Journal of Social Work Values and Ethics, Volume 7, Number 2 (2010) Copyright 2010, White Hat Communications This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of White Hat Communications.
Abstract This study examined the degree to
which social workers perceived experiencing ethical conflicts in the contexts of their practice environments. A sample of 376 NASW members filled out questionnaires to report on a Likert scale the degree to which eight vignettes describing practice situations presented a value conflict, were frequent, and were inevitable. Findings indicated that respondents tended to view most situations as creating an ethical conflict and infrequent. Financially-related situations were seen as inevitable more often than others. Findings are discussed and implications for the profession are offered.
Keywords: Ethical Dilemmas, Values, Mission, Market
1. Introduction In making professional decisions,
social workers are currently caught between two conflicting sets of demands, one informed by the mission of the profession and the other by market forces. The professional commitment is guided by the NASW 1996 Code of Ethics, which describes social works mission as meeting
client needs and attending to environmental forces that create and contribute to their problems, and, requires that social workers place service to others above self-interest, provide access to services for all who need it, and challenge social injustice (preamble). The market forces, which have become apparent since the 1990s, include reduced funding for human services, the decrease in federal welfare provisions, delegation of service delivery to states and cities, and, tighter eligibility requirements for services (Brill, 2001).
As funding became scarce because of conservative tax policies and human services dwindled in tandem with tighter eligibility requirements, the government began to privatize its services in an effort to become more fiscally prudent (Beresford, 2005; Munger, 2006; Zullo, 2006) and practice started to be driven by funding sources such as managed care (Alegria, et al., 2001). For example, employment and foster care services, once offered by the Department of Social Services, are now being provided through individual agencies in the nonprofit sector (Zullo, 2006). The move to outsourcing of service delivery to the private sector using federal and state grants and contracts led to
Journal of Social Work Values and Ethics, Vol. 7, No. 2, Fall 2010 http://www.socialworker.com/jswve
governments increased vigilance over funding and the demand for accountability and evidence-based practice. The push for fiscal solvency among the nonprofits has grown and requirements have become more rigid with demand for demonstrated outcomes, to the degree that some grants delay the release of funding until outcome targets have been met (Abramovitz, 2005).
The aforementioned changes in the practice environments require social work settings to augment their performance (Schneider, Hyer, & Luptak, 2000), as well as provide a growing amount of documentation relative to utilization rates, client outcomes, and capitation, while struggling to perform in the context of decreasing funding. In an effort to address these growing pressures, secure funding, satisfy performance and outcome requirements, as well as improve the appearance of service utilization, human services have developed strategies such as misreporting, inflating statistics, prolonging treatment of clients, multiple counting and double booking of clients, selecting clients based on ability to pay and potential for success, as well as terminating clients who are unable to meet fees (Abramovitz, 2005; Arches 1991; Gallina, 2007; Kane, Hamlin, & Hawkins, 2003).
Because of the increasing rigidity of eligibility criteria, decreasing resources dictated by market philosophy embraced by the organizations that restrict service delivery, and growing demands for spending time and energy on producing written reports, social workers professional obligations became hard to achieve, and their ability to provide satisfactory direct service to all who need them has shrunk (Abramovitz, 2005; Brill, 2001; Carpenter & Platt, 1997; Franklin, 2001; Galambos, 1999; Gibelman & Whiting, 1999; Mirabella & Wish, 2000;
Reisch & Lowe, 2000). Consequently, social workers have been positioned in a situation of dual citizenship with conflicting demands resulting from their professional and organizational affiliations. As members of the professional community, they are obliged to follow NASW Code of Ethics, whereas administratively, they need to follow the guidelines of managed care companies or their government and nonprofit agency employers. This position increasingly creates for social workers a role conflict, i.e., a situation in which societal standards, norms and expected behaviors connected to one position disagree with those ascribed by another position held by the same individual (Biddle & Thomas, 1979; Broderick, 1998; Turner, 1996). When charged by the profession to deliver services to those in need (i.e., expectations derived from the professional role) and faced with organizational policies that restrict service delivery (i.e. expectations related to employment affiliation), the potential for conflict is high. The conflict may be exacerbated by the large and growing number of untreated populations, such as the chronically mentally ill, uninsured, underinsured, and those struggling with substance-related issues (Amaro, 1999; Gibeaut, 2000; Meinert, Pardeck, & Kreuger, 2000). Furthermore, the aforementioned strategies used by agencies to alleviate the pressures may in themselves conflict with the professional ethics, further intensifying workers role conflict.
