Social media and networks in health and social care
Social media and networks in health and social care

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Social media and networks in health and social care

2.4 The ethical debate on PTG

You will have seen that there are a range of different perspectives about using internet search engines to find publicly accessible information about people. When working in health and social care it is important to put the service user at the centre of what you do and so the decisions you make about care need to be justified. In order to use the internet or social media responsibly in relation to service users, a study by Ryan et al. (2019) found members of the public felt that:

  • the act needs to be in the best interests of the patient/service user
  • curiosity is not enough to justify searching for a service user’s information
  • wherever possible, consent should be sought and documented
  • justification for the ‘search’ needs to be documented
  • ethical principles need to be considered (i.e. beneficence, maleficence, autonomy and justice).

Ryan and Cornock (2019) and Ryan (2019) suggest a framework by which to consider the professional, employer, ethical and legal implications of PTG so that you can most effectively make and justify your decisions.

The next activity guides you to think more carefully about the searching the internet for information about service users.

Activity 8 Making an internet search on a service user for the purpose of protection

The following video describes the findings of a research project that examined how social workers should or should not use Facebook profiles as part of their practices in child protection. You are advised to watch this video on a full-sized monitor or laptop rather than a mobile device if possible.

This is a relatively challenging video, so don’t worry too much if you find it difficult to follow all of it. Focus on the main message, which is around the ethics of using information from social media as part of child protection assessments. As you watch this video, consider whether you think that professionals in health and social care should use social media to find information about their patients or service users.

How would you feel as a patient or service user if a professional did this to you? Make some notes about the circumstances when you think this would be appropriate.

Download this video clip.Video player: Video 1 Facebook: An unethical practice or effective tool in child protection?
Skip transcript: Video 1 Facebook: An unethical practice or effective tool in child protection?

Transcript: Video 1 Facebook: An unethical practice or effective tool in child protection?

TARSEM SINGH COONER
Hello, My name is Tarsem Singh Cooner, from the University of Birmingham in the United Kingdom. And this is my colleague--
LIZ BEDDOE
Liz Beddoe from the University of Auckland in New Zealand.
TARSEM SINGH COONER
Together we will be exploring the following topic-- the use of Facebook in social work practise with children and families, an unethical practise or an effective tool in child protection.
LIZ BEDDOE
In this presentation, we will be drawing from our two-year ethnographic research project that explored what can help or hinder social workers from beginning, developing, and sustaining relationships over time with children and families involved in child protection processes.
TARSEM SINGH COONER
This short presentation is inspired by both the data obtained in the study and the much wider debates about the impact of technology use in the wider human services fields. Our study has allowed us to observe how some social workers use Facebook as part of risk assessments and ongoing casework with families. We'll explore how their actions can be framed within these wider debates.
LIZ BEDDOE
We begin by exploring this topic from two ethical positions-- Kantian and utilitarian. From the perspective of our research, we consider the Kantian position to be one where there is an intrinsic principle of respect for persons. Therefore, any actions that result in a social worker deceiving or acting covertly to access the family's social media information to undertake child protection work is considered morally wrong.
TARSEM SINGH COONER
In contrast to Kantian ethics, from a utilitarian perspective, the moral worth-- that is, the rightness or wrongness of an action-- is set to lie in its consequences. Therefore, if accessing a parent's social media account through deceit or covert surveillance produces a good consequence, such as protecting a child from harm, then this action would be considered morally right. Here the principle of justice comes in, arguing that the right action is that which produces the greatest good to the greatest number of people-- the child, social worker, agency, and so forth. In the following segments, we will consider an ethical position, draw on quotes from our research, and then pose a question for you to consider with the aim of stimulating further debate.
LIZ BEDDOE
From a broadly utilitarian position, Sage and Sage argue, in a risk-focused orientation, child welfare workers should be thorough in their family assessments, exploring any resource available, including social media. Client privacy and confidentiality is seen as secondary to child safety from this lens. Using this argument, consider the following quotes about Facebook use drawn from our research. "There are some positives to it, you can find out if parents are in relationships still even when they've said they aren't."
"I know my manager had an instance once when she was a social worker. She told me she'd gone around her and done a home visit, and then checked the mum's Facebook as she was still sitting in the car outside the house. And the mother's written on Facebook, silly twat didn't even see the bag of weed down the side of the sofa-- laughing. So she's gone back in and said, oh, I forgot, and had a look down the side of the sofa." How comfortable are you with this kind of surveillance of service users? Is it acceptable to say that the end justifies the means?
TARSEM SINGH COONER
Thanks, Liz. Now, consider the opposite Kantian perspective. Kolmes and Taube ask, is there a difference between a practitioner physically following a client compared to following them around online? They go on to argue that the crucial differences between this analogy and the intentional searching for client information on the internet are the ease, convenience, invisibility, and inexpensive nature of the activity. We found that using Facebook can make it really easy for social workers to follow service users. But is it too much like stalking? And does this behaviour cut across the need to establish a rapport and trust in order to gain a full assessment?
Our research found that some social workers were clear about what they considered to be the right and wrong uses of Facebook in these situations. "I don't go looking them up on Facebook to see what they're up to, because I think that's an invasion of their privacy." "I personally find that morally and ethically not right. I think that, you know, everybody's got a right to a private life." But is it that simple? Consider-- is it acceptable practise to ignore possible sources of data that may well help you protect children from risk of harm?
RACHEL
LIZ BEDDOE
As our research progressed, we began to ask, is there a more balanced approach. Clinton, et al. Suggest a framework that takes into account the contextual nature of professionals using social media with six questions that would need to be asked prior to conducting a search on service users. These questions cover motivation, threats to the therapeutic relationship, obtaining informed consent, sharing the found information with the client, documenting findings, and an ongoing need for the practitioner to recheck their motivations for such searches.
During our research, we observed social workers engaging with some of these issues. For example-- "Because we know that when you get to court, that's when these things become unstuck, when you're questioned on information. And- well, how can you validate things? Do you know what I mean? Is an honest approach possible? How can you guarantee that anything that service users are putting on Facebook is factual?
TARSEM SINGH COONER
Sage, Wells, Sage and Devlin suggest strategies that can attempt to maximise confidentiality and support ethical practise. They argue that agencies can consider the viewpoints of all potential stakeholders, including community members, foster parents, youth, biological parents and relatives, social, workers supervisors, and administrators, and consider whether the proper resources are available to support and monitor policy and practise initiatives. The following quote from our research, for us, captures the dilemmas that these topics can present.
"But it's protection for ourselves as well, isn't it? At the end of the day, we don't want to be reprimanded for doing something that we shouldn't be doing. But equally, we don't want to be missing stuff where children are being put at risk. I don't know. It's a weird-- it's a weird one, isn't it?" At this point, what we question is, should the profession stop, have a think, have a debate about the types of issues that we have raised here?
LIZ BEDDOE
For example, we know from our study and other research that these Kantian and utilitarian practises are happening. But should we now take a metaphoric pause and consider the consequences? For example, there are current debates about governments using sophisticated algorithms to predict harm. But just because we can doesn't mean we should. In the past, social work practise has unquestionably acted in ways that we consider to be bad practise now-- for example, removing children from single parents, those with learning disabilities, and from indigenous communities. Using these lessons learned from these past experiences, we need to think through our use of social media now before social media surveillance becomes unquestioningly too institutionalised.
TARSEM SINGH COONER
Therefore, having viewed this presentation, what do you think of the wider issues for debate when considering, is Facebook use in social work practise for children an families an unethical practise or an effective tool in child protection?
End transcript: Video 1 Facebook: An unethical practice or effective tool in child protection?
Video 1 Facebook: An unethical practice or effective tool in child protection?
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Revisiting the activity in the previous section, has your opinion changed?

Do you think that it is acceptable for health and social care workers to use social media to find out information about service users in their care?

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Interactive feature not available in single page view (see it in standard view).

Discussion

This is a relatively new area of debate and there are a range of ethical, legal and professional issues associated with using the internet to find information about service users. You might agree with such activity because anything you might find through an internet search is publicly accessible, or it might be that you feel there needs to be more awareness about what people share and how they share it.

Either way, it is important to make sure that anything you do as a professional or employee in health and social care is clearly justifiable and in the best interests of the people in your care. You should consider Beauchamp and Childress’s (1989) four components of ethics and make sure you are operating within current professional guidance, policy and procedure.

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