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Issues in Ethics

American Speech-Language-Hearing Association (ASHA) Practice Policy

Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified

Board of Ethics


About this Document

1996; revised 2003.



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 illustrate the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders engage 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 the previous one of the same title (1996, Spring).

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Introduction

Speech-language pathology and audiology are separate professions with differentiated scopes of practice. Nevertheless, since both serve children and adults with communication disorders, they share common concerns and responsibilities. There may also be misunderstandings about the scope of practice of these professions by the general public, by practitioners of other professions, and by the people speech-language pathologists and audiologists serve.

This statement interprets those sections of the Code of Ethics that pertain to the provision of services in areas that are common to the scope of practice of both professions but that are more closely associated with the profession in which the individual is not certified. These ethical considerations are independent of state licensure laws, which may define the scope of practice of the professions more broadly or more narrowly than the Association defines it. Individuals must abide by the Association's Code of Ethics in deciding whether or not they may provide professional services.

The Board of Ethics refers readers to Principle of Ethics II and Rules of Ethics IIA, IIB, and II-C for discussion of this issue:

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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 B. Individuals shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience.

Rule C. Individuals shall continue their professional development throughout their careers.

The Board of Ethics interprets these sections of the Code of Ethics as follows:

When speech-language pathologists and audiologists are engaged in any aspect of professional practice, it is essential that they practice within the scope of practice of their respective professions (i.e., speech-language pathology or audiology) and only within the scope of their competence, as determined by their level of education, training, and experience.

Areas of practice common to both professions include screening, aural rehabilitation, and evaluation/management of auditory processing disorders. Ethical considerations for audiologists and speech-language pathologists who practice in these areas are discussed below.

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Discussion

Individuals who hold only the Certificate of Clinical Competence in Audiology (CCC-A) may perform screening of speech-language and other factors affecting communication function for the purposes of an audiologic evaluation and/or initial identification of individuals with other communication disorders. The screening procedures used should adhere to current ASHA guidelines and position statements. Individuals who hold only the CCC-A shall limit judgments and descriptive statements about the results of such screening procedures to a determination as to whether the person has passed. Persons who do not pass the screening shall be referred for evaluation.

Individuals who hold only the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) may screen hearing of individuals who can participate in conventional pure-tone air conduction methods, as well as screen for middle ear pathology through screening tympanometry for the purpose of referral of individuals for further evaluation and management. The screening procedures used should adhere to current ASHA guidelines and position statements. Individuals who hold only the CCC-SLP shall limit judgments and descriptive statements about the results of such screening procedures to a determination as to whether the person has passed. Persons who do not pass the screening shall be referred for evaluation.

Individuals who hold only the Certificate of Clinical Competence in Speech-Language Pathology and who have appropriate training may perform newborn hearing screening using otoacoustic emissions (OAE) or auditory brainstem evoked response in collaboration with an audiologist and in compliance with current ASHA guidelines and position statements.

The scope of practice of both audiology and speech-language pathology includes providing services for audiologic/aural rehabilitation (AR). However, the evolving breadth of AR services makes it less likely that audiologists and speech-language pathologists will have identical roles in AR or that they will bring the same knowledge and skills to the process. It is more likely that individual clinicians will have knowledge and skills specific to their professions and that AR will be provided as a collaborative service. Individuals who provide AR should reference the Association's document on skills and knowledge in AR to determine their personal scope of practice in this area in light of their education, training, and experience.

Evaluation of central processing of auditory information and treatment of its disorders in adults and children is a third area in which there is some similarity or overlap of professional function between persons who hold the CCC-SLP and those who hold the CCC-A. A collaborative approach to the assessment and management of a central auditory processing disorder is often recommended, with audiologists performing the assessment and management of the peripheral and central auditory system and management of its disorders, and speech-language pathologists performing the assessment of language skills and intervention in disorders of that function. Intervention to improve auditory prcessing provided by professionals in both areas might incorporate auditory training and stimulation, as well as communication and/or education strategies.

Speech-language screening, hearing screening, aural rehabilitation, and intervention for central auditory processing disorders are examples of areas of practice that fall within the scope of practice of both speech-language pathologists and audiologists. Individuals are encouraged to consult current Association documents to determine if they possess the necessary knowledge and skills to provide these services and to make appropriate referrals if they do not.

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Index terms: certification, ethics

Reference this material as: American Speech-Language-Hearing Association. (2004). Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified [Issues in Ethics]. Available from www.asha.org/policy.

© Copyright 2004 American Speech-Language-Hearing Association. All rights reserved.

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.ET2004-00165