Dual relationships in child welfare practice: A framework for ethical decision making

Children and Youth Services Review 32 (2010) 1437–1445

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Children and Youth Services Review j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c h i l d yo u t h

Dual relationships in child welfare practice: A framework for ethical decision making Eliot Brenner a,⁎, Diane Kindler a, Madelyn Freundlich b a b

Casey Family Services, United States Excal Consulting Partners, New York, United States

a r t i c l e

i n f o

Article history: Received 17 February 2010 Received in revised form 23 June 2010 Accepted 23 June 2010 Available online 1 July 2010 Keywords: Ethics Dual relationships Advocacy Permanency Permanency planning

a b s t r a c t This article provides guidelines for ethical decision making with regard to two professional boundary issues that arise in child welfare practice: the extent to which child welfare social workers should be considered as permanent family resources for children in foster care; and the extent to which child welfare social workers should engage clients in presentations for public audiences, advocacy on child welfare issues, and technical assistance to agencies desiring to strengthen their child welfare practices. The authors illustrate the guidelines with case examples. © 2010 Elsevier Ltd. All rights reserved.

1. Introduction Since the 1980s, the social work literature on ethics has significantly expanded. Attention has focused on ethical challenges in practice and the development of protocols for ethical decision making (Reamer, 2003). As the growing body of literature makes clear, one of the most challenging ethical issues for social workers relates to professional boundaries (Dietz & Thompson, 2004; Jayaratne, Croxton, & Mattison, 1997; Kagel & Giebelhausen, 1994; Mayer, 2005; Pugh, 2007; StromGottfried, 1999). Authors have defined professional boundaries as “the limits that allow for a safe connection based on the client's needs” (c.f., Peterson, 1992, p. 74). Professional boundary issues for social workers who work in the field of child welfare have received only limited attention. The principal focus of the scant literature has been on professional boundaries in connection with the mandatory reporting of and response to cases of incest (Anderson, 1999; Serrano & Gunzburger, 1983). To date, the literature has not addressed two key professional boundary issues that arise in child welfare practice: (1) the extent to which child welfare social workers should be considered as permanent family resources for children in foster care; and (2) the extent to which child welfare social workers should engage clients in presentations for public audiences, advocacy on child welfare issues, and the provision of technical assistance to agencies desiring to strengthen their child welfare practices. These issues are important because (a) there is dearth of permanency resources for many youth in the foster care system and the ⁎ Corresponding author. Casey Family Services, 127 Church Street, New Haven, CT 06510, United States. Tel.: + 1 203 401 6903; fax: + 1 203 401 6878. E-mail address: [email protected] (E. Brenner). 0190-7409/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2010.06.023

strongest resources are often individuals whom the youth already know, and (b) youth and parents are often the strongest and most influential advocates for reforming the child welfare system. Casey Family Services, the direct services agency of the Annie E. Casey Foundation, is a multi-service child welfare agency that provides foster care, permanency planning, and family preservation and support services to more than 4,000 children annually in six northeast states and Maryland. Recognizing the need for clear guidance for direct service staff in both of these child welfare professional boundary areas, the agency developed guidelines to assist staff in ethical decision making. This article begins with a brief description of ethical issues involving professional boundaries in the social work profession. It then outlines the process that Casey Family Services used to develop its guidelines for ethical decision making regarding child welfare staff becoming permanent family resources for children in its foster care program and staff engagement of clients and foster parents in training, advocacy, and technical assistance activities. The article then provides the specific guidelines that Casey Family Service has developed and applies these guidelines to illustrative case examples. 2. Literature review: The framework for assuring appropriate professional boundaries As Dietz and Thompson (2004) point out, the need to maintain appropriate professional boundaries in the helping professions is grounded, at least in part, in concerns about a power differential between the client and the professional. The nature of the social work relationship inherently brings these concerns into focus because it is, in effect, comprised of two relationships: a fiduciary relationship and a therapeutic relationship (Johner, 2006). As a fiduciary, the social

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worker is expected to practice with integrity and in accordance with professional standards of conduct. The National Association of Social Workers (NASW) Code of Ethics (2008) explicitly recognizes integrity as one of the six values that frame the ethical practice of social work. The NASW Code provides as a key principle that social workers behave in a trustworthy manner, acting honestly and promoting ethical practices. The fiduciary relationship between social worker and client acknowledges that the social worker holds greater power and responsibility than the client and requires that the social worker does not abuse that power (Kutchins, 1991). In the therapeutic relationship between the client and social worker, clients also are vulnerable to the social worker's influence (Kagel & Giebelhausen, 1994), further underscoring the power differential and the importance of social workers' ethically using their greater power in the relationship. Professional boundary issues generally involve circumstances in which social workers face conflicts of interests—either real or perceived— between their professional duties and other relationships. These boundary issues are often referred to as dual or multiple relationships. Kagel and Giebelhausen (1994) state that “a professional enters into a dual relationship whenever he or she assumes a second role with a client, becoming social worker and friend, employer, teacher, business associate, family member or sex partner” (p. 213). The NASW Code of Ethics states that “dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively” (Standard 1.06c). In Standard 1.06c, the NASW Code of Ethics states: Social workers should not engage in dual or multiple relationships with clients or former clients in which there are risks of exploitation or potential harm to the clients. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. As the NASW Code recognizes, there are different types of dual relationships. Some dual relationships are inherently unethical and should always be avoided (Reamer, 2003). The NASW Code of Ethics (2008) explicitly prohibits sexual relationships between social workers and clients. Other types of dual relationships also may be unethical. These dual relationships typically have one or more of following characteristics: they interfere with the exercise of professional discretion and impartial judgment; they exploit clients to further the social worker's personal interests; and they harm clients, colleagues or third parties (NASW, 2008; Reamer, 2003). Some dual relationships do not involve these issues. Some, for example, cannot be avoided (Reamer, 2003), such as a social worker who joins a new church and finds that one of her clients sings in the choir. Other dual relationships are more nuanced. It is these types of dual relationships that require careful consideration to determine whether the dual relationship is one that should be avoided or one that involves circumstances into which a social worker, with appropriate precautions, might enter (Reamer, 2003). These types of dual relationships may involve value conflicts and require that the social worker balance professional boundaries and practice values related to achieving the best outcomes for clients (Strom-Gottfried, 2008). Some ethical issues that arise in the practice of child welfare have been addressed in the NASW Standards of Social Work Practice in Child Welfare (2005). These Standards are grounded on the principle that “social workers in child welfare shall demonstrate a commitment to the values and ethics of the social work profession, emphasizing client empowerment and self-determination, and shall use the NASW Code of Ethics (2008) as a guide to ethical decision- making”. The Standards for Social Work Practice in Child Welfare, however, do not address the two ethical issues that are the focus of the Casey Family Services guidelines: to what

extent social work staff should be allowed to be permanent families for children in foster care and under what circumstances social workers may engage clients and foster parents in presentations, advocacy, and technical assistance activities. To the best of our knowledge, these issues likewise are not addressed in state laws or regulations. 3. Development of the Casey Family Services guidelines Casey Family Services began to develop guidelines for ethical decision making in 2006 following a complaint lodged against an agency staff member after she asked a parent to assist her child's former therapist in making a child welfare conference presentation. The presentation did not reveal any personal or confidential details about the child or the parent. The state asserted that the prohibition against dual relationships with clients exists “in perpetuity” and requested that the social worker complete 12 months of supervision concerning boundary issues. After this incident, the agency recognized that neither it, the state, nor the NASW professional code of ethics addressed the issue of staff involving clients in conference presentations and advocacy. The agency determined that it needed to develop guidelines for staff on involving clients in such activities. At the same time, the agency was in the process of implementing an organization-wide change to ensure that children and youth in the agency's care achieve family permanency through reunification, adoption, guardianship, or permanent placements with relatives. With the emphasis on finding permanent families for the children and youth in its care, the agency recognized that circumstances may arise when agency staff members may be considered the best family permanency option for certain children and youth. Casey decided that guidelines were essential in such circumstances. Knowing that it needed to address these two issues, Casey Family Services carefully reviewed relevant professional codes of ethics, practice standards, and federal and state laws and regulations for any guidance. The NASW Code of Ethics (2008) provided the strongest foundation for the guidelines but did not offer direct assistance on the professional boundary issues of concern. Casey Family Services staff engaged in a series of discussions and drafted a set of guidelines that were reviewed by Dr. Frederic Reamer, professor in the graduate program of the School of Social Work, Rhode Island College and a leading social work ethicist; and three attorneys, one who specializes in child welfare law and policy, one who litigates claims against psychotherapists who breached professional ethics in their work with clients, and one who specializes in human resources issues. The guidelines were revised based on these reviews and then were further reviewed and refined through discussion with agency leadership. The guidelines were finalized in 2007. In developing the guidelines, Casey Family Services was careful to note that “if there are state or professional regulatory standards for staff that prohibit them from serving as permanency resources or participating in conferences, advocacy events, or technical assistance with current or former clients, then such standards shall supersede this policy.” 4. The scope of the Guidelines for Dual Relationships and Strategic Sharing In its Guidelines for Dual Relationships and Strategic Sharing, Casey Family Services states that “dual relationships” occur when a direct service staff member is or has been in a professional role with a client and: • At the same time is in another role with the client, or • At the same time is and has been in a relationship with a person closely associated with the client, or • Has an interest in entering into another relationship in the future with the client (American Psychological Association, 2002; National Association of Social Workers, 2008).

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Consistent with the NASW Code of Ethics, Casey Family Services recognizes that dual relationships can occur simultaneously or consecutively. In its introduction to the guidelines, Casey Family Services (CFS) states that it is “committed to managing boundary and dual relationships issues in a manner that protects clients and relevant third parties, consistent with prevailing ethical standards in the human services. Casey Family Services (CFS) guidelines are designed to avoid conflicts of interest that cause harm.” Further, the agency emphasizes in its introduction that staff are encouraged to maintain healthy boundaries with clients and foster parents. The agency makes clear staff's obligation to be cognizant of the power differential between staff and clients and foster parents and at all times to maintain appropriate limits and boundaries in these relationships. The guidelines specifically state that “any staff conduct that is exploitative, deceptive, manipulative, or coercive is unacceptable.” The agency directs staff with questions about appropriate limits and boundaries to consult their supervisors. In this section of the article, we present Casey Family Services guidelines and then illustrate with case examples that have been developed to demonstrate how the guidelines might be applied. First, we present information on dual relationships and permanency planning. Second, we provide information on engaging clients in presentations, advocacy activities, and technical assistance. 4.1. Dual relationships and permanency planning Child welfare agencies are charged with achieving permanency for each child in out-of-home care, through safe reunification with parents, adoption, guardianship, or permanent placement with relatives. The federal Adoption Assistance and Child Welfare Act of 1980, also known as P.L. 96-272, mandated that assessment, planning, and permanency be fully implemented as core elements in child welfare practice (Maluccio, Fein, & Olmstead, 1986). The Adoption and Safe Families Act (ASFA) of 1997, among other things, strengthened time limits within which children in foster care should be placed with permanent families and enacted a system of accountability for child welfare services. The Fostering Connections to Success and Increasing Adoptions Act of 2008 created new supports for adoption and relative guardianship as permanency options for children in foster care. Child welfare agencies across the United States report challenges in securing and supporting permanent family living arrangements for children exiting foster care, especially older children, children from minority groups and children with disabilities (U.S. Department of Health & Human Services, 2005). These challenges exist in achieving adoption as well as other permanent family outcomes such as guardianship and placement with relatives (U.S. Department of Health & Human Services, 2005). State agencies and community programs often cite a lack of adoptive and other permanent families as a major challenge in achieving permanency for older youth in foster care (Landsman & Malone, 1999; Macomber, Scarcella, Zielewski, & Geen, 2004; Tello & Quintanilla, 2003; Winkle, Ansell, & Newman, 2004); children of minority ethnic origin (Roberts, 2002; Smith & Devore, 2004; Thoburn, Norford, & Rashid, 2000); and children with disabilities (Cousins, 2005; National Council on Disability, 2008; Pineles, 2005). Experience has taught that the strongest permanency resources for older youth are often individuals whom they already know, such as teachers, caregivers, and other adults in their lives (McRoy & Madden, 2008). In response to the challenges in recruiting permanent families for these children and youth, a growing number of child welfare agencies have begun to consider the possibility of finding permanent families in the professional relationships that children and youth in foster care already have. This work requires an understanding of the ethical issues related to dual relationships while, importantly, a firm commitment to placing priority on children's needs for permanent families. In a report from the 2003 National Youth Permanence Convening, participating professionals recommended that adults whose relationships with youth

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begin on a professional basis should not be ruled out as permanent family resources for children and youth for whom families have not been identified. They urged that policies regarding dual relationships, which are designed to protect children, not be a barrier to considering adults in the child's life who may be their only option for permanency (National Youth Permanency Convening, 2003). With its internal organizational change, Casey Family Services implemented policies and practices to promote the timely achievement of family permanence for the children and youth in its foster care program. Social workers began intensive work to identify permanent family resources for each child and youth in their caseloads, working with permanency teams consisting of the child or youth, parents, foster parents, service providers, the social worker and other important individuals in the child's or youth's life. In the course of that work, the agency recognized that in the permanency planning process for a child or youth in the agency's care, the social workers responsible for planning for the child may identify former or current agency staff members as potential permanent family resources. Casey Family Services' practice is to avoid dual relationships between staff and clients but, at the same time, the agency is aware that for some children and youth, the search for a permanent family and lifelong connection may identify an agency staff member as the best possible permanency resource. These situations raise value conflicts that must be resolved: the value of maintaining professional boundaries as the staff member assigned to a case and the value of ensuring that each child and youth in foster care has a permanent, committed family. In cases where an agency staff member or another professional involved in the child's life, such as the child's psychotherapist, wants to establish a permanent relationship with a youth and the youth also wants this connection, the agency (adhering to the value of permanence for the children and youth in its care) makes all reasonable efforts to consider these individuals, carefully weighing all relevant ethical issues. 4.1.1. Agency staff Under the Casey Family Services guidelines, the appropriateness of identifying and moving forward with an agency staff member as a permanent resource for a child in the agency's care generally depends on three factors: • The type of case: This factor refers to whether the case is a reunification, adoption (parental rights already terminated), or foster care (no family involvement or plans to reunify and parental rights not terminated) case. The nature of the agency's responsibilities to children and youth, parents, and extended family will differ depending on the type of case. • The role of the agency staff member: This factor refers to whether the staff member has responsibility for the case, specifically for planning and decision making. When an agency staff member is directly involved in planning and decision making for the child, there are likely to be ethical concerns related to the individual's involvement as a permanent family resource. • The geographic assignment of the agency staff member. Casey Family Services has direct service divisions throughout New England and in Maryland and as a result, one factor in considering the appropriateness of a staff member as a permanent family resource for a child in the agency's care is whether the interested staff member works within the division with responsibility for the child. Employment by the division that is charged with planning and decision making for the child or youth may raise ethical concerns regarding the staff member's involvement as a permanent family resource. At the same time, the agency recognizes that the child welfare staff in the division that serves the young person are the adults that the youth already knows and may be the most likely permanency resources for him or her. These three factors provide a framework for ethical decision making as summarized in Table 1. The agency, however, makes clear that “there is no absolute answer as to whether, in a particular case, a

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Table 1 Considerations of Casey Family Services staff as permanent resources: general guidelines. Staff member's status

Permanency plan for the child Reunification (as concurrent plan)

Adoption (termination of parental rights [TPR] completed)

Foster care (reunification/adoption not goals; goal is guardianship or permanent connection)

Current agency social worker for the child

No

Former agency social worker for the child

No

Another agency social worker in the service division Another agency social worker in another service division Non-social worker in the service division Non-social worker in another service division

No

Yes, if the social worker was not involved Yes in planning for TPR Yes, if the social worker was not involved Yes in planning for TPR Yes, if no involvement pre-adoption Yes

If a relative, may be appropriate Yes

Yes

No Yes, if no involvement pre-adoption If a relative, may be appropriate Yes

Yes Yes

Casey Family Services staff member will or will not be appropriate as a permanent resource; however, these are general considerations that can guide the assessment”. The Casey Family Services guidelines state that supervisors must assess the boundary issues involved in permanency planning. This approach is consistent with the vital role of supervisors in modeling, coaching, and engaging staff in discussion about appropriate boundaries in the social worker and client relationship (Handon, 2009). When the permanency plan for a child in the agency's care involves a former or current agency staff member, the division director or deputy division director has final approval of the permanency plan. When necessary, the agency's ethics committee reviews the permanency plan. The ethics committee is comprised of the agency's director of clinical services, a member of the agency's executive committee, a division director or deputy division director, two supervisors, and one outside consultant who is knowledgeable in social work ethics. The following two cases provide examples of how an agency might apply the Casey Family Services guidelines in assessing the appropriateness of a staff member becoming the permanent family resource for a child in the agency's care. 4.1.1.1. Alana and Abigail. Astrid is a social worker for a private child welfare agency. Astrid's two nieces, Alana and Abigail, entered foster care at ages 11 and 13. Astrid immediately approached the public child welfare agency about having Alana and Abigail placed with her. After the girls were initially placed with unrelated foster parents, the state child welfare agency approved Astrid as a relative foster parent and placed the two girls with her. The state agency worked with the girls' mother, Ingrid (Astrid's sister) toward reunification but little progress has been made over the past 12 months. The state agency has now referred the case to the private agency for permanency planning. There is no other private agency in the community that provides permanency planning services. Astrid continues to be the girls' caregiver, but is not their private agency social worker. Astrid believes that because of substance abuse issues, Ingrid will not be able to parent the children again. She wants to adopt them or become their legal guardian. In an ideal world, the private agency would be able to decline the referral of Alana and Abigail and work with the public child welfare agency to refer the case to another agency in the community that provides permanency planning services, avoiding dual relationship issues altogether. In this case, however, the agency is the only private child welfare agency in the community that does this work. Applying the Casey Family Services' guidelines, the agency would consider three factors: 1. The type of case. Although it appears that little progress has been made toward reunification, the case continues to have reunification as the permanency goal. The goal could conceivably change within a few months as federal law requires that the permanency goal be changed to adoption and a petition to terminate parental rights be filed when children have been in foster care for 15 of the most recent

22 months unless certain exceptions are met. If the public child welfare agency follows this mandate, the permanency goal for Alana and Abigail could change to adoption in three months. However, because the permanency goal continues to be reunification, it is important to examine carefully the ethical issue presented by Astrid's dual social worker and caregiver positions. 2. The role of the private agency social worker: Astrid is a social worker for the agency but does not have responsibility for the case in terms of planning or decision making. Nonetheless, she has professional— and in all likelihood personal—relationships with the social workers who have responsibility for the case. As a result, she has a level of access and potential influence that may be significantly greater than other caregivers may. 3. The geographic assignment of the staff member: Astrid is working in the same office as the social workers with responsibility for the case. Because this case is a reunification case, at least for the time being, there are greater limitations on the consideration of Astrid as a permanent family resource for Alana and Abigail because of the potential (either real or perceived) for conflicts of interest. Reunification is an active goal for the girls, and concurrent planning efforts that support adoption or guardianship with Astrid would not be appropriate. Even the appearance of such efforts during the reunification process may suggest that the legal mandate of “reasonable efforts” to reunify the girls and their mother are not being made – which can subsequently present legal problems. If the decision is made to end efforts to reunify and pursue adoption or legal guardianship for the girls with Astrid, Ingrid could contest the termination of parental rights on the grounds that reasonable efforts were not made to reunify her with her children because Astrid was the preferred resource from the outset. Perceptions of unfairness in permanency planning that gives preference to the private agency's staff members also has the potential of undermining the credibility of the agency in the community. With these considerations in mind, the agency might advise Astrid that reunification continues to be goal for Alana and Abigail and that she is expected to support this plan as the agency expects of any other caregiver in these circumstances. The agency might consider creating firm boundaries on the discussion of the case between the social workers with responsibility for planning for the girls and Astrid, limiting discussions to issues that are integral to Astrid's caregiving role. Astrid's supervisor can play a vital role in supporting Astrid in this complex situation, providing her with support in navigating her role in the girls' lives. 4.1.1.2. Jake. Jake, now age 14, has been in foster care with a private child welfare agency since he was 11. He has lived with the Smith family the entire time that he has been in foster care with the agency. The state agency terminated the rights of Jake's parents last year. Originally, the plan was to move forward with adoption by the Smiths, and Jake's social

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worker, Alvin, has been working closely with Jake and the Smiths on this plan. Three months ago, however, Mr. Smith had a massive heart attack, and his recovery is going slowly. The Smiths love Jake but now feel that they cannot adopt given Mr. Smith's tenuous health. Jake is hurt, angry and confused and has turned more and more to Alvin. Alvin, in turn, has found that his relationship with Jake has deepened into a significant personal relationship. Alvin, a divorced dad of two adult children, believes that he can be the dad that Jake needs. An agency utilizing the Casey Family Services' guidelines would consider three factors: 1. The type of case. In this case, the rights of Jake's parents were terminated by the state child welfare agency and the goal for Jake is adoption. Alvin, the social worker, has worked to support Jake's adoption by the Smiths but the plans for adoption have unraveled as a result of circumstances outside the control of the Smiths, Jake, and Alvin. 2. The role of the private agency social worker: Alvin is the current social worker for Jake but was not involved in planning for or pursuing the termination of parental rights. 3. The geographic assignment of the staff member: Alvin is stationed in the office with responsibility for Jake's case. Jake's case does not involve the complex reunification issues that arose in the case of Alana and Abigail. In this adoption case, there is no real or perceived conflict of interest involving the private agency social worker. Alvin was not involved in the termination of parental rights planning and his work to date has been focused on supporting Jake's adoption with the Smith family. At this point, however, Jake is at a very vulnerable point in his life. He has lost the opportunity to have a permanent family with the Smiths with whom he has lived for three years—and who he expected to be his “forever family”. Jake has turned to an important and consistent person in his life—his social worker— for support and help in understanding what has happened. Jake's emotional dependence on Alvin has grown, and Alvin has responded to Jake's needs professionally and to a growing extent, personally. Alvin has now begun to identify himself as the appropriate adoptive father for Jake. In this situation, the agency may wish to view the issue of a dual relationship with a focus on the clinical issues that may need to be addressed. Alvin is convinced that he can be the adoptive father that Jake needs. What is Jake feeling that he needs now from Alvin? Does he need a social worker who can help him make sense of his loss and grief? Does he need Alvin to step up and take the place that Ms. Smith was to hold for him? 4.1.2. Other professionals In some cases, another professional involved in the child's life, such as the child's psychotherapist, may step forward in the permanency planning process and express interest in serving as the permanent family resource for the child. The Casey Family Services guidelines state that in such cases, the individual's interest and the appropriate next steps should be assessed in relation to the: • Type of case (reunification, foster care, or adoption), and • Best practices in child welfare and human services regarding the appropriateness of any individual as a possible permanent resource for the child (as an adoptive parent, guardian, mentor or other permanent resource) The following case illustrates how the Casey Family Services guidelines might be applied in such a case. 4.1.2.1. Millie. Millie, age 12, has been in foster care with the agency for 18 months. A permanency team has been convened to work together to plan the best permanent family arrangement for Millie. Her permanency team consists of Millie; the state child welfare agency social worker, Dan; the private agency social worker, Donna; Millie's mom and dad, Elaine and Tom; Millie's foster mother, Hallie;

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and Millie's psychotherapist, Suzanne. Reunification is the permanency goal for Millie within a concurrent planning framework in which adoption is the goal for Millie if reunification cannot be achieved. Suzanne has been working with Millie in weekly individual sessions for the last 12 months. Suzanne is an active participant on the team, providing Millie with support and helping other team members to understand Millie's strengths and needs. Reunification efforts have not progressed as hoped. Elaine and Tom have serious marital problems that include domestic violence. After a team meeting in which Elaine and Tom acted out their intense anger with one another, Suzanne pulled Donna, the private agency social worker, to the side. Suzanne told Donna that she strongly believes that Millie cannot be safely reunited with her parents and that she wants to adopt Millie. Applying the Casey Family Services guidelines, the agency would consider two factors: 1. The type of case. Millie's permanency goal is currently reunification. At this point, adoption has been identified as the alternate permanency goal should reunification no longer possible. The team, however, has not recommended to the court that the goal be changed to adoption nor has the court changed the goal to adoption. 2. Best practices in child welfare and human services regarding the appropriateness of any individual as a possible permanent resource for the child. Suzanne, as Millie's therapist over the past year, knows Millie well. She understands Millie's strengths and needs. Millie sees Suzanne as a source of support. Much more would need to be known about Suzanne in assessing her appropriateness as a permanency resource for Millie. For example, Suzanne's emotional involvement in the outcome of Millie's case suggests that she may not be able to distinguish between her own wishes and what is best for Millie. This case involves a reunification plan within a concurrent planning framework in which adoption has been identified as “Plan B.” Reunification remains the goal after 18 months of work with Elaine and Tom, despite ongoing problems associated with domestic violence. Suzanne, as Millie's therapist, is an “expert”: she understands Millie and can educate others on the team about Millie's strengths and needs. She also holds a special place in Millie's life as a vital support. These circumstances present the possibility of a conflict of interest—either real or perceived. As long as reunification remains an active goal, working with Suzanne as a viable alternate permanency resource may lead to perceptions of unfair advantage. Elaine and Tom may see themselves at a disadvantage because Suzanne seems to have a better understanding of Millie than they do. They may see Suzanne as positioning herself to greater advantage because she is a professional and can easily communicate with social workers, the court, and others. They may believe that her voice carries the authority and weight that their voices do not. If the agency chooses to move forward with Suzanne's interest in adopting Millie, Elaine and Tom could contest a termination of parental rights based on the failure of the agency to use “reasonable efforts” to reunite them with Millie, having preferred Suzanne all along. In this case, the agency might wish to assess Suzanne's role as the ongoing therapist for Millie and her role on the permanency team. Of concern is the potential conflict of interest that Suzanne may have: on the one hand, serving as Millie's therapist and supporting Millie in making the best decisions for her and on the other hand, having a personal interest in parenting Millie. Assigning Millie a new therapist, however, may cause Millie to experience significant loss and grief and may negatively impact her therapeutic progress. Should Suzanne continue as Millie's therapist, the agency may wish to consider whether and, if so, how Suzanne will participate on the team. Work may need to be done with Suzanne individually to assist her in understanding and fulfilling an appropriate team member role.

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4.2. Client participation in conference presentations, advocacy events, and technical assistance Over the past decade, there has been a growing recognition of the importance of listening to the voices of individuals who have had direct experience with the child welfare system. Youth engagement generally has been defined as “involving young people in the creation of their own destinies,” and in the field of child welfare, as genuinely involving young people in foster care in planning for themselves and advocating for themselves and others in the foster care system (Pittman, n.d.). The concept of youth engagement has emerged in recent years as a leading-edge, broad-based approach and best practice to meet the needs of vulnerable youth, including youth in foster care (Strangler & Shirk, 2004). Youth engagement is a process that offers meaningful participation for youth and opportunities for youth to take responsibility and leadership while working in partnership with caring adults who value, respect and share power with them (Trillium Foundation, 2009). The concept of strategic sharing has emerged as a process by which youth in foster care share personal experiences to educate, influence and inspire others, and make a difference for the young people who succeed them in foster care. It is a process that helps ensure that when they share their experiences, young people will not feel manipulated or exploited or experience harmful consequences (Foster Care Alumni of America, n.d.; Casey Family Programs & Foster Care Alumni of America, n.d.). Greater attention also has been given to engaging, educating, and organizing parents of children who have entered foster care. Some of the activities in which parents engage include public hearings, conferences and forums, professional education, and meetings and public events to inform practitioners and policy makers about the needs of families who come into contact with the child welfare system (Child Welfare Organizing Project, 2010). Likewise, there has been growing recognition of the importance of hearing the voices of foster parents as child welfare agencies assess the quality of services they provide and the outcomes they achieve for children and families. As with young people in foster care, strategic sharing is a vital concept for parents, other family members and foster parents. The Casey Family Services guidelines address three specific situations in which dual relationships with agency clients—youth and families—may occur: conference presentations, advocacy events, and technical assistance. The guidelines address the potential benefits and risks in these types of dual relationships. As benefits, direct service staff may be able to provide clients with opportunities to develop in new ways and to explore new aspects of their abilities and skills. Their voices and perspectives can greatly enhance the agency's ability to influence best practices in the field of child welfare. On the other hand, the agency's clients are vulnerable children, youth, and families and it is essential that careful attention be given to the potential for harm or exploitation. The guidelines expressly state that “ethical practice requires that when dual relationships occur we take steps to protect clients, ensure clients' understanding of the risks and benefits of the activities that are being discussed, and set clear boundaries.” Similarly, the agency recognizes potential boundary issues when foster parents are asked to participate in conference presentations, advocacy events, and technical assistances. Clear boundaries with foster parents are essential because foster parents consult with direct service staff and receive different forms of assistance from the agency. The guidelines provide that “at minimum, staff should inform foster parents of travel arrangements and stipends in advance and should make clear to foster parents that they may decline invitations to participate in conferences and advocacy events without any negative impact on their relationship with the children in their care, agency staff, or the agency as a whole”. The guidelines make clear that “the decision to involve any individual should also involve a comprehensive and individualized assessment.” The guidelines outline a number of factors that may be

Table 2 Factors that may be relevant in assessing the potential vulnerability of an individual in conference presentations, advocacy events, and technical assistance. • • • •

Age Level of cognitive and social development Ability to provide informed assent or consent Presence of psychiatric illness or developmental challenges that would increase vulnerability • Sensitive personal issues that participant may discuss in public and possible repercussions for doing so • Personality traits that may increase the likelihood of exploitation, such as dependency, poor self image, or an excessive need for approval

relevant in assessing the potential vulnerability of a specific individual. Table 2 presents these factors, with the caveat that they do not represent a comprehensive list of the factors that agencies should consider. 4.3. Selecting opportunities for client and foster parent participation The Casey Family Services guidelines emphasize the importance of carefully considering the types of presentations that are appropriate for clients and foster parents. Opportunities should be offered to individuals based on their potential to contribute on issues that are personally meaningful to them and an assessment of possible risks. Case Example: An agency receives support from the United Way which enables it to provide a range of community-based services for vulnerable families. The United Way is holding a forum in which several grantees, including the agency, have been asked to make presentations about the work they are doing. A social worker with the agency suggests that the agency approach Brenda Thomas, a single mother who has received day care and family support services from the agency. She wants to ask Brenda to participate in the presentation with the agency director and a social worker from the agency. In this case, the agency has been asked to make a presentation to a funder on the work that it does in the community. The presentation to the United Way is primarily for the benefit of the agency—to provide the United Way with information that, it is hoped, will support a decision to continue to fund the agency. This circumstance raises the importance of a careful assessment of the appropriateness of inviting Brenda to present. Will the presentation offer her the opportunity to contribute on issues that are meaningful to her? Is she an advocate for child care and family support services and can she comfortably share her experiences? Or, alternatively, is the agency identifying her as an “example” of a client whom the agency helps with the primary goal of promoting support for the agency? 4.4. Selecting clients The Casey Family Services guidelines state that when selecting clients to co-present at conferences or advocacy events or to provide technical assistance, staff should select clients who are at minimal risk of harm or exploitation. Four populations are identified as at particular risk of harm or exploitation, with the caveat that they do not represent a comprehensive list of those at risk: • Current clients for whom the social worker is the primary clinical case manager, group or individual psychotherapist, or for whom the social worker has a significant clinical relationship • Youth • Individuals who receive payment from the agency • Birth families • Individuals with pending child welfare cases before the court Case Examples: The agency is planning a special conference about foster care and would like to invite current and former clients and

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foster parents to co-present with agency staff. At a staff meeting, the following individuals are suggested as possible presenters: • Donnie, a 16 year old boy who has been in foster care with the agency for 3 years. His social worker, Terry, says that Donnie needs opportunities to build self esteem. She thinks that involving him in the conference and giving him a chance to talk about his experience will be empowering. Terry has the primary clinical relationship with Donnie. Under the Casey Family Services guidelines, she should not be the staff person to select him to present at the conference. If Terry's responsibility is to help plan the conference by identifying young people who might present, she should talk with other primary clinicians about youth whom they believe could benefit from the experience and who would not be at risk of harm nor likely to feel pressured to participate. • Gladys and Hank, foster parents who have worked with the agency for 12 years. Two social workers who have worked with Gladys and Hank love them because they are very cooperative and work hard to follow the agency's rules and requirements. They feel confident that these foster parents would be an asset to the conference program. Casey Family Services guidelines provide that staff may offer foster parents opportunities to participate in conference presentations. Staff should select opportunities for foster parents based on the potential these activities offer foster parents to contribute on issues that are personally meaningful to them. Gladys and Hank may be interested in participating in the conference and may see the invitation as a special “perk” after fostering for 12 years. On the other hand, Gladys and Hank may have been selected because they are compliant and will meet the agency's desire to showcase “rule followers” at the conference. If the social workers are interested in Gladys and Hank because they believe that they will comply with the agency's request (even if they have doubts about presenting), then the social worker's selection needs to be carefully assessed. • Mira, a birth mother whose children are on a trial discharge home with her. Mira's two sons were in the agency's foster care program for nine months after Mira's boyfriend physically abused both boys. Mira has ended her relationship with the boyfriend and is committed to keeping her sons safe. Both boys are now on a trial discharge home with Mira, and the social worker makes weekly home visits. Mira's case is scheduled to return to court for a review hearing shortly after the conference. The social worker believes that Mira can share in meaningful ways and encourage other birth parents working to have their children returned to them. Casey Family Services guidelines emphasize that it is essential that Mira's potential vulnerability be carefully assessed. Several facts in this case suggest that Mira may be particularly vulnerable: the children have only recently returned home after a nine-month stay in foster care; the physical abuse may be a highly sensitive issue for both Mira and her sons and she may not be comfortable talking about it in public; and Mira's case goes before the court shortly after the conference and she may feel that she is obligated to participate in the conference in order for the agency to give the court a “good report.” The pending child welfare case before the court also raises the issue that the agency has asked Mira to present as a parent who has been successful in reuniting but at the court hearing, may need to present concerns about the legal return of her children to her. In such a case, the agency would have placed itself in an extremely difficult position. Under these circumstances, an agency should strongly consider the risks to Mira of asking her to present at the conference. 4.5. Preparing clients The Casey Family Services guidelines specify that a key responsibility of agency staff is to prepare clients for conference presentations,

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advocacy events, or the provision of technical assistance. Once a client decides to participate in a presentation, advocacy event, or technical assistance, the primary clinical social worker should help prepare the client. In cases of youth participation, the primary social worker may suggest that the youth contact him/her while the youth is at the conference, advocacy event, or technical assistance site. Preparing youth, parents, and foster parents includes the concept of strategic sharing. Prior to the presentation or advocacy event, staff are expected to coach clients so that they share only the personal information that is necessary for the presentation, thereby minimizing the likelihood that clients will reveal too much and then later regret having done so. If there is a question and answer session following a presentation, staff coach and role-play with clients constructive ways to protect their privacy. Case Example: The agency is working with a group of young people in foster care who are interested in advocating with state leaders on foster care issues. They have had several opportunities to talk together and with staff about advocacy and strategic sharing. The agency was recently contacted by a state legislator who is interested in focusing on the educational needs of children in foster care. The legislator would like to meet with agency staff and young people who can talk about their educational experiences in foster care. The staff member who facilitates the group of foster youth, Danny, knows that two of the youth have strong feelings about educational issues. One young person, Charlene, was required to change schools five times after entering foster care, and the other young person, Franklin, has had great difficulty getting his high school credits documented for college. Danny is aware that Charlene has been working very hard with her psychotherapist to try to resolve the traumatic impact of the abuse that led to her entering foster care. Danny wants to approach these young people about meeting with the state legislator. When young people in foster care express a desire to influence policy that impacts all youth in foster care, they can play vital roles in educating key policy makers. Casey Family Services guidelines focus on staff and youth preparation and skill-building so that youth have opportunities to learn about the issues and hone their skills. In this case, Danny may wish to bring together other social workers and communications staff to help Charlene and Franklin with the following: • Proper management of private and confidential information concerning the youth, family members and other clients of the agency • Communication skills • Professional appearance and etiquette • Use of storytelling as a healing medium • The art of making presentations • How to be an effective advocate • Facilitation techniques • Time management • Crafting the message • Understanding the context for system reform efforts, including relevant public policy and promising practices in the field • Public speaking, and • Addressing challenging questions from the audience. It is essential that Danny and other staff support Charlene and Franklin as they prepare to share their personal information in a thoughtful and purposeful manner. Among the skills that Danny should help them develop is the art of deflecting revealing questions, such as by saying “that is information I would rather not share.” When agency staff ask young people to participate in such events, a staff member should be physically present at the event and be prepared to step forward to support the young person in strategically sharing. Under the Casey Family Services guidelines, staff must maintain the privacy of all confidential and privileged information obtained from clients' counseling or psychotherapy sessions. In this

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case, for example, Danny must carefully avoid any mention of Charlene's work with her psychotherapist. 4.6. Obtaining informed consent/assent, establishing boundaries and providing support during travel The Casey Family Services guidelines require that staff obtain informed consent or assent from clients and maintain boundaries when traveling to and from public presentations, advocacy events, or social activities. The following case provides an example of how the specific guidelines might be applied. Case Example: Amy, a foster care social worker with the agency, has asked Jennie, a 17 year-old in foster care to participate in a conference where they will present together on the importance of sibling connections for youth in foster care. Amy and Jennie will travel by train to a city about two hours away and spend two nights at the hotel where the conference is being held. Jennie has not traveled much and is very nervous about the trip, so her primary social worker Cindy will help prepare her. This case illustrates the Casey Family Services guideline that a youth's current social worker should not be the staff member who requests that a youth participate in a conference presentation. Amy, not Cindy, made the request of Jennie. Cindy, however, is expected to help prepare Jennie for the presentation and to make herself available by phone in case Jennie needs to contact her during the conference. Casey Family Services has developed an invitational letter which is presented to all clients whom staff members invite for conference presentations or participation in advocacy events. The invitational letter explains what is being requested, describes the potential benefits and risks of participating, and establishes the financial arrangements and procedures for reimbursement of travel and accommodations. For youth under the age of 18 years old, such as Jennie, staff present the letter to the individual who under state law or policy must consent to their participation (depending on state law, this individual may be the birth parents, guardians or foster parents). In this case, Jennie's foster parents, Hank and Maggie, must consent. Amy, Hank, and Maggie are given at least 72 hours to review the letter before deciding whether Jennie will present at the conference. During this time, Amy is available to answer their questions about the presentation and the travel arrangements. The 72 hour period is designed to ensure that Jennie does not perceive that Amy is exerting undue influence on her to participate. If Jennie decides to participate, the required consent letters must be signed. If Jennie were age 18 or older, she would sign an Informed Consent letter; however, because she is 17, Hank and Maggie will sign the informed consent letter and Jennie will sign an informed assent letter. Applying the Casey Family Services guidelines with respect to travel arrangements, Amy and Jennie will have separate hotel rooms. Amy will provide on-site support for Jennie, which will be especially important because Jennie is not accustomed to being away from home and may find it stressful. Amy will pay close attention to Jennie's feelings and help her contact Hank and Maggie or significant others at home if she desires. Finally, applying Casey Family Services guidelines, Amy will not, while at the conference, drink alcohol with or in the vicinity of Jennie. 5. Conclusion Professional boundary issues are common in child welfare practice, particularly in relation to serving children and youth. Value conflicts make resolving these issues especially challenging. The Casey Family Services guidelines provide a framework for ethical decision making with regard to two of these critical professional boundary issues: the extent to which child welfare social workers should be considered as permanent family resources for children in foster care; and the extent to which child welfare social workers should engage clients in presentations for public audiences, advocacy on child welfare issues, and the provision of technical assistance to agencies

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