Reamer, F. G. (2021). Ethics & risk management in online & distance social work. Cognella.
Reviewed by Laura Gibson, PhD, Brescia University, IJSWVE Book Review Editor
Journal of Social Work Values and Ethics • Volume 18(2), Copyright 2021 by IFSW
This text may be freely shared among individuals, but it may not be republished in any medium without express written consent from the authors and advance notification of IFSW.
Reamer holds a PhD in social work from the University of Chicago. He is the author of more than 20 books on social work practice and is well-known in the field for his expertise in the area of social work ethics. He has additional expertise in the area of criminal justice and is a professor at Rhode Island College. For full disclosure, it should be noted that Reamer serves on the editorial board of this journal.
This book is divided into five short chapters: “Introduction;” “The Contours of Online and Distance Social Work: Ethical Challenges;” “Ethical, Regulatory, and Practice Standards;” “Challenges in Integrated Health and Social Work Education Settings;” and “Preventing and Managing Risk.” Reamer defines online and distance technology use as the use of a computer or other electronic means to “(a) deliver services to clients, (b) communicate with clients, (c) manage confidential case records, and (d) access information about clients” (p. 3). This is a broad definition, and this 75-page book tries to cover a lot of territory.
I found that the way language was used caught my attention. As an example, when discussing the pros and cons, Reamer indicates that “many social workers” (p. 3) appreciate being able to use distance counseling tools, but “many seasoned (italics mine) social workers have ethical and clinical concerns (p. 4). In another instance, the advice to social workers to use “sophisticated” (p. 15) encryption, as opposed to encryption, implies that this could be a particularly challenging endeavor. However, there are many products on the market today that are encrypted and suitable for online social work. The author’s choice of words may be suggesting a biased meaning he did not intend.
In discussing challenges, Reamer indicates that social workers could miss important clinical cues such as facial expressions or squirming and that social workers may find it difficult to maintain clear boundaries in their relationships with clients (p. 4). These concerns are not supported by any research cited by Reamer, and as an online practitioner, I would suggest that the former could be related to the type of technology used, but the latter leaves me puzzled. Using video conferencing, I do not believe I have had the experience of missing visual cues (any more than when in the same room), and I am unclear how services such as video counseling pose more risk to boundary crossing than when the social worker and client are located in the same place. Furthermore, I’m reasonably sure that clinical social workers who are visually impaired also have the experience of not seeing visual cues and have adapted their practice accordingly.
Reamer, in the second chapter, defines many of the terms used in distance social work. This is useful, both because of the many types of technologies that will be discussed, but also because the professional literature and state legislatures define such terms in different ways. It is helpful to have a shared meaning to provide the context for the later discussions. I did find the distinction between online counseling and video counseling to be a little unclear. Reamer characterizes online counseling as consistent with synchronous online “chat,” which is itself not defined. Some readers may interpret chat as text-based, and other readers may interpret this as video-based.
The example given that Skype is inappropriate is dated. The Department of Health and Human Services lists Skype for Business as one of many products that represents itself as HIPAA compliant and is willing to enter into a Business Associate Agreement with users. Reamer’s statement about “video counseling software that claims [emphasis mine] to be HIPAA compliant” (p. 6) warrants further explanation.
Also in Chapter 2, Reamer identifies informed consent; privacy and confidentiality; boundaries, dual relationships, and conflicts of interest; practitioner competence; records and documentation; and collegial relationships as the most pertinent ethical issues in online work. These topics will be familiar to most social workers, and this book seeks to apply them to online practice and technology use. Many of the suggestions are relevant regardless of whether technology is used, such as adhering to HIPAA requirements, avoiding inappropriate disclosures of protected health information, and staying current with the requirements of licensing jurisdictions. In some cases, it is unclear how some topics such as psychotherapy notes, confidentiality agreements in group treatment, and entering electronic notes in a timely fashion poses any different challenges than in traditional practice.
Some social workers may be disappointed that much of the book reminds social workers to do what they were already doing – using the Code of Ethics and the Standards for Technology in Social Work Practice developed by NASW et al. in 2017. With the exception of the social media policy, Reamer’s recommended steps in Chapter 5 to protect clients and practitioners are tried and true and could apply to any ethical situation, regardless of technology:
- Consult colleagues
- Obtain appropriate supervision
- Review relevant ethical standards
- Review relevant regulations, laws, and policies
- Develop a social media policy for clients and staffers
- Review relevant literature
- Obtain legal consultation when necessary
- Document decision-making steps.
Unfortunately, Reamer does not address the effectiveness of online & distance social work or the research that guides best practice. He remarks about the “ambiguity and controversy surrounding social workers’ use of technology,” (p. 57), but is this warranted in 2021? There is a wealth of research that has found online interventions to be as effective as in-person interventions. This is critical to understanding and using best practices in online social work. I would have liked to have seen discussion about online counseling platforms such as Better Help or Talk Space, as there are ongoing ethical dialogues regarding these approaches. I would also like to have seen discussion about the current partnership between the Council of State Governments and ASWB to develop an interstate compact for licensure portability. Also missing are the topics of providing services to clients in other areas of the country where social workers are not familiar with the cultural context, and providing services internationally where emergency support services may be unknown or absent. There is also some debate about whether BSWs and MSWs may provide services online that are non-clinical in nature. For example, some states restrict online practice to clinical social workers, making a discussion about scope of practice highly relevant. Addressing these areas would have helped make the book more current. Overall, I was disappointed in the lack of up to date information. Most sources cited ranged from approximately 2003 to 2015, with only about a fourth of the over 90 references being within the last 5 years. A great deal of information from Reamer’s 2015 article (“Clinical Social Work in a Digital Environment: Ethical and Risk-Management Challenges”) and 2013 article (“Social Work in a Digital Age: Ethical and Risk Management Challenges”) is reproduced verbatim in this work. Much has changed in online social work within the last six years and particularly within the last 18 months.
If you would like to submit a book for review, please contact Laura Gibson, book review editor.