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Ethics and Speech-Language Pathology Assistants (SLPAs): Consensus building in real-world applications

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Ethics and Speech-Language Pathology Assistants (SLPAs): Consensus building in real-world applications Ethics Across the Curriculum 2013 Jennifer A. Ostergren, PhD ... – PowerPoint PPT presentation

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Title: Ethics and Speech-Language Pathology Assistants (SLPAs): Consensus building in real-world applications


1
Ethics and Speech-Language Pathology Assistants
(SLPAs) Consensus building in real-world
applications
  • Ethics Across the Curriculum 2013
  • Jennifer A. Ostergren, PhD, CCC-SLP Department of
    Communicative Disorders California State
    University, Long Beach

2
Lecture
3
Integrity
  • 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.

4
Ethics
  • 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)

5
Laws versus Morals
  • Laws dictate what we must do.
  • Morals (and thereby ethics) address what we
    should do.

6
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.

7
American Speech-Language-Hearing Association
(ASHA) Code 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
8
ASHA Code of Ethics (2010) Four 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.

9
Principle I- Guidance 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.

10
Principle I, Rule A Guidance 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.

11
Principle I, Rule D Guidance 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.

12
Principle I, Rule F Guidance for SLPA
Supervisors
  • 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.

13
Applicable Principle I Rules Compass for SLPAs
  • A. 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.

14
Principle II, Rule B Guidance for SLPA
Supervisors
  • 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.

15
Principle II, Rule D Guidance 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.

16
Applicable Principle II Rules Compass 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.
17
Applicable Principle III Rules Compass 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.
18
Principle IV, Rule B Guidance for SLPA
Supervisors
  • 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.

19
Applicable Principle IV Rules Compass for SLPAs
  • 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.

20
Ethical Decision-Making Worksheet
  • 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?

21
Class discussion ethical worksheet
applied/sample case
22
Worksheet Applied Case Example
  • 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. Julies 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.
    Julies 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.

23
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).

24
Step 2 Action Analysis
  • Possible Courses of Action?
  • Benefits?
  • Risks?
  • Ethical Resolution? Yes or No

25
Step 3 Action Implementation
  • What action was implemented?
  • What was the outcome of that action?
  • -----
  • If ethical dilemma has not resolved, start again

26
Small Group discussion (Case Analysis)
27
Group Presentations (Case Analyses)
28
SLPA Ethics Case 1
  • Jonathan 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 supervisors caseload.
  • __________
  • Are there any potential conflicts with ASHAs
    Code of Ethics?
  • Which ethical principles are involved? Why?
  • What is a potential resolution to this situation?

29
SLPA 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 ASHAs
    Code of Ethics?
  • Which ethical principles are involved? Why?
  • What is a potential resolution to this situation?

30
SLPA Ethics Case 3
  • Edith is an SLPA working in a medical setting
    that bills Medicare for services provided to
    patients. During Ediths 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, Ediths 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 ASHAs
    Code of Ethics?
  • Which ethical principles are involved? Why?
  • What is a potential resolution to this situation?

31
SLPA Ethics Case 4
  • Leena 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 clients 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 ASHAs
    Code of Ethics?
  • Which ethical principles are involved? Why?
  • What is a potential resolution to this situation?

32
SLPA Ethics Case 5
  • Bill 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 students mother
    that does not get along with his supervising SLP.
    As a result, the students mom asks Bill
    questions about the students 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
    daughters disorder and treatment.
  • __________
  • Are there any potential conflicts with ASHAs
    Code of Ethics?
  • Which ethical principles are involved? Why?
  • What is a potential resolution to this situation?

33
Case Creation and Presentation
34
LESSONS LEARNED
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