Issues in Ethics: Speech-Language Pathology Assistants

About This Document

Published 2017. This Issues in Ethics statement is a revision of Speech-Language Pathology Assistants (2014), which revised Support Personnel (2004) and ASHA Policy Regarding Support Personnel (1979). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.

Issues in Ethics Statements: Definition

From time to time, the Board of Ethics (hereinafter, the "Board") 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 (2016) (hereinafter, the "Code") and are 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.

Introduction

This Issues in Ethics statement is intended to provide guidance for speech-language pathology assistants (SLPAs) and their supervisors. SLPAs assist speech-language pathologists (SLPs) to provide a variety of services in all work settings. They go by a variety of job titles, including SLPA, communication aide, paraprofessional, speech aide, technician, and therapy assistant, and they may possibly hold various credentials from organizations or training programs. SLPAs may or may not be regulated by state laws and regulations, and their activity may or may not be recognized by various funding sources. Given that standards, licensure, and practice issues vary from state to state, this Issues in Ethics statement describes ASHA’s policy for the use of SLPAs. It does not supersede federal legislation and regulation requirements or any existing state licensure laws, nor does it affect the interpretation or implementation of such laws. The Code provides members and certificate holders with guidance regarding the issues that may arise concerning ethical considerations related to SLPA practice parameters.

Discussion

Preparation of SLPAs may vary considerably across states and across work settings; however, the Speech-Language Pathology Assistant Scope of Practice policy document (ASHA, 2013) states, "An SLPA must complete an approved course of academic study, field work under the supervision of an ASHA-certified and/or licensed SLP, and on the job training specific to the SLPA responsibilities and workplace behaviors."

Tasks performed by SLPAs differ widely and may be limited to preparation of materials, checking the condition of equipment or programming, and providing instruction in the use of augmentative and alternative communication devices. Tasks also may include assisting the SLP with speech, language, and hearing screenings without interpretation; assisting the SLP during the assessment of students, patients, and clients exclusive of administration and/or interpretation; following documented treatment plans or protocols that are designed and supervised by an ASHA-certified SLP; compilation of data regarding client/patient/student performance; and assistance with research protocols. Differing levels of SLPAs also exist across work settings, states, or organizations.

As ASHA’s Speech-Language Pathology Assistant Scope of Practice states, "Some tasks, procedures, or activities used to treat individuals with communication and related disorders can be performed successfully by individuals other than SLPs if the persons conducting the activity are properly trained and supervised by ASHA-certified and/or licensed SLPs." It is the supervising SLPs (and not the SLPAs) responsibility to design and implement a supervisory plan that protects consumer care, maintains the highest quality of practice, and documents supervisory activities, and all persons who provide support services in speech-language pathology—regardless of job title, preparation, tasks, and other credentials—must be directed and supervised by a speech-language pathologist who holds current ASHA certification and/or state licensure. The amount and type of supervision should meet the minimum requirements and be increased as appropriate based on the needs, competencies, skills, expectations, philosophies, and experience of the SLPA and the supervisor; the needs of students, patients, and clients served; the service setting; the tasks assigned; and other factors. More intense supervision, for example, would be required in the orientation of a new SLPA; initiation of a new program, equipment, or task; or a change in client/patient/student status (e.g., medical complications). One of the guidelines for SLP supervision of SLPAs listed in the Speech-Language Pathology Assistant Scope of Practice is not technically based: "SLPs and SLPAs should treat each other with respect and interact in a professional manner."

Functional assessment of SLPA skills in performing assigned tasks should be ongoing, regular, and an integral element of supervision. In addition to employer-provided assessment tools, ASHA offers a Verification of Technical Proficiency of SLPAs [PDF], which can be used to verify achievement of core skills in the areas of clinical/administrative skills, conduct in work setting, and technical skills as prescribed by the supervising SLP.

Because the SLPA is an integral figure in many settings, the individual with ASHA certification and the support personnel must work together to help ensure appropriateness in all tasks. These include, but are not limited to, client and task assignment, supervision, competence, accountability, and representation to consumers, employers, and regulatory and funding agencies.

Because SLPAs are not individuals who can work independently, it is imperative that the professional with ASHA certification (and/or state licensure) ensure that their roles and responsibilities are clearly delineated. Items to be stressed may include, but may not be limited to, ensuring that (a) the appropriateness of client and task assignments is commensurate with level of training and experience, (b) there is adherence to and accountability of recognized standards of supervisory practices, and (c) SLPAs are appropriately identified to consumers, employers, colleagues, and regulatory and funding agencies. The responsibility of SLPAs is to comply with the mandates of the guidelines established with their supervisors. Lack of compliance will negatively impact the reputation of the supervisor and place the position of the SLPA in jeopardy. It is imperative that an ASHA-certified and/or licensed SLP appropriately supervise the SLPA because the supervising SLP retains full legal and ethical responsibility for students, patients, and clients served by the SLPA. The amount of supervision may vary, and must depend on the complexity of the case and the experience of the assistant.

Guidance

Guidance relating to SLPAs is provided in the Speech-Language Pathology Assistant Scope of Practice and the Speech-Language Pathology Assistants Practice Portal. The following principles and rules of the Code specifically address issues that are pertinent to an SLPs supervision of support personnel when services are provided or when research is conducted:

Principle of Ethics I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.

Guidance: The supervising SLP or speech-language scientist remains responsible for the care and well-being of the client or research subject. If the supervisor fails to intervene when the assistant’s behavior puts the client or subject at risk or when services or procedures are implemented inappropriately, the supervisor could be in violation of the Code.

Principle of Ethics I, Rule A: Individuals shall provide all clinical services and scientific activities competently.

Guidance: The supervising SLP or speech-language scientist must ensure that all services and scientific activities, including those provided directly by the assistant, meet practice standards and are administered competently. If the supervisor fails to intervene or correct the actions of the assistant as needed, this failure could be a violation of the Code.

Principle of Ethics I, Rule C: Individuals shall not discriminate in the delivery of professional services or in the conduct of research and scholarly activities on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialect.

Guidance: The supervising SLP or speech-language scientist is responsible for ensuring that there is no discrimination in service delivery or scientific activities, as indicated above. Discrimination exhibited by the SLPA could be a violation of the Code.

Principle of Ethics I, Rule D: Individuals shall not misrepresent the credentials of aides, assistants, technicians, support personnel, students, research interns, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name, role, and professional credentials of persons providing services.

Guidance: The supervising SLP or speech-language scientist must ensure that clients and subjects are informed of the title, role, and qualifications of the assistant. This is not a passive responsibility—that is, the supervisor must make this information easily available and understandable to the client or subject and not rely on the individual to inquire about or ask directly for this information. Any misrepresentation of the assistant’s qualifications or role could result in a violation of the Code by the supervisor.

Principle of Ethics I, Rule E: Individuals who hold the Certificate of Clinical Competence may delegate tasks related to the provision of clinical services to aides, assistants, technicians, support personnel, or any other persons only if those persons are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served remains with the certified individual

Guidance: The supervising SLP or speech-language scientist is responsible for providing appropriate and adequate direct and indirect supervision to ensure that the services provided are appropriate and meet practice standards. The SLP should document supervisory activities and adjust the amount and type of supervision to ensure that the Code is not violated.

Principle of Ethics I, Rule F: Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills, knowledge, judgment, or credentials that are within the scope of their profession to aides, assistants, technicians, support personnel, or any nonprofessionals over whom they have supervisory responsibility.

Guidance: The supervising SLP or speech-language scientist is responsible for monitoring and limiting the role of the assistant as described in these guidelines and in accordance with applicable licensure laws.

Principle of Ethics II, Rule E: Individuals in administrative or supervisory roles shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's certification status, competence, education, training, and experience.

Guidance: The supervising SLP or speech-language scientist must ensure that the assistant performs only those activities and duties that are defined as appropriate for the level of training and experience and in accordance with applicable licensure laws. If the assistant exceeds the practice role that has been defined for him or her, and the supervising SLP or speech-language scientist fails to correct this, the supervisor could be found in violation of the Code. 

Principle of Ethics IV, Rule I: Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics.

Guidance: Because the assistant provides services as "an extension" of those provided by the professional, the SLP or speech-language scientist is responsible for informing the assistant about the Code and monitoring the performance of the assistant. Failure to do so could result in the SLP or speech-language scientist being found in violation of the Code. 

Principle of Ethics IV, Rule R: Individuals shall comply with local, state, and federal laws and regulations applicable to professional practice, research ethics, and the responsible conduct of research.

Guidance: This rule emphasizes the importance of the supervising SLP or speech-language scientist ensuring that the assistant complies with all laws and regulations applicable to their setting/facility and practice, not only state codes of ethics and state licensure laws.

Failure to adhere to these principles and rules constitutes a violation of the Code. Although some SLPAs may choose to affiliate with ASHA as Associates, the Code does not directly apply to Associates. However, any individual who is working in a support role (technician, aide, assistant) under the supervision of an SLP or speech-language scientist must be knowledgeable about the provisions of the Code. It is imperative that the supervising professional and assistant behave in a manner that is consistent with the principles and rules outlined in the Code. Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech-language scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code, the supervising professional may be found in violation of the Code if adequate oversight has not been provided. This is likewise true with respect to assistant’s actions that violate state licensure laws or regulations.

Further, it is the responsibility of ASHA members and certificate holders to ensure that support personnel under their supervision behave in an ethical manner, which includes not engaging in activities outside their education, level of training, experience, and competence. This responsibility may begin with development of the job description and tasks to be assigned and extends to supervision of all work performed and monitoring of daily activities; typically it will include evaluation of support personnel job performance. Education and guidance of employers and consumers may be necessary, particularly in order to ensure that credentials of support personnel are not misrepresented in dealing with the public, including persons served and their families, as well as funding sources and regulatory agencies.

The activities of the ASHA-certified SLP in supervising support personnel may take several forms, including direct supervision, onsite supervision, in-view observation and guidance, and indirect supervision that does not require the SLP to be present/available (either physically or via telecommunication in real time) while the SLPA is providing services. Indirect supervisory activities may include review of treatment plans and timely implementation of modifications, demonstration tapes, record review, review and evaluation of audio- or videotaped sessions, review of data collected, informal documentation, supervisory conferences that may be conducted by telephone and/or live, training, and performance appraisal.

The amount of supervision for any one paraprofessional is determined by the training and experience of both the SLPA and the certified individual as well as by the specific job tasks and any state or federal laws or regulations pertaining to such activity. Similarly, the number of assistants, aides, or technicians supervised by a professional must allow supervision that is appropriate in both quantity and quality. Members who exercise only nominal supervision over an individual because they have responsibility for too many SLPAs may be found to violate Code requirements in failing to hold paramount the welfare of persons served (Principle of Ethics I).

SLPAs may not independently diagnose, treat, or advise clients of disposition. They may, however, perform speech and language services in support of an ASHA-certified SLP when the specific tasks are within their repertoire of training, experience, and competence and when the tasks are supervised by an ASHA-certified SLP. In all aspects of the interaction, the ASHA-certified SLP maintains ethical and legal responsibility for the work performed and its outcome.

Conclusion

Resources are available to help SLPs maintain and enhance the use of SLPAs within the profession. Individuals are encouraged to consult current ASHA position statements, the Speech-Language Pathology Assistant Scope of Practice, the Speech-Language Pathology Assistants Practice Portal, and guidelines and practice policy documents pertaining to the training, use, and supervision of SLPAs and support personnel.

ASHA Corporate Partners