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Ethical Exceptions for Social Workers in Light of the COVID-19 Pandemic and Physical Distancing

Ethical Exceptions for Social Workers in Light of the COVID-19 Pandemic and Physical Distancing

by Allan Barsky, PhD, JD, MSW

                As the saying goes, “Extraordinary times call for extraordinary measures.” In light of the COVID-19 pandemic, we are certainly in extraordinary times. As social workers, we are facing a myriad of challenges. Many of us are working in organizations that have temporarily closed or are replacing in-person meetings with clients to telephone and digital communication. Some of us are in working organizations that are being overwhelmed with client concerns, ranging from anxiety about the pandemic, to unemployment and financial concerns, to difficulties with access to COVID-19 testing and healthcare services for themselves and their loved ones. All of us are working in environments of uncertainty, stress, and yes, also opportunities — opportunities to promote health, well-being, social justice, empowerment, and a stronger sense of community.

     Social workers possess many important methods and skills to help clients and communities to cope and thrive in times of crisis and transition. We can provide moral and instrumental support, access to services, advocacy to address client needs, therapy to help clients deal with anxiety and trauma, community organization, and a myriad of other methods of helping. But what are our ethical obligations when we are not able to provide services in our usual ways, particularly, the ways that are authorized by our codes of ethics, agency policies, and regulatory laws? Under what circumstances, if any, is it ethical for social workers to breach particular ethical standards, agency policies, or regulatory laws? And if we do breach any of these guidelines, what can we do to minimize the risk of harm to our clients, ourselves, and our practice settings?

ethical-exceptions-social-workers-in-light-of-covid-19-pandemic-physical-distancing

COVID-19: the struggle, success and expansion of social work

IFSW Secretary-General, Rory Truell provides an overview of the first 5 months of the Social Work Response to COVID-19. He says there are clear phases highlighting social workers’ struggles and outcomes:

1. Making governments recognise that a social response is imperative;

2. Advocating for social services to remain open during lockdown;

3. Adapting social services to a new world & managing ethical dilemmas, and

4. Integrating transformative practice.

Dr Truell comments, “What has become clear is that this transformative process, though far from painless, has seen a new rising of the profession”.

Download pdf https://www.ifsw.org/wp-content/uploads/2020/05/2020-05-18-COVID-19-the-struggle-success-and-expansion-of-social-work-1.pdf

Pandemic Principles: Responding to Anomie During Unprecedented Times

by Holly Dreger, LCSW

     In sociology, anomie is the term used to describe a social condition in which there is a disintegration of norms and high levels of uncertainty in a society. Durkheim identified this concept and noted that when things rapidly change in a society, often people may not know how to behave or respond. This raises levels of stress, frustration, anxiety, and confusion. It can even prompt feelings of powerlessness.

    Our current circumstances as we seek to gain homeostasis and balance during the COVID-19 pandemic is an in vivo experience of anomie. The routines of our daily lives have been disrupted, and in some cases, abandoned for something entirely different. Our sense of autonomy and ability to influence the outcome has also been restricted. Feelings of powerlessness have driven some to cope by hoarding supplies, buying up provisions in an effort to mitigate anxiety and fears about going without. We are a society that is waiting for the threat to pass.

    Experts in mental health are encouraging those who are physically distancing at home to keep a schedule, to step away from constant media consumption, to focus on “positives,” and to embrace the time this crisis has created. But living in a heightened state of arousal that is due to a pending threat can substantially tax the coping of any person, and social workers are highly susceptible to this stress overload.

    Many social workers are still at work, continuing to perform their duties during the pandemic. Social workers are called to step forward in service to their communities when the majority of other professions are instructed to step back. This places social workers directly in the midst of potential harm, at risk of contracting the COVID-19 virus. Social workers are also experiencing significant anomie because the “normal” way of doing business has been suspended.

    Many social workers are struggling to continue to serve their clients through technology such as telehealth. Many social workers are struggling with not being able to see their clients in their home, school, or office settings. As the anxiety elevates in our clients, social workers, too, are also feeling anxious, uncertain, and frustrated. Many social workers are new to the telehealth process, and many work for organizations that are rapidly rolling out new ways to engage our clients throughout the duration of the pandemic. We are struggling through the changes, too. We may be feeling less than competent, less helpful, and less effective.

    Social workers are feeling stressed. As colleagues, we are talking with one another, talking about our own feelings of anxiety and how we are handling it. We are discussing our frustration with how our agencies are rapidly changing how to move forward, what process to use, and when to use it. Sometimes, these updated protocols change multiple times throughout the day, raising stress levels and narrowing the emotional and cognitive bandwidth we each have. We find ourselves having to very quickly become knowledgeable and skilled with technology that we may not be very proficient with and feeling the pressure to get it done and get it done right. We may see our clients struggling with the technology, as well, many of whom do not either have access or they lack the skill set to properly navigate the digital world.

    As social workers, we are exhausted. One of my colleagues said, “I’m doing the best I can. I guess that’s all I can do.” This is a profoundly true statement, and this very acknowledgment produces substantial cognitive dissonance. As social workers, we strive for sustained excellence. During this time of rampant anomie, in the midst of helping our clients cope with their own fears and challenges, with new skill sets being demanded of us and new technology being thrust upon us to suddenly use, we can feel as if we are failing. FAILING. We can feel we are failing when we are “only doing our best.” As social workers, we want not just the best; we want excellence.

    So how do we sustain excellence during these uncertain times when the very foundation of what we are doing is shifting constantly?

    We can do this by challenging ourselves to redefine how we measure our excellence. We must change how we measure our job well done, and this must shift from doing the “best we can” to doing the “most we can do” to have a positive impact on the lives of those we serve. We cannot use the old measures right now, and perhaps we won’t fully return to those measures in the future. But we can provide the best possible care by responding to the needs not only of our clients, but of ourselves, as well.

    We must acknowledge that we are not going to get everything done each day, that we may need to triage the most important things and defer on those tasks that must wait. We need to ensure that we are acknowledging our feelings, our uncertainty, by taking a step back and labeling our feelings and thoughts, and must challenge ourselves to let them go instead of grappling with them like we are attempting to solve a Rubik’s Cube. We won’t be solving all of the problems, but we can facilitate healing with how we approach our clients and ourselves.

    We must also honor our limitations and prioritize rest. We tend to postpone the times of restoration for ourselves. It is essential that we shift our priorities and recognize that rest is sacred and healing. We need to be sure that we are reaching out to our own community, our own supports, so that we can continue to serve those who depend on us to lead them away from patterns of brokenness and illness.

    Football’s greatest coach, Vince Lombardi, once said, “After all the cheers have died down and the stadium is empty, after the headlines have been written, and after you are back in the quiet of your room and the championship ring has been placed on the dresser and after all the pomp and fanfare have faded, the enduring thing that is left is the dedication to doing with our lives the very best we can to make the world a better place in which to live.”

    We need to know it will all be okay. We have already won. We will rise and continue to make the world a better place to live.

Holly Dreger is a licensed clinical social worker who works full time with veterans. She has worked in the field of social work since 1998 in various capacities and treatment settings, both as a practitioner and as a field instructor mentoring new social workers. She has provided services in elder residential (nursing home), inpatient psychiatric, as an embedded mental health provider for the DOD, private practice, outpatient, and partial hospitalization. Dreger also worked as an adjunct instructor of psychology for Eastern Connecticut State University.https://www.socialworker.com/feature-articles/practice/pandemic-principles-anomie-unprecedented-times/

Exploring adolescent experiences and priorities under Covid-19

The study presents the findings from rapid virtual qualitative research. The presentation outlines :

  • Virtual research sample and methodology
  • Key findings on adolescents’ knowledge, attitudes and behaviours related to Covid-19, and risks of HTPs
  • Young people’s priorities and policy implications

Download PDF GAGE_Covid-19_rapid_assessment_findings_CPRF 

The Complexity of Behavior Change Within the Context of the Coronavirus

The Complexity of Behavior Change Within the Context of the Coronavirus

by Jeff Driskell, PhD, LICSW

     The unexpected and spontaneous arrival of the coronavirus crisis has had a dramatic impact on the health and well-being of individuals, families, and communities. Social workers are in a unique position to support those in crisis, as we are educated and trained to engage in brief interventions that foster health and wellness. Focusing on health and wellness is not new to the field of social work. The Centers for Disease Control and Prevention has established a set of guidelines that are deemed effective in preventing the acquisition and/or transmission of the COVID-19 virus.

    Among these guidelines is the practice of maintaining and keeping physical distance from others. This behavioral practice is known as physical distancing (aka social distancing). Maintaining physical distance sounds simple enough. Right? Well, quite the contrary.

    As we know with other health behaviors such as smoking and substance use, changing our behaviors and adopting healthier ones can be difficult. As an attempt to modify people’s behavior, local, state, and federal governments have implemented restrictions that support physical distancing. Some of these strategies include restricting dining establishments to take-out only, the closure of all non-essential businesses (such as barber shops and malls), encouraging avoidance of large gatherings, and the moving of schools and universities to an online virtual platform.

    The strategies put in place by local, state, and federal governments have been adopted by many individuals. Unfortunately, there are a number of people who are struggling to adhere to physical distancing protocol. Daily, the media share stories of physical distancing disobedience—for example, stories of college students celebrating spring break on the beaches of Florida, as well as images of adolescents playing basketball, which is a close contact sport.

    So why do some people adhere to and adopt the physical distancing protocol while others do not? You would assume that people would want to avoid contracting and/or spreading this potentially lethal virus. For years, the social sciences have been researching and studying factors that influence health behavior and behavior change. As a result, the social sciences have generated a wealth of knowledge that helps us to better understand individual health behavior and behavior change.

    Social workers and social work students specifically are no strangers to the concept of behavior change, as they are exposed to theories and models in their education and training. However, often lacking is the public health interdisciplinary perspective on behavior change.

    Public health professionals have been examining behavior in the context of prevention for several decades. As a result, we now have, more than ever, a better understanding of factors that influence health behavior and behavior change. Knowledge of these factors has led to the development and evolution of public health theories and models that help explain and predict why people change their behavior and why others do not.

    I will introduce three theories and models that relate to the coronavirus and physical distancing. They are the health belief model, theory of reasoned action, and social cognitive theory.  

Theories and Models

    Health Belief Model (HBM). The HBM is one of the most widely used models in helping to understand and predict behavior change. It has been used in a variety of health prevention programming, including HIV/AIDS prevention, seatbelt campaigns, and mammogram screening campaigns. The model focuses on understanding a person’s beliefs and attitudes (cognition) as they relate to the adoption of a health behavior.

    The specific constructs of the HBM include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy.

    Perceived susceptibility and severity together have been labeled as perceived threat. So how do these constructs relate to the coronavirus? Perceived susceptibility is linked to one’s belief around the chances of contracting the virus. Perceived severity is based on one’s belief of how serious the virus is along with the potential consequences of contracting it. Perceived benefits focuses on how one interprets the pros of adopting the new physical distancing behavior. Perceived barriers looks at the cons or the negative aspects of adopting the practice of physical distancing, which also includes the evaluation of both psychological and emotional costs. Self-efficacy addresses a person’s level of self-confidence in adopting and successfully implementing physical distancing.

    In a nutshell, for behavior change to occur and to be successful, people must see the coronavirus as a threat to their health, understand that adopting the new behavior (physical distancing) will result in positive outcomes/benefits, and feel confident in their ability to overcome any perceived barriers that may get in their way of taking action.

    Theory of Reasoned Action (TRA): As with the HBM, TRA has been used to explain and predict a variety of health-related behaviors, including the use of contraceptives, smoking/tobacco use, and substance use. This theory suggests that the biggest predictor of behavior change is the concept of intentions. Intention implies one’s readiness to engage in a specific health-related behavior.

    The theoretical concepts of TRA that feed and nourish intention include one’s attitude and subjective norms. A person’s attitude is based on the evaluation, both positive and negative, of the particular behavior in question. In relation to the coronavirus, a person may ask, “How important is it for me to practice physical distancing?” OR “Do I think physical distancing will really make a difference in keeping me safe from the virus?” Thus, if a person strongly believes that positive outcomes outweigh the negative, then they are more likely to have a positive attitude toward physical distancing.

    Subjective norms are linked to one’s peer/social network in terms of approving or disapproving of performing a specific behavior. For example, an individual’s level of motivation to practice physical distancing may be a result of whether it is valued or not by a peer/social group. If one’s peer/social group has a strongly held belief that practicing physical distancing is important to preserve one’s health from the coronavirus, it is more likely an individual will be motivated to adopt that behavior.

    Social media have been playing a role in trying to get those who are not practicing physical distancing to stay home. For example, many people are changing their Facebook profile pictures with a frame that reads “#StayHome.” This is an example of a subjective norm being promoted by one’s peer/social network, which in turn can have an impact on one’s intentions.

 In summary, for a person to adopt the practice of physical distancing, that person must have strong intentions to do so. The ingredients that strengthen these intentions are a person’s attitude toward the new behavior and the influence of subjective norms.

    Social Cognitive Theory (SCT): Elements of SCT are reflective of social work’s emphasis on the ecological perspective. Social cognitive theory proposes that behavior change is influenced by the reciprocal interaction between a person, the person’s environment, and their behavior. This theory contains approximately nine concepts. For the purposes of this article, I will highlight the three most relevant concepts, which will add to our understanding of behavior change. Please note that self-efficacy is a key concept of SCT, but it was addressed above under HBM. The concepts include observational learning, outcome expectancies, and emotional coping.

    Whether a person adopts a protective health behavior (e.g., physical distancing) is often influenced by observing others (observational learning) within a person’s peer/social network. For example, if a person continues to witness social media posts of their peer group practicing physical distancing by using alternative ways of socializing (e.g., use of Zoom for virtual game night or happy hour) and doing so with some success, they are more likely to adopt the new behavior.

    The concept of outcome expectancies assesses the worth and possible consequences of adopting a new health behavior. For example, media have highlighted that some who are not practicing physical distancing have expressed fears of becoming depressed or too isolated. In weighing the possible benefits and consequences of adopting physical distancing, some feel the emotional toll is too much of a burden, and as a result, the new behavior is not adopted.

    This leads to the final concept, which is emotional coping. If and when a person adopts physical distancing, does that person have the capacity and skills necessary for coping with the potential emotional impact? If a person lacks the ability to cope with the negative emotional state associated with physical distancing, they may reverse the practice and begin to disobey such practices, thus putting themselves and others at potential risk of acquiring and/or transmitting the virus.

Conclusion

    The COVID-19 crisis and its resulting implications have underscored the importance of understanding behavior and behavior change. We know that changing behavior is often a complex task. We have learned from this crisis that physical distancing is one such complex behavior that some struggle to adopt.

    As we continue to navigate this new reality, having an understanding of theories and models that influence behavior change will be critical for assessment, as well as for development and implementation of prevention efforts.

Jeff Driskell, PhD, LICSW, is a professor of social work at Salem State University in Salem, MA.https://www.socialworker.com/feature-articles/practice/complexity-behavior-change-coronavirus/

USAID/Ethiopia Virtual Implementing Partners Meeting

USG will (1) Save lives by improving countries’ and international partners’ ability to respond to the pandemic; (2) Reduce secondary impacts of the pandemic; and (3) Promote U.S. leadership and share U.S. expertise for global benefit.

“SAFER” Approach:

  • Scale up community approaches to slow the spread of COVID-19
  • Address critical needs of health care facilities (public and private, including faith-based), health care workers, and patient
  • Find, investigate, and respond to COVID-19 cases
  • Employ strategies to address second order impacts
  • Ready plans for deployment of therapeutics and vaccines Implementation:  Whole-of-government, with USAID and State leading and coordinating efforts

Download PDF:  USAID_Virtual_IP_Meeting_Slides_Public.pptx

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