Ethics in Child Welfare: Aspiring to Practice Standards Kent Jones: Hello, I'm Kent Jones. Your host on behalf of the Children and Family Services Division of the Oklahoma Department of Human Services. Our topic today is Ethics in Child Welfare: Aspiring to Practice Standards. And joining in me in our discussion is Dr. Jim Burk, Department of Human Resources Chair, East Central University. Dr. Burke thank you for joining us today. Dr. Jim Burke: Thank you for having me. Kent Jones: Tell you what, I would just want first of all to start, why in the world are we talking about ethics? Why do we need to do that? Dr. Jim Burke: That's a good question Kent, because of a lot of people view this as it's a black and white issue as far as it's either right or wrong. And I think there's been a reemergence in the past few years emphasizing ethics in all professions. I almost pinpoint it back to the collapse of Enron. There was a lot of concerns about proper behavior in businesses. I think everybody took a step back and looked at themselves and said are we doing things right? How can something go on like this, this type of behavior, unethical, illegal kind of behavior in the helping professions. Particularly in child welfare. Which have been dominated with the profession of social work. They've had a code of ethics that they have adhered to. What we're seeing today, particularly in the state of Oklahoma, in child welfare, is because of the huge demand for the number of workers, social work can not meet the demand to fill all those positions. So counties across the state are filling these positions with people from a lot of different disciplines and backgrounds. Not necessarily backgrounds of helping professions. People who are trained, prepared, this was their goal to go into child welfare. A lot of times people see this as an opportunity, they feel well I can do this. This is something I would be good at. It's an opportunity in my community for a job. And they get interviewed and they become part of the staff. I think that's part of the reasons why we're having a conversation today on why it's important to understand code of ethics and what we need to be aspiring to. Kent Jones: And I would think that, right or wrong, it still seems rather simple. I mean even in the Enron example that you gave, I'm sure that those people who were doing wrong kind of hand that feeling. Isn't that something that we're born with? An intuition? But does that need to be so enforced, if you will, with the people, anyone for that matter, in the people that you're bringing in to do the work? Dr. Jim Burke: I would hope that everyone would have that innate ability. Sometimes we heard people referred to as being ethically challenged. And so perhaps there are some individuals that don't always make the right choice. Or when given an opportunity make choices they'll regret or the agency would regret. And what I hope that we focus on today, or to look at is, understanding that in child welfare there is a certain value system that we want our workers to adhere to. Part of those values are believing the individual worth of people that we work with. Believing that people have a right to participate in decisions affecting their life. That there's a certain self determination people have a right to have. That their confidentiality about the information that we talk about needs to be adhered to. Privacy. Privacy's become a big issue throughout our lives now. We talk about identity theft and things like this. But in child welfare, we're dealing with such sensitive areas and people are reluctant to allow us into their lives and part of their concern is who else is going to know this? Who else is going to find out about this? That's why we really have to emphasize the importance of confidentiality. And a key thing that someone working in child welfare, I think, needs to adhere to is belief that people can change. That if we don't believe that, then we are really working against the system. Because the system believes that with resources, help, proper kind of assessments and consultations and services provided to these people, they can change and have the life that they want, so their children can remain in their home. Or their children can be put in a safe environment. Kent Jones: Well I can see why that would be an important belief, because that's really why the service exists, is to help create a better atmosphere for the kids for example. So, I hear what you're saying, that it's more than just a cut and dried right or wrong. Some of the things you've mentioned actually get rather involved. Privacy issues and things that may not have been ... That really need to be taught in learning how to do child welfare work. So, let's get right to the ethics, and that word in itself. Can you define that for us? And really what it means to aspire to the program standards? Dr. Jim Burke: In preparing for today I was reviewing a lot of literature. And one of the first books I picked up about ethics in child welfare was talked about, and their research in writing their book, they came across I think it was 180 different definitions that someone can have for values or for ethics. For me, my interpretation is that the values are those things we believe in. And what I had previously mentioned. And the ethics are those guidelines we want to adhere to that's going to guide us through in our decision making. And the ethics is going to lead to the principles that we will have that will, if we hold to those principles we will act on the standards that we want to have. And that's that kind of practice standards that the department has wisely developed within the past year or so. They, I think, have recognized that we've got a diverse population in our workforce. Not everyone has come out of college and prepared for this. So we've got to make sure we're all on the same page. How can we make sure we're working towards the same goal, the same principles and achieve that same standards? So that's why they have developed, which I applaud, their practice standards. Kent Jones: And I'm sure they've developed this over a number of years and things have changed over time too I'm sure. Dr. Jim Burke: Correct, correct. Kent Jones: As different situations have taught us different ethics are needed or different standards. Do you have some examples of how it was and how things have changed over time? Dr. Jim Burke: I do. The way it's often been described now is that we have what we refer to as mandatory ethics. These are the ethics, the principles that we adhered to, that we have to follow because the policies, the procedures, government laws and regulations say this is what you have to adhere to. You violate these, you could be sanctioned. You could lose your job. You could have criminal offenses filed against you. And so those are the basic, minimal kind of standards one has to adhere to. And that's where we've kind of stayed with that all along when we talk about ethics. And that's why I think people might see it as black or white. You don't cheat, you don't lie, you don't do fraudulent acts. You don't have illicit affairs with clients. It's almost like what part of "no" don't you understand? But, what the department has done, what I believe, they've raised the bar to, with this practice standards, to what's referred to as aspirational ethics. And these are the standards you need to adhere to in order to conduct best practice. And if you do these things that adhere to best practice, you have very little concern about am I in ethical violation. Am I doing the right thing for the individuals and families that I work with. Kent Jones: Yeah, we get above what the law would say, and then you have the ethics, the standards, the best practices that you're talking about, really have been laid out for the workers. Is that a complex set? Or is it pretty cut and dry as well? Dr. Jim Burke: No, it becomes difficult if you don't have the training. I think what's unique about child welfare is that it's more than just a job. One has to bring into a compassion for it. That this is, there's almost a calling to be in this area. If you're viewing it as a job I think it makes it more difficult for you to understand the aspirational standards. You can get the mandatory standards because okay, if I do this, I'll get fired or I'll get in trouble or I'll get sanctioned. Or called in to the county director's office. That those who don't come in to the field with preparation of their discipline has a code of ethics, and so they have been, they've talked about it. They've been given examples on what it means to have a dilemma. An ethical dilemma. An ethical dilemma with a family exists when I don't know quite what to do. In those situations that's when a worker needs to realize that's when I need to consult with someone. I'm not sure what to do, is this the right thing to do? It may be the easiest thing to do at the time. Or convenient thing. Because it's Friday and it's 5:00 and you just got this call. But that's why the system is set up where everybody has a support. Someone to call to confer. Workers have the supervisors. Supervisors have liaisons, liaisons has the office people. Where it's a real team approach, is what it takes, for people to be able to understand how can I fall into best practice standards. Kent Jones: Because everyone has been brought up differently. And different people, even the workers, have different sets of values, ways that they might respond to certain situations. Do the workers really need to kind of get out of that or use that? Do they want to avoid their own personal upbringing and values and standards in trying to aspire to the best practice? Or are there the set guidelines, you really should consult with another supervisor or something? Dr. Jim Burke: I think what you're asking is kind of two things. First of all, they do need, any time they have a question about what's the proper thing to do, they need to consult with a supervisor. The other part, what I was hearing, is that a worker does have to have self monitoring. You've got to be asking yourself these questions. Just don't assume you know it all. And that you've got the answers. And this stuff seems easy. And I get it. Because it isn't that easy. The kind of the irony of our education, our education system tends to teach us in generalities. And we deal with generalizations. If you're taking a human development course, they're telling you this is what a typical two-year-old will look like. And so you're a child welfare worker and you go out to that home and they've got a two-year-old. And they go, well that two-year-old doesn't match up with what I've learned in class. Where they're really, that's just kind of the average. You can have a two-year-old that functions as a four-year-old or a two year old that's very limited in their verbal skills and their attention span and things that they should be doing at that point. So what we ask workers to do is take the knowledge that you have, but be sure that you individualize it with the families and realize every family is different. One of the issues that, in preparing for today, they were asking different supervisors and workers and administrators, what are some of the things that we should be talking about? That there's a concern about. And one thing that consistently came up was judgmental attitudes that workers may have. And what this tells me is they've got this kind of preconceived notion of what families are like or about. So if I get this referral on the telephone, or I receive a referral from someone else, and they say, here's the case, here's the situation. Well, in a way, we're trained to prepare to anticipate what we're going to find. But don't come to conclusions about that. Don't take you're, don't be judgmental about it, where I've done that type of case before, I know that type of family. This is probably what I'm going to find. I'll probably be back with the kids in two hours. That's a real dangerous type of approach to take, being judgmental. Because then, if you remember earlier, I was talking about one of the things that we believe in is that people can change. And we want people to participate in their plan of action to change. Well if I've got my mind made up, what type of family or category this family falls into, I've missed the boat on some of the key values that we say that we're to adhere to in child welfare. Kent Jones: I can imagine it would be difficult to be helpful if you've already tried the case, if you will, and judged it and that's it. So really, open mindedness is a key because every situation is different. Dr. Jim Burke: Yeah. Being open minded and non-judgmental. You take your knowledge; you take your experience into that situation. But you don't draw the conclusions until you've gathered all that information, is real key in ... And I hope workers see that. Now doing that is an ethical practice, not best practice in doing that. And if we see ourselves, sometimes we, there's a part of when I do training on ethical behavior, is what I call a slippery slope that we can fall into. And one of the things that I mention is the negative attitudes towards clients. How having that, and that ties in with the judgmental attitude, and those negative attitudes can adversely affect our ability to do the best practice with them, if we have negative attitudes. We are not going to enjoy every family that we go out and work with. There are going to be situations that are just abhorrent to us. Or appalling to us. I understand that. I'm not naive enough to say you guys will go out there and embrace everyone as your best friend. You've got to go out there as a professional in every situation. And engage them as a professional. And give them the opportunities to change and to realize that outcome. If they choose not to take advantage of those opportunities, that's their choice. But it's not our choice to decide they're not going to get to do this or have an opportunity to change there. Kent Jones: You mentioned the slippery slopes. Define that for us, so we really know. Dr. Jim Burke: It's situations that you'll put yourself in that can lead to decisions that will be in ethical violations. One of the things that a slippery slope is the negative attitudes. Another one that I think of is cutting corners. One thing that we know about the child welfare workers, is that they can be overwhelmed. In many of the county offices they have large case loads. And demanding kind of situations that you can be in a situation, you can get a call referral first thing Monday morning. And that situation is so demanding, that one family can demand, not unrealistically, your whole time that week. And you've got all these other families that you got a deadline that you've got to meet. That the state has policies that says you've got to make contacts every so often. And those contacts have to be face to face, in their home. And a lot of times they'll be situations regrettably, a worker will call a family and talk to them. How are things going? Anything change? Things are fine. And a worker will make the wrong decision to count that as a face to face contact. And put that in to the system as if they were there. That's a dangerous situation to be into. Because the next call you could get, you could be gone and someone else has to go out on your case, they go out there and they see a situation like, well you know, Joe was out here last week. How did this deteriorate in just a week? When in fact Joe wasn't there. So there's situations, the thing that I would really emphasize, a point I would want to make is that every case a worker has is everybody in your office is one phone call away from being responsible for that case. That we are so interconnected and sometimes it's not just within your office. It can be adjoining counties. Because we have what they're referred to as primary and secondary cases. Where a case may be in one city or one county and because the child is in foster care in another county, so counties work together. But we've got to appreciate that it's just not your case load you're concerned about. I can handle this because I remember what I did, or how I documented that. That it has to be clear enough, and honest enough, and developed with integrity, because someone else could be dealing with that tomorrow. Kent Jones: Well, and you bring up a good point, if you get a call on Monday morning that you need to help a family and it's going to take you all week, you have to rely on your other members of your team to help your other cases that you're working with. Dr. Jim Burke: Right. Kent Jones: So really it's a good support system within the system. Dr. Jim Burke: And the counties I go into, where I see that support system, that's where I see the best practice happening. And they realize they have to count on each other and they realize they could be involved in their case and so they're making the right decisions. They're following that policy correctly. I kind of think of an example, when someone has been charged with embezzlement at the bank, and they go well how can they get away with embezzling for so long? And then you find out, well they haven't had a vacation in five years. They haven't called in sick. So no one's looked into their books and saw that. You don't have that because your case is being reviewed. And it has to be accurate information that's put in there. And so those are really the kind of mandatory things that if that is discovered, it certainly will be a sanction and probably cost your job. And those are legal documents that if you're putting misinformation into, that you'll bear the burden of the responsibility for that. Kent Jones: For instance, something as simple as I made the visit when actually it was just a phone call? Dr. Jim Burke: Yeah, yeah. Kent Jones: You've identified a couple of slippery slopes. One is negative attitude going in. Which really is unfair to the family because they don't have a chance to, things may be better than what you initially judge it to be. Dr. Jim Burke: Right. Kent Jones: And then the other one is the fact that if you're overloaded you're not- Dr. Jim Burke: Overwhelmed. Kent Jones: Overwhelmed you're not taking advantage of your coworkers and helping make sure things are right. Some other slippery slopes that you might identify for us? Dr. Jim Burke: One that I want to talk about is confidentiality. That being loose on that. I think too many workers, particularly someone that's coming into this field without preparation, they have a very limited definition of confidentiality. Some view it as long as I don't use names then I'm not breaking confidentiality. Because you don't know I'm talking about the Smith family. I haven't mentioned that. But if, the way I interpret confidentiality, by professional standards, that unless that information is being shared for professional purposes, it shouldn't be shared. Because if I'm talking to you about a family, and it's not your case, and I'm saying oh, you should have seen this case, this family I just came back from. And I'm talking about it. I'm breaking confidentiality because I'm not sharing it for professional purposes. I'm not consulting with you. It borders on gossip. But also, here's the problem Kent, that you can get into, is that that could be your case two months from now. And you remember the conversation that we had and you're going, I remember when Jim talked about, oh god, that's this case. And so you've got, I've set you up to have these preconceived notions about that family. And that's not fair to them. That may have been my opinion, my perception because of how I saw that. And I tell you, I've got a couple of good examples of how confidentiality, we've got to be careful. This morning someone was telling me that they remember a situation where two professionals out to eat in a restaurant. They were talking about a case. Someone overheard them in that restaurant and they knew the client they were talking about. They called in and said I've heard this and that about that family. And that person was working on their clinical license, was dismissed from school for that. Someone else there, they said they needed to get with a colleague. Because they did need to consult. And they were doing it for professional reasons. Again, they chose a restaurant. Because they go, let's go to lunch, I've got a bunch of stuff to talk about. And they felt like they were using their inside voice. And after about 30 minutes of conversation they said the guy sitting by himself in the booth behind them stood up and said, you know, if you're going to talk about people in public you shouldn't use names. And he said his immediate reaction was defensiveness. Like why are you eavesdropping? But then he realized, thank you. I needed that reminder. And that's part of that slippery slope where we get very casual, very relaxed. We think oh, everybody's here in the office, but there's, if you go to some of these county offices there's cubicles and peoples that don't have anything to do with child welfare that can participate, listen in on these conversations. And particularly in rural counties, in smaller counties. Where I have workers tell me that a day doesn't go by they don't have contact with a client that they know previously. Or had some kind of connection with them. And so in the smaller counties we really have to be cautious about adhering the ethical standard of confidentiality. To make sure that we're guarding that. So that clients aren't reluctant to seek our help. And that we're protecting that information so best practice can be adhered to. Kent Jones: Another slippery slope that I can imagine might happen is getting emotionally involved with the family. Of course you want to care, but where do you draw the line on getting personally, emotionally involved in that? Dr. Jim Burke: That's a good question, I'm glad you brought that up. Because that falls in, what I believe, the category of boundary issues. Boundary violations. We've got to recognize and to remember at all times that the reason we're in contact with this family, or this individual, is for professional reasons. We've been called because there's a referral, a complaint, a concern, an issue. And we get involved with them. And go back to my example if in rural practice, we may know them because we go to the same church. Or they're husband works on our car. Or our kids go to the same school. Or we play on the same ball team. And so there can be this kind of familiarity that we have with each other, but we have got at that point, to make sure that we keep that professionalism. That's the reason that we're even together. We have that relationship. And the thing to remember is that it is the worker's responsibility to maintain that boundary. The client may be wanting to say can't I know you? Gosh, we've known each other since junior high, can you help me with this? Or you know, don't turn that in this time. I slipped up. I'll have the place clean next time. Or I'll make sure I won't have any booze around the house. But we've got to make clear with them as far as how this relationship sets up. And that also brings me to mind an issue that was brought up as far as informed consent. Now that is an ethical principle that we have to adhere to. And what informed consent means is that we have to make the clients fully aware of what their rights are. What information they share with me. That if they share certain things I'm going to have to share that with others. What information they share with me I can keep confidential. What their rights are in refusing treatment, or requesting for treatment. What opportunities they can have. We've got, and a lot of times we have families that are challenged. They're not as educated. They're not as informed. They may be limited in some ways. And it's like, well I'm not sure that they'll even get this or understand this. We still have to make efforts to make sure they understand the process that's going on, what their options are, and put it in a way to make sure that they understand. That the clients have to be informed of, you share this information with me, this is where it goes. Here are what your rights are. When you go to court, this is what's going to happen. So informed consent, making sure that clients are aware, and the more that they're aware, the more that they can participate. So it goes back to client participation. And they can make choices and self determination. This all ties into it. Trying to create a situation of best practice. Kent Jones: When you do the informed consent, is that all written down somewhere to hand to a client? Dr. Jim Burke: That, yes. They have documents that have to, treatment plans, that they have to develop. Now, an issue that becomes here, which I think is an ethical violation, those plans are to be developed with the client. It's not something that I talk to you, then I go back to my office and then I develop the plan, and I go this is what Kent needs. And so I, here's my ten step, cookie cutter that I use for 90% of my families. I've got to individualize that plan with you, in discussion with you. And make sure, Kent do you understand why I want you to go for counseling? And that you need to do this. And not have it like, go back to your home or meet you in the courthouse and say, here's the plan that I developed after we talked in your home last week. I need you to sign this before we go in here. Because the judge is going to ask you if you understand this. Do you have any questions with that? Often the clients are so intimidated they don't know that they should have participated in this. Or they have a right to say why are you making me do this? Kent Jones: It's almost easier to work it out in a conversational setting. Dr. Jim Burke: Yes, yes, yes. Kent Jones: Working with the client. Dr. Jim Burke: To have that. Kent Jones: I would imagine that the feedback the client gives you in that kind of a setting is helpful for the worker as well. Dr. Jim Burke: Yes, yes it is. And you've got to engage the client and part of engaging that client is generally caring about them, having empathy for them. And respecting them. They may have done some things that you don't like at all. But it is still your professional responsibility to work with them to bring about the best solution that you can bring for the best interest of the children. The children are primary and if the best interest is that this family, we can work with them, and get them reunified or to keep them together, then that's what we're going to do. But if we determine that those efforts aren't being made, truly made those efforts and not have prejudged and say these people aren't ever going to get it. Why am I wasting my time? I've got families out there wanting me. But sometimes, I think it's natural for them to be defensive initially. Someone came knocking on my door tomorrow and said Dr. Burke, I need to talk to you, we've got a complaint. I'm not going to say come on in, let's talk about. I'm going to say well who are you, and what is the complaint, and why are you here talking to me about this? We've got to understand that. And I think our role in maintaining best practice, the practice standards that the Department of Human Service has developed is what allows us to stay ethically inline with the principles that they've developed.