Professional Boundaries in Dual Relationships: A Social Work Dilemma

By Lynn Milgram Mayer, MSW, Ph.D.
The Catholic University of America, National Catholic School of Social Service

Abstract

Social workers have traditionally been underutilized by Head Start programs. With the increasing emphasis on the professionalization of Head Start staff, it is pertinent to explore issues that social workers would face in this practice context. One such issue is the risk of engaging in dual relationships between parent-employees and social workers in this practice context. This ethical dilemma is explored through review of the literature, consideration of two case examples, and application of a modified ethical problem-solving model (Joseph, 1985). After evaluation of three alternatives, one option is recommended.
Key Words

Ethical Dilemma, Dual Relationship, Social Work, Head Start, Ethical Problem-solving

Introduction

Originally, Head Start was grounded in research which suggested that programs could help poor children be prepared for school and, thereby, compensate for their economic disadvantage (Hofferth, 1992). At that time, Head Start was viewed as a community action effort “aimed at improving whole communities by giving parents and community members new opportunities to participate in the nurturing and education of their children (Kuntz, 1998, p.1). Initially, few social workers were hired (Frankel, 1997; Zigler, 1997). However, as Head Start approaches its 40th birthday, the staffing debate over providing jobs for community members versus upgrading services through hiring outside professionals continues. The philosophical heart of this ongoing debate – remaining true to Head Start’s anti-elitist ideological roots versus professionalizing service – stems from a federal directive to hire parents of currently or formerly enrolled children (Head Start Program Performance Standards Final Rule 45 CFR Part 1304, 1996). While the drive to professionalize has an impact on all Head Start services, the increasing complexity of the needs of Head Start children and families make the issue of professionalization particularly relevant to the provision of mental health services (Gould, 2002).

When professionals, such as social workers, are hired by Head Start and Early Head Start programs, the federal directive places them in work environments in which 28% or more of all program staff members are parents with children currently or formerly enrolled in Head Start (ACF, 2004). In this practice context, social workers find themselves in collegial employee relationships or in administrative and supervisory employer–employee relationships with current or former clients. Thus, once social workers are hired, the philosophical staffing debate shifts focus from professionalizing Head Start staff to ethical dilemmas involving professional boundaries and dual relationships. According to Reamer (2000), boundary issues confront social workers who are engaged in more than one relationship with their clients, and these boundary issues put the social workers at risk and require careful evaluation. As such, within this practice context, dual relationships may raise numerous ethical issues revolving around confidentiality, role conflict, quality of services, and self-determination. Therefore, this article reviews the literature on dual professional relationships, presents a case example that illustrates the difficulties with dual relationships in Head Start, utilizes an adapted model of ethical problem-solving (Joseph, 1985), proposes and evaluates three alternatives, and presents a second case example that demonstrates the use of the recommended solution.

Literature Review

As defined by the NASW Code of Ethics (1999), dual relationships occur “when social workers relate to clients in more than one relationship, whether professional, social, or business” (p.9). Dual relationships can occur in both therapeutic, clinical settings, and non-therapeutic, community-based settings. When social workers are employed by Head Start, the dual relationships that they find themselves in are primarily professional, but could also be characterized as social depending on the situation. These relationships could reflect either a therapeutic or non-therapeutic context depending on the design of the individual Head Start program. Dual relationships are considered to be a conflict of interest for social workers when there is a risk of potential exploitation or harm (NASW, 1999). Due to conflicting opinions surrounding their appropriateness, dual relationships have recently been a central focus of discussion in the social work literature (DuMez & Reamer, 2003; Freud & Krug, 2002; Mattison, Jayarante, & Croxton, 2002; Reamer, 2003). Gripton and Valentich (2003) argue that part of the difficulty stems from a failure to adequately address dual relationships in codes of ethics. As such, the literature highlights both the potential benefits and problems associated with dual relationships in both clinical and community practice settings; therefore, literature on both perspectives is reviewed.

Potential Benefits of Dual Relationships

From the literature, it is evident that dual relationships do exist in social work practice in both clinical and community practice settings. These relationships can be productive if handled properly. Dual relationships should be viewed on a continuum as not all dual relationships are unethical or harmful (Bader, 1994; Corey, Corey, & Callanan, 1998; Reamer, 1998). Rather than a negative, the blending of roles in dual relationships is regarded either as a natural part of human life or as an inevitable outcome due to power differentials within the therapeutic relationship (Bograd, 1993; Brown, 1994).

The client’s right to self-determination, a long standing social work value, is pertinent in the consideration of the ethics of dual relationships (Freedburg, 1989; Hancock, 1997). Failure to support this right would be unethical action on the part of the social worker who has “a moral injunction to uphold the rights of clients to a life of self-fulfillment and noninterference” (Manning, 1997, p. 227). The Head Start Performance Standards Final Rule (1996), including the standard to hire parents, was written with an underlying respect for self-determination: “family development planning and service provision will be grounded in the belief that families, including those whose problems seem overwhelming, can identify their own goals and strengths and needs, and are capable of growth and change” (U.S. DHHS, 1994, p.13). Bass (1996) supports this interpretation, indicating that social services in Head Start are designed to empower parents by giving them the opportunity to make decisions regarding their strengths, weaknesses, need for help, and mechanism for getting help.

Vodde and Giddings (1997) suggest that dual relationships may lead to an improved sense of empowerment: “when aspects of nonsexual dual relationships are used in the service of greater connectedness, more honesty, integrity for both parties, and an increase in the power and self-determination of the client, the relationship may become enhancing or empowering” (p. 63). Bograd (1993) indicates that “some even argue that dual relationships offer protection against the damage done within the traditional model of therapy because they do not reinforce the therapist power advantage” (p.12). According to Tomm (1993), dual relationships prevent the social worker from dehumanizing a client by forcing her or him to respond to the client as a unique person. Dual relationships may also serve to make the client less vulnerable, enhance reality testing, and provide productive role models (Schank & Skoyholt, 1997; Tomm, 1993; Vodde & Giddings, 1997).

Potential Problems with Dual Relationships

While evidence of dual relationships is found in the literature in a variety of practice contexts, including community action agencies, clinical practice, social work education, and substance abuse treatment, it is clear that these relationships may lead to ethical dilemmas and violations. Dual relationships can be problematic because the possibility exists that the social worker will put her or his needs first and will utilize impaired judgment (Bader, 1994; Vodde & Giddings, 1997; Herlihy and Corey, 1992). In their study of attitudes and practices regarding dual professional roles, Borys and Pope (1989) found that almost half of the respondents in the study felt that it was unethical to employ a client. Three primary areas of objection to dual relationships include: boundary issues, role confusion, and power exploitation.

Boundaries exist to protect the client from misuse by the social worker and to establish the professional nature of the relationship (Borys, 1994; Brown, 1994; Gabbard, 1994; Pope & Vasquez, 1991). Whether the social worker is working in a community or clinical setting, the helping relationship is considered to be a professional relationship and can be adversely affected by boundary issues, including boundary confusion, boundary crossing, and boundary violations. While boundary crossings may not be unethical inherently, as are boundary violations, they do have the potential for harm (Reamer, 2003). According to Reamer (1995), “it is essential that social workers maintain clear and unambiguous boundaries in their relationships with clients. Effective practice depends on a clear delineation of professional roles. Worker-client relationships that are based on confused boundaries can be very destructive” (p. 105). When the boundaries are confused or crossed as they are in dual relationships, it is not helpful to the client, the social worker, or the agency (Congress, 1996; Ramsdell & Ramsdell, 1993). Hancock (1997) characterizes boundary issues as unethical. Boundary confusion, boundary crossing, and boundary violation may reinforce maladaptive beliefs and negatively impact self-esteem and separation-individuation issues for the client (Borys, 1994).

Issues of role conflict are likely to materialize when social workers engage in dual relationships with clients as they are either taking on more than one role with the client or the client is taking on more than one role. Ramsdell and Ramsdell (1993) indicate that role confusion for both the client and the counselor is likely. According to Jones (1984), “the agent may not know which of two or more well-defined social roles is appropriate in the circumstances in which he finds himself” (p. 609). Jones (1984) characterizes differing expectations as a conflict of prima facie duties. The role confusion could easily lead to difficult situations for both the client and the social worker:

… the patient may misinterpret confrontation or painful interventions as reflections of the therapist dissatisfaction with the product or service the patient is providing in the other role… Alternatively, the therapist may be hard pressed to adaptively resolve any actual dissatisfaction he or she may find in the patient’s work (Borys, 1994, p. 271).

The dynamics of power clearly are a potential problem stemming from dual relationships, as the possibility of exploiting or harming the client is evident (Reamer, 1998). According to Kagle and Giebelhausen (1994), “in any dual relationship, the practitioner’s influence and the client’s vulnerability carry over into the second relationship. Even if no sexual intimacy occurs, the practitioner is in a position to subordinate the client’s interests to his or her own” (p.215). As a result of the first relationship, the client can never be equal to the social worker in terms of power (Pope & Vasquez, 1991). When the imbalance of power is increased, the social worker’s ability to meet the client’s needs is further jeopardized (Brown, 1994). As a result of the power differential, “even an ethical practitioner may unconsciously exploit or damage clients or students, who are inherently vulnerable in the relationship. Once the clarity of professional boundaries has been muddied, there is a good chance for confusion, disappointment, and disillusionment on both sides” (Bograd, 1993, p.7). As such, the social worker is possibly in jeopardy of violating the fiduciary obligations inherent in the social work contract (Kutchins, 1991).

An organization that permits dual relationships may experience significant detrimental outcomes. Dual relationships may have a negative impact on the client in numerous ways: for example, “a client who comes to feel exploited by a dual relationship is bound to feel confused, hurt, and betrayed. This erosion of trust may have lasting consequences” (Herlihy & Corey, 1992, p. 14). While the impact on the individual client is the first concern, the dual relationship may also have broader repercussions on the organization. For instance, Ramsdell and Ramsdell (1993) indicate that confidentiality is likely to be diminished in cases of dual relationships, a circumstance which would have a negative impact on the agency’s credibility. Furthermore, employing parents would likely produce a ripple effect as other clients might resent that one parent has been picked for a “special relationship” (Herlihy & Corey, 1992, p.15).

Case 1

The following practice case example is presented to illustrate the problems that can arise from dual relationships within the context of Head Start. The case is from an Early Head Start program that was administered by a social worker. While the social worker administrator was not in a direct, therapeutic relationship with the client, the social worker felt that the boundary issues from participating in multiple relationships with the client negatively impacted the professional helping relationship.

Yolanda, an Early Head Start Program parent, was hired by the program director to provide center-based child care to toddlers. At the time of hire, Yolanda had two children; one was in the infant room and the other was in the mobile infant room. Her assignment to the toddler room was to ensure that Yolanda was not working in the same classroom as her children. From her previous experience working with young children and her training in early childhood development, Yolanda initially appeared to have the basis for becoming a talented early childhood professional. However, over time, she became increasingly focused on the care that one of her children, the infant, was given to the detriment of the children in her care. As her focus on her youngest child’s care increased, she spent more and more of her day watching her daughter through the window of the room, neglecting the toddlers for whom she was the primary caregiver. She then became fixated on how her infant daughter was exposed to self-feeding once she turned one year of age and insisted that her daughter must always use utensils. Yolanda wanted food to be used as a reward and as a punishment for table manners, a practice which was strictly prohibited in the Early Head Start Program. Yolanda began to refer to other children in the program as “animals” if they were self-feeding with their hands and not using utensils. Resentment began to build among the other staff members, who felt that Yolanda was constantly “spying” on them and criticizing them and that she was not providing appropriate care to the children in her primary caregiving group. This situation began to create a division among the staff and to impact on the quality of service that Yolanda was receiving as a parent in the program. Yolanda became increasingly distressed and irrational while at work, which further impacted the quality of care she was providing to the toddlers. The social worker program administrator met with Yolanda on several occasions to discuss her job performance. When the situation did not improve, the social worker was faced with terminating her employment.

Ethical Dilemma

Reamer (1990) defines ethical dilemmas as involving decisions the social worker makes about intervening, the nature of the professional relationship, the role of the government, and the distribution of resources. In this case, the ethical dilemma centered around issues of self-determination, confidentiality, and quality of service. When Yolanda was first hired, the potential role conflict that she would experience between being a parent and an employee was discussed. In particular, the difficulties in working in the same child care setting with her children were explored. Yolanda expressed her belief that the role conflict would be something that she could manage, and the social worker felt that to deny her the opportunity would impinge upon her right to self-determination. Confidentiality was at issue as Yolanda was privy to information about other program participants who were her friends. Furthermore, confidentiality was complicated as other parents in the program, as members of the Policy Council, had to approve the decision to terminate Yolanda. The quality of service to children was also an issue as Yolanda was neglecting the children in her care to focus on one of her own children. In addition, quality of service to Yolanda was also an issue as she was creating tension among the staff. Her family support worker felt put in the middle and conflicted about confidentiality, which created tension in their relationship and negatively impacted the professional helping relationship. The ethical dilemmas faced included self-determination v. quality of services to children, and self-determination v. quality of services to parent. Other ethical dilemmas in this case example centered on issues of confidentiality and role conflict.

Values and Salient Ethical Principles

A number of societal and social work values relate to the question of dual relationships in Head Start programs in general and to Case 1 in particular. Values are part of the ethical decision-making process because “the ethical model of decision-making is a values-inclusive process model which differs from a generic problem-solving model in that it is geared to surface value and ethical conflicts and to utilize ethical principles in its decision-making process” (Joseph, 1985, p.6).

The value of autonomy would lead to the belief that Yolanda should retain the ability to decide if she wants to become employed by the program, as part of the right to self-determination. A second critical value is the dignity and worth of the person, which would lead to the decision that Yolanda is able to decide if pursuing employment with the program is a good decision for her. This value relates to the principle that “social workers respect the inherent dignity and worth of the person” (NASW, 1999, p.5). Privacy, another pertinent value, is the philosophical base of confidentiality, which could be negatively affected by Yolanda’s employment as she is privy to confidential information on other children and families in the program. Yolanda’s family support worker also felt that her confidentiality as a client was at risk.

Well-being, a multi-faceted value, has many implications in this situation. First, there is the well-being of the children enrolled as the “programs are only as good as the individuals who staff them” (US DHHS, 1994, p.18). Second, there is the well-being of the parents. If the parent cannot handle the role conflict inherent in working for the program, then employment could be said to diminish well-being as in Case 1. Third, there is the well-being of the social worker. The program administrator in the case example experienced role-conflict from employing the parent and from working to reconcile incompatible policies (Erara, 1991). Fourth, the well-being of the other staff members is at risk, as was evident in Case 1.

Importance of human relationships is also a relevant social work value. Social workers are taught to “recognize the central importance of human relationships” (NASW, 1999, p.6) and to use their relationship with the client as a mechanism for change. As demonstrated in the literature review, it can be argued effectively that dual relationships lead to positive aspects of the human relationship by increasing empowerment and decreasing power disparity. If the human relationship is to be based on partnership, the parent should be given the opportunity to be an active decision maker in how she or he is utilizing all aspects of the program. However, it can also be demonstrated that dual relationships have the ability to harm the client and create a compromised human relationship. If the dual relationship does not enhance the well-being of the parent, but instead diminishes the parent’s well-being, it violates the social work principle. By engaging in a dual relationship, the nature of the human relationship between social worker and parent changes dramatically, as was evident in Case 1. The relationship between the caregiver and the children in care was also affected. Furthermore, the dual relationship could possibly affect the relationship of the parent to other parents and to other staff members.

Integrity also plays a role in this consideration, as a dual relationship requires the social worker to consider whether her or his action in hiring the parent is responsible and trustworthy. If the social worker hires a parent more to fill a vacant position than because of the needs of the parent, she or he would be lacking in integrity. The social work value of service reinforces integrity by establishing that the needs of the clients are to be placed above those of the social worker and that the social worker needs to question whether or not she or he is providing appropriate service to the child and to the family. While there are overlaps between service delivery to the children and to the parent, the underlying value can lead to different decisions when thinking of the enrolled children versus thinking of the parents.

Evaluation of Options

Three alternatives to this ethical dilemma are presented. As per the adapted ethical problem-solving model, it is imperative to generate and evaluate alternatives after explicating the pertinent values (Joseph, 1985). Each alternative presented meets Rothman’s (1998) criteria of being reasoned and considered, indicative of a realistic course of action, and possible for implementation by the social worker. Ethical principles and theories are applied in the discussion of each alternative as per the ethical problem-solving model (Joseph, 1985). A case example to illustrate the strongest option is provided.

Option 1

The first, and weakest, option involves determining that dual relationships can have positive outcomes for clients, and, as a result, that parents should be hired, without hesitation or guidelines, to work in Head Start programs. The application of this option in practice is illustrated by Case One. While appearing to ignore the NASW Code of Ethics (1999) recommendation against dual relationships, this solution, instead, focuses on the clause indicating that dual relationships are acceptable if not exploitive. To ensure that the relationships do not cross the line into exploitation, it would be important to follow the recommendations of Corey, Corey, and Callanan (1998), including informed consent, open discussion, consultation, supervision, documentation, and examination of personal motivation.

This option would maximize a minimal number of values and principles while minimizing many. Hiring parents would honor autonomy, self-determination, and the worth and dignity of the person, while also possibly enhancing the economic well-being of the parent. However, the values of privacy, well-being of children, well-being of parents, human relationships, integrity, service, and equality would be potentially lessened. This option also diminishes both beneficence (providing benefits) and nonmaleficence (avoiding causing harm) as defined by Beauchamp and Childress (1994) since the hiring of parents may not be in the best interest of each individual parent interested in employment.

This alternative is ethically grounded in consequentialist theory, which determine that “actions are right or wrong according to the balance of their good and bad consequences” (Beauchamp & Childress, 1994, p 47). First, classic teleological theory or proportionalism could be applied using the principle of the lesser of two evils. As there are possible negative outcomes to both hiring parents and to not hiring parents, this ethical principle justifies the decision to hire parents on the basis of it being the lesser of the two evils. From this principle, the potential good that can come from hiring parents outweighs the potential bad effect because of the belief, supported by the literature review, that dual relationships can be positive. As such, any possible negative outcomes for the enrolled children or parents are outweighed by the potential good, making it the better of the two options. This theoretical perspective recognizes that the choice to hire or to not hire a parent is not going to consistently result in positive outcomes, but determines that it is better to decide on the option that produces the least harm. Utilitarianism can also be used, which defines that an action is right if it produces the greatest good for the greatest number (Beauchamp & Childress, 1984; Reamer, 1990). Hiring parents could be thought to benefit the majority because the employed parent would provide a role model to other parents and may, therefore, positively impact other parents, which would be a significant good for the greatest number.

This option is the weakest alternative as it decreases more values and principles than it enhances. Furthermore, the support provided for this option by the application of consequentialist theory is not of sufficient strength: the risk of harm remains great, outweighing the possible benefits. Therefore, while it is a plausible option, it is not recommended.

Option 2

The second alternative is the determination that dual relationships are negative, and, therefore, programs should not hire parents of enrolled children to work under any circumstances. Though this option would be in compliance with the NASW (1999) recommendation against participating in dual relationships, it would be in direct contradiction to the Head Start Performance Standards Final Rule (1996). To follow this course of action, the social worker would have to inform the agency that it is unethical to hire parents, as per the NASW Code of Ethics (1999), and to then not engage in this practice.

Using this option, the social worker is maximizing more values and principles than are being minimized. However, autonomy and the worth and dignity of the person are lessened by preventing the parent from making a choice on her or his own behalf, and the economic well-being of the parent may also be decreased. Despite these deficits, this option maximizes the well-being of the children, general well-being of the parent, well-being of the social worker, and well-being of the staff. The social worker’s integrity is maintained while providing quality services and acting in a trustworthy manner. Equality is not infringed upon and the quality of the human relationships is maintained. Beneficence and nonmaleficence are also supported as the social worker is endeavoring to act for the benefit of others and to do no harm (Beauchamp & Childress, 1994).

Not hiring the parents of enrolled children is also best justified utilizing consequentialist theory. In particular, a utilitarian theoretical argument can be used in which “the right act … is the one that produces the best overall result, as determined from an impersonal perspective that gives equal weight to the interests of each affected party” (Beauchamp & Childress, 1994, p.47). Therefore, failing to hire parents is acting in a manner that promotes the greatest good for the greatest number. Using this perspective, the social worker would consider everyone involved in the program, including all of the children, parents, and staff, and would act in a manner that benefits the majority. While hiring parents may benefit the few parents who are hired, it clearly has the ability to negatively impact on the majority, as in Case 1. Therefore, utilitarian theory supports the judgment that parents should not be hired.

While this alternative maximizes a number of pertinent values and principles and has a stronger grounding in consequentialist theory, it is not reflective of optimal desirability because it diminishes the values of freedom and dignity and worth of the person. In addition, using this option could jeopardize the continuation of federal funding because it would be a violation of the Head Start Performance Standards Final Rule (1996). Though this option is more acceptable than the first one proposed, it is not the best alternative available.

Case 2

The following practice case example provides an illustration of the use of Option 3 to resolve the conflict of dual relationships in Head Start. This case demonstrates how a social worker administering a Head Start program can meet the federal requirement to give parents preference for positions without jeopardizing her ethical base for practice and with minimizing the risk of negatively affecting the professional helping relationship.

The social worker administrator of an Early Head Start program had open positions which had been advertised. She was contacted by a social worker from a local, unaffiliated Head Start program as to the education and employment requirements for the position. A parent from the Head Start program, Tabatha, was then referred by the Head Start program social worker to the Early Head Start program administrator for consideration. Tabatha was a current Head Start parent, but she did not have children enrolled in the Early Head Start program that was hiring. As per the compromise solution guidelines, Tabatha was hired after a consultation process and approval by the Policy Council. The program administrator met with Tabatha regularly to support her role as a Head Start parent while also helping her to develop her professional skills. She was encouraged to remain actively involved in the child development program that her daughter attended. She was supported in dealing with issues of role conflict that arose, such as what to do when her daughter was ill and had to remain home when Tabatha was due to report to work at the Early Head Start program. Tabatha was not in a collegial relationship with her case manager, which protected that relationship, while also protecting Tabatha’s relationships with her co-workers, parents enrolled in her daughter’s program, and parents enrolled in the Early Head Start program.

Option 3

The third alternative, illustrated in Case 2, reflects a mediating course of action, recognizing that dual relationships can be harmful, while also acknowledging that hiring parents in some circumstances can be beneficial. It uses the literature to craft a viable alternative that hinges on the understanding that each situation is different and must be treated as unique. In this option, parents may be hired to work in Head Start programs, but guidelines and policies would be established to ensure that the ensuing dual relationships are neither exploitive nor harmful. Specific policies to guide practice would be established and maintained that would support the ethical conduct of the social worker rather than a blanket policy supporting or banning dual relationships. For example, one guideline could be that parents would not be employed to work in the same setting as their child. Another guideline could be that the program would hire parents from a local, nonaffiliated Head Start and that the program would refer parents interested in employment opportunities to this separate Head Start. As such, parents could still receive priority for employment without establishing dual relationships as illustrated above. As the Head Start Performance Standards Final Rule (1996) indicates that priority is to be given to former parents as well as to currently enrolled parents, staff recruitment efforts would first be aimed at former parents.

This solution maximizes all of the values and principles by virtue of the decision making process involved. Parents retain their autonomy and worth and dignity by being free to apply for the available positions as per their choice and the quality of the services is maintained by the right of the program to not hire the parent if it is not determined to be a good fit. In Case 2, Tabatha had the choice to apply or to not apply for the position, maintaining her autonomy and dignity, and the social worker administrator had the ability to determine that Tabatha would be a good fit with the program, maintaining the quality of services. Individualized decisions in hiring also serve to protect privacy, as parents who do not seem able to navigate the confidentiality issues raised by dual relationships would not be hired. As the parent would not be working in the same setting as her/his child, issues of equality are addressed, the well-being of the enrolled children is ensured, and role conflict issues are diminished. In Case 2, Tabatha did not experience the same level of personal distress over the care of her child that Yolanda did in Case 1, and, therefore, she was freer to meet the needs of the children in her care. The well-being of the parents is also supported by recognizing that employment in the program may be beneficial for some parents but not for others. Individual decisions would permit the social worker to utilize practice wisdom rather than blindly following a maxim to either hire all parents or to not hire any parents. With this alternative, human relationships would be enhanced by the value placed on the individual. In fact, Tabatha’s experience of relationships and social support was expanded by working for the Early Head Start program as she was able to maintain her friendships with parents in the Head Start program while forming new friendship and collegial relationships with her co-workers at the Early Head Start program. The overall integrity, well-being, and trustworthiness of the social worker is maintained because it is acceptable for the social worker to utilize free choice in deciding to begin or to not begin a dual relationship (Tomm, 1993).

Unlike the first two options which were best supported by consequentialist theories, this option is best grounded in deontological theory. While consequentialist theories focus on the consequences of an action, deontological theory determines that actions are right based upon principle (Reamer, 1990). Act deontological theory, particularly, supports this option by allowing for rules to be generated over time and to be based on specific situations (Frankena, 1973). With each parent applicant, such as Tabatha, new wisdom is gained as to how best to resolve this dilemma and new guidelines evolve that would continue to guide the social worker in the future. From the act deontological perspective, general rules do not take precedence over particular judgments (Frankena, 1973). Therefore, the social worker could utilize the developing base of knowledge to make decisions about hiring parents without having to follow a guideline that always prohibits hiring parents or that always compels hiring parents. From the act deontological perspective, the situation is clearly taken into consideration, and the principle that best applies to that situation is utilized (Beauchamp & Childress, 1994; Frankena, 1973). However, while taking the situation into consideration is paramount, it would also be important to build a body of policies and guidelines for the social worker to follow in the future as the major limitation of this option is that the potential for inequality exists. If parents are not treated equally, the definition of standards over time could prove to be unethical.

Clinical pragmatism also provides support for this solution by its focus on the individual and on the process used for decision-making (Tong, 1997). In this option, the attention is clearly on the individual and on deciding what is best for that particular individual rather than on what is best for parents as a group, as demonstrated by Case 2 The guidelines encourage a reflection process in making the decision rather than a reliance on following the Head Start Performance Standard Final Rule (1996) or the NASW Code of Ethics (1999) without contemplation or deliberation. This type of reflection is in sync with Mattison’s (2000) assertion that ethical decision-making involve continuous reflection and self-awareness. Clinical pragmatism also revolves around the use of consensus (Fins, Bacchetta, & Miller, 1997). In this option, consensus could be incorporated into the hiring decision process by involving the staff member who is providing case management services or the program manager, ensuring that the social worker receives guidance in coming to a determination, rather than making a unilateral decision. This step of consulting with colleagues is in keeping with Congress’s (2000) process model for the resolution of ethical dilemmas. In Case 2, the social worker administrator of the program consulted with Tabatha’s case manager after obtaining Tabatha’s consent and with members of the Early Head Start program management and staff. The Policy Council was also actively involved in making the decision regarding hiring Tabatha.

Overall, this option presents as the strongest of the three possible alternatives to resolving this dilemma in the practice situation. It is supported by ethical theory, it maximizes values and principles, and it adheres to the author’s hierarchy of values. Based on these factors, the author would choose to follow this compromise solution and would support the hiring of parents to work in programs in some circumstances provided that guidelines were developed and were utilized to ensure that the risk of harm was significantly minimized.

Conclusion

As more social workers are hired by Head Start and by other programs that hire clients or community members as staff, the issue of dual relationships will become increasingly pertinent. Through the use of an ethical model for decision-making, it is possible to determine that the compromise solution is the best option for the social worker in this situation to use in resolving this ethical dilemma. With this resolution, the social worker maintains the ability to act in compliance with federal regulations, and, thereby ensures that the program funding is not placed in jeopardy. While this solution does potentially result in the establishment of some dual relationships with parents of enrolled children, the practice of coming to individualized decisions ensures that the possibility of harm or exploitation is significantly diminished. Social workers employed by programs using this solution would need to remain vigilant as to the potential for problems when dual relationships are established and to the potential for issues of inequality if parents are not treated equally as guidelines develop over time. Overall, this decision, which is securely grounded in the ethical and practice knowledge bases, represents the best alternative for ethical practice.

References

Administration for Children and Families. (2004, April). Head Start program fact sheet: Fiscal year 2003. Washington, DC: Head Start Bureau. Retrieved from the World Wide Web on June 1, 2004 from http://www.acf.hhs.gov/programs/hsb/research/2004.htm.

Bader, E. (1994). Dual relationships: Legal and ethical trends. Transactional Analysis,24 (1), 64-66.

Bass, D. (1996). Family support across programs and populations. In G.H.S. Singer, L.E. Powers, & A.L. Olson (Eds.), Redefining family support: Innovations in public-private partnerships (pp.39-55). Baltimore, MD: Paul H. Brooks Publishing Co.

Beauchamp, T.L., & Childress, J.F. (1994). Principles of biomedical ethics (4th ed.). New York: Oxford University Press.

Bograd, M. (1993). The duel over dual relationships. The California Therapist, 5(1), 7-16.

Borys, D.S. (1994). Maintaining therapeutic boundaries: The motive is therapeutic effectiveness, not defensive practice. Ethics & Behavior, 4(3), 267-273.

Borys, D.S., & Pope, K.S. (1989). Dual relationships between therapist and client: A national study of psychologists, psychiatrists, and social workers. Professional Psychology: Research and Practice, 20(5) 283-293.

Brown, L.S. (1994). Concrete boundaries and the problem of literal mindedness: A response to Lazarus. Ethics & Behavior, 4(3), 275-281.

Congress, E.P. (1996). Dual relationships in academia: Dilemmas for social work educators. Journal of Social Work Education, 32(3), 329-338.

Congress, E.P. (2000). What social workers should know about ethics: Understanding and resolving practice dilemmas. Advances in Social Work, 1(1), 1-25.

Corey, G., & Corey, M.S., & Callanan, P. (1998). Issues and ethics in the helping professions. Pacific Grove, CA: Brooks/Cole Publishing Company.

DuMez, E., & Reamer, F.G. (2003). Discussing the NASW Code of Ethics. Families in Society, 84, 449-450.

Erara, I.P. (1991). Role conflict among public welfare supervisors. Administration in Social Work, 15(4), 35-51.

Fins, J.J., Bacchetta, M.D., & Miller, F.G. (1997). Clinical pragmatism: A method of moral problem solving. Kennedy Institute of Ethics Journal, 7(2), 129-143.

Frankel, A.J. (1997). Head Start and social work. Families in Society, 78, 172-183.

Frankena, W. (1973). Ethics (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.

Freedburg, S. (1989). Self-determination: Historical perspectives and effects on current practice. Social Work, 34(1), 33-38.

Freud, S., & Krug, S. (2002). Beyond the Code of Ethics, part II: Dual relationships revisited. Families in Society, 83, 483-492.

Gabbard, G.O. (1994). Teetering on the precipice: A commentary on Lazarus’s ‘how certain boundaries and ethics diminish therapeutic effectiveness. Ethics & Behavior, 4(3), 283-286.

Gould, B. (2002). Promoting mental health. Head Start Bulletin, 73.

Gripton, J., & Valentich, M. (2003). Making decisions about non-sexual boundary behavior. Canadian Social Work Journal, 5(1), 108-125.

Hancock, M.R. (1997). Principles of social work practice: A generic practice approach. New York: The Haworth Press.

Head Start Program Performance Standards Final Rule, 45 C.F.R. § 1304 (1996).

Herlihy, B., & Corey, G. (1992). Dual relationships in counseling. Alexandria, VA: American Association for Counseling and Development.

Hofferth, S.L. (1992). The demand for and supply of child care in the 1990s. In A. Booth (Ed.), Child care in the 1990s: Trends and consequences (pp.3-25). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.

Jones, W.T. (1984). Public roles, private roles, and differential moral assessments of role performance. Ethics, 94(4), 603-620.

Joseph, M.V. (1985). Ethical decision-making in clinical practice: a model for ethical problem solving. In C.B. Germaine, Advances in clinical social work. Silver Spring: National Association of Social Workers.

Kagle, J.D. & Giebelhausen, P.N. (1994). Dual relationships and professional boundaries. Social Work, 39(2), 213-220.

Kuntz, K.R. (1998). A lost legacy: Head start’s origins in community action. In J. Ellsworth & L. Ames (Eds.), Critical perspectives on project head start: Revisioning the hope and challenge (pp.1-48). Alabany, NY: State University of New York Press.

Kutchins, H. (1991). The fiduciary relationship: The legal basis for social workers’ responsibilities to clients. Social Work, 36(2), 106-113.

Lazarus, A.A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness. Ethics & Behavior, 4(3), 255-261.

Manning, S.S. (1997). The social worker as moral citizen: Ethics in action. Social Work, 42, 223-230.

Mattison, D., Jayaratne, S., & Croxton, T. (2002). Client or former client? Implications of ex-client definition on social work practice. Social Work, 47, 55-64.

Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45, 201-212.

National Association of Social Workers. (1999). Code of ethics of the national association of social workers. Washington, DC: NASW.

Pope, K.S., & Vasquez, M.J. (1991). Ethics in psychotherapy and counseling: A practical guide for psychologists. San Francisco: Josey-Bass Publishers.

Ramsdell, P.S. & Ramsdell, E.R. (1993). Dual relationships: Client perceptions of the effect of client-counselor relationship on the therapeutic process. Clinical Social Work Journal, 21(2), 195-212.

Reamer, F.G. (1990). Ethical dilemmas in social service (2nd ed). NY: Columbia University Press.

Reamer, F.G. (1995). Social work values & ethics. New York: Columbia University Press.

Reamer, F.G. (1998). Ethical standards in social work: A critical review of the NASW code of ethics. Washington, DC: NASW Press.

Reamer, F.G. (2000). The social work ethics audit: A risk-management strategy. Social Work, 45(4), 355-366.

Reamer, F.G. (2003). Boundary issues in social work: Managing dual relationships. Social Work, 48, 121-132.

Rothman, J.C. (1998). From the front lines: Student cases in social work ethics. Boston: Allyn and Bacon.

Schank, J.A., & Skovholt, T.M. (1997). Dual relationship dilemmas of rural and small-community psychologists. Professional Psychology, 28(1), 44-49.

Tomm, K. (1993). The ethics of dual relationships. The California Therapist, 5(1), 7-19.

Tong, R. (1997). The promises and perils of pragmatism: Commentary on Fins, Bacchetta, and Miller. Kennedy Institute of Ethics Journal, 7(2), 147-152.

U.S. Department of Health and Human Services. (1994). The statement of the advisory committee on services for families with infants and toddlers. (DHHS Publication No. 1994 – 615-032/03062). Washington, DC: U.S. Government Printing Office.

Vodde, R., & Giddings, M.M. (1997). The propriety of affiliation with clients beyond the professional role: Nonsexual dual relationships. Arete, 22(1), 58-70.

Zigler, E. (1997). Social work and Head Start: A question of quality. Families in Society, 78, 177.