CHAPTER 282
PRACTICE OF SOCIAL WORKERS
645—282.1(154C) Definitions.
“Client” means the individual, couple, family, or group to whom a licensee provides direct social work services.
“Clinical services” means services provided by an LMSW or LISW which involve the professional application of social work theory and methods in diagnosing, assessing, treating, and preventing psychosocial disabilities or impairments, including emotional and mental disorders.
“Counseling” means a method used by licensees to assist clients in learning how to solve problems and make decisions about personal, health, social, educational, vocational, financial, and other interpersonal concerns.
“Psychosocial therapy” means a specialized, formal interaction between an LMSW or LISW and a client in which a therapeutic relationship is established and maintained to assist the client in overcoming or abating specific emotional, mental, or social problems and achieving specified goals for well-being. Psychosocial therapy is a form of psychotherapy which emphasizes the interface between the client and the client’s environment. Therapy is a planned, structured program based on a diagnosis and is directed to accomplish measurable goals and objectives specified in the client’s individual treatment plan.
645—282.2(154C) Rules of conduct.
	282.2(1) Informed consent.
	a. 	A licensee shall provide services to clients only in the context of a professional relationship based, when appropriate, on valid written informed consent. A licensee shall use clear and understandable language to inform clients of the proposed services, purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, a client’s right to refuse or withdraw consent, and the time frame covered by the consent.
	b. 	If a client is not literate or has difficulty understanding the primary language used in the practice setting, a licensee shall 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.
	c. 	If a client lacks the capacity to provide informed consent, a licensee shall protect the client’s interests by seeking permission from an appropriate third party and shall inform the client consistent with the client’s level of understanding. In such instances, a licensee shall seek to ensure that the third party acts in a manner consistent with the client’s wishes and interests. A licensee shall take reasonable steps to enhance the client’s ability to give informed consent.
	d. 	If a client is receiving services involuntarily, a licensee shall 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, shall constitute the practice of social work in the state of Iowa and shall 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 shall inform recipients of the limitations and risks associated with such services.
	f. 	A licensee shall obtain a client’s informed consent before audiotaping or videotaping the client or permitting a third party to observe services provided to the client.
	282.2(2) Competence.
	a. 	A licensee shall 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 shall 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 shall exercise careful judgment and take responsible steps, including appropriate education, research, training, consultation and supervision, to ensure competence and to protect clients from harm.
	282.2(3) Supervision.
	a. 	A licensee shall exercise appropriate supervision over persons who practice under the supervision of the licensee.
	b. 	A licensee who provides supervision or consultation shall have the necessary knowledge and skill to supervise or consult appropriately and shall 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 shall 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 shall 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 shall 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 shall not practice without receiving supervision, as needed, given the licensee’s level of practice, experience, and need.
	282.2(4) Privacy and confidentiality.
	a. 	A licensee shall not disclose or be compelled to disclose client information unless required by law, except under the following limited circumstances:
	(1)	If the information reveals the contemplation or commission of a crime. This includes 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)	If 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 shall 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 shall disclose the least amount of confidential information necessary and shall reveal only that information that is directly relevant to the purpose for which the disclosure is made.
	b. 	Before the disclosure is made, a licensee shall inform a client, to the extent possible, about the disclosure of confidential information and the potential consequences of the disclosure. This requirement applies whether a licensee discloses confidential information on the basis of client consent or other legal basis.
	c. 	A licensee shall discuss with clients and other interested parties the nature of confidentiality and limitations of a client’s right to confidentiality. A licensee shall 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 shall 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 shall 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 shall inform clients involved in family, couples, marital, or group counseling or psychosocial therapy of the licensee’s, the licensee’s employer’s, and agency’s policy concerning the licensee’s disclosure of confidential information among the parties involved in the counseling or therapy.
	f. 	A licensee shall not disclose confidential information to third-party payers unless a client has authorized such disclosure. A licensee shall inform the client of the nature of the client information to be disclosed or released to the third-party payer.
	g. 	A licensee shall not discuss confidential information in any setting unless privacy can be ensured. A licensee shall not discuss confidential information in public or semipublic areas such as hallways, waiting rooms, elevators, and restaurants.
	h. 	A licensee shall protect the confidentiality of clients during legal proceedings to the extent permitted by law.
	i. 	A licensee shall protect the confidentiality of clients when the licensee is responding to requests from members of the media.
	j. 	A licensee shall protect the confidentiality of clients’ written and electronic records and other sensitive information. A licensee shall 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 shall 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 shall 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 shall take reasonable precautions to protect client confidentiality in the event of the licensee’s termination of practice, incapacitation, or death.
	n. 	A licensee shall 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 shall 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 shall protect the confidentiality of deceased clients.
	282.2(5) Record keeping.
	a. 	A licensee shall maintain sufficient, timely, and accurate documentation in client records. A licensee’s records shall 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, shall 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 shall 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 shall store all client records for a minimum of seven years following the termination of services to ensure reasonable future access.
	282.2(6) Access to records. A licensee who provides clinical services shall:
	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 shall 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.
	282.2(7) Billing and fees.
	a. 	A licensee shall bill only for services which have been provided.
	b. 	A licensee shall not accept goods or services from the client or a third party in exchange for the licensee’s services.
	c. 	A licensee shall 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 shall 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 shall not permit any person to share in the fees for professional services, other than a partner, employee, an associate in a professional firm, or a consultant to the licensee.
	f. 	A licensee who provides clinical services shall, 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 at the initial session or meeting with the client. A licensee shall provide a written payment arrangement to a client at the commencement of the professional relationship.
	(3)	Ensure that the fees are fair, reasonable, and commensurate with the services performed.
	282.2(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 or business association. For purposes of these rules, “dual relationship” does not include a sexual relationship. Standards governing sexual relationships are found in subrule 282.2(9).
	(1)	Current clients. A licensee shall not engage in a dual relationship with a client.
	(2)	Former clients. A licensee shall not engage in a dual relationship with a client within five years of the termination of the client relationship. A licensee shall 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 shall take steps to protect the client and shall be responsible for setting clear, appropriate, and culturally sensitive boundaries. The burden shall be on the licensee to show that the dual relationship was unavoidable. In determining whether a dual relationship was unavoidable, the board shall 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 shall avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment.
	(2)	A licensee shall 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 shall 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 shall 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 shall clarify with all parties, when appropriate and in a manner consistent with the confidentiality standards of subrule 282.2(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 shall clarify, when appropriate and in a manner consistent with the confidentiality standards at subrule 282.2(4), the licensee’s role with the parties involved and take appropriate action to minimize any conflict of interest.
	282.2(9) Sexual relationships.
	a. 	Current clients. A licensee shall 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 shall not engage in sexual activities or sexual contact with a former client within the five years following termination of the client relationship. A licensee shall 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 shall not engage in sexual activities or sexual contact with a client’s or former client’s spouse or significant other.
	d. 	A licensee shall 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 shall not provide clinical services to an individual with whom the licensee has had prior sexual contact.
	282.2(10) Physical contact. A licensee shall 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 which govern such contact.
	282.2(11) Termination of services.
	a. 	A licensee shall terminate services to a client when such service is no longer required or no longer serves the client’s needs or interests.
	b. 	A licensee shall take reasonable steps to avoid abandoning clients who are still in need of services. A licensee shall assist in making appropriate arrangements for continuation of services when necessary.
	c. 	A licensee shall 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 shall 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 shall 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 shall 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 shall comply with the following additional standards regarding termination of the client relationship:
	(1)	Termination of a client relationship shall be documented in the client record. Absent written documentation of termination, the professional relationship shall 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 shall make reasonable efforts to collect the unpaid fees and shall make appropriate referrals for the client.
	282.2(12) Misrepresentations, disclosure. A licensee shall 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, the 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 which 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 which 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 which 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; or 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.
	282.2(13) Impairments.
	a. 	A licensee shall 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 shall be provided the Impaired Practitioner Report form to initiate the process. Standards governing the impaired practitioner review committee may be found in 645—Chapter 16.
	282.2(14) Research. If engaged in research, a licensee shall:
	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 which 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.
	282.2(15) Organization relationships and business practices. A licensee shall 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 which 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.
	282.2(16) Discrimination and sexual harassment.
	a. 	A licensee shall 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 shall 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.
	282.2(17) General. A licensee shall 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.
	282.2(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.
These rules are intended to implement Iowa Code chapters 21, 147, 154C, and 272C.
[Filed 8/14/03, Notice 6/11/03—published 9/3/03, effective 10/8/03]