Your supervisor asks you to evaluate a Cantonese-speaking 7-year-old. Her family came from China. No Cantonese-speaking speech-language pathologist is available in your district, so you evaluate her through an interpreter. This interpreter knows the dialect spoken by the child, and understands the purpose of a speech-language evaluation and her role in the evaluation. You know of no standardized speech-language tests in Cantonese, and you know you shouldn't report scores on translated tests. You have kept up to date on all the research, and your evaluation is consistent with current preferred practice guidelines for the assessment of bilingual/bicultural children.
A few days after you submit the evaluation, you receive a phone call. Your district has rejected your evaluation because it does not contain any test scores. You explain that translated tests are invalid because they do not take into account differences between the two languages. You also explain why what you have done is a good estimate of the child's communication skills.
Your district supervisor, however, reminds you that up until this point you and every other SLP in the district provided test scores. These scores, she explains, were an easy way to see the child's level of performance to determine eligibility for services. So, you must go back, re-test the child using a translated test, and report those test scores.
Your ethical dilemma: Do you go back with your interpreter, have her translate the tests, and then determine eligibility based upon the child's scores?
Before the first case is resolved, you are asked to evaluate a bilingual third-grader who is having trouble mastering the curriculum. His family came to your town from the Dominican Republic a number of years ago. At home he tends to use Spanish with his parents and mostly English, but some Spanish, with his older brothers.
You are bilingual in Spanish, with near-native proficiency. You have several tests published in Spanish, but you have reviewed their normative samples and determined they are flawed. You also question their validity because their discriminate accuracy findings-a test accuracy in identifying whether a child has a communication disorder-are inadequate.
You do the evaluation based upon current preferred practices, and again provide an estimate of the child's functioning level in the various areas assessed based upon the information elicited during the evaluation and your clinical judgment. This time your supervisor contacts you within a day of handing in your report. You explain that you used some subtests on the Spanish tests to probe for information, but you could not report scores because of the psychometric limitations. She complains that the district purchased the Spanish tests for you, and there should be no reason why the test scores can't be reported.
Your ethical dilemma: Do you go back, give the student the tests, and report the scores?
Your supervisor decides that until the issue is resolved she will not ask you to do any more bilingual evaluations because you are creating so many administrative problems for her. So, she asks you to evaluate an 11-year-old boy who speaks African American English as his primary dialect of English. The boy is from a low-income family with many of the cultural characteristics of the "Trackton" community (a working-class African American community in the southeastern United States, where most of the adults have had little schooling and most of the community speaks African American English; Heath, 1982). You are aware that the test biases will negatively affect his performance and may erroneously indicate that he needs special education services. Your evaluation conforms to preferred practice guidelines. Once again, you decide not to report scores.
Your supervisor cannot understand why there is a problem reporting test scores for children who speak English. This is unbelievable to her-especially because all your colleagues report scores for all the English-speaking students they evaluate.
Your ethical dilemma: Do you report the scores on the tests to determine eligibility?
What happened? Just a few years ago, you were in blissful ignorance of the problems with using test-derived scores to determine eligibility. You gave the tests and reported scores, and everyone was happy. Why are you now faced with ethical dilemmas when there weren't any in the past? If only you hadn't read the research articles or attended the ASHA conferences-you never would have questioned the practice.
When did this become an ethical issue and not just a difference of opinion? ASHA's Code of Ethics requires us to provide "all services competently" (ASHA, 2003b). The challenge is that as our field develops, matures, and expands, the standard for what are competent services changes (ASHA, 2003a). This means that what were once competent services may not be considered competent today.
But, you say, it is just too difficult to stay current and have to deal with the ethical issues. You consider telling your supervisor that you don't want to evaluate these students anymore. That way, you hope, you won't violate your ethical code, and you won't have to deal with an unhappy supervisor. Sorry to say, but this does not resolve your dilemma. The ASHA Code of Ethics also prohibits discrimination-including on the basis of race, ethnicity, or national origin-in the delivery of professional services (ASHA, 2003b).
There is some good news. SLPs and audiologists across the country are finding themselves in situations just like yours. Many of them have worked with their colleagues and administrators to change the way things are done with the goal of providing more effective services for culturally and linguistically diverse children. Also, since the passage of the 1997 amendments to the Individuals with Disabilities Education Act, districts can be in violation of federal law if too many of its minority children are referred for special education services, so administrators may be more open to alternative assessment procedures.
The accompanying stories (above and on page 26) are true experiences of SLPs who worked in their school districts to modify assessment requirements so that they could continue to provide ethical services as the standard of competency changed. They are models for all of us.