs) and electronic medical records (EMRs). 

All of these points have raised ethical and risk management issues, which are relatively new to social work. The profession has been around for over a century, but these issues have been on our webscape in recent years. 

Key Ethical Challenges in the Digital Age

I want to address three major themes: 

• Ethical Dilemmas: Conflicts between social workers’ duties and obligations-- difficult choices.
• Ethical decision-making: Deciding on a course of action when ethical dilemmas arise.
• Ethics risk management: Protecting clients and practitioners (lawsuits, licensing board complaints, ethics complaints, e.g., National Association-Social Workers (NASW)).

Ethical dilemmas are difficult choices. I would be the first to admit that many ethical issues in social work are not that complicated. We do not need a speech to persuade social workers to not have a relationship with a client or to not falsify records. There are other more difficult dilemmas. For example, a social worker may be using technology to serve clients remotely when they would normally insist on seeing clients in the office due to the level of need. However, due to the pandemic, social workers may not have that option. Should we serve these clients remotely knowing the limitations of technology? Another dilemma may involve searching for information online without a client's knowledge or consent. Social workers may want to respect their clients’ privacy on one hand but may feel a compelling need to locate information about them. There are a range of ethical dilemmas related to informed consent, confidentiality and privacy, boundary issues, and dual relationships. There are other issues regarding documentation and termination of service as well. 

I want to address ethical decision-making. How do we decide on the course of action? We want to protect clients, but also protect ourselves. That leads to ethics risk management. That is a practical application of ethical standards and decision-making protocols. This way, lawsuits prevent licensing board complaints and ethics complaints filed with NASW, employers, or other organizations. 

Emerging Ethical Issues in Online and Distance Social Work

There are six fundamental questions that we need to ask: 

• What do we mean by “relationship”?
• Who do we aim to serve?
• What do we mean by “privacy”?
• What are the boundaries of professional-client relationships?
• What do we mean by “informed consent”?
• How do we manage and access clinically relevant information?

When we talk about relationships, this usually means connecting with a client and developing a therapeutic alliance in the office. We now need to relate to clients we may never meet in-person. How does that redefine what we mean by relationship? 

Regarding who we serve, the NASW Code of Ethics includes a statement about how we are deeply committed to helping all people, especially those who are oppressed and vulnerable. I know many clients who cannot afford a smartphone or a data plan. Our dependence on technology can limit who we are able to serve, which raises an ethical issue.

With privacy, a client can typically come into an office and have a private session. When you provide remote services to clients, you may not know who else is in that client's living space. When you conduct a Google search or a Facebook search without your client's consent, it raises some complicated questions about the nature of the client's right to privacy. Additionally, there are questions about your right to privacy. Many clients conduct searches for information about their social worker. In many instances, clients find personal information about where their social worker lives, if they are married, and so on. 

Looking at boundaries, clients may ask the social worker how old they are, if they have kids, if they are a person of faith, and so on. Clients are often curious about social workers’ private lives, and that raises new boundary issues because of technology. How does a social worker respond to a client's Facebook friend request? If you are providing services remotely, when does your workday end? Suppose the client sends a crisis-related message late at night. Is it okay to engage with a client late at night? 

Informed consent is not a new concept. We ordinarily get a client's consent when they are sitting in front of us, and now we may have to get a client's consent remotely. How do we assess their ability to understand the informed consent explanation? A client may tell us they are 22 years old. How do we know that they are not 17? 

How do we manage and access clinically relevant information? Some of you may be working in integrated care settings. I am a fan of this because you can have primary health care, psychiatric services, and social work services all in one location. It is great that we are able to connect both physical and mental health. However, how do we determine which employees should have access to sensitive information about our client's lives? A growing number of agencies are now providing clients with a username and a password in order for them to remotely access clinical notes. 

Examples of Ethical Challenges in the Digital Age: Key Themes

This also raises interesting and complicated ethical issues. Here are some examples of ethical challenges in the digital age: 

• Confidentiality and privacy: Protected health information (PHI); Health Insurance Portability and Accountability Act (HIPAA)-compliant software; searching online for information about clients. 
• Boundary issues and dual relationships: Clients who search online for information about social workers; responding to Facebook requests; Facebook relationship with former clients; after-hours digital communications; social workers and clients “see” each other’s homes during virtual sessions.
• Documentation: Clients’ remote access to records; challenges of EHR/EMR; integrated health records. 
• Termination of services and client abandonment: Clients who need a higher level of care; response time and digital communications; managing emergencies; limiting services to short message service (SMS)/text messages. 

With regard to confidentiality and privacy, we have to be concerned about the protection of PHI. If you fall under HIPAA guidelines, we have to be careful of how we protect this information. Many of you are using software to communicate with clients to deliver services to them and store your records. On March 17th of 2020, the Federal Office for Civil Rights issued a policy that relaxed enforcement of practitioners’ use of HIPAA compliant software due to COVID-19. However, that relaxation of enforcement only applies to times of emergency due to COVID-19. We need to think carefully about using HIPAA compliant software. Even if you are not formally required to use HIPAA on your device, I encourage you to do so anyway because it can enhance the likelihood that you will protect clients and yourself in the event that there is a breach. There are privacy issues when social workers search for information online about a client’s life, particularly if it is without that client's knowledge. There are new standards regarding this issue. 

Boundary issues and dual relationships refer to clients who search online for information about you. What if you have a Facebook account and you receive a request for services from a Facebook friend? Is it ethically appropriate for you to provide services to this friend? These are novel questions with video counseling. On video, you can see the inside of your client's home. You may also see the inside of a client's bedroom, which raises some boundary issues as well. On one hand, it might be useful to do a virtual home visit. Even though you are not formally providing home-based services, that might provide you with useful clinical information. However, you want to recognize that clients are also seeing the inside of your home. For example, some of you may not be able to go to your office due to the pandemic. Glimpses of your home may humanize the relationship. However, it is possible that clients are paying attention to your surroundings rather than to you. That raises an interesting intersection between clinical and boundary issues. 

Another major theme is documentation. An increasing number of clients have remote access to your clinical notes. There is debate about whether this is a good idea or not. Many social workers argue that this is a way to empower clients and allow them to become more engaged in their care. However, many social workers are uncomfortable with this because they worry about how clients might interpret their notes. They may misunderstand a term when the social worker is not there to explain. Our Code of Ethics says that clients generally have a right to see their records. When I drafted the standard for the NASW Code of Ethics and included this statement, I never imagined that clients would be able to do this remotely. An increasing number of social workers are working in integrated care settings and we have to make some hard decisions about which employees should have access to clinical notes. It may be necessary to create firewalls, drop-down menus that limit access, and so on. I have been involved in licensing board cases where agencies did not have those precautions in place. Employees who did not have a clinical role were then curious about a client and accessed their information when they should not have. 

In addition, there is the termination of services and client abandonment. Our Code of Ethics includes a number of ethical standards pertaining to this theme. When my colleagues and I drafted this section in the 1990s, we thought about the difficult decisions that social workers need to make when they have to terminate services. They may need to refer a client to a higher level of care when the social worker believes that they do not have the expertise that the client needs. Additionally, we are now addressing newer issues related to technology. You may feel uncomfortable providing remote services to someone who has significant clinical needs, but you also may not have a choice in the middle of the pandemic. You may not be able to promptly respond to a client's message about a potential crisis, and that raises issues of client abandonment. Did you abandon your client because you were not available? How do you manage emergencies remotely? 

There are some platforms that enable social workers to provide counseling entirely through text messaging. I know some social workers who are comfortable using that as an option, and some clients prefer that. I know other social workers who believe that that is not counseling. It is a debate within the profession. Are we abandoning clients if we limit our services to text messaging? 

Terminology in the Digital Age

We are now using terminology that did not exist when many of us started with social work: 

• Internet-supported Intervention
• Web-based therapy
• E-interventions 
• Computer-mediated interventions
• Online therapy
• Online counseling
• Technology-assisted distance counseling (TADC) 
• Virtual social work
• E-therapy/e-counseling
• Cybertherapy/cybercounseling 
• E-health
• Psycho-technology 
• Tele-Health 
• Internet counseling
• Therapy-E-Mail

Forms of Online and Distance Social Work Services

There are social workers who are using technology to provide all of these services that are now part of the profession:

• E-therapy chat (live)
• Moderated forum
• Web-based psychoeducation
• Self-guided, web-based interventions with automated feedback (e.g., anxiety, phobia, self-esteem, anger, weight loss).
  • Human support
  • No human support
• Video conferencing
• Mobile apps
• Social networking
• Telephone therapy
• Avatar therapy
• Expert systems
• Email exchanges 
• Text messages
• Client Blogs 
• Client Twitter

Potential Advantages

Having done research on the ethical and risk management implications of online and distance social work, I believe that there are potential advantages: 

• Emotionally safe (e.g., shy, anxious client)
• Semi-anonymity regarding self-disclosure
• Increased chance of candor
• Convenience 
• Absence of geographical barrier
  • Rural areas
  • Clients with disabilities 
• Immediacy 
• Flexible scheduling
• Cost-effective

For some clients, online services are a safe way to get help because they may be shy or anxious. They may prefer the semi-anonymity and the convenience. If they live far away from a social worker’s office, they can get services without driving long distances. If they have disabilities, they do not have to travel. They can find somebody who is available to provide them with crisis intervention. Many people enjoy flexible scheduling and it is often cheaper than office space services. 

Potential Risks and Challenges

There is evidence of potential risks and challenges:

• Loss of human factor, nonverbal cues
• Misunderstandings 
• Compromised privacy and confidentiality
• Boundary issues (ambiguous access, self-disclosure)
• Difficulty addressing long-term, complex problems
• Delayed response
• Feeling rushed to respond to emails, texts
• Emergencies
• Identity fraud
• Interstate practice without a license
• Technological failure 

There is the absence of the human factor and nonverbal cues, which are often meaningful in our relationships with clients. There is also the potential for misunderstandings, as well as compromised privacy and confidentiality. 

Boundary issues include clients discovering information about our personal lives and difficulty addressing long-term, complex problems remotely. There is risk for delayed response if we are not communicating with clients synchronously, as opposed to asynchronously. Social workers have reported feeling rushed to respond to messages and may find it burdensome. How do you handle emergencies? What do you do about identity fraud? A client may give a name, but that is not who they really are. They may also say that they are 22 years old, but they are really 16 or 17 and are not authorized to consent to services under state law. What about social workers whose clients suddenly move to another state? They want to continue with that social worker when they may not be licensed in the client's home state. 

What about the possibility of technology failure? The WiFi can stop working, the computer screen can freeze, or the audio can break up. These things can happen right when there is a clinical breakthrough or when the client is sharing intense information that requires attention. 

High-Risk Clients for Online and Distance Services

Evidence suggests that there are high-risk clients when it comes to providing remote services. 

Here are some characteristics that can be seen in high-risk clients: 

• Suffering from psychiatric disorders needing immediate attention.
• Significantly depressed.
• A danger to themselves or others.
• Struggling with serious substance abuse issues.
• Presenting psychotic or actively suicidal concerns.
• Struggling with psychological disorders characterized by distortion of reality
• Highly reactive and potentially dangerous.
• Struggling with certain personality disorders such as those with borderline personality disorder, paranoia, or dissociative disorders.

The literature suggests that if these characteristics are present in clients, it may not be appropriate for online and distance services. However, we may not have a choice during the pandemic.

New Standards in Social Work

For the past couple of years, we have had new standards governing social workers' use of technology to do the three things that I mentioned earlier: deliver services to clients remotely, communicate with clients using technology, and manage, store, and locate information using technology. 

Here are three sets of standards that probably did not exist when many of you started your careers in social work: 

• Regulatory standards 
  • State licensing boards: https://www.aswb.org/wp-content/uploads/2015/03/ASWB-Model-Regulatory-Standards-for-Technology-and-Social-Work-Practice.pdf
• Practice standards
  • NASW, The Association of Social Work Boards (ASWB), Counsel on Social Work Education, (CSWE) and The Clinical Social Work Association (CSWA) (2017):https://www.socialworkers.org/LinkClick.aspx?fileticket=lcTcdsHUcng=&portalid=0
• Ethical standards
  • NASW Code of Ethics (effective 2018): https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Highlighted-Revisions-to-the-Code-of-Ethics

Regulatory standards are promulgated by licensing boards. Several years ago, the ASWB appointed an international task force to develop model standards pertaining to social workers’ use of technology. 

The second point is about practice standards. The NASW, ASWB, CSWE, and CSWA, the four major national organizations of the United States’ social work, combined forces for the first time in history. They developed new practice standards related to social workers' use of technology. These standards were adopted in 2017 and are now considered the measuring rod. Private practitioners and licensing boards are using them when there are issues related to technology in a licensing board case in litigation. 

Regarding ethical standards, the NASW Code of Ethics was drafted and updated for one primary purpose: to include new standards related to social workers’ use of technology.

Key Ethical Issues in Online and Distance Social Work

Let me highlight the ethical issues that those three sets of standards address: 

• Informed consent
• Privacy and confidentiality
• Boundaries, dual relationships, and conflicts of interest
• Practitioner competence
• Records and documentation
• Collegial relationships

Informed Consent

An example of informed consent is about standards regarding verification of client identity and their capacity to consent-based on their age and competence. Potential informed consent risks relate to confidentiality breaches, emergency services when we are working remotely, the potential interruption of services, and challenges related to a client's language or literacy. Issues related to privacy and confidentiality. 

Privacy and Confidentiality

The next theme relates to confidentiality. The three sets of standards address privacy, protection, and encryption. There is adherence to relevant laws and regulations regarding remote delivery of services, electronic records, and conducting online searches without client knowledge or consent. Confidentiality agreements when we are conducting online group treatment brings up an issue as well because the clients never meet. Exceptions to clients' confidentiality rights, which all social workers are familiar with but these are particularly challenging when we're providing services remotely. 

Boundaries, Dual Relationships, and Conflicts of Interest

These next points are related to boundaries, dual relationships, and conflicts of interest. The three sets of standards address boundary issues that emerge when we have online social networking relationships. These relationships can be with current clients, former clients, or former social media friends who want to become clients. There can be trouble with social worker self-disclosure in online communications as well. When we are providing virtual services, clients and social workers may see the inside of each other's homes. 

There are boundary issues pertaining to social worker-client access late at night as well. We need to consider online relationships with former clients. These are issues we did not have to think about in the 1990s when my colleagues and I drafted the Code of Ethics. There are potential conflict of interest issues as well. Some social workers are using commercially sponsored software because it is cheap or free, but it has advertisements embedded in it. Clients may then have the impression that social workers endorse those products. 

Practitioner Competence

Regarding practitioner competence, the three sets of standards address issues related to social worker competence when they are using technology to serve clients. You should learn how to communicate effectively using technology and how to handle emergency situations from a remote location. You want to know how to abide by laws of both the social worker’s and the client’s locations, including licensure laws. Be sensitive to the client's culture. This includes the client's cultural community and their linguistic, social, and economic environment. Not all clients relate to technology in the same way. There are some cultural differences that we should always be thinking about. Know how to attend to a client's unique needs and challenges. Learn how to ensure that the technology is in working order to provide effective services and avoid disruption. You want to keep abreast of the changing landscape. Technology changes rapidly and we need to know how to adapt. 

Documentation and Records

With documentation, the three sets of standards address issues related to encryption and staff access. I mentioned the issue involving integrated care settings and third party remote access. Issues can arise if clients have access to your clinical notes using a portal. You want to know what to document and how to document all messages and other cybertherapy communications that are embedded in a software. There are other issues around record retention. We now have electronic records as opposed to a file cabinet. Be mindful of issues surrounding how we dispose and destroy electronic records. Also, it is important to know how to comply with federal and state laws regarding electronic records. 

Collegial Relationships

Looking at relationships among colleagues, it is important to consider how we relate to each other. We want to treat each other with respect in our digital communications. There have been licensing board complaints focused on alleged unprofessional communications between social workers online. We should be avoiding derogatory and defamatory postings in online communications and social networking. Our obligation to respect colleagues' work products is still present online. I have been involved in cases where social workers copied and pasted a colleague's online content for their own website. They never acknowledged where it came from. Also, be cognizant of issues around unauthorized uploads. Be aware of responding to colleagues' unethical conduct. I have been involved in several cases where a social worker became aware of a colleague's unethical conduct online. Additionally, avoid cyberbullying with colleagues. 

Potential Ethics Risks in Online and Distance Social Work

There are three prominent risks when social workers use technology to serve clients, communicate with them, and so on: 

• Ethical mistakes: Inadvertent errors.
• Deliberate ethical decisions: Ethical judgments in the face of ethical dilemmas.
• Ethical misconduct: Violation of ethical standards. 

The first risk refers to ethical mistakes, which are inadvertent errors. The vast majority of social workers are not going to engage in unethical conduct. However, I have been involved in a number of lawsuits as an expert witness where good social workers made mistakes with regard to technology. One case was about a social worker who sent an email message that contained confidential information and it ended up in the wrong hands. Another case included a social worker communicating with clients, and some of the content was not appropriate. There were boundary issues because it was happening late at night. I was involved in another case where a social worker, a person of faith, posted on Facebook asking the social worker prayer group to pray for one of their clients who was having a tough time. They did not disclose the client’s name, but they did include too much information that enabled one of those group numbers to identify that client. This situation then led to a licensing board complaint. Another example is how a social worker had previously exchanged text messages with a clerical person in their agency, gossiping about a client. 

The second category involves deliberate ethical decisions, which are tough decisions. Should we provide remote services using only text messaging? When we have electronic records, who should have access to sensitive information? Should we conduct an online search for information about a client without their knowledge or consent? 

There are also cases involving the violation of ethical standards. I recently testified as an expert witness in a case where there was evidence of a social worker violating boundaries through text messages exchanged with a client. Some of those messages include graphic language and inappropriate photos. This is a social worker who is now in deep trouble with the licensing board because of their misuse of technology. I also testified in a case where a social worker was arrested, charged, and sentenced to prison. They conducted inappropriate relationships with several clients. 

Standard of Care in Online and Distance Social Work

In cases with allegations of social workers violating ethical standards, the measuring rod is what lawyers call standard of care. This is a key concept that every social worker needs to know. It is defined as, “what a reasonable and prudent professional with the same or similar training should have done under the same or similar circumstances.” This concept has been around since the late 1800s. A famous court case called Coombs v. Beede gave rise to this standard in the United States. The same language is now being used to assess whether social workers are using technology appropriately to deliver services, communicate with clients and manage, and store and locate information. Would a reasonable and prudent social worker provide clinical services to a high-risk client using only text messaging? Would they provide services to a former Facebook friend? Would they conduct an online search without the client's knowledge or consent? These are complicated ethical issues in the digital age, and the standard of care language is as relevant to these challenges as it was in the late 1800s. 

Two Views of the Standard of Care

Social workers who are trying to determine the standard of care should think about two views. The first view is the substantive standard of care. This means that we now have standards regarding online relationships with clients and the delivery of remote services. These are issues relating to the delivery of remote services using technology. This includes conducting online searches without a client’s knowledge or consent. I encounter many situations where reasonable and prudent social workers disagree about the substantive standard of care. There are reasonable differences of opinion regarding whether social workers should use text messaging to provide psychotherapy if they should conduct online searches without the client's knowledge or consent, and whether they should allow clients to read the social worker's notes remotely without the social worker sitting there. In my experience, there are differences in social workers' opinions regarding these substantive standards of care. 

I argue that in the digital age, social workers should consider eight elements as part of the procedural standard of care. If we disagree about the substantive standard of care, we should think about the procedural standard of care. We can then use the same language when we disagree about substantive standards of care. Recognize that minds may differ here, but these eight elements go a long way towards protecting clients and ourselves:

• Consult colleagues and supervisors.
• Review relevant ethical standards.
• Review relevant laws, policies, and regulations.
• Review national practice standards.
• Review relevant literature.
• Obtain legal consultation when necessary.
• Consult the ethics committee, if available. 
• Document decision-making steps.

The first point is consultation. If you are unsure about something, seek consultation, and document it. This shows a good effort to do this ethically. The second point is to review the new NASW Code of Ethics standards related to technology. The third step is to become familiar with the federal and state laws related to your use of technology. This includes HIPAA at the federal level and the Health Information Technology for Economic and Clinical Health (HITECH), which is a federal law regarding use of technology. If you work in a school setting, review the Family Educational Rights and Privacy Act (FERPA). 

Review your licensing board regulations regarding permitted and prohibited use of technology. There have been changes following the model regulations that the International Task Force developed several years ago. There is now extensive literature on social workers’ use of technology, particularly about ethical and risk management implications. There may be some instances where it would be wise to consult a lawyer who specializes in health care law and the use of technology in terms of providing behavioral health and social work services. They can help social workers who are struggling with informed consent, confidentiality and privacy, and documentation issues. If you work in a hospital or rehabilitation facility, there is a good chance you have access to an ethics committee that can provide useful consultation in these instances. 

Finally, I urge you to document your decision-making carefully. Document your review of the NASW Code of Ethics and your state licensing or regulations regarding technology use, your review of federal and state laws that are relevant, your findings with any literature, and your consultation with a lawyer or ethics committee. Having a paper or digital trail can be helpful if questions ever surface about how you manage your technology. I have been an expert witness in many lawsuits where somebody alleged that a social worker was negligent, and they claimed malpractice. This is now happening in regard to social workers’ use of technology. For example, a client may attempt to commit suicide and allege that their social worker was not available when they needed help. There is then a negligence lawsuit that alleges how the social worker did not protect the client’s confidential information in the electronic record. 

Professional Negligence

There are four elements that the party bringing the lawsuit must prove to establish negligence: 

• A duty exists.
• Dereliction or breach of the duty.
• Damage or injury.
• Causal connection between the breach of the duty and the damage or injury (proximate cause or “cause in fact”).

First, establish that a duty existed. If you agree to provide services to a client remotely, that establishes a duty. Second, find if there is evidence dereliction or a breach of duty. This means a violation of the standard of care. You may have used software that was not HIPAA compliant and it did not encrypt the communications properly. Maybe you failed to document the informed consent protocol you followed with a client. Violation of the standard of care is evidence of a breach of duty. 

In cases of negligence, there must be evidence of damage or injury. That is not the case in a licensing board case. In these cases, you did not protect the client’s privacy and they were harmed by that. The fourth element is called proximate cause, or “cause in fact.” This means there is evidence of a causal connection between the breach of duty and the damage or injury. This is the standard framework that lawyers march through in a negligence lawsuit filed against a social worker. 

Relevant Laws

There are four different types of laws that you need to be familiar with: 

• Statutory law
  • Federal: HIPAA, HITECH (Health Information Technology for Economic and Clinical Health) Act, FERPA
  • State: treatment of minors, confidentiality, telehealth, social work licensure
• Regulatory law 
  • Federal: 42 CFR Part 2
  • State: treatment of minors, confidentiality, telehealth, social work licensure
• Federal and state executive orders (e.g., HIPAA compliance, telehealth, licensure)
• Case law
  • Federal: Jaffe v. Redmond 
  • State: Tarasoff v. Board of Regents (California), Volk v. Demeerleer (Washington), Pollack v. Cruz, Henderson Behavioral Health, et al. (Florida)

The first is statutory law. It is created by the legislative branch of government and there are federal and state statutes. The federal level includes HIPAA, HITECH, and FERPA if you work in a school setting. Additionally, every state and province in Canada has statutes pertaining to the age an individual can consent to services or release of electronic records. 

The second type is regulatory law. It is created by the executive branch of government. An example of this at the federal level would be the United States Department of Health and Human Services or the Department of Veterans Affairs. At the state level, it could be the Public Child Welfare Department. This level develops regulations and addresses the use of technology. 42 Code of Federal Regulations (CFR) Part Two exists at the federal level as well. This is the strictest federal regulation in the United States and it covers any social worker who works in a federally funded setting. It also assesses diagnosis and refers to treatment for substance use disorders. These agencies are using technology to serve clients remotely, particularly if they do not have easy access to the agency. 42 CFR Part Two was recently revised to address technology issues. Any social worker governed by these regulations needs to be familiar with them. There are state regulations pertaining to technology adopted by public health departments, child welfare departments, and so on. 

The third type is federal and state executive orders. For example, these orders are issued by governors or county executives. Due to the pandemic, these county executives were issuing orders that pertain to social workers’ use of technology within a matter of days. 

Finally, case law is enacted by the judicial branch. There are federal and state cases that have created standards regarding social workers’ management of confidential information. Social workers’ efforts to protect third parties might require disclosure of confidential information.

The Importance of Malpractice Insurance

Some of you may be independent or private practitioners and I imagine you have your own malpractice insurance. You may know that your agency has a good malpractice policy that includes coverage for you in the event of a lawsuit. The statistical likelihood of a lawsuit involving your use of technology is not great, but it is not impossible. I have seen many licensing board cases where the issue had to do with whether a social worker was using technology properly. Some of these turned into malpractice lawsuits. There is a chance that your employer's malpractice policy will provide you with coverage. However, I believe every social worker should have their own malpractice policy, particularly in this digital age. 

There are three reasons for this. The first reason is a potential conflict of interest. An example of this would be your employer, who has been sued along with you, retaining legal counsel. When the employer recruits a lawyer through their malpractice coverage, the lawyer's client is the agency, not you. Suppose an employer alleges that you violated their policies related to technology. You can have a conflict of interest and you may be better off having an attorney for you and nobody else. They have to earn a living and I suspect you would prefer not to pay that lawyer out of your pocket. Your employer's policy may have a provision in it, which authorizes retaining separate counsel under that policy to provide you with legal representation. However, your employer's policy might not have that provision. Therefore, one benefit of having your own coverage is that you would then be entitled to separate counsel for you. 

The second reason is about judgments that exceed the cap on your employer’s policy. Many employer's policies have a cap of $1 or $2 million dollars, which sounds like a lot of money. However, I recently testified in a case where there was a jury verdict exceeding $40 million dollars. That judgment exceeded the cap on that employer's policy. Chances are you will never need your own personal coverage, but you do not want to take that chance. 

Finally, a lot of employer policies do not provide legal representation in the event of a licensing board complaint. This is because it is not included in your employer's malpractice coverage. The risk of a licensing board complaint being filed against you is much greater than the risk of a lawsuit. Your employer's policy may not provide any legal representation, but there is always separate coverage if you have your own malpractice policy. Additionally, lawyers can be expensive. A case that may seem simple can end up costing a lot of money. However, I would get your own coverage. If you do that, then I also recommend you maximize it. You can decide how much coverage you want as well. Chances are you will never need it, but there is a possibility. 

With the pandemic and other reasons, many of us are using technology to serve clients and have electronic records. Most of you consider cyber-liability coverage as part of your own policy. There may be an extra premium, but it provides added coverage specifically related to cyber-liability issues.

Resources

• Deardorff, William, “Internet-Based Treatment: A Comprehensive Review and Ethical Issues”: http://www.behavioralhealthce.com/index.php/component/courses/?task=view&cid=69 
• Kolmes, Keely, My Private Practice Social Media Policy: http://www.drkkolmes.com/docs/socmed.pdf 
• Reamer, Frederic G. (2021). Ethics and Risk Management in Online and Distance Social Work. San Diego: Cognella Academic Publishing. 
• Reamer, Frederic G., Risk Management in Social Work: Preventing Professional Malpractice, Liability and Disciplinary Action. New York: Columbia University Press, 2015.
• Reamer, Frederic G., Social Work Values and Ethics (5th  ed.). New York: Columbia University Press, 2018.
• Reamer, Frederic G., The Social Work Ethics Casebook: Cases and Commentary (2nd ed.). Washington, DC: NASW Press, 2018.
• Reamer, Frederic G., Boundary Issues and Dual Relationships in the Human Services.  New York: Columbia University Press, 2012.
• Reamer, Frederic G., “Ethical Standards for Social Workers’ Use of Technology: Emerging Consensus. Journal of Social Work Values and Ethics, 15(2), 2018, pp. 71-80.
• Reamer, Frederic G., Ethical Standards in Social Work: A Review of the NASW Code of Ethics (3rd ed.). Washington, DC: NASW Press, 2018.
• Reamer, Frederic G., "Evolving Ethical Standards in the Digital Age," Australia Social Work, 70(2), 2017, pp. 148-159.
• Reamer, Frederic G., "Distance and Online Social Work Education: Novel Ethical Challenges," Journal of Teaching in Social Work, 33(4-5), 2013, pp. 369-384.
• Reamer, Frederic G., "Social Work in a Digital Age: Ethical and Risk Management Challenges," Social Work, 58(2), 2013, pp. 163-72.
• Reamer, Frederic G., "The Digital and Electronic Revolution in Social Work: Rethinking the Meaning of Ethical Practice," Ethics and Social Welfare, 7(1), 2012, pp. 2-19. 
• Reamer, Frederic G., The Social Work Ethics Audit: A Risk-management Tool. Washington, DC: NASW Press, 2001.
• Reamer, Frederic G., “Eye on Ethics: Novel Boundary Challenges—Social Networking,” Social Work Today: http://www.socialworktoday.com/news/eoe_111309.shtml 
• Zur Institute , Digital Ethics—Internet and Therapy: http://www.zurinstitute.com/articles.html#boundariesemail 

References

Assor, Y., & Goodman, Y. C. (2020). Beyond Ethics: Professionalism and Social Belonging in Social Workers’ Moral Deliberations. Ethnos: Journal of Anthropology, 85(1), 168–187. https://doi.org/10.1080/00141844.2019.1575889

Barsky, A. (2017). Social work practice and technology: Ethical issues and policy responses. Journal of Technology in Human Services, 35, 8-19.

Botrugno, C. (2019). Towards an ethics for telehealth. Nursing Ethics,26, 357-367.

Cooper, S., Campbell, L., & Smucker Barnwell, S. (2019). Telepsychology: A primer for counseling psychologists. The Counseling Psychologist, 47, 1074-1114.

Reamer, F. (2018). Ethical standards for social workers’ use of technology: Emerging consensus. Journal of Social Work Values and Ethics, 15, 71-80.

Reamer, F. (2017). Evolving ethical standards in the digital age. Australia Social Work, 70, 148-159.

Stang, E. (2020). Ethical decision-making in internet research – Investigating protest groups against Child Welfare Services on Facebook. Qualitative Social Work, 19(2), 301–317. https://doi.org/10.1177/1473325018796120