The Social Work Ethics Audit: A Risk-Management Strategy
Author(s): Frederic G. Reamer
Source: Social Work, Vol. 45, No. 4 (July 2000), pp. 355-366
Published by: Oxford University Press
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The Social Work Ethics Audit:
A Risk-Management Strategy
Frederic G. Reamer
In recent years, social work's knowledge base related to
professional ethics has expanded significantly. However, most
practicing social workers concluded their formal professional
education at a time when comprehensive ethics education was not
a critical or mandated component of the curriculum. This article
integrates current knowledge on social work ethics and introduces
the concept of a social work ethics audit to aid social workers in
their efforts to identify pertinent ethical issues; review and assess
the adequacy of their current ethics-related practices; modify
their practices as needed; and monitor the implementation of
these changes.
Key words: ethical standards; ethics; malpractice;
NASW Code of Ethics; risk management
As a result, contemporary social workers,
supervisors, and administrators have access, in
principle, to more sophisticated information
than any previous generation of practitioners.
knowledge base related to professional eth
Especially
the early
1980s,
social
work's
ics hassince
burgeoned.
Social
work's
literature
on the subject has expanded considerably in
several key areas: the nature of social work's
In practice, however, many social workers com
core values and conflicts between personal and
professional values; conflicts among social
workers' professional duties and obligations
(ethical dilemmas); ethical decision making;
ethical misconduct and social worker impair
ment; and ethics-related malpractice and liabil
pleted their formal professional education at a
time when comprehensive ethics education was
not a critical component of the social work cur
riculum (Reamer, 1999). Consequently, social
workers who wish to examine ethical issues ger
mane to their practice settings have had to lo
cate, peruse, and synthesize a wide range of lit
erature on the subject, construct their own list
of relevant issues and topics, and design their
own ethics-related quality assurance strate
gies—a very labor-intensive, daunting process
for most practitioners.
The primary purpose of this article is to inte
grate current knowledge on social work ethics
ity risks (leading to strategies to prevent law
suits alleging negligence related to, for example,
confidentiality, informed consent, social work
interventions, boundary issues, and termination
of services) (Barker & Branson, 1993; Besharov,
1985; Bullis, 1995; Gambrill & Pruger, 1997;
Houston-Vega & Nuehring, 1997; Joseph, 1989;
Loewenberg & Dolgoff, 1996; Reamer, 1990,
1994,1999; Rhodes, 1986).
to aid social workers in their efforts to identify
CCC Code: 0037-8046/00 $3.00 & 2000
National Association of Social Workers, Inc.
355
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pertinent ethical issues in their practice settings,
review and assess the adequacy of their current
practices, modify current practices as needed,
and monitor the implementation of these
changes. I refer to this process as a social work
ethics audit—a process that can be conducted
by individual practitioners and social services
portant aspects of organizational functioning,
when they examine various aspects of an
organization's operations. A comparable tool
can similarly facilitate social workers' efforts to
conduct ethics audits.
As noted earlier, a social work ethics audit
should include two major sections, reflecting
agencies to enhance quality assurance and pro
current knowledge about social work ethics and
mote ethics-related risk management.
their relevance to practice settings: ethical risks
The Concept of an Ethics Audit
and ethical decision making. The audit should
address a number of topical items to guide so
Audits of various types are conducted in many
cial workers as they examine ethics-related
organizations. Ordinarily, an audit entails an
practices in their work settings. In the audit
"official examination and verification" of
organization's functioning, such as its book
each topic can be assessed and assigned one of
four risk categories: (1) no risk—current prac
tices are acceptable and do not require modifi
cation; (2) minimal risk—current practices are
reasonably adequate; minor modifications
would be useful; (3) moderate risk—current
practices are problematic; modifications are
necessary to minimize risk; and (4) high risk—
keeping procedures, service delivery, personnel
and financial records, and billing practices
current practices are seriously flawed; signifi
cant modifications are necessary to minimize
(Courtemanche, 1989; Russell & Regel, 1996).
This concept and practice can be extended
risk.
records and other organizational practices
( Webster's College Dictionary, 1991). Both pro
prietary and nonprofit organizations routinely
conduct audits for accounting purposes, quality
control and assurance, and utilization review.
Audits typically focus on essential aspects of an
easily and fruitfully to the subject of profes
sional and social work ethics. A social work eth
Ethical Risks
Bullis, 1995; Gambrill & Pruger, 1997; Hous
ton-Vega & Nuehring, 1997; Loewenberg 8c
Dolgoff, 1996; Reamer, 1990, 1994, 1999;
Rhodes, 1986).
Traditional organizational audits are con
ducted using structured outlines and invento
A comprehensive ethics audit should assess the
extent to which social workers and agencies
have procedures in place to identify ethics-re
lated risks and prevent ethics complaints and
ethics-related litigation. This form of risk man
agement is an essential function of an ethics au
dit. In tort law (a tort involves a private or civil
wrong, from the Latin "tortus' or 'twisted'), a
risk entails a "hazard, danger, or peril, exposure
to loss, injury, disadvantage, or destruction
The risk that should be reasonably perceived
and avoided defines the common law duty con
cerning the probability or foreseeability of in
jury to another" (Gifis, 1991, p. 426). This sec
tion of the audit should highlight a number of
risks germane to ethical issues encountered in
typical social work practice settings. Consistent
with longstanding social work principles and
values, priority should be given to ethical risks
involving imminent and foreseeable harm to
clients and others (NASW, 1996). Currently
available data and professional standards sug
ries. Accountants and other auditors typically
follow structured guides, listing critically im
gest that there are a number of key risk areas
that should be addressed in an ethics audit in an
ics audit should focus on what currently is con
sidered to be essential or core knowledge in the
profession. Social work's literature suggests two
key knowledge areas that should form the foun
dation of the audit: ( 1 ) the extent of social
workers' familiarity with known ethics-related
risks in practice settings, based on empirical
trend data summarizing actual ethics com
plaints and lawsuits filed against social workers
and summarizing ethics committee and court
findings and dispositions; and (2) current
agency procedures and protocols for handling
ethical issues, dilemmas, and decisions (Please
eliminate some of these citations, preferably
the older works. Barker & Branson, 1993;
Social Work / Volume 45, Number 4 / July 2000
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procedures concerning protection of confiden
effort to protect clients and prevent ethics com
plaints and ethics-related lawsuits (Austin,
tial written and electronic records, information
Moline, & Williams, 1990; Barker & Branson,
transmitted to other parties through the use of
computers, electronic mail, facsimile machines,
1993; Besharov, 1985; Houston-Vega &
Nuehring, 1997; Reamer, 1994). These topics to
telephones and telephone answering machines,
and other electronic or computer technology;
transfer or disposal of clients' records; protec
tion of client confidentiality in the event of the
social worker's death, disability, or employment
termination; precautions to prevent social
workers' discussion of confidential information
be included in an audit include client rights,
confidentiality and privacy, informed consent,
service delivery, boundary issues, conflicts of
interest, documentation, defamation of charac
ter, supervision, training, consultation, referral,
fraud, termination of services, and practitioner
impairment.
in public or semipublic areas such as hallways,
waiting rooms, elevators, and restaurants; dis
Client Rights
closure of confidential information when dis
An ethics audit should assess whether social
cussing clients with consultants or for teaching
workers have developed comprehensive, clearly
worded, and comprehensible summaries of cli
ents' rights. Typically such statements address
practitioner and agency policy concerning con
fidentiality and privacy, release of information,
informed consent, access to services, access to
or training purposes; and protection of confi
dentiality during legal proceedings. Finally, the
audit should assess the adequacy of the proce
dures used to inform clients of practitioners'
and agencies' confidentiality policies.
Informed Consent
records, service plans, service provision, options
for alternative services and referrals, the right to
refuse services, termination of services, and
An ethics audit should examine closely social
workers' informed consent documents and pro
cedures (Applebaum, Lidz, & Meisel, 1987;
Cowles, 1976; Reamer, 1987a; Rozovsky, 1984).
grievance procedures. In addition, the audit
should assess how frequently and competently
social workers inform clients of their rights and
Informed consent is required in a variety of cir
cumstances, including release of confidential
assess the procedures used to do so.
information to protect clients from self-harm
and to protect third parties from harm inflicted
by clients; release of confidential information
information, program admission, service deliv
ery, videotaping, and audiotaping. Although
various courts, state legislatures, and agencies
have somewhat different interpretations and
applications of informed consent standards,
there is considerable agreement about the key
elements that social workers and agencies
should incorporate into consent procedures.
These include procedures and documents that
ensure that coercion and undue influence do
not affect a client's decision to consent; that cli
pertaining to alcohol and substance abuse treat
ment; disclosure of information about deceased
ents are mentally capable of providing consent,
that clients' consent to specific procedures or
clients; release of information to parents and
actions (as opposed to providing blanket or
general consent), consent forms and procedures
Confidentiality and Privacy
An ethics audit should focus considerable atten
tion on a wide range of confidentiality and pri
vacy issues (Dickson, 1998). These include the
adequacy of social workers' policies and proce
dures concerning solicitation of private infor
mation from clients; disclosure of confidential
guardians; sharing of confidential information
among participants in family, couples, marital,
and group counseling; and disclosure of confi
are valid, that clients are informed of their right
to refuse or withdraw consent, and that clients'
decisions are based on adequate information.
The audit should also assess the adequacy of
procedures used to obtain clients' informed
dential information to media representatives,
law enforcement officials, protective service
agencies, other social service organizations, and
collection agencies.
The audit also should examine policies and
consent.
Reamer / The Social Work Ethics Audit: A Risk-Management Strategy
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Service Delivery
Documentation
An ethics audit should assess the extent to
An ethics audit should assess social workers'
which social workers provide services and rep
documentation styles and procedures. Careful
and diligent documentation enhances the qual
ity of services provided to clients. Comprehen
resent themselves as competent only within the
boundaries of their education, training, license,
certification, consultation received, supervised
experience, or other relevant professional expe
rience. In addition, the audit should explore
whether social workers provide services in sub
stantive areas and use practice approaches and
techniques that are new to them only after en
gaging in appropriate study, training, consulta
tion, and supervision from people who are
competent in those practice approaches, inter
ventions, and techniques. The audit should fo
cus too on social workers' procedures when
they use practice approaches and interventions
for which there are no generally recognized
standards; in such instances social workers
should obtain appropriate education, training,
consultation, and supervision.
sive records identify, describe, and assess cli
ents' circumstances; define the purpose of
service; document service goals, plans, activi
ties, and progress; and evaluate the effectiveness
of service (Kagle, 1991, 1995; Madden, 1998;
Wilson, 1980).
Careful documentation helps social workers
recall relevant detail from session to session and
can enhance coordination of services and su
pervision among staff members within social
service agencies. Thorough documentation also
helps to ensure quality care if a client's primary
social worker becomes unavailable because of
illness, incapacitation, vacation, or employment
termination.
Defamation of Character
Boundary Issues and Conflicts of Interest
Related to documentation, an ethics audit
Social work's literature demonstrates that
should assess the extent to which social workers
boundary issues—where social workers relate to
have training to ensure that their documenta
clients in more than one relationship, whether
tion and communication about clients and em
sexual, social, or business—are among the
ployees avoid harmful language that rises to the
level of defamation of character. In addition to
greatest risks (Berliner, 1989; Bullis, 1995;
Jayaratne, Croxton, & Mattison, 1997; Reamer,
1994, 1998; in press). An ethics audit should
assess the extent to which social workers have
established clear criteria to help them maintain
proper boundaries with respect to sexual rela
tionships with current and former clients,
friendships, encounters with clients in public
settings, physical contact, gifts to and from cli
being disrespectful, some forms of pejorative,
derogatory, and inaccurate statements can ex
pose social workers to ethical and legal risk.
Defamation of character occurs as a result of
"the publication of anything injurious to the
good name or reputation of another, or which
tends to bring him into disrepute" (Gifis, 1991,
p. 124). It can take two forms: libel and slander.
ents, financial conflicts of interest, delivery of
Libel occurs when the publication is in written
services to two or more people who have a rela
tionship with each other (such as couples or
form—for example, a social worker's progress
notes about a client that are read by third par
ties concerned about the client's circumstances.
family members), bartering with clients for
goods and services, attending clients' social or
lifecycle events, and self-disclosure to clients.
Social workers need to develop procedures to
enable them to be alert to and avoid real or po
tential conflicts of interest (often known as
testifies about a client in a court of law or pro
vides an oral report about the client's progress
to a parole officer or child welfare official. So
harmful dual or multiple relationships) that in
cial workers can be legally liable for defamation
terfere with the exercise of professional discre
of character if they say or write something
about a client or colleague that is untrue, if they
knew or should have known that the statement
tion and impartial judgment (Kagle 8c
Giebelhausen, 1994).
Slander occurs when the representation is in
oral form—for example, when a social worker
Social Work / Volume 45, Number 4 / July 2000
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was untrue, and if the communication caused
practice skills, professional ethics and liability
some injury to the client or colleague (for ex
ample, the client was terminated from a treat
(especially major risk areas and the phenom
enon of ethical decision-making), and relevant
ment program or the colleague was fired from a
federal, state, and local statutes and regulations.
job)(Reamer, 1994).
Other topics include assessment tools, interven
tion techniques, evaluation methods, emer
gency assistance and suicide prevention, super
Supervision
Because of their oversight responsibilities, social
vision of clients in residential programs,
confidentiality and privileged communication,
informed consent, improper treatment and ser
vice delivery, defamation of character, bound
ary issues in relationships with clients and col
leagues, consultation with and referral to
work supervisors can be named in ethics com
plaints and lawsuits alleging ethical breaches or
negligence by those under their supervision.
These claims often cite the legal principle of re
spondeat superior, which means "let the master
respond," and the doctrine of vicarious liability
specialists, fraud and deception, and termina
tion of services.
(Reamer, 1994). That is, supervisors may be
held partly responsible for actions or inactions
in which they were involved only vicariously, or
indirectly. An ethics audit should examine the
extent to which social work supervisors provide
information necessary for supervisees to obtain
clients' consent; identify and respond to
Consultation
Social workers often need to or should obtain
consultation from colleagues, including social
workers and members of other allied profes
sions, who have special expertise. Social work
supervisees' errors in all phases of client con
tact, such as the inappropriate disclosure of
confidential information; protect third parties;
detect or stop a negligent treatment plan or
treatment carried out longer than necessary;
determine that a specialist is needed for treat
ment of a particular client; meet regularly with
the supervisee; review and approve the
supervisees' records, decisions, and actions; and
provide adequate coverage in the supervisee's
absence (Besharov, 1985; Cohen & Mariano,
1982; Hogan, 1979; NASW, 1994; Reamer,
1989).
An ethics audit should assess social work su
pervisors' documentation of the nature of the
supervision they have provided. Supervisors
should have regularly scheduled appointments
it is warranted or consult a colleague with inad
equate expertise; this is known as "negligent
consultation." An ethics audit should focus on
social workers' procedures to locate and use
consultants.
Referral
Similarly, an ethics audit should assess social
workers' policies and procedures concerning
client referrals. Social workers have a responsi
bility to refer clients to colleagues when social
workers do not have the expertise or time to
assist clients in need. As part of this process,
social workers should refer clients only to col
leagues with strong reputations and to practi
tioners with appropriate credentials. Other
wise, social workers may be accused of
with supervisees, request detailed information
about the cases or other work they are supervis
ing, and, when possible, occasionally observe
supervisees' work. Supervisors should be careful
not to sign off on insurance or other forms for
ers can be vulnerable to ethics complaints and
litigation if they fail to seek consultation when
negligent referral.
Fraud
cases they have not supervised.
An ethics audit should examine the extent to
Training
dures in place to prevent various forms of
fraud. Prominent risk areas include fraudulent
which social workers have policies and proce
An ethics audit also should examine training
that agencies provide their staff on ethics-re
lated topics. Such training should include a dis
cussion and review of issues related to relevant
documentation and billing (Jayaratne et al.,
1997; Kirk & Kutchins, 1988). Practice settings
should have procedures in place to ensure that
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staff do not falsify case records (for example,
recording that home visits occurred when they
did not or that client consent was obtained
when it was not), exaggerate clinical diagnoses
to obtain third-party payment, or bill third
party payers for services that were not provided.
Termination of Services
Termination is a critically important risk area,
particularly in light of current managed care
providing flawed or inferior services, sexual in
volvement with a client, or failure to carry out
professional duties as a result of substance
abuse or mental illness (Lamb et al., 1987).
Such impairment may be the result of a wide
range of factors, such as employment stress, ill
ness or death of family members, marital or re
lationship problems, financial difficulties,
midlife crises, personal physical or mental
policies and procedures (Reamer, 1997;
health problems, legal problems, and substance
abuse (Bissell 8c Haberman, 1984; Guy,
Schamess 8c Lightburn, 1998; Strom-Gottfried,
Poelstra, 8c Stark, 1989; Thoreson, Miller, 8c
1998). Social workers expose themselves to risk
when they terminate services improperly—for
example, when a social worker leaves an agency
relatively suddenly without adequately referring
a client in need to another practitioner or ter
Krauskopf, 1989).
minates services to a vulnerable client who has
In light of the importance of the subject of
impaired practitioners, an ethics audit should
examine the extent to which social workers un
derstand the nature of professional impairment
and possible causes, are alert to warning signs,
not paid an outstanding balance. Social workers
and have procedures in place to prevent, iden
also may be at risk if they are not available to
clients or do not properly instruct them about
how to handle emergencies that may arise. In
general these problems pertain to what lawyers
tify, and respond appropriately to impairment.
Ethical Decision Making
call "abandonment." Abandonment is a legal
Since the early 1980s most professions, includ
ing social work, have developed protocols to
concept that refers to instances when a profes
sional is not available to a client when needed.
help practitioners make difficult ethical deci
sions when they encounter ethical dilemmas
Once social workers begin to provide services to
a client, they incur an ethical and legal responsi
bility to continue that service or to properly re
fer a client to another competent service pro
vider. Hence, an ethics audit should assess the
adequacy of social workers' termination criteria
and procedures.
(Loewenberg 8c Dolgoff, 1996; Reamer, 1999).
Ethical dilemmas occur when social workers
encounter conflicting professional duties and
obligations. Such conflicts may occur in clinical
social work, administration, community orga
nizing and advocacy, research, and policy for
mation. In philosophical language, ethical di
lemmas entail conflicts among "prima facie
Practitioner Impairment
All professions need to be concerned about the
possibility of impaired practitioners or col
leagues whose functioning falls below accept
able standards (Barker & Branson, 1993; Ber
liner, 1989; Besharov, 1985; Bullis, 1995). A
significant percentage of ethics complaints and
lawsuits are filed against social workers who
meet the definition of impaired professional
(Reamer, 1992, 1994). Reflecting growing rec
ognition of this phenomenon, several standards
specifically on this subject were added to the
NASW Code of Ethics in 1993.
Impairment may involve failure to provide
competent care or violation of social work's
ethical standards. It also may take such forms as
duties" (Ross, 1930)—that is, conflicts among
duties that social workers are ordinarily obli
gated to fulfill.
An ethics audit should assess social workers'
familiarity with the variety of ethical dilemmas
germane to their practice setting and the proce
dures they use to make ethical decisions. Clini
cal social workers should be familiar with ethi
cal dilemmas that occur among such duties as
protecting client confidentiality, respecting cli
ents' right to self-determination, respecting cli
ents' social and cultural norms, protecting cli
ents and third parties from harm, being
truthful, and maintaining clear professional
boundaries (Dean 8c Rhodes, 1992; Loewenberg
8c Dolgoff, 1996; Reamer, 1998, 1999). For ex
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ample, ordinarily social workers are inclined to
respect clients' right to self-determination and
components. Most of these protocols include an
outline of steps that practitioners can follow to
protect clients from harm. On occasion, how
help them approach ethical dilemmas system
ever, clients exercise their right to self-determi
nation in ways that are likely to cause harm to
atically, drawing especially on ethical theory;
relevant professional literature; statutes, regula
themselves—for example, when a homeless cli
ent decides to sleep outdoors in below-freezing
tation. An ethics audit should assess social
weather or when a battered woman informs her
social worker that she plans to return home yet
again to her abusive partner, consistent with
her ethnic community's norms.
In contrast, social work administrators
should be familiar with ethical dilemmas in
volving the allocating of scarce or limited re
sources (what moral philosophers refer to as
problems of distributive justice), being truthful,
and adhering to relevant regulations, policies,
and laws (Kurzman, 1983; Levy, 1982; Reamer,
2000). For example, a social work administrator
may find himself caught between his obligation
to be truthful and his duty to withhold poten
tially damaging information from newspaper
reporters who are investigating alleged fraud at
the agency. The director of an affordable hous
ing program for low-income people may
struggle to determine the most ethical approach
to allocating a relatively small number of subsi
dized housing units among a large number of
applicants (for instance, whether to allocate this
limited resource based on need, affirmative ac
tions, codes of ethics, and policies; and consul
workers' familiarity with and use of such deci
sion-making protocols, including their specific
components. For example, one decision-mak
ing protocol entails seven steps (Reamer, 1999;
also see Joseph, 1985; Loewenberg & Dolgoff,
1996).
1. Identify the ethical issues, including the
social work values and duties that conflict
2. Identify the individuals, groups, and or
ganizations who are likely to be affected
by the ethical decision
3. Tentatively identify all possible courses of
action and the participants involved in
each, along with possible benefits and
risks for each.
4. Thoroughly examine the reasons in favor
of and opposed to each possible course of
action, considering relevant: ethical theo
ries, principles, and guidelines; codes of
ethics and legal principles; social work
practice theory and principles; personal
values (including religious, cultural, and
ethnic values and political ideology), par
tion criteria, a lottery, or a first come-first
ticularly those that conflict with one's
served basis).
own.
A community organizer might find herself
caught between her duty to support neighbor
hood residents' right to self-determination and
her obligation to challenge residents' racist ef
forts to drive out low-income neighbors of
color under the guise of urban renewal. A social
work supervisor might face a difficult choice
between protecting an agency's reputation (and
future funding) and exposing ethical miscon
duct on the part of the agency's executive direc
tor. In these instances social workers must rec
oncile conflicting duties and obligations in a
manner that is consistent with the profession's
values and ethical standards.
An ethics audit should assess social workers'
familiarity with and use of recently developed
decision-making protocols designed to address
such ethical dilemmas, including their specific
5. Consult with colleagues and appropriate
experts (such as agency staff, supervisors,
agency administrators, attorneys, ethics
scholars).
6. Make the decision and document the de
cision-making process.
7. Monitor, evaluate, and document the de
cision.
Some of the elements of this decision-making
protocol require technical knowledge and skill.
With regard to step 4, for example, the ethics
audit should assess the extent to which social
workers are familiar with widely taught ethical
theories, principles, and guidelines. Social work
students and students in other professions are
now routinely acquainted with standard ethical
theory which, until the early 1980s, was ad
dressed primarily in traditional moral philoso
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phy and ethics courses rather than in profes
sional education (Callahan & Bok, 1980). In the
early 1980s, however, the various professions
began to recognize the relevance of ethical
theory to professionals' attempts to grapple
with difficult ethical judgments. Consequently,
social workers are now taught about classic
theories of "normative ethics," including what
philosophers refer to as "deontological,"
"consequentialist," "utilitarian," and "virtue"
theory. These diverse philosophical perspectives
commonly are used to analyze ethical dilemmas
from different conceptual angles. (For in-depth
discussions of these different philosophical per
spectives, see Frankena, 1973; Hancock, 1974;
Rachels, 1993; Reamer, 1993.)
Use of relevant codes of ethics, another com
ponent of step 4, also requires specialized
knowledge, especially since the ratification of
the 1996 NASW Code of Ethics. The 1996
code—only the third formal code in NASW's
history—constitutes a sea-change in the
profession's ethical standards (Reamer, 1998).
The first NASW code, ratified in 1960, was only
one page long and included 14 broadly worded
"proclamations" concerning, for example, every
social worker's duty to give precedence to pro
fessional responsibility over personal interests;
respect the privacy of clients; give appropriate
professional service in public emergencies; and
contribute knowledge skills, and support to hu
man service programs.
In contrast, the 1996 NASW Code of Ethics
contains an enormous range of much more spe
cific content relevant to contemporary practice.
In addition to a newly constructed mission
statement for the profession and a relatively
brief description of core social work values and
broad ethical principles, the code includes 155
specific ethical standards to guide social work
ers' conduct and provide a basis for adjudica
tion of ethics complaints filed against NASW
members (the code also is used by many state
licensing boards charged with reviewing com
plaints filed against licensed social workers and
by courts of law that oversee litigation involving
alleged social worker negligence or miscon
duct). A social work ethics audit should pay
particular attention to the code's standards that
address concrete ethics-related risks—for ex
ample, confidentiality (standard 1.07), in
formed consent (1.03), competence (1.04,
2.10), client records (1.08, 3.04), conflicts of
interest (1.06, 1.09, 1.10), fraud (4.04), inter
ruption and termination of services (1.15, 1.16),
supervision and consultation (2.05, 3.01), refer
ral (2.06), practitioner impairment (2.09, 4.05).
In light of these available resources, the social
work ethics audit also should assess the extent
to which social workers avail themselves of con
sultation when they encounter ethical dilem
mas, consult ethics committees, codes of ethics,
and so on.
Using the Findings of an Ethics Audit
Once an ethics audit has been completed, social
workers need to take assertive steps to make
constructive use of its findings. Areas that fall
into the "high risk" category should receive im
mediate attention. These are areas that jeopar
dize clients and expose social workers and their
agencies to serious risk of ethics complaints and
litigation. Areas that fall into the "moderate
risk" and "minimum risk" categories should
receive attention as soon as possible.
In agency settings, administrators are often
the most appropriate individuals to oversee ef
forts to address problem areas identified in an
ethics audit. In some cases, administrators may
want to appoint a special task force or commit
tee to address the issues. An increasing number
of agencies have established "institutional ethics
committees" (IECs) that can assume this re
sponsibility (Conrad, 1989; Reamer, 1987b).
IECs—which were first introduced in 1976 as a
result of a New Jersey Supreme court ruling in
the Karen Ann Quinlan case—may be a very
useful mechanism to address problem areas
identified by an ethics audit (for example, anti
quated informed consent forms, incomplete
confidentiality policies, and inadequate proce
dures for the termination of services).
Individual practitioners, administrators, and
ethics committees can address the findings of
an ethics audit by following several steps. First,
they should establish priorities among the areas
of concern, based on the degree of risk involved
and available resources. Second, practitioners,
administrators, and ethics committees should
spell out specific measures that need to be taken
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to address the identified problem areas. Ex
consultants included the executive director of a
amples include reviewing all current informed
consent forms and creating updated versions;
writing new, comprehensive confidentiality
local agency who once chaired the NASW state
chapter's Committee on Inquiry and a local so
cial work educator who was knowledgeable
about social work ethics).
policies; and preparing detailed procedures for
staff to follow when terminating services to cli
ents. Third, practitioners, administrators, and
ethics committees should identify which staff
will be responsible for the various tasks and es
tablish a timetable for completion of each. Fi
nally, these parties should identify a mechanism
to follow up on each task to ensure its comple
tion and monitor its implementation.
Case Illustration
Once the data were gathered and collated,
copies of all the relevant documents and survey
and interview results were distributed to the
committee members. Time was scheduled for
the committee to review and discuss the results
and, as a group, review each item addressed in
the audit and assign a rating (that is, no risk,
minimum risk, moderate risk, and high risk).
When the task force was unable to reach con
The executive director of a family service
agency in a major metropolitan area attended a
workshop on social work ethics. At the work
shop the social worker was introduced to the
sensus about a topic's risk category, the group
members' individual ratings were averaged,
with the topic placed in the risk category corre
sponding most closely to the group mean.
Results of the ethics audit indicated that the
concept of an ethics audit and decided to con
family service agency faced several high-risk is
duct one in her agency. During the workshop
the administrator realized that at least several of
sues. These included a need to update the
agency's confidentiality policy, develop proce
her agency's practices were not in compliance
with current ethical standards and, as a result,
dures to protect electronically stored client
records, develop a clients rights statement, re
vise informed consent forms and procedures to
posed a risk to the agency's clients and the
agency itself.
The administrator delegated oversight of the
ethics audit to the agency's associate director.
The associate director convened a meeting of
the agency's division and program managers,
reviewed the concept of an ethics audit, and
brainstormed with staff strategies they could
use to gather the necessary information. By the
end of the first meeting the staff agreed that the
information would need to be acquired from
several sources, including existing agency docu
ments (for example, informed consent forms,
confidentiality statements, and personnel pro
cedures), self-administered questionnaires
completed by staff concerning various agency
practices (for example, supervision protocols,
referral procedures, and procedures commonly
used to terminate services), and in-person in
terviews with management staff concerning
highly sensitive subjects (for example, percep
tions about impaired colleagues and proposals
to respond to impairment). The staff also
agreed that they could enhance the quality and
credibility of the audit by including two exter
nal consultants on their task force (the outside
comply with current legal standards, and de
velop a policy on staff s relationships (especially
sexual and social) with former clients. A num
ber of other issues fell into the moderate-risk
and minimal-risk categories, such as the need
for a written protocol to guide staff supervision,
guidelines for documentation and case record
ing, and formation of a committee to develop
an in-service training curriculum related to the
NASW Code of Ethics and strategies for ethical
decision making.
Once the topics were placed in rank-ordered
risk categories, the task force discussed concrete
steps they could take to address the issues con
sidered high risk; the task force also discussed
their timetable and the resources they would
need to address the issues. In addition, the task
force discussed whether to wait until the high
risk issues were addressed before proceeding
with the moderate-risk and minimal risk issues.
The task force agreed that two of the moderate
risk and minimal-risk issues could be addressed
simultaneously (formation of an in-service
training committee and development of a writ
ten protocol to guide staff supervision), and the
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others should wait until the high-risk issues
were addressed.
ics audits may be especially valuable when they
are conducted by independent parties outside
Within a six-month period all of the high
risk issues were addressed to the task force's sat
of one's practice or agency, much like the
isfaction, with one exception. The exception
involved the development of guidelines for
staff s relationships with former clients; staff
Also, despite the structure, formality, and
apparent objectivity of the social work ethics
audit process described in this article, social
workers must recognize that any assessment of
this nature necessarily involves considerable
subjective judgment. Certainly it is useful to
disagreed about the nature of appropriate limi
tations on these relationships. They agreed to
take some time to survey other family services
agency accreditation process.
agencies in the region about their policies, re
structure and "routinize" an ethics audit; how
view relevant literature on the subject of profes
ever, social workers must recognize that the
sional boundaries, and consult with nationally
auditor's own values, ethical instincts, ideologi
known experts on social work ethics in an effort
cal biases, formal authority, and political status
to achieve more insight and consensus on the
will influence the outcome. Realistically, orga
issue.
Conclusion
The remarkable maturation of ethical standards
in a number of pertinent areas—such as confi
dentiality and privacy, service delivery, profes
sional boundaries, informed consent, defama
tion of character, fraud, consultation and
referral, practitioner impairment, and termina
tion of services—has accelerated the need for
nizational dynamics and politics may affect
both the audit process and results.
The concept of an ethics audit is consistent
with social work's enduring efforts to protect
clients and prevent ethics-related breaches.
Such systematic attempts to highlight, address,
and monitor the ethical dimensions of social
work practice will, in the final analysis,
strengthen the profession's integrity. ■
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