Serving Diverse Populations
by Mary Bolton-Koppenhaver
(This article originally appeared in the April 2, 2002 issue of The ASHA Leader.)
Many organizations have codes of ethics to serve as guides for the professional conduct of their members. Such codes create a public trust that members are governed by ethical and moral conduct in the performance of their duties. This trust is imperative for optimum treatment benefits. When the individual does not trust the provider, outcomes may be seriously compromised. Equally important, if the provider does not trust or does not respect the client, outcomes also are jeopardized.
Some professions address services to diverse populations directly in their code of ethics. For example, in the American Psychological Association's "Human Differences of the Code of Conduct" (1992), members are directed to obtain the "training experience, consultation, or supervision necessary" to provide services to individuals who differ in "age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status," when those differences might affect treatment outcomes.
The ASHA Code of Ethics (2001) also provides guidance. Principle of Ethics I and Rules A, B, and C direct members to "hold paramount the welfare of persons they serve professionally" and to provide "all services competently" without discrimination "on the basis of race or ethnicity, gender, age, religion, national origin, sexual orientation, or disability." Members are directed to offer "high-quality" services, including referral when necessary, but according to whose value system?
Discrimination, subtle or overt, may occur in the delivery of services, education of students, or the hiring and supervision of staff. It often is based upon the misconception that members of a particular linguistic, ethnic, or cultural group behave and believe in certain predictable ways. In fact, individuals and families often form their own unique values and beliefs. The role of the ASHA member is not to embrace these values if they differ, but rather to try to understand and respect them and to refer, when possible, if the value differences threaten outcomes.
Recommendations and treatment regimens should never jeopardize an individual's membership in any group, family, clan, tribe, or community. This means respecting the family's choice of alternative medicine or traditional healing ceremonies and practices; adapting to different communication modes or styles, including who should be included in communication; and ensuring that testing and treatment materials are appropriate, applicable, and non-offensive. Comparisons of assessment results with normative data across diverse groups should be scrutinized. A paraprofessional or interpreter may become pivotal in the delivery of services to individuals who are linguistically different. Principle of Ethics I, E cautions that any designated tasks must be within the skill and knowledge level of the designee and that they must be "adequately supervised." Clearly, if the supervisor does not speak the language used in treatment, there may be serious compromises to the quality of services. Additionally, it is important to remember that bilingual is not synonymous with bicultural.
Finally, Principle of Ethics IV addresses responsibilities in creating and maintaining harmonious relationships with colleagues, students, and members of allied professions. Embodied in this principle is respect for others' differences. We cannot know every behavioral code for every diverse individual; rather, we need to think about sensitizing our staff, our students, and ourselves to broad categories of human differences.
Some of our members face complex dilemmas in providing services to, hiring and supervising, or educating diverse individuals. In facing these challenges, we should first consult our Code of Ethics and then our scope of practice statements, preferred practice patterns, position statements, and practice guidelines, which can provide understanding and guidance for decision making. Members of the National Office staff—particularly David Denton, former director of ethics, and Vicki Deal-Williams, former director of multicultural affairs (firstname.lastname@example.org)—are invaluable resources. Though the challenges are thorny, we ultimately are directed to hold paramount the welfare of persons we serve professionally and to create and maintain harmonious relationships with those with whom we work. These principles must always be central in our practice.
Mary Bolton-Koppenhaver is a former member of ASHA's Board of Ethics. She has served diverse populations at the University of New Mexico since 1973.