Fall 2026 SOWK 430 Week 06 - Working with Clients - Standards, Bias, and Confidentiality

In week six, we will begin a four-week, in-depth review of the social worker’s ethical standards. The first group of standards covers the expectations social workers have towards their clients. We will also review each of the social worker’s values and discuss how they relate to our lives. During my lecture video we will discuss bias and confidentiality for Substance Use Disorder treatment. The agenda of that session includes:

  • Tasks for week six
  • Understanding bias
  • Confidentiality for SUDPs

Week 6 Objectives:

  • Understand the value of Service and provide an example from the student’s life that illustrates the principle.
  • Describe several examples of the ethical standards under Commitment to Clients in the NASW Code of Ethics.
  • Describe implicit attitudes, implicit stereotypes, and ingroup bias, and how each can shape the way we see and work with clients
  • Reflect on a personal bias you are likely to encounter in practice and why it matters for providing non-judgmental services
  • Explain how 42 CFR Part 2 and the NAADAC Code of Ethics add to NASW Standard 1.07 when working with clients with substance use disorders

Week Six Plan

Agenda

  • Tasks for week 6
  • Understanding bias
  • Confidentiality for SUDPs

Learning Objectives

  • Describe implicit attitudes, implicit stereotypes, and ingroup bias, and how each can shape the way we see and work with clients
  • Reflect on a personal bias you are likely to encounter in practice and why it matters for providing non-judgmental services
  • Explain how 42 CFR Part 2 and the NAADAC Code of Ethics add to NASW Standard 1.07 when working with clients with substance use disorders

Week Six Tasks

This is a big reading week, so plan your time. The forums are where most of this week’s work happens.

  • Read Chapter 2 in Reamer (2023), Ethical Responsibilities to Clients. It is long, almost four times the length of Chapter 1, because it covers all 17 standards in Section 1. If you can’t read it all closely, read the introduction and the standards you choose to write about, and skim the rest
  • Review Section 1 of the NASW Code of Ethics, Social Workers’ Ethical Responsibilities to Clients, on the NASW website
  • Watch this lecture video
  • Values exercise: Make at least one post on the Padlet, then reflect on what you read in the Values Exercise forum
  • A-01: Three replies across this week’s five forums, including at least one in Ethical Standard 1 on a sub-standard no one else has written about yet
  • Coming up next week: A-02: Reflecting on Biases Worksheet is due Monday 10/12 at 8:00 AM. Use the Questions Regarding A-02 forum if anything is unclear

Who’s the Doctor? A Riddle to Start Us Off

I want to start with a short riddle. Don’t call out the answer right away. Just notice what your mind does with it. You might have heard this before.

A father and his son are in a horrible car crash. The father dies at the scene. The son is rushed to the hospital and needs emergency surgery. Just as he is about to go under the knife, the surgeon looks at him and says:

“I can’t operate on this boy. He’s my son!”

How is that possible?

The surgeon is the boy’s mother. We know that women can be surgeons… but why isn’t that our initial response or why do people maybe come up with something else.

  • Most people miss it: Researchers at Boston University gave this riddle to 197 psychology students and 103 children ages 7 to 17. Only 14% of the students and 15% of the children said the surgeon was the boy’s mother. Even among students who described themselves as feminists, 78% did not come up with it (Barlow, 2014)
  • The workarounds we invent: Instead of the simplest answer, people came up with a ghost, a robot, a priest, or a father who wasn’t really dead (Barlow, 2014)
  • Why it happens: The researchers pointed to gender schemas, “generalizations that help us explain our complex world,” which don’t necessarily reflect our personal values or experiences (Barlow, 2014)

This is what implicit bias looks like. It isn’t about what we believe. It’s about the associations our minds reach for automatically, in this case “surgeon” with “man.” Today we look at how those same automatic associations can shape how we see and work with clients.

What do we mean by implicit bias?

Implicit biases are associations outside our conscious awareness that lead to a negative evaluation of a person because of an irrelevant characteristic, such as race or gender. They can exist even in people who explicitly reject those ideas and want to treat everyone equally (FitzGerald & Hurst, 2017).

Reference

Barlow, R. (2014, January 16). BU research: A riddle reveals depth of gender bias. BU Today. https://www.bu.edu/articles/2014/bu-research-riddle-reveals-the-depth-of-gender-bias/

Implicit Bias Toward Clients: What Does the Research Show

I’m framing some of our discussion on implicit bias releated to a systematic review wehre FitzGerald and Hurst reviewed 42 studies of trained physicians and nurses to see whether helping professionals carry these biases toward the people they serve.

  • Helping professionals are not immune. Healthcare professionals show the same levels of implicit bias as the wider population. Thirty-five of the 42 studies found evidence of it.
  • Many kinds of clients might be the object of bias. Race and ethnicity were studied most often (27 studies). Others included gender, age, weight, disability, mental illness, people living with AIDS, people who inject drugs, and patients seen as having contributed to their own brain injury.
  • Bias can impacts care. Every study that looked for a link found that higher implicit bias went with lower quality of care. Implicit bias also shows up in nonverbal behavior, such as how much eye contact we make and how close we stand.
  • Identities often intersect. One study found bias against low-SES Latina patients but not high-SES Latina patients.
  • Applying a group level stereotype to an individual is problematic. Applying a group-level stereotype to an individual instead of seeking information about this client.

(FitzGerald & Hurst, 2017)

Reference

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8

Types of Implicit Bias: Naming What Happens Outside Our Awareness

Greenwald and Krieger define implicit biases as “discriminatory biases based on implicit attitudes or implicit stereotypes” (2006, p. 951). What makes them hard is that they “can produce behavior that diverges from a person’s avowed or endorsed beliefs or principles” (p. 951). You may have seen infographics about unconscious bias with labels such as affinity bias, perception bias, the halo effect, and confirmation bias. Those are popular terms, and most of them map onto what the research describes.

Research term (Greenwald & Krieger, 2006) What it is Popular term In practice with clients
Implicit attitude An automatic like or dislike, a tendency “to like or dislike, or to act favorably or unfavorably toward, someone or something” (p. 948). How we feel about one person can spill over onto people connected to them (p. 948) Halo or horns effect A warm first impression of a parent carries over to how we read their parenting, before we know much about them
Implicit stereotype “A mental association between a social group or category and a trait” (p. 949). Even when a trait is only somewhat more common in a group, it can become “a default assumption” about every member (p. 949) Perception bias Assuming an older client can’t manage technology, or that a young parent isn’t ready to parent
Ingroup bias “Favoritism toward groups to which one belongs” (p. 951). Favoring an ingroup “necessarily implies a relative negativity toward a complementary outgroup” (p. 952) Affinity bias Feeling easier rapport with clients who share our background, and giving them more benefit of the doubt
Not in this paper Once a stereotype is in place, we tend to notice what fits it. FitzGerald and Hurst (2017) name the risk: applying a group-level stereotype “and fail[ing] to follow-up with a search for individuating information” (p. 15) Confirmation bias Reading a client’s file and then hearing the session through it
  • Most of us show it: Across a dozen IAT data sets, 42% of people reported being neutral on explicit measures, but only 18% were neutral on the implicit measure (Greenwald & Krieger, 2006, p. 955)
  • It leaks out in small ways: Implicit measures better predict “spontaneous behaviors such as eye contact, seating distance, and other such actions that communicate social warmth or discomfort” (p. 955)

Reference

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8

Greenwald, A. G., & Krieger, L. H. (2006). Implicit bias: Scientific foundations. California Law Review, 94(4), 945-967. https://doi.org/10.2307/20439056

A-02: Reflecting on Biases Worksheet (1 of 2)

Your first written assignment takes what we just talked about and turns it inward. It’s due next week, and the values exercise this week is the start of it.

Details: 50 points (10% of total points); due Monday 10/12/26 at 8:00 AM; upload the completed worksheet to MyHeritage Assignments

Purpose: A bias can be defined as prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair. All humans have biases. As social workers, considering our biases and how they might impact our work is essential to provide ethical practice. This worksheet is to help students process their biases.

Task: Download the Reflecting on Biases Worksheet (a Word document) from MyHeritage, complete it, and upload it to MyHeritage Assignments. Only the instructor reads this assignment, so be truthful and reflective. It is not graded on the biases you identify but on the depth of your reflection. The worksheet asks you to:

  • Identify a bias you have that you are likely to encounter in social work practice.
  • Identify three reasons that you believe you have developed this bias.
  • Identify how this bias might become problematic in social work practice if it was not addressed.
  • Describe the importance of providing non-judgmental services as a social worker.

A-02: Reflecting on Biases Worksheet (2 of 2): Rubric

The rubric looks at the depth of your reflection, not at which bias you choose.

Description Initial Emerging Developed Highly Developed
Identify bias: Identify a bias you have that you are likely to encounter in social work practice. Does not identify a bias. Identifies a bias, but it is unclear and unlikely to be a problem in practice. Identifies a bias but lacks clarity or is unlikely to be a problem in practice. One to two sentences about identifying biases is written. This bias is likely to be problematic in social work practice. The presented idea is clear and easy to understand.
Reasons for Bias: Identify three reasons that you believe you have developed this bias. Provides no well-explained reasons the bias may have developed. Provides one well-explained reason the bias may have developed. Or offers less than two sentences per example. Provides two well-explained reasons the bias may have developed. Or offers less than two sentences per example. Three well-explained reasons the bias may have developed are written.
Why Problematic: Identify how this bias might become problematic in social work practice if it was not addressed. It does not explain the harm that could be done. Does not provide information about a significant harm that could be done. Provides somewhat unclear explanation. A clear explanation of the possible harms to the client that biases can cause is identified.
Non-judgmental services: Describe the importance of providing non-judgmental services. No description is provided about non-judgmental services. The argument is both unclear and weak. The argument is somewhat unclear or weak. A robust and clear argument of the essentiality of examining prejudices and how this can honor clients individually is expressed.

Confidentiality and SUD Clients (1 of 2): A Quick Review of 42 CFR Part 2

Some of you saw this in SOWK 486. Standard 1.07 asks us to protect client confidentiality, and for people in substance use disorder (SUD) treatment, federal law adds a stricter layer on top of HIPAA. It applies to federally assisted programs that provide SUD treatment, diagnosis, or referral (Actionable Intelligence for Social Policy, 2024).

“Confidentiality protections help address concerns that discrimination and fear of prosecution deter people from entering treatment for SUD” (U.S. Department of Health and Human Services, 2026, para. 2)

  • Even the fact of treatment is protected: You can’t confirm that someone is a patient
  • Written consent is required to share records: SUD counseling notes need their own separate consent then other consent
  • Records can’t be used to investigate or prosecute the patient without their consent or a court order
  • The records requirements are for anybody that receive them: You may receive them in child welfare, housing, schools, or case management even if you never work in a Part 2 program

[Content Note] ✅ SUD (r)

Confidentiality and SUD Clients (2 of 2): Two lProfessional Codes

Social workers follow the NASW Code of Ethics. Many SUD professionals look to the NAADAC Code of Ethics (NAADAC is the Association for Addiction Professionals). Both protect confidentiality, but the SUD code is more specific, and it names the federal law directly.

  NASW Code of Ethics (2021) NAADAC Code of Ethics (2025)
How it frames confidentiality Protect confidential information “except for compelling professional reasons” (1.07[c]) “Privacy, confidentiality and anonymity are foundational to addiction treatment and recovery support,” and protecting them is a “primary obligation” (II-1)
Federal law Does not mention 42 CFR Part 2 Records and releases must meet HIPAA and 42 CFR Part 2 (II-2, II-20)
Consent to disclose “Valid consent” from the client or a legally authorized person (1.07[b]) Written consent; verbal authorization is not enough, except in emergencies (II-5)
Danger to self or others May disclose to prevent “serious, foreseeable, and imminent harm,” sharing the least amount necessary (1.07[c]) Only for “clear and imminent danger” or a medical emergency, and only to emergency personnel directly involved (II-8)
Telling the client Inform clients before disclosing, “when feasible and to the extent possible” (1.07[d]) Every release carries the federal regulations and a statement prohibiting re-release; the professional keeps a list of to whom and why records were released, available to the client on written request (II-19)

NASW also has practice standards for this work. The NASW Standards for Social Work Practice with Clients with Substance Use Disorders (2013) direct social workers to “comply with local, state, and federal mandates related to informed consent, privacy and confidentiality, and access to records,” and to inform clients, families, and other professionals of the limits of confidentiality “when services are initiated” (Standard 1). They name HIPAA but not Part 2, and they predate the 2024 rule.

[Content Note] ✅ SUD (r)

(Confidentiality of substance use disorder patient records, 42 C.F.R. pt. 2, 2024; NAADAC, 2025; National Association of Social Workers, 2013, 2021)

Reference

Confidentiality of substance use disorder patient records, 42 C.F.R. pt. 2 (2024). https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2

NAADAC, the Association for Addiction Professionals. (2025). NAADAC/NCC AP code of ethics. https://www.naadac.org/code-of-ethics

National Association of Social Workers. (2013). NASW standards for social work practice with clients with substance use disorders. https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/NASW-Standards-for-Social-Work-Practice-with-Clients-with-Substance-Use-Disorders

National Association of Social Workers. (2021). NASW code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

U.S. Department of Health and Human Services. (2026, January 30). Fact sheet: 42 CFR Part 2 final rule. https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/fact-sheet-42-cfr-part-2-final-rule/index.html