Issues in Ethics: Support Personnel
About This Document
Published 2004. This Issues in Ethics statement is a revision of ASHA Policy Regarding Support Personnel (1979). 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 Code of Ethics 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 replaces an earlier version titled ASHA Policy Regarding Support Personnel (1994, March).
Support personnel work with audiologists and speech-language pathologists and assist them in providing a variety of services in all work settings. They go by a variety of job titles, including, but not limited to, audiology assistant, speech-language pathology assistant, communication aide, hearing aid technician, paraprofessional, speech aide, therapy assistant, hearing testing specialist, communication aide, and so on.
Preparation of support personnel may vary considerably. For example, the speech-language pathology assistant may hold an associate degree; the hearing aid technician may have completed a prescribed course of study; the communication aide may have completed a program with specified knowledge and skills. For some, the preparation may be on-the-job training and supervision.
Tasks performed by support personnel also differ widely. They may be limited to preparation of materials or checking the condition of equipment. Tasks also may include completion of diagnostic procedures and/or administration of treatment programs that are designed and supervised by an ASHA-certified audiologist or speech-language pathologist, compilation of data regarding client/patient/student performance, and assistance with research protocols. Differing levels of support personnel may exist within and across work settings, states, or organizations.
Support personnel may or may not be regulated by state laws and regulations. Their activity may or may not be recognized by various funding sources. They may or may not hold credentials from certain organizations or training programs.
Regardless of job title, preparation, tasks, and other credentials, all persons who provide support services in audiology and speech-language pathology should be directed and supervised by ASHA-certified audiologists and/or speech-language pathologists.
Because the assistant, aide, or technician 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 (2003) for specific discussion of these issues; Principle of Ethics I, Rules of Ethics D and E; Principle of Ethics II, Rules A, D, and E; and Principle of Ethics IV, Rule A.
Principle of Ethics I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or participants in research and scholarly activities and shall treat animals involved in research in a humane manner.
Rule D. Individuals shall not misrepresent the credentials of assistants, technicians, or support personnel and shall inform those they serve professionally of the name and professional credentials of persons providing services.
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, students, or any nonprofessionals over whom they have supervisory responsibility. An individual may delegate support services to assistants, technicians, support personnel, students, or any other persons only if those services are adequately supervised by an individual who holds the appropriate Certificate of Clinical Competence.
Principle of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence.
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 D. Individuals shall delegate the provision of clinical services only to: (1) persons who hold the appropriate Certificate of Clinical Competence; (2) persons in the education or certification process who are appropriately supervised by an individual who holds the appropriate Certificate of Clinical Competence; or (3) assistants, technicians, or support personnel who are adequately supervised by an individual who holds the appropriate Certificate of Clinical Competence.
Rule E. 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 IV: Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of allied professions. Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.
Rule A. 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. Further, it is the responsibility of ASHA members and certificate holders to ensure that support personnel under their supervision behave in a 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 audiologist or speech-language pathologist in supervising support personnel may take several forms, including direct, onsite observation; review of plans prepared, 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 support person 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 support personnel may be found to violate Code requirements in failing to hold paramount the welfare of persons served (Principle of Ethics I).
Support personnel may not independently diagnose, treat, or advise clients of disposition. They may, however, perform audiology, balance, speech, and language services in support of the ASHA-certified audiologist or speech-language pathologist when the specific tasks are within their repertoire of training, experience, and competence and when the tasks are supervised by an ASHA-certified audiologist or speech-language pathologist. In all aspects of the interaction, the ASHA-certified audiologist or speech-language pathologist maintains ethical and legal responsibility for the work performed and its outcome.
Resources are available to help audiologists and speech-language pathologists maintain and enhance the use of support personnel within the professions. Individuals are encouraged to consult current ASHA position statements, guidelines, and practice documents pertaining to the training, use, and supervision of support personnel.