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Social Work Exam Content: Self-Determination

downtownSelf-determination shows up multiple times in ASWB exam content outlines. Here's how self-determination appears in the clinical outline's Professional Values and Ethics section:

  • Techniques for protecting and enhancing client/client system self-determination
  • Client/client system competence and self-determination (e.g., financial decisions, treatment decisions, emancipation, age of consent, permanency planning)
  • The client's/client system's right to refuse services (e.g., medication, medical treatment, counseling, placement, etc.)

Three appearances? That tells you something. This is a topic worth knowing-not just for the social work licensing exam, but for social work practice.

Okay, so what's to know? Let's first open up the NASW Code of Ethics for basic principles. Here's the section, which appears right up top in Social Workers' Ethical Responsibilities to Clients:

1.02 Self-Determination

Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients' right to self-determination when, in the social workers' professional judgment, clients' actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.

What does this mean in practice? Julie Fanning puts it nicely in her article, If I Were My Client I Would…:

Clients often make life choices we wouldn't choose for ourselves.  Sometimes people prefer to be homeless rather than live in an apartment.  Sometimes people will choose to cheat on their spouse.  Sometime people will stay in a job that seems to be completely unhealthy.  Someone could choose to not take psychotropic medication and still function in the community.   A client's religious or other cultural values might feel abhorrent to you but it is not on the social worker to change them but to meet the client where they are at and let them live their own destiny.  It can be frustrating for a social worker because you want so much for your client's to be successful.  Each of the clients we work with know themselves better than we know them.

If you were your client, you'd do things your way. But clients don't have to do things your way. They get to choose. That's self-determination.

How might this look on the exam? Exam writers might grab any of the examples from the above paragraph and throw them into a vignette. Like this:

After many months of effort, a social worker finds a Section 8 apartment for a homeless client. After seeing the apartment, the client says he prefers to sleep on the street. "I like the open air," he says. The social work is worried that the client's judgment is impaired and that he is putting himself in unnecessary danger. How should the social worker intervene?

Right? Thinking like an exam writer, what options would you include? One correct answer (the self-determination one) is required. Plus a couple of look-good-but-aren't-the-right-answer choices. And maybe one clearly wrong one. Something like these:

A. Convince the client to try the apartment out for a month before deciding.

B. Discuss the pros and cons of apartment versus street living with the client.

C. Bring up the client's decision in a group setting so he can hear from others in a similar situation.

D. Insist that the client try the apartment for his own safety.

How would you answer?

Taking the options one-by-one. A has "convince." That's acting on the social worker's worries, not the clients self-determination. Not the answer. B has "discuss"-usually a good idea (except sometimes in imminent harm situations where more decisive action is indicated). Put a pin in it as a maybe. Answer C involves eliciting help from group members. This might be an effective way to shame the client into a safer decision, but again, the client can make a dangerous choice. It's his choice to make. Finally, D, "insist." Pass.

That leaves B and C as the only viable answers. One doesn't involve shame or using others to bend the client to the will o the social worker. So, there you have it. The correct answer is B.

Got it? Great! Will this be on the exam? Very likely. Maybe not exactly in this form, but the basic concept is a crucial part of social work and something the ASWB will often test for. Now you're ready!

Find more questions about self-determination and many, many other topics on our full-length practice tests. Sign up to get started.

Happy studying and good luck on the exam!

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