Ethics and Speech-Language Pathology Assistants (SLPAs):

Consensus building in real-world applications

Ethics Across the Curriculum 2013

Jennifer A. Ostergren, PhD, CCC-SLPDepartment of Communicative DisordersCalifornia State University, Long Beach

LECTURELECTURE

IntegrityIntegrity

Adherence to high moral standards (Horner, 2003)

◦A person with professional integrity is someone who adheres to ethical principles in the execution of their professional duties.

EthicsEthics“The discipline dealing with what

is good and bad and with moral duty and obligation” (http://www.merriam-webster.com/dictionary/ethic)

The study of the morality, or what is good/bad and right/wrong (Horner, 2003)

Laws versus MoralsLaws versus MoralsLaws dictate what we must do.Morals (and thereby ethics)

address what we should do.

Why Study Ethics?Why Study Ethics?

“Ethics is really about helping one to make good decisions” (Carbon and Morris, 2004, para. 2)

Ethical principles can serve as a compass in performing your duties as an SLPA.

American Speech-Language-American Speech-Language-Hearing Association (ASHA) Hearing Association (ASHA) Code of EthicsCode of Ethics

“Preservation of the highest standards of integrity and ethical principles is vital to the responsible discharge of obligations by speech-language pathologists, audiologists, and speech, language, and hearing scientists. This Code of Ethics sets forth the fundamental principles and rules considered essential to this purpose.” (ASHA, 2010, para 1)

Not directly applicable to SLPAs (ASHA, 2013)

Applicable to: ◦A member of ASHA, whether certified or not◦A nonmember holding the ASHA Certificate of Clinical Competence◦An applicant for membership or certification◦A Clinical Fellow seeking to fulfill standards for certification.

American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from www.asha.org/policy

ASHA Code of Ethics (2010)ASHA Code of Ethics (2010)Four Basic PrinciplesFour Basic Principles

Principle 1 (Responsibility to Clients Served and Research Participants)Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.

Principle 2 (Responsibility for Maintaining Professional Competence) Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

Principle 3 (Responsibility to the Public)Individuals shall honor their responsibility to the public by promoting public understanding of the professions, by supporting the development of services designed to fulfill the unmet needs of the public, and by providing accurate information in all communications involving any aspect of the professions, including the dissemination of research findings and scholarly activities, and the promotion, marketing, and advertising of products and services. 

Principle 4 (Responsibility to Other Members, Students, and Other Profession and Disciplines)Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines.

Principle I-Principle I-Guidance for SLPA SupervisorsGuidance for SLPA Supervisors

Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.

Guidance (ASHA, 2013):The supervising SLP remains responsible for the

care and well-being of the client or research subject. If the supervisor fails to intervene when the assistant's behavior puts the client or subject at risk or when services or procedures are implemented inappropriately, the supervisor could be in violation of the Code of Ethics.

Principle I, Rule A –Principle I, Rule A –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors Individuals shall provide all services

competently.Guidance (ASHA, 2013):The supervising SLP must ensure that all

services, including those provided directly by the assistant, meet practice standards and are administered competently. If the supervisor fails to intervene or correct the actions of the assistant as needed, this could be a violation of the Code of Ethics.

Principle I, Rule D –Principle I, Rule D –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors Individuals shall not misrepresent the

credentials of assistants, technicians, support personnel, students, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name and professional credentials of persons providing services.

Guidance (ASHA, 2013):The supervising SLP must ensure that clients and

subjects are informed of the title and qualifications of the assistant. This is not a passive responsibility; that is, the supervisor must make this information easily available and understandable to the clients or subjects and not rely on the individual to inquire about or ask directly for this information. Any misrepresentation of the assistant's qualifications or role could result in a violation of the Code of Ethics by the supervisor.

Individuals who hold the Certificate of Clinical Competence may delegate tasks related to provision of clinical services to assistants, technicians, support personnel, or any other persons only if those services are appropriately supervised, realizing that the responsibility for client welfare remains with the certified individual.

Guidance (ASHA, 2013): The supervising SLP is responsible for providing

appropriate and adequate direct and indirect supervision to ensure that the services provided are appropriate and meet practice standards. The SLP should document supervisory activities and adjust the amount and type of supervision to ensure that the Code of Ethics is not violated.

Principle I, Rule F –Principle I, Rule F –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors

Applicable Principle I Rules –Applicable Principle I Rules –Compass for SLPAsCompass for SLPAsA. Individuals shall provide all services competently.

C. Individuals shall not discriminate in the delivery of professional services or the conduct of research and scholarly activities on the basis of race or ethnicity, gender, gender identity/gender expression, age, religion, national origin, sexual orientation, or disability.

M. Individuals shall adequately maintain and appropriately secure records of professional services rendered, research and scholarly activities conducted, and products dispensed, and they shall allow access to these records only when authorized or when required by law.

N. Individuals shall not reveal, without authorization, any professional or personal information about identified persons served professionally or identified participants involved in research and scholarly activities unless doing so is necessary to protect the welfare of the person or of the community or is otherwise required by law.

O. Individuals shall not charge for services not rendered, nor shall they misrepresent services rendered, products dispensed, or research and scholarly activities conducted.

Q. Individuals whose professional services are adversely affected by substance abuse or other health-related conditions shall seek professional assistance and, where appropriate, withdraw from the affected areas of practice.

Individuals shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their level of education, training, and experience.

Guidance (ASHA, 2013): The supervising SLP is responsible for ensuring

that he or she has the skills and competencies needed in order to provide appropriate supervision. This may include seeking continuing education in the area of supervision practice.

Principle II, Rule B –Principle II, Rule B –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors

Individuals shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's competence, level of education, training, and experience.

Guidance (ASHA, 2013): The supervising SLP must ensure that the

assistant only performs those activities and duties that are defined as appropriate for the level of training and experience and in accordance with applicable licensure laws. If the assistant exceeds the practice role that has been defined for him or her, and the supervisor fails to correct this, the supervisor could be found in violation of the Code of Ethics.

Principle II, Rule D –Principle II, Rule D –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors

Applicable Principle II Rules –Applicable Principle II Rules –Compass for SLPAsCompass for SLPAs

B. Individuals shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their level of education, training, and experience.

C. Individuals shall engage in lifelong learning to maintain and enhance professional competence and performance.

E. Individuals shall ensure that all equipment used to provide services or to conduct research and scholarly activities is in proper working order and is properly calibrated.

Applicable Principle III Rules –Applicable Principle III Rules –Compass for SLPAsCompass for SLPAs

A. Individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly or research contributions.B. Individuals shall not participate in professional activities that constitute a conflict of interest.D. Individuals shall not misrepresent research, diagnostic information, services rendered, results of services rendered, products dispensed, or the effects of products dispensed.E. Individuals shall not defraud or engage in any scheme to defraud

in connection with obtaining payment, reimbursement, or grants for services rendered, research conducted, or products dispensed.F. Individuals' statements to the public shall provide accurate information about the nature and management of communication disorders, about the professions, about professional services, about products for sale, and about research and scholarly activities.G. Individuals' statements to the public when advertising, announcing,

and marketing their professional services; reporting research results; and promoting products shall adhere to professional standards

and shall not contain misrepresentations.

Individuals shall prohibit anyone under their supervision from engaging in any practice that violates the Code of Ethics.

Guidance (ASHA, 2013): Because the assistant provides services as “an

extension” of those provided by the professional, the SLP is responsible for informing the assistant about the Code of Ethics and monitoring the performance of the assistant. Failure to do so could result in the SLP's being found in violation of the Code.

Principle IV, Rule B –Principle IV, Rule B –Guidance for SLPA SupervisorsGuidance for SLPA Supervisors

A. Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.

C. Individuals shall not engage in dishonesty, fraud, deceit, or misrepresentation.

D. Individuals shall not engage in any form of unlawful harassment, including sexual harassment or power abuse.

E. Individuals shall not engage in any other form of conduct that adversely reflects on the professions or on the individual's fitness to serve persons professionally.

I. Individuals' statements to colleagues about professional services, research results, and products shall adhere to prevailing professional standards and shall contain no misrepresentations.

K. Individuals shall not discriminate in their relationships with colleagues, students, and members of other professions and disciplines on the basis of race or ethnicity, gender, gender identity/gender expression, age, religion, national origin, sexual orientation, or disability.

Applicable Principle IV Rules –Applicable Principle IV Rules –Compass for SLPAsCompass for SLPAs

Ethical Decision-Making Ethical Decision-Making WorksheetWorksheet

Step 1: Gather/Clarify Facts◦ Who is involved in this situation?◦ Who is impacted by this situation?◦ What are the motives and roles of those involved in this

situation?◦ List applicable ASHA Ethical Principles and Rules of Ethics

(if any). Step 2: Action Analysis

◦ Possible Courses of Action? Benefits? Risks? Ethical Resolution? Yes or No

Step 3: Action Implementation◦ What action was implemented?◦ What was the outcome of that action?

CLASS DISCUSSION: CLASS DISCUSSION: ETHICAL WORKSHEET ETHICAL WORKSHEET APPLIED/SAMPLE APPLIED/SAMPLE CASECASE

Worksheet Applied: Case Worksheet Applied: Case ExampleExample

Julie is an SLPA employed in a large, urban high school setting. Julie is bilingual and frequently assists her supervisor as an interpreter during assessment. Julie has worked in this setting for more than a year. She is currently supervised by an experienced SLP with her ASHA CCCs. Julie’s supervisor has one of the highest caseloads in their district. Next week, her supervisor has several Individualized Educational Plan (IEP) meetings scheduled. She has expressed to Julie that she is behind schedule in writing documentation for these meetings and in performing follow-up assessments. Julie’s supervisor asked her to perform an assessment on a bilingual client in preparation for an upcoming IEP meeting. Julie is concerned because performing diagnostic assessment is outside the scope of her practice, as per both ASHA recommendation and state licensing standards.

STEP 1: Gather/Clarify STEP 1: Gather/Clarify FactsFactsWho is involved in this situation?

Who is impacted by this situation?

What are the motives and roles of those involved in this situation?

List applicable ASHA Ethical Principles and Rules of Ethics (if any).

Step 2: Action AnalysisStep 2: Action Analysis

Possible Courses of Action?◦Benefits?◦Risks?◦Ethical Resolution? Yes or No

Step 3: Action Step 3: Action ImplementationImplementationWhat action was implemented?What was the outcome of that

action?-----If ethical dilemma has not

resolved, start again

SMALL GROUP SMALL GROUP DISCUSSION (CASE DISCUSSION (CASE ANALYSIS)ANALYSIS)

GROUP GROUP PRESENTATIONS PRESENTATIONS (CASE ANALYSES) (CASE ANALYSES)

SLPA Ethics Case #1SLPA Ethics Case #1Jonathan is a newly hired SLPA, working in an elementary school setting. This is his first SLPA position and his first job in a public school. His supervisor trained him for approximately 1 week, consisting of showing him paperwork and having him observe her providing services to students. She then became seriously ill and has taken an extended medical leave. The district supervisor has asked Jonathan to work until they can find a replacement supervisor for him, including providing treatment services to the students on the supervisor’s caseload.

__________

Are there any potential conflicts with ASHA’s Code of Ethics?

Which ethical principles are involved? Why?What is a potential resolution to this situation?

SLPA Ethics Case #2SLPA Ethics Case #2 Susan is an SLPA working in a private practice setting

while attending graduate school to become an SLP. She has been employed as an SLPA for approximately 2 years, under the supervision of an ASHA certified SLP. There is an opening for a SLP position at the site where she works. The owner of this site told her they would like to hire Susan for this position. The owner indicated that Susan could be begin working in this position immediately because she is in school to become an SLP. Further, the owner states that they would list her title on official records as an SLP, because clients prefer to be seen by an SLP.  

__________

Are there any potential conflicts with ASHA’s Code of Ethics?

Which ethical principles are involved? Why?What is a potential resolution to this situation?

SLPA Ethics Case #3SLPA Ethics Case #3 Edith is an SLPA working in a medical setting that bills

Medicare for services provided to patients. During Edith’s initial training, her supervisor mentioned that SLPA services are not “billable” under Medicare, unless the paperwork indicates that the SLP provided the services. Because of this, Edith’s supervisor instructed Edith that she is not to record anything in official records. Her supervisor instructed Edith to tell her verbally the outcome of the treatment so that she can enter that information into the billing system as if an SLP provided the services.

_______

Are there any potential conflicts with ASHA’s Code of Ethics?

Which ethical principles are involved? Why?What is a potential resolution to this situation?

SLPA Ethics Case #4SLPA Ethics Case #4Leena is an SLPA working in a private practice.

Her supervisor has trained her to work with individuals in this setting and she feels competent in doing so with the supervision. She is assigned a new client to work on treatment goals addressing memory and attention. When Leena reads the client’s chart, she sees that the client is HIV positive. Leena is concerned that she will contract HIV/AIDs so she tells her supervisor that she does not want to provide services to this client.

_______Are there any potential conflicts with ASHA’s Code of

Ethics?Which ethical principles are involved? Why?What is a potential resolution to this situation?

SLPA Ethics Case #5SLPA Ethics Case #5Bill is an SLPA working in a public school setting.

He has been working in this setting for 6 months. Thus far, he has received excellent training. There is a particular student’s mother that does not get along with his supervising SLP. As a result, the student’s mom asks Bill questions about the student’s goals, progress, results of assessment, and future recommendations for services. She tells Bill, “I trust you” and as such she wants to know his opinion about her daughter’s disorder and treatment.

__________

Are there any potential conflicts with ASHA’s Code of Ethics?Which ethical principles are involved? Why?What is a potential resolution to this situation?

CASE CREATION AND CASE CREATION AND PRESENTATIONPRESENTATION

LESSONS LEARNEDLESSONS LEARNED