Ethical Decision Making in School-Based Speech-Language Pathology Practice
School-based speech-language pathologists (SLPs) and speech-language pathology assistants (SLPAs) may encounter situations that raise ethical, legal, moral, and professional questions. These situations can involve any of the following topics:
- collaboration with families and colleagues
- confidentiality
- culturally responsive practice
- documentation
- eligibility decisions
- feeding and swallowing
- Medicaid billing
- missed sessions
- service delivery
- staffing
- supervision
Ethical dilemmas in schools rarely have a simple solution. A thoughtful process can help decision makers clarify the issue, identify applicable requirements, evaluate options, and select an appropriate course of action.
Use the steps and reflection questions below to guide ethical decision making and problem solving. When guidance is needed, school-based professionals are encouraged to review federal, state, and local requirements; consult district policies and appropriate administrators; and contact ASHA Ethics (ethics@asha.org) or other appropriate resources.
A 10-Step Process for Resolving Ethical Challenges in School-Based Practice
ASHA adapted the following framework from Power-deFur's 2026 Perspectives tutorial and earlier decision-making models for school-based ethical challenges.
1. What do I want to accomplish?
Define the desired outcome. Clarify the purpose of addressing the issue.
- Is the goal to (a) improve outcomes for students, (b) strengthen relationships, (c) support compliance, or (d) change practice? (Or some or all of the above?)
- What would a successful outcome look like?
- Who will the outcome affect?
2. What do I know about the situation?
Gather facts, identify missing information, and understand the content.
- What happened, and what led to the situation?
- What efforts have already been made to address it?
- What information is still needed?
3. Is the concern primarily (a) moral, (b) ethical, (c) legal, or (d) policy-related—or is it a combination (and if so, which ones)?
Determine the nature of the concern, and identify the standards, requirements, or principles that apply.
- Is the concern primarily moral, ethical, legal, policy-related, or a combination?
- Who may the situation affect?
- Does the concern involve student welfare, professional integrity, compliance, or relationships?
- Are competing obligations or priorities creating tension?
4. What ethical, legal, and policy requirements apply?
Review the standards, requirements, and guidance relevant to the situation.
- What does the ASHA Code of Ethics say?
- What federal, state, or local requirements apply?
- What district policies or procedures are relevant?
- Are there licensure, supervision, Medicaid, or other professional requirements to consider?
5. What resources and people can I consult?
Seek information and perspectives that clarify the issue.
- What resources, professional guidance, or research can help clarify the issue?
- What state or district resources are relevant?
- Who can provide informed guidance while protecting confidentiality?
- What expertise do I need to better understand the situation?
6. What actions can I take?
Identify possible courses of action.
- What options are available?
- Who has authority to make or approve changes?
- Which options protect student welfare, relationships, professional integrity, and the desired outcome?
7. What are the potential consequences of each option?
Evaluate the benefits, risks, student impact(s), and likely outcomes of each option.
- What are the potential benefits of each option?
- What unintended consequences might occur?
- Which option will most likely resolve the issue and prevent recurrence?
8. What action will I select?
Choose and implement the most appropriate course of action.
- Which action best aligns with applicable requirements?
- Do I have enough information to move forward?
- Who do I need to involve or inform?
9. How will I monitor and adjust my plan as needed?
Monitor results and make changes when necessary.
- Is my plan moving toward the desired outcome?
- Have new concerns or barriers emerged?
- Do I need to adjust my plan?
10. Was the approach successful?
Reflect on the outcome. Identify lessons for future situations.
- Was the issue resolved?
- Were desired outcomes achieved?
- What was learned from this process?
- What changes might prevent similar challenges in the future?
Common School-Based Ethical Dilemmas and What to Consider
Culturally and Linguistically Responsive Assessment
Situation: A clinician receives a referral for a multilingual student or for a student whose language(s) or cultural and linguistic experiences differ from the clinician's own. The clinician determines that additional cultural or linguistic expertise, including possible collaboration with a qualified interpreter, transliterator, or translator, is needed to conduct an appropriate assessment.
What to consider: Review requirements for nondiscriminatory assessment, the student's language history and language use, district policies and procedures for language assistance services, and ASHA guidance on Multilingual Service Delivery in Audiology and Speech-Language Pathology and Collaborating With Interpreters, Transliterators, and Translators. Use culturally and linguistically appropriate assessment methods and qualified language assistance providers when needed.
Eligibility Team Disagreement
Situation: A team makes an eligibility decision that seemingly conflicts with what the evaluation data might otherwise suggest. Here are two examples:
- A team finds a student eligible despite evaluation data that do not support a speech-language impairment.
- A team finds a student ineligible despite evaluation data that identify a disorder and indicate educational impact.
What to consider: In compliance with federal and state law, the school-based team must review evaluation data, adhere to eligibility criteria, identify educational impact, follow state and district procedures, and be clear on who has authority over eligibility-related decision making. Consider engaging in collaborative, constructive conversations with the student's individualized education program (IEP) team members and administrators before escalating the issue.
Feeding, Swallowing, and Student Safety
Situation: A clinician observes the student showing signs of possible swallowing difficulty.
What to consider: Gather information from the student's records and from team members, identify district procedures and medical information, consult appropriate professionals, and work within scope of competence and school procedures to support student safety in pediatric feeding and swallowing.
Medicaid Billing and Documentation
Situation: A district asks an SLP to sign documentation or Medicaid-related forms for services that the SLP did not supervise or cannot verify.
What to consider: Review Medicaid rules, state supervision requirements, district procedures, ASHA guidance, and documentation records. Consult appropriate administrators or billing specialists when concerns arise.
Missed Sessions and Make-up Services
Situation: An absence, a schedule conflict, or a staffing issue results in missed services.
What to consider: Review the student's IEP, district procedures, state requirements, and guidance on determining whether the student needs compensatory or make-up services. Consider student impact rather than assuming that all missed sessions require the same response.
Outdated or Inappropriate Assessments
Situation: A district requires the use of standardized assessments, yet those available are outdated, invalid for the student, or not appropriate for the student's language, culture, disability, or needs.
What to consider: Review current assessment guidance, including ASHA's Assessment and Diagnosis in School Services; familiarize yourself with state and district procedures; consult ASHA Practice Portal resources; and consider alternatives such as dynamic assessment, language sampling, classroom observation, and other valid data sources when appropriate.
Requests for Test Protocols or Records
Situation: A student's family requests protocols, records, or other assessment materials.
What to consider: Clarify what the family is requesting, review the Family Educational Rights and Privacy Act of 1974 (FERPA) and district procedures, consider publisher restrictions and confidentiality concerns, and consult administrators as needed. See ASHA's Documentation in Schools.
SLPA Supervision
Situation: A district asks an SLP to supervise more SLPAs than state guidelines allow.
What to consider: Review state supervision requirements, district procedures, and ASHA guidance (which includes the ASHA SLPA Scope of Practice, recommended SLP-to-SLPA ratio, and supervision requirements).
Supervising Clinical Fellows, Students, or Support Personnel
Situation: A clinician supervises learners or support personnel and has questions about competence, scope, feedback, or accountability.
What to consider: Review ASHA's supervision guidance, state supervision requirements, and district policies. Keep the welfare of persons served at the center of all supervision decisions.
Unqualified Personnel or Substitutes
Situation: A district uses personnel who may not meet state qualifications to cover services or provide speech-language support.
What to consider: Clarify the individual's credentials, role, scope of responsibilities, supervision plan, state requirements, district policy, and impact on student welfare before determining next steps. See ASHA's Frequently Asked Questions: Qualified Providers in Schools.
Summary
Ethical decision making in schools requires reflection, consultation, and collaboration. Following a careful process can help clarify the issue, identify applicable requirements, support respectful relationships, and lead to solutions that both protect your students and strengthen your practice.
If you need guidance about ASHA's Code of Ethics or the process for filing an ethics complaint, contact ASHA Ethics at ethics@asha.org. If the concern involves legal requirements, district procedures, staffing, special education compliance, Medicaid, or records, then consult the appropriate school district, state agency, licensure board, or legal resource in your state.
References
Power-deFur, L. (2020). What do I do now? Resolving school-based ethical challenges. Perspectives of the ASHA Special Interest Groups, 5(1), 282–289. https://doi.org/10.1044/2019_PERSP-19-00084
Power-deFur, L. (2022). Ethical challenges in special education? An approach for resolution. Perspectives of the ASHA Special Interest Groups, 7(1), 1–5. https://doi.org/10.1044/2021_PERSP-21-00210
Power-deFur, L. (2026). Thoughtfully resolving ethical dilemmas in school settings. Perspectives of the ASHA Special Interest Groups, 11(3), 641–648. https://doi.org/10.1044/2026_PERSP-25-00269
