Issues in Ethics: Speech-Language Pathology Assistants
About This Document
Published 2014. This Issues in Ethics statement is a revision of Support Personnel (2004), which revised ASHA Policy Regarding Support Personnel (1979). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics as revised in 2010. 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 are illustrative of the ASHA Code of Ethics (2010r) and 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.
This Issues in Ethics statement is intended to provide guidance for speech-language pathology assistants (SLPAs) and their supervisors. SLPAs assist speech-language pathologists (SLPs) to provide a variety of services in all work settings. They go by a variety of job titles, including SLPA, communication aide, paraprofessional, speech aide, and therapy assistant, and may possibly hold various credentials from organizations or training programs. SLPAs may or may not be regulated by state laws and regulations, and their activity may or may not be recognized by various funding sources. Given that standards, licensure, and practice issues vary from state to state, this Issues in Ethics statement describes ASHA’s policy for the use of SLPAs. It does not supersede federal legislation and regulation requirements or any existing state licensure laws, nor does it affect the interpretation or implementation of such laws. The ASHA Code of Ethics (2010r) provides members and certificate holders with guidance regarding the issues that may arise regarding ethical considerations related to SLPA practice parameters.
Preparation of SLPAs may vary considerably across states and across work settings; however, the Speech-Language Pathology Assistant Scope of Practice policy document (ASHA, 2013) states, "...An SLPA must complete an approved course of academic study, field work under the supervision of an ASHA-certified and/or licensed SLP, and on the job training specific to the SLPA responsibilities and workplace behaviors."
Tasks performed by SLPAs differ widely and may be limited to preparation of materials, checking the condition of equipment or programming, and providing instruction in the use of augmentative and alternative communication devices. Tasks also may include assisting the SLP with speech, language, and hearing screenings without interpretation; assisting the SLP during the assessment of students, patients, and clients exclusive of administration and/or interpretation; following documented treatment plans or protocols that are designed and supervised by an ASHA-certified SLP; compilation of data regarding client/patient/student performance; and assistance with research protocols. Differing levels of SLPAs also exist across work settings, states, or organizations.
Regardless of job title, preparation, tasks, and other credentials, all persons who provide support services in speech-language pathology should be directed and supervised by ASHA-certified speech-language pathologists. It is the SLP’s responsibility to design and implement a supervision system that protects students, patients, and clients and maintains the highest possible standards of quality. The amount and type of supervision should meet the minimum requirements and be increased as appropriate based on the needs, competencies, skills, expectations, philosophies, and experience of the SLPA and the supervisor; the needs of students, patients, and clients served; the service setting; the tasks assigned; and other factors. More intense supervision, for example, would be required in the orientation of a new SLPA; initiation of a new program, equipment, or task; or a change in student, patient, or client status (e.g., medical complications). Functional assessment of SLPA skills in performing assigned tasks should be ongoing, regular, and an integral element of supervision. One of the guidelines for SLP supervision of SLPAs listed in the Speech-Language Pathology Assistant Scope of Practice is "SLPs and SLPAs should treat each other with respect and interact in a professional manner."
Because the SLPA is an integral figure in many settings, the individual with ASHA certification and the support personnel must work together to help ensure appropriateness in all tasks. These include, but are not limited to, client and task assignment, supervision, competence, accountability, and representation to consumers, employers, and regulatory and funding agencies. The Board of Ethics refers individuals to the following sections of the current Code of Ethics (2010r) for specific discussion of these issues: Principle of Ethics I, Rules of Ethics D and E; Principle of Ethics II, Rules D and E; and Principle of Ethics IV, Rule A.
Because SLPAs are not individuals who can work independently, it is imperative that the professional with ASHA certification (and/or state licensure) ensures that their roles and responsibilities are clearly delineated. Items to be stressed may include, but not be limited to, ensuring that the appropriateness of client and task assignments are commensurate with level of training and experience, that there is adherence to and accountability of recognized standards of supervisory practices, and that SLPAs are appropriately identified to consumers, employers, colleagues, and regulatory and funding agencies. The responsibility of SLPAs is to comply with the mandates of the guidelines established with their supervisors. Lack of compliance will negatively impact the reputation of the supervisor and place the position of the SLPA in jeopardy. It is imperative that an ASHA-certified SLP appropriately supervise the SLPA, because the supervising SLP retains full legal and ethical responsibility for students, patients, and clients served by the SLPA. The amount of supervision may vary and must depend on the complexity of the case and the experience of the assistant.
The Board of Ethics refers individuals to the following sections of the current Code of Ethics (2010r) for discussion of issues related to the use of SLPAs. Guidance relating to these sections of the Code of Ethics is also provided in the Speech-Language Pathology Assistant Scope of Practice.
Principle of Ethics I: 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 of Ethics I, Rule D. 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.
Principle of Ethics I, Rule E. Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills, knowledge, and judgment that are within the scope of their profession to assistants, technicians, support personnel, or any nonprofessionals over whom they have supervisory responsibility.
Principle of Ethics I, Rule F. 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.
Principle of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.
Principle of Ethics II, Rule D. 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.
Principle of Ethics II, Rule 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.
Principle of Ethics IV: Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines.
Principle of Ethics IV, Rule A. Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.
Principle of Ethics IV, Rule B. Individuals shall prohibit anyone under their supervision from engaging in any practice that violates the Code of Ethics.
Failure to adhere to these principles and rules constitutes a violation of the Code of Ethics. Although some SLPAs may choose to affiliate with ASHA as Associates, the Code of Ethics does not directly apply to Associates. However, any individual who is working in a support role (technician, aide, assistant) under the supervision of an SLP or speech scientist must be knowledgeable about the provisions of the code. It is imperative that the supervising professional and assistant behave in a manner that is consistent with the principles and rules outlined in the ASHA Code of Ethics (2010r). Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the code if adequate oversight has not been provided.
Further, it is the responsibility of ASHA members and certificate holders to ensure that support personnel under their supervision behave in an ethical manner, which includes not engaging in activities outside their level of training, experience, and competence. This responsibility may begin with development of the job description and tasks to be assigned and will extend to supervision of all work performed, monitoring of daily activities, and typically will include evaluation of support personnel job performance. Education and guidance of employers and consumers may be necessary, particularly in order to ensure that credentials of support personnel are not misrepresented in dealing with the public, including persons served and their families, as well as funding sources and regulatory agencies.
The activities of the ASHA-certified SLP in supervising support personnel may take several forms, including direct, onsite, in-view observation and guidance, and indirect supervision that does not require the SLP to be physically present or available via telecommunication in real time while the SLPA is providing services. Indirect supervisory activities may include review of treatment plans and timely implementation of modifications, demonstration tapes, record review, review and evaluation of audio- or videotaped sessions, review of data collected, and informal documentation; conferencing; training; and performance appraisal.
The amount of supervision for any one paraprofessional is determined by the training and experience of both the SLPA and the certified individual, as well as by the specific job tasks and any laws or regulations pertaining to such activity. Similarly, the number of assistants, aides, or technicians supervised by a professional must allow supervision that is appropriate in both quantity and quality. Members who exercise only nominal supervision over an individual because they have responsibility for too many SLPAs may be found to violate Code requirements in failing to hold paramount the welfare of persons served (Principle of Ethics I).
SLPAs may not independently diagnose, treat, or advise clients of disposition. They may, however, perform speech and language services in support of an ASHA-certified SLP when the specific tasks are within their repertoire of training, experience, and competence and when the tasks are supervised by an ASHA-certified SLP. In all aspects of the interaction, the ASHA-certified SLP maintains ethical and legal responsibility for the work performed and its outcome.
Resources are available to help SLPs maintain and enhance the use of SLPAs within the profession. Individuals are encouraged to consult current ASHA position statements, the Speech-Language Pathology Assistant Scope of Practice, the ASHA Practice Portal, and guidelines and practice policy documents pertaining to the training, use, and supervision of SLPAs and support personnel.