FUNDAMENTALS OF

CASE MANAGEMENT
PRACTICE:
SKILLS FOR THE HUMAN
SERVICES
FIFTH EDITION
Nancy Summers

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 Chapter 2:
Ethics and Other
Responsibilities for
Human Service Workers
Fundamentals of Case Management Practice:
Skills for the Human Services
5th edition
Nancy Summers

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WHAT IS MORAL?
Moral choices have to do with culture and
socialization
What we feel is right
Often tied to religion
We generally feel guilt when we violate our
own moral code

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WHAT IS ETHICAL?
Generally represented in ethical codes
Developed for specific professions
Often required to maintain professional
status
Violations result in sanctions and loss of
privileges

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WHAT IS LEGAL?
May embody moral and ethical codes
We are talking about the law
Violations are violations of the law – a
criminal offense
Courts make decisions about the
consequences of illegal behavior

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THESE CAN OVERLAP
What you find to be immoral may not be
embodied in any ethical or legal code
Behaviors deemed unethical in your
professional code may be behaviors you
never considered either immoral or illegal
Some behaviors are prohibited in both
ethical and legal codes and may be obviously
immoral to you

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DUAL RELATIONSHIPS
A dual relationship occurs when you and a
client to whom you are giving services have
more than one relationship.
Make every effort to avoid dual relationships.
Your position gives you a position of power.
It is possible to exploit or give the
impression of exploiting this power.
When in a situation where a dual relationship
cannot be avoided, give the client a choice
about continuing services with you.

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GIFTS FROM CLIENTS
It is best to avoid accepting gifts from
clients.
Sometimes clients give gifts with the
expectation of receiving special
consideration in the future.
Sometimes, however, they are given out of
gratitude and a need to stop always being
on the receiving end.

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ACCEPTING THE GIFT
If you accept a gift from a client:
◦ Document the offer and how you responded in the
client’s chart.
◦ Always attempt to accept the gift on behalf of the
entire agency rather than as a personal gift to you.
◦ Acceptance can pose a conflict of interest.

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SEXUAL OR ROMANTIC
RELATIONSHIPS
Sexual or romantic relationships with clients
are almost always illegal and always
completely unethical.
For clients, the respectful and concerned
relationship they form with a case manager
may be the first time they have experienced
such a relationship.
For a case manager who is facing difficulties
in his or her own life, a sensitive and
concerned client is appealing.

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WHO IS ALWAYS
RESPONSIBLE?
It is the case manager’s job to make sure
that sexual or romantic relationships do not
develop!
Relationships with clients are exploitive, can
add to a client’s emotional burdens, and will
always involve a power differential.
◦ One person is the helper with all the answers and
resources while the other is the person with all the
problems.

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AVOIDING VALUES
CONFLICTS
Be respectful of attitudes and lifestyles that
differ from your own.
Never practice prejudice toward minorities,
those with disabilities, or those with differing
sexual preferences.
Always give your best service to your client,
even when you disagree with the person.
Never attempt to change a client’s values to
coincide with your own.

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SELF-DETERMINATION
Clients have the right to self-determination.
◦ This includes:
● The right to research their diagnosis and treatment
and ask questions about it
● The right to make mistakes
● The right to decide when and for how long they will
use the services of an agency or engage in treatment
Government and other funding sources are
asking case managers to talk to clients about
what clients envision for themselves in the
future beyond grappling with social and
emotional problems.

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INFORMED CONSENT
A client always has the right to consent to or
withdraw from services.
The client has the right to be informed about:
◦ Side effects, adverse effects, or negative
consequences that could occur as a result of
treatment, medication, or procedures
◦ Any risks that might occur if the client elects not to
follow through with treatment or services
◦ What is being offered, including what the treatment
is, what will be included, and potential risks and
benefits
◦ Any alternative treatments or procedures available

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WHAT CONSTITUTES INFORMED
CONSENT IN 3 PARTS
Capacity
◦ The client has the ability or capacity to make clear,
competent decisions in his or her own behalf.
Comprehension of Information
◦ The client clearly understands what is being told to
him or her. To make sure that this is so, give the
information carefully and check to see if the client
understands what you have told him or her.
Voluntariness
◦ The client gives his or her consent freely with no
coercion or pressure from the agency or the
professional offering the service.

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CONFIDENTIALITY
This is both an ethical principle and legal right.
Ask clients for their permission before sharing
their case with colleagues unless this sharing
takes place in normal supervision and agency
planning.
If asked on the phone about a client, request a
release-of-information form and indicate you will
see if the client is known to your agency when
the form is received.
Do not discuss your cases with relatives or
friends, even when leaving out the names.

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MINIMUM NECESSARY RULE
Use the Minimum Necessary rule:
◦ Only release the minimum amount of information
needed for the other agency to fulfill their
responsibility to the client.

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WHEN YOU CAN BREAK
CONFIDENTIALITY
When you must warn others of possible harm
by the client
When the client needs professional services
and cannot obtain these voluntarily
When protecting clients from harming
themselves
When you are attempting to obtain payment
for services
When obtaining a professional consultation
from your regular supervisor in the course of
regular supervision

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Health Insurance Portability
and Accountability Act (HIPAA)
Passed in 1996
Requires agencies to inform clients of the
agency’s privacy and confidentiality
procedures
Security: Requires agencies to protect health
information from inappropriate access by
others
Privacy: The client’s right to keep certain
information private

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MORE ON HIPAA
Stipulates what must be stipulated on a
release-of-information form
IHI or Identifiable Health Information: Clients
have the right to ask that this information be
restricted.
Clients have the right to access their files,
make copies of their records, and make
corrections or additions to their files if these
are accurate.

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SOCIAL NETWORKING
Social networking is a way to connect with
those who share our experiences at work.
Away from the work site, it helps to be able
to talk frankly about what happened.
Social networking sites are not secure.
Comments made can be read by others and
misconstrued.
It is unethical to talk about clients in any
forum where confidentiality is not
guaranteed.

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PRIVILEGED COMMUNICATION
Privileged communication is a legal concept.
Protecting the right of the client to withhold
information in a court proceeding

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WHEN YOU CAN REVEAL
INFORMATION
You can reveal information about a client in
a court proceeding when:
◦ You are acting in a court-appointed capacity such
as guardian or payee
◦ A child under 16 is believed to be the victim of a
crime such as sexual or physical abuse
◦ You determine the client needs to be hospitalized
◦ The client has told you of his intention to commit a
crime or harm himself or another

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MANDATED REPORTING
All states have laws requiring professionals
to report the abuse or neglect of children.
Some states have laws requiring
professionals to report the abuse, neglect, or
exploitation of older people.
What does your state require?
Even where there are no laws mandating that
you report elder abuse, ethically you have an
obligation to do so.

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INVOLUNTARY COMMITMENT
CRITERIA
Criteria for committing someone against his
or her will are:
◦ The person poses a danger to himself or others
and one of more of the following:
● Severe mental illness or severe mental illness that is
acute
● Unable to function and thus unable to provide self-care
● Has refused to sign a voluntary commitment
● There are known treatments that can be applied once
the person is committed
● The commitment adheres to the principle of least
restrictive treatment setting

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ETHICAL RESPONSIBILITY TO
THE CLIENT
DON’T burden clients with your problems or
tell clients worse has happened to you.
DON’T ask a client to meet your needs
◦ Asking them to buy Avon from you, buy insurance
from a friend starting an insurance business
DON’T insist that the client do what you
think the client should do. Don’t insist that
your solutions are the only solutions.
DON’T continue to treat the client as being
in need of your services when the client has
grown beyond needing these services.

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PROTECTING THE CLIENT’S
SELF-ESTEEM
When you diminish another person’s self-esteem,
you are stealing what feelings of confidence and
self-worth they may have.
Some workers think they can justify
mistreatment of clients because the clients are
difficult, don’t follow through, call too often, etc.
Many clients already feel unsure, vulnerable, and
awkward over needing help.
We have a responsibility never to diminish
another person’s sense of self-esteem or self-
worth.

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FOUR REASONS CLIENTS ARE
MISTREATED
There are 4 reasons clients are often
mistreated:
◦ The worker is unpleasant with everyone.
◦ The worker needs to feel superior and to have
power over the client.
◦ The worker has no supervisory support and feels
isolated with unpredictable behavior or unfamiliar
problems and develops an us-vs.-clients attitude.
◦ The worker is trying to control unpredictable
behavior with verbal or physical aggression
because the worker lacks training and support in
other ways to handle the behavior.

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HOW WE STEAL CLIENTS’
SELF-ESTEEM
We steal a client’s self-esteem by:
◦ Being rude, brusque or demeaning
◦ Ignoring the client
◦ Refusing to return calls or acknowledge the clients
concerns
◦ Denigrating, ridiculing, or demeaning the client
◦ Forcing clients to perform actions the client is not
capable of performing

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IMPAIRED WORKERS
A social service worker is considered
impaired when he or she is unable to
function effectively due to substance abuse,
mental illness or personal problems.
If a co-worker becomes impaired:
◦ Start by talking to the worker
◦ If need be, talk to your supervisor
◦ Do not allow clients to become endangered

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IF YOU BECOME IMPAIRED
If you become impaired:
◦ Take steps to resolve personal problems promptly
◦ Do not work with clients if you are not able to
function effectively

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