Ethics Q&A for School-Based Speech Language Pathology Practice
General Ethics Questions
Is it unethical for me to accept referrals for my part-time private practice for children who attend my school or district?
A number of cases have come before ASHA's Board of Ethics that revolve around a real or potential conflict of interest. In its summary, the Board stated that practitioners who intend to accept cases for their private practice from the place of primary employment should observe the following guidelines:
- Check first with your local district and/or administrator about guidelines or restrictions that may exist regarding this question.
- The persons served professionally must be fully informed of services available from the practitioner's primary employment setting as well as those from the private practice or other practice environment and given freedom to choose whether and from whom they will obtain professional services.
- The costs associated with obtaining services from the practitioner's primary employment setting versus those associated with the private practice must be made clear.
- Practitioners accepting cases in a private setting from their primary place of employment should inform the administrator at their primary employment setting of their intent.
For more information on this topic and a scenario taken from a school setting, please refer to the Accepting Referrals for Private Practice From Primary Place of Employment Issues in Ethics document.
My school system hires unqualified personnel as substitutes when I am ill or away from the job attending a professional meeting. Is this practice ethical?
There are typically two levels of support personnel-aides and assistants. Aides and assistants should not be used to substitute for a qualified professional. Based on level of training, these support personnel may have a different scope of responsibilities in the work setting. Aides, for example, have a different (usually narrower) training base and a more limited scope of responsibilities than speech-language pathology assistants. States may use different terminology to refer to support personnel in speech-language pathology (e.g., communication aides, paraprofessionals, service extenders). It is important to evaluate the role of a substitute. A substitute who is providing coverage for a day or two may be considered to play a different role (i.e., maintaining levels of student performance) than that of a long-term substitute hired to cover a leave of absence. It is important to discuss these situations with the supervisory staff to ensure both the needs of the student and ethical issues are addressed.
It is also important to check state and local district regulations or policies regarding support personnel and missed sessions. See the IDEA Issues Brief on missed sessions [PDF] for more information.
ASHA's Code of Ethics lists its first rule of ethics as follows: 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. Speech-language pathology aids or assistants are not considered qualified providers of speech-language services in the schools. Questions and answers about who is a qualified provider are on the Qualified Provider Provisions for Related Services Personnel in IDEA [PDF] ASHA website.
You can find other related documents on the Additional Resources on Qualified Providers ASHA webpage.
Other documents of interest on this topic, Frequently Asked Questions About Speech-Language Pathology Assistants, and information about Support Personnel from the Board of Ethics can be found on the ASHA website.
I sometimes have disagreements with parents about the amount of service their child needs. How can I avoid providing services that I feel are unwarranted or ethically wrong?
Your decision should be guided by appropriate sections of ASHA's Code of Ethics, district policies, and state and federal regulation. Usually, when professional and parent or clients disagree, the conflict is related to one of the following: dismissal, frequency and intensity of treatment, type of treatment/therapeutic approach, eligibility for services, or specific assistive technology. It is often helpful to review the evidence used to make decisions with parents. Information about some of the existing evidenced-based practices can be found on the ASHA website.
Illustrative examples of typical scenarios, including when parents refuse dismissal from services for their child, insist on more services than recommended for their child, or demand a treatment approach that has not been proven effective, can be found in the article "When Clinician and Parent Disagree" by Polly B. Pooser.
Additional information is in the article by Melanie Frazek, "Ethics vs. Legal Jurisdiction."
What are my ethical responsibilities related to assessing and treating children from culturally diverse populations?
Evaluations of students from culturally diverse backgrounds should be based on current preferred practices providing an estimate of the child's functioning level in the various areas assessed using information elicited during the evaluation and your clinical judgment. Test scores should not be reported when using translated tests not normed on the population representing the student, nor should you use tests containing biases that will negatively affect a child's performance and may erroneously indicate the need for special education services. It is also important to discriminate between communication problems that may be relative to learning English as a second language versus those that are truly considered to be a speech-language disorder.
For additional information on services to children from culturally diverse populations, you may wish to contact ASHA's Office of Multicultural Affairs: firstname.lastname@example.org.
What are my ethical responsibilities in mentoring clinical fellows and supervising student clinicians?
Under ASHA's Code of Ethics, members providing supervision must hold ASHA Certification in the area of their supervisory work. School-based members may be directed by their administrators to comply with requirements that conflict with ASHA standards. In districts where credential requirements or state licensure requirements differ from ASHA certification standards, supervised clinical experiences (including student practica for teacher licensing) will count toward or may be applied toward ASHA certification (CCC) requirements only if those practicum hours have been supervised by ASHA-certified personnel. For further discussion, see Supervision of Student Clinicians Issues in Ethics document on the ASHA website.
For information regarding responsibilities in mentoring Clinical Fellows, see the Issues in Ethics Statement on that topic in the Cultural and Linguistic Competence Issues in Ethics document on the ASHA website.
Visit the ASHA website page on ASHA certification standards to find more information about the topic.
What should I do if asked to "sign off" on Medicaid for speech-language pathologists I have not supervised?
ASHA's Code of Ethics provides guidance for the speech-language pathologist confronted with conflicting information or differing opinions that can trigger ethical dilemmas. Speech-language pathologists must be very firm yet cautious when dealing with administrators who direct them to "sign off" for services not rendered, such as supervision of service providers not supervised. It is important to share with the administrators the consequences for violations of the rules and regulations set by Medicaid. Services not adequately supervised and claims for services not provided are among those that could result in a school district having to repay Medicaid funds received for such services. In addition, fraudulent billing is a criminal activity that may be punishable by law-not only for the school district but also for the speech-language pathologist participating in the activity. For additional information on this topic, visit the ASHA website Medicaid Guidance for School-Based Speech-Language Pathology Services: Addressing the "Under the Direction of" Rule.
What are my responsibilities for supervising unqualified personnel?
In ASHA's position statement on "Training, Use, and Supervision of Support Personnel in Speech Language Pathology," it is stated that support personnel may be used to perform activities adjunct to the primary clinical efforts of speech-language pathologists. Appropriate training and supervision must be provided by speech-language pathologists who hold ASHA's Certificate of Clinical Competence in Speech-Language Pathology. Activities may be assigned only at the discretion of the supervising speech-language pathologist and should be constrained by the job responsibilities for support personnel. The communication needs and protection of the consumer must be held paramount at all times. For more on this topic see Qualified Providers in Schools on the ASHA website.
Does ASHA have a process for reporting ethical violations?
Instructions for completing and submitting a complaint form for alleged violations can be found in the document Instructions & Form For Filing a Complaint [PDF] on the ASHA website.
For information on how ethics complaints are processed and adjudicated, see the procedures of the Board of Ethics on the ASHA website, Statement of Practices and Procedures of the Board of Ethics.
Where can I find published articles and continuing education programs related to ethical problem solving?
Articles related to ethical issues can be searched online in The ASHA Leader.
In addition, ASHA Professional Development offers live and self-study programs in a wide variety of subject matter in multiple formats: Web, telephone seminars, and conferences. Some examples of professional development products are: Ethics and IDEA a guide that focuses on the challenges of ethical issues confronting SLPs as they implement IDEA in their school districts.
A listing of all ASHA ethics-related Professional Development products can be found in the ASHA online store.
General Ethics Questions
What is the ASHA Code of Ethics and why is it important for me to follow the code?
ASHA's Code of Ethics contains the rules or standards agreed upon by our membership that govern our conduct and activities. A code of ethics is a shared statement of the values specific to a particular group. The importance of adherence to the Code by ASHA members lies in the preservation of the highest standards of integrity and ethical principles, and it is vital to the responsible discharge of obligations by members of our profession working in all settings. For additional information, see ASHA's Code of Ethics, and a presentation titled Ethics for Real: Case Studies Applying the ASHA Code of Ethics [PDF].
Are there penalties for members who refuse to adhere to the Code, or is adherence optional?
The Code of Ethics is not simply inspirational in nature; it is essential to ensuring the welfare of those served and protecting the integrity and reputation of the professions. As a consequence, ASHA members and certificate holders are required to abide by the code's principles and rules, and the Association enforces that mandate by sanctioning those found in violation. Depending on the egregiousness of the misconduct, the sanctions that the Board of Ethics can impose range from a confidential reprimand for lesser violations to revocation of ASHA membership and certification for a period of years, up to life, for violations of a serious nature.
What are the ASHA documents that can give me guidance in making decisions that are ethically correct?
Start with the ASHA Code of Ethics. The Ethics Resources page is a convenient place to look for ASHA's ethics guidance and information.
For a collection of information targeted at school-based SLPs who are dealing with ethical issues in the school setting see the Ethics and Schools Practice webpage.
How do I know if I am facing an ethical dilemma?
In "A Consensus Model for Making Ethical Decisions in a Less-Than-Ideal World" (Rockhurst University, 2005) Morris and Chabon state that if the situation is one in which personal and professional integrity are being challenged, the answer will likely be "Yes, it is an ethical situation."
An ethical dilemma is defined as a situation that requires a choice between options that are or seem to be equally unfavorable or mutually exclusive. In its main sense, a dilemma refers to a situation in which a choice must be made between alternative courses of action or argument. For example, in schools, SLPs could be asked to provide services for children who no longer qualify for intervention to satisfy a parent's request or an employer's demands. You can appreciate that dilemma: On the one hand, if you adhere to the parent's request or employer's demand to provide the services and those services are not needed, you risk being sanctioned for unethical conduct; on the other hand, if you do not provide the unneeded services, you could suffer employment discipline or termination. That is a classic dilemma that has arisen because of the conflict between the SLP's requirement to abide by the ASHA Code of Ethics and the demand of the parent and/or employer.
Once it is established that an ethical dilemma exists, the questions addressed include the following: "What possible courses of action are permissible, impermissible or necessary?" and "What are the effects (benefits and burdens) of each action?" (Chabon & Morris, 2006).
For information about ethical issues confronting speech-language pathologists working in the schools, the publication Ethics and IDEA: A Guide for Speech-Language Pathologists and Audiologists Who Provide Services Under IDEA (ASHA 2003) provides pointers on how to approach solution and resolution to the everyday problems that they may face.
What are the most frequently recurring themes of ethics inquiries made to ASHA?
- Employer demands
- Use and supervision of support personnel
- Cultural competence
- Reimbursement for services
- Professional (vs.) business ethics, and
- Clinical fellowship supervision
ASHA typically receives approximately 3,000 ethics inquiries each year.
Where can I get guidance when I find myself embroiled in an ethical dilemma?
The ASHA website can provide additional assistance. Check the Schools Page for "A Ten Step Process in Resolving Ethical Issues."
The ASHA Ethics webpage also has information and guidance that may be helpful to you. ASHA's Director of Ethics is available for confidential consultation through the ASHA Action Center at 800-498-2071.
You may also want to consider contacting your state Speech-Language-Hearing Association, state Department of Education, state licensure boards, colleagues, employers, or unions.
How can I avoid ethical difficulties?
- Advocate for best practices.
- Use evidenced-based practices as the basis for decision making.
- Know and understand the ASHA Code of Ethics and your employer's handbook and guidelines.
- Connect the Code of Ethics with your program's mission statement, policies and procedures, and performance evaluations.
- Acquaint supervisors,administrators, and colleagues with the Code of Ethics, Issues in Ethics Statements, and potential for ethical conflicts.
- Discuss potential ethical issues before they become a problem.
- Review federal, state, and local regulations and requirements.