1. Ethical Considerations in Home Visiting
Maggie Brett, L.C.S.W.
May 18, 2012

2. Overview
There are no experts, in the usual sense, in ethics or morality. Objectivity (and the move away from subjectivity) in ethical judgments is increasingly achieved as one's ethical judgments are grounded in a broader and broader base of human experience ‑‑ both one's own personal experience and the experience of other humans shared in dialogue. -David T. Ozar, Ph.D.

3. Agenda Lay a foundation: What are ethics? NASW Code of Ethics
Build a framework: Model of Ethical Decision Making
Put up a few walls: Abuse and Neglect Reporting, Informed Consent, Confidentiality

4. It is not enough, to know, one should also use; it is not enough to want, one should also act.
Geothe

5. What are ethics?
Ethics are not feelings, science, following the law, religion, or culturally accepted norms (Santa Clara University)
Moral principals that govern a person’s or group’s behavior
A person’s or group’s responsibilities to the larger society
Behavioral expectations
“Values in action,” (Levy, 1976)

6. How do we come to develop a system of ethics?
One’s own family and upbringing
Culture
Informal life contacts
Religious background
Education
Professional experience
Personal reflection
--David T. Ozar, Ph.D.

7. NASW Code of Ethics Rooted in 6 Core Values: Service Social justice
Dignity and worth of the person
Importance of human relationships
Integrity
Competence
“Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience.”

8. NASW Code of Ethics
Does not state a hierarchy of values, so there can be reasonable differences of opinion.
Considers ethical decision making as a process which considers even competing values.
Requires the professional to look at conflicts between personal and professional values
Recognizes that there may be times that what is ethical by these standards may not be in accordance with the law or agency regulations.
Sets forth standards to which a professional should aspire or by which their actions could be judged.
Asks for a commitment to “engage in ethical practice.”

9. NASW Code of Ethics
Some specific ethical standards relating to responsibility to clients:
Promote well-being of clients
Promote self-determination
Informed consent
Competence
Cultural competence
Avoid conflicts of interest
Guaranteeing confidentiality and privacy

10. Informed Consent
Obligated to inform client in a way she/he can understand about all the parameters of treatment (e.g., purpose, risk, cost, etc.)
When client does not have the capacity to provide informed consent (e.g., a young child or client with developmental issues), professional has to seek consent of a 3rd party. The professional needs to ensure that the 3rd party is looking out for the client’s best interests.

11. Conflicts of Interest
When a professional provides services to more than one member of a family, it is essential that it is clear who the client is and what the boundaries are between family members.
When a parent’s goals for intervention are unrealistic or even harmful, it is the professional’s responsibility to be clear about the limits of the intervention.

12. Privacy and Confidentiality
Privacy—the right of an individual to make decisions about how much of her/his thoughts, feelings, or information is shared with others
Confidentiality—the obligation of a professional to refrain from disclosing any information about a client, except under very specific circumstances
When a client is unable to make decisions, a 3rd party makes all the decisions regarding confidentiality.
Home visitors should engage the clients in a discussion about the release of information and its subsequent use.

13. Child Abuse and Neglect Reporting
Related to the ethical standard of commitment to client’s well-being
Involves other ethical standards: conflict of interest, informed consent, and confidentiality

14. Why are some professionals reluctant to report?
Ignorant of the full extent of reporting laws
Feel it’s not in the child’s or family’s best interest
Feel it’s not serious enough
Not sure if it really happened
Is concerned about DCFS and its ability to correct the situation
Doesn’t want to disrupt the relationship
Afraid of retaliation
-LeRoy G. Schultz

15. Some root causes of ethical dilemmas
Competing values
Competing loyalties
Differing perspectives because of culture, religion, gender, ethnicity, etc.
-Braniff

16. An Ethical Decision Making Model (work of David T. Ozar, Ph.D.)
Identifying the alternatives
Determining what is morally/ethically at stake by reason of our social roles
Determining what else is morally/ethically at stake
Determining what should be done all things considered
Choose a course of action

17. An Ethical Decision Making Model (Markkula Center for Applied Ethics at Santa Clara University)
Recognize an ethical issue
Get the facts
Evaluate alternative actions
Make a decision and test it (publicity, universality)
Act and reflect on the outcome

18. An Ethical Decision Making Model (based on1996 American Counseling Association model)
Using Kitchener’s (1984) 5 moral principles (autonomy, nonmaleficence, beneficence, justice, and fidelity) as the cornerstone:
Identify the problem.
Apply the Code of Ethics.
Determine the nature and dimensions of the dilemma.
Generate potential courses of action.
Consider the potential consequences of all options and determine a course of action.
Evaluate the selected course of action.
Implement the course of action.

19. Addendum to Framework
Reflective Practice needs to be infused in the process; part and parcel of each step in ethical decision making. Our own histories, vulnerabilities, and countertransference can influence our ability to make ethical decisions.

20. When things go wrong with a client
Act promptly and appropriately when a complaint is received
Remedy any harm done and work to avoid further harm
Apologize if appropriate
Discuss with supervisor, manager, or consultant ways to remedy current situation and/or prevent it from happening in the future
If the home visitor feels she/he acted appropriately, may be necessary to bring in 3rd party for mediation or a second opinion

21. Action indeed is the sole medium of expression for ethics.
Jane Addams