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Issues in Ethics

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

Fees for Clinical Service Provided by Students and Clinical Fellows

Board of Ethics


About this Document

1978; 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 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 statement replaces an earlier version (1978) titled, “Fees for Clinical Service Provided by Students.”

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Introduction

The Board of Ethics has been asked to address ethical questions that may arise when fees are charged for clinical services provided by students and clinical fellows. These ethical issues involve the following: (1) the legitimacy of charging for work done by individuals who are not yet fully trained or certified; (2) the nature of supervision provided these individuals; and (3) the public's right to be informed regarding the qualifications of those providing the services.

The Board of Ethics refers readers to Principles of Ethics II and III and Principle of Ethics II, Rule A, and Principle of Ethics III, Rule A, for discussion of these issues:

Principle of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence.

Principle of Ethics II, 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.

Principle fo Ethics III: Individuals shall honor their responsibility to the public by promoting public understanding of the professions, by supporting the development of services designed to fulfill the unmet needs of the public, and by providing accurate information in all communications involving any aspect of the professions, including dissemination of research findings and scholarly activities.

Principle of Ethics III, Rule A: Individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly or research contributions.

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Discussion and Guidance

Principle of Ethics II, Rule A of the Code of Ethics recognizes the professional acceptability of appropriately supervised clinical practice by students and clinical fellows in training. Hence, the Board of Ethics has concluded that it has no basis for suggesting or requiring that such fees be fixed at any specific level or differ in any manner or proportion from the fees normally charged for services provided by certified audiologists or speech-language pathologists. Although students and clinical fellows may be involved in the provision of clinical services, client welfare is the responsibility of the certified supervisor. Clinical fellows are covered under the Code of Ethics and must adhere to its principles and rules.

Of importance here is the nature, type, and quality of the supervision, rather than the fee schedule. The services provided must meet or exceed professional standards of supervision, as well as any legal and regulatory standards that may apply. The nature and intensity of supervision should be based on the stage of clinical development of each student or clinical fellow. If appropriate supervision is provided, the fees charged are justified; if not, there is something fundamentally wrong with the service offered, and the fee level is immaterial in view of Principle of Ethics I of the Code, which obligates members and/or certificate holders to “honor their responsibility to hold paramount the welfare of persons they serve professionally.”

Third-party payors may be very specific as regards payment for services provided by students and clinical fellows. Therefore, it is imperative that supervisors be knowledgeable regarding these specific requirements.

A final issue concerns the client's right to be fully informed of the professional qualifications of the service provider. Principle of Ethics III, Rule A of the Code instructs that members and/or certificate holders “shall not misrepresent their credentials, competence, education, training, or experience.” Students, clinical fellows, and supervisors must identify themselves as such to those they service, for example, by use of an appropriate name tag.

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Index terms: fees, students, clinical fellowship, ethics

Reference this material as: American Speech-Language-Hearing Association. (2004). Fees for Clinical Service Provided by Students and Clinical Fellows [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.ET2004-00170