ISSUE NUMBER 7 • FALL 2020

The Compliance Toolkit is a regular feature of the Board Bulletin that will provide you with tools for handling common ethical dilemmas and issues related to the Standards of Practice found in the Minnesota Social Work Practice Act. Consider the following scenario:

I am licensed independent clinical social worker (“LICSW”) working for a small agency providing individual therapy to adults and adolescents. With the pandemic, I am exclusively meeting with clients via video conferencing using my cell phone. In sessions with some of my adolescent clients, I have noticed they are occasionally in a communal space in their home, like a kitchen, and I can hear other people in the background. I am concerned about confidentiality and am not sure what to do.

Also, some of my clients have temporarily left Minnesota and are staying with family in other states. Am I able to continue seeing these clients via video conference or phone while they are in another state?

Informed Consent and Confidentiality

Earlier this spring, things changed dramatically and quickly for all of us. While many providers may have found it relatively easy to shift from in-person services to electronic services, there may not have been time to consider important factors regarding electronic practice. Minnesota Statutes section 148E.230, subd. 1, requires licensed social workers to “obtain valid, informed consent, appropriate to the circumstances, before providing services to clients.” Even if you have been providing services via electronic means for months, it is not too late to take the time to review the verbal and written information you provide to clients about electronic practice. Consider whether the documents and scripts you have relied on in the past continue to be the best approach. Here are some helpful questions to ask:

• Do you provide clients an alternative to meeting via phone or video?
• Do you let the client choose what method of technology to use?
• Do you explain how electronic data is stored and shared?
• Do you have a dedicated device for work with clients?
• How do you ensure you are maintaining a confidential space while using electronic means?
• What expectations do you set with the client around contacting you outside scheduled appointments, such as via phone or text message?
• Do you have a backup plan if the technology fails during a session?
• How do you document services provided and are those records secure?

In the situation described above, it is a concern that the licensed social worker is using a personal cell phone, particularly if others may sometimes have access to use or view the information on the phone. Using the same phone for personal and business creates a risk to client confidentiality (148E.230, subd. 3) and professional boundaries (148E.220). Electronic practice inherently raises these risks because technology has the potential to make the licensed social worker more available and the licensed social worker may not have complete control over the data exchanged and disseminated over third party platforms. It may be helpful to consult with other licensed social workers engaged in a similar practice setting or with legal counsel to ensure clients are effectively informed and their data is secure.

Many people, including clients, are at home more than ever, including for school and work. This could mean that the client is rarely in the home alone. If you have a client who has a living situation where they struggle to find a confidential space to meet with you, consider discussing the issue directly with the client. Perhaps you and the client can brainstorm a place within the home that provides more privacy. Perhaps providing an appointment at a different time of day would allow the client to be in a confidential space. This is another area where consultation with other licensed social workers could provide valuable insight and ideas. Minnesota Statutes section 148E.200, subd. 1(b) specifically notes the importance of consultation and supervision about providing social work services through electronic means.

Providing Social Work Services across State Lines

When a Minnesota licensed social worker  provides social work services to a client located in another state, the Minnesota licensed social worker may also need to be licensed in the other state, even if the client is only planning to be in that state temporarily. Due to the long-running states of emergency in many states caused by the COVID-19 pandemic, some states have made changes to their regulations to facilitate electronic practice across state lines. The Association of Social Work Boards (ASWB) is keeping an updated list of regulatory changes during the state of emergency across the country. Licensed social workers providing services to clients in other states are obligated to ensure they are in compliance with that state’s regulations.

Key Takeaways

• Review written policies and procedures and ensure they fit your current practice (if not, update them!)
• Review the written information you provide to clients about your services and verify that your clients understand the expectations and limitations of electronic practice
• Review best practices for electronic social work practice (Electronic Practice Reports on the Board’s website) and consult with other licensed social workers or legal counsel
• If your clients are outside Minnesota, be sure you know the regulatory requirements in the other state(s)