Current through Register Vol. 47, No. 6, September 18, 2024
(1)
Informed consent.
a. A
licensee will provide services to clients only in the context of a professional
relationship based, when appropriate, on valid written informed consent. A
licensee will use clear and understandable language to inform clients about the
nature of available services, potential benefits and risks, limits and risks of
confidentiality, alternative ways of receiving assistance, applicable fees, and
involvement of and sharing information with third parties.
b. If a client has difficulty communicating,
a licensee will attempt to ensure the client's comprehension. This may include
providing the client with a detailed verbal explanation or arranging for a
qualified interpreter or translator whenever possible. A licensee will provide
information in a manner that is understandable and culturally appropriate for
the client. Clients will be given sufficient opportunity to ask questions and
receive answers about social work services, including electronic delivery of
services, if appropriate.
c. If a
client lacks the capacity to provide informed consent, a licensee will protect
the client's interests by seeking permission from an appropriate third party
and will inform the client consistent with the client's level of understanding.
In such instances, a licensee will seek to ensure that the third party acts in
a manner consistent with the client's wishes and interests. A licensee will
take reasonable steps to enhance the client's ability to give informed
consent.
d. If a client is
receiving services involuntarily, a licensee will provide information about the
nature and extent of services and about the extent of the client's right to
refuse services.
e. The provision
of social work services to an individual in this state through any electronic
means, including the Internet, telephone, or the Iowa communications network or
any fiberoptic media, regardless of the location of the licensee, constitutes
the practice of social work in the state of Iowa and will be subject to
regulation in accordance with Iowa Code chapters 147 and 154C and the
administrative rules of the board. A licensee who provides services via
electronic media will inform recipients of the limitations and risks associated
with such services.
f. A licensee
will obtain a client's informed consent before audiotaping or videotaping the
client or permitting a third party to observe services provided to the
client.
g. A licensee will develop
policies regarding the sharing, retention, and storage of digital and other
electronic communications and records and will inform clients of applicable
policies.
(2)
Competence.
a. A licensee
will provide services and represent oneself as competent only within the
boundaries of the licensee's education, training, license, certification,
consultation received, supervised experience, or other relevant professional
experience.
b. A licensee will
provide services in substantive areas or use intervention techniques or
approaches that are new only after engaging in appropriate study, training,
consultation, and supervision from people who are competent in those areas,
interventions, or techniques.
c.
When generally recognized standards do not exist with respect to an emerging
area of practice, a licensee will exercise careful judgment and take
responsible steps, including appropriate education, research, training,
consultation and supervision, to ensure competence and to protect clients from
harm.
(3)
Supervision.
a. A licensee
will exercise appropriate supervision over persons who practice under the
supervision of the licensee.
b. A
licensee who provides supervision or consultation will have the necessary
knowledge and skill to supervise or consult appropriately and will do so only
within the licensee's areas of knowledge and competence.
c. A licensee who provides supervision or
consultation is responsible for setting clear, appropriate, and culturally
sensitive boundaries.
d. A licensee
will not engage in any dual or multiple relationships with supervisees if there
is a risk of exploitation of or potential harm to the supervisee.
e. A licensee will not engage in sexual
activities or sexual contact with a supervisee, student, trainee, or other
colleague over whom the licensee exercises professional or supervisory
authority.
f. A licensee will not
employ, assign, or supervise an individual in the performance of services that
require a license if the individual has not received a license to perform the
services or if the individual has a suspended, revoked, lapsed, or inactive
license.
g. A licensee will not
practice without receiving supervision, as needed, given the licensee's level
of practice, experience, and need.
(4)
Privacy and
confidentiality.
a. A licensee will
not disclose or be compelled to disclose client information unless required by
law, except under the following limited circumstances:
(1) Situations in which the licensee
determines that disclosure is necessary to prevent serious, foreseeable, and
imminent harm to the client or another specific identifiable person.
(2) Situations in which the client waives the
privilege by bringing criminal, civil, or administrative charges or action
against a licensee.
(3) With the
written informed consent of the client that explains to whom the client
information will be disclosed or released and the purpose and time frame for
the release of information. If the client is deceased or unable to provide
informed consent, a licensee will obtain written consent from the client's
personal representative, another person authorized to sue, or the beneficiary
of an insurance policy on the client's life, health, or physical
condition.
(4) To testify in a
court or administrative hearing concerning matters pertaining to the welfare of
children.
(5) To seek collaboration
or consultation with professional colleagues or administrative superiors on
behalf of the client.
(6) Pursuant
to a validly issued subpoena or court order.
In the event of a disclosure of information under any of the
circumstances stated above, the licensee will disclose the least amount of
confidential information necessary and will reveal only that information that
is directly relevant to the purpose for which the disclosure is made.
b. Before the disclosure
is made, on the basis of client consent or other legal basis, a licensee will
inform the client, to the extent possible, about the disclosure of confidential
information and the potential consequences of the disclosure.
c. A licensee will discuss with clients and
other interested parties the nature of confidentiality and limitations of a
client's right to confidentiality. A licensee will review with clients the
circumstances under which confidential information may be requested and when
disclosure of confidential information may be legally required. This discussion
should occur as soon as possible in the professional relationship and as needed
throughout the course of the relationship.
d. When a licensee provides counseling or
psychosocial therapy services to families, couples, or groups, the licensee
will seek agreement among the parties involved concerning each individual's
right to confidentiality and obligation to preserve the confidentiality of
information shared by others. A licensee will inform participants in family,
couples, or group counseling or psychosocial therapy that the licensee cannot
guarantee that all participants will honor such agreements.
e. A licensee will inform clients involved in
family, couples, marital, or group counseling or psychosocial therapy of the
licensee's, the licensee's employer's, and the agency's policy concerning the
licensee's disclosure of confidential information among the parties involved in
the counseling or psychosocial therapy.
f. A licensee will not disclose confidential
information to third-party payers unless a client has authorized such
disclosure. A licensee will inform the client of the nature of the client
information to be disclosed or released to the third-party payer.
g. A licensee will not discuss confidential
information in any setting unless privacy can be ensured.
h. A licensee will protect the
confidentiality of clients during legal proceedings to the extent permitted by
law.
i. A licensee will protect the
confidentiality of clients when the licensee is responding to requests from
members of the media.
j. A licensee
will protect the confidentiality of clients' written and electronic records and
other sensitive information. A licensee will take reasonable steps to ensure
that client records are stored in a secure location and that client records are
not available to others who are not authorized to have access.
k. A licensee will take precautions to ensure
and maintain the confidentiality of information transmitted to other parties
through the use of computers, electronic mail, facsimile machines, telephones,
telephone answering machines, and other electronic or computer
technology.
l. A licensee will
transfer or dispose of client records in a manner that protects client
confidentiality and is consistent with federal and state statutes, rules and
regulations and the guidelines of the licensee's employer or agency, if
applicable.
m. A licensee will take
reasonable precautions to protect client confidentiality in the event of the
licensee's termination of practice, incapacitation, or death.
n. A licensee will not disclose identifying
information when discussing a client for teaching or training purposes or in
public presentations unless the client has consented to disclosure of
confidential information.
o. A
licensee will not disclose identifying information when discussing a client
with consultants unless the client has consented to disclosure of confidential
information or there is a compelling need for such disclosure.
p. Consistent with the preceding standards, a
licensee will protect the confidentiality of deceased clients.
(5)
Recordkeeping.
a. A licensee
will maintain sufficient, timely, and accurate documentation in client records.
A licensee's records will reflect the services provided, facilitate the
delivery of services, and ensure continuity of services in the
future.
b. A licensee who provides
clinical services in any employment setting, including private practice, will
maintain timely records that include subjective and objective data, assessment
or diagnosis, a treatment plan, and any revisions to the assessment, diagnosis,
or plan made during the course of treatment.
c. A licensee who provides clinical services
will store records in accordance with state and federal statutes, rules, and
regulations governing record retention and with the guidelines of the
licensee's employer or agency, if applicable. If no other legal provisions
govern record retention, a licensee will store all client records for a minimum
of seven years following the termination of services to ensure reasonable
future access.
(6)
Access to records. A licensee who provides clinical services
will:
a. Provide the client with reasonable
access to records concerning the client. A licensee who is concerned that a
client's access to the client's records could cause serious misunderstanding or
harm to the client will provide assistance in interpreting the records and
consultation with the client regarding the records. A licensee may limit a
client's access to the client's records, or portions of the records, only in
exceptional circumstances when there is compelling evidence that such access
would cause serious harm to the client. Both the client's request and the
rationale for withholding some or all of a record should be documented in the
client's records.
b. Take steps to
protect the confidentiality of other individuals identified or discussed in any
records to which a client is provided access.
(7)
Billing and fees.
a. A licensee will bill only for services
that have been provided.
b. A
licensee will not accept goods or services from the client or a third party in
exchange for the licensee's services.
c. A licensee will not solicit a private fee
or other remuneration for providing services to clients who are entitled to
such available services through the licensee's employer or agency.
d. A licensee will not accept, give, offer or
solicit a fee, commission, rebate, fee split, or other form of consideration
for the referral of a client.
e. A
licensee will not permit any person to share in the fees for professional
services, other than a partner, an employee, an associate in a professional
firm, or a consultant to the licensee.
f. A licensee who provides clinical services
will, when appropriate:
(1) Establish and
maintain billing practices that accurately reflect the nature and extent of
services provided.
(2) Inform the
client of the fee for services at the initial session or meeting with the
client. A licensee will provide a written payment arrangement to a client at
the commencement of the professional relationship.
(8)
Dual relationships and
conflicts of interest.
a. "Dual
relationship" means that a licensee develops or assumes a secondary role with a
client, including but not limited to a social relationship, an emotional
relationship, an employment relationship, or a business association. For
purposes of these rules, "dual relationship" does not include a sexual
relationship. Standards governing sexual relationships are found in subrule
897.2(9).
(1) Current clients. A licensee will
not engage in a dual relationship with a client.
(2) Former clients. A licensee will not
engage in a dual relationship with a client within five years of the
termination of the client relationship. A licensee will not engage in a dual
relationship with a former client, regardless of the length of time elapsed
since termination of the client relationship, when there is a risk of
exploitation or potential harm to a client or former client.
(3) Unavoidable dual relationships with
current and former clients. If a dual relationship with a current or former
client is unavoidable, the licensee will take steps to protect the client and
will be responsible for setting clear, appropriate, and culturally sensitive
boundaries. The burden will be on the licensee to show that the dual
relationship was unavoidable. In determining whether a dual relationship was
unavoidable, the board will consider the size of the community, the nature of
the relationship, and the risk of exploitation or harm to a client or former
client.
b. Conflicts of
interest.
(1) A licensee will avoid conflicts
of interest that interfere with the exercise of professional discretion and
impartial judgment.
(2) A licensee
will not continue in a professional relationship with a client when the
licensee has become emotionally involved with the client to the extent that
objectivity is no longer possible in providing the required professional
services.
(3) A licensee will
inform the client when a real or potential conflict of interest arises and take
reasonable steps to resolve the issue in a manner that makes the client's
interests primary and protects the client's interests to the greatest extent
possible. In some cases, protecting the client's interests may require
termination of the professional relationship with proper referral of the
client.
(4) A licensee will not
take unfair advantage of any professional relationship or exploit others to
further the licensee's personal, religious, political, or business
interests.
(5) A licensee who
provides services to two or more people who have a relationship with each other
will clarify with all parties, when appropriate and in a manner consistent with
the confidentiality standards of subrule 897.2(4), which individuals will be
considered clients and the nature of the licensee's professional obligations to
the various individuals who are receiving services. A licensee who anticipates
a conflict of interest among the individuals receiving services or who
anticipates having to perform in potentially conflicting roles will clarify,
when appropriate and in a manner consistent with the confidentiality standards
at subrule 897.2(4), the licensee's role with the parties involved and take
appropriate action to minimize any conflict of interest.
(9)
Sexual
relationships.
a. Current clients. A
licensee will not engage in sexual activities or sexual contact with a client,
regardless of whether such contact is consensual or nonconsensual.
b. Former clients. A licensee will not engage
in sexual activities or sexual contact with a former client within the five
years following termination of the client relationship. A licensee will not
engage in sexual activities or sexual contact with a former client, regardless
of the length of time elapsed since termination of the client relationship, if
the client has a history of physical, emotional, or sexual abuse or if the
client has ever been diagnosed with any form of psychosis or personality
disorder or if the client is likely to remain in need of therapy due to the
intensity or chronicity of a problem.
c. A licensee will not engage in sexual
activities or sexual contact with a client's or former client's spouse or
significant other.
d. A licensee
will not engage in sexual activities or sexual contact with a client's or
former client's relative within the second degree of consanguinity (client's
parent, grandparent, child, grandchild, or sibling) when there is a risk of
exploitation or potential harm to a client or former client.
e. A licensee will not provide clinical
services to an individual with whom the licensee has had prior sexual
contact.
(10)
Physical contact. A licensee will not engage in physical
contact with a client when there is a possibility of psychological harm to the
client as a result of the contact. A licensee who engages in appropriate
physical contact with a client is responsible for setting clear, appropriate,
and culturally and age-sensitive boundaries that govern such contact.
(11)
Termination of
services.
a. A licensee will
terminate services when such services are no longer required or no longer serve
the client's needs or interests.
b.
A licensee will take reasonable steps to avoid abandoning clients who are still
in need of services. A licensee will assist in making appropriate arrangements
for continuation of services when necessary.
c. A licensee will not terminate services to
pursue a social, financial, business, romantic, or sexual relationship with a
client.
d. A licensee who
anticipates the termination or interruption of services to a client will notify
the client promptly and seek the transfer, referral, or continuation of
services in relation to the client's needs and preferences.
e. A licensee who is leaving an employment
setting will inform clients, to the extent possible given the nature of the
termination of the employment relationship, of appropriate options for the
continuation of services and of the benefits and risks of the
options.
f. If the employer who
terminates a licensee is also a licensee, the employer will provide notice to
clients or allow the licensee the opportunity to provide notice to clients to
ensure appropriate case closure or continuation or transfer of services if
continued treatment is necessary.
g. A licensee who provides clinical services
will comply with the following additional standards regarding termination of
the client relationship:
(1) Termination of a
client relationship will be documented in the client record. Absent written
documentation of termination, the professional relationship will be considered
ongoing.
(2) A licensee who
practices in a fee-for-service setting may terminate services to a client who
is not paying an overdue balance only if the financial contractual arrangements
have been made clear to the client, if the client does not pose an imminent
danger to self or others, and if the clinical and other consequences of the
current nonpayment have been addressed and discussed with the client. Prior to
terminating services under this subrule, a licensee will make reasonable
efforts to collect the unpaid fees and will make appropriate referrals for the
client.
(12)
Misrepresentations, disclosure. A licensee will not:
a. Knowingly make a materially false
statement, or fail to disclose a relevant material fact, in a letter of
reference, application, referral, report or other document.
b. Knowingly allow another person to use the
licensee's license or credentials.
c. Knowingly aid or abet a person who is
misrepresenting the person's professional credentials or
competencies.
d. Impersonate
another person or misrepresent an organizational affiliation in one's
professional practice.
e. Further
the application or make a recommendation for professional licensure of another
person who is known by the licensee to be unqualified in respect to character,
education, experience, or other relevant attribute.
f. Fail to notify the appropriate licensing
authority of any human services professional who is practicing or teaching in
violation of the laws or rules governing that person's professional
discipline.
g. Engage in
professional activities, including advertising, that involve dishonesty, fraud,
deceit, or misrepresentation.
h.
Advertise services in a false or misleading manner or fail to indicate in the
advertisement the name, highest relevant degree, and licensure status of the
provider of services.
i. Fail to
distinguish, or purposely mislead the reader or listener, in public
announcements, addresses, letters and reports as to whether the statements are
made as a private individual or whether they are made on behalf of an employer
or organization.
j. Engage in
direct solicitation of potential clients for pecuniary gain in a manner or in
circumstances that constitute overreacting, undue influence, misrepresentation
or invasion of privacy.
k. Fail to
inform each client of any financial interests that might accrue to the licensee
for referral to any other person or organization or for the use of tests,
books, or apparatus.
l. Fail to
inform each client that the client may be entitled to the same services from a
public agency if the licensee is employed by that public agency and also offers
services privately.
m. Make claims
of professional superiority that cannot be substantiated by the
licensee.
n. Guarantee that
satisfaction or a cure will result from the performance of professional
services.
o. Claim or use any
secret or special method of treatment or techniques that the licensee refuses
to divulge to professional colleagues.
p. Take credit for work not personally
performed, whether by giving inaccurate information or failing to give accurate
information.
q. Offer social work
services or use the designation of licensed bachelor social worker, licensed
master social worker, or licensed independent social worker; use the
designations LBSW, LMSW, or LISW or any other designation indicating licensure
status; or hold oneself out as practicing at a certain level of licensure
unless the licensee is duly licensed as such.
r. Permit another person to use the
licensee's license for any purpose.
s. Practice outside the scope of a
license.
(13)
Impairments.
a. A licensee
will not:
(1) Practice in a professional
relationship while intoxicated or under the influence of alcohol or drugs not
prescribed by a licensed physician.
(2) Practice in a professional relationship
while experiencing a mental or physical impairment that adversely affects the
ability of the licensee to perform professional duties in a competent and safe
manner.
(3) Practice in a
professional relationship if involuntarily committed for treatment of mental
illness, drug addiction, or alcoholism.
b. A licensee who self-reports an impairment
or suspected impairment to the board may be eligible for confidential
monitoring by the impaired practitioner review committee. The licensee will be
provided the Impaired Practitioner Report form to initiate the process.
Standards governing the impaired practitioner review committee may be found in
481-Chapter 505.
(14)
Research. If engaged in research, a licensee will:
a. Consider carefully the possible
consequences for human beings participating in the research.
b. Protect each participant from unwarranted
physical and mental harm.
c. Ensure
that the consent of the participant is voluntary and informed and that each
participant executes a signed informed consent form that details the nature of
the research and any known possible consequences.
d. Treat information obtained as
confidential.
e. Not knowingly
report distorted, erroneous, or misleading information.
(15)
Organization relationships and
business practices. A licensee will not:
a. Solicit the clients of colleagues or
assume professional responsibility for clients of another agency or colleague
without appropriate communication with that agency or colleague.
b. Abandon an agency, organization,
institution, or group practice without reasonable notice or under circumstances
that seriously impair the delivery of professional care to clients.
c. Deliberately falsify client
records.
d. Fail to submit required
reports and documents in a timely fashion to the extent that the well-being of
the client is adversely affected.
e. Delegate professional responsibilities to
a person when the licensee knows, or has reason to know, that the person is not
qualified by training, education, experience, or classification to perform the
requested duties.
(16)
Discrimination and sexual harassment.
a. A licensee will not practice, condone, or
facilitate discrimination against a client, student, or supervisee on the basis
of race, ethnicity, national origin, color, sex, sexual orientation, age,
marital status, political belief, religion, mental or physical disability,
diagnosis, or social or economic status.
b. A licensee will not sexually harass a
client, student, or supervisee. Sexual harassment includes sexual advances,
sexual solicitation, requests for sexual favors, and other verbal or physical
conduct of a sexual nature.
(17)
General. A licensee
will not:
a. Practice without receiving
supervision as needed, given the licensee's level of practice, experience, and
need.
b. Practice a professional
discipline without an appropriate license or after expiration of the required
license.
c. Physically or verbally
abuse a client or colleague.
d.
Obtain, possess, or attempt to obtain or possess a controlled substance without
lawful authority; or sell, prescribe, give away, or administer controlled
substances.
(18)
Relationship between the board's rules of conduct and the National
Association of Social Workers (NASW) Code of Ethics. The NASW Code of
Ethics is one resource for practitioners with respect to practice and ethical
issues, and selected sections from the NASW Code of Ethics have been
incorporated into the rules of conduct. A licensee's professional conduct is
governed by the board's rules of conduct, and a licensee may be disciplined for
violation of these rules.
(19)
Electronic social work services. A licensee will:
a. Assess the client's suitability and
capacity for online and remote services at the point of the client's first
contact and use professional judgment to determine whether an initial
in-person, videoconference, or telephone consultation is warranted before
undertaking electronic social work services.
b. Take reasonable steps to verify the
client's identity, ability to consent to services, and location. When
verification of a client's identity is not feasible, social workers will inform
the client of the limitations of services that can be provided.
c. Continually assess a client's suitability
for electronic social work services during the course of the professional
relationship.