An Exploratory Study Examining Instructional Decisions and Strategies and Ethics in Social Work Education

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Social workers make difficult decisions every day and must do so in keeping with professional ethical standards. This exploratory study examined the types of instructional strategies used to teach social work ethics and ethical decision-making along with the topics of ethics instruction. Using a mixed-methods approach, social work students, educators, and practitioners identified instructional strategies and ethics related topics addressed in social work education. Respondents identified lectures and analysis of ethical dilemmas as the top two instructional strategies. Common ethics related topics among all respondents included boundaries/dual relationships, confidentiality and privacy, as well as sexual relationships with clients. Likewise, respondents indicated confidence in their ability to identify and respond to ethics related issues in practice. Only a minority of respondents indicated that previous training or education was used as a resource to resolve ethical dilemmas. Topics related to social media, technology, and challenges dealing with employers and colleagues were lacking from ethics instruction. Ethics education should include a variety of proven instructional strategies to ensure social workers have the requisite skill and knowledge to resolve ethical dilemmas in practice. Moreover, the complexity of ethical issues and topics of instruction should reflect the nuances of contemporary practice. More research is needed to explore instructional strategies such as think aloud protocols to analyze how social workers resolve ethical dilemmas.

Professional social workers make critical decisions that have a significant impact on the lives of individuals and families. On any given day, social workers may have to determine whether sufficient evidence of abuse exists such that a child should be removed from the home or whether a teenager who posts a comment on Facebook about harming himself rises to the level of hospitalization. Often, there is not an obvious right or wrong answer to these problems. By definition, these types of problems are considered ill-structured, in that no single, correct solution can be arrived at but rather several possible solutions must be evaluated based on the context of their application (Jonassen, 1997).

Ill-structured problems closely resemble problems encountered in real life due to vague goals, unknown problem elements, and no clear path to the solution (Jonassen, 2011). As is often the case in social work practice, professionals encounter complex situations and must choose between several possible options without knowing the outcome of those choices. Therefore, it is imperative that social work students, and practitioners alike, are able to effectively resolve ill-structured problems and ethical dilemmas as these types of problems are present throughout their professional careers.

Empirical evidence for designing instruction that addresses ill-structured problems and ethical dilemmas exists on many levels. From models and frameworks to specific instructional strategies, the literature provides numerous, proven options for educators to use when teaching ethics and ethical decision-making. However, practice settings are changing and technology is evolving, which presents new ethical challenges for social workers. Ethics instruction should be designed to address these novel situations and provide social workers with the tools needed to resolve these complex dilemmas. This study adds to the emerging literature base regarding instructional strategies and topics currently being used to teach ethics and ethical decision making.

Literature Review

Empirical research in social work focuses primarily on intervention strategies for working with individuals, families, and communities, rather than instructional strategies. Moreover, social work scholars have only recently begun conducting research related to ethics and ethical decision-making. Thus, the convergence of research related to ethical decision-making and instructional strategies in the social work literature is growing, but limited. This exploratory study was conducted to identify the types of instructional strategies currently being used to teach social work ethics and ethical decision-making, along with the specific topics of instruction in social work ethics education.

Instructional Strategies Used to Teach Ethical Decision Making

Vignettes or case studies are the most common activities used to reinforce ethical thinking and behavior. Ringel and Mishna (2007) used vignettes focused on giving and receiving gifts, relationships with clients during treatment, and contact with clients after terminating services to review ethical guidelines in a classroom environment. Fossen et al. (2014) used case examples from various settings such as a domestic violence shelter, child protective services investigation, and a community mental health center to illustrate the steps in the ethical decision-making process. Continuing education providers in medical social work used case studies to illustrate ethical concepts, such as patient autonomy and capacity, and to stimulate discussion among training participants (McCormick et al., 2014). Dodd and Jansson (2004) used case examples from a hospital setting as a teaching tool to highlight the need for ensuring that patient and client needs are represented in ethical deliberations.

While case vignettes are often used when teaching social work ethics, very few experimental studies in social work have explored the effectiveness of this approach. One such study used case vignettes to evaluate child protection social workers’ decision-making process (Stokes & Schmidt, 2012). The researchers concluded that while risk assessment tools can inform decision-making, social workers also relied on relationships and experience during the decision-making process (Stokes & Schmidt, 2012).

By far, the primary emphasis in the social work literature related to teaching social work ethics or ethical decision-making focuses on conceptual or theoretical models along with examples of ethical situations. Some authors have proposed ethical decision-making models with catchy acronyms such as ETHIC which stands for Examine, Think, Hypothesize, Identify, and Consult (Congress, 2000) and ETHICS-A which adds Select/ Support and Advocate to the ETHIC model (Fossen et al., 2014) as a way to reinforce core ethical decision-making concepts and scaffold learning activities. Still others have proposed conceptual frameworks for teaching ethical behavior and decision-making such as the Top 5 Ethical Lessons approach (Castro-Atwater & Hohnbaum, 2015), the application of a common morality focusing on what one should not do (Bryan, 2006), and an ethical genogram that explores family of origin issues that impact ethical decision-making (Peluso, 2003).

A variety of instructional approaches can be found in the literature regarding the design and sequencing of ethics education. For example, Fossen et al. (2014) taught ethical decision-making to undergraduate social work students by infusing readings, short lectures, small group case studies, and discussions throughout the curriculum. Conversely, Edwards and Addae (2015) developed a stand-alone, web-based elective course on rural social work practice for undergraduate students that included ethical scenarios and the application of ethical standards using an ethical decision-making model. Similarly, Gray and Gibbons (2007) developed a five-week learning unit on ethical decision-making, with an emphasis on values and ethics, rather than frameworks for logical decision-making. Boland-Prom and Anderson (2005) approached teaching ethical decision-making by using dual relationship principles to evaluate complex ethical situations and apply the National Association of Social Workers (NASW) Code of Ethics. Osmo and Landau (2001) asserted that teaching students the value of explicit argumentation in ethical decision-making would better prepare students to justify ethical decisions in practice. More recently, Groessl (2015) conceptualized a social work course that used problem based learning, reflective thinking, and the application of the ETHIC model to teach ethics in a master’s level social work program.

Ethics topics in social work education and practice

Several exploratory studies have been conducted to identify the types of ethical issues encountered in social work practice and how those issues were resolved. Dodd (2007) distributed a survey at a Council on Social Work Education (CSWE) accredited Master of Social Work (MSW) program to examine the ethical issues students experience in their field placements. The results were examined using the NASW Code of Ethics as a frame of reference, categorizing the identified ethical issues by ethical construct (such as beneficence or autonomy) and by context (such as setting or relationship). The study yielded interesting information about the variety of ethical issues students experience in field placements, including confidentiality, reporting incompetence, and client self-determination. The author noted that more research was needed to test ethics teaching strategies so that students are prepared for ethical practice in field placements and throughout their careers.

Gough and Spencer (2014) conducted a similar exploratory study designed to examine ethical situations experienced by social workers in Canada. The survey also investigated conflicts with personal values, the use of ethical standards to address conflicts, and the decision-making processes used to resolve dilemmas. The results of the study provided valuable information regarding how social work practitioners resolved ethical issues in practice. A vast majority of respondents used a non-formal approach, such as a caring attitude, intuition, or consultation, to resolve the ethical issue. The authors suggested that acknowledging personal beliefs and values was critical to resolving ethical issues and there was a need for continuing education to improve the ethical decision-making processes.

Reamer (2012) argued that ethics education should include specific topics such as client rights, confidentiality and privacy, informed consent, service delivery, conflicts of interest, documentation, defamation of character, supervision, referrals, fraud, practitioner impairment, and termination of services. Similarly, Pawlukewicz and Ondrus (2013) explored six common ethical topics including gifts/solicitation, boundaries/dual relationships, safety, client rights/confidentiality, self- awareness, and duty to warn using a survey containing 25 ethical scenarios.

As a profession, social work educators and continuing education professionals are eager to identify the most effective techniques to teach ethics and ethical decision-making while attending to relevant issues that social workers confront in practice settings. Ongoing research is needed to ensure social workers are prepared to address current ethical challenges in practice settings. Likewise, more research is needed to explore effective instructional strategies for teaching ethics content and ethical decision-making. Instructional strategies should be consistent with best practices and topics of ethics instruction should be relevant to all types of social work practice in the 21st century.

Purpose of the Study

Given the strong emphasis on ethics education by CSWE during social work professional education and continued education requirements for licensure post-MSW, it is critical that students and practitioners are adequately prepared to address the complex ethical issues presented in professional social work practice. The purpose of this exploratory study was to gain a better understanding of the instructional strategies used to teach social work ethics and the topics of ethics instruction currently being used in social work education and professional development.

The following research questions guided this study:

  1. What types of instructional strategies are being used to teach social work ethics?
  2. What types of ethics related topics are being addressed in social work education and professional development?

Methods

Research Design

This exploratory study utilized a mixed-methods approach for investigating the research questions. An online survey solicited quantitative data related to instructional strategies and ethics topics in social work education. Semi-structured interviews, with a small sub-group of respondents, were used to collect qualitative data to explore innovative instructional strategies and unique ethical dilemmas encountered in social work practice settings.

Participants

Participants in this exploratory study were primarily social work students, educators, and practitioners in North Carolina (n = 112). Participants included social work students (29.4%), social work educators (19.6%), and social work practitioners (51%). As a group, respondents were predominantly female (87.2%), white (84.4%) and between 36-45 years old (31.8%). Most respondents had a MSW degree (70%) and almost 73% of respondents were working in the social work field (see Table 1).

Table 1

Participant Demographics

Demographic n %
Gender    
Male 11 10.0
Female 96 87.2
Transgender 1 0.9
Cis-Female 2 1.8
Affiliation with social work profession    
Student 30 29.4
Educator 20 19.6
Practitioner 52 51.0
Age range    
18-25 12 10.9
26-35 16 14.5
36-45 35 31.8
46-55 24 21.8
46-65 19 17.2
Over 65 4 3.6
Ethnicity    
Black/African American 9 8.2
White/Caucasian (Non-Hispanic) 92 84.4
Hispanic/Latino 4 3.7
Asian/Pacific Islander 1 0.9
American Indian 1 0.9
Other 2 1.8
Currently employed in social work field    
Yes 74 72.5
No 28 27.5
Number of years post-graduation social work experience    
0–5 years 44 42.3
6–10 years 10 9.6
11–15 years 18 17.3
16–20 years 9 5.8
21–25 years 6 5.8
Over 25 years 17 16.4
Type of degree    
BSW (or currently enrolled in BSW) 13 11.8
MSW 77 70.0
DSW 0 0
PhD 1 0.9
Other 19 17.2

Most respondents had less than 5 years’ post-graduation experience (42.3%) and over half graduated from an accredited social work program in North Carolina (57%). A wide range of practice experience was represented including mental health (32%), social work education (22%), hospital (20%), government (8%), child welfare (4%), substance use (3%), aging (3%), hospice (1%), community organizing (1%), and school social work (1%).

Procedures

No standardized instrument was available to survey social workers about the types of instructional strategies used to teach social work ethics or the topics of ethics instruction, therefore two instruments were created for this exploratory study. The first instrument, a 39-item web-based survey, was developed and administered using Qualtrics software. The second instrument consisted of a seven question, semi-structured interview that was conducted over the phone. A human subjects research review board and the National Association of Social Workers (NASW) approved the survey and interview instruments prior to distribution and data collection. The survey link was distributed electronically to all active members of the North Carolina (NC) Chapter of NASW through the NC Chapter office email titled EnewSWire in August, 2016. The survey link was distributed a second time, two weeks later, and was posted on various social media networks of the co-investigator such as Facebook and LinkedIn.

Data Collection

Online survey instrument

The web-based survey instrument contained 39 items designed to assess participant demographics, strategies or methods used to teach social work ethics, topics of ethics instruction, and resources used to resolve ethical dilemmas in practice. Likert-type questions as well as open-ended questions were used to solicit participants’ beliefs and experiences with social work ethics education and training.

The online survey consisted of four sections. The first section addressed basic demographic data (e.g. age, gender, and race) along with more specific questions related to participants’ involvement in social work. Additional questions included the highest social work degree earned, college/university attended, length of practice experience, primary work setting, and attendance at ethics related training or continuing education in the previous 12 months. The second section focused on the types of strategies or methods used to teach social work ethics, the topics of ethics instruction, goals of ethics education, and resources used to resolve ethical dilemmas in practice. A review of the social work literature was used to generate the list of instructional strategies. The topics of ethics instruction were drawn from the NASW Code of Ethics. The third section contained twenty-one questions, using a five-item Likert scale of (1) strongly agree, (2) agree, (3) neutral, (4) disagree, (5) strongly disagree, to identify agreement with statements related to ethics education and practice, teaching approaches, and strategies for solving ethical problems. The Likert scale items were developed to assess viewpoints about current ethics training and education. The fourth section contained open-ended questions related to creative or innovative strategies for teaching ethics and unique ethical dilemmas encountered in practice, as well as an option to indicate willingness to participate in a brief follow-up interview. The online survey instrument was pilot tested with a small group of social work faculty, students, and practitioners. Feedback from the pilot test was used to enhance the survey instructions and ensure ethics concepts were properly construed.

Semi-structured interview

The second instrument was a brief, semi-structured interview, which was conducted by phone. Respondents to the online survey interested in taking part in the interview were contacted by the co-investigator. The interview consisted of seven questions related to creative and innovative approaches to teaching ethics as well as unique ethical dilemmas encountered in professional practice. Respondents described creative or innovative approaches to teaching ethics or ethical decision-making and what aspects of the approach contributed to their ability to resolve ethical dilemmas. Interviewees shared their opinions regarding how closely the ethical dilemmas used in teaching and training represented the types of dilemmas encountered in practice. Finally, participants provided an example of an ethical dilemma encountered in practice that was not addressed in ethics related education or training. Responses to the semi-structured interview were summarized by the co-investigator and emailed to participants for review and approval. Responses were independently coded by the authors. Codes originated from the interview responses and inductive thematic analysis was used to identify themes within the data.

Results

Survey

The results were analyzed with respect to the two research questions: (1) the types of instructional strategies used to each social work ethics and (2) topics of ethics instruction. The survey also assessed resources used to resolve ethical issues and the goals of ethics training and education.

Instructional strategies

Multiple instructional strategies to teach social work ethics were identified. The most frequently cited instructional strategy was lecture (73.9%), followed by an analysis of ethical dilemmas (65.2%), readings (63%), and discussions (large group 60.9% and small group 57.6%). Half of the respondents indicated that guest speakers and/or a panel of experts were used to teach ethics. Less commonly used instructional strategies were roleplays (21%), experiential exercises such as art, drawing, and games (16%), observation (13%), and popular media videos (13%) (see Table 2). For most strategies, responses between respondent types were congruent, however, students reported the development of professional forms (43.5%) and observation (30.4%) at higher percentages than educators (5% and 0%) or practitioners (27.1% and 10.4%) (see Table 3). A clear majority of respondents agreed that the instructional strategies used in coursework (73.2%) and continuing education (81.4%) were appropriate. Nearly 80% of respondents agreed that realistic and relevant examples were used in ethics related training and education.

Table 2

Types of Instructional Strategies or Methods Used to Teach Social Work Ethics


Instructional strategy or method


n


%

Lecture

68

73.9

Analysis of ethical dilemma/vignettes

60

65.2

Readings (journal articles, books, or other literature)

58

63.0

Large group discussion

56

60.9

Small group discussion

53

57.6

Guest speakers and /or panel of experts

46

50.0

Self-assessments

35

38.0

Educational videos

29

31.5

Development of practice forms (e.g. informed consent document)

24

26.1

Debates

23

25.0

Role plays

20

21.7

Experiential exercises (e.g. art, drawing, games)

15

16.3

Student presentations (individual or group)

14

15.2

Popular media videos

12

13.0

Observation

12

13.0

Other

9

9.8

Table 3

Types of Instructional Strategies or Methods Used to Teach Social Work Ethics by Respondents


Instructional strategy by respondent type


Student

 

Educator

 

Practitioner

 

n

%

 

n

%

 

n

%

Lecture

19

82.6

 

16

80.0

 

33

68.7

Analysis of ethical dilemma/vignettes

15

65.2

 

11

55.0

 

33

68.7

Readings (journal articles, books, other literature)

16

69.5

 

14

70.0

 

28

58.3

Large group discussion

14

60.9

 

12

60.0

 

30

62.5

Small group discussion

14

60.9

 

12

60.0

 

27

56.2

Guest speakers and /or panel of experts

13

56.5

 

7

35.0

 

26

54.2

Self-assessments

11

47.8

 

5

25.0

 

19

39.6

Educational videos

9

39.1

 

2

10.0

 

18

37.5

Development of practice forms

10

43.5

 

1

5.0

 

13

27.1

Debates

8

34.7

 

4

20.0

 

11

22.9

Role plays

5

21.7

 

3

15.0

 

12

25.0

Experiential exercises (e.g. art, drawing, games)

7

30.4

 

3

15.0

 

5

10.4

Student presentations (individual or group)

6

26.1

 

0

0.0

 

8

16.7

Popular media videos

4

17.4

 

1

5.0

 

7

14.6

Observation

7

30.4

 

0

0.0

 

5

10.4

Other

5

21.7

 

0

0.0

 

5

10.4

Innovative teaching approaches

The most frequently identified innovative teaching approach was the use of scenarios/case examples/vignettes. Less frequently used approaches included roleplaying, discussion, games, lecture, and art. Experiential activities, which involved respondents interacting with one another, were also noted. One respondent stated: “He used the game of Jeopardy as a learning tool. [The] team competed and answered questions and scenarios about ethical principles” (participant survey response). Another described the use of: “slow motion role play in which we and a partner spoke to a ‘client’ and had the instructor pointing out things we did correctly or that needed improvement” (participant survey response, n.d.). Another respondent described an activity where: “participants stood in a line ranging from agree to disagree with various scenarios that were presented” (participant survey response).

Topics in ethics related training and education

Respondents overwhelmingly noted that ethics instruction addressed broad topics including ethical standards (90%) as well as ethical principles and values (89%). A majority noted instruction related to legal and regulatory issues (67%), ethical decision-making models (51%), and malpractice and professional liability (51%). Overall, fewer noted ethics training related to professional licensing requirements (43%), although students reported a higher percentage (59.1%).

Regarding specific ethical standards, over 88% indicated that boundaries and/or dual relationships, as well as confidentiality and privacy, were addressed. Other frequently addressed topics included sexual relationships with clients (83%), duty to warn (78%), conflicts of interest (77%), cultural competence (76%), giving and receiving gifts (76%), competence (73%), and termination of services (73%). Conversely, topics covered less regularly included private conduct (42%), technology in social work practice (40%), commitments to employers (35%), and solicitation of clients (29%) (see Table 4).

Table 4

Topics in Ethics-Related Training and Education


Topic


n


%

Boundaries and/or dual relationships

78

88.6

Confidentiality and privacy

78

88.6

Sexual relationships with clients

73

92.9

Duty to warn

69

78.4

Conflicts of interest

68

77.3

Giving and/or receiving gifts

67

76.1

Cultural competence

67

76.1

Termination of services

64

72.7

Competence

64

72.7

Physical contact with clients

61

69.3

Personal versus professional values

60

68.2

Attraction to clients

60

68.2

Access to client records

59

67.1

Integrity of the profession

58

65.9

Unethical conduct of colleagues

55

62.5

Supervision and training

54

61.4

Impairment or incompetence of colleagues

49

55.7

Bartering for services

48

54.5

Evaluation and research

48

54.5

Referral for services

44

50.0

Use of social media

42

47.7

Payment for services

42

47.7

Social and political action

40

45.4

Private conduct

37

42.0

Technology in social work practice

35

39.8

Commitment to employers

31

35.2

Solicitation of clients

26

29.5

Other

2

2.3

Student ratings differed from educators and practitioners on several topics. Students noted private conduct was addressed more frequently (72.7%) as compared to educators (26.3%) and practitioners (34.7%). Likewise, students noted the use of social media (86.3%) as a topic more frequently than educators (21.0%) and practitioners (41.3%). Technology in social work practice was rated at a higher percentage by students (68.2%) as compared to educators (15.8%) and practitioners (36.9%) as well (see Table 5).

Table 5

Topics in Ethics-Related Training by Respondents


Topic by respondent type


Student

 

Educator

 

Practitioner

 

n

%

 

n

%

 

n

%

Boundaries and/or dual relationships

21

95.4

 

15

78.9

 

42

91.3

Confidentiality and privacy

20

90.9

 

17

89.4

 

41

89.1

Sexual relationships with clients

20

90.9

 

15

78.9

 

38

82.6

Duty to warn

16

72.7

 

17

89.4

 

36

78.2

Conflicts of interest

19

86.3

 

11

57.9

 

38

82.6

Giving and/or receiving gifts

19

86.3

 

12

63.1

 

36

78.2

Cultural competence

20

90.9

 

12

63.1

 

35

76.1

Termination of services

18

81.8

 

10

52.6

 

36

78.2

Competence

19

86.3

 

12

63.1

 

33

71.7

Physical contact with clients

19

86.3

 

10

52.6

 

32

69.5

Personal versus professional values

18

81.8

 

11

57.9

 

30

65.2

Attraction to clients

17

77.2

 

11

57.9

 

32

69.5

Access to client records

18

81.8

 

13

68.4

 

28

60.8

Integrity of the profession

20

90.9

 

11

57.9

 

27

58.7

Unethical conduct of colleagues

16

72.7

 

10

52.6

 

29

63.0

Supervision and training

17

77.2

 

7

36.8

 

30

65.2

Impairment or incompetence of colleagues

17

77.2

 

6

31.5

 

26

56.5

Bartering for services

14

63.6

 

8

42.1

 

26

56.5

Evaluation and research

16

72.7

 

5

26.3

 

27

58.7

Referral for services

14

63.6

 

4

21.0

 

26

56.5

Use of social media

19

86.3

 

4

21.0

 

19

41.3

Payment for services

17

77.2

 

5

26.3

 

20

43.4

Social and political action

15

68.1

 

4

21.0

 

21

45.6

Private conduct

16

72.7

 

5

26.3

 

16

34.7

Technology in social work practice

15

68.1

 

3

15.8

 

17

36.9

Commitment to employers

13

59.1

 

4

21.0

 

14

30.4

Solicitation of clients

9

40.9

 

3

15.8

 

14

30.4

Other

1

4.5

 

0

0.0

 

1

2.1

Compelling or memorable topics

In addition to a prescribed list of ethical topics, respondents freely noted the most compelling or memorable ethics related topic addressed in their social work education. The most frequently identified topics included boundaries, confidentiality, self-determination, and cultural competency. Also cited more than once were topics such as supervision, end of life, ethical decision-making, code of ethics, social media and technology, and issues related to transference and countertransference. Some of the more unique topics included institutional racism, money, whistleblowing, and the sexuality of clients.

Topics not addressed in training or education

To identify gaps between training and professional practice, respondents described ethical dilemmas and topics encountered in practice but not covered in training or education. As expected, responses to these questions reflected a wide range of complex situations. Common elements from the responses were identified and categorized into four key areas: (1) client related practice, (2) practitioner related issues, (3) challenges with employers and colleagues, and (4) commitments to the profession and broader society.

Client related practice

Respondents noted many complex client related situations such as suspected foul play by the spouse of a client who committed suicide, a client in an inpatient psychiatric unit seeking an abortion, and ensuring self-determination of a non-English speaking refugee slave. Other client related examples included gift giving, end of life care for pediatric patients, diagnosing, and confidentiality.

Practitioner related issues

Social media and technology were cited frequently by respondents as not being addressed in training or education. In addition, respondent’s highlighted issues associated to self-care, personal versus professional boundaries, being in recovery, setting fees, private conduct, and practice skills.

Challenges with employers and colleagues

The most frequently noted responses fell into this category. Challenges with employers included a lack of training in dealing with impaired colleagues, responding to a supervisor who asks you to do something unethical, working in interdisciplinary groups, and agencies wanting practitioners to provide services without proper training or resources. One respondent put it this way: “keep the job or go with the flow” (participant survey response). Challenges with colleagues included dishonesty and deceit of a colleague, avoiding confronting colleagues’ unethical behavior, and alleged negligent supervision. One respondent stated: “more discussion of the professional challenges of doing what is ethically correct even when that decision goes against one’s boss or agency” (participant survey response).

Commitments to the profession and broader society

Finally, respondents noted a lack of training related to obligations to engage in social action and advocacy as well as obligations to serve vulnerable populations. Additionally, respondents listed issues related to the implications of racism, sexism, heterosexism, and how to respond to current events occurring in the community, nation, and world.

Characteristics of ethics related training and education

Most respondents (92.4%) indicated that social work ethics content was infused throughout their social work curriculum, although 25% also indicated that ethics was taught as a discrete (standalone) course during their social work education. Over 76% of respondents attended an average of 5.5 hours of ethics related professional development or continuing education within the past 12 months.

Ethics content and preparation for practice

Likert scale questions revealed respondents’ perceptions about ethics related training and education. Almost all respondents agreed that they could identify an ethical situation when confronted with one (97.7%). Likewise, respondents agreed that social work ethics coursework and continuing education was relevant to their professional practice (88%). Far fewer agreed whether ethics education should focus primarily on the NASW Code of Ethics (59.7%) or ethical decision-making models (60.4%).

Resources used to resolve ethical issues

Respondents identified the top three resources that were most helpful in resolving ethical issues. The NASW Code of Ethics (76%) and consultation/supervision (74%) were the most frequently cited resources used to resolve ethics related issues, although educators relied more heavily on the NASW Code (90%) as compared to students (78.2%) and practitioners (69.5%). Moreover, practitioners noted the use of consultation/supervision more frequently (78.2%) as compared to educators (75%) and students (65.2%). Less frequently used resources included previous training and/or education (37%), ethical decision-making models (22%), and books/journal articles (12%). Educators relied on previous training (55%) more so than practitioners (34.8%) and students (30.4%) (see Tables 6 and 7).

Table 6

Top 3 Resources Used That are Most Helpful When Resolving Ethical Dilemmas


Resource


n


%

NASW Code of Ethics

69

76.6

Consultation or supervision

67

74.4

Previous training and/or education

34

37.7

Prior experience with a similar ethical dilemma

23

25.5

Ethical decision making models

20

22.2

NASW (state or national)

18

20.0

Ethics committee (agency)

15

16.6

Books or journal articles

11

12.2

Intuition

11

12.2

Table 7

Top 3 Resources That are Most Helpful When Resolving Ethical Dilemmas by Respondent Type

Top 3 resources used by respondent type

Student

 

Educator

 

Practitioner

 

n

%

 

n

%

 

n

%

NASW Code of Ethics

18

78.2

 

18

90.0

 

32

69.5

Consultation or supervision

15

65.2

 

15

75.0

 

36

78.2

Previous training and/or education

7

30.4

 

11

55.0

 

16

34.7

Prior experience with a similar ethical dilemma

8

34.7

 

8

30.0

 

9

19.5

Ethical decision making models

3

13.0

 

4

20.0

 

13

28.2

NASW (state or national)

5

21.7

 

1

5.0

 

12

26.1

Ethics committee (agency)

4

17.4

 

1

5.0

 

10

21.7

Books or journal articles

6

26.1

 

3

15.0

 

2

4.3

Intuition

3

13.0

 

0

0.0

 

7

15.2

Malpractice carrier

0

0.0

 

0

0.0

 

0

0.0

Most respondents agreed that ethics related training prepared them to address ethical challenges in practice (93.1%). Likewise, the clear majority of respondents indicated they felt both confident (90%) and competent (93%) in their ability to resolve ethics related issues and dilemmas in practice. Responses varied regarding the specific techniques or approaches used to solve dilemmas. Most respondents agreed they thoroughly evaluated options before taking action (96.5%), mentally rehearsed what-if scenarios (88.5%), and generated arguments for and against each decision (83.9%), but far fewer respondents used decision-making tools to solve ethical dilemmas (30.2%).

Interviews

Fifteen individual interviews were conducted by the co-investigator to further understand respondent’s experiences with ethics related education and training. The co-investigator conducted the interviews after respondents completed the online survey. Responses to the interview questions were transcribed and coded. Several themes emerged related to the instructional strategies as well as the types of ethical dilemmas encountered in practice.

Instructional strategies

Regarding creative or innovative instructional approaches in ethics training or education, one third of respondents stated that no creative or innovative strategies were used, as reflected in this typical response “Can’t describe one. No creative approach” (Participant 1, Interview). However, when respondents were able to identify creative approaches, almost half identified the use of vignettes or scenarios which incorporated discussion elements. One respondent stated: “I like specific case examples that might mirror what we face in practice. Talk about possible solutions and having someone with experience to explain what they would do” (Participant 2, Interview). Two respondents noted the use of role-plays such as “some form of role-playing, where we talk about initial reactions and then we get to unpack it and discuss what it really looked like. Identifying the roadblocks you would run into” (Participant 3, Interview). Two respondents identified more unique approaches such as games/competition and experiential activities. One respondent recounted a “game of ethics Jeopardy” (Participant 4, Interview) that was used as an activity in the afternoon session to reinforce the didactic portion of the training from the morning. Another respondent detailed an “experiential art therapy technique” (Participant 5, Interview) which included reviewing ethical standards and presenting cases, along with an expressive art project and creating an ethics board game to take with them from the training.

Ethics related topics

Interviewees identified specific ethics related topics that were not addressed in training or education. Most topics were client related and reflected the complexity of social work practice. While common topics such as documentation, boundaries, and confidentiality were noted, the specific situation in which the conflict arose was quite exceptional. For example, one respondent reflected on an instructor who asked whether it was “ever okay to be in bed with a client” and then recounted an experience with an 87-year-old hospice patient who requested the social worker to “get into the hospital bed and hold her” (Participant 6, Interview). Regarding documentation, one respondent said: “Many ethical dilemmas regarding documentation. How much is enough and too much? Are you helping or hindering by labeling?” (Participant 7, Interview).

Participants also identified topics such as working with attorneys and the court system, insurance and billing, eligibility for services, money and client care, and impaired colleagues. The most complex scenarios reflected the intersection of multiple ethical standards such as conflicts between personal and professional values related to religion and faith, interpersonal relationships with colleagues and supervisees, and interdisciplinary work with professionals from other disciplines such as doctors, nurses, probation officers, and other helping professionals.

Resolving ethical dilemmas

When asked how the teaching approaches contributed to their ability to resolve ethical dilemmas, interviewees noted the value of engaging in discussion and hearing alternative viewpoints. One interviewee stated: “I enjoy thinking about different sides of things. Helpful because you have to be able to look at different sides to come to a solution. Even if you end up going with the original decision, you at least looked at the other side. I’m proud to bring up other things or ways of looking at situations” (Participant 8, Interview). Additionally, interviewees reiterated that teaching approaches which reinforced critical thinking and used examples which were connected to previous experience prepared social workers for practice and contributed to their ability to resolve ethical dilemmas.

Discussion

To prepare practitioners for ethical practice, sound instructional strategies and relevant ethics topics must be addressed during coursework and continuing education. Overall, the results of this exploratory study illustrate that the vast majority of social work students, practitioners, and faculty respondents believed that ethics related coursework and continuing education were relevant to their professional practice. Likewise, respondents were confident in their ability to identify and resolve ethics related issues in practice. Despite this confidence, however, several inconsistencies regarding instructional practices and topics of instruction were noted.

Instructional strategies

Two of the top three instructional strategies used to teach social work ethics were passive strategies (lectures: n = 68; readings: n = 58). In fact, when asked specifically whether respondents had ever participated in a class or training where a creative or innovative instructional strategy was used almost 69% said they had not. One respondent stated: “Off the top of my head, I can’t think of one. That’s one of the biggest struggles attending ethics trainings, new information may be presented, but I’ve not attended one that was innovative or provided a new way of learning about it. Typically, a decision making model is presented and here’s how to use it. Nothing super creative, not innovative” (Participant 9, Interview).

Experiential exercises (n = 15), which incorporate active learning, were identified as unique or innovative approaches to teaching ethics or ethical decision-making. One respondent stated: “You had people line up along a continuum from agree to disagree and then move your position along the continuum as new information was given” (Participant 6, Interview). Another respondent noted: “I created an experiential art therapy technique. It was an expressive use of your ethical self and participants had to do an expressive art project. The group also created an ethics board game to use if they had to teach other about ethics. Each person left the training with a game for the organization” (Participant 5, Interview). These innovative approaches to teaching ethics departed from the typical “tell me about ethics” lecture style by implementing active learning strategies.

Ethics related topics

Ethics related education and training addressed a multitude of topics, however the most frequently cited topics related to work with clients. A variety of instructional approaches are being used to teach social work ethics however, the results are inconsistent with the social work literature. Vignettes and case studies are common activities used to teach ethics (Dodd & Jansson, 2004; Fossen et al., 2014; McCormick et al., 2014; Ringel & Mishna, 2007), yet this survey found that lectures were the most common method of ethics instruction. Non-interactive instructional methods such as the use of lectures and readings were found to be used quite frequently in this study, which supports the opinions of several respondents regarding the lack of creativity in teaching methods. If ethics education is meant to prepare students and practitioners for ethical practice, then the strategies used to teach ethics should aid in this endeavor, yet only a small minority of respondents (37%) indicated that previous training or education was used as a resource for resolving ethical dilemmas. Likewise, the social work literature focuses on the use of conceptual or theoretical models to teach ethical decision-making (Congress, 2000; Castro-Atwater & Hohnbaum, 2015; Fossen et al., 2014) but only 22% of the respondents in this study actually used ethical decision making models when resolving ethical dilemmas.

In open-ended survey responses and follow-up interviews, participants identified the importance of reviewing cases and then discussing them as a group. This type of debriefing encourages learners to consider multiple perspectives and evaluate their position on an ethical issue. Similarly, respondents valued the opportunity to talk through an ethical dilemma. Using a think-aloud strategy illustrates different problem-solving approaches among learners and provides novice learners with useful steps for solving complex problems. The use of debriefing and think-aloud strategies provides social workers with valuable feedback while completing ethics activities and encourages the exploration of alternative viewpoints. Faculty and instructors should consider incorporating these strategies in ethics related training and education.

The results from this study and the literature concur that ethics instruction focuses predominantly on client related topics such as boundary issues, confidentiality, sexual relationships with clients, and duty to warn. Equally as important, but not addressed as frequently are topics related to practitioner competence, impaired colleagues, commitments to employers, and political/social action. Likewise, the use of technology and social media is proliferating in personal and professional settings yet ethical standards for guiding social workers is only beginning to emerge. Ethics instruction should be broadened to address relevant, contemporary topics.

As this study highlights, there appears to be a disconnect between the types of instructional strategies used in ethics education (lecture and readings) and what practitioners value in practice (scenarios and discussion to uncover alternative viewpoints). Moreover, the topics most commonly addressed in ethics related education are not reflective of the complex situations social workers encounter in the field or more contemporary topics that are emerging in practice. These findings inform the development and delivery of ethics related education and training in multiple ways.

Implications

Often, in social work education, faculty and instructors provide ethics related information via lecture and readings. Standards from the NASW Code of Ethics may be reviewed in addition to an ethical decision making model to assist with analyzing a case example. While this approach to teaching ethics likely resonates with most social workers, it is unclear whether this instructional approach provides social workers with the skills and knowledge needed to resolve ethical dilemmas in practice. Ethics instruction should include a variety of proven instructional strategies such as the analysis of ethical dilemmas, group discussion, and role-plays. Furthermore, the variety of ethics related topics should move beyond commitments to clients and address commitments to colleagues, employers, the profession, and the broader society. Moreover, the complexity of ethical issues explored during instruction should reflect the nuances of contemporary practice.

Moving forward, instructors and educators teaching ethics, or including ethics related content in their courses, should review material to ensure current, complex, and relevant case examples are being used. Likewise, interactive activities such as role-playing, small group discussions, or analysis of case examples should be infused throughout the training session to provide opportunities for participants to engage with one another and reflect on their professional practice. Think aloud strategies can be used to highlight problem solving steps and aid novice learners in solving ethical dilemmas.

Limitations

The results of this exploratory study provide valuable information to social work students, educators, and practitioners about ethics related instruction, although several limitations of this study must be noted. First, a new survey instrument was developed because no previously tested survey instrument was available for use in this exploratory study. Several social work students, faculty, and practitioners pretested the survey instrument before being distributed, however, no reliability measures were performed. Second, respondents were asked to recall specific information related to ethics related training that may have occurred many years ago. Thus, the precision of the data was dependent upon the accurate recall of respondent’s memories, which may not be complete or precise. Another limitation included sampling bias. The survey was distributed using a NASW state chapter online newsletter and various social media sites such as LinkedIn and Facebook. The survey instrument did not ask respondents to indicate how they learned of the survey, therefore further exploration of sampling concerns would be difficult. The small sample size (n=112), in which respondents were predominantly female, White, and situated in one state limits the generalizability of the findings. A more representative sample of social work students, educators, and practitioners may have yielded different conclusions.

Future Research

This exploratory study investigated the types of instructional strategies being used to teach social work ethics and ethical decision-making as well as the types of ethics related topics being addressed in education and professional training. The results of this study are a beginning step to understanding the broad and multifaceted topic of ill-structured problem solving in social work education. Additional research is needed to explore various teaching strategies such as the use of think-aloud protocols to analyze how social workers resolve ethical dilemmas, the use of argumentation to elaborate and justify solutions to ethical problems, and the use of complex case vignettes that mirror the types of ethical dilemmas encountered in practice. Likewise, more research is needed to explore the ethical decision-making process itself including the use of frameworks and models that guide the process as well as the role of personal, professional, and societal values in decision-making. Finally, additional research should be conducted regarding the advantages and disadvantages of teaching ethics as a standalone course versus ethics content being infused throughout the BSW or MSW social work educational experience.

Conclusion

Social workers encounter complex situations on a daily basis and make ethical decisions that affect the lives of their clients as well as their professional careers. The ability to identify and resolve ethical dilemmas in practice is a critical aspect of social work education and training. It is imperative that the types of instructional strategies used to teach social work ethics as well as the topics covered in education and training enable social workers to engage in effective decision-making in the field. Additional research is needed to explore the effectiveness of different instructional strategies for teaching ethics and ethical decision-making. Furthermore, the complexity of ethical issues social workers confront in practice should be reflected in ethics related training and education. Ultimately, social workers must be prepared to address a wide range of ethical issues related to clients, colleagues, and professional practice. Effective and relevant ethics related instruction is necessary to prepare students and practitioners for ethical practice and the ability to resolve ethical dilemmas in complex, real life settings.

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Suggested Citation

& (2020). An Exploratory Study Examining Instructional Decisions and Strategies and Ethics in Social Work Education. The Journal of Applied Instructional Design, 9(2). https://edtechbooks.org/jaid_9_2/an_exploratory_study