Week 2: Ethical Issues in Social Work Research

Whether social workers are counseling clients or conducting research, an adherence to standards for ethical practice is mandated. Persuading a client to participate in sexual activities during sessions is clearly unethical. Conducting research that puts clients in either physical or emotional danger is clearly unethical. However, there are myriad situations in which the answer of right or wrong is not so clear. This week, you consider the mandates and standards for ethical practice in social work. You also review guidelines in Walden University’s Institutional Review Board (IRB) document.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

The Parker Family

Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years, since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance abuse; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and Klonopin®.

Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie currently has active Medicare and receives Social Security Disability (SSD).

Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance abuse. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge.

A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing all my stuff.”

During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home.

Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing, but denied physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get my things back.”

The APS worker observed that Sara’s appearance was unkempt and disheveled, but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family was in need of a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women.

As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home, based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept what needed to be done so they would not be forced to move.

The Parker Family

Sara Parker: mother, 72

Stephanie Parker: daughter, 48

Jane Rodgers: daughter, 45

Stephanie reported her mother is estranged from her younger sister, Jane, because of the hoarding. Stephanie also mentioned she was dissatisfied with her mother’s psychiatric treatment and felt she was not getting the help she needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently increased her Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel this had been helpful and actually wondered if it was contributing to her mother’s confusion. I asked for permission to contact Jane and both of their outpatient treatment teams, and both requests were granted.

I immediately contacted Jane, who initially was uncooperative and stated she was unwilling to assist. Jane is married, with three children, and lives 3 hours away. At the beginning of our phone call, Jane said, “I’ve been through this before and I’m not helping this time.” When I asked if I could at least keep in touch with her to keep her informed of the situation and any decisions that might need to be made, Jane agreed. After a few more minutes of discussion around my role and responsibilities, I was able to establish a bit of rapport with Jane. She then started to ask me questions and share some insight into what was going on in her mother and sister’s home.

Jane informed me that she was very angry with her mother and had not brought her children to the apartment in years because of its condition. She said that her mother started compulsively shopping and hoarding when she and Stephanie were in high school, and while her father had tried to contain it as best he could, the apartment was always cluttered. She said this had been a source of conflict and embarrassment for her and Stephanie all of their lives. She said that after her father died of a heart attack, the hoarding got worse, and neither she nor Stephanie could control it. Jane also told me she felt her mother was responsible for Stephanie’s relapses. Jane reported that Stephanie had been compliant with her medication and treatment in the past, and that up until a few years ago, had not been hospitalized for several years. Jane had told Stephanie in the past to move out.

Jane also told me that she “is angry with the mental health system.” Sara had been recently hospitalized for depression, and Jane took pictures of the apartment to show the inpatient treatment team what her mother was going home to. Jane felt they did not treat the situation seriously because they discharged her mother back to the apartment. Stephanie had been hospitalized at the same time as her mother, but in a different hospital, and Jane had shown the pictures to her sister’s treatment team as well. Initially the social worker recommended that Stephanie not return to the apartment because of the state of the home, but when that social worker was replaced with someone new, Stephanie was also sent back home.

When I inquired if there were any friends or family members who might be available and willing to assist in clearing out the apartment, Jane said her mother had few friends and was not affiliated with a church group or congregation. However, she acknowledged that there were two cousins who might help, and she offered to contact them and possibly help herself. She said that she would ask her husband to help as well, but she wanted assurance that her mother would cooperate. I explained that while I could not promise that her mother would cooperate completely, her mother had stated that she was willing to do whatever it took to keep living in her home. Jane seemed satisfied with this response and pleased with the plan.

I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the psychologist who administered the tests she had stopped taking her medications for depression. It was determined Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more specialized treatment. Sara’s psychologist was in agreement.

Because they had both stated that they did not want to be removed from their home, I worked with Sara and Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the house for 1 hour a day until arrangements were made for additional help from family members. In an attempt to alleviate Sara’s anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional support and observation as it progressed. Jane notified me that her two cousins were willing to assist with the cleanup, make minor repairs, and paint the apartment. Jane offered to schedule a date that would be convenient for her and her cousins to come and help out.

Key to Acronyms

APS: Adult Protective Services

ICM: Intensive Case Management services

SSD: Social Security Disability

We then discussed placement for at least some of the cats, because six seemed too many for a small apartment. Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats were adopted within a week.

During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to continue to live with her mother. She requested that I complete a housing application for supportive housing stating, “I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the supermarket was pleased with her performance and was prepared to hire her as a part-time cashier soon. She expressed concern about how her mother would react to this decision and asked me for assistance telling her.

We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was initially upset and had some difficulty accepting this decision. Sara said she had fears about living alone, but when we discussed senior living alternatives, Sara was adamant she wanted to remain in her apartment. Sara said she had lived alone for a number of years after her husband died and felt she could adjust again. I offered to help her stay in her apartment and explore home care services and programs available that will meet her current needs to remain at home.

Yegidis, B. L., Weinbach, R. W., & Myers, L. L.  (2018). Research methods for social workers (8th ed.). New York, NY:  Pearson.
Chapter 2, “Ethical Issues in Research” (pp. 24-51)

Labott, S. M., & Johnson, T. P. (2004). Psychological and social risks of behavioral research. IRB: Ethics & Human Research, 26(3), 11–15.
Retrieved from Walden Library databases.

Nicotera, N., & Walls, N. E. (2010). Challenging perceptions of academic research as bias free: Promoting a social justice framework in social work research methods courses. Journal of Teaching in Social Work, 30(3), 334–350.
Retrieved from Walden Library databases.

Walden University (n.d.). Academic Guides: Research Ethics & Compliance: Welcome from the IRB. Retrieved September 12, 2016, from http://academicguides.waldenu.edu/researchcenter/orec
Research Ethics FAQs for Doctoral Students in the Clinical/Intervention Fields: Practical Tips for Avoiding Delays and Problems in the Research Approval Process

Ries, N. M. (2007). Growing up as a research subject: Ethical and legal issues in birth cohort studies involving genetic research. Health Law Journal, 15, 1–41.
Retrieved from Walden Library databases.

National Institutes of Health Office of Human Subjects Research Regulations and Ethical Guidelines (n.d.). Ethical principles for human subjects research. Retrieved June 8, 2016, from https://humansubjects.nih.gov/ethical-guidelines-regulations

Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Sessions: Case histories. Retrieved from Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
The Parker Family

Discussion 1: Sara Parker and Ethics

One of the reasons there can be so much debate about ethical issues is because ethics are opinions informed by people’s values and people have different values. People can disagree about whether or not something is unethical, and, oftentimes, there is no right answer. In order to make decisions about what may be ethical or unethical, Yegidis (2018, p. 25) suggests focusing on these three questions:

1. “Who should benefit or suffer from the actions of the researcher?”
2. “Whose rights should take priority over those of others?”
3. “Does the end (increased knowledge) justify the means (the methods used to acquire it and their potential for harm)?”

For this Discussion, view the Sessions episode on the Parker family. As you do so, consider which, if any, ethical mandates or standards were violated.

By Day 3

Post a response explaining your reaction to the Parker episode. Be sure to address whether or not the social worker violated any ethical mandates or standards. Also explain which strategies could have been used to guide ethical practice. Finally, describe the responsibility of the social workers in the Parker case. Please use the resources to support your answers.

By Day 5

Respond with a reaction to a colleague’s views on the Sara Parker case study. Use these questions to guide your thinking:

1. Do you think that research participants should be compensated?
2. How would compensation impact voluntary participation?
3. Do research regulations do enough to protect special populations?
4. Are there any changes you would like to make to our current research protections?

Please use the resources to support your post.

Discussion 2: The Research Approval Process

The early years of the 20th century were host to a number of unethical research studies. Research involving the way that a young child reacts to and generalizes fear responses, medical experiments conducted in concentration camps, and observing the way people respond to authority were just a few of the most famous experiments whose byproduct was placing clients in physical pain and/or mental anguish. Since then, it has been recognized that research subjects need to be protected from the flagrant disregard of researchers. This week, you consider the guidelines in Walden University’s Institutional Review Board (IRB) document, “Research Ethics FAQs for Doctoral Students in the Clinical/Intervention Fields: Practical Tips for Avoiding Delays and Problems in the Research Approval Process.”

By Day 5

Post a description of two ways the guidelines in Walden University’s IRB document may impact the selection of a research population, research setting, and/or research design. Please use the resources to support your answer.

By Day 7

Respond to a colleague’s post in one of the following ways:

1. Expand upon your colleague’s post regarding ways that the IRB’s ethical guidelines may impact his or her study.
2. Explain an insight you gained from this week’s Resources that addresses a topic in your colleague’s post.

Please use the resources to support your post.

Rhondas Response

The Parker case is a case where a mother, Sara, and daughter, Stephanie, are living in home together. Sara has recently lost her husband and Stephanie suffers from multiple mental health diagnosis. Stephanie feels as though Sara is a hoarder and attempts to clean the home by throwing somethings away. This cause conflict between Sara and Stephanie. The social worker became very pushy towards the end of the video. I seemed as though she was putting her client on the spot to decide on something that she was very leery of.

Ethics violation

The social worker in this video did in fact violate a few ethics principles. One of a social worker’s ethical responsibilities include privacy and confidentiality (NASW,2018). In this video, the social worker pushed the client to be okay with the social worker giving the client’s phone number to a colleague for her to participate in a study (Plummer, Makris & Brocksen, 2014). Not only did Sara indicate verbally that she was not interested in participating in this study, but she also changed her posture and facial expressions to allow the social worker now that this is not something that she was comfortable doing (Plummer, Makris & Brocksen, 2014). Instead of backing away from the idea, the social worker continued to force the client to participate in the study.

Another ethical violation that the social worker exhibited was solicitations (NASW,2018).  She continuous solicited her client to participate in a study that she obviously did not was to participate in.  One of the ethical responsibilities states that a social worker is not to solicit unwarranted clients. The social worker was very adamant about allowing the client to participate in this study.

Additionally, the social worker violated the ethical principles by referring a client for services when it was not necessary for her treatment (NASW,2018).  The client’s participation in this study is not something that is mandatory, and therefore should not have been pushed onto the client. The social worker also avoided answering the client’s questions. Instead of provided answers to the questions, she continued to remind her client that she would receive compensation for her participation.

Strategies that Could have been used

                A strategy that could have been used in the scenario is to explain to the client what the study consists of in as much detail as possible and using layman terms when possible. Also, the social worker could explain how participating in this study may benefit the client. Often, people do not want to participate in something if they feel that they will not get anything from it. There could be other benefits that would benefit the client other than money. This way the client may have been able to make an informed decision instead feeling forced to participate.

Responsibilities

In the Parker episode for this week, Sara is speaking with a social worker to create a sense of peace within the home, by reaching a common ground that will satisfy both parties. Other responsibilities of the social worker include referring or providing other resources that she tells her clients may benefit from.

 Angelica Wiggins RE: Discussion 1 – Week 2COLLAPSE

Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization (Dixon, Holoshitz & Nossel, 2016). A specific challenge in the mental health care system for the care of individuals with chronic illnesses is the treatment gap. The treatment gap represents the absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder (Kohn et al., 2004).

In the Parker case, mental illness is apparent. Both the mother, Sara, and daughter, Stephanie, suffer from depression. It has been said that the mental health system has not done enough to care for Sara and Stephanie’s illness. This results back to the treatment gap. The depression is there but the treatment has been ineffective.

With the intensity of this case, the social worker did well however, she did violate ethical mandates or standards. In a sense the social work became a little pushy and forced what she thought was best for the client onto the client, which was participating in the study.

The treatment gap needs to be addressed and will guide ethical practice. The treatment gap must be bridged in order to effectively identify a client’s disconnection. As social workers we may want things for our clients so bad however, they ultimately have to make the decision. Stressors and uncomfortableness can aggravate mental illness and the treatment gap and make treatment more challenging.

It is the social worker’s role to reduce any stressors and present the clients with treatment and resolutions that will best fit their situation and lifestyle while allowing them a say-so in the process.