Issues in Ethics: Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Pathology Students
About This Document
Published 2025. This Issues in Ethics statement was originally published in 2003 and was last revised in 2017. It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2023) (hereinafter, "Code of Ethics"). The Board of Ethics (hereinafter, the "BOE") reviews Issues in Ethics statements periodically to ensure that they reflect current practices and the current Code of Ethics.
Issues in Ethics Statements: Definition
From time to time, the BOE 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 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
The Code of Ethics provides guidance regarding the ethical issues that may arise when professional service is provided by students. Although the BOE does not have jurisdiction over students, the Code of Ethics does apply to their supervisors, clinic directors, and mentors. Clinicians are ultimately responsible for services to clients/patients and must comply with all requirements for supervision of students.
The Issues in Ethics statement, Supervision of Student Clinicians, also provides guidance on working with students.
Discussion and Guidance
Ethical questions such as the following may arise as ASHA certificate holders supervise the clinical practice of students.
Question 1: Must clients be informed of the qualifications of those providing the clinical service?
Yes. The Code of Ethics speaks directly to the issue of accurately representing the credentials of students in Principle III, Rule A, which states, "Individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly contributions."
It is always the client's right to be fully informed of the service provider's professional qualifications. Students must be appropriately identified to those they serve. Name tags should clearly indicate the status of students, and it is always good practice for clinicians to fully introduce themselves, including professional status, when beginning service. Supervisors and students should invite any questions that clients/patients may have regarding the qualifications of the individuals providing professional service. By describing the background and education of students and certificate holders fully and accurately, professionals are promoting a fuller understanding of the profession.
Question 2: What level of supervision must be provided to students?
It depends. Supervisor must base the nature and intensity of supervision on the stage of clinical development of each student and on the complexity of each client/patient. Supervisors must be mindful that the ultimate responsibility for client/patient welfare remains with the certified audiologist or speech-language pathologist (SLP).
The Code of Ethics provides the following guidance to certificate holders who are responsible for the supervision of students in Principle I, Rule G: “Individuals who hold the Certificate of Clinical Competence may delegate to students tasks related to the provision of clinical services that require the unique skills, knowledge, and judgment that are within the scope of practice of their profession only if those students are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served remains with the certified audiologist or speech-language pathologist.” The main emphasis of Rule G is found in the last sentence, which states "the responsibility for the welfare of those being served remains with the certified individual." As indicated, the supervisor is always responsible for the care provided by their student clinicians.
Additionally, Principle IV, Rule F states, “Individuals who mentor Clinical Fellows, act as a preceptor to audiology externs, or supervise undergraduate or graduate students, assistants, or other staff shall provide appropriate supervision and shall comply—fully and in a timely manner—with all ASHA certification and supervisory requirements.”
Supervisors must comply with the supervision requirements of (a) the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) and the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC), (b) the setting where the services are delivered, and (c) the third-party payer. Although supervision standards and regulations provide guidance regarding minimum supervision requirements, supervision may need to exceed the minimum requirements so that the supervisor is confident regarding client outcomes. It is the supervisor's responsibility to intervene in a timely manner if there is any question regarding the quality of the care being provided.
Third-party payers are often very specific about the supervision required in order to receive reimbursement for services provided by students; therefore, it is imperative that supervisors be knowledgeable regarding these specific requirements and meet them. Because the rules and regulations regarding reimbursement by federal, state, and private health plans are constantly changing, supervisors must keep abreast of all reimbursement policies, rules, and regulations. As a general rule, when more than one supervision requirement applies, the most stringent requirement should be followed.
Question 3: Is it legitimate to charge fees for services provided by individuals who are not yet fully trained or certified?
Yes. There is no basis for suggesting or requiring that fees charged for services provided by supervised students differ in any way from those provided by certified audiologists or SLPs. When students are involved in the provision of clinical services, client/patient welfare and the quality of service remains the responsibility of the certified supervisor. If appropriate supervision is provided, the fees charged are justified.
As mentioned in Question 2, third-party payers may be specific about the supervision required in order to receive reimbursement for services provided by students, and supervisors must be knowledgeable regarding these requirements.
Question 4: Must students complete all related course work before being assigned to a particular case?
Ideally, the sequencing of a student's graduate program would provide all necessary course work before clinical practice in a particular area; however, in clinical settings, occasionally students are assigned to a case or a client/patient before completing related courses. The Code of Ethics indicates that supervisors must determine the nature and intensity of supervision based on the stage of clinical development of the student and the complexity of the case. If a student is faced with a case in an area where course work has not been completed, then the student and supervisor should develop a plan so that the student can appropriately prepare (e.g., examine previous case notes and reports, read supervisor-assigned texts and journal articles, become familiar with test manuals and procedures, etc.). The supervisor must provide a level of supervision that will ensure the welfare of the person served.
Question 5: Can students be paid for practicum?
Yes, ASHA policy allows students to receive pay for services that they provide within the clinical practicum setting. However, some academic programs or state licensure laws may have policies that prohibit students from being paid for their practicum work. In such cases, ASHA defers to the university’s or state’s decision about such payment
Question 6: Can a graduate student work as an audiology or speech-language pathology assistant while in graduate school?
Yes, but this is a complicated issue. The roles and responsibilities of a graduate student in a practicum assignment and an assistant in the work setting must not be confused. Audiology and speech-language pathology assistants have a limited scope of practice and must not provide clinical services that require the unique knowledge, skills, and judgment of an audiologist or SLP. Graduate students, on the other hand, can provide such services when appropriately supervised.
Graduate students who are also working as assistants, as well as their supervisors, must exercise caution so that the roles are not confused. This can be especially difficult if the student is given a practicum assignment in their own setting. Because of the potential for confusion of roles, the student should work closely with the academic program, their employer, and their supervisor to clearly delineate when the individual is working as an assistant and when the individual is accruing clock hours as a graduate student. Only then can appropriate assignments and supervision be determined. Finally, graduate students must meet the requirements to work as an assistant in their state, including licensing or registration where required.
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