Ethical Issues in Integrated Health Care: Implications for Social Workers

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Integrated health care has come of age. What began modestly in the 1930s has evolved into a mature model of health care that is quickly becoming the standard of care. Social workers are now employed in a wide range of comprehensive integrated health care organizations. In these contexts, social workers are encountering complex, sometimes unprecedented, ethical challenges.

In a recent issue of the journal Health & Social Work, published by NASW Press, an article by Frederic G. Reamer, PhD, identifies and discusses the ethical issues facing social workers in integrated health care settings, especially related to informed consent, privacy, confidentiality, boundaries, dual relationships, and conflicts of interest.

Integrated health care settings include deliberate and sustained coordination of care among health care practitioners (physicians, nurses, nurse practitioners, and physician assistants, among others) and behavioral health professionals (social workers, psychiatrists, psychologists, mental health counselors, and addiction specialists, among others). This is reflective of professionals’ increasingly rich understanding of the complex and essential connections between individuals’ physical health and mental health. For many years health and behavioral health professionals have appreciated the ways in which patients’ and clients’ mental health challenges can affect their physical health and how, in turn, physical ailments can have a profound impact on individuals’ sense of well-being and functioning. But what ethical challenges do these settings bring to the social work professional in particular.

Dr. Reamer groups the challenges into three topic areas:

  • Informed Consent
  • Privacy and Confidentiality
  • Professional Boundaries

He addresses issues for each area. For example, he says that Social workers should not assume that all providers within their organization should have access to clients’ protected health information without clients’ explicit consent. Rather, social workers and their colleagues should establish protocols that enhance clients’ control over their health-related information.

Issues concerning professional boundaries may arise when different health care center practitioners may refer different members of a family to the same social worker; the various family members may not know that the social worker is counseling other family members. This can pose significant boundary challenges for the social worker. Especially in relatively small and rural communities where the integrated health care organization is the only available option for health care, social workers may be called on to serve fellow employees who are also patients. These dual relationships require skilled management that adheres to prevailing ethical standards in social work.

To aid social workers wishing to know more about the ethical issues that arise in integrated health care setting, Dr. Reamer gives several examples of helpful resources to consult. He concludes:

Social workers are held to strict ethical standards that have evolved over time. In integrated health care settings, social workers are collaborating with professionals who adhere to different codes of ethics, some of which differ significantly from social work’s with respect to important ethical issues. On occasion, ethical standards in social work may conflict with comparable standards in medicine, nursing, and other allied health professions regarding key ethical issues, such as informed consent, privacy, confidentiality, boundaries, and dual relationships. Ideally, social workers in integrated health care settings will acquaint their colleagues, supervisors, and administrators with pertinent social work ethics standards and draw on these to develop comprehensive guidelines to protect service recipients and, as well, the professionals who serve them.

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