8 Ethical Considerations for Upholding Privacy and Confidentiality in Social Work Practice

social workers in conversation, reviewing paper files

Privacy and Confidentiality, 1.07, is one of the most cited areas of the NASW Code of Ethics. The twenty-three items in this section of the code provide substantive guidance related to social workers’ ethical obligations regarding verbal, written, and electronic communications with and about clients. The following eight considerations underscore key elements for honoring the sacred clinical relationship and communications between social workers and their clients.


1. Avoid Google searching clients.

The NASW Code of Ethics guides social workers to respect clients’ rights to privacy and to avoid soliciting private information from or about clients except for compelling professional reasons, per 1.07(a).

With social media offering easy access to information, social workers should avoid using the internet to search and gather information about clients, per 1.07(q). An exception may be made to address safety concerns and/or as deemed clinically appropriate with client consent.


2. Limit and ideally avoid disclosing confidential information.

Recognizing that social workers have access to sensitive information, the code guides clinicians to limit the disclosure of confidential information to the extent possible. This includes refraining from sharing or referencing information about clients in social media posts. Even when there are no identifying details provided, clients and/or their associates may recognize the post as detailing their information and have grounds to allege a breach of confidentiality.

In instances when disclosure is required by law or client consent, if feasible social workers should first discuss the possible implications of the disclosure with clients and then proceed to disclose the least amount of information necessary to achieve the desired purpose. This guidance applies whether disclosure is predicated by valid consent or is due to a legal mandate.


3. Know the exceptions that may limit or impact privacy and confidentiality.

There are exceptions that may limit the confidentiality owed clients. For example, Commitment to Clients, 1.01, references circumstances, such as state-mandated reporting laws applicable to reporting child abuse or neglect, that may supersede the loyalty owed to clients. Moreover, as a result of the 1974 Tarasoff vs. Regents of the University of California case, most states have “duty to warn/protect” laws that either require or permit mental health professionals to disclose information about patients who may become violent or pose a threat to others.

Finally, standard 1.07(c), states that confidentiality “does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or others.” This guidance is not based on law, but rather on social workers’ professional judgment, or “compelling professional reasons.”

When in doubt, social workers should seek legal consultation about these exceptions.


4. During legal proceedings, uphold clients’ privacy and confidentiality to the extent possible.

Social workers are ethically required to protect information shared in therapy to the extent permitted by law during legal proceedings. Per standard 1.07(j), if a subpoena is issued requiring disclosure of privileged information without the client’s consent and such disclosure could cause harm, social workers should request to have the order withdrawn or limited as narrowly as possible, and that the records be maintained under seal, unavailable for public access.

The appropriate handling of subpoenas has both ethical and legal considerations. To find NASW resources for social workers who have questions about handling subpoenas, see Responding to a Subpoena.


5. Always establish privacy and confidentiality protocols, especially when working with couples and groups.

Establishing the rules of engagement at the onset of treatment is essential to setting clear expectations and client rapport. Standard 1.07(d) guides social workers to discuss the nature of and limitations to confidentiality with clients. This discussion should occur as soon as possible in the social worker/client relationship and continue as needed throughout the course of services.

When working with couples or groups, confidentiality protocols are complicated by the fact that there must be agreement between clients and the social worker as well as “agreement between the parties concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by the other individual,” per 1.07(f). Therefore, social workers providing services to families or groups should pursue the appropriate training and experience to ensure they are practicing with competence.


6. Maintain confidentiality when storing or transmitting written and electronic records.

When selecting a platform for telehealth service delivery, social workers should consider the ethical guidance in standard 1.07(m), which addresses the necessary safeguards that should be taken to protect confidentiality when communicating electronically, specifically the use of encryption, firewalls, and passwords. Generally, video conferencing platforms used for telehealth service delivery should be HIPAA compliant. Although NASW does not presently endorse any particular technological platform, social workers can learn more about available resources on the Telehealth webpage.


7. Develop “breach of confidentiality” procedures and policies.

Standard 1.07(n) guides social workers to develop and disclose procedures for addressing breach of confidentiality or unauthorized access to client information. These polices should be consistent with applicable laws and professional standards. Consulting with an attorney for guidance around the development of “breach of confidentiality” policies is strongly recommended.


8. Consult when faced with privacy and confidentiality dilemmas.

Section 1.07, Privacy and Confidentiality, provides ethical guidance that often is linked to legal considerations and other sometimes conflicting interests. For instance, common privacy and confidentiality dilemmas are raised when working with minors and families or when addressing posthumous issues after a client has passed away. In these and the myriad of other complex situations that clinicians may face, it is important to consult with other professionals and the literature to inform good ethical decision making. NASW offers a wide array of resources and services to meet these needs.

Additional Resources

NASW Law Notes provide legal guidance on various common themes in social work practice. Titles include "Social Workers and Subpoenas" and "Legal Rights of Children."

An Hour with Private Practice offers on-demand audio recordings for NASW members. Relevant titles include "Legal Considerations When Working with Minors" and "Ethical Responsibilities in Private Practice Settings: New Considerations and Challenges."

Reference

National Association of Social Workers Code of Ethics (2021)