Children’s Institute, Inc: Core Values

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Introduction

The Children’s Institute, Inc. (CII) is a premier agency providing pro bono emergency intervention services primarily designed for child victims of family violence. Since its inception, the CII at the Compton city location, south of Los Angeles, has rendered children services to over 27,000 affected minors in the county (Children’s Institute, Inc. 1).

The services provided include counseling to enable vulnerable children to recover from trauma, empowerment of caregivers, and social support, among others. The CII’s vision is founded on a three-R model, i.e., “recovery, resiliency, and readiness” (Children’s Institute, Inc. 3). It aspires to help affected minors heal from trauma, foster resiliency, and prepare them for a prosperous academic and social future. This essay examines the CII’s operations in the context of social work values and the administrative and micro-level steps for resolving any conflict between the CII’s policies and professional values.

Policies/Operations Reflecting the Value-based of the Social Work Profession

The professional code of ethics prescribes three core value bases that represent the social work profession, i.e., human rights, social justice, and professional integrity (British Association of Social Work [BASW] 10). Upholding human rights means “respect for the inherent worth and dignity” of all individuals while social justice entails promoting equity, fairness, and diversity (BASW 16). The professional integrity theme requires social workers to preserve professional values in their conduct and practice.

One way in which the CII’s operations reflect the value-base of the social work profession is through its focus on the whole child or the entire family. A core principle of the human rights value base is the treatment of a person as a whole. The holistic approach entails the recognition of the whole individual in the context of his or her family, community, or natural settings (BASW 15). This means that social work interventions should consider all facets of an individual’s life. CII’s operations aim at three agency outcomes, namely, recovery, resiliency, and readiness (Children’s Institute, Inc. 3). This family-centered approach is formulated to treat the whole child or family. It supports recovery from unpleasant childhood experiences, resiliency and prevention, and preparedness for academic and social success.

The agency uses an integrated service model encompassing clinical services for trauma victims, child/youth development services (resiliency), family support (parenting education), and early childhood services. It provides family support through ‘Project Fatherhood’, child prepares for kindergarten, evidence-based mental health services for vulnerable groups, and youth development to improve social skills. These services reflect the principle of treating each individual as a whole, which underlies the human rights value base.

Policies/Operations Conflicting the Value-based of the Social Work Profession

The CII’s privacy policy appears to conflict with the underlying principles of professional integrity value-base. One of the ethical principles, i.e., professional accountability, requires social workers to “account for and justify their judgments and actions” to clients, employers, and the public (BASW 16). It entails being answerable to others, i.e., patients, insurance companies, the public, etc., for particular decisions or interventions.

The CII’s privacy policy, which emphasizes on non-disclosure of protected patient health information (PHI) conflicts with the professional accountability value-base. The agency requires a written authorization by the client to disclose PHI for treatment, payment, health operations, and/or legal actions as per the HIPAA guidelines (Children’s Institute, Inc. 6).

However, this disclosure excludes psychotherapy notes documenting the details of a counseling session. The provisions of the confidentiality policy give psychologists the right to disclose psychotherapy notes to the patient. In other words, the psychologist decides whether to release this information, which is kept separate from the PHI record, to the patient. Therefore, the policy, in this respect, raises an ethical dilemma relating to professional accountability and confidentiality.

Social workers are required to be accountable for their actions and decisions and rationalize their clinical judgments. Psychotherapy notes contain the therapist’s impressions about the client; they form the basis for selecting a particular treatment/intervention. Under the HIPAA rule, patients can access their PHI records; however, this right of access does not cover psychotherapy notes, which are accorded protection that is more stringent. Therefore, a psychologist may deny patient access to this information, resulting in an ethical conflict with the professional accountability principle.

In light of this, the CII’s privacy policy could be considered to cause a value conflict in balancing the professional accountability principle and the HIPAA policy on PHI disclosure. Legally, the psychologist is required to maintain the confidentiality of the patient. However, he or she is under an ethical obligation to the social work occupation to embrace professional accountability. This raises an ethical conflict between safeguarding the confidentiality of the patient and maintaining accountability in professional conduct.

Administrative-level Steps for Resolving the Conflict

In CII, balancing between the issues of confidentiality and professional values on accountability would require a series of administrative-level actions. One administrative-level step that could be taken to resolve the identified ethical conflict is by holding regular administrative meetings to brief staff on PHI privacy issues and how to navigate through the ethical dilemma related to confidentiality and professional practice. A series of meetings will allow the CII staff to share the ethical conflicts experienced and devise ways of handling privacy matters without subjugating professional accountability.

Another step that the CII could take to address the ethical conflict is through educational programs. The understanding of possible privacy issues is a prerequisite for ethical decision-making. A training program involving educational workshops will help impart ethical decision-making skills to the CII’s staff. In particular, the administrators will learn how to identify and resolve ethical issues related to PHI privacy without appearing to derelict their professional responsibility. Further, the training will communicate the organizational policy on confidentiality and relate it to the requirements of the HIPAA act. Additional educational workshops will train the CII employees on ethical considerations relevant to patient confidentiality.

An employee assistance program could help develop staff capacity to balance between confidentiality and the professional accountability obligation. Such programs should focus on supporting new CII volunteers, such as psychologists participating in its early childhood services and youth development programs, to understand the organizational policy on confidentiality. Moreover, the assistance programs will educate staff on the PHI disclosure and reporting procedures in the event of a breach.

The agency should also review its privacy policy for compliance with the professional values of social work. The current privacy policy, though grounded in the HIPAA rules, does not seem to include the professional values of the social work practice. The CII management should review this policy to reflect the professional values, especially on professional accountability. The agency should also formalize the social work values of “respect for human rights, social justice, and professional integrity” to assist its staff in the provision of integrated care to the Los Angeles children and families (BASW 10).

Another important administrative step is establishing an ethical committee at the agency to address ethical challenges and promote adherence to the privacy policy. Competent, ethical decision-making is required to navigate through confidentiality issues, promote trust in the agency, and support professional accountability. The ethical committee will provide guidelines to volunteer professionals to act in a way that upholds the CII’s privacy policy but does not infringe on their professional values.

Micro-level Steps for Resolving/Minimizing the Conflict

At the individual level, one could minimize the ethical conflict through knowledge and application of the CII privacy policy and professional values in practice. This approach will help one meet the professional obligation of accountability without negating the legal/policy requirements of confidentiality. A second step could involve engagement in ethical analysis with peers to familiarize oneself with complex ethical issues. In this way, one will be develop the capacity to develop solutions that could be considered ethical and compliant with the HIPAA requirements.

Another individual-level action involves helping others in identifying solutions to ethical conflicts related to the privacy issue. This action will enable one become familiar with the resolution of ethical issues related to confidential information. In addition, it will broaden one’s understanding of the ethical reasoning behind information disclosure as well as how to balance between confidentiality requirements and professional accountability for mutually acceptable outcomes.

Conclusion

The CII’s family-centered and integrated service model reflects the social work professional value of upholding human rights, especially on holistic care. However, the agency’s privacy policy, which emphasizes on non-disclosure of PHI, appears to conflict with the professional accountability principle. A series of administrative-level and micro-level steps could help resolve the conflicting values and achieve a balance between confidentiality and professional principles.

Works Cited

British Association of Social Work [BASW]. The Code of Ethics for Social Work: Statement of Principles, 2012. PDF file.

Children’s Institute, Inc. Impact Report, 2015. PDF file.

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