ACADEMIA Letters Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic Erika Gergerich, New Mexico State University Jason Mallonee, University of Texas at El Paso Stacy Gherardi, New Mexico State University Alexa Copeland, New Mexico State University Introduction The COVID-19 pandemic had an immediate impact on the provision of social services throughout the United States. Agencies experienced disruptions in funding and client interactions were quickly transitioned to an online format (Ben-Zeev, 2020; Mann et al., 2020; Mishna et al., 2021). Unique ethical considerations arose as a result of these fast-paced changes (Banks et al., 2020). With the purpose of better understanding the pandemic’s effects on social work ethics in direct practice, researchers at New Mexico State University conducted a qualitative study wherein a sample of U.S. social work practitioners were surveyed regarding challenges faced during the spring of 2020. Researchers observed major themes regarding ethical dilemmas and provided recommendations for navigating these challenges within the field of social work. Methods The data analyzed in this qualitative study was obtained through an online Qualtrics survey disseminated to social work practitioners through electronic mailing lists, social media outlets, and chain referral sampling.The survey was open between May 15 and June 15, 2020. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Erika Gergerich, egerger@nmsu.edu Citation: Gergerich, E., Mallonee, J., Gherardi, S., Copeland, A. (2021). Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic. Academia Letters, Article 4336. https://doi.org/10.20935/AL4336. 1 Participants responded to open ended questions regarding concerns about how the COVID-19 pandemic had affected social work client experiences, the personal and professional impacts of the pandemic on practicing social workers, and client strengths and resilience factors witnessed by social workers during the initial stages of the pandemic. There were 431 survey responses overall. Of these, 181 participants were licensed social workers who were active in their practice and who provided responses to the open-ended questions. These responses were analyzed specifically for ethics-related content. Qualitative data was examined separately by two research team members. Then, observations were discussed by the research team, and themes were determined collaboratively. Additionally, non-participant social work clinicians were asked to review themes in an effort to foster validity. Of the survey participants, 73% (n=133) were licensed clinical social workers, 22% (n=39) were licensed master social workers, and 5% (n=9) were licensed social workers. Participants practiced in a variety of regions, with 31 states and Washington D.C. represented in the data. Respondents reported working within a wide range of practice areas, including mental health, children and families, trauma, geriatrics, youth and school, veterans, and addiction. Amongst the survey participants, practice experience ranged from 1 to 50 years, with the average being 20 years of practice experience. Results Researchers identified five main ethical dilemmas related to direct client service within the context of the COVID-19 pandemic. These dilemmas involved (1) Informed Consent, (2) Practitioner Competence, (3) Privacy/Confidentiality, (4) Interruption of Services, (5) Private Conduct and Impairment. Below we highlight these ethical dilemmas in light of the ethical standards in the National Association of Social Workers Code of Ethics (National Association of Social Workers [NASW], 2021) that they reflect. Informed Consent (1.03) Respondents indicated that adhering to the National Association of Social Workers Code of Ethics regarding informed consent became more challenging when transitions were made from face-to-face service provision to virtual formats. In particular, the ability of social workers to “assess the clients’ suitability and capacity for electronic and remote services” (NASW, 2021, 1.03f). Workers struggled to navigate the imperative to provide services with client capacity and preference for telehealth. Many social workers saw a significant portion of their Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Erika Gergerich, egerger@nmsu.edu Citation: Gergerich, E., Mallonee, J., Gherardi, S., Copeland, A. (2021). Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic. Academia Letters, Article 4336. https://doi.org/10.20935/AL4336. 2 clients discontinue services due to the adoption of teletherapy as clients did not feel capable of navigating the required technology or “could not relate to a therapist without being in person.” Practitioner Competence (1.04) Many social workers expressed concerns regarding their ability to adhere to competent practice guidelines, given that the adoption of technology impacted many aspects of their practice. Respondents were concerned that delivering services through a virtual platform would impair the ability of practitioners to build rapport, conduct comprehensive assessments, and deliver intervention strategies effectively. Additionally, some practitioners expressed concerns that they did not have strong technical skills themselves, a conflict with standard 1.04 which states that social workers “should ensure that they have the necessary knowledge and skills to provide such services in a competent manner” (NASW, 2021, 1.04d) and this lack of knowledge could negatively impact their clients. Privacy/Confidentiality [1.07 (i.)] Many respondents described having concerns about privacy and confidentiality while using technology when the client’s environment was less controlled and other individuals might have been within hearing distance. In addition, social workers who transitioned to working from home also expressed concerns about maintaining an appropriate level of privacy and confidentially when meeting with clients from their own at-home location. Interruption of Services (1.15) The extent and impact of the interruption of services on a client’s experience was a common concern identified as some respondents saw an influx of new clients whose services had been terminated elsewhere, while other respondents had to terminate their own clients’ services because of changing circumstances. Factors that led to disruption in services included unavailability, problems with electronic communication, relocation, illness, cognitive or physical ability, or death. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Erika Gergerich, egerger@nmsu.edu Citation: Gergerich, E., Mallonee, J., Gherardi, S., Copeland, A. (2021). Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic. Academia Letters, Article 4336. https://doi.org/10.20935/AL4336. 3 Private Conduct/Impairment (4.03/4.05) Respondents described issues that arose due to the pandemic and how changing circumstances affected their ability to maintain the Code of Ethics’ standards regarding private conduct and professional responsibilities. Another main theme identified in survey responses was possible impairment caused by social worker psychosocial distress due to pandemic-related factors. Respondents cited difficulties in managing their own mental health and well-being due to increased workload, transition to virtual service delivery, and challenges in maintaining work and home balance. Discussion This study uncovered five primary direct-practice ethical dilemmas social workers faced during the early days of the COVID-19 pandemic. These areas included (1) Informed Consent, (2) Practitioner Competence, (3) Privacy/Confidentiality, (4) Interruption of Services, (5) Private Conduct and Impairment. Researchers developed the following informed recommendations for countering or adapting to the challenges identified. As social workers contend with issues regarding technology, a client technology assessment could be utilized to evaluate suitability and capacity before services are continued virtually. Practitioners should clearly communicate with clients about difficulties in maintaining privacy and confidentiality when using virtual formats to ensure fully informed client consent. Practitioners should pursue additional education regarding rapport building in a virtual setting so that clients are not unduly impacted by the transition from in-person to online service delivery. Given the continued need for these services and the likelihood that it will remain throughout and beyond the pandemic, telehealth competency should be included in social work pre-service education. Lastly, social workers should learn and employ evidence-based virtual techniques for assessment, intervention and working with Special Populations. In order to maintain adherence to personal conduct and impairment guidelines, practitioners should identify and manage their personal issues and impairments. This imperative is not unique to the pandemic but the experience of providing service in the midst of a global crisis highlights the necessity of balancing service with practitioner capacity. The 2021 revisions to the Code of Ethics added language addressing the necessity of self-care, explaining that, “Professional demands, challenging workplace climates, and exposure to trauma warrant that social workers maintain personal and professional health, safety, and integrity” (NASW, 2021, preamble). As such, supporting social workers to engage in proactive self-care, to recognize the signs of impairment, and to engage in appropriate action to manage such should Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Erika Gergerich, egerger@nmsu.edu Citation: Gergerich, E., Mallonee, J., Gherardi, S., Copeland, A. (2021). Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic. Academia Letters, Article 4336. https://doi.org/10.20935/AL4336. 4 be central features of social work organizations. Social workers are called to balance the need to provide service to clients with the assurance that they will provide services that are within their area of competency, utilizing referrals when this is not possible. The COVID-19 pandemic, the demand for mental health services it created, and the demand that those services be provided in a format that was largely new to many practitioners presented an acute ethical challenge. In addition to establishing a base of competence in the provision of remote and technology-based services, social workers should ensure that they build deep and broad networks which they can call upon to provide services to clients in need of services outside of their areas of competency. Conclusion Responses gathered from social workers in direct practice during spring of 2020 reveal significant challenges in maintaining professional ethics due to the unique practice implications of COVID-19. Practitioners were forced to quickly adapt to new ways of delivering services and communicating with clients. Despite this, some clients experienced discontinuation of services or reduced quality of services because of the changing paradigm. Social workers may employ new strategies to ensure that social work ethics are maintained in direct practice despite the shifting realities, such as those posed by the pandemic. Academia Letters, December 2021 ©2021 by the authors — Open Access — Distributed under CC BY 4.0 Corresponding Author: Erika Gergerich, egerger@nmsu.edu Citation: Gergerich, E., Mallonee, J., Gherardi, S., Copeland, A. (2021). Ethical Issues in Social Work Practice at the Onset of the COVID-19 Pandemic. Academia Letters, Article 4336. https://doi.org/10.20935/AL4336. 5 References Banks, S., Cai, T., de Jonge, E., Shears, J., Shum, M., Sobočan, A. M., Strom, K., Truell, R., Úriz, M. J., & Weinberg, M. (2020). 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