ethics
ethical
social work
practice
Raise your hand if you have had a client offer you a gift.
Did you accept the gift or politely refuse it because you thought accepting the gift might complicate the boundaries in your professional-client relationship?
Brief Case
Whenever one Social Worker has to deal with any ethical issues, one can always reflect upon SASW professional ethics which can be found on www.sasw.org.sg or to discuss with their supervisor.
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C. SOCIAL WORKERS’ ETHICAL RESPONSIBILITY IN PRACTICE SETTINGS:
Social Workers do not accept goods or services from clients as payment for professional services.
There are 2 straightforward scenarios that we will look at. It’s a Yes or No response in whichever situation.
Usually, when client or family comes to me with a gift, I will explain to them the reason why I cannot accept the gift. If they insist on giving out of appreciation and not as a form of payment, I will declare the gift as this is my agency's rules & regulations to declare all gifts given to us. Then I will share the gift especially if the gift is a food item. If it is not a consumable item, this gift will be used in charity events in the company. Thus, the gift must be made known to my supervisor.
However, if the client or family came to me with monetary gifts, this has to be rejected immediately, as it won’t be right to accept any monetary gifts. I will instead suggest to them to donate to the organisation as this will also benefit the beneficiaries.
If the case of giving becomes complicated, the Social Worker may notify their supervisor to resolve the issue together. As long as the Social Worker abides by the above mentioned steps, it should be clear and concise and able to maintain the professional relationship with the clients.
What is also important is that when workers reject a client’s gift, workers should be mindful not to make their clients feel like their gifts are not good enough. Neither should the worker say no in a harsh manner. We can inform them tactfully, and that we take their gratitude to heart.
Julia Ao
Social Work Associate
Fei Yue FSC (Yew Tee)
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Firstly, the organization needs to put in place a policy on gifts & mementos, and a whistle blowing policy to ensure transparency, a framework to guide all staff in the human service sector (not just social workers) on the handling of such gifts and mementos and prevent ethical dilemmas and conflicts.
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The policy for gifts & mementos should contain the following:
a) Cash gifts regardless of amount is not to be accepted – even if it is for festive occasions, birthdays, etc. If there are concerns that clients will feel offended, staff can state that the organization policy prohibits them from receiving cash.
b) Non-cash items including mementos and tokens of appreciation exceeding $xx (say, $50 – each organization may defer) must be declared and surrendered. The organization should appoint a senior officer to decide if staff can keep the item, or surrender the item – which may be used as prizes for staff D&D. If the item is surrendered, a letter should be sent to the ‘donor’ to state the organisation’s policy, and how the item will be used.
c) Food items (eg. Chinese new year oranges, moon-cakes, even food hampers etc) should also be declared – however, these may be shared between staff and consumed as there is an expiry date on food items.
d) Meal treats – again, the Head of Department (HOD) should be informed, and if the HOD thinks that the meal could create conflict of interest, perception by other clients on favoritism or special favours for particular clients, the meals should be avoided.
e) Staff may keep items with no commercial value, eg empty CNY red packets (does not contain cash), calendars if offered by clients/vendors.
Concurrently, a whistle blowing policy should be in place so that all staff are aware all eyes are watching. Any inappropriate conduct (receiving cash and high value gifts, etc) will be reported.
These policies should be regularly communicated, especially at staff orientation for new staff. This is to ensure a high standard of practice, gain public trust – which is critical for the social service sector, and eliminate any avenues to discredit the organization.
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Jeannie Ho
Senior Manager
SAC Cluster Support
NTUC Healthcare
Spirit of Giving
Responses from social workers:
Families giving gifts to social workers is not an uncommon act. However, there is little discussion about this issue in the social work. Many thanks to the ethics committee for coming up with this question at this platform for discussion. There are pros and cons to accepting gifts from clients.
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Receiving gifts from family members is a form of Acknowledging their gratitude towards the worker, and the worker may feel appreciated in turn. However, there might be hidden agenda behind the gift giving by family members. For example, expecting to receive faster nursing home placement or financial assistance.
As humans, we are unable to read the minds of each other, hence both parties could have different interpretations of the meaning behind receiving or giving gifts. This might seem like an insignificant issue; however if not dealt carefully, it may affect the rapport built with the clients. Some might feel offended if their kindness is rejected.
Personally, I had accepted gifts such as cards, chocolates and homemade cookies during festive periods. I would like to share a couple of my personal guidelines when receiving gifts:
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Ensure that there are little or no possibilities for bribery when accepting gifts. I will only keep small gifts like cards, chocolates or homemade cookies. For example: I will not receive gifts from family members when I am in the midst of processing nursing home referrals or financial assistance for the family.
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When receiving food gifts, I will inform the family members that I will share the food with the rest of the team , the nurses, therapist, doctors or other care professionals. I will also reinforce that the gift will be declared to my superior.
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For gifts with a high monetary value, I will explain and decline politely. A smile works :)
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Jocelyn Toh
Medical Social Worker
AMK-THK Hospital
The following commentary is reprinted and adapted with the permission of Social Work Today ©. Great Valley Publishing, Co.
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The Gift That Keeps on Giving
Throughout social work’s history, practitioners have wrestled with the perennial challenge of gifts offered by clients. Clearly, some clients offer social workers gifts—often modest in value—as genuine expressions of appreciation with no ulterior motive or hidden agenda. A client may give the practitioner home cooked curry or kueh-kueh at festive times, an infant’s outfit when the counselor has delivered a baby, a framed poem that has special meaning to the client, or a piece of handmade craft at the conclusion of treatment. Typically, these gifts represent tokens of appreciation—nothing more and nothing less. The client likely would feel wounded or insulted if the professional rejected such a gift on ethical grounds.
Then there are more complicated situations involving clients who offer social workers gifts of considerable value or gifts that represent a more complex practitioner-client relationship (sometimes from the client’s view, sometimes from the practitioner’s, and sometimes from both). Relatively affluent clients—and even clients of more modest means—sometimes will feel moved to give a practitioner a gift as a gesture of pure, unadulterated generosity.
In my experience, most social workers agree that in many instances, especially when there is no evidence of ulterior motives that may lead to egregious boundary violations, practitioners may keep gifts of minimal value and emotional significance. As a matter of policy, some social service agencies permit workers to do so, particularly when the gift is one that can be shared among colleagues, although they may stipulate that staff members must thank the clients on behalf of the agency. This protocol can defuse the interpersonal dynamic and potential boundary confusion between the client and practitioner; depersonalizing the transaction may help staff members avoid complicated boundary issues.
Social workers face unique challenges when they receive gifts that appear to have no ulterior motive but could introduce complex boundary issues. Sometimes clients may not be consciously aware of the emotional meaning and significance—and the mixed messages and complications—that may be attached to a gift. Social workers sometimes face a difficult choice in these situations; the decision to reject a gift can have significant clinical repercussions because the client may feel hurt, wounded, humiliated, or guilty and the decision to accept a gift may trigger boundary issues that complicate and reverberate throughout the clinical relationship.
Ethical Judgments
In such circumstances, social workers are wise to obtain sound consultation and supervision to think through how best to handle the client’s gesture, including assessing the meaning behind the gift, ethical and clinical implications, potential responses and related consequences, and any risk management issues (e.g., related to potential ethics complaints and lawsuits). It is critically important to document the client’s gift and any related consultation and supervision to protect both the client and practitioner.
In their book Preventing Boundary Violations in Clinical Practice, Thomas Gutheil and Archie Brodsky encourage practitioners to carefully consider several key criteria when deciding whether to accept a gift from a client:
• Monetary value of the gift: Inexpensive gifts are more likely than expensive gifts to be mere expressions of appreciation or personal consideration, although their potential symbolic meanings still must be considered.
• Handmade vs. purchased gifts: If a client makes the social worker a ceramic bowl as an expression of appreciation, it may be best to accept the gift while exploring its meaning. A client may be especially upset by the rejection of his or her own handiwork. At the same time, the clinical significance of such a gift is that it was made with the social worker in mind and therefore could be saturated with personal meaning and active fantasies, including perhaps the assumption that the gift would be accepted coupled with fear that it would not be. Thus, a handmade gift is all the more to be appreciated and all the more to be understood.
• Characteristics of the client: The clinical and ethical calculus with respect to giving or receiving gifts is different when the client is a child. Likewise, since gifts have different meanings in different cultures, the client’s cultural background is another contextual factor to be evaluated. The nature of the client’s unique clinical profile and challenges is also a factor. Managing gifts offered by clients who struggle with boundary issues in their personal lives can be especially complex.
• Type of therapy or relationship: Where the contract between a social worker and client does not limit their interaction to words, a gift is not necessarily a breach of contract. In contrast, when a social worker is in a position of authority (e.g., a social worker who serves as a client’s probation or parole officer), it would not be appropriate to accept a gift, which could take on the appearance of a bribe even if it is offered innocently.
• Appropriateness of the type of gift: A home cooked curry generally is regarded as innocuous. Likewise, books or articles relevant to the clinical relationship may be appropriate when offered in a spirit of mutual interest or simple goodwill. At the other extreme, sexually suggestive gifts are clearly inappropriate.
• Stage of relationship: Early in the professional relationship, considerations of trust and therapeutic alliance building may argue for accepting a gift, at least provisionally, in marginal cases. On the other hand, early in the relationship it is also critical to establish and maintain a therapeutic frame strong enough to withstand the client’s wishes, fantasies, or bribes. Gifts at termination also raise special issues.
• Red-flag contexts: Anything out of the ordinary about the situation in which a client offers a gift should be documented and explored, and usually will rule out accepting the gift. Any circumstances indicating an expectation of a quid pro quo (a return of a gift or favour) also change the nature of the gift.
In Conclusion
Whenever a social worker seriously considers accepting a gift or favour from a client, of whatever value or tangibility, the practitioner should consult with thoughtful colleagues and supervisors, when feasible. The clinical and ethical implications should also be critically examined, including current ethical standards and agency policy, the client’s and practitioner’s motives, and any alternatives. The social worker should carefully document in the case record the client’s offers, the process the practitioner used to make the decision (e.g., relevant consultation and review of the SASW Code of Ethics), the nature of the decision, and the rationale. This documentation can prove to be enormously helpful if the client or some other party raises questions about the appropriateness of the practitioner’s judgment.
Commentary
