Social Worker Ethics

 

Social Worker Ethics Continuing Education Course Material                                                   

The code of ethical practice and professional conduct constitutes the standards by which the expected professional conduct of social workers shall be measured. The rules of ethical practice and conduct shall apply to the conduct of all social worker licensees and registrants, including applicants' conduct during the period of education, and training, which is required for licensure.  A violation of these rules of ethical practice and professional conduct constitutes unprofessional conduct and is sufficient reason for a reprimand, suspension, revocation, other disciplinary action, or for restrictions to be placed upon a license or for the denial of the initial license or renewal, or reinstatement of a license.

Responsibility to Clients/Consumers of Services

Competency 

Licensees and registrants must be able to present reliable and substantial evidence of competency in the areas in which they practice. Licensees shall not misrepresent directly, indirectly or by implication their professional qualifications such as education, specialized training, experience, or area(s) of competence. Licensees or registrants may not use a doctorate designation in their professional capacity unless it is related to the field of mental health and is from a recognized accredited educational institution.

Licensees and registrants may practice only within the competency area for which they are qualified by education and training. Licensees and registrants shall maintain appropriate standards of care based on their individual professional license. Standards of care shall be defined as what an ordinary, reasonable professional with similar training would have done in a similar circumstance.

While developing new skills in specialty areas a social worker shall take steps to ensure the competence of their work and to protect the clients from possible harm. A social worker shall develop skills in specialty areas only after appropriate education, training, and while receiving approved supervision.

Licensees and registrants do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies. Licensee and registrants must make appropriate referrals when the client's needs exceed the social worker's competence level. The referrals must be made in a timely manner.

Informed Consent

Social workers  shall inform clients/consumers of services the extent and nature of services available to them, as well as the limits, rights, opportunities and obligations associated with the services to be provided which might effect the clients/consumers of services decisions to enter into or continue the relationship.

Licensees and registrants shall provide services to clients only in the context of a professional relationship based on valid informed consent. Licensees and registrants shall use clear and understandable language to inform clients of the purposes of services, limit to the services due to legal requirements, relevant costs, reasonable alternatives, the clients' rights to refuse or withdraw consent, and the time frame covered by the consent.

In instances when clients are unable to read or understand the consent document or have trouble understanding the primary language contained in the informed consent document, licensees must take steps to ensure the clients comprehension including providing a detailed verbal explanation or arranging for a qualified interpreter or translator as needed. If a client because of age of mental condition is not competent to provide informed consent the licensee will obtain consent from the parent, guardian, or court appointed representative. Best professional practice dictates that a social worker should adhere to the court documents. If a social worker does not understand the court document, they must contact the court for clarification before proceeding with treatment.

In situation when clients are receiving services involuntarily, social workers shall provide information about the nature and extent of the services and about the client's right to refuse services.  Social workers who provide services via electronic means shall inform the clients and recipients of the limitations and risks associated with such services.

When a social worker provides services to two or more clients who have a relationship with each other and who are aware of each other's participation in treatment (for example couples, family members), a social worker shall clarify with all parties the nature of the licensee's professional obligations to the various clients who are receiving services, including limits of confidentiality. A social worker who anticipates a conflict of interest among the clients receiving services or anticipate having to perform in potentially conflicting roles (for example a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.

When a social worker sees clients for individual or group treatment, there may be reason for a third party to join the session for a limited purpose. The client of legal guardian must provide a release document so the third party can join the session. The social worker must make clear that the third party is not a client and there is no confidentiality between the licensee and the third party. The social worker must make it clear to the third party that he/she will not have rights to access the client's file but would have rights to the individual session notes in which he/she participated. A  social worker shall not make recommendations to courts, attorneys or other professionals concerning non-clients.

Delegation

Social workers shall not delegate professional responsibilities to another person when the licensee delegating the responsibilities knows or has reason to know that such a person is not qualified by training, experience or licensure to perform them.

Confidentiality

 Social workers shall have a primary obligation to protect the client's right to confidentiality as established by law and the professional standards of practice. Confidential information shall only be revealed to others when the clients or other persons legally authorized to give consent on behalf of the clients, have given their informed consent, except in those circumstances in which failure to do so would violate other laws or result in clear and present danger to the client or others. Unless specifically contraindicated by such situations, clients shall be informed and written consent shall be obtained before the confidential information is revealed.

Social workers shall discuss with clients and the client's legally authorized representatives, the nature of confidentiality and the limitation of clients' right to confidentiality. Licensees should review with client circumstances where confidential information may be requested and where disclosure of confidential information is legally required. This discussion should occur as soon as possible in the professional relationship and as needed throughout the course of the relationship.

When social workers provide counseling services to families, couples, or groups, licensees should seek agreement among the parties involved concerning each individual's right to confidentiality and obligations to preserve the confidentiality of information shared by others. Licensees should inform participants in family, group, or couples counseling that the licensee cannot guarantee that all participants will honor such agreements.

Social workers shall take reasonable and appropriate steps to protect the confidentiality of information transmitted to other parties through the use of computers, electronic mail, facsimile machines, telephones and telephone answering machines, and other electronic or computer technology.

Termination

Social workers shall terminate services only after giving careful consideration to factors affecting the relationship and making effort to minimize possible adverse effects. If an interruption or termination of services is anticipated, reasonable notification and appropriate referral for continued services shall be provided to the client/consumer of services.

Social workers employed by an agency or practice may not solicit or refer a current client of the agency or practice to the licensee's private practice. Licensees and registrants when leaving the employment of an agency or practice may offer referrals to the client. The referral must include multiple options for the client to choose from, and the agency where the client is currently being seen must be included as an option; the licensee's private practice may be one of the multiple options.

In the event that a licensee or registrant is terminated, it is not the responsibility of the licensee or registrant to provide continuation of services or appropriate referrals. Licensees who are terminated should not contact their ex-clients.

Sexual harassment

Social workers shall not sexually harass clients/consumers of services or family members of clients. Licensees shall also not sexually harass supervisees, students, or colleagues. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.

Discrimination

Social workers shall not practice, condone, facilitate or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, veteran status, or mental or physical challenge.

Conduct with clients

Social workers shall not physically or verbally abuse or threaten clients or family members of clients. Licensees must be aware that any physical touching between the professional and the client is subject to review for appropriate professional boundaries. The professional will have the burden of proof to explain why physical touching was professionally necessary.

Social workers should not use derogatory language in their written or verbal communications to or about clients. Licensees shall use accurate and respectful language in all communications to and about clients.

Multiple relationships affecting the Social Worker’s Judgment

Social workers should avoid multiple relationships and conflicts of interest with any client/consumer of services which might impair professional judgment or increases the risk of client/consumer of services exploitation. The licensed professional shall not undertake or continue a professional relationship with a client/consumer of services, supervisee, or student when the objectivity or competency of the social worker, is or could reasonably be, expected to be impaired or where the relationship with the client/consumer of services, supervisee, or student is exploitative. The social worker should be particularly aware that familial, social, emotional, financial, supervisory, political, administrative, or legal relationships with a consumer or a person related to or associated with the client/consumer of services must be carefully considered to insure that impaired judgment or exploitation is not involved.

Social workers must always be sensitive to the potentially harmful effects of other contacts on their practice and on those persons with whom they deal. A professional refrains from entering into, or promising another, personal, scientific, professional, or other relationships with such persons if it appears or should appear likely that such a relationship might reasonably impair the professionals objectivity or otherwise interfere with the professional's effectiveness as a social worker, or  might harm or exploit the other party.

When a multiple relationship cannot be avoided social workers shall take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and that no exploitation occurs.

If a social worker finds that, due to unforeseen factors, a potentially harmful, multiple relationship has arisen, with a client/consumer of services, the professional shall attempt to resolve it with due regard for the best interests of the client/consumer of services and maximal compliance with the statue and Board rules.

When social workers provide services to two or more people who have a relationship with each other (for example couple, family members), licensees shall clarify with all parties which individuals will be considered clients and the nature of the licensee's professional obligations to the various individuals who are receiving services. Licensees who anticipate a conflict of interest among the individuals receiving services or who anticipate having to perform in potentially conflicting roles (for example, a licensee who is asked or ordered to testify in a child custody dispute or divorce proceeding involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.

Sexual Relationships

Social workers shall not engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced. Social workers shall not have sexual intimacies with clients and shall not counsel persons with whom they have had a sexual relationship. (Social Workers Ethics Ceu)

Social workers shall not engage in sexual intimacies with former clients after terminating the therapeutic relationship. Social workers shall not engage in sexual activities or sexual contact with client's relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation or potential harm to the client. Sexual activity or sexual contact with clients' relatives or other individuals with whom the client maintains a personal relationship has the potential to be harmful to the client and may make it difficult for the social worker to maintain appropriate professional boundaries. Social workers, not their clients, their clients' relatives, or other individuals, with whom the client maintains a personal relationship, assume the full burden for setting clear, appropriate, and culturally sensitive boundaries.

If the social worker engages in conduct contrary to this prohibition or claims that an exception to this prohibition is warranted because of extraordinary circumstances, it is the social worker's not his/her clients, who assumes the full burden of demonstrating that the client or former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.

 Impaired Practice

Social workers shall not undertake or continue professional relationships with a client, supervisee, or student when the objectivity or competency of the social worker or could reasonably be expected to be, impaired due to mental, emotional, physiological, pharmacological, or substance abuse conditions. If such a condition develops after a professional relationship has been initiated, the social worker shall terminate the professional relationship in an appropriate manner, shall notify the client of the termination in writing, and shall assist the client in obtaining services from another professional.

Use of Assessment and Testing Instruments

Appraisal techniques

The primary purpose of educational and psychological assessment is to provide measures that are objective and interpretable in either comparative or absolute terms. Social workers recognize the need to interpret the statements in this section as applying to the whole range of appraisal techniques, including test and non-test data.

Client welfare

Social workers promote the welfare and best interests of the client in the development, publication, and utilization of educational and psychological assessment results and interpretations and take reasonable steps to prevent others from misusing the information these techniques provide. They respect the client's right to know the results, of the interpretations made, and the bases for their conclusions and recommendations.

Competence to use and interpret tests:

Limits of competence

Social workers recognize the limits of their competence and perform only those testing and assessment services for which they have been trained. They are familiar with reliability, validity, related standardization, error of measurement, and proper application of any technique utilized. Social workers using computer-based test interpretations are trained in the construct being measured and the specific instrument being used prior to using this type of computer application. Social workers take reasonable measures to ensure the proper use of psychological assessment techniques by persons under this supervision.

Appropriate use

Social workers are responsible for the appropriate application, scoring, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use computerized or other services.

Decisions based on results

Social workers responsible for decisions involving individuals or policies that are based on assessment results have a thorough understanding of educational and psychological measurement, including validation criteria, test research, and guidelines for test development and use.

 Accurate information

Social workers shall provide accurate information and shall not make false claims or misconceptions when making statements about assessment instruments or techniques. Special efforts are made to avoid unwarranted connotations of such terms as IQ and grade equivalent scores.

Informed consent:

Explanation to clients

Prior to assessment, social workers explain the nature and purposes of assessment and the specific use of results in language the client (or other legally authorized person on behalf of the client) can understand, unless an explicit exception to this right has been agreed upon in advance. Regardless of whether scoring and interpretation are completed by social workers, by assistants, or by computer or other outside services,  social workers take reasonable steps to ensure that appropriate explanations are given to the client.

Recipients of results

The examinee's welfare, explicit understanding, and prior agreement determine the recipients of test results. Social workers shall include accurate and appropriate interpretations with any release of individual or group test results.

Release of information to competent professionals:

Misuse of results

Social workers shall not misuse assessment results, including test results, and interpretations, and take reasonable steps to prevent the misuse of such by others.

Proper diagnosis of mental disorders:

Proper diagnosis

Social workers take special care to provide proper diagnosis of mental disorders. Assessment techniques (including personal interview) used to determine client care (e.g., locus of treatment, type of treatment, or recommended follow-up) are carefully selected and appropriately used.

Cultural sensitivity

 Social workers recognize that culture affects the manner in which client's problems are defined. Clients' socioeconomic and cultural experience is considered when diagnosing mental disorders.

Test selection:

Appropriateness of instruments

Social workers carefully consider the validity, reliability, psychometric limitations and appropriateness of instruments when selecting tests for use in a given situation or with a particular client.

Culturally diverse populations

Social workers are cautious when selecting tests for culturally diverse populations to avoid inappropriateness of testing that may be outside of socialized behavioral or cognitive patterns.

Conditions of test administration:

Administration conditions

Social workers administer tests under the same conditions that were established in their standardization. When tests are not administered under standard conditions or when unusual behavior or irregularities occur during the testing session, those conditions are noted in interpretation, and the results may be designated as invalid or of questionable validity.

Computer administration

Social workers are responsible for ensuring that administration programs function properly to provide clients with accurate results when a computer or other electronic methods are used for test administration.

Unsupervised test-taking

Social workers do not permit unsupervised or inadequately supervised use of tests or assessments unless the tests or assessments are designed, intended, and validated for self administration and/or scoring.

Disclosure of favorable conditions

Prior to test administration, conditions that produce most favorable test results are made known to the examinee.

Diversity in testing: Social workers are cautious in using assessment techniques, making evaluations, and interpreting the performance of populations, and interpreting the performance of populations not represented in the norm group on which an instrument was standardized. They recognize the effects of age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation and socioeconomic status on test administration and interpretation and place test interpretation results in proper perspective with other relevant factors.

Test scoring and interpretation:

 Reporting reservations

In reporting assessment results social workers indicate any reservations that exist regarding validity or reliability because of the circumstances of the assessment or the inappropriateness of the norms for the person tested.

Testing services

Social workers who provide test scoring and test interpretation services to support the assessment process confirm the validity of such interpretations. They accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use. The public offering of an automated test interpretations service is considered a professional-to-professional consultation. The formal responsibility of the consultant is to the consulted, but the ultimate and overriding responsibility is to the client.

Test security: Social workers maintain the integrity and security of tests and other assessment techniques consistent with legal and contractual obligations. Social workers do not appropriate, reproduce, or modify published tests or parts thereof without acknowledgment and permission from the publisher.

Obsolete tests and outdated test results: social workers do not use data or test results that are obsolete or outdated for the current purposes, social workers make every effort to prevent the misuse of obsolete measures and test data by others.

Test construction: social workers use established scientific procedures, relevant standards, and current professional Knowledge for test design in the development, publication, and utilization of educational and psychological assessment techniques.

Research responsibilities:

 Use of human subjects

 Social workers plan, design, conduct, and report research in a manner consistent with pertinent ethical principles, federal and state laws, host institutional regulations, and scientific standards governing research with human subjects. Social workers design and conduct research that reflects cultural sensitivity appropriateness.

Precautions to avoid injury

Social workers who conduct research with human subjects are responsible for the subjects' welfare throughout the experiment and take reasonable precautions to avoid causing injurious psychological, physical, or social effects to their subjects. Social workers warn clients of any possible harm that might come from being involved in a research project.

Diversity

Social workers are sensitive to diversity and research issues with special populations. They seek consultation when appropriate.

Informed consent:

Topics disclosed: In obtaining informed consent for research, social workers use language that is understandable to research participants and that: Accurately explains the purpose and procedures to be followed; Identifies any procedures that are experimental or relatively untried; Describes the attendant discomforts and risks; Describes the benefits or changes in individuals or organizations that might be reasonably expected; Discloses appropriate alternative procedures that would be advantageous for subjects: Offers to answer any inquiries concerning the procedures; Instructs the subjects that they are free to withdraw their consent and to discontinue participation in the project at any time.

Deception: social workers do not conduct research involving deception unless alternative procedures are not feasible and the prospective value of the research justifies the deception. When the methodological requirements of a study necessitate concealment or deception, the investigator is required to explain clearly the reasons for this action as soon as possible.

Voluntary participation: Participation in research is typically voluntary and without any penalty for refusal to participate. Involuntary participation is appropriate only when it can be demonstrated that participation will have no harmful effects on subjects and is essential to the investigation.

Confidentiality of information: Information obtained about research participants during the course of an investigation is confidential. When the possibility exists that others may obtain access to such information, ethical research practice requires that the possibility, together with the plans for protecting confidentiality, be explained to participants as a part of the procedure for obtaining informed consent.

Persons incapable of giving informed consent: When a person is incapable of giving informed consent, social workers provide an appropriate explanation, obtain agreement for participation and obtain appropriate consent from a legally authorized person.

Explanations after data collections: After data are collected, social workers provide participants with full clarifications of the nature of the study to remove any misconceptions. Where scientific or human values justify delaying or withholding information, social workers take reasonable measures to avoid causing harm.

Agreements to cooperate:   Social workers  who agree to cooperate with another individual in research or publication incur an obligation to cooperate as promised in terms of punctuality of performance and with regard to the completeness and accuracy of the information required.

Informed consent for sponsors: In the pursuit of research, social workers give sponsors, institutions, and publication channels the same respect and opportunity for giving informed consent that they accord to individual research participants. Social workers are aware of their obligation to future research workers and ensure that host institutions are given feedback information and proper acknowledgement.

Reporting results:

Information affecting outcome; when reporting research results social workers explicitly mention all variables and conditions known to the investigator that may have affected the outcome of a study or the interpretation of this data.

Accurate results: Social workers plan, conduct and report research accurately and in a manner that minimizes the possibility that results will be misleading. They provide thorough discussions of the limitations of their data and alternative hypotheses.  Social workers do not engage in fraudulent research, distort data, misrepresent data, or deliberately bias their results.

Obligation to report unfavorable results: Social workers communicate to other social workers the results of any research judged to be of professional value. Results that reflect unfavorably on institutions, programs, services, prevailing opinions, or vested interests are not withheld.

Identity of subjects: Social workers who supply data, aid in the research of another person, report research results, or make original data available take due care to disguise the identity of respective subjects in the absence of specific authorization from the subjects to do otherwise.

Publication:

Recognition of others: When conducting and reporting research, social workers  are familiar with, and give recognition to, previous work on the topic, observe copyright laws, and give full credit to those to whom credit is due.

Student research: For an article that is substantially based on a student's dissertation or thesis, the student is listed as the principal author.

Duplicate submission: Social workers submit manuscripts for consideration to only one journal at a time. Manuscripts that are published in whole or in substantial part in another journal or published work are not submitted for publication without acknowledgment and permission from the previous publication.

Professional review: Social workers who review material submitted for publication, research, or other scholarly purposes respect the confidentiality and proprietary rights of those who submitted it.

Payment for Services
When setting fees, social workers should ensure that the fees are fair, reasonable, and commensurate with the services performed.

Social workers should not accept goods or services as payment for professional services. Bartering arrangements, particularly involving services, create the potential for conflicts or interest, exploitation, and inappropriate boundaries in  social worker's relationships with clients. Social workers may explore and may participate in bartering only in very limited circumstances when it can be demonstrated that such arrangements are an accepted practice among professionals in the local community, considered to be essential for the provision of services, negotiated without coercion, and entered into at the client's initiative and with the client's informed consent. Social workers who accept goods or services from clients as payment for professional services assume the full burden of demonstrating that this arrangement will not be detrimental to the client or the professional relationship.

Social workers may not solicit a private fee or other remuneration for providing services to clients who are entitled to such available services through the social worker's  employer or agency.

Record Keeping

For each client/consumer, a licensee or registrant shall keep records of the dates of counseling, social work and therapy services, types of counseling and social work, termination, and billing information. Records held by the licensee shall be kept for five years. Records held or owned by government agencies or educational institutions are not subject to this requirement.

Social workers shall take reasonable steps to ensure that documentation in records is accurate and reflects the services provided. Dates reflected in case notes must be accurate with respect to dates of service and when the case note was written. Clinical records should include but not limited to appropriate diagnosis, if any; individual services plans; in-take assessments; informed consent documents; and releases of information documents.

Social workers shall include sufficient and timely documentation in records to facilitate the delivery of services and to ensure continuity of services provided to clients in the future.

Social workers' documentation should protect clients' privacy to the extent that it is possible and appropriate and should include only information that is directly relevant to the delivery of services.

Social workers shall store records following termination of services to ensure reasonable future access. Records should be maintained as required by this rule unless a longer retention period is required by statue or relevant contracts.

Social workers shall provide clients with reasonable access to records concerning the client. Social workers who are concerned that clients' access to their records could cause serious misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Licensees should limit clients' access to their records, or portions of their records, only in exceptional circumstances when there is compelling evidence that such access would cause serious harm to the client. Both the clients' requests and the rationale for withholding some or all of the records shall be documented in the clients' files. When providing clients with access to their records, licensees shall take steps to protect the confidentiality of other individuals identified or discussed in such records.

A social worker shall not condone, partake, assist in billing irregularities or fraud with respect to insurance companies or direct billing.

Mandatory Reporting
Child Abuse

Child abuse is not a new phenomenon. The abuse and neglect of children has been documented for more than two thousand years. However, attempts to prevent child abuse are relatively new. The first documented legal response to child abuse in the United States occurred in 1874. The New York Society for the Prevention of Cruelty to Animals pleaded in court to have an eight year- old child removed from her abusive and neglectful environment. Since there were no child abuse laws, the Society argued that the child was, in fact, an animal, and should be provided the same protection as other animals. During the last few decades of the 1800s, societies to protect children from cruelty were formed in many states. The next movement to protect children came as the result of several pediatricians publishing articles about children suffering multiple fractures and brain injuries at the hands of their caretakers. In 1961, Dr. C. Henry Kempe, then president of the American Academy of Pediatrics, held a conference on the “battered child syndrome,” in which he outlined a “duty” to the child to prevent “repetition of trauma.” The Battered Child Syndrome Conference resulted in many states passing laws to protect children from physical abuse. Child abuse is now recognized as a problem of epidemic proportions. Child abuse has serious consequences that may remain as indelible pain throughout the victim’s lifetime. The violence and negligence of parents and caretakers serve as a model for children as they grow up. The child victims of today, without protection and treatment, may become the child abusers of tomorrow.

As with any social issue, child abuse is a problem for the entire community. Achieving the goals of protective services requires the coordination of many resources. Each professional group and agency involved with a family assumes responsibility for specific elements of the child protective service process.

National Data

Nationally, the 2002 “Child Maltreatment Report,” published by the U.S. Department of Health and Human Services Children’s Bureau, indicates that an estimated 2.6 million reports of child abuse involving 4.5 million children were made to child protection agencies, and that approximately 67% were accepted for investigation or assessment. Less than one-third of the investigations/assessments (30%) confirmed child abuse. There were an estimated 896,000 victims of child abuse nationwide. The rate of victimization was 12.3 per 1,000 children. The highest victimization rates were for the 0-3 age group (16 per 1,000 children). National studies continue to indicate that only about one-third of maltreated children are reported to child protection agencies. Significant numbers of victims remain unidentified without protection and treatment.

The law requires you to report suspected child abuse to DHS orally within 24 hours of becoming aware of the situation. You must also make a report in writing within 48 hours after your oral report. The law requires the reporting of suspected child abuse. It is not the reporter’s role to validate the abuse. The law does not require you to have proof that the abuse occurred before reporting. The law clearly specifies that reports of child abuse must be made when the person reporting “reasonably believes a child has suffered abuse.”

Reports are made in terms of the child’s possible condition, not in terms of an accusation against parents. A report of child abuse is not an accusation, but a request to determine whether child abuse exists and begin the helping process. Making a report of child abuse may be difficult. You may have doubts about whether the circumstances merit a report, how the parents will react, what the outcome will be, and whether or not the report will put the child at greater risk. The best way to minimize the difficulty of reporting is to:

• Be knowledgeable about the reporting requirements, and
• Be aware of the Department’s intake criteria and the response that is initiated by making a report.
• Oral and written reports should contain the following information, if it is known:
• The names and home address of the child and the child’s parents or other persons believed to be responsible for the child’s care.
• The child’s present whereabouts.
• The child’s age.
• The nature and extent of the child’s injuries, including any evidence of previous injuries.
• The name, age, and condition of other children in the same household.
• Any other information that you believe may be helpful in establishing the cause of the abuse or neglect to the child.
• The identity of the person or persons responsible for the abuse or neglect to the child.
• Your name and address.

Waiver of Confidentiality

The issues of confidentiality and privileged communication are often areas of concern for mental health and health service professionals. Rules around confidentiality and privileged communication are waived during the child abuse assessment process

Indicators of Possible Child Abuse

The following physical and behavioral indicators are listed as signs of possible child abuse for you to consider in making your report. These indicators need to be evaluated in the context of the child’s environment. The presence of one or more of these symptoms does not necessarily prove abuse. These lists are examples and are not all-inclusive.

Physical Indicators 

• Bruises and welts on the face, lips, mouth, torso, back, buttocks, or thighs in various stages of healing
• Bruises and welts in unusual patterns reflecting the shape of the article used (e.g., electric cord, belt buckle) or in clusters indicating repeated contact
• Bruises on infant, especially facial bruises
• Subdural hematomas, retinal hemorrhages, internal injuries
• Cigarette burns, especially on the soles, palms, backs or buttocks
• Immersion burns (sock-like, glove-like, doughnut-shaped) on buttocks or genitalia
• Burns patterned like an electric element, iron or utensil
• Rope burns on arms, legs, neck or torso
• Fractures of the skull, nose, ribs or facial structure in various stages of healing
• Multiple or spiral fractures
• Unexplained (or multiple history for) bruises, burns or fractures
• Lacerations or abrasions to the mouth, frenulum, lips, gums, eyes or external genitalia
• Bite marks or loss of hair
• Speech disorders, lags in physical development, ulcers
• Asthma, severe allergies or failure to thrive
• Consistent hunger, poor hygiene, inappropriate dress
• Consistent lack of supervision; abandonment, unattended physical or emotional problems or medical needs
• Difficulty in walking or sitting
• Pain or itching in the genital area
• Bruises, bleeding or infection in the external genitalia, vaginal or anal areas
• Torn, stained or bloody underclothing
• Frequent urinary or yeast infections
• Venereal disease, especially in pre-teens
• Pregnancy
• Substance abuse – alcohol or drugs
• Positive test for presence of illegal drugs in the child’s body

Behavior Indicators

• Afraid to go home; frightened of parents
• Alcohol or drug abuse
• Apprehensive when children cry, overly concerned for siblings
• Begging, stealing or hoarding food
• Behavioral extremes, such as aggressiveness or withdrawal
• Complaints of soreness, uncomfortable movement
• Constant fatigue, listlessness or falling asleep in class
• Delay in securing or failure to secure medical care
• Delinquent, runaway or truant behaviors
• Destructive, antisocial or neurotic traits, habit disorders
• Developmental or language delays
• Excessive seductiveness or promiscuity
• Extended stays at school (early arrival and late departure)
• Extreme aggression, rage, or hyperactivity
• Fear of a person or an intense dislike of being left with someone
• Frequently absent or tardy from school or drops out of school or sudden school difficulties
• History of abuse or neglect provided by the child
• Inappropriate clothing for the weather
• Massive weight change
• Indirect allusions to problems at home such as, “I want to live with you”
• Lack of emotional control, withdrawal, chronic depression, hysteria, fantasy or infantile behavior
• Lags in growth or development
• Multiple or inconsistent histories for a given injury
• Overly compliant, passive, undemanding behavior; apathy
• Poor peer relationships; shunned by peers
• Poor self-esteem, self-devaluation, lack of confidence or self-destructive behavior
• Role-reversal behavior or overly dependent behavior; states there is no caretaker
• Suicide attempts
• Unusual interest in or knowledge of sexual matters, expressing affection in inappropriate ways
• Wary of adult contacts, lack of trust, uncomfortable with or threatened by physical contact or closeness

Physical Abuse 

“Physical abuse” is defined as any non-accidental physical injury, or injury which is at variance with the history given of it, suffered by a child as the result of the acts or omissions of a person responsible for the care of the child. Common indicators could include unusual or unexplained burns, bruises, or fractures. Health services personnel should be especially alert to cases of child abuse where inconsistent histories are presented. Inconsistent histories can take the form of an explanation that does not fit the degree or type of injury to the child, or where the story or explanation of the injury changes over time. Some indicators of child abuse are not visible on the child’s body. Many times there are no physical indicators of abuse. A child’s behavior can change as a result of abuse. Health services personnel need to be alert to possible behavioral indicators of abuse and if they believe those to be present, they are required to make a report. Behavioral indicators include behaviors such as:

• Extreme aggression.
• Withdrawal.
• Seductive behaviors.
• Being uncomfortable with physical contact or closeness.

Mental Injury

“Mental injury” is defined as any mental injury to a child’s intellectual or psychological capacity as evidenced by an observable and substantial impairment in the child’s ability to function within the child’s normal range of performance and behavior as the result of the acts or omissions of a person responsible for the care of the child.

Examples of mental injury may include:

• Ignoring the child and failing to provide necessary stimulation, responsiveness, and validation of the child’s worth in normal family routine.
• Rejecting the child’s value, needs, and request for adult validation and nurturing.
• Isolating the child from the family and community; denying the child normal human contact.
• Terrorizing the child with continual verbal assaults, creating a climate of fear, hostility, and anxiety, thus preventing the child from gaining feelings of safety and security.
• Corrupting the child by encouraging and reinforcing destructive, antisocial behavior until the child is so impaired in socio-emotional development that interaction in normal social environments is not possible.
• Verbally assaulting the child with constant, excessive name-calling, harsh threats, and sarcastic put downs that continually “beat down” the child’s self-esteem with humiliation.
• Over pressuring the child with subtle but consistent pressure to grow up fast and to achieve too early in the areas of academics, physical or motor skills, or social interaction, which leaves the child feeling that he or she is never quite good enough.

Sexual Abuse

• “Sexual abuse” is defined as the commission of a sexual offense with or to a child as a result of the acts or omissions of the person responsible for the care of the child.

There are several sub-categories of sexual abuse:

• First degree sexual abuse
• Second degree sexual abuse
• Third degree sexual abuse
• Detention in a brothel
• Lascivious acts with a child
• Indecent exposure
• Assault with intent to commit sexual abuse
• Indecent contact with a child
• Lascivious conduct with a minor
• Incest
• Sexual exploitation by a counselor or therapist
• Sexual exploitation of a minor
• Sexual misconduct with offenders and juveniles

Behavioral indicators of sexual abuse could include things such as excessive knowledge of sexual matters beyond their normal developmental age or seductiveness. Physical indicators of sexual abuse could include things such as bruised or bleeding genitalia, venereal disease, or even pregnancy.

Denial of Critical Care

“Denial of critical care” is defined as the failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing or other care necessary for the child’s health and welfare when financially able to do so or when offered financial or other reasonable means to do so.

Note: What most people think of as an issue of “neglect” is covered under the child abuse category of “denial of critical care.”

A parent or guardian legitimately practicing religious beliefs who does not provide specified medical treatment for a child for that reason alone shall not be considered abusing the child. However, this does not preclude a court from ordering that medical service be provided to the child where the child’s health requires it.

1. Denial of critical care includes the following eight sub-categories:
2. Failure to provide adequate food and nutrition to such an extent that there is danger of the child suffering injury or death.
3. Failure to provide adequate shelter to such an extent that there is danger of the child suffering injury or death.
4. Failure to provide adequate clothing to such an extent that there is danger of the child suffering injury or death.
5. Failure to provide adequate health care to such an extent that there is danger of the child suffering serious injury or death.
6. Failure to provide the mental health care necessary to adequately treat an observable and substantial impairment in the child’s ability to function.
7. Gross failure to meet the emotional needs of the child necessary for normal development evidenced by the presence of an observable and substantial impairment in the child’s ability to function within the normal range of performance and behavior.
8. Failure to provide proper supervision of a child which a reasonable and prudent person would exercise under similar facts and circumstances, to such an extent that there is danger of the child suffering injury or death. This definition includes cruel and undue confinement of a child and the dangerous operation of a motor vehicle when the person responsible for the care of the child is driving recklessly or driving while intoxicated with the child in the vehicle.

Other situations that fall under this subcategory include:

• Illegal drug usage by the caretaker of a child

When you make an allegation of denial of critical care because a child lacks proper supervision due to illegal drug usage by a caretaker you may be asked questions to help DHS determine the type of drug and the degree of risk to the child. Some illegal drugs may have a greater impact on the supervision abilities of the caretaker than others. For example, methamphetamine usage by a child’s caretaker has inherent risks to the child given the known effects of methamphetamines. DHS will consider the known effect of the drug named and other information to assess risk to the child’s safety.

• Children home alone

DHS receives many inquiries each year regarding when a child can be left home alone safely. Each situation is unique. Examples of questions to help determine whether there are safety concerns for the child include:

1. Does the child have any physical disabilities?
2. Could the child get out of the house in an emergency?
3. Does the child have a phone and know how to use it?
4. Does the child know how to reach the caretaker?
5. How long will the child be left home alone?
6. Is the child afraid to be left home alone?

Does the child know how to respond to an emergency such as fire or injury?

• Lice and truancy

Head lice and truancy are often reported as child abuse allegations. However, the endangerment does not generally rise to the level that must be present to constitute a child abuse allegation. If other conditions are present or the situation poses a risk to the child’s health and welfare, it should be reported as child abuse. Even if the report is rejected for assessment, other services may be offered to the child and family.

♦ Failure to respond to the infant’s life-threatening conditions by failing to provide treatment which in the treating physician’s judgment will be most likely to be effective in ameliorating or correcting all conditions. This subcategory or the denial of critical care abuse type is also known as “withholding of medically indicated treatment.” The type of treatments included are appropriate nutrition, hydration, and medication. The term does not include the failure to provide treatment other than appropriate nutrition, hydration and medication to an infant when, in the treating physician’s medical judgment, any of the following circumstances apply:

• The infant is chronically and irreversibly comatose.

• The provision of treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant’s life-threatening conditions, or otherwise be futile in terms of the survival of the infant.

• The provision of the treatment would be virtually futile in terms of the survival of the infant and the treatment itself under the circumstances would be inhumane.

Detention of Mentally Disordered Persons For Evaluation and Treatment (5150)

5150. When any person, as a result of mental disorder, is a danger to others, or to himself or herself, or gravely disabled, a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, designated members of a mobile crisis team provided by Section 5651.7, or other professional person designated by the county may, upon probable cause, take, or cause to be taken, the person into custody and place him or her in a facility designated by the county and approved by the State Department of Mental Health as a facility for 72-hour treatment and evaluation.

Such facility shall require an application in writing stating the circumstances under which the person's condition was called to the attention of the officer, member of the attending staff, or professional person, and stating that the officer, member of the attending staff, or professional person has probable cause to believe that the person is, as a result of mental disorder, a danger to others, or to himself or herself, or gravely disabled. If the probable cause is based on the statement of a person other than the officer, member of the attending staff, or professional person, such person shall be liable in a civil action for intentionally giving a statement which he or she knows to be false.

Code of Ethics of the National Association of Social Workers

Approved by the 1996 NASW Delegate Assembly and revised by the 1999 NASW Delegate Assembly

Social Workers Ethics Continuing Education