Reflection of the reading Unethical social work: Comparing licensing and NASW perspectives’ perspectives Unethical Social Work: Comparing Licensing and NAS

Unethical social work: Comparing licensing and NASW perspectives’ perspectives

Unethical Social Work:
Comparing Licensing and NASW Perspectives

Michael R. Daley and Michael O. Doughty

Previously published studies of ethics complaints have been based primarily on
records of the National Association of Social Workers (NASW). However, with the
extension of legal regulation for social work throughout the country, state
regulatory bodies are assuming an increasingly important role in reviewing the
ethical behavior of social workers, many of whom are not members of NASW. Yet,
there has been little study of ethical complaints against this much larger group of
social workers. This article examines ethics complaints filed between 1995 and 2003
against licensed social workers in Texas in order to better understand how ethics
review in the public regulatory sector compares with that of NASW. Findings
indicate some similarities between the two types of complaints in the areas of poor
practice and boundary violations and differences between the two in reports of
honesty and conflict-of-interest violations.

Introduction

For many years social work has been a leader among the professions in
developing a strong ethical base for practice. The profession’s commitment
to ethical practice is formalized in ways that include the development of a
strong and detailed code of ethics (NASW, 1999), integration of ethics
content in social work education (CSWE, 2003), the development of a
commitment to ongoing professional education including ethics (ASWB,
n.d.-b; NASW, 2002), and the requirement in state licensing laws for
continuing ethics education. These measures are designed both to promote
ethical practice and to discourage the unethical practice of social work.

Yet, despite the importance of ethical behavior to the profession,
surprisingly little empirical research into unethical practice and the
associated behaviors has been done. Three studies examining violations of
the NASW Code of Ethics (McCann & Cutler, 1979; Berliner, 1989; Strom-
Gottfried, 2000) have been published since the late 1970s. Taken together,
these studies provide a historical perspective by investigating ethical
violations of the NASW Code of Ethics that occurred in the forty-three-year
span from 1955 to 1997 and offer a good description and analysis of

Aretê, Vol. 30(2), 35-50
© 2007 Universitv of South Carolina

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unethical social work behavior and code violations.
However, the landscape of ethics has changed over time, and NASW is

no longer the only entity reviewing the ethical behavior of social workers.
The growth of legal regulation of the profession has now reached all 50
states, the District of Columbia, Puerto Rico, and the Virgin Islands (ASWB,
n.d.-b). Each entity that provides legal regulation has some code of ethics or
conduct that guides the practice of social work. These codes of conduct may
incorporate or parallel the NASW Code of Ethics, but their primary intent is
protection of the public, as opposed to defining principles to guide practice
(ASWB, n.d.-b; Strom-Gottfried, 2003).

The research on ethics complaints reported to state social work
licensing boards is even less well developed than NASW-based studies of
professional ethics reviews. Only one published study of ethics complaints
filed with a state regulatory body was identified, and it appears to differ in
complaint profile from NASW-based data (Kinderknecht, 1995).
Furthermore, no comparison of NASW and public regulatory ethics
complaints has been undertaken.

The regulation of unethical behavior by social work boards is an
important avenue for investigation for three reasons. First, NASW
membership currently represents only a fraction of social work practitioners
in the United States. The Department of Labor estimated that in 2004 there
were 562,000 social workers in the United States, while NASW reports a
membership of 153,000, or 27.2% of the total (U.S. Dept. of Labor, 2004;
NASW, 2006). The NASW membership may not be entirely representative
of the profession in another way, as only about 5% of NASW members have
a BSW as the highest degree (Gibelman & Schervish, 1993). Thus, ethics
data drawn exclusively from NASW members may not give the entire
picture of what is happening across the profession. Second, the process of
ethical review of social workers may be changing. With the growth of legal
regulation of the profession, state entities have increasingly assumed
primary responsibility for the investigation of ethical complaints. Third,
relatively little research on ethical violations as determined by the social
work regulatory entities has been conducted. As a result of these factors, the
published studies on ethical complaints in social work may represent only a
partial picture of unethical practice for the whole profession.

If the profession is to follow through on its commitment to promote
ethical practice, we should examine data on social workers who violate
these standards, with the aim to address these violations more effectively
and to protect the public. This article reports on the results of a study of
data collected from a state social work licensing board related to ethics

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complaints. Complaints filed with the Texas State Board of Social Worker
Examiners (TSBSWE) from 1995 through 2003 are examined, compared with
NASW studies of ethics complaints, and discussed in terms of the
implications for addressing ethical social work practice.

Previous Research on NASW Ethics Complaint

In the most current and comprehensive examination of ethics
complaints to date, Strom-Gottfried (2000) shidied ethical complaints filed
with NASW between 1986 and 1997. She reviewed 894 of the 901
complaints filed during that period. Her report documents that hearings
were not held on 466 cases (52.1%) and that violations were found in 276
(62.3%) of the 428 cases that were heard.

Strom-Gottfried (2000) noted that in the 276 sustained cases, 785
different violations occurred under the 1979 NASW Code of Ethics. For the
purpose of analysis, she placed the violations in 10 categories: Violating
Boundaries (32.4%), Poor Practice (20.4%), Competence (12.0%), Record Keeping
(8.9%), Honesty (6.5%), Confidentiality (5.2%), Informed Consent (4.7%),
Collégial Actions (4.2%), Reimbursement (2.9%), and Conflicts of Interest (2.8%).
She also identified subcategories of these classifications that were used to
provide detail and clarity in explaining her findings. With the exceptions of
collégial violations and, to a lesser extent, record keeping, all of the
categories identified by Strom-Gottfried (2000) relate to ethical violations
that could negatively impact the social worker’s professional relationships
with and services provided to clients.

Berliner (1989) studied 292 ethics cases filed between 1979 and 1985,
presumably, based on the 1979 NASW Code of Ethics (NASW, 1979). He
found that 58 (18.5%) were closed without a formal hearing, and allegations
were sustained in 96 of 243 cases (41.5%). Of the 96 validated complaints, 19
violations of social worker responsibility to clients were found. These
included 8 cases of sexual misconduct, 6 breaches of confidentiality, 3 cases
of fee splitting, and 2 cases of soliciting another’s clients.

Berliner (1989) also found evidence of a negative correlation between
the number of complaints filed with NASW and the state regulation of
social work practice. Complaints to NASW were more likely to come from
states that did not regulate social work practice. This finding would tend to
support the importance of examining complaint data from the state
regulatory bodies. This finding may also be an early indicator of the current
trend for many ethics complaints to go first to state regulatory bodies before
being reviewed by NASW.

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McCann and Cutler (1979) reported on 154 ethics complaints filed with
NASW between 1955 and 1977. Only 21 (13%) of these complaints dealt
with the relationship between a client and a social worker, but the specific
nature of these complaints was not identified. This low proportion of
worker-client complaints may reflect the practice of NASW receiving
agency personnel standards cases more frequently than is done currently.
This study reported 10 violations of confidentiality and 8 sexual practices
violations, which may be client related; however, both categories could
include violations of other professional relationships. McCann and Cutler
recognized that the official record of complaints they examined likely
underestimated the actual number of violations due in part to the general
nature of the Code of Ethics (NASW, 1969) at that time. The current code’s
ethical tenets and its public protection provisions are far more specific and
detailed (NASW, 1999).

State Complaints

UrJike NASW, no comprehensive national data set exists on ethical
complaints filed against state-regulated social workers. The Association of
Social Work Boards (ASWB, n.d.-a) compiles and maintains a national
Disciplinary Action Reporting System (DARS) that identifies social workers
against whom action has been taken (ASWB, n.d.-a), but the information in
this database does not appear to have been used in social work ethics
research. Much of the specific information on violations of social work
ethics regulated by the states must be obtained from the regulatory body
that took the action.

Only one published study of social work complaints filed with a state
regulatory body was identified. Kinderknecht (1995) examined 252
complaints filed against social workers with the State of Kansas Behavioral
Sciences Regulatory Board from 1980 through 1994. Kinderknecht’s study
classified complaints in four categories, including conduct and comportment,
client-related, colleague-related, and employer/social work profession. Though
most of the complaints contained multiple allegations, she limited her
analysis to the “presenting or focal complaint” (p. 271). She found that
54.8% of the complaints were client-related, 19% were conduct and
comportment, 15.1% were employer/social work profession-related, and 11.1%
were colleague-related.

Kinderknecht (1995) analyzed the client-related complaints in her study
and found that 26.1% of the violations related to reporting false or
misleading information about the client. This type of complaint parallels

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Strom-Gottfried’s (2000) honesty category, which addressed fraudulent
actions and intentional misrepresentation but contained orJy 6.29% of the
complaints. Kinderknecht found that 23.2% of the complaints involved
sexual advances or impropriety and that 17.4% were for breaches of
contidentiality, while Strom-Gottfried’s figures were 32.4% and 5.2%,
respectively. The Kansas study also found that 13.8% of ethics complaints
were for discrimination, 6.5% were for undue influence, 6.5% were for
abandonment, 5.1% were for conflicts of interest, and 1.4% involved failure
to terminate.

These variances between state regulatory data and that from NASW
could indicate a number of things, including inconsistencies in the unethical
practices between state-licensed social workers and NASW members,
regional differences in reporting, changes occurring in the five years that
elapsed between the two studies, or differing research methodologies used
by the two authors. Strom-Gottfried examined all the alleged violations in
sustained cases. Kinderknecht (1995) looked only at the primary allegation
in all complaints that went to a hearing, without regard to its final
disposition.

The present study takes advantage of the previous research to explore
these differences further. Using data from complaints filed with TSBSWE
between 1995 and 2003, this stiady presents its findings utilizing violation
categories developed by Strom-Gottfried (2000) to facilitate comparison of
complaints against licensed social workers in Texas versus those filed
against NASW members and to examine the similarities and differences.

Method

The authors analyzed complaint data on 594 cases filed with TSBSWE
from 1995 through 2003. TSBSWE licensed approximately 23,000 social
workers at multiple levels during this time period. Complaint data is
maintained on the board’s computer tracking system, which processes all
applications, examinations, licensing actions, renewals, and complaints. The
database includes information on the licensing law and rules that social
workers were alleged to have violated.

TSBSWE uses a code of ethics that parallels, but is not identical to, the
NASW Code of Ethics (1999) section that addresses worker-client
relationships. TSBSWE also operates under a set of administrative
regulations that define a code of conduct for social workers. In applying the
Texas Code of Ethics and the Code of Conduct, the sole purpose is public
protection. The most significant difference between Texas licensing

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regulations and the NASW Code of Ethics is that Texas does not attempt to
regulate a social worker’s professional responsibilities beyond those to the
client. The Texas Code of Conduct includes 13 specific standards of practice
that parallel, but are not identical to, the NASW Code of Ethics. Generally
the standards of practice in the Texas Code appear to be based on ethical
standards from the NASW Code. However, the wording of the Texas
standards of practice is more succinct and without as much explanation as
is found in the NASW Code. The Texas Code of Conduct has specific
sections addressing confidentiality, prohibition of sexual contact with
clients, dual relationships, conflicts of interest, professional boundaries,
professional competence, honesty, accuracy of billing, and termination of
services. It also establishes basic standards of practice such as basing
services on assessment, evaluation or diagnosis, and continuing evaluation
of client progress (TSBSWE, 2004). In many respects, the Texas Code of
Conduct is similar to section 1 of the NASW Code of Ethics, which
addresses social workers’ ethical commitment to clients (NASW, 1999).
However, the Texas Code does not contain specific elements that address
commitment to clients, self-determination, informed consent, cultural
competence, access to records, or derogatory language. The Texas Code also
adds provisions from sections 2 and 4 of the NASW Code of Ethics, which
prohibit discrimination, require honesty, promote continuing education,
encourage the use of supervision, and address impairment. Violation of the
Texas Code of Conduct may result in an ethical complaint to TSBSWE.

When a complaint is received, each alleged violation of ethics or code of
conduct is recorded based on an evaluation of the best available
information. Any alleged ethical breach may be covered by more than one
section or subsection of the regulations. In most cases, more than one
alleged violation of the code is recorded for each complaint received.

A decision was made to compare the Texas licensing complaint data
with those of Strom-Gottfried (2000) because the latter was the most
comprehensive study of NASW ethics violations and the closest to the
reporting period. We used the 10 violation categories that Strom-Gottfried
developed for her study to classify the Texas licensing data and to facilitate
comparison. These categories were violating boundaries, poor practice,
competence, record keeping, honesty, confidentiality, informed consent,
collégial actions, reimbursement, and conflicts of interest. In general,
matching Texas violations to appropriate categories (Strom-Gottfried, 2000)
was straightforward. In some cases, matching data to categories required
explication of the wording of the complaint. Complaints that could not be
matched to specific subcategories were placed in a general nonspecific

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violation category.
Using this approach, matches between the Texas regulations and nine

violation categories were found. No matches were found for the collégial
actions category, which is not client-related and therefore not covered under
Texas regulations. The authors did identify two types of allegations that
could not be matched directly with Strom-Gottfried’s violation categories.
These violations were legal requirements for licensure and nonspecific ethics
violations. These violations were excluded from the analysis since the first
was not covered by the NASW Code and the other was too vague.

In the analysis of data, tables were created and used to categorize each
of the alleged violations cited in 594 complaints filed with TSBSWE from
1995 through 2003. The findings for each of the violation categories are
presented and compared with the earlier research, noting, where
appropriate, the differences between the NASW Code and the state
regulations. Conclusions are drawn from the comparisons, and
recommendations for future research are made.

Results: Reported Licensing Violations

Within the 594 complaints, there were 2,139 specific allegations of
violations of Texas licensing law or the Code of Conduct, ranging from very
specific charges such as practicing without a license or having sexual relations
with a client to vague allegations such as unethical conduct or conduct that
discredits the profession. Five hundred individuals were named in the
complaints. The complaint rate was only 0.24% of the 23,000 licensed social
workers per year over the nine-year period, a relatively low rate.

Of the 500 social workers, 428 had a single complaint, 56 had two
complaints, 12 had three complaints, 3 had four complaints, and 1 had six
complaints during the nine years covered by the study. Only the complaints
alleged were analyzed, as information on dispositions was not in the
database. Complaint data were reviewed, and complaints were categorized
using Strom-Gottfried’s (2000) classification in order to facilitate
comparison with her research on NASW. The results of this stiady’s analysis
of ethical complaints lodged with the Texas State Board of Social Worker
Examiners are reported in Table 1 alongside those of NASW (Strom-
Gottfried, 2000).

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Table 1:
Ethical Complaints by Citation Category

Citation Category

Poor practice
Boundary violations
Honesty
Conflicts of interest
Breach of confidentiality
Competence
Informed consent
Record keeping
Billing
Total

n
310
291
198
158
131
107
65
65
64

1,389

Texas
%

22.3
21.0
14.3
11.4
9.4

in
4.6
4.7
4.6

100.0

Rank
1
2
3
4
5
6
7
8
9

n
160
239
51
22
41
94
37
70
23

737

NASW
%

21.7
32.4
6.9
3.0
5.6

12.8
5.0
9.5
3.1

100.0

Rank
2
1
5
9
6
3
7
4
8

Poor Practice

Practice, as used here, refers to the activities directly related to the
provision of services to clients from initial assessment to termination.
Standards of practice are based on a conception of what is reasonable or
normal within the profession, and poor practice covers actions and omissions
that do not conform to the concept of standard practice. Specific behaviors
identified in this category included failure to use accepted treatment
methods, misapplying self-determination, yelling at a client or using
derogatory language, using inappropriate techniques, and failing to follow
accepted processes for termination or transfer (Strom-Gottfried, 2000).

In this study, 22.3% of reports for ethics violations fell into the poor
practice category. This proportion of poor practice is consistent with
findings of Strom-Gottfried (2000), who found poor practice in 21.7% of the
NASW cases examined. Poor practice complaints were examined further
using subcategories developed by Strom-Gottfried (2000). Within this
category, 53.9% of the Texas complaints were general, 31.6% were ior failure
to use accepted practice skills, 11.3% were for prolonged care, and 3.2% were for
failure to act regarding child abuse.

Boundary Violations

Business and social relationships with a client outside the treatment

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setting are potentially harmful to the client and to the professional
relationship. Because outside contact with clients presents a potential risk to
clients, social workers must discuss potential boundary issues with clients
and develop a plan to “set clear, appropriate, and culturally sensitive
boundaries” (NASW, 1999). The boundary violation category included
behaviors such as inappropriate physical contact with clients, pursuit of a
sexual relationship, social relationships, bartering, business partnerships,
and other exploitive relationships.

In Texas reports, 21% of the complaints were classified as boundary
violations. The violations in this category were split between dual
relationships (62%) and sexual relations (38%). Specific dual relationship
complaints were primarily linked to two types of violations, business
relationships and supplying drugs or alcohol. The Texas sexual relations reports
include contact with clients prior to, during, and after treatment.

Strom-Gottfried (2000) found the highest percentage of ethics violations
within the boundary violations category (32.4%), with dual relationships at
30.3%, sexual relationships at 42.1%, and more general boundary violations at
27.6%. While boundary violations were a significant source of complaints in
both studies, Strom-Gottfried found significantly higher percentages of
boundary violations.

Honesty

Public perception of the integrity of the social work profession is critical
to its members. Clients and the public must believe in the basic honesty of a
social worker to enter into and maintain working relationships with the
social worker. Any action by a social worker that raises questions about her
or his honesty threatens that relationship and the public trust. This category
included both intentional misrepresentations and fraud.

Our data indicated that the honesty category had the third-highest
percentage of violations (14.3%), most of which (50.5%) were general.
Intentional misrepresentations (48.5%) accounted for most of the remainder,
with 1% being fraudulent actions. The honesty category was ranked lower
(fifth) in Strom-Gottfried’s study, with only 6.9% of the violations.

Conflicts of Interest

The NASW Code of Ethics (1999) states, “Social workers elevate service
to others above self-interest.” Thus, practice decisions based primarily on
the interests of the social workers, rather than the clients, are unethical. This
category included behaviors in which the needs of the social workers or the

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social workers’ organizations came in conflict with the needs of the clients.
Often these infractions involved allegations of conflicting relationships
between social workers and members of the clients’ families. In this study,
11.4% of the complaints were for conflicts of interest. This ranked fourth in
frequency among the categories. Within this category 90.5% of the
violations alleged conflict between the social worker and the client, and 9.5%
alleged denial of care. The conflict of interest category ranked last in Strom-
Gottfried’s (2000) study with only 3% of the reported violations. Conflicts of
interest frequently involve conflicts between the clients’ needs and those of
the employing organizations (Strom-Gottfried, 2000), as is the case with the
Texas data.

Breaches of Confidentiality

Both legal and ethical tenets affirm the client’s right to privileged
communications. It is the social worker’s responsibility to respect and
protect that privilege. Allegations of confidentiality violations included
revealing confidential information without the client’s consent, failure to
obtain adequate consent for shared information, and issues related to duty
to warn (Strom-Gottfried, 2000). The breach of confldentiality category ranked
fifth in frequency at 9.4% in our study versus sixth in Strom-Gottfried’s
study with 5.6% of violations.

Competence

The criteria for licensure established by state agencies are designed to
screen for competency through requirements such as academic degrees,
examination scores, references, experience, and supervision in an effort to
assure that licensees possess the minimum entry-level knowledge and skills
necessary for safe practice. Here the provisions of the Texas Code of
Conduct are similar to the provisions of the NASW Code of Ethics standard
1.04 (a). Allegations of competency violations included lack of competency
due to impairment, inadequate professional preparation, and failure to use
supervision appropriately. Competency violations were ranked sixth in
percentage of complaints at 7.7% in this study, as opposed to Strom-
Gottfried’s (2000) study, in which it ranked third with 12.8% of the
violations. Although the Texas standards of practice lack the specificity of
the NASW Code, they are very close to the NASW ethical standards 1.04
(a), 1.04 (b), and 4.05 in the competency category. In the present study,
competency violations could be classified as insufficient education or training at
65.6%, practitioner impairment at 13.1%, and substance abuse with 1.9% of the

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complaints. The remaining 19.4% of the complaints were too general to
classify.

Informed Consent

Full knowledge of the nature and potential consequences of proposed
services is necessary for a client to give informed consent to care. Alleged
behaviors related to informed consent were failure to discuss fees or polices
with the client, obtaining consent from an inappropriate source, and taking
actions after the clients objected to them. Informed consent ranked seventh in
our study with 4.6% of the complaints and is similar to Strom-Gottfried’s
(2000) findings, where 5% of the violations occurred in this category.
Specifically, our data indicated that all informed consent complaints were for
failure to discuss policies adequately with clients.

Record Keeping

Case records are intended to document what and how services are
provided, and keeping accurate records is generally viewed as a means of
protecting the social worker if ethical violations are reported. Reports of
ethical violations in this category included keeping records that were
incomplete or inaccurate, mishandling of records, or withholding records
from clients (Strom Gottfried, 2000). The record keeping category, with 4.7%
of the total citations, ranked eighth in frequency in our study. This
compares to Strom-Gottfried’s (2000) results, in which a higher percentage,
or 9.5%, of the violations were classified as record keeping. Our data indicate
that 40% of the reports of record keeping violations were for failure to make
records or reports and that 43.1% were for withheld records. General
allegations account for the remainder of complaints.

Billing/Reimbursement

The reimbursement or billing category of complaints contained reports of
violations related to reimbursement for services such as fraud, billing for
services that were not rendered, and charging in excess of agreed rates. In
our study this allegation ranked as the ninth most frequent with 4.6% of the
complaints. This compares to Strom-Gottfried’s (2000) results with
reimbursement identified in 3.1% of the violations.

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Discussion of Findings

The purpose of this study was to examine reports of unethical practice
from the perspective of public regulation of social work and to compare this
with published NASW data on ethics complaints. Any evaluation of this
study’s findings must keep in mind the limitations of the data and the
methods. Allegations of ethical breaches in one state represent a limited
view into the consumer’s perspective, and regional conditions may affect
these results. Thus, the results should be interpreted with some degree of
caution. This research is exploratory, and the data are drawn from only one
state; thus, the ability to generalize from its findings is limited as the legal
regulation of social work differs from state to state (Strom-Gottfried, 2003).
Clearly, some of the findings may be idiosyncratic to Texas. Because
multiple reports of ethical violations were often lodged against individual
social workers, the comparative data could be reported only descriptively,
and statistical significance of the differences that were observed could not
be determined. At best, the differences reported are comparative tendencies
that may suggest better understanding of the differences between state
licensing and NASW in reviewing ethics complaints. It should also be
remembered that the Texas data are based on consumer complaints of
ethics violations, whereas the NASW data were based on adjudicated
complaints. However, these comparisons do provide a good perspective on
what the public believes to be the unethical behavior of social workers, and
all ethics reports are potentially serious in that they represent violations of
the worker-client relationship that could undermine public trust in the
profession.

Our data indicate that differences, do indeed exist between ethics
complaints submitted through a social work regulatory body and data from
ethics violations reported by NASW. Such findings are not surprising, as
previous research had suggested that such differences might exist (Berliner,
1989; Kinderknecht, 1995; McCann & Cutler, 1979; Sti-om-Gottfried, 2000).
Indeed, review of alleged unethical conduct by NASW and public
regulatory bodies are independent but parallel processes. NASW’s ethics
review is limited to its members, while regulatory review covers the actions
of a broader group of social workers, many of whom are not members of
NASW. In addition, NASW and regulatory review serve similar purposes in
protecting the public from the unethical practice of social work. Yet, the
review processes proceed from somewhat different perspectives, as NASW
uses peer review to promote “the quality and effectiveness of social work
practice,” whereas licensing is designed to “protect the public” through

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administrative review to address …

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