Winter 1-2008 Social Workers ' Management of Error

Social workers, like all professionals, sometimes make mistakes. For example, they may disclose clients’ confidential information inappropriately, fail to respond to clients’ reasonable requests in a timely manner, or engage in improper dual relationships with clients. Ideally, social workers who err would follow a protocol that honors the profession’s commitment to responsible and honest communication and minimizes the practical risks faced by social workers who might be named in lawsuits, licensing board complaints, and ethics complaints. This article explores the nature and forms of social work error and possible constructive responses to it that (a) protect clients, (b) minimize risk to social workers, (c) prevent future error, and (d) adhere to prevailing ethical standards in the profession. disgruntled clients or colleagues (for example, ethics complaints filed with the National Association of Social Workers). Preferably, social workers who err would follow a protocol that simultaneously honors the profession’s deepseated commitment to open, responsible, and honest communication and minimizes the practical risks faced by social workers who might be named in lawsuits, licensing board complaints, and ethics complaints. The purpose of this discussion is to explore the nature and forms of social work error and possible constructive responses to it that (a) protect clients, (b) minimize risk to social workers, (c) prevent future error, and (d) adhere to prevailing ethical standards in the profession. The Nature of Professional Error Professional error occurs when practitioners depart from widely accepted standards and best practices in the profession. Prevailing standards in a profession—typically known as standards of care—are based on what an ordinary, reasonable, and prudent practitioner with the same or similar training would have done under the same or similar circumstances (Madden, 2003; Reamer, 2003; Stein, 2004). Professional error can be defined as “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” (Gallagher, Waterman, Ebers, Fraser, & Levinson, 2003, p. 1002). Some professional errors occur unintentionally—for example, when a clinical social worker inadvertently discloses confidential information, without proper authorization, to a client’s spouse or neglects to complete a client’s insurance claim form in a timely manner. However, other errors occur with intent—for example, when a social worker fraudulently documents services that were never provided or when an impaired clinician becomes sexually involved with a client. In general, errors may occur because of social workers’ incompetence (for example, unskilled use of widely accepted interventions, failure to use best practices, or inadequate training), unethical behavior, or impairment. Some professional errors cause harm and some do not. For example, a social worker who releases confidential information about a client’s substance abuse, without consent, to an estranged spouse might cause harm if the estranged spouse uses that information against the client during a child custody dispute. In this instance, the social worker’s error or departure from the profession’s standard of care related to informed consent causes harm. In contrast, a social worker who errs clinically by disclosing too much personal information to a client—in a manner that is inconsistent with current standards of care and confuses boundaries in the professional-client relationship—would not necessarily (although could possibly) harm the client. Thus, some errors do not cause significant injury. Social work errors that cause harm or injury constitute adverse events. An adverse event entails injury caused by the provision of care rather than by the client’s clinical condition (Cantor, 2002; Kohn et al., 2000; Wu, 1993). Case Studies: Theo and Martha In social work, errors occur in three forms. First, some errors result from genuine mistakes or inadvertent oversight on the part of social workers—for example, related to proper management and protection of confidential information. Theo L. , a school social worker, was preparing a clinical summary of his work with a 15-year-old client to be submitted to the local juvenile court. The juvenile court judge planned to use the report when she conducted a hearing concerning the student’s arrest on robbery charges. Theo L. was unable to finish his report by the end of the day. He left the report on his desk and planned to complete it the following morning. However, during the evening a custodian was in Theo L. ’s office and noticed the report sitting on the desk. The custodian recognized the client’s unusual surname on the exposed file label and read the report. The custodian shared confidential information about Theo L. ’s sensitive family circumstances with several acquaintances. Martha B. was a social worker in a family service agency. One afternoon, she stepped onto the elevator in the agency’s building and encountered one of her colleagues. Martha B. had been trying to reach this colleague to give her an update on a client they shared who is prominent in the local community. During the elevator ride, Martha B. told her colleague about the client’s psychiatric hospitalization. Martha B. did not realize that one of the other elevator passengers knew the client, overheard the conversation, and shared the news about the hospitalization with several friends and relatives. The inadvertent disclosure embarrassed Martha B. and harmed her reputation. Case Studies: Benita and Sondra The second form of error occurs when social workers make deliberate decisions about how best to work and intervene with a client. These errors are the result of social workers’ thoughtful, intentional, but mistaken, attempts to do what they believe is in clients’ best interests—for example, their use of high-risk clinical interventions and casework services. Benita D. was a social worker in independent (private) practice. One of her clients—a nine-year-old child diagnosed with “reactive attachment disorder”—struggled in her relationships with family members, primarily her parents. In an effort to help this child, Benita D. decided to use a controversial clinical intervention known as “rebirthing therapy. ” Rebirthing therapy involves FAMILIES IN SOCIETY | Volume 89, No. 1