Issues in Ethics: Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified

About This Document

Published 2017. 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 and 2013). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). 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 (hereinafter, the "Board") 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 are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging 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.

Introduction

Because the professions of both audiology and speech-language pathology 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 an ASHA-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 in other professions, and by the people whom audiologists and speech-language pathologists serve.

This statement interprets those sections of the Code 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 ASHA (also known as the "Association") defines them.

The Board of Ethics refers readers to Principle of Ethics II, Rules A, B, and D, as well as Principle of Ethics IV, Rule R, for discussion of this issue in the sections that follow.

Principle of Ethics II

Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

Rule A. Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.

Rule B. Members who do not hold the Certificate of Clinical Competence may not engage in the provision of clinical services; however, individuals who are in the certification application process may engage in the provision of clinical services consistent with current local and state laws and regulations and with ASHA certification requirements.

Rule D. Individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning applicable to their professional activities and skills.

Principle of Ethics IV

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

Rule R. Individuals shall comply with local, state, and federal laws and regulations applicable to professional practice, research ethics, and the responsible conduct of research.

The Board interprets these sections of the Code as follows:

When audiologists and speech-language pathologists are engaged in any aspect of professional practice, it is essential that they function within the scope of practice of their respective professions (i.e., audiology or speech-language pathology) and only within the scope of their competence, as determined by their certification status, 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 relies on the ethical sense of the practitioner. Practitioners must also abide by their state's code of ethics/conduct in deciding whether or not they may provide professional services.

Areas of practice common to both professions include (a) hearing and speech-language screening, (b) audiologic/aural rehabilitation (AR), and (c) evaluation/management of auditory processing disorders. Ethical considerations for audiologists and speech-language pathologists who practice in these areas are discussed below.

Discussion

Hearing and Speech-Language Screening

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 the hearing of individuals who can participate in conventional pure-tone air conduction methods. They may also screen for middle ear pathology through screening tympanometry, for the purpose of referring 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 the CCC-A, but who have appropriate training, may perform newborn hearing screening using otoacoustic emissions or brainstem auditory evoked response in collaboration with an audiologist and in compliance with current ASHA guidelines and position statements.

Audiologic/Aural Rehabilitation

The scopes of practice of both audiology and speech-language pathology include providing services for 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/Management of Auditory Processing Disorders

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-A and those who hold the CCC-SLP. A collaborative approach to the assessment and management of a (central) auditory processing disorder is often recommended. In such cases, audiologists perform the assessment and management of the peripheral and central auditory system and management of its disorders, and speech-language pathologists perform the assessment of language skills and intervention in disorders of that function. Hearing screening, aural rehabilitation, assessment and intervention for (central) auditory processing disorders, and speech-language screening are examples of areas of practice that fall within the scopes of practice of both audiologists and speech-language pathologists. Individuals are encouraged to consult current Association documents to determine whether they possess the necessary knowledge and skills to provide these services or to make appropriate referrals if they do not.


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