A regulatory board complaint may be filed against a social worker by a client, colleague, employer, and/or other regulatory agency, such as the State Board of Licensed Social Workers, Department of Health, or the Department of Family and Children Services. Complaints are subsequently investigated by the regulatory board in order to ensure that social workers are practicing safely, professionally, and ethically. Regulatory board investigations may lead to outcomes ranging from no action against the licensee to revocation of one’s license to practice.
This matter involves a Board complaint against a social worker who violated confidentiality of their clients involved in a custody dispute.
The Facts
A Licensed Clinical Social Worker (LCSW), with over 15 years of clinical experience and five years of employment as a child and adolescent therapist in an outpatient counseling practice, was providing reunification therapy to two minor clients within the same family system. One client, hereafter referred to as Child A, was the subject of a recently finalized divorce between her parents, who remained involved in a contentious custody dispute, with both parents seeking sole legal custody. The second client, hereafter referred to as Child B, was the mother’s child from a prior relationship. The LCSW was aware from Child A’s clinical history that she had previously experienced sexual assault perpetrated by a non-family member.
Although only the children were designated as clients, the LCSW periodically included the children’s mother and maternal grandmother in conjoint sessions to support the therapeutic process. The LCSW also conducted individual sessions with each child. During these sessions, the LCSW explored the children’s relationships with one another and their interactions with their mother and grandmother, with whom they were residing at the time.
In one individual session, Child A described an interaction with her grandmother that she reported made her feel uncomfortable. Based on this disclosure, the LCSW developed concerns that the grandmother might be mistreating or potentially abusing Child A.
At a subsequent conjoint session involving the children, their mother, and their grandmother, the LCSW recommended comprehensive psychological evaluations for all four individuals to further assess family dynamics, mental health needs, and potential risk factors. The mother declined this recommendation after learning of the associated costs and expressing the belief that such evaluations were not necessary. Following the mother’s refusal and in light of ongoing concerns regarding Child A’s safety, the LCSW filed a report with Child Protective Services (CPS), documenting his suspicion that Child A might be experiencing mistreatment by her grandmother. CPS conducted a home visit and determined that there was no immediate risk of harm or danger to the children; however, this outcome was not communicated to the LCSW.
In addition, out of continued concern for Child A’s welfare within the context of the custody dispute, the LCSW authored a letter addressed to Child A’s father and his legal counsel. Upon learning of this correspondence, the mother filed a complaint with the State licensing board against the LCSW, alleging that he had improperly disclosed confidential information obtained during therapy sessions. The complaint prompted the Board to initiate a formal investigation.
The Board’s Investigation
A Board investigator interviewed both children, the mother, the grandmother, and the LCSW. The mother and grandmother confirmed that the letter authored by the LCSW contained sensitive clinical information that he had obtained during therapy sessions and that they had not provided consent for him to prepare or disclose such a letter. They further alleged that the letter contained inaccurate statements regarding the grandmother and her treatment of the children. The mother also reported that, as a direct result of the LCSW’s letter, the father’s attorney obtained an emergency court hearing that led to restrictions on the grandmother’s unsupervised contact with Child A.
During his interview with the Board, the LCSW acknowledged that he had not obtained consent from the mother, grandmother, or either child prior to writing or releasing the letter. He maintained that his actions were undertaken in what he perceived to be the best interests of the children. The LCSW further indicated that the mother’s refusal to proceed with the recommended psychological evaluations raised additional concerns for him about the family’s willingness to invest in services that he believed would benefit the children. He disclosed that this refusal had caused him some anger, and that this emotional response was a contributing factor in his decisions to file the CPS report and to contact the children’s father and his attorney.
Outcome
The State Board concluded that the LCSW’s decision to file a report with CPS did not constitute misconduct, as he was acting in his capacity as a mandated reporter and had a reasonable basis for concern regarding potential mistreatment of Child A.
However, with respect to the letter sent to Child A’s father and his attorney, the Board found that the LCSW had violated the state Social Workers Act by failing to adequately protect the confidentiality of client communications and by disclosing confidential information to a third party without appropriate authorization or legal mandate. The Board further determined that the LCSW’s actions enabled the father’s attorney to obtain legal restrictions on the grandmother’s contact with Child A, and that this outcome constituted an additional violation of the state Social Workers Act.
Resolution
The Board suspended the LCSW’s license to practice for a period of two months, followed by an additional one year of probation. The probation terms required the completion of Board-approved courses in HIPAA compliance, professional ethics, and client confidentiality. The cost to defend the matter exceeded $9,000.
Risk Management Recommendations
- Adhere to professional standards, ethical guidelines, and applicable state and federal laws when addressing confidentiality issues with clients. The NASW Code of Ethics outlines several key responsibilities owed to clients:
- Privacy and confidentiality. Social workers should respect clients’ right to privacy. Once private information has been shared, standards of confidentiality apply (Standard 1.07(a)).
- Consent to disclosure. Social workers may disclose confidential information with valid consent from a client or a person legally authorized to consent on behalf of a client (Standard 1.07(b)).
- Informing clients of disclosure. If social workers plan to disclose information, they should inform clients about the disclosure and the potential consequences prior to disclosing the information (Standard 1.07(d)). This obligation applies regardless of whether disclosure is made pursuant to a legal requirement or with client consent.
- Group counseling services. When providing counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others (Standard 1.07(f)). (NASW Code of Ethics)
- Prioritize your clients’ best interests and their right to self-determination. Maintaining your clients’ trust is one of the most important ways to ensure the effective delivery of services and achieve the client’s goals. Taking actions without the client’s knowledge can degrade the quality of trust in the social worker-client relationship. Disclosing information revealed to you in confidence, especially disclosing it to someone who has a relationship with the client, is particularly egregious and damaging to the client’s trust in you as a social worker.
- Be aware of potential conflicts of interest when providing services to multiple clients who have a relationship with one another, and be knowledgeable about ethical standards for these situations. The NASW Code of Ethics states: ”Social workers who anticipate a conflict of interest among the individuals receiving services, or who anticipate having to perform in potentially conflicting roles (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients) should clarify their role with the parties involved and take appropriate action to minimize any conflict of interest.” (Standard 1.06(d))
- Be knowledgeable about laws around mandated reporting of abuse. In most US states, social workers are mandated reporters of child abuse (LegalClarity.org). As such, reporting concerns of abuse to Child Protective Services is highly unlikely to result in any State Board action for breach of confidentiality – however, a client can still initiate a Board complaint or malpractice lawsuit. By contrast, disclosing confidential information obtained during therapy (including the possibility of abuse) to any other third party is considered a breach of confidentiality (NASW Code of Ethics, Standard 1.07).
- Review the NASW Code of Ethics at least annually and recognize the professional obligation to uphold the code.
- Know and practice within the scope of practice as defined by your state Social Work Practice Act, and in accordance with the standard of care and State Board requirements.
Disclaimer
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