by Valerie Villanueva, Seton Hall University
For student clinicians in the field of speech-language pathology, a supervisor is their mentor and guiding example of theory in practice, an individual who can help one grow as a speech-language pathologist. For a supervisor, overseeing a student clinician is an opportunity to share clinical expertise and experiences, and help teach the speech-language pathologists of the future. This professional relationship can spark meaningful discussion about current topics and ideas in education and experience and clinical knowledge. With students still developing their clinical footing, mistakes are bound to be made, but supervisors are there to guide them to ensure the best care for clients. A caveat to this relationship is that students are not under the jurisdiction of the American Speech-Language-Hearing Association (ASHA) Board of Ethics, but supervisors are. The topic that will be further explored in this essay is ethical dilemmas faced by both student clinicians and supervisors as they navigate their roles in clinical practice.
The ASHA (2016) Code of Ethics Principle IV, Rule I states: “Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics,” meaning that the students do not directly face disciplinary actions for violating the Code of Ethics, but their supervisor can. This may lead to various ethical dilemmas from both the student and supervisor perspective. For example, a student clinician learns about PROMPT therapy from a PROMPT trained professor in her graduate program. In her clinical placement at a preschool, the student uses PROMPT techniques briefly mentioned in the lecture with a three-year-old student who has apraxia. The student clinician’s supervisor is also not PROMPT trained and not familiar at all with the program. The supervisor then faces a dilemma: should she continue to allow her supervisee to continue to use these few PROMPT techniques with the child or not?
This scenario would strike the supervisor as a potential violation of the ASHA (2016) Code of Ethics because of the following statement in Principle II, Rule A, “Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.” The supervisor herself should not do PROMPT treatment for the child because she is not considered competent in it since she is not properly trained. Since she does not have a background on the rationale of that treatment program, it would be completely unethical to claim being PROMPT certified or for her student clinician to claim that either. This could even result in legal issues.
When considering whether to allow her student clinician to continue using this approach in her therapy sessions, the supervisor can reflect on the universal principles of ethics. The most relevant to this situation is beneficence, meaning to benefit the client. Is this strategy helping the child? If it is, would the supervisor want to stop using a strategy that she sees the child benefiting from? The supervisor could also consider the ethical principle of nonmaleficence, meaning not harming the client. Without proper training, is it possible that the student clinician could hurt the child using this approach, especially since it involves physically prompting the child?
The supervisor should refer to the ASHA Code of Ethics to support her decision making. As previously stated, the supervisor cannot use the PROMPT approach because she is not formally trained. Providing services in which she is not competent in would be considered unethical. Since the student clinician is not properly trained in this program either, using this approach in therapy would be considered unethical even though she is not overseen by the Board of Ethics. Per ASHA (2016) Code of Ethics Principle IV Rule I, it is the supervisor’s obligation to not allow her student clinician to engage in a practice that violates the Code of Ethics. If it is unethical for the supervisor to do, it is also unethical for the student clinician. In addition, the American Speech-Language-Hearing Association (n.d.) states that supervisors should “provide supervision only in practice areas for which they possess the appropriate knowledge and skills,” confirming that the supervisor in this scenario would not be able to provide guidance for her student clinician on PROMPT techniques, which could lead to the methods being misapplied or even possibly harming the child by accident. Ultimately, it would also be unethical for the student clinician and supervisor to claim or have families believe that they are PROMPT certified when they are not.
The supervisor can use this situation as a learning opportunity. They can have a meaningful discussion on why continuing to use PROMPT techniques in therapy would be an unethical decision. The supervisor can also share her clinical experiences and suggestions on what she can do instead in therapy. Additionally, they can take time together to research other evidence-based practices that they can implement and both grow their clinical knowledge through professional development. The supervisor is setting an example for the student of the many approaches one can take to a goal, within the Code of Ethics and within one’s scope of practice and competence. If the supervisor strayed from that or chose not to speak up, the student clinician may assume that using the PROMPT approach without being trained is acceptable and may continue to do so into her clinical fellowship and into her career, when it would be a violation of the Code of Ethics.
In a supervisor-student clinician relationship, the student views the supervisor as a mentor. A mentor is defined as an experienced and trusted advisor so the student clinician is forming her own clinical judgement based on the supervisor’s actions. Supervisors should therefore lead by example, using her own clinical judgement and ethical decision-making skills to ensure clients are receiving the highest quality services possible and simultaneously adhering to the ASHA Code of Ethics while ensuring that the rising speech-language pathologists practice by this standard as well.
American Speech-Language-Hearing Association (2016). Code of ethics. Retrieved from https://www.asha.org/Code-of-Ethics/
American Speech-Language-Hearing Association (n.d.). Issues in ethics: Supervision of student clinicians [Guidance].
Retrieved from https://www.asha.org/Practice/ethics/Supervision-of-Student-Clinicians/