1. In an
initial session with a social worker, the client mentions that she has been
hospitalized several times for “depression”. When the social worker attempts to
explore the hospitalizations, the client becomes tense and guarded, saying it
is “old history”. She also declares that she won’t give permission for those
records to be released. The social
worker should FIRST:
(A) explore why this topic
appears to be upsetting to her
(B) acknowledge her right to
decide about release of records
(C) reassure her that the focus
will be on present issues
(D) assess the client’s current level
of depression
2. As
an ethical social worker, you would never do which of the following?
(A) get consultation on a case without getting a client's permission to do so first
(B) get angry at one of your clients
(C) breach a client's confidentiality
(D) make a recommendation to a client regarding her medication
(A) get consultation on a case without getting a client's permission to do so first
(B) get angry at one of your clients
(C) breach a client's confidentiality
(D) make a recommendation to a client regarding her medication
3. In mediation, the role of the mediator is to
(A) manage the flow of information between disputing parties and then get them to agree on a compromise.
(B) make a formal and final recommendation when one is needed to break a deadlock between disputing parties.
(C) work with disputing parties to help them reach a satisfactory agreement and allow the parties to decide for themselves whether or not to accept the agreement.
(D) weigh the facts and the preferences of each disputing party, and then make a final, binding recommendation.
(A) manage the flow of information between disputing parties and then get them to agree on a compromise.
(B) make a formal and final recommendation when one is needed to break a deadlock between disputing parties.
(C) work with disputing parties to help them reach a satisfactory agreement and allow the parties to decide for themselves whether or not to accept the agreement.
(D) weigh the facts and the preferences of each disputing party, and then make a final, binding recommendation.
4. A
Social Worker is subpoenaed to testify in Federal Court about conversations he
had with Mr. J. while Mr. J was receiving services. According to the Jeffe v.
Redmond decision, the Social Worker:
(A) must comply with the subpoena.
(B) may refuse to reveal the information.
(C) must choose the information to reveal.
(D) must insist on a release of information from Mr. J.
5. Mrs.
K, a twenty-six-year-old secretary, shares with her male Social Worker that she
is becoming attached to him and often has sexual fantasies about him. She also
shares that she wants to see him in a variety of social situations and is
willing to terminate the clinical relationship. What should be the Social
Work's [FIRST] responsibility:
(A) discuss the client's feelings about her sexual needs and fantasies.
(B) immediately refer the client to a female worker.
(C) clarify the clinical professional relationship.
(D) assess the client's ability to maintain a personal relationship.
6. Bob
has experienced a brief psychotic episode which cleared without
hospitalization. He is concerned that his employers would dismiss him if his
true condition is discovered. He needs his job as his wife and three children
are dependent on him. The Social Worker agrees to call the condition an
adjustment reaction for purposes of insurance. This is an example of:
(A) reframing.
(B) insurance fraud.
(C) insurance modification.
(D) naming.
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7. What is the purpose of peer review?
(A)To monitor practices.
(B)To settle disputes among
consumers, practitioners, and third party payers.
(C)To determine whether patient
services meet predefined standards.
(D)To receive informal feedback about
professional conduct and practices.
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8. An
insurance company conducting a peer review requests that a social worker
provide it with information about a current client whose fee is being paid by
the insurance company. In this situation, the social worker should do which
of the following?
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12.
During a utilization review phone call, a social worker is asked by the
managed care representation to provide specific details of the sexual abuse
incidents the client experienced. The social worker should FIRST:
(A)Provide all requested
information to the reviewer
(B) Refuse to give specific information to
protect the client’s privacy
(C) Review the release of information with
the client prior to providing information
(D) Review the managed care contract with the
supervisor prior to providing information
13. Privilege and confidentiality
are the same, except that
(A) privilege is an ethical obligation and confidentiality is a legal one. (B) confidentiality is an ethical obligation and privilege is a legal one. (C) privilege is usually held by the therapist and confidentiality is the client's right. (D) privilege and confidentiality are indeed the same.
14.
Which of the following actions by a social worker is considered unethical?
(A) Receiving portion of the
treatment fees for the referral of a client to another social worker
(B) Informing the client of
fees in advance of services
(C) Engaging in private practice
while holding an agency employment
(D)Establishing rates for
professional services not commensurate with those of other professionals
15.
A social worker has been appointed to the board of directors of a
family counseling agency. All of the following are appropriate actions for
the social worker as a board member EXCEPT:
(A)Determining the performance
criteria for the agency director position
(B) Reviewing data about
utilization of agency services by clients
(C) Acting as a paid consultant
to agency staff who deliver direct services
(D) Serving as chair of a board
committee on service delivery
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16. A social worker who has a private
practice is interviewing candidates to fill an open bookkeeping position at her
practice. She realizes that one of the applicants for the job is a former
client. The social worker should:
A meet with the former client to find out whether he would feel
comfortable working for her
B treat the former client just like she treats the other applicants
and hire him if he is the best candidate for the job
C consider hiring the former client only if his therapy was
successful
D not hire the client
17. A social worker is working in
individual therapy with a 40-year-old client who is on probation and who was
ordered into therapy by the court. The client’s probation officer contacts the
social worker, asking for information about the client’s therapy. In this
situation, the social worker:
A can release information to the
probation officer if she has the client’s permission to do so
B can release information to the
probation officer without the client’s permission because the client’s
treatment is court ordered
C can release information to the
probation officer without the client’s permission because the client is on
probation
D does not need the client’s
permission to release information to the probation office, but should release
only limited information, such as about the client’s attendance in therapy and
anything he has disclosed to her about other crimes he committed in the past
18. The court has appointed a legal guardian for
an 8-year-old child after the child’s biological parents were found guilty of
chronic physical abuse. The legal guardian brings the child to a clinical
social worker for therapy. What should the social worker do?
A get the court’s permission before providing
treatment
B get permission from one
biological parent before providing treatment
C get permission from both biological parents
before providing treatment
D provide the treatment
19.
A social
worker who often treats couples in therapy receives a phone call from a man who
is seeking a therapist who can provide him and his partner with couples
therapy. In the course of the phone call, the man mentions that he’s gay. The
social worker knows that she’s uncomfortable working with gay clients because
of some personal biases. The social worker should:
A give the man some referrals to other therapists
B let
the man know that she’s not the best therapist for him because of her biases
C let
the man know about her biases and allow him to choose what to do
D see the man and his partner for therapy if the man chooses her,
because declining to see this couple would be unethical
20. A social worker has been
providing individual therapy to an 18 year old whose parents are paying for her
treatment. The client has not been getting along with her father, who treats
her “like a child.” During a session, the client tells the social worker that
she feels ready to confront her father about this. A few days later, the
client’s father calls the social worker. He is upset and asks the social worker
why she encouraged his daughter to confront him. The social worker should:
A validate the father’s
feelings and answer his question briefly, focusing on only the progress his
daughter is making in therapy
B validate the father’s
feelings and let him know that she and his daughter will discuss this event the
next time she comes in
C encourage the father
and his wife to come in for a family session
D tell the father that
she cannot talk with him about this
21.
A
hospital social worker learns that the husband of a hospital patient has been
eating food from other patients’ trays. The social worker should FIRST:
A provide the man
information about local soup kitchens
B give the man
meal tickets
C talk with the
man and his wife
D ask hospital
staff about the couple’s financial status
22.
A
social worker is on a managed-care panel. A client with a 10-session limit was
referred to the social worker. Without calling to cancel, the client does not
show up for one of her sessions. How should the social worker bill for the
missed session?
A
according to his office policy
B
using the CPT code for “no-shows”
C
have the client cover the copayment as well as the fee the insurance company
would usually pay
D
the social worker cannot bill either the client or insurance company
23.
Just
as a social worker is about to leave on a one-week vacation, he finds phone
messages from two clients. One is distraught because his wife walked out on him
the night before and the other is a sober alcoholic who is tempted to drink.
Both clients have asked to see the social worker that day. The social worker
should:
A
recognize that these are emergencies, see the clients that day, and start his
vacation tomorrow
B
call the clients and remind them that they should contact the on-call therapist
C
call the clients and schedule to see them on the day he returns from vacation
D
call the clients and assess their situations before deciding what to do
24.
A
social worker is providing couples therapy to a husband and wife who sought
help because they argue a lot. In an individual session, the wife discloses to
the social worker that she had an affair a year ago. She asks the social worker
to keep this information secret from her husband. The social worker should:
A
withhold the information from the husband because the wife revealed it during
an individual session
B
follow whatever policy regarding private information he discussed with the
couple at the beginning of treatment
C
tell the wife that he cannot keep this information from her husband because it
probably plays a significant role in their problems
D
tell the wife that he can’t withhold this information from her husband but that
he will help her practice disclosing it beforehand
25.
A
social worker’s new clients are a mother, father, and 7-year-old son. The
family has been referred to the social worker by their physician because they
were reluctant to accept medical treatment for their son. The parents confirm that
their son has a congenital heart condition that is growing worse. A few days
ago, the family was told that the boy needs heart surgery immediately or he
will die very soon. The parents tell the social worker that they decided this
morning to go against the doctor’s recommendation for surgery because it is
inconsistent with their religious beliefs. They believe that their son will be
healed without medical intervention and that invasive medical procedures are
unholy and would, therefore, endanger not only their son but also the whole
family. The social worker’s PRIORITY is to:
A
let the doctor know what they’ve decided
B
file a child abuse report
C
attempt to establish a working alliance with the family so that she can more
effectively encourage them to accept the medical treatment
D
respect the clients’ religious beliefs and provide support
26.
A Social worker is working with Ali, age 27.
Ali and his wife divorced three months ago and Ali sought help from the social
worker to cope with this. After the fourth session with Ali, the social worker
receives a call from Ali’s ex-wife. The ex-wife says she has information about
Ali, which she thinks the social worker should have, too. The social worker had
never spoken to the ex-wife before this call. The social worker’s BEST action
is to:
A
tell the woman that his impression is that she wants to maintain a relationship
with her ex-husband, and ask if she would like to talk about this with another
therapist
B
let the woman know that he will talk to Ali about this, and if Ali consents, he
(the social worker) will get back to her
C
explain to the woman that he is not allowed to discuss anything with her
D
invite the woman for a conjoint session so that she can reveal the information
with Ali present
27.
A
social worker discovers that a former client has filed a complaint against her
with the state board. When the board contacts her asking for her clinical
records on this client, the social worker should:
A
refuse to submit the records whether or not the client signs a release because
they contain confidential information
Bprovide
the records only if the client has signed a release
C
provide the records immediately
D.
provide only information related to the client’s complaint
28. A client, age 16, tells her social worker
that she plans to have an abortion, but doesn’t want her parents to know. The
social worker should:
A
maintain the client’s confidentiality
B
advise the client to tell her parents
C
notify the parents
D
schedule a family session
29. The best decisions regarding children and
custody or visitation are based on which of the following?
A
the family’s best interests
B
the children’s best interests
C
the parents’ and children’s best interests
D
the parents’ preferences
30. A
24-year-old client seeks therapy because she has been feeling anxious since
moving out of her parents’ home several months ago. The client’s managed care
company authorizes 15 sessions of outpatient psychotherapy for the client.
After meeting with the client six times and beginning to work with her on the
goal of managing her anxiety, the social worker learns some details about the
client’s personal history that the client had been unwilling to disclose
earlier in treatment. This information leads the social worker to determine
that the client needs more than 15 sessions of individual therapy. The social
worker attempts to get authorization for additional sessions from the client’s
managed care company, but his request is refused. The social worker should:
A
discuss alternative treatments with the client, such as psychiatric care or
group support
B
explain to the client what has happened and refer her to a low-fee community
mental health clinic
C
explain to the client what has happened and work with her on whatever goals can
be achieved in the remaining sessions
D
challenge the managed care company’s denial
31.
A
clinical social worker recently lost his wife in an accident. He is
experiencing difficulty sleeping and a loss of appetite, and finding it
difficult to focus on therapeutic issues during his sessions with clients.
Under these circumstances, which of the following BEST meets the guidelines for
ethical social work practice?
A
reduce his client caseload and make appropriate referrals
B
discontinue his clinical practice until grief issues are resolved and refer his
clients to another therapist
C
discuss practice concerns with a supervisor to jointly determine whether his
clinical practice should be temporally suspended or cut back
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D begin personal therapy to work on unresolved
grief issues and maintain his current caseload
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32. A social worker has been
treating a client who is angry at his wife for leaving him. He says it’s her
fault that their marriage failed and she gave up on them too easily. He tells
the social worker that he thinks about killing his wife and knows her
schedule well. She gets home from work late on some nights, he says, and it
would be easy to “surprise her in the driveway and slip away quickly.” The
social worker is surprised by the client’s statements because he has no
history of violent behavior. In this situation, the social worker is REQUIRED
to:
A. notify the police about the client’s threat
B contact emergency personnel to have the client hospitalized as
a danger to others
C maintain confidentiality because the client has no history of
violent behavior and attempt to defuse his anger
D provide crisis intervention and referral for a psychiatric
medication evaluation
33. Which
of the following BEST describes the main function of state licensing boards?
A establishing minimal standards of competence for social
work professionals in the state
B keeping unqualified social workers from practicing in the
state
C developing and administering licensing or certification exams
D enforcing ethical practice by social workers in the state
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34.
Phil
and Martin, social workers who work at the same agency, go to a local bar after
work one day. Phil ends up drinking too much and by the end of the night he is
obviously intoxicated. Martin notices that one of the agency’s clients is also
at the bar, and she has seen them from across the room – she has seen that Phil
is quite drunk. Martin should
A.
talk
briefly with the client to make sure she’s OK and then call a cab for Phil
B.
talk
briefly with the client to let her know her that Phil is OK and then drive Phil
home
C.
not
talk to the client at this time, call a cab for Phil, and then report his
unethical conduct the next day
D.
not
talk to the client to at this time; just drive Phil home
35. A 21-year-old client, whom you have been
seeing for three months, tells you that his last therapist initiated a sexual
relationship with him during treatment for his substance abuse problem. As an
ethical social worker, your BEST action is to:
A contact the area ethics committee to
report the alleged abuse
B direct the client to file charges
against the offending therapist
C introduce the client to all of the
options available to him
D explain the limits of confidentiality
to the client and then file a report with the police and/or an ethics committee
36. A social worker is asked to testify in a
court case involving the custody of a child he has been treating in play
therapy for many months. The social worker should:
A
decline
to testify
B testify only about objective facts
C
testify only if he can evaluate all involved parties
D go ahead and testify as requested
37.
In
his first session with a social worker, a client discloses that he has been
seeing another therapist for individual therapy for about three months. The
other therapist has been helping the client work through some “issues left over
from childhood.” The client says that he would like to see both the social
worker and the other therapist because he thinks this will allow him to reach
all of his goals more effectively. The social worker should:
A help the client clarify his needs and goals and then decide
whether it is appropriate for him to see both therapists
B.
discourage the client from seeing two therapists at the same time by explaining
the process of therapy to him
C see the man for therapy but make sure to
coordinate her services with the other therapist
D tell
the man that, for ethical reasons, she can’t see him for therapy while he is in
treatment with another therapist
38. A social worker is treating a
20-year-old man in individual therapy, who reports having intense anxiety in
social situations. The client reveals that he was sexually abused by his
grandfather for several years when he was in elementary school. When the client
now sees his grandfather at family gatherings, he becomes very anxious. He
feels panicky when he sees his grandfather playing with the young kids in the
family or hears that Grandpa has taken one of them to the park or the zoo. The
social worker should:
A explain to the client that she doesn’t have to file a child
abuse report because he is now an adult, but discuss other options with him
B.
explain to the client that she doesn’t have to file a child abuse report
because he is now an adult, but discuss other options with him
C file
a child abuse report on the grandfather
D
praise the client for disclosing this information and encourage and help him to
warn people in his family about the danger posed by the grandfather
39. The NASW Code of Ethics requires
you to take action through appropriate channels when you believe that a
colleague has acted unethically. What is the PRIMARY reason why the Code of
Ethics requires this?
A to protect the reputation of the social work profession
B to
advance the reputation of the social work profession
C to
protect clients and the public from harm
D to reinforce social workers’ awareness of
what constitutes unethical behavior
40. A local charitable organization
invites a social worker serve on its board. The social worker knows that one
his clients is active and long-time member of this board. The social worker
should:
A turn down the invitation
B accept the invitation only if the client is comfortable
serving on the board with him
C accept the position but make sure to discuss this situation
with the client before attending a board meeting
D tell the board members that he would be happy to join the
board after he has terminated treatment with the client
ANSWERS
1. The correct answer is B. The social worker might very well do all of
these with the client, but B should be FIRST because of the need to relieve the
client’s anxiety by acknowledging her right to self determination and to confidentiality.
2. The Correct Answer Is D
Option "D" is the only action among the answers that an ethical social worker would never do. If this was not clear to you, using process of elimination might have helped you choose the correct answer. We can begin by ruling out option "B," which is not prohibited, of course. However, you should refer the client if your negative feelings interfere with your therapeutic objectivity or effectiveness. Option "C" might sound right at first. However, if you think about it, there are situations where you would either have to or be allowed to breach a client's confidentiality; e.g., to file a child abuse report. Option "A" might sound right, too, but in an emergency; you might have to discuss a client's case with a colleague without first getting the client's permission to do so. In addition, if you will not be revealing the client's identity, you can seek consultation without getting his or her permission.
Option "D" is the only action among the answers that an ethical social worker would never do. If this was not clear to you, using process of elimination might have helped you choose the correct answer. We can begin by ruling out option "B," which is not prohibited, of course. However, you should refer the client if your negative feelings interfere with your therapeutic objectivity or effectiveness. Option "C" might sound right at first. However, if you think about it, there are situations where you would either have to or be allowed to breach a client's confidentiality; e.g., to file a child abuse report. Option "A" might sound right, too, but in an emergency; you might have to discuss a client's case with a colleague without first getting the client's permission to do so. In addition, if you will not be revealing the client's identity, you can seek consultation without getting his or her permission.
3.
The Correct Answer Is C
Mediation involves intervention into disputes between parties (e.g., divorcing spouses, landlords and tenants) to help them reconcile differences, find compromises, or reach satisfactory agreements. The mediator is a neutral and impartial third party”he or she does not seek an outcome for a particular client. Instead, a mediator is concerned that any agreement reached through the intervention is understood by and fair to each party. The mediator uses various tactics and encourages the parties to speak freely in order to facilitate voluntary agreement between the parties; the mediator can make recommendations or suggestions, but he or she has no formal power and cannot impose a solution or decision. If the parties cannot come to an agreement, then the mediator’s work is finished. When an impasse is reached and a more formal evaluation or recommendation is needed (e.g., when a court is seeking an evaluation or recommendation), this role must be filled by someone other than the mediator.
Mediation involves intervention into disputes between parties (e.g., divorcing spouses, landlords and tenants) to help them reconcile differences, find compromises, or reach satisfactory agreements. The mediator is a neutral and impartial third party”he or she does not seek an outcome for a particular client. Instead, a mediator is concerned that any agreement reached through the intervention is understood by and fair to each party. The mediator uses various tactics and encourages the parties to speak freely in order to facilitate voluntary agreement between the parties; the mediator can make recommendations or suggestions, but he or she has no formal power and cannot impose a solution or decision. If the parties cannot come to an agreement, then the mediator’s work is finished. When an impasse is reached and a more formal evaluation or recommendation is needed (e.g., when a court is seeking an evaluation or recommendation), this role must be filled by someone other than the mediator.
4. The
Correct Answer Is B.
You must know the court decisions that affect privilege. We can refuse to testify in federal Court in many cases.
You must know the court decisions that affect privilege. We can refuse to testify in federal Court in many cases.
5. The Correct Answer Is C.
While you might get to other issues later; you want to immediately clarify the professional nature of the relationship. Stay within boundaries, you do not need to explore client issues while she is still confused about the relationship or to divert treatment to other issues.
While you might get to other issues later; you want to immediately clarify the professional nature of the relationship. Stay within boundaries, you do not need to explore client issues while she is still confused about the relationship or to divert treatment to other issues.
6. The
Correct Answer Is B.
This is another excellent example of insurance fraud
This is another excellent example of insurance fraud
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7. The
Correct Answer Is A. According to Barker (“Social Work Dictionary,”
5th Edition, 2003), in social work and other professions, peer review refers
to “a formal periodic process in which professional standards of intervention
have been spelled out and practices are monitored by colleagues.” In other
words, peer review is a formal evaluation by a relevant peer group of a
professional’s specific actions or general competence. It is primarily used
for the purpose of quality assurance. For instance, peer review committees
are used to control abuse of third-party reimbursement by
unethical/incompetent practitioners; they often serve as an alternative to
the legal system for settling disputes between practitioners, consumers, and
third-party payers. Answer Is B: Peer review may be used to settle disputes
between consumers, practitioners, and third party payers; however, this
answer is too narrow. Answer C: This describes the primary purpose of quality
assurance: Quality assurance is used to verify that services and programs are
effective, efficient, and available. It involves comparing services rendered
to the accepted standards of quality in the professional field. Answer D:
Peer review is a formal process.
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8. The Correct Answer Is C. The correct answer balances three relevant
issues. First, although this situation is not addressed explicitly in the NASW
Code of Ethics, the “spirit” of the code clearly indicates that confidential
information should be treated with care. Second, when a client’s therapy fee is
being paid by an insurance company, it’s likely that the client has signed a
waiver on her insurance form. Third, therapists are expected to cooperate with
peer reviews. “C” best incorporates these three issues: The social worker would
be required to provide information to the insurance company as requested, but
should release only relevant information and take steps to ensure that the
client’s confidentiality will be safeguarded as much as possible.
9. The
Correct Answer Is B. “Vicarious liability” refers to a social
worker’s liability when he or she is responsible for the services delivered to
clients by a supervisee or employee. A social worker would be “vicariously
liable” for a supervisee’s or employee’s services whenever there is a
significant discrepancy between his or her training and experience and those of
the supervisee or employee. In such cases, the social worker with greater
training and experience (e.g., a supervisor) is presumed to have some degree of
control over the client services provided by his or her supervisees or
employees and, therefore, is ethically and legally responsible (liable) for
those services.
10. The
Correct Answer Is “D” - Seek supervision and/or consultation regarding
transferring Dave’s case to another worker. Refusing to consider Dave’s request
because the social worker thinks the request is an attention-seeking gesture
(answer “A") is not correct because a social worker cannot ethically take
that kind of action. Continuing to work with Dave (answer “C”), petitioning the
court (answer “B”), or transferring the case all might be options, but the
social worker should seek supervision and/or consultation in order to make a
correct decision.
11. The Correct Answer Is
D. This is a boundaries question. This covered in the NASW code of
ethics, section 1.13, “payment of services” That section states that “Social
Workers should avoid accepting goods or services from clients as payment for
professional services. Bartering arrangements, particularly involving services,
create the potential for conflicts of interest, exploitation, and inappropriate
boundaries in social workers’ relationships with clients”.
12. The Correct Answer Is C. The social worker
must always use judgment in accordance with social work principles and ethics
to make decisions of this kind. Managed Care are entitled to a diagnosis for a
clients before making benefit decisions, but other details may need to be
withheld for the good of the client, regardless of what the benefits policy may
say. A decision such as this should be reviewed with the client, and the social
worker should be prepared to support the client in any choice that is made.
13.
The Correct Answer Is B.
Although there are laws that protect the confidential relationship between clients and therapists, legal protection of information revealed in therapy is primarily offered through laws governing privileged communication. Privilege is asserted in legal (court) situations, such as divorce proceedings, criminal trials, etc. Only laws establish privilege. Confidentiality, on the other hand, is an ethical obligation and must be provided to all clients and research participants. Privilege is usually held by the client, and never by the therapist.
Although there are laws that protect the confidential relationship between clients and therapists, legal protection of information revealed in therapy is primarily offered through laws governing privileged communication. Privilege is asserted in legal (court) situations, such as divorce proceedings, criminal trials, etc. Only laws establish privilege. Confidentiality, on the other hand, is an ethical obligation and must be provided to all clients and research participants. Privilege is usually held by the client, and never by the therapist.
14.
The Correct Answer Is A. The NASW Code of Ethics, section 2.05, “Consultation”
second listing under (c) says “Social workers are prohibited from giving or
receiving payment for a referral when no professional service is provided by
the referring social worker.”
15.
The answer is C. All of the other options except the C are activities that
would be normal for a board member. It would be a clear conflict of interest to
act as a paid consultant to agency staff, because it would create a boundaries
issue. The board member would presumably have an employee relationship of sorts
to the agency head, someone that as a board member he oversees and might help
to evaluate for promotions or raises.
16. Answer “d” is most consistent with NASW’s Code of Ethics,
which states that social workers should not engage in dual or multiple
relationships with clients or former clients in which there is a risk of
exploitation or potential harm to the client. A dual or multiple relationship
occurs when a social worker relates in more than one relationship with a client
either simultaneously or sequentially and whether professional, social, or
business – e.g., in this situation, the social worker would be the man’s
therapist and then his employer. Any dual relationship presents a risk that the
current or former client will be exploited, in part, because of the power
differential that is an inherent part of a therapeutic relationship. In this
case, we don’t know exactly how much risk is present, but whenever a situation,
such as a dual relationship, could pose a risk to a current or former client, a
social worker should err on the side of caution. Therefore, this social worker
should not hire her former client.
17. A The fact that a court has ordered a client to get
treatment does not do away with the client’s right to confidentiality. The
social worker must have a release of information signed by the client before
she shares confidential information with the probation officer or anyone else.
The same is true when client ordered to receive therapy is on parole. What
usually happens when a client is ordered by the court to receive therapy is
that the court requires the client to attend a certain number of therapy
sessions as a condition of his probation, parole, or sentence; determines what
information the therapist will not keep confidential; and requires the client
to sign a release of information that allows his therapist to inform the court
about whether he complies with the court’s mandate. If the client refuses to
comply with a court’s request that he sign a release of information, he may be
held in contempt of court. Note, too, that even when your services are court
ordered or otherwise mandated, you must still inform the client at the
beginning of treatment about the nature of the services you will provide,
including whether they are mandated and all limits to confidentiality. Answer
“d” is also wrong for another reason: A client’s confession to a crime that he
committed in the past is privileged information and a social worker has an
ethical duty to keep that information confidential, unless the crime was a form
of child abuse or (in many states) elder or dependent adult abuse. The same is
true if a client discloses information about a crime that he intends to commit
in the future, unless the crime meets the standards of a “Tarasoff/duty to
warn” situation.
18.D In most cases, the
biological parents are a minor child’s legal guardians and at least one of the
biological parents must give consent for the child to receive treatment. In
this case, however, the court has appointed the child a legal guardian. A
minor’s legal guardian (i.e., legal representative) has a right to request
treatment for the child, and approval from the court or the child’s biological
parent or parents is not necessary
19.A As suggested by answer “d, ethical social workers do not
discriminate against clients or potential clients. On the other hand, ethical
social workers also recognize when they lack objectivity and may not be
qualified to provide effective therapy as a result. This social worker’s biases
are likely to prevent her from serving these clients’ needs and interests, and
therefore, providing referrals is the best answer offered. Rule out “b” and “c”
because the social worker’s disclosing her negative biases to this man would
serve no purpose and would be inappropriate.
20.D
It was important to note this client’s age – 18. In
addition, the question provides no information about what arrangements the
social worker has made with the client and her parents regarding sharing
confidential information (we don’t know whether the social worker has a release
from the client allowing her speak with the parents). Therefore, “d” is
correct. What may have misled you in this case, however, is that the client’s
parents are paying for her therapy. Parents or others paying for an adult
client’s treatment do sometimes assume that they have a right to be given
confidential information about the client, but this is not true. A social
worker should make information available to the people paying for a client’s
therapy only at the client’s request or when the client has consented to have
the information released at the request of another person, and only when
disclosing the information is in the client’s best interests. At the beginning
of therapy, a social worker should clarify with all involved persons (in this
case, the client and her parents) the conditions surrounding the release of
confidential information.
21. C If we assume that the man is taking food because he can’t
afford to buy any, then answers “a” and “b” might eliminate the problem;
however, we don’t know why the man is taking food. Therefore, the best approach
is to explore the situation further, and the best way to do this would be to
speak with the man and his wife directly.
22. A The best answer is that the social worker should bill
according to his office policy (which, we assume he explained to the client at
the beginning of treatment). The social worker is not required to have the
client cover the copayment and the fee the insurance company would usually pay
(“c”) (i.e., this may or may not be his policy); nor is he prohibited from
charging the client something for the missed session (which “d” suggests).
Option “d” is partly correct, however: It is true that the social worker cannot
bill the insurance company, since a social worker should only bill insurance
for services that he actually provides. Regarding “b,” Current Procedural
Terminology (CPT) codes do not provide a code for no-shows.
23. D The best choice is to call the clients to assess their
situations. Standard 5 of NASW’s Standards for the Practice of Clinical Social
Work says “... when the social worker is unavailable because of vacation ... he
or she should make arrangements for coverage by competent peers.” It sounds as
though this statement would make answer “b” correct; however, because these
clients may be in crisis, it would not be appropriate to merely remind them to
phone the on-call therapist. Choice “a” is unnecessary before first phoning
these clients to assess their needs — i.e., it may turn out that seeing the
on-call therapist would meet their needs. Option “c” is not appropriate: The
social worker should call the clients, but he should not automatically put them
off like this because their needs sound as though they may be quite urgent.
24. B This question is difficult if your own policy is to either keep
“secrets” or not keep “secrets.” If you have a policy that you generally
follow, then you might be tempted to choose one of the incorrect answers. The
issue underlying this question, however, is that different therapists handle
“secrets” in different ways and that there are several ethical ways of handling
secrets. Therefore, you should not attempt to apply your own (or your agency’s)
policy when answering this question. As this question illustrates, the ethical
responsibility to maintain confidentiality is more complicated when working
with multiple clients. In couples or family therapy, for example, a therapist
may be told a “secret” if he willing to see one of the clients in individual
sessions (as happened in this case) or if he speaks to one of the clients over
the phone. To minimize problems stemming from “secrets,” a social worker should
clearly explain to the clients at the beginning of therapy his own policy (and,
as relevant, his employer’s or agency’s policy) with regard to either keeping
or sharing “secrets” and then should follow this policy if one of the clients
reveals a “secret” to him. Some therapists view each person in couples or
family therapy as an individual client and never or rarely reveal “secrets”;
others discourage clients from sharing information on an individual basis and
refuse to keep “secrets”; and others adopt an approach that falls somewhere in
between (e.g., they decide that confidentiality will not be maintained between
the clients unless a client explicitly asks that something be kept
confidential). According to Corey, Corey, and Callahan, the best policy is to
let clients know at the start of therapy that information disclosed in private
sessions “will be divulged as ... [social workers] see fit in accordance with
the greatest benefit for the couple or the family” (1988, p. 307). Finally, the
correct answer to this question is also consistent with Ethical Standard
1.06(d) of NASW’s Code of Ethics, which states, “When social workers provide
services to two or more people who have a relationship with each other (for
example, couples, family members), social workers should clarify with all
parties which individuals will be considered clients and the nature of social
workers’ professional obligations to the various individuals who are receiving
services.”
25.
B A social worker must consider relevant
cultural/religious differences when evaluating whether her clients’ behavior
constitutes child abuse or neglect. Due to the severity of this boy’s medical
condition, however, his parents’ unwillingness to follow the doctor’s urgent
treatment recommendation would be considered a form child endangerment, or
neglect of his medical needs.
26. C Options “a,” “b,” and “d” are incorrect because each would
entail breaching Ali’s confidentiality. The social worker must keep not only
the content of therapy confidential, but also the fact that a therapeutic
relationship exists (i.e., the fact that someone either is or is not his
client). Even though option “a” is not an explicit violation of Ali’s
confidentiality, since it does not actually verify that Ali is the social
worker’s client, making this suggestion could very well imply to the caller
that he is. Option “c” is a far better thing to do: The social worker should
not acknowledge to the caller that Ali is (or is not) his client and must
refuse to discuss anything at all with her.
27. B Answer “c” is correct, in that the social worker will need
to provide the records: NASW’s Standards for the Practice of Clinical Social
Work say that social workers must “cooperate fully and in a timely fashion with
the adjudication procedures of the Committee of Inquiry, peer review, and
appropriate state boards.” However, “b” is a better answer than “c” because the
social worker shouldn’t provide any confidential information to the board until
she knows that the client has signed a release. A client’s complaint to a
licensing board (or to any other professional association) does not, in and of
itself, give a social worker the right to reveal confidential information; the
client also has to have signed a release. Additionally, this social worker
should hire an attorney to help her handle her response to this complaint.
Answer “d” is incorrect not only because it doesn’t say anything about having a
release from the client, but also because the board has asked the social worker
for her “clinical records” on this client. The social worker, therefore, needs
to submit the full records, not just what she thinks relates to the client’s
complaint.
28. The social worker should maintain the client’s
confidentiality. Privilege laws applying to adolescents (minors) vary from
state to state, so the correct answer is the one that doesn’t violate NASW’s
Code of Ethics or its Standards for the Practice of Social Work with Adolescents.
The latter state that social workers “shall maintain confidentiality in their
relationship with youths and of the information obtained within that
relationship.” The only blanket exceptions to this requirement listed in these
standards are child abuse and neglect reporting and situations in which it is
necessary to disclose information in order to avert danger to the adolescent or
others. The social worker can discuss with the client her decision to withhold
this information from her parents, as “b” suggests, but an ethical social
worker would not take a side on this issue. Rather than advising the client to
tell her parents, the social worker would help the client clarify her own
thoughts and feelings about this matter. Attempting to schedule a family
session (“d”) is probably a good idea, but the social worker is not required to
do this. Because question asks what the social worker “should” do, “a” is a
better choice. Note, however, that many states have laws that require at least
one parent to be involved in the abortion decision of a minor; therefore, one
of the girl’s parents may have to be involved if the girl does have an
abortion. (You should be familiar with the laws in effect in the state where
you work, but because the social work exam a national exam, it will not test
your knowledge of state-specific laws.)
29. B In child custody and visitation decisions, the guiding
standard is always the best interests of the child.
30. D The key issue
underlying this question is that a social worker’s ethical duty to a client
overrides the limitations imposed on him by a client’s managed care plan (or
any other insurance coverage). In this case, the social worker has seen this
client six times, apparently has a therapeutic relationship with her, and has
determined that she needs more therapy than her managed care plan will pay for.
The managed care company’s decision is affecting the quantity and quality of
care the social worker can provide this client – it is preventing him from
providing treatment that matches the standard of care he would normally provide
a client. When this happens, a social worker should advocate on behalf of his
client by initiating an appeal in which he challenges the managed care
company’s decision. In making the appeal, the social worker should argue for
the provision of care that he believes the client needs – i.e., for treatment
that matches the standard of care he would normally provide a client. This
includes (with appropriate permission from the client) providing the managed
care company with support for his position, such as therapy and progress notes,
test results, confirming opinions of other professionals, etc. Additionally,
the social worker should carefully document every step of the appeal process,
including all of his contacts with the managed care company. The incorrect
answers don’t mention the social worker’s obligation to advocate on behalf of
this client by filing an appeal; they all suggest that the social worker would
simply accept the managed care company’s decision, which would not be
appropriate. Another problem with answers “a” and “c” is that recommending
alternative treatments or simply working toward whatever goals can be achieved
in 15 sessions implies that the social worker would not be providing this
client with treatment that meets the standard of care he would normally provide
for a client – i.e., it suggests that the social worker would alter the
treatment goals or plan or even recommend a less effective form of treatment
simply because the managed care company has denied his request for additional
sessions of psychotherapy. And another problem with “b” is that the question
suggests that the social worker and client have a therapeutic alliance (they
have met six times and the client recently disclosed information she was
unwilling to disclose earlier): After treatment is underway and a therapeutic
relationship has been established, a social worker should be very careful about
referring a client to a lower-cost provider because doing so may constitute
abandonment. While the appeal is underway, the social worker should instead
attempt to continue treatment with this client at a lower cost or reduce the
frequency of sessions, depending on the client’s preferences and needs.
(Additional information: You should discuss all potential limitations imposed
by a client’s managed care company in the first treatment session, not after a
request for additional sessions has been denied. The first treatment session
should also include a discussion of what steps will be taken if the managed
care company denies the client needed services.)
31. C In this question, your focus should be on the fact that the
social worker is having difficultly concentrating during therapy sessions. This
is fairly serious, but not necessarily harmful to his clients. Therefore, the
social worker’s ethical obligation is to seek professional guidance to
determine whether he should maintain or, instead, reduce or discontinue his
caseload until he has formally resolved his personal areas of concern. Response
“a” or “b” would be appropriate if a greater degree of impairment or
dysfunction were involved, such as if a social worker is using alcohol during
work hours (or one of these steps may be recommended by his supervisor when
they meet). Option “d” is not appropriate: Although seeking therapy may help
the social worker, concluding that he should maintain his current caseload
fails to consider how he might need to protect his clients while resolving his
grief.
32. Answer “a” is correct because the question asks what the
social worker is “required” to do. The other answers describe steps that may be
taken when a client is in crisis or appears generally dangerous. In this case,
however, the client has expressed to the social worker a serious threat of
physical violence against his wife – i.e., he says he thinks about killing her
and he seems to have developed a plan for how he would do so. According to the
Tarasoff ruling, when a client makes a serious threat to physically harm an
identifiable person, a therapist has a duty to notify the police and to attempt
to warn the intended victim. This ruling applies in California and in other
states with similar laws. In states without a similar law, the “duty to warn”
applies as a general principle, and many legal experts have recommend that
therapists follow this principle.
33. Answer “a” describes the “main” function of state licensing
boards. Options “b” and “c” are done as well, when a licensing board
establishes minimal standards of competence for professionals in the state
(though licensing boards do not necessarily “develop” exams), but “a” is a more
complete and precise answer to this question. Answer “d” (enforcing ethical
practice) is accomplished primarily by the NASW.
34. D This question presents a few different issues: First, the
client has seen the social workers, but she hasn’t approached them in any way
that we know of. Therefore, Martin should not talk to her at the bar. If he
did, he might reveal to other people that she is receiving services from the
agency. This rules out answers “a” and “b”. (Note, too, that in discussing
chance encounters with clients in public places, Knapp and VandeCreek [2003]
recommend a “you first” policy that allows the client to decide if she will
acknowledge her therapist in a public place.) Next, “c” can be ruled out
because drinking too much one night at bar is not “unethical”; moreover, if
this were unethical conduct, Martin would probably talk it over with Phil
first, before “reporting” the behavior to anyone. Last, as all four answers
suggest, Martin should prevent Phil from driving while drunk, and this can be
done by either driving him or calling a cab. All of this indicates that “d” is
the correct answer. Note that it would also be important to address this event
later with the client – e.g., during her next meeting at the agency – and with
Phil
35. NASW’s Code of Ethics requires social workers to take action
against unethical conduct by their colleagues. An overriding principle,
however, is that social workers must also (with a few exceptions) maintain the
confidentiality of their clients. Therefore, the correct answer in this
situation is to introduce the client to all of the options available to him, so
that he can make an informed decision about how to proceed with the matter.
This may include deciding to allow you to break his confidentiality so that a
report can be filed with an ethics committee.
36. A Because this social worker has an established therapeutic
relationship with the child, it is in the child’s best interests for him to
refrain from testifying. The social worker’s role in this situation instead
should be to provide the child with support during the custody battle. (See,
e.g., W. Bernat, The therapist’s role in child custody disputes, “Journal of
the American Academy of Child Psychiatry,” 22, 180-183, 1983). Answer “c” would
describe the best response if the social worker did not have a relationship
with one of the involved parties or had a past (rather than present)
relationship with an involved party.
37. A A social worker is not prohibited by the Code of Ethics from
seeing a client who is receiving services from another mental health
professional (which rules out “d”), but the social worker does need to avoid
duplicating the services of another professional for an extended period of
time. Therefore, ethically and clinically, it would be best for this social
worker to help the man clarify his goals and needs with respect to the services
she might provide and the services provided by other therapist; she can then
use this information to decide what would be in this client’s best interests.
And, if the social worker did end up treating this man, then she would seek his
permission to contact the other therapist so that they could work toward congruent
goals and avoid duplicating their services (as “c” suggests).
38. C Whenever an adult client (this client is 20) discloses
childhood abuse, a social worker must be alert to the possibility that the
client’s abuser is now abusing other minors. As “b” suggests, this may require
the social worker to solicit the client’s help in collecting information. In
this case, however, the social worker has enough information already to
determine that she should file a child abuse report, as answer “c” says: The fact
that the grandfather currently has contact with and access to children
(including during solo outings) is sufficient for a reasonable suspicion of
current child abuse. If the social worker had doubts about whether to file a
report, she could call CPS anonymously for guidance, but we’re not offered an
answer that says that. Answer “a” is correct in stating that, because the
client is no longer a minor, the social worker doesn’t have to file a child
abuse report about the abuse he experienced as a child. However, as noted
above, answer “a” is not sufficient because the social worker (and you, as a
test-taker) should recognize that the client’s information about the family
gatherings and about the grandfather’s solo outings with children give rise to
a fairly strong possibility that the grandfather is currently abusing other
kids. In addition to reporting this current abuse, however, the social worker
may also review “other options” with the client, as “a” suggests, such as the
options of filing assault charges or initiating civil action for damages. Some
clients benefit therapeutically from taking control of their experience by
confronting it in one these ways. During this discussion, it is important to
talk with the client about the potential negative consequences of taking legal
action and to allow him to make a decision about what he wants to do without
any pressure.
39. C The “primary” reason why social workers are required to take
action to address the unethical conduct of their colleagues is to protect clients
and the public from unethical social workers – from the harm that can result
from their unethical conduct. When you suspect a colleague of behaving
unethically, NASW’s Code of Ethics allows you to use your discretion in
determining the best course of action, however: You can either try to resolve
the violation informally or use more formal means, such as contacting an ethics
committee, depending on which action you think would be most appropriate. For
instance, you would to try to resolve the problem by discussing it with your
colleague when doing so is feasible and when you believe that this discussion
is likely to be productive. Otherwise, you should take action through formal
channels – e.g., contact a state licensing board or regulatory body, an NASW
committee on inquiry, or other professional ethics committee. Whatever action
you take, however, you must also consider and protect the confidentiality
rights of any client affected by your colleague’s ethical violation.
40. A Option “a” is the
only plausible answer. If the social worker joined this board, he would relate
to this client in two different relationships, which is the definition of a
“dual relationship.” The Code of Ethics prohibits social workers from engaging
in dual relationships with clients or former clients when there is a risk of
exploitation or potential harm to the client. Rule out answer “b” because the
social worker should not make the client responsible for making this ethical
decision. And rule out “d” because telling the board members this would violate
his client’s confidentiality
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