Ethical Decision-Making

Ethical Decision-Making
Chapter 3

Chapter Purpose Discuss the purposes and functions of ethical decision making Identify and discuss the legal duties of professional helpers Access the laws that regulate the practice of social work in their locale Identify and discuss the fundamental values of social work Discuss the ethical principles and standards that guide social work practice Identify the relevant legal duties and ethics that might apply in various professional contexts Analyze and determine the relative priority of competing legal and ethical obligations though the development and use of a case-specific values hierarchy Use critical thinking skills to reach and ethical decision and plan appropriate action

…Laws, Values and Ethics
Obey? Pledge? Social Work …Laws, Values and Ethics Abide?

Social worker investigated for missing government money, January 31, 2005
Saskatchewan social worker was convicted, tried and found guilty in connection with a million dollars in missing government money. Hynes started welfare files for 16 fictitious people, issuing cheques in their names and starting bank accounts and credit cards for several of them, boosting her income by about $7,000 a month. At least a million dollars went missing over a 10-year period. Hynes was convicted of defrauding a bank in Newfoundland in the 1980s for more than $600,000 but was later pardoned after spending two years in jail. She then obtained a Masters in social worker and moved to Saskatoon. Her criminal record was not checked when she was hired in 1989 as mandatory criminal record checks were not instituted until 1997. She was found guilty of fraud and sentenced to 4 years in a federal penitentiary This minister comments "This is a very huge breach of trust Social worker investigated for missing government money Last Updated: Monday, January 24, 2005 | 7:28 PM ET CBC News A social worker in Saskatchewan, fired this month by the provincial government, is being investigated in connection with as much as a million dollars in missing government money, a CBC investigation has uncovered. The probe into a breach of policy at Saskatchewan's social services department has become an RCMP investigation of what may be, if proven, the biggest fraud ever perpetrated on the province. While no charges have been laid, police raided Evelyn Hynes's office, seized files and a computer. Evelyn Hynes On Monday, Community Resources Minister Joanne Crofford confirmed that slightly more than a million dollars went missing over a 10-year period. She said the RCMP were contacted when staff in the Saskatoon office of the department raised "serious concerns" following a regular review of files. Hynes was convicted of defrauding a bank in Newfoundland in the 1980s for more than $600,000. Working as an assistant loans manager, she made up phoney clients and bogus loans over six years. She was sentenced to two years in jail, but was later pardoned. After getting out of jail and becoming a social worker, she moved to Saskatoon, rising through the ranks of the provincial government to become a middle-level manager. But government officials didn't check Hynes's criminal record when they hired her in At that time, she had not been pardoned. "This was 1989, when criminal record checks aren't common and I'm sure that it would have been the practice, as it is in most places, that your employer phones your references that you've provided," said Crofford. "This would not be the first instance where that does not turn up perhaps information that should be turned up." Crofford said that since 1997, all new employees of the department are subject to checks, including police record checks for employees who work in trusted positions such as child protection workers and income assistance staff. Crofford said she is disappointed, sad and angry over the unaccounted for money. "This is a very huge breach of trust," she said. Hynes wouldn't comment about the missing money when approached by CBC News at her home in Saskatoon. Saskatchewan's provincial auditor Fred Wendel said he's been warning of lax financial controls for years. "The potential exists, and those are the things that happen when you don't follow the rules and procedures," he said. Crofford says staff in her department are doing a better job of overseeing public money since the auditor first raised concerns several years ago. Blogged January 2005 Stealing from the poor. The government gave welfare recipients an extra $10 on their cheques after having not made an increase for almost 20 years. Meanwhile this woman had set up phony accounts and had been robbing money -- a million maybe? we can't know for sure. Turns out she'd already been convicted of fraud in another province. But the government was busy trying to criminalize innocent people and din't have time to check on proper crims like Evelyn Hynes. $1M fraud lands Hynes four-year term Former welfare managerhad history of lucrative scams Lori Coolican, The StarPhoenix, Thursday, July 13, A former Saskatoon manager for the provincial government's welfare system is on her way to prison for defrauding taxpayers of more than $1 million over a 12-year period. Evelyn Mary Hynes, 56, frittered away money intended for some of the province's neediest citizens on "frivolous" shopping trips, personal services, travel and a gambling habit that "verged on addiction," Crown prosecutor Perry Polischuk told a provincial court judge in a joint submission, after Hynes pleaded guilty to a single count of fraud Wednesday. Her sentence of four years in a federal penitentiary includes a restitution order, allowing the province to avoid launching an expensive civil suit to recover at least some of the stolen funds. Investigators were unable to find any assets purchased with the money. Hynes' lawyer, Si Halyk, told court she was careful not to spend her ill-gotten bounty on big-ticket items because her husband would have asked too many questions. Hynes started welfare files for 16 fictitious people between Aug. 24, 1992, and Nov. 26, 2004, issuing cheques in their names and eventually starting bank accounts and credit cards for several of them, boosting her income by about $7,000 a month. The situation first came to light in December 2004 and was referred to the RCMP. Hynes was fired the following January, but no charges were laid until April 2006 because investigators were still working to uncover the full amount of the missing money. Hynes already had a history of lucrative fraud when she was hired by the Department of Community Resources in Five years earlier, she was convicted of defrauding her employer, CIBC in Cornerbrook, N. L., of $590,702 by issuing loans to 22 people who didn't exist. She served two years less a day in jail and received a pardon in early Ironically, she was once the author of a victim impact statement in a fraud case against a welfare recipient, in which she wrote welfare fraud may be seen as a victimless crime, but it affects everyone in society, Polischuk said. Hynes received a master's degree in social work from the University of Regina in 2002, has been a professor and lecturer there and is "highly respected and regarded in her field," Halyk told court, adding she co-operated with police as soon as she became aware of their investigation and even helped them trace the extent of what she had done. "She knew she had to pay a price and she wanted to pay that price, and she wanted it done as soon as possible," he said. Outside the courthouse, Halyk ignored a reporter's question about whether his client has a gambling addiction. Before she was led away in handcuffs, Hynes told Irwin she was sorry for the pain and embarrassment she caused her family and her employer and co-workers, adding some of them must wonder if they ever knew her at all. She said she is taking counselling to try to figure out why she did it.

Seana Dobbin-Gayowsky,
Kitchener-Waterloo CAS worker commits PERJURY in court Feb 5, 2004 (Canada Court Watch Report) A Kitchener, Ontario couple submit documents which appear to show that a worker with the Waterloo, Ontario, Children's Aid Society made false and misleading statements under Oath to a court in which the Waterloo CAS worker, Seana Dobbin-Gayowsky, Said she was a social worker. Yet, a letter from the Ontario College of Social Workers indicates that Ms. Seana Dobbin-Gayowsky was not registered with the College Under the law in the Province of Ontario, workers cannot claim to be social worker unless they are duly licensed and registered with the Ontario College of Social Workers.

Which of these social workers have exposed themselves to the threat of a malpractice suit?
A social worker finds himself attracted to a client and begins a sexual relationship with her. A second social worker quits the profession before starting a relationship with her client. A third social worker meets with a divorced father who asks the social worker to provide therapy for his children who are suffering emotional trauma because of the divorce and the therapist agrees without the mother’s consent. A fourth social worker, wishing to help a poor client, agrees to trade services and lets the client do carpentry on his house in exchange for therapy.

Answer: All of Them In a litigious age when it’s said that anybody can sue anyone for anything, social workers in clinical and therapeutic practice appear to be especially vulnerable. According to records kept by the National Association of Social Workers (NASW) Insurance Trust, malpractice suits against social workers have increased dramatically over the past 25 years. Part of this increase is due, no doubt, to the infamously litigious climate we live in, in which social workers’ clients are simply more aware of their opportunities to sue and seek monetary compensation for real or imagined damages.

Understanding Your Legal Obligations

Malpractice “A form of negligence that occurs when a practitioner acts in a manner inconsistent with the profession’s standard of care —the way an ordinary, reasonable, and prudent professional would act under the same or similar circumstances” (Reamer, 1994)

Common Features of Malpractice
Malfeasance Nonfeasance Misfeasance

Malfeasance Where the professional intentionally engages in a practice known to be harmful Malfeasance is ordinarily defined as the commission of a wrongful or unlawful act (Bernstein & Hartsell, 1998; Gifis, 1991). Thus, A social worker who engaged in a sexual relationship with a client after convincing her that this would be therapeutic A social worker who used so-called rebirthing techniques without proper training or empirically based evidence of effectiveness A social worker who traveled with a client and misappropriated some of the client’s funds, in the name of re-parenting therapy, Could all potentially be accused of malfeasance

Misfeasance Where the professional makes a mistake in the application of an acceptable practice Employer Getting in trouble for things you did Most common malpractice acts among NASW members (Reamer, 1995). Thus, A social worker who used hypnosis, art, or wilderness therapy techniques negligently Either because of inadequate training or lack of skill Might be accused of misfeasance; these clinical approaches, which are based on solid research and theoretical foundations, should only be used by practitioners who have sufficient training, knowledge, and competence.

Nonfeasance Where the professional fails to apply a standard, acceptable practice when action is needed Getting in trouble for what you didn’t do (e.g., visit a client at a prescribed time). Not visiting a client at a specified and agreed up time and place would be an example Failure to refer a client for consultation or treatment

The GOOD NEWS In the US between 1969 and 1990 a total of 634 claims were filed against the NASW Insurance Trust, compared to the 60,000 NASW members insured through the trust (Reamer, 1995) Canada has a good track record too Most complaints against social workers in the popular media do not translate to actions against individuals, and in fact the number of formal complaints submitted to the regulatory boards remains consistently low from year to year. Ontario, the province with the largest number of registered social workers, received 30 complaints in 2000. Quebec had 28 open files at the end of the last fiscal year. Alberta was next highest with 8 complaints. Regulation of Social Work | Practice in Canada Alison MacDonald, M.S.W., R.S.W. & Rod Adachi, M.S.W, R.S.W. "Regulation appears simple but is in fact enormously complicated." (Gowanlock, 1990) The power of self-government granted to the professions has two essential aspects - the authority to license and the ability to discipline licensees. The licensing power is essentially the authority to decide who shall be permitted to earn their living by the pursuit of a particular calling. This means that professional organizations act as the gatekeepers to the professions in their assessment of the qualifications of prospective members. Once an individual becomes a member of a profession, the professional organization has the power to regulate the conduct of the licensee by establishing rules of practice and standards of conduct enforceable through the discipline process.... The Supreme Court of Canada has concluded that it is difficult to overstate the importance in our society of the proper regulation of our learned professions. The primary purpose of the establishment of self-governing professions is the protection of the public. This is achieved by ensuring that only the qualified and the competent are permitted to practise and that members of the profession conform to appropriate standards of professional conduct. (Casey, 1994, pp ) Within the Canadian federal system, regulation of the professions is a provincial matter. In each province, that authority has been further delegated to a regulatory board with specific statutory provisions and regulations. The oldest social work legislation still in use is the Act to Incorporate the Manitoba Institute of Registered Social Workers, Statutes of Manitoba, Most other jurisdictions have legislation proclaimed sometime in the 1990s.While one would normally anticipate that legislation with common goals would have common structures and processes, this is not the case. The 10 acts regulating social work practice have more differences than similarities, making comparison difficult. Finding a common ground for joint efforts such as the Agreement on Internal Trade, a code of ethics or standards of practice, or promotion of the profession are hampered by this fact.Registration Defined One basic difficulty is the use of common terminology with varied definitions. All social work legislation in Canada refers to “registration” as the legal term for regulated practice. In The Social Worker, Graeme Roderick (1990) provided a glossary of terms that defined registration as follows:Registration - refers to the issuance of a certificate of registration by a public or private governing body. Registration attests to persons meeting objective criteria or qualifications to carry out an occupational activity. Registered practitioners pledge to adhere to ethical standards: however their competence in the provision of service is their own responsibility. Consumers of the service are provided with a means to identify those who are qualified. Non-registered care providers do not incur legal penalty from engaging in practice activities unless claiming to be registered. (p. 20)Based on this definition, none of the provinces uses a true “registration” approach, which is simply a list of people who meet a set of criteria. Within a registration framework, a person who may or may not have a degree in social work can hold a job within the scope of social work practice and may use the title “social worker” without holding a certificate of registration. Manitoba and Quebec have legislation which most closely reflects this model.Two other terms in common use in other jurisdictions and professions are certification and licensure, defined by Roderick as follows:Certification - refers to the issuance of certificate of certification by a public or private governing body. Certification attests to a person’s attainment of specific knowledge and skill. Periodic reconfirmation may be required. Certified practitioners’ adherence to ethical and competence standards is available to scrutiny and sanction. An avenue for consumer complaint is provided. Certification allows more finite judgment of individual competency than does registration. Non-certified care providers do not incur legal penalty unless claiming to be certified.Certification is based on a model of defining eligibility, which indicates practitioners have met a specific level of competence. Legislation in Nova Scotia and British Columbia demonstrates aspects of a certification model.Licensure - refers to the issuance of a licence by a publicly mandated governing body granting right to engage in the activities of a given occupation. Licensure attests to a person’s attainment of a degree of competency required to ensure protection of the public’s health/welfare or safety. Periodic reconfirmation may be required. The licenced practitioner’s adherence to ethical and competence standards are available to scrutiny and sanction. An avenue for consumer complaints is provided. Non-licenced care providers could incur legal penalty for the performance of any activities within the scope of practice.Licensing, by definition, moves past the notion of eligibility and into the realm of accountability. A licensed practitioner is given permission to work with the public, and that permission may be removed by the licensing body if standards are not maintained. A jurisdiction using a licensure model is more likely to have mandatory regulation of practice based on a broadly defined scope of practice. This model captures the greatest number of practitioners and holds them accountable in a system available and transparent to the public. The legislation in Alberta is most closely aligned with this model.The concepts within these definitions are certainly similar, but the nuances between them are at the root of some of our difficulties in working together interprovincially. Within a licensing framework the focus is on protecting the public, whereas certification focuses more on providing credentials to members. Certification is in part designed to protect the profession and establish public respect for it (Aukamp, 1997). None of the provincial social work legislation fits cleanly into any of these definitions, and each jurisdiction is slightly different in its approach. For example, both Manitoba and Quebec add a component on competence to their registration requirements, but neither province gives the profession control of the title “social worker.” It is important to note that every province has elements of all three definitions, which only adds to the confusion.Protection of Title or Control of Scope of Practice? All the legislation in question provides for a protected title. In some jurisdictions that protection only applies to “Registered Social Worker” while other provinces have additional protections, including “social worker,” abbreviations of the title, or other terms as specified clearly in law. Still others are given protection of the concept of social work with a clause restricting non-RSWs from “holding themselves out to be” social workers. This is less clearly defined and yet to be tested in a court of law.A more complex matter is legislating a scope of practice. Due in part to the broad nature of social work practice, the definitions contained in the legislation tend to be somewhat circular. For example, the Social Workers Act of Nova Scotia states that social work practice “requires the application of specialized knowledge, values and skills in the field of social work.” An attempt to define these criteria further led back to an examination of the knowledge, values, and skills imparted in an accredited social work education program. As a group, the registrars for social work in Canada have concluded that, due to variations in provincial legislation, further progress with regard to interprovincial mobility as required by the Agreement on Internal Trade is unlikely to succeed until a practice analysis (or an occupational profile) has been completed and accepted by all parties, thus providing us with a common base for defining core social work practice at the entry level.A trend gaining some ground in North America is legislation that protects both a title and a scope of practice without granting any profession an exclusive scope of practice. Under this model, if a practitioner qualifies for registration in a profession and works within the scope of that profession, the person must be registered, regardless of title. Those who do not qualify for registration are prevented from using the professional title, but may be able to carry out some of the tasks within the scope of the profession. Restrictions are placed on the use of specific procedures that are considered to be high risk and that require a level of specialization to ensure the public is protected.An example of this model is provided by addictions counsellors under the Health Professions Act in Alberta. The counsellor’s education determines whether he or she must be a registered social worker, a registered nurse, or a chartered psychologist. If the person’s education does not qualify them for registration with any professional body, he or she may continue to be an addictions counsellor, but may not provide any restricted activities except under the supervision of a qualified professional.This model does not require a regulatory board to define practice exclusive to the profession. It gives recognition to the fact that many approaches may be used to address similar problems and that many techniques are shared among professions. It tends to encompass a broader range of professionals within the defined scope, while reducing the profession’s monopoly on the provision of services.The Language of the Law The legislation in each province defines the specific role of the regulatory body. Several tasks are common to all jurisdictions, including: the obligation to issue a certificate of registration to an applicant who meets the eligibility criteria as defined in the act; the responsibility to accept and act on complaints from the public with regard to a registered social worker’s practice; the right to adopt a code of ethics or standard of practice to be followed by registered social workers. How each of those roles and responsibilities is carried out varies greatly among jurisdictions. Looking at just these three areas, we can identify dozens of differences, for example:Registration There is a range of entry level criteria. Some jurisdictions require a period of provisional registration for new applicants. Required documentation varies with regard to such aspects as references, criminal record checks, evidence of academic preparation, and provision of a personal statement. Categories of membership are not consistent. Some jurisdictions have criteria for assessing equivalence. Categories of people required to be registered and definitions of mandatory registration vary. In some jurisdictions registration remains a voluntary. Some jurisdictions exempt specific groups, such as government employees, from any legal requirements. Some jurisdictions are authorized to use examinations in the registration process for all or for a specified type of applicant. Complaints Some jurisdictions contract investigators to review complaints. Some jurisdictions require all complaints to be reviewed by a discipline committee whether or not the committee has the authority to act on the complaint. In some jurisdictions employers are required to notify the regulatory body when they discipline a staff member. In some jurisdictions the regulatory body is required to notify the employer when a member has been sanctioned. Some jurisdictions are authorized to publish or otherwise make public decisions with regard to disciplinary actions. Codes and Standards At least four separate codes of ethics are in use in Canada. Some jurisdictions write standards of practice for different fields of practice. Some jurisdictions write standards of practice to apply to all registered social workers. Some jurisdictions have no written standards of practice. Again, these differences highlight the fact that, while our legislation may be written using similar language, the interpretations vary widely across the country.Roles and Responsibilities When a government makes a decision to impose regulation on the practice of a profession, it does so in recognition of the fact that the practitioners being regulated are providing a service that may involve some risk to the public. The purpose of the legislation is to define who is eligible to provide those services in the name of the profession and to provide recourse to members of the public who have suffered harm as a result of actions or lack of action by a regulated professional. As all provincial social work regulatory bodies have the legal right to deal with complaints against RSWs, all RSWs in Canada are accountable for their practice to the public and to the profession.So far in Canadian history we have been lucky. Most complaints against social workers in the popular media do not translate to actions against individuals, and in fact the number of formal complaints submitted to the regulatory boards remains consistently low from year to year. Ontario, the province with the largest number of registered social workers, received 30 complaints in Quebec had 28 open files at the end of the last fiscal year. Alberta was next highest with 8 complaints. We can assume that this is a result of exemplary service by almost all registered social workers, or we can recognize that the individuals with whom we work are usually in a vulnerable position and may view themselves as relatively powerless in their relationships with professionals.It is the role of regulatory bodies to provide consumer protection. This carries with it a responsibility to inform the public about social work practice accountability and one’s right to recourse if one believes that the treatment received does not reflect an appropriate level of skill or violates the code of ethics.Social work regulatory bodies are given a legislated mandate to protect that vulnerable public. This is accomplished first by determining “who gets in.” The regulatory board, not the degree- granting institution, holds legal control of the professional title. A university may give a person a degree in social work, but, if that person does not meet the additional criteria established by the regulatory board, he or she may not be permitted to work within the scope of practice in the jurisdiction. The role of the university is to prepare a graduate to meet the practice standards as defined by the regulatory body. The connection is further controlled by the requirement in some jurisdictions for the practice component of the education, the field placement, to be supervised by a registered social worker if it is to count toward meeting registration requirements.Once a person is a registered social worker, again the regulatory board determines whether or not the person can continue to practise and whether there are any limitations on that person’s practice. This determination may be based on a demonstrated level of competence, requirements for ongoing professional development, payment of fees, or disciplinary action. For example, both Ontario and Alberta have legislation requiring graduates of a two-year social services diploma program to be registered, albeit under different titles. In both jurisdictions, those registrants are restricted from using psychosocial interventions in their practice unless they have undertaken additional training to develop appropriate skills. In some jurisdictions, social work practice is limited by legislation such as that in British Columbia and elsewhere that prevents social workers from using the DSM-IV to assess mental health status.Several provinces have mandatory continuing education requirements, and social workers who fail to provide appropriate documentation may be denied the right to practise until they have complied with the legislation. While employers may not have a legislated requirement to support continuing education, they may find that, if they fail to do so, their staff may lose the right to practise. Several initiatives are currently underway to bring together regulatory bodies, academic institutions, and employers to address the continuing professional development needs of social workers. Most university social work programs have a clear role to play in the provision of continuing education for social workers in their communities and increasingly to other communities through distance education. However, the regulatory body determines what requirements individuals must meet to maintain their registration status within the profession.The regulatory body also has the authority to define social work practice within the jurisdiction. Historically, employers have called many people “social workers” who have neither been educated in the profession nor been accountable for their practice through registration within the profession. In most Canadian jurisdictions, this is no longer possible. An employer may advertise for a social worker, but if the candidate selected does not meet the standards for registration, that employer will likely have to use a different title if indeed the candidate can be offered the position at all.We all have an interest in promoting skilled and ethical social work practice. Schools of social work want to know that their graduates will be able to move into the work force with a level of competence recognized as at least adequate to enter the profession. Employers want to know that, when they hire a new graduate, they can expect a basic level of competence and that the consumers of their services will be well served. Regulatory boards will continue to set the minimum standards for eligibility and ensure that all regulated practitioners continue to be accountable for their practice.Finding Common Ground Over the past eight years, the social work registrars from each of the Canadian provinces have been meeting annually to discuss issues of mutual interest and concern. The day-to-day functions of regulating the profession are conducted by paid staff in eight of the ten jurisdictions, while two still rely largely on volunteer support. Social work regulatory boards, which may be elected, appointed, or a combination of both, continue to deal with matters such as setting policy, reviewing complaints, and hearing appeals of decisions made by staff and committees. All these functions will continue as prescribed by the legislation in each province.The relationship with association activities varies according to the legislation as well. In some provinces, there is no distinction made between the body regulating social work practice and the body fulfilling the role of professional association. In three provinces, the legislation defines bodies for regulatory purposes, entirely separate from the professional association. The remaining provinces have a hybrid with both the association and the regulatory body named in a single piece of legislation, each with clearly defined roles and operating in a shared space.The relationship with academic institutions also varies greatly from province to province but is rarely defined in the legislation. Functionally, most social work regulatory boards are authorized to approve social work programs for the purpose of registration, but traditionally this role has been minimal, as the boards have accepted the accreditation process under CASSW to maintain the standard.There is often a tension between academic institutions and regulatory boards, due in part to the expectation among regulators that academics who are teaching members of the profession should be accountable to the profession. Two questions are asked, and the answers are not always clear. First, is teaching the profession part of the practice of the profession? People tend to respond with a definite yes or no and see little middle ground on this issue. The second often unresolved question is whether teachers should be held to the same ethical standards with the same legal accountability as other members of the profession. In some jurisdictions, the legislation remains silent on these questions, while others specifically include or exclude academic instructors. It should be noted that this tension exists in a few other professions besides social work.Regardless of whether we agree with each other’s viewpoint, there is no doubt that we have common ground and mutual interests. We all support best practices. We all want to ensure that consumers of social work services are treated skilfully and ethically. We all want social work to be a recognized and respected profession. We can all recognize the benefits to be achieved by working together to be the best.In Summary We thus face difficulties in Canada in our attempts to work collectively on regulation matters. We all use the same words, but our meaning in what we say and our interpretations of what others say are not the same. Ten separate pieces of legislation were written at different times and with different goals. From the definition of social work practice, through the regulations, and on to the design of the organizational structures, there are more differences than similarities among the jurisdictions.The regulation of social work in Canada falls within the scope of provincial authority. There is not a will within the various governments to establish national standards or to abdicate the responsibility for control of professional practice back to the federal government. The Agreement on Internal Trade requires that the provinces find a way to work together to remove any barriers to mobility within Canada, but this is not likely to be accomplished until we have agreement on the meaning of the words we use.Regulatory bodies, social work education programs, professional associations, and those who employ social workers all have a common interest in promoting skilled and ethical social work practice. The role of the regulatory bodies is to ensure that those who are doing social work are accountable in fulfilling their mandate. Gweneth Gowanlock’s statement of 1990 is as true now as it ever was: “Regulation appears simple but is in fact enormously complicated.”References Association of Social Work Boards (2001). Social Work Laws and Regulations: A Comparison Guide. Culpeper, VA: ASWB. Aukamp, A. W. (1997). Presentation to the Continued Competency Summit, Chicago, July Casey, J. T. (1994). The Regulation of Professions in Canada. Toronto: Carswell Thomson Professional Publishing. Roderick, G. (1990). Glossary of terms. The Social Worker, 58 (1). Alison MacDonald and Rod Adachi are members of the Alberta College of Social Workers.

Protecting Yourself To reduce the risk of civil claims or disciplinary complaints against social workers, AON Reed Stenhouse Inc., in co-operation with the CASW and your insurer offer protection CASW PROFESSIONAL LIABILITY INSURANCE PROGRAM PROFESSIONAL LIABILITY For damages resulting from a negligent act, error, omission or malpractice arising out of your professional capacity as a social worker. SOCIAL WORK It is not the role of your insurer to define the activities of a social worker. If the activity is approved by your Provincial Organization (CASW member), then your professional liability insurance coverage would apply. DISCIPLINARY COSTS Provides for the cost of defending you against a disciplinary action brought against you.

Paying the Consequences of Professional Misconduct
Sanctions Paying the Consequences of Professional Misconduct

CONSEQUENCES

To Trust or Not to Trust…
Repressed Memories To Trust or Not to Trust… Repressed memory is one of the most controversial subjects in the history of psychology and psychiatry. A repressed memory, according to some theories of psychology, is a memory (often traumatic) of an event or environment which is stored by the unconscious mind but outside the awareness of the conscious mind. Some theorize that these memories may be recovered (that is, integrated into consciousness) years or decades after the event, often via therapy. They may also reoccur in dreams. The theory of dissociative amnesia makes the assumption that memory repression is possible. The repressed memory concept was popularized during the 1980s and partly the 1990s by the popular press, some feminist groups, and some psychological schools of thought; however it is suffering a retreat in popularity with professionals and the public during recent years after a series of scandals, lawsuits, and license revocations concerning it.[citation needed] The concept was originated by Sigmund Freud in his 1896 essay Zur Ätiologie der Hysterie ("On the etiology of hysteria"), however Freud himself abandoned his theory between , and during replaced it with his impulse-based concept of Id, Super-ego, and Ego. Friedrich Nietzsche was the first to suggest an active, conscious thought management method in the second essay of his On the Genealogy of Morals as a necessary fundament of efficiency, responsibility, and maturity. The theory of repressed memories must not be confused with the established psychological concept of repression in general which stresses impulses instead of memories. [Do repressed memories actually exist? Repressed memories may or may not exist. Amnesia of traumatic events does appear to happen, as do false memories or pseudo-memories; however, the hypothesis of repressed memories involves far more, as it theorizes not only that memories can become completely unavailable to the conscious mind (amnesia) but that those same memories could later be retrieved, and at the time of retrieval have the same (or greater) reliability as memories which were never unavailable to the conscious mind. Many theories of Amnesia, such as Dissociative Amnesia, involve recall. However it remains true that one must distinguish general psychological repression, amnesia, false memories or pseudo-memories, and the hypothesis of repressed memories. They all are different concepts, each building upon different theoretical conceptions. There currently exists a great controversy among researchers, treating professionals, law professionals, and the general public as to whether repressed memories actually exist, and even more heated controversy over whether recovered memories are valid, especially in the absence of corroboratory evidence. This is particularly important as many controversial criminal cases have been based on a witness' testimony of recovered repressed memories, often of alleged childhood sexual abuse. In some instance, the presumed existence of repressed memories are used to extend the Statute of limitations of child abuse case. Abuses of the Repressed Memory Theory and of controversial therapies like Recovered Memory Therapy often cause false memories to be formed.[1] The Recovered Memory Therapy industry involved thousands of psychotherapists using hypnosis, group therapy and other means to help patients recover alleged "repressed memories". This industry was dismantled over a five year period by hundreds of malpractice lawsuits beginning with the Hamanne v. Humenansky trial of August of [2] Subsequent cases produced similar results culminating in the Burgus v. Braun case which, at $10.6 million, remains the world record for a psychotherapy malpractice settlement.[3] Recovered memory therapy today is considered a dangerous form of malpractice and a cause for license revocation. Research and hypothesis supporting repressed memories Some hypothesis claiming support for so-called repressed memories are controversial and have little support among some mainstream memory experts. One speculative theory on how repressed memories originate is that traumatic memories are stored scattered about in the amygdala and hippocampus but not integrated into the neocortex. Also, it could be possible the right brain stores the memory but does not communicate it to the verbal left brain. This may mean that there is a continual active effort by the unconscious to repress memories, which can be dropped at a moment's notice should the unconscious decide The recovery of such information is neccesary or vital.[citation needed] For example, one possibility might be the anterior cingulate actively inhibits the memory from reaching consciousness. Another hypothesis is that the cortisol, a chemical released during trauma, may induce forgetting.[4][5] Cortisol appears to have the ability to erase details and possibly induce amnesia. One anecdotal study done by ABC News showed military personnel who were put through an extremely traumatic situation were unable to properly identify details of the memories, even remembering the perpetrator as someone of a different sex or with a different skin color.[citation needed] Some people believe that people just force themselves to forget. Some studies have shown that people can force themselves to forget non-traumatic facts though memory inhibition processes. Other researchers say that this might be explained by normal forgetting and normal recall experienced with all memories.[6] Many opposing studies exist. A review of these hypotheses has been published by Professors Harrison Pope and James Hudson of Harvard Medical School.[7] Other opposing views are cited in Charles Whitfield's book Memory and Abuse.[8] Research and theories critical of the theory of repressed memories Some studies of more than 10,000 trauma victims found none of them had repressed or recovered memories of trauma[9]. Similarly, some studies of thousands of abused children found no evidence at all for so-called repressed or recovered memories. Coupled with laboratory studies and other naturalistic investigations, most prominent researchers in the field agree with Harvard University's Richard McNally and consider the notion of repressed memory to be a "pernicious bit of psychiatric folklore" [10]. A recent Amicus Brief to the California Supreme Court drafted by R. Christopher Barden and signed by nearly 100 international experts in the field of human memory emphasized there is no credible scientific support for the notions of repressed and recovered memories. [11] In addition, recent research demonstrating the relative ease of deliberately implanting false memories has been cited as evidence for this hypothesis. Hundreds of people who went through therapy and were convinced that they had been abused by their family members have recanted and no longer believe they were abused.[12] However, there have been many other studies that show a small percentage of childhood trauma that was verified by medical records, was forgotten for some significant period and remembered or verified later in life[13]. Repressed memories also may be mistaken for a normal form of amnesia of early childhood experienced by all humans. Memories before age 2 are almost always false or at least inaccurate, and few adults remember anything before age 3. This does not mean the individual was not abused, just that they do not have any memory of it and should not be expected to recall it. [Recovered memory therapy Main article: Recovered memory therapy The recovered memory therapy (RMT) movement peaked in the mid-1990s with tens of thousands of patients annually reporting new so-called recovered memories. Thousands of patients’ families were torn asunder by allegations of abuse produced in therapy. The recovered memory movement was ultimately decimated by a wave of successful malpractice lawsuits. The first multi-million dollar verdict against a recovered memory therapist was the 1995 case of Hamanne v. Humenansky case in the U.S.[14] The final crushing blow to the RMT movement came in 1997 with a $10.6 million legal award to the Burgus family.[15] "The next thing I think there will be is legislation to require informed consent from psychiatric patients for such so-called 'treatments'," said Dr. R. Christopher Barden, a psychologist and lawyer [for the plaintiff], "This (case) is the death knell for recovered memory therapy." World-wide attention on the Burgus case exposed the glaring scientific, methodological and ethical errors inherent in recovered memory therapy and the underlying theory of so-called repressed memories. Following a series of high profile litigation losses, many of the professional leaders of the RMT movement suffered licensing prosecutions, license revocations, disciplinary actions and even criminal prosecutions. The leading journal in the field, Dissociation, ceased publication. By 2000, the "memory wars" were largely over and it is rare in 2005 to find a therapist who will admit conducting any form of therapy to recover so-called repressed memories. International experts in memory, research procedures and ethics continue to document how and why such an odd form of quackery became so widespread. The definitive work on the subject to date is "Remembering Trauma" by Prof. Richard McNally, Harvard University Press (2003). Prof. McNally summaries the relevant scientific research and concludes that the notion of repressed memory is nothing more than psychiatric "folklore". Body memory A form of repressed memory is supposed to be Body memory. Body memory is a claim that the body itself (rather than the brain) remembers something - typically abuse. This is characterised by a pain in a body part where there appears to be no present day physical reason for the pain, so this is seen as evidence of the body remembering a past pain, similar to phantom limb syndrome. [citation needed] Some psychologists and social workers use the term body memory to refer to physical symptoms that accompany trauma. Studies have shown that survivors of trauma, specifically with PTSD, have a predisposition to illness and injuries. Stress headaches would also be an example of a "body memory" when you use this definition. However, these symptoms are not only trauma induced and do not prove or disprove memories or trauma.[citation needed] There currently is no scientific evidence of body memory corresponding with either of these two definitions. Freud on repressed memory Please improve the article or discuss this issue on the talk page. This article has been tagged since September 2007.Freud abandoned his theory of repressed memory not "during his later years in life" and not due to social pressure, as some feminist schools of thought[citation needed] claim today. Some sources do not even mention Freud's decision of abandonment at all (for example Bass and Davis 1988,[16] Herman 1992[17]). Freud encountered facts in his psychoanalytical practice that contradicted his initial theory of repressed memories of traumatic sexual experiences during early childhood (mostly referred to as Freud's Seduction theory).[18] These were a.) that he increasingly came upon evidences in individual cases logically outruling any possibility the 'recovered' events could have occurred, b.) that, to a degree, he found himself able to direct his more suggestible patients into any recollection of memory he wanted to (especially while they were undergoing hypnosis), even more so in an entirely boundless manner when he turned to sexual matters, and c.) linked aspects (to repressed memories timewise, spatially, and/or causally) that in contrary had not been repressed or that had always been manifest to the conscious mind of his patients in a transformed appearance (see defence mechanism) were not perceived by his patients as alarming or frightening on themselves. If negative trauma was the cause for the repression Freud observed, they should hence be perceived as negative. In fact these linked aspects frequently were connoted with positive emotions, partly even very intensely so, that the patients themselves could not explain.[citation needed] Freud deduced from a.) and b.) that the unconscious mind actually knows no distinction between memories and imagination and therefore easily becomes subject to manipulation of memories and imagination, and by combining this analysis with c.), he concluded that it is personal desires and fantasies that are getting repressed instead as demanded according to social taboo.[citation needed] This theory of repressed impulse in fact was the fundament of Freud's psychology, and it was essentially much more provocative and controversial than his initial theory of repressed memory had been already. First advancements after abandoning his initial theory of repressed memory can be seen in his Oedipus complex concept developed (by his 1905 Three Essays on the Theory of Sexuality, it had completely replaced his initial theory), however it would take until the years that Freud would introduce Id, Super-ego, and Ego. One might say that by the recent disillusionment concerning sensationalist Recovered Memory Therapy during the past few years, mainstream scientific research is currently undergoing the acknowledgement of Freud's stages of a.) and b.). Whether scientists and even the public will acknowledge c.) and accept Freud's conclusions is a matter that only time can tell. Famous trials involving repressed/recovered memories Famous cases involving repressed memories come in two forms. The first was a wave of criminal prosecutions based upon recovered memories of abuse. George Franklin Sr., charge: murder, accuser: Eileen, daughter crime: 1969, convicted 1995 time in jail: 6 years, duration of memory suppression: 20 years accuser: Nicole Taus, charge: abuse, duration of suppression: 11 years In some of the cases of Catholic priests accused of fondling or sexually assaulting juvenile-turned-adult parishioners [19][20]; also in the case of Joseph Cardinal Bernardin. The second was a wave of malpractice litigation cases that ended the reign of terror and collapsed the recovered memory therapy movement. Few if any recovered memory cases have been seen since many of the proponents of this controversial therapy suffered lawsuits and license revocations. Examples include the highly visible cases of Vynette Hamanne, Elizabeth Carlson and Patty Burgus, all of whom received multimillion dollar jury verdicts or settlements. Another example is the case of Tom Rutherford, who sued a Missouri church therapist and won a $1 million settlement for claims that he molested his four-year-old daughter and then forced her to have an abortion (he had, in fact, had a vasectomy year before and medical examination showed his daughter was still a virgin at age 23). State licensing boards also acted to end the recovered memory therapy movement, revoking or restricting the licenses of many prominent recovery memory proponents. See, Belluck, P. Memory Therapy Leads to a Lawsuit and Big Settlement [$10.6 Million], The New York Times, Page 1, Column 1, Nov. 6, 1997.; See also, Guthrey, M. and Kaplan, T., 2nd Patient Wins Against Psychiatrist: Accusation of planting memories brings multi-million dollar verdict. St. Paul Pioneer Press, Jan. 25, 1996, 4B. The Christian 'inner healing' movement There has recently been a resurgence of interest in the idea of repressed/recovered memories among members of the Christian Inner Healing Movement. Critic Jan Fletcher describes one prominent example - Theophostic Prayer Ministry - as 'a form of Recovered Memory Therapy' [1]. Repressed memories in popular entertainment Repressed memories were a frequent topic among talk-show hosts in the 1990s . Repressed memories have frequently been portrayed in popular entertainment, especially as a plot device. The film Tommy: the title character is coerced into forgetting that he has witnessed the killing of his father. The film Nurse Betty: Betty also witnesses a murder and as a result of the trauma forgets her entire reality for a time, deluded into being a character in her favourite soap opera. The film The Butterfly Effect: Evan has blackouts throughout his childhood when in traumatic situations. As a college student, he attempts to recover these memories and finds that he can change the past. The film Spellbound: a horrible childhood memory has been suppressed and causes nightmares for years afterwards. The video game Final Fantasy VII: the protagonist Cloud Strife carries false memories of his service in SOLDIER, the real memories suppressed after his Mako treatment. The anime/manga Elfen Lied: one of the main characters, Kouta, suppressed the majority of his childhood after seeing his little sister being murdered by the protagonist Lucy. The anime/manga Fruits Basket: the supporting character, Hatori Sohma had to suppress the memories of his love, Kana, after Akito Sohma blinded Hatori's left eye by throwing a vase at him and blamed Hatori's injury on Kana. The guilt from the accident drove her into madness and Hatori was forced to suppress her memories so that she could once again smile. Hatori has also had to suppress the memories of Yuki Sohma's friends, and Momiji Sohma's mother. The anime/manga His and Her Circumstances: When Arima visits his girlfriend, Yukino's house for the first time he realizes he doesn't have a deep bond with his adoptive parents and is confronted with repressed memories of abuse and abandonment from his real parents. The novel The Perks of Being a Wallflower: Charlie is confronted with repressed memories of being sexually abused by his aunt in the end of the novel after being upset and confused by sexual contact with his crush/friend, Sam. The protagonist of the video game Silent Hill 2, James Sunderland, repressed his memory of murdering his wife prior to the game's events. In the movie Total Recall, set in the year 2084, a man travels to Mars for a virtual vacation that implants memories of the trip in his mind, to recall those memories in exact detail. During his trip he recalls the truth about himself. In the television series Dexter, main character Dexter Morgan has repressed memories of his mothers brutal murder. References ^ See, e.g., Brandon, et al. (1998) Recovered Memories of Childhood Sexual Abuse: Implications for Clinical Practice, Working Party report of the British Royal College of Psychiatrists, British Journal of Psychiatry, pgs ^ Gustafson, Paul. Jury awards patient $2.6 million: Verdict finds therapist Humenansky liable in repressed memory trial. Minneapolis St. Paul Tribune, August 1, See also, Associated Press, Doctor Loses False-memory Suit, Chicago Tribune, Wed. Aug. 2, 1995, Sec. 1, pg. 12 "I think the effect is a stunning warning to therapists... and to insurance companies that they had better start obeying the informed consent laws and stop using experimental treatments like recovered memory treatments on patients…," attorney/psychologist R. Christopher Barden said. "This is a huge warning shot to them." ^ Belluck, P. Memory Therapy Leads to a Lawsuit and Big Settlement [$10.6 Million], The New York Times, Page 1, Column 1, Nov. 6, "The next thing I think there will be is legislation to require informed consent from psychiatric patients for such [recovered memory] 'treatments'," said Dr. R. Christopher Barden, a psychologist and lawyer [for the plaintiff]... "I think insurance companies will stop reimbursing people for mental health treatments that are not proven safe and effective. This is the death knell for recovered memory therapy." And it was. ^ ^ ^ ^ Pope HG Jr, Oliva PS, Hudson JI. Repressed memories. The scientific status of research on repressed memories. In: Faigman DL, Kaye DH, Saks MJ, Sanders J, eds. Science in the law: social and behavioral science issues. St. Paul, MN: West Group, 2002, pp ^ Charles L. Whitfield, M.D., Memory and Abuse, 1995, pg 70 ^ Pope HG Jr, Oliva PS, Hudson JI. Repressed memories. The scientific status of research on repressed memories. In: Faigman DL, Kaye DH, Saks MJ, Sanders J, eds. Science in the law: social and behavioral science issues. St. Paul, MN: West Group, 2002, pp ^ McNally RJ. The science and folklore of traumatic amnesia. Clinical Psychology: Science and Practice 11:29-33, 2004 ^ Barden, R. C. Amicus Brief in Taus v. Loftus, Superme Court of California, Feb. 21, 2006. ^ The False Memory Syndrome Foundation, Memory and Reality, retrieved 11/8/06. ^ Charles Whitfield, MD, Memory and Abuse, 1995, pg 69 ^ Associated Press, Doctor Loses ($2.5 Million) False-memory Suit, Chicago Tribune, Wed. Aug. 2, 1995, Sec. 1, pg. 12. ^ Belluck, P. Memory Therapy Leads to a Lawsuit and Big Settlement [$10.6 Million], The New York Times, Page 1, Column 1, Nov. 6, 1997. ^ Bass, E.; L. Davis (1988). The courage to heal, 347. ^ Herman, J. L. (1992). Trauma and recovery, 13. ^ Freud, Sigmund (1952). Zur Geschichte der analytischen Bewegung, from: Gesammelte Werke in Einzelbänden (Volume 10) (in German), 55ff. ^ Martin Gardner (January 2006). "The Memory Wars, Part 1". Skeptical Inquirer Magazine 30(1). ^ Martin Gardner (March 2006). "The Memory Wars, Parts 2 and 3". Skeptical Inquirer Magazine 30(2).

Trust Memory? Question: Trust Memory? Answer: Don’t!!!

Repressed memories A hot issue since the mid 90s. Number of
Cases exloded.  Into the thousands. People have been sued and convicted Of ghastly crimes (often involving relatives) Based on concept of repression (Introduced by Freud).

Trust Memory? ‘Repressed’ Memories?
So-called “Repressed Memories” brought back by therapists and hypnotists are very dubious in terms of scientific support, and the hazards this dubious hypothesis presents is profoundly frightening!

Case in Point… Eileen was 8 years old when her friend Susan died in 1969. Twenty years later Eileen had grown up and had a daughter who reminded her of her long lost friend Susan. One day when Eileen was looking into her daughter’s eyes she suddenly remembered what had happened to her friend Susan 20 years previously. Eileen had witnessed her own father sexually assault and then murder Susan by hitting her with a rock. He had then threatened to kill Eileen if she told anyone. Her father was subsequently found guilty of murder and sentenced to life. (Reported by Zimbardo et al 1995).

Susan Eileen in later life Eileen’s father

Trust Memory? ‘Repressed’ Memories?
George Franklin (the father) served 6 years of his sentence before being acquitted of the murder. At trial Eileen had failed to inform the court that she’d been hypnotized prior to the return of the memory. Franklin later sued Eileen, her hypno-therapist and the prosecuting counsel (outcome unknown!). He claimed it had all been a case of ‘false memory syndrome’ in which a false memory had been created by the process of hypnosis.

Repressed memories While it is impossible to tell in an invididual case, some things are very troubling... Scientific concept of Repression is extremely shaky. No evidence that it can happen. In fact, the opposite seems to be true (PTSD) It has been shown that very vivid memory can be implanted into the minds of both adults and children. The subjects can´t discriminate real vs. implanted memories. The process of recovery (recovery therapy) is very similar to the process used for artificial implantation. Evidently wrong recovered memories seem to be progressive,  the reports of the abuse get more and more severe over time.

What’s the issue? We potentially have a situation in which someone who is having troubles in life and is seeking answers is told to determine whether or not memories for historical events in their lives exist What are some techniques that are used to “assist” recollection? hypnosis, imagery, dream analysis, story telling

Conclusion: We cannot know with certainty (without corroborating evidence) whether a derepressed memory is true Therapists should engage in probing this possibility very carefully avoiding suggestive questions remaining unconvinced without corroborating evidence being “gently confrontational” to encourage patient to consider the possibility that the events didn’t happen

Disability Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.

Disability… Disability is difficult to define because it is a multi-dimensional concept with both objective and subjective characteristics According to the Ontario Human Right’s Commission: Pyhsical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness, and without limiting the generality of the foregoing, including diabetes mellitus, epilepsy, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or on a wheelchair or other remedial appliance or device, A condition of mental retardation or impairment, A learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, A mental disorder, or an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997. "Disability" should be interpreted in broad terms. It includes both present and past conditions, as well as a subjective component, namely, one based on perception of disability. 1. WHAT IS DISABILITY? 1.1 THE DEFINITION IN THE HUMAN RIGHTS CODE Section 10 (1) of the Code defines "handicap" as follows: "because of handicap" means for the reason that the person has or has had, or is believed to have or have had, (a) any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness, and without limiting the generality of the foregoing, including diabetes mellitus, epilepsy, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or on a wheelchair or other remedial appliance or device, (b) a condition of mental retardation or impairment, (c) a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, (d) a mental disorder, or (e) an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997. "Disability" should be interpreted in broad terms. It includes both present and past conditions, as well as a subjective component, namely, one based on perception of disability. Although sections 10(a) to (e) set out various types of conditions, it is clear that they are merely illustrative and not exhaustive. Protection for persons with disabilities under this subsection explicitly includes mental illness,8 developmental disabilities and learning disabilities. Even minor illnesses or infirmities can be "disabilities", if a person can show that she was treated unfairly because of the perception of a disability.9 Conversely, a person with an ailment who cannot show she was treated unequally because of a perceived or actual disability will be unable to meet even the prima facie test for discrimination. It will always be critical to assess the context of the differential treatment in order to determine whether discrimination has taken place, and whether the ground of disability is engaged. 1.2 A BROADER APPROACH TO UNDERSTANDING DISABILITY: A SOCIAL PERSPECTIVE The Supreme Court of Canada has recently shed new light on the approach to be taken in understanding disability. In Mercier,10 a case arising in Quebec, the Supreme Court made it clear that disability must be interpreted to include its subjective component, since discrimination may be based as much on perceptions, myths and stereotypes, as on the existence of actual functional limitations. In Mercier, the complainants were denied employment or dismissed when it was discovered that they had medical conditions. However, their conditions did not result in any functional limitations. The employers argued that since the conditions did not give rise to any functional limitations, they could not be "disabilities" under Quebec's human rights law. The Supreme Court of Canada disagreed. The Court chose not to create an exhaustive definition of disability. Instead, it opted for an equality-based framework that takes into account evolving biomedical, social and technological developments. This includes a socio- political dimension that emphasizes human dignity, respect and the right to equality. Thus, a disability may be the result of a physical limitation, an ailment, a perceived limitation or a combination of all these factors. The focus is on the effects of the distinction, preference or exclusion experienced by the person and not on proof of physical limitations or the presence of an ailment. Another Supreme Court of Canada decision11 has since confirmed that "social handicapping", i.e., society's response to a real or perceived disability, should be the focus of the discrimination analysis. This approach is consistent with the Code, which includes past, present and perceived conditions. It affords a broad and liberal interpretation and promotes the objectives of the Code. 1.3 NON-EVIDENT DISABILITIES The nature or degree of certain disabilities might render them "non-evident" to others. Chronic fatigue syndrome and back pain, for example, are not apparent conditions. Other disabilities might remain hidden because they are episodic. Epilepsy is one example. Similarly, environmental sensitivities can flare up from one day to the next, resulting in significant impairment to a person's health and capacity to function, while at other times, this disability may be entirely non-evident. Other examples might include: persons whose disabilities do not actually result in any functional limitations but who experience discrimination because others believe their disability makes them less able; persons who have recovered from conditions but are treated unfairly because of their past condition, and persons whose disabilities are episodic or temporary in nature. Other disabilities may become apparent based on the nature of the interaction, such as when there is a need for oral communication with an individual who is deaf, or there is a need for written communication with an individual who has a learning disability. A disability might become apparent over time through extended interaction. It might only become known when a disability accommodation is requested or, simply, the disability might remain "non-evident" because the individual chooses not to divulge it for personal reasons. Regardless of whether a disability is evident or non-evident, a great deal of discrimination faced by persons with disabilities is underpinned by social constructs of "normality" which in turn tend to reinforce obstacles to integration rather than encourage ways to ensure full participation. Because these disabilities are not "seen", many of them are not well understood in society. This can lead to stereotypes, stigma and prejudice. 1.4 MENTAL DISABILITY Although mental disability is a form of non-evident disability, it raises particular issues that merit independent consideration. Over the years, many employers have expressed the need for specific guidance on the issue of mental disability. Section 10 of the Code expressly includes mental disabilities. Persons with mental disabilities face a high degree of stigmatization and significant barriers to employment opportunities.12 Stigmatization can foster a climate that exacerbates stress, and may trigger or worsen the person's condition. It may also mean that someone who has a problem and needs help may not seek it, for fear of being labelled. The Supreme Court of Canada has recognized the distinct disadvantage and negative stereotyping faced by persons with mental disabilities, and has held that discrimination against individuals with mental disabilities is unlawful. In Gibbs v Battlefords13 the Court struck down an insurance plan for employees with disabilities that limited benefits for mental disabilities to a lower level as compared to physical disabilities. It is therefore the Commission's position that such distinctions are prima facie discriminatory.

Disability in Canada Some 3,601,000 Canadians have a disability — that’s one in eight. The rate of disability increases with age Disability rates are highest among older seniors (75 and over), with fully 53.3 percent in this age group reporting a disability The majority of Canadians with disabilities have mild to moderate disabilities. Childhood disabilities is more likely to be severe to very severe compared to working-age disabilities. Disability in Canada: A 2001 Profile (December 2003) Published on the occasion of the United Nations International Day of Disabled Persons (December 3, 2003), this report draws a national demographic profile of disability in Canada, using data from the Participation and Activity Limitation Survey (PALS), a 2001 survey sponsored by the Government of Canada. PALS gathered information on 35,000 adults and 8,000 children with disabilities living in Canada. [1] Selected Key Findings: • Some 3,601,000 Canadians have a disability — that’s one in eight. • While the overall rate of disability in Canada is 12.4 percent, the rate of disability increases with age: from 3.3 percent among children, to 9.9 percent among working-age adults (15 to 64), and 31.2 percent among seniors 65 to 74 years of age. Disability rates are highest among older seniors (75 and over), with fully 53.3 percent in this age group reporting a disability. • The majority of Canadians with disabilities have mild to moderate disabilities. Overall, children with disabilities are slightly more likely to experience severe to very severe disabilities than are working-age persons or seniors with disabilities. However, this pattern varies from one province to the next. • Mobility, agility, and pain-related disabilities are by far the most common types, each accounting for approximately 10 percent of reported disabilities nationally. Four percent of respondents reported a hearing limitation. • About 1 percent of the population overall have psychological disabilities, while 2 percent have learning- and 2 percent memoryrelated disabilities. • Learning disabilities are prominent among children of school age and young adults, but less common among seniors. In addition to providing basic disability rate statistics from PALS, Disability in Canada presents information about issues facing Canadians with disabilities; including challenges in relation to education, employment, income, access to supports and assistive technologies required for daily living. Disability in Canada: A 2001 Profile is available from the website of the Office for Disability Issues, at To order the document in alternative formats (large print, audio cassette, Braille and computer diskette) in French or English, just call:

Disability Rates by Age, Canada and Provinces

Disability in Canada Mobility, agility, and pain-related disabilities are by far the most common types, each accounting for approximately 10 percent of reported disabilities nationally. Four percent of respondents reported a hearing limitation. About 1 percent of the population overall have psychological disabilities, while 2 percent have learning- and 2 percent memory-related disabilities. Learning disabilities are prominent among children of school age and young adults, but less common among seniors.

Types of Disability in Canada

Selected Government of Canada Disability Programs
Type of Disability Infirm Severe and prolonged disability Permanent disability Long-term or recurring Not specified Objectives Antidiscrimination Employment Equity Act (self-identified) Daily living activities and assistance in home Infirm Dependant Credit Caregiver Credit Disability Tax Credit Income CPPD Veterans pension Learning CPPD vocational rehabilitation Attendant care deduction OF (Self-identified) CSLP (3 provisions) EAPD*

Canadian with Disabilities: Accountability Framework
The Accountability Framework Reporting back to Canadians on progress on disability issues began with a Government of Canada commitment to the House of Commons Subcommittee on the Status of Persons with Disabilities in The first report in 2002 presented a comprehensive accountability framework designed to help Canadians assess the Government’s success in promoting the full inclusion of people with disabilities. The framework identified important aspects of inclusion, provided indicators for measuring progress and linked Government of Canada programs, policies and expenditures to them. Building on this framework, a second report was released in It included improvements based on suggestions from members of disability organizations, Aboriginal organizations, academic experts and disability researchers. The accountability framework presented in Advancing Inclusion is built around six outcome areas: disability supports, health and well-being, income, skills development and learning, employment, and capacity of the disability community. These outcome areas (illustrated in Figure 1.1) represent the building blocks of full inclusion. Figure The Accountability Framework Skills development and learning: Adults and seniors with disabilities want to learn and develop skills whether for employment or for other reasons. Children and youth with disabilities, like all children, require opportunities to participate in formal education to gain the knowledge and skills needed later in life. Employment: Having paid employment is often the key to economic independence and full participation in the community. However, issues such as lack of experience or appropriate skills, inaccessible transportation, employer and public attitudes and the lack of information on potential opportunities can all make finding steady employment difficult. Government programs aim to help reduce these obstacles so that people with disabilities may obtain and retain stable employment. Disability Community Capacity: People with disabilities themselves, along with the organizations that serve or represent them, all help to advance inclusion. The government contributes by providing support and resources to help voluntary sector organizations effectively run disability programs, contribute to policy and program development, and stimulate the involvement of people with disabilities in civic and volunteer activities. Disability supports: Individuals with disabilities may need goods and services such as special equipment, help from friends, family and agencies, respite care or modifications to homes, vehicles, workplaces and recreational facilities. Supports may also be provided to families and caregivers to help them carry out their responsibilities. Disability supports also include accessible environments and systems such as transportation, public buildings and accessible information. Disability supports are the essential foundation for people with disabilities to actively participate at home, in school, at work and in the community. Health and well-being: Good health is another foundation of individual participation in society. Health is more than the absence of disease. The World Health Organization defines health as complete physical, mental, and social well-being. Environmental and social factors, individual behaviour, violence and injuries, as well as chronic and mental conditions all have an impact on the well-being of people with disabilities. Income: Having enough money to meet personal and family needs including activity in the community is essential to the well-being and inclusion of people with disabilities. Many factors influence how much income people have, including the ability to be employed, the adequacy of income support, and the cost and availability of disability supports. Each of these six areas represents an important aspect of inclusion and all are related. To present them more fully, a set of indicators of progress was identified and elaborated in the 2002 and 2004 reports. Analysis of these indicators has led to recognition of issues and monitoring of progress that can be reported to citizens.

For More Information

Ontarians with Disabilities Act, 2005

What’s a HIPAA?

What is HIPAA? HIPAA ( Health Insurance Portability and Accountability Act) was passed in 1996. Department of Health & Human Services (DHHS) issued the final Privacy rule in April 2001. Regulation requires compliance by: April 14, 2003 HIPPA regulations encompass many different aspects of healthcare. For instance, the regulations will have a profound impact on operational issues such as how we process health care claims. They also mandate that we implement certain security provisions to secure the integrity of health information. But the biggest impact of HIPPA is on protecting the privacy and confidentiality of health information.

What Information is covered under HIPAA
Personal Health Information (PHI) Anything that can potentially identify an individual Name Zip code of more than 3 digits Dates (except year) Telephone and fax numbers addresses Social Security Numbers Medical Record Numbers Health Plan Numbers License numbers

Privacy Objectives Protect patients rights by giving them access to their health information and control over how it will be used Improve the quality of care by restoring trust in the health care system Protect the security & privacy of all medical records that are used or shared in any form HIPPA privacy regulations spell out the rights of the individual in respect to their data. Breaches in confidentiality seriously erode the trust of the general public concerning how their information is kept confidential.

Why do we need a Privacy Rule?
HIPAA came about as the result of concerns from patients regarding: Breeches in Confidentiality Three cases in point: Accidentally, hospital in Michigan posted thousands of patient medical records on the Internet Employee from a Florida health department took home a disk containing names of 4,000 patients w/ positive HIV tests. Congressional Candidate stated that her campaign was derailed when the media published her psychiatric treatment after a suicide attempt.

Personal Health Information Protection Act (PHIPA), 2004
Canadian counterpart to HIPAA Provides consistent and comprehensive rules governing the collection, use, retention, disclosure and disposal of personal health information in the custody and control of health information custodians

According to ocswssw…

Student Activity The following scenario deals with professional integrity as it relates to protection of client identity Did the student intern act in the right way? What might you have done?

Standards for Privacy of Individually Identifiable Health Information

Are breaches of confidentiality ever justified?
Write down 3 situations in which a breach of confidentiality might be justified?

Circumstances in which confidentiality might be breached for ethically or legally justifiable reasons include cases where professional knows or suspects: That an individual is acting illegally. That an individual is harming others. That an individual might harm others in future. That an individual is harming themselves. That an individual might harm themselves in future. That a minor is being exploited or abused by others. That a competent adult is being exploited or abused by others.

The Duty to Care You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour Lord Atkin 1932

Duty of Care A social worker's initial contacts, including screening and intake, are key to establishing a duty of care An explicit duty of care occurs, for example, when a social worker establishes a working agreement, bills a client, or places his or her name in a client's record. A practitioner might implicitly establish a duty of care by providing counseling over the telephone or emergency back up for a colleague. Professional duty, or obligation, may be established explicitly or implicitly. An explicit duty of care occurs, for example, when a social worker establishes a working agreement, bills a client, or places his or her name in a client's record. A practitioner might implicitly establish a duty of care by providing counseling over the telephone or emergency back up for a colleague. If the person knows that the practitioner is a social worker and assumes that the practitioner has delivered professional services, the practitioner will have to prove that he or she did not establish professional duty. However, this may be difficult. For example, if a social worker lectures to a community group and speaks to a group member alone during a break, the practitioner may have established duty of care. If the person assumes that the practitioner has provided expert services, he or she will more than likely be found to have established a duty of care because the practitioner's actions spoke for themselves (Bennett et al., 1990). A social worker's initial contacts, including screening and intake, are key to establishing a duty of care

If the person knows that the practitioner is a social worker and assumes that the practitioner has delivered professional services, the practitioner will have to prove that he or she did not establish professional duty. However, this may be difficult. For example, if a social worker lectures to a community group and speaks to a group member alone during a break, the practitioner may have established duty of care. If the person assumes that the practitioner has provided expert services, he or she will more than likely be found to have established a duty of care because the practitioner's actions spoke for themselves (Bennett et al., 1990).

Duty of Care A Legal Term applicable to across a wide range of domains
In the health professional domain: A person who practices in a health profession owes the patient a duty. The duty of care involves applying skill, knowledge, diligence and caution when caring for clients.

Duty of Care Ms. Young a former Memorial University student had successfully sued the university and Social Work professors Leslie Bella and William Rowe (former director of the School of Social Work). Ms. Young claimed that the university and the social work professor had breached a “duty of care” owed to students when she reported a suspected case of child abuse based on an academic paper written by her in The province's Child Protection Services waited two years until 1996 before investigating the report after which Ms. Young was quickly cleared of any suspicion in the matter. In 2003 a jury awarded Ms. Young a total of $839,400 in damages relating to her complaint. The university disagreed with that decision citing errors made by the jury, Ms. Young's solicitor and the trial judge. The appeal was heard in June of this year and the decision favouring Memorial University was rendered in October. October 15, 2004 University wins court appeal The Supreme Court of Newfoundland and Labrador Court of Appeal has found in favour of Memorial University in its appeal of the case of former student Wanda Young. The finding is being welcomed by the university and its School of Social Work. “From the outset, the university argued that the professors had acted out of good faith, with the highest professional standards and out of a sense of legal duty,” said Peter Morris, associate director of university relations. “There was no malice and no negligence. They had some reason to be concerned and they felt they had a legal obligation under the Child Welfare Act to report that concern.” Matter goes back 10 years Ms. Young had successfully sued the university and Social Work professors Leslie Bella and William Rowe (former director of the School of Social Work). Ms. Young claimed that the university and the professors had breached a “duty of care” owed to students when they reported a suspected case of child abuse based on an academic paper written by her in The province's Child Protection Services waited two years until 1996 before investigating the report after which Ms. Young was quickly cleared of any suspicion in the matter. In 2003 a jury awarded Ms. Young a total of $839,400 in damages relating to her complaint. The university disagreed with that decision citing errors made by the jury, Ms. Young's solicitor and the trial judge. The appeal was heard in June of this year and the decision favouring Memorial University was rendered in October. Decision important Mr. Morris said the Appeal Court decision is important for the university. “This has clarified the issue and the question of what exactly is the responsibility of a professor when faced with a reasonable suspicion,” he said. “Should they report it or not? Our people did report it because they thought they had a professional and legal responsibility to do so. The Appeal Court decision confirmed that this was the right course of action.” School of Social Work The case has had an impact on the School of Social Work at Memorial. Dr. Shelly Birnie-Lefcovitch, director of the school, said that the decision was important for the School. “There is no doubt that last year's decision cast a long shadow over the School,” he said. “It left a number of questions unanswered. We felt it was the wrong decision. We felt our professors had acted with the highest professional standards. This Appeal Court decision will provide reassurance to our faculty in terms of how they exercise their best professional social work judgment. Also, beyond the School, the decision serves as a reminder to all individuals who have information indicating that a child is or may be in need of protection that they are required to report that information and they need not fear legal action, so long as their report is not made maliciously or without reasonable cause.” NLASW investigation Dr. Birnie-Lefcovitch added that the matter and the subsequent finding of the original trial also led to a separate investigation by the Newfoundland and Labrador Association of Social Workers (NLASW). That independent investigation was conducted in early The NLASW found that the actions taken by Drs. Bella and Rowe were “deemed to be reasonable actions of a social worker in this context”. “The NLASW findings, first, and now the Appeal Court ruling certainly confirm that our professors acted appropriately. We hope we can now close the book on the matter,” he said. MUN sympathetic Mr. Morris added that the university was sympathetic to Ms. Young's situation. “There is no doubt that this matter has had a profound impact on her and one can't help but feel for the situation she has endured,” he said. “But we have always held, and this has been supported by both the Appeal Court and the Newfoundland and Labrador Association of Social Workers, that as regrettable as the misfortune is that befell her, it was not the result of any action by the university or our professors.” Ms. Young has already received over $300,000 from the original award and the university's insurance company, which had paid out that amount, has indicated that it will seek its return.

What does this mean for YOU?
Doing what is reasonable Working to level of competence Higher the competence, higher the expected standard Judged against respected body of opinion Reasonable in relation to level of experience Considered clinical risk

Duty to Respect Privacy

Duty to Maintain Confidentiality
Professional norm that information shared by or pertaining to clients will not be shared with third parties Privilege The disclosure of confidential information in court proceedings Informed consent Under most circumstances, clients must give informed consent before you may share information with another person or organization

Confidentiality Professional norm that information shared by or pertaining to clients will not be shared with third parties NASW Code of Ethics

NASW Code of Ethics

Confidentiality The NASW Code of Ethics (1996) recommends that:
Clients be apprised of the limits on client confidentiality before they begin to disclose. This is part of obtaining informed consent, and should occur at the beginning of treatment before any opportunity for disclosure occurs. Note that unusual circumstances can arise. Thus, it is wise practice to anticipate when you could potentially breach confidentiality and to inform the client of this anticipation.

Duty to Inform Obligation to educate about
Your qualifications and field of expertise Extent of services offered Privacy practices Matters of cost, length of treatment, risks, probability of success, best practices, practice guidelines and community resources Duty to warn

The Client must give consent This is a fundamental client right
Once informed… The Client must give consent This is a fundamental client right

3. Acceptance or Rejection
1. Relevant Information 2. Client Competence Informed Consent 3. Acceptance or Rejection

CASW Informed Consent, May 2007
CASW recently developed a new document entitled “Informed Consent and Confidentiality Canadian Association of Social Workers Guidelines”. Electronic copies of the guidelines are available on the Members’ Site of the CASW website

Duty to Report Outrages against humanity
Child abuse, child neglect, child molestation, incest Exploitation of children, elderly, physically or mentally challenged or developmentally disabled Procedures for reporting vary from place to place

Duty to Warn and Protect
Responsible to warn potential victims Responsible to take action to protect people a client might harm Tarasoff v. California Board of Regents

Tarasoff v. Regents This University of California student was stalked and killed by fellow student Prosenjit Poddar after he had discussed his intention to kill her with a University Health Service psychologist. Her family sued and the resulting court opinions formed the basis for general acceptance of the notion that treating professionals have a duty to protect known intended victims.

Class Activity Break Into Groups Read the Case Study Presented
Identify the issues at hand What would you do as the social worker? What are the possible consequences of your action(s)?

So many…How to protect myself?
First and foremost, know that laws in your area as they relate to areas of practice In Ontario e-law website offers downloads of each law Be especially familiar with the Social Work and Social Service Work Act Know the major codes of ethics Discuss with experts, fellow students, supervisors observations, experiences, confusion Ask questions Be aware Be proactive; take steps to protect yourself from potential problems

www.e-laws.gov.on.ca E-law Government of Ontario Website
Allows you to search for any type of law Allows you to download the law

Social Work and Social Service Work Act

Understanding the Fundamental Values and Ethics of Social Work

Most common ethical violations (Strom-Gottfried)
Sexual activity Dual relationship Other boundary violations Failure to seek supervision or consultation Failure to use accepted practice skills Fraudulent behavior Premature termination Inadequate provisions for case transfer or referral Failure to maintain adequate records or reports Failure to discuss policies as part of informed consent

NASW Bulletin Ethical Dilemma of the Month
Identify the ethical dilemma What would you do?

The World of Social Work
Organizations and Governing Bodies

International Federation of Social Workers (IFSW)

IFSW Aims

NASW’s Preamble to the Code of Ethics

Council on Social Work Education’s endorsement of the NASW Code of Ethics

NASW Procedures for Professional Review (National Association of Social Workers, 2005)
Available online:

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Ethical Decision-Making

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