Social Work Ethics Audits: A New Tool for Ethical Practice. Dr Donna McAuliffe School of Social Work and Social Policy University of Queensland

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1 Social Work Ethics Audits: A New Tool for Ethical Practice Dr Donna McAuliffe School of Social Work and Social Policy University of Queensland Abstract This paper presents preliminary results of a research project focusing on implementation and evaluation of a 'Social Work Ethics Audit' risk management tool. The concept of the 'ethics audit' in Australia has not, as yet, been developed as a useful process or tool for front-line professional practice in human service organisations. The leader in the area of 'ethics audits' with specific reference to social work and human services is Frederic Reamer, a social work academic from the US who has developed the 'social work ethics audit' risk management tool. The ethics audit is described as an easy to use, practical risk management tool to assess and identify pertinent ethical issues, assess current practices, design strategies to stop ethics complaints, prevent lawsuits and monitor quality assurance. Reamer has outlined the concept of social work 'ethics audits' in detail and has proposed 17 areas of ethical risk that warrant consideration. As many of these areas are specific to the US context, and to social work as a licenced profession in the US, this research was developed to ascertain how the ethics audit could be modified for adaptation to the Australian context. The instructions for conduct of an ethics audit outlined by Reamer have been followed to pilot test the ethics audit process in 11 selected government and non-government human service organisations located in Queensland. Preliminary results presented in this paper demonstrate the process that agencies have engaged in to implement the ethics audit, and the areas of ethical risk that have been assessed as relevant and important. The research aims to explore the usefulness of the ethics audit to human service agencies and front-line staff, and its complementarity with existing quality assurance or accreditation processes. Introduction While issues of moral and ethical significance are commonplace in the public sphere, concern has been increasingly expressed about the behaviour of public officials, the accountability of professions, and the transparency of organisational processes (Bishop & Preston 2000). Debate has been ongoing over the past few decades about the meaning of personal, professional and social ethics, raising questions about how the understanding of ethics should be translated into actual dealings and interactions with service users. The various professions have adopted codes of ethics and standards of conduct in attempts to ensure member's compliance with publicly acceptable behaviour. Ethics training and education has continued to receive greater attention in higher education, corporate services and the community sector. While some professional bodies (eg medicine, psychology) have greater ability to address malpractice by virtue of regulation, the self-regulating professions (eg social work) have more difficulty dealing with ethical violations by those who lay claim to the professional title. Recent research exploring ethical dilemmas in social work found that autonomous front-line workers were able to disguise problematic and unethical practice as there was often little call to ethical accountability from the employing organisation (McAuliffe 2000). Blurred guidelines, unclear policies, lack of supervisory structures and unwillingness to consult for fear of retribution led workers to manage difficult and complex ethical issues in relation to clients and colleagues in 1

2 a context akin to an ethical vacuum (McAuliffe 2000). These findings raise serious concerns for client rights and welfare, and place agencies and workers in precarious legal positions. The research outlined in this paper had its foundations in the abovementioned exploratory qualitative study on ethical dilemmas in social work practice (McAuliffe 2000). The research moves beyond the exploratory stage to pose questions about how workers in human service organisations can better understand, evaluate and respond to the ethical climate within which they provide human services, and thus protect themselves and their clients from risk of harm or liability. A concept designed to promote such responses that has emerged from the business field over the past decade, is that of the 'ethics audit' (Hill et al 1992; Wiley 1995; Gray 1996; Reamer 2000). Canada (EthicScan) and the US have led the way in ethics consultations in management and business by developing comprehensive 'ethics audit' programs to apply to large corporations and industry bodies. Similar (although much smaller) companies such as the Ethica Management Group and Walker Tate & Associates exist in Australia and offer 'ethics auditing' services to industry and public services. Building on the concept of financial auditing of organisations, long an acceptable practice in the business world, 'ethics auditing' has been described as an 'appraisal activity', the purpose being to 'determine if changes need to be made in the climate, environment, codes, and the enforcement of ethics policies' (Wiley 1995, p.33). Different disciplines refer to this concept in a variety of ways. The environmental area, for example, refers to 'responsibility audits' (Waddock & Smith 2000), and industry refers to 'social audits' (Nixon, Wiley & West 1991; Knouse & Giacalone 1992). In the Australian context, 'ethics audit's bear mention in relation to public sector ethics reviews such as that conducted by the PSMPC in 1996, where it was recommended that 'an important step in developing an agency approach to ethics is to establish the current state of the agency's ethical culture'. Furthermore, in relation to local government and public sector ethics, Preston (2000) recommended that an 'ethics audit' be conducted as an initial step in the chain of developing an ethical culture within an organisation. Mention has also been made of 'ethics audits' by the Australian International Health Institute in relation to determining values of health care systems (Galbally 2001), and by early childhood educators referring to conceptual leadership in ethics (Newman 2000). In none of these cases, however, is a process of how to go about conducting such an 'ethics audit' actually spelled out. Management groups have presumably developed these tools for application in the corporate world. The concept of 'ethics audits' in Australia does not, then, appear to have been developed to the point of creating a useful process or tool that could have adaptability to front-line professional practice in human service organisations. The Social Work Ethics Audit developed by Frederic Reamer (2001) lists 17 areas that warrant consideration. These areas include attention to client rights (eg complaint processes, access to records); confidentiality and privacy (existence of protocols); informed consent (existence of documents); service delivery (competency); boundary issues and conflicts of interest (sexual, social, financial); documentation (casenotes); defamation (written/verbal); supervision (accountability); staff development and training (updating knowledge); consultation (with experts); client referral (to other agencies), termination of services (appropriateness); client records (storage), fraud (prevention policies); practitioner impairment (quality of service), research and 2

3 evaluation (duty of care), and ethical decision-making. While many of these areas are specific to the US context, and relate specifically to the NASW Code of Ethics and to social work as a licenced profession in the US, the areas of ethical risk correlate closely to previous research findings about ethical issues confronting Australian practitioners (McAuliffe 1999, 2000). Ethical decision-making is also an area that practitioners need information and training about as this is often lacking in education (McAuliffe & Ferman 2002). Overview of the research project The principal aim of the research project, funded by the University of Queensland, is to explore the applicability of 'ethics audits' to human services in the Australian context, specifically the context of direct human service practice. Using the Reamer model as a benchmark, a secondary aim is to modify the tool to meet the needs of multidisciplinary services that may not employ predominantly social work staff. As concern for quality assurance has increased in human services over the past decade, and many organisations are subjected by their funding bodies to rigorous accreditation and accountability processes, it is important to view the 'ethics audit' as an adjunct to these existing processes. Concerns have been expressed for some time about the reliance on business-based concepts to define quality in human services (Evers et al 1997), and although based on 'ethical foundations', texts on Total Quality Management, for example, fail to explore the ethical issues that commonly emerge in human services (Gunther & Hawkins 1999). One of the aims of the research is to determine whether there are some areas of ethical concern that are overlooked in traditional accreditation or quality assurance processes. Issues relating to worker/client relationships, conflicts of interest, appropriate supervision and practitioner impairment, to cite some examples, are rarely addressed by agency policy and procedure. It is anticipated that the modified 'ethics audit' will be developed as a complimentary quality assurance tool to address ethical issues not generally covered by pre-existing agency accreditation and quality assurance mechanisms. In summary, the research aims to explore the following questions: Is the Social Work Ethics Audit, a tool developed in the US, applicable to human services in the Australian context? Can the ethics audit meet the needs of services that employ staff other than social workers? How does the ethics audit compliment existing quality assurance processes? What processes can agencies put in place to implement the ethics audit? What challenges does the ethics audit present for agencies with different structures/contexts of practice? Beginning the Research Expressions of Interest The first stage in the research was to introduce the Social Work Ethics Audit to practitioners by way of a half-day workshop. The interest in this workshop was significantly higher than expected, and a further three workshops were scheduled for those who could not access the first. The workshop introduced the Social Work Ethics Audit manual and audit instrument, explaining the 17 areas of ethical risk in detail. At the end of the workshop, participants were given information about the research process and invited to submit an Expression of Interest for selection into the project. It 3

4 was acknowledged that agency approval would need to be sought in most instances, and time was allowed for this consultation to take place. Eleven agencies submitted expressions of interest, and all were accepted. It was important that agencies clearly understood that they were in control of the process of the ethics audit and that the researchers would not seek to influence policies and procedures that agencies decided to adopt. The outcomes of the ethics audit (policies and procedures) are owned by the agency, not by the researchers. It was also made clear that although the research is time-limited (3 visits over a six month period), agencies could continue to work through the ethics audit over a much longer timeframe. The Expression of Interest proforma requested potential participants to describe why they considered that the ethics audit could be of benefit to their agency. There were essentially five reasons provided. The first reason, mentioned by a number of agencies, focused on the need for identification of gaps in policies and procedures, and the identification of discrepancies between policies and procedures. Also mentioned were the lack of formal processes to implement written policies and the need to explore ethical decision-making processes and increase awareness of areas of potential ethical risk. The second reason highlighted the links to quality assurance and accreditation processes, with some agencies expressing the view that the ethics audit would be a useful process in assisting preparation for accreditation. Some of the Queensland Health associated services were also preparing to implement IS42A (Information Privacy Guidelines), or were involved in trials of a Performance Measurement Framework. Also mentioned were the benefits of identifying areas of ethical risk not covered by accreditation frameworks, and the contributions that could be made by the staff team to quality practice and risk management. A third set of reasons related to perceived benefits to staff and agency by being involved with a University research project. Involvement in the ethics audit was seen as a positive way to enhance research capacity and research profile, as well as being able to make good use of external expertise and support offered by the researchers. Also mentioned were the benefits of increased ethical conversations, opportunity for critical reflection, and the support that could be offered to staff with no professional qualifications. A fourth set of reasons related to perceived benefits to clients in that increased ethical practice would contribute to a higher quality of services, and would increase accountability for service provision. Finally, two of the agencies mentioned the external pressures that underpinned the expressed interest in the research. These agencies mentioned requirements of funding bodies to have practice standards in place, and the need to justify quality of practice in a climate of threat to continued existence. First Interviews Stage One The 11 agencies that expressed interest and were accepted into the research are widely diverse in organisational structure, number of staff, and experience of quality processes. The profile of participating agencies with a health focus includes three hospitals of varying size and location, one community health service with a range of programs attached to it, and one community-based women s health service. Four counselling agencies are participating, and these are also widely diverse, one being a tertiary education counselling service, one a state-wide relationship and education service, one a very small program attached to a statutory welfare organisation aimed 4

5 at supporting young people, and one a community-based domestic violence service. In addition, there is one disability support service, and one small volunteer-based service working in the area of adoptions. This diversity means that the ethics audit can be tested out in both government and community-based agencies, with large and small staff groups, and social work specific and multidisciplinary teams. All participants were provided with a copy of the Social Work Ethics Audit Manual and computer disc, which includes a step-by-step process of how an agency should go about conducting an ethics audit. The Manual includes a comprehensive itemised checklist of polices and procedures against each of the 17 areas of ethical risk, and levels of risk are rated as either High, Moderate or Minimal. One of the first tasks was for participating agencies to consider how they would go about putting the process into action. In the first round of interviews, each of which lasted approximately 2 hours, agencies were asked to consider any questions or concerns they had about engagement with the ethics audit process. The list of questions and concerns was substantial and included the following: Questions about the roles and expectations of the researchers. Clarification was required about whether the expectation was that the entire ethics audit be completed in the six-month time-frame. Agencies were assured that the researchers had no expectations about outcomes the research focus was on the relevance of the tool and on the process of implementation of the audit; Concerns about the ethics audit identifying unethical or poor practice, and associated concerns about liability and legal issues. Concern was also expressed about how best to manage discussion of sensitive issues such as boundary violations, practitioner impairment; Questions about the focus of the audit whether it was to be done in relation to the team, or in relation to the whole organisation; Discussion about the best way to involve as many staff as possible and the difficulties of individual interpretation of meaning in relation to particular sections of the audit; Concerns about the time that it would take to implement the ethics audit in a way that would ensure that it was a quality process. It was acknowledged that current workload issues make taking on additional tasks very difficult, and there are also time issues with the head-space needed to give full consideration to what can be quite complex ethical issues; Concerns about how to access specific information, particularly relevant legislation and networks that could supply information necessary as part of the process; Questions about how to actually write policy; Issues about sharing of information between agencies involved in the audit. As these concerns and questions were raised and clarified, staff who had nominated to drive the ethics audit process forward in each agency were requested to keep reflective notes on the process as it unfolded. Some agencies had already started the process before the first interview, while others were unsure of where or how to begin. In all cases, staff had discussions about how best to dedicate time to the process, most agreeing to commit time in regular staff meetings or planning days to monitoring and updating of the process. 5

6 The second round of interviews, to be conducted within the forthcoming month, will focus on the process of benchmarking and risk assessment, and will explore the primary areas of ethical risk nominated for action. Informal feedback from a number of the agencies has revealed that the process of risk assessment was conducted in a variety of ways. One of the hospitals, for example, used a staff meeting to explain the research, and then divided the audit checklist between staff, giving them time to complete it without the opportunity to engage in group discussion or discuss possible answers. A comment about this process was We suggested that staff didn t think too long about each answer, rather be guided by what they thought their initial reactions were to the indicator and degree of risk they perceived. This seemed to work well, otherwise, if we had given it to them to complete in their own time, at their leisure, we would not have got half of them back. The staff member from this agency went on to say that there were no huge surprises for those of us involved, just a confirmation of our hunch that there were areas that need work and improvement. Another agency used quite a different approach, with the senior staff member nominating three areas for focus, and then handing this over to other staff to discuss the audit checklist in relation to those specified areas. One of the difficulties that appears to have arisen is in the individual interpretation of some of the checklist items. This has required time for discussion and clarification. There has also been identification of a number of items that are not relevant to the public health context in Australia. Items about billing, for example, are not relevant to many of the agencies involved in the research. Most of the agencies are reporting moderate levels of risk across the majority of ethical risk areas. In most cases, there are one or two areas that stand out as high risk, although these are more in relation to particular items within a broad category, rather than the category itself. Boundary issues, documentation, client records, confidentiality and privacy, supervision and informed consent appear to be emerging as the primary areas in need of attention. A number of workers requested information about ethical decision-making frameworks, and the researchers provided all participants with additional information about a range of models from the social work literature (Congress 1999, Loewenberg, Dolgoff & Harrington 2000, Mattison, 2000). A forum will also be held in coming weeks with a visiting social work academic from the US (familiar with the ethics audit) where research participants are invited to come together and discuss issues arising from the audit process. This sharing of information and engagement in discussion and dialogue is a critical part of heightening ethical awareness that will ultimately impact on practice. The preliminary consensus is that what looks like a straightforward and well structured process on paper is not as straightforward when transferred to the often chaotic world of human service practice. One of the comments from a participant that reflects this complexity was: The process of gaining information is timeconsuming and more complex than was first thought. It can often be restricted by access to resources eg computers. Another commented: To complete the entire inventory with action and analysis plans could take us months/years. It is a lot of work but pretty good to do. Yet another telling comment was that: Our participation in the audit has been enjoyable and has been a great way to examine our practice. We were often challenged. We found a lot of areas in the audit were 6

7 already covered by hospital and district policies, though some still required us to address them on an individual basis as a department, due to them lacking relevance to our work. I think we now realise the audit was the easy part! Conclusions There are still two stages of this research to be conducted, involving two further sets of evaluative interviews over the next four months. The anticipated outcomes from the research are that the Social Work Ethics Audit will eventually be modified to reflect ethical issues in the Australian context, including the fact that many agencies are multidisciplinary in nature. The research will also identify ethically problematic areas not covered in the original ethics audit tool. It is expected that the ethics audit will be of particular value for smaller communitybased agencies that require guidance in the development of policies and procedures, but that the process will also benefit larger organisations where policies do not adequately address the complexities of worker/client relationships. Ultimately, it is hoped that the ethics audit process will become an integral part of quality assurance, and that it will provide a useful mechanism for the ongoing monitoring of ethical practice standards in human services. References Bishop, P. & Preston, N. (Eds) (2000) Local Government, Public Enterprise and Ethics, Federation Press, Sydney. Congress, E. (1999) Social Work Values and Ethics: Identifying and Resolving Professional Dilemmas, Nelson-Hall Publishers, Chicago. Evers, A., Haverinen, R., Leichsenring, K. & Wistow, G. (eds) (1997) Developing Quality in Personal Social Services: Concepts, Cases and Comments, Ashgate, Aldershot. Galbally, R. (2001) 'The Ethics of Health Care Research - Paper 12', Australian International Health Institute, University of Melbourne. Gray, Sandra Trice (1996) 'Audit your Ethics', Association Management, vol 48, no.9, p.188. Gunther, J. & Hawkins, F. (1999) Making TQM Work: Quality Tools for Human Service Organisations, Springer Publishing Company, New York. Hill, John W, Metzger, M. & Dalton, D. (1992) 'How ethical is your company?' Management Accounting, vol 74, no. 1, pp

8 Knouse, S. B. & Giacalone, R.A. (1992) 'Ethical decision-making in business: Behavioural issues and concerns', Journal of Business Ethics, vol 11, no 5-6, pp Loewenberg, F., Dolgoff, R. & Harrington, D. (2000) Ethical Decisions for Social Work Practice, F.E. Peacock Publishers, Illinois. Mattison, M. (2000) Ethical decision-making: The person in the process, Social Work, Vol 45, No. 3, pp MAB/MIAC Report No 19 (May 1996) Ethical Standards and Values in the Australian Public Service McAuliffe, D. (1999) ' Clutching at codes: Resources that influence social work decisions in cases of ethical conflict', Professional Ethics, Vol 7 (3/4), pp McAuliffe, D. (2000) Beyond the Hypothetical: Ethical Dilemmas in Front-line Social Work, University of Queensland, Unpublished Thesis. McAuliffe, D. & Ferman, T. (2002) Meeting the challenges of designing ethics education for social work, ultibase e-journal, September. Newman, Linda (2000) 'Ethical leadership or leadership in ethics', Australian Journal of Early Childhood, March, Vol 25, pp Nixon, J.C., Wiley, C. & West, J. (1991) 'Beyond survival: Ethics for industrial managers, Industrial Management, vol 33, no 3, pp Preston, N. (2000) 'Public Sector Ethics: What are we talking about?' in Bishop, P. & Preston, N. (Eds) Local Government, Public Enterprise and Ethics, Federation Press, Sydney. Reamer, F. (2000) 'The Social Work 'ethics audit': A Risk-Management Strategy', Social Work, vol 45, no 4, pp Reamer, F. (2001) The Social Work Ethics Audit: A Risk Management Tool, NASW Press, Washington. Waddock, S. & Smith, N. (2000) Corporate responsibility audits: Doing well by doing good', Sloan Management Review, vol 41, no 2, pp Wiley, C. (1995) 'The ABC's of business ethics: Definitions, philosophies and implementation, Industrial Management, 37 (1), p