The Code of Ethics is one of the first ASHA practice policy documents that a newly certified speech-language pathologist encounters. From the moment we are certified, we agree to uphold and abide by this code. Sounds easy, right? But the dynamics of the school setting can leave even the most experienced SLPs wondering what to do. Here are some common scenarios that school-based SLPs ask about.
Is it a conflict of interest to see students from my school or district on a private basis?
The answer to this question varies across states and districts. Some jurisdictions offer clear guidelines, and others remain silent. In consideration of this, Principle of Ethics III, Rule B applies: "Individuals shall not participate in professional activities that constitute a conflict of interest." To avoid conflicts of interest, take the following steps:
- Check with your local district and/or administrator about any existing guidelines or restrictions. Make sure your administrator knows of your intentions and plans.
- The parent must be fully informed of services available in the school setting as well as from other private practitioners.
- The costs and timing associated with services in both available settings must be made clear.
Do your homework if you do plan to see students privately. Weigh all aspects of your decision and consider obtaining professional liability insurance. You can read about the outcome of a school's case study in ASHA's "Issues in Ethics" statement written by the Board of Ethics, Accepting Referrals for Private Practice From Primary Place of Employment (2008).
What are my ethical obligations when a parent doesn't agree with my recommendations for treatment?
The most classic example are parents who don't agree with the recommended frequency and/or duration of treatment sessions, but instead want an intense, individual treatment schedule for their child. What to do?
Ask the following questions before you respond:
- Is the parents' request reasonable and necessary for the child to access the curriculum?
- Will the frequency and duration of treatment requested comply with the child's right to be educated in the least restrictive environment?
Principle I of ASHA's Code of Ethics states that we must hold paramount the welfare of our clients, which means we are obligated to provide the most appropriate services for every student we see. In schools, we are also bound by Individuals with Disabilities Education Act (IDEA) laws and regulations, which state that all children receiving special education services are entitled to a free and appropriate public education.
In cases like these, look at the data collected on the student's Individualized Education Plan (IEP) objectives, work samples from the classroom, and teacher report to determine if an increase is warranted. In keeping with IDEA, we must consider overall academic performance and access to the curriculum in the least restrictive environment. Parents may not always understand that increasing treatment time may interrupt their child's access to the classroom environment and, therefore, violate the rights of their child.
Principle of Ethics I, Rule B —that individuals shall use every resource, including referral when appropriate, to ensure that high-quality service is provided—applies. Principle of Ethics IV, Rule J, also applies: "Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription."
This scenario presents an opportunity to educate the IEP team on the law, various service delivery models, and ways that student goals and objectives can be supported in the classroom and with home programs. All of these factors help to guide the IEP team decision. In the end, it is the IEP team that collectively determines what is best for the child. The decision should not fall only to one member of the team.
What is my ethical obligation to treat students with dysphagia if I have not received proper training or preparation in dysphagia?
This theme is common among SLPs who did not receive training and preparation in this area and then find themselves with a child on their school caseload with a feeding and swallowing disorder. Several principles and rules of the Code of Ethics apply here.
- Principle I: "Individuals shall honor their responsibility to hold paramount the welfare of persons they serve."
- Principle II: "Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance."
- Principle II, 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."
What to do? First, do not attempt to treat the child if you are not properly trained and prepared. Next, take steps to find a colleague who has experience and training in dysphagia to provide treatment until you receive appropriate training and education to do so on your own.