Issues in Ethics: Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified
About This Document
Published 2013. This Issues in Ethics statement is a revision of Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified (originally published in 1996 and revised in 2004). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They illustrate the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders to engage in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Because the professions of both speech-language pathology and audiology serve adults and children with communication disorders, their practitioners share common concerns and responsibilities. Nevertheless, these professions are separate and have differentiated scopes of practice. There may be instances in which a certified practitioner in one of the professions might wish to provide services that are solely within the scope of practice of the other profession; in such cases, certification in the other profession would be required. There may also be misunderstandings about the scopes of practice of these professions by the general public, by practitioners of other professions, and by the people speech-language pathologists and audiologists serve.
This statement interprets those sections of the ASHA Code of Ethics (2010) that pertain to the provision of services in areas that are common to the scopes of practice of both professions, but that are more closely associated with the profession in which the individual is not certified. These ethical considerations are independent of state licensure laws, which may define the scopes of practice of the professions more broadly or more narrowly than the Association defines them. Individuals must abide by the Association's Code of Ethics in deciding whether or not they may provide professional services.
The Board of Ethics refers readers to Principle of Ethics II and Rules of Ethics II-A, II-B, and II-C for discussion of this issue:
Principle of Ethics II
Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.
Rule A. Individuals shall engage in the provision of clinical services only when they hold the appropriate Certificate of Clinical Competence or when they are in the certification process and are supervised by an individual who holds the appropriate Certificate of Clinical Competence.
Rule 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.
Rule C. Individuals shall engage in lifelong learning to maintain and enhance competence and performance.
The Board of Ethics interprets these sections of the Code of Ethics as follows:
When speech-language pathologists and audiologists are engaged in any aspect of professional practice, it is essential that they practice within the scope of practice of their respective professions (i.e., speech-language pathology or audiology) and only within the scope of their competence, as determined by their level of education, training, and experience. The Association provides defined scopes of practice for audiology and speech-language pathology, which are available on the ASHA website. Defining the scope of one's competence to provide a service within the scope of practice relies on the ethical sense of the practitioner.
Areas of practice common to both professions include screening of both speech-language and hearing, aural rehabilitation, and evaluation/management of auditory processing disorders. Ethical considerations for audiologists and speech-language pathologists who practice in these areas are discussed below.
Individuals who hold only the Certificate of Clinical Competence in Audiology (CCC-A) may perform screening of speech-language and other factors affecting communication function for the purposes of an audiologic evaluation and/or initial identification of individuals with other communication disorders. The screening procedures used should adhere to current ASHA guidelines and position statements. Individuals who hold only the CCC-A shall limit judgments and descriptive statements about the results of such screening procedures to a determination as to whether the person has passed. Persons who do not pass the screening shall be referred for evaluation.
Individuals who hold only the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) may screen hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screen for middle ear pathology through screening tympanometry, for the purpose of referral of individuals for further evaluation and management. The screening procedures used should adhere to current ASHA guidelines and position statements. Individuals who hold only the CCC-SLP shall limit judgments and descriptive statements about the results of such screening procedures to a determination as to whether the person has passed. Persons who do not pass the screening shall be referred for evaluation.
Individuals who hold the CCC-SLP and not CCC-A, but who have appropriate training, may perform newborn hearing screening using otoacoustic emissions or auditory brainstem evoked response in collaboration with an audiologist and in compliance with current ASHA guidelines and position statements.
The scopes of practice of both audiology and speech-language pathology include providing services for audiologic/aural rehabilitation (AR); however, the evolving breadth of AR services makes it less likely that audiologists and speech-language pathologists will have identical roles in AR or that they will bring the same knowledge and skills to the process. It is more likely that individual clinicians will have knowledge and skills specific to their professions and that AR will be provided as a collaborative service. Individuals who provide AR should refer to the Association's document on skills and knowledge in AR to determine their personal scope of competence in this area in light of their education, training, and experience.
Evaluation of (central) processing of auditory information and treatment of its disorders in adults and children is a third area in which there is some similarity or overlap of professional function between persons who hold the CCC-SLP and those who hold the CCC-A. A collaborative approach to the assessment and management of a (central) auditory processing disorder is often recommended, with audiologists performing the assessment and management of the peripheral and central auditory system and management of its disorders and speech-language pathologists performing the assessment of language skills and intervention in disorders of that function. Speech-language screening, hearing screening, aural rehabilitation, and assessment and intervention for (central) auditory processing disorders are examples of areas of practice that fall within the scopes of practice of both speech-language pathologists and audiologists. Individuals are encouraged to consult current Association documents to determine if they possess the necessary knowledge and skills to provide these services or make appropriate referrals if they do not.