Ethics i n the School System

1. Ethics in the School System Dr. Jill C. Williamson, CCC-SLP

2. Calvin and Hobbes https://cellcode.us/quotes/calvin-and-hobbes-ethics-test.html

3. What is Ethics?

4. According to Merriam-Webster…. Ethics: 1. “the discipline dealing with what is good and bad and with moral duty and obligation.” 2. A. “a set of moral principles: a theory or system of moral values.” B. “the principle of conduct governing an individual or group.” C. “a guiding philosophy” D. “a consciousness of moral importance” 3. “a set of moral issues or aspects (such as rightness)” https://www.merriam-webster.com/dictionary/ethic

5. ASHA Professional Development Requirements for the 2020 Audiology and Speech-Language Pathology Certification Standards • Effective 1-1-20 • ALL Individuals who hold CCC-A &/or CCC-SLP • At least 1 hour of 30 required professional development hours for certification maintenance intervals must be in the area of ethics • Beginning with certification maintenance interval: 1/1/20-1/31/22 • Each 3-year maintenance interval • https://www.asha.org/Certification/Prof-Dev-for-2020-Certification-Standards/

6. Roles and Responsibilities of School-based SLPs • ASHA’s Roles and Responsibilities of Speech-Language Pathologists in Schools –guidelines, 2010 • Integral roles in education and essential members of school faculties • Work in partnership with others to meet student needs • Help define students’ roles and responsibilities • Ensure appropriate services provided to students • www.ASHA.org

7. ASHA Code of Ethics • I work in a school. Ethics are for SLPs that work in medical settings. It does not apply to me.

8. “The ASHA Code of Ethics is intended to ensure the welfare of the consumer and to protect the reputation and the integrity of the professions. The ASHA Code of Ethics is a framework and focused guide for professionals in support of day-to-day decision making related to professional conduct.” For: • a member of the American Speech-Language-Hearing Association holding the Certificate of Clinical Competence (CCC) • a member of the Association not holding the Certificate of Clinical Competence (CCC) • a nonmember of the Association holding the Certificate of Clinical Competence (CCC) • an applicant for certification, or for membership and certification https://www.google.com/search?q=asha+code+of+ethics+summary

9. 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. • Rules of Ethics :A-T • http://www.asha.org/code-of-ethics

10. Principle of Ethics II • Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. • Rules of Ethics: A-H

11. Principle of Ethics III • Individuals shall honor their responsibility to the public when advocating for the unmet communication and swallowing needs of the public and shall provide accurate information involving any aspect of the professions. • Rules of Ethics: A-G

12. Principle of Ethics IV • Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessionalrelationships, and accept the professions' self-imposed standards. • Rules of Ethics: A-T

13. Ethics: Improving Clinical Practice (Quality) • Develop intervention goals: Knowledge-based to help students connect prior knowledge to new information. • Develop tasks to optimize long-term retention. • Create language goals that match environmental contexts. • Prioritize goals for students with language learning difficulties. • Embrace traditionalism challenges: choose different service deliveries. ASHA Code of Ethics: Principle of Ethics I- Rule B (Quality service is provided)

14. Ethics: Placement for Services • Follow district, state, and federal guidelines for placement. ASHA Code of Ethics: Principle of Ethics: IV, Rule B—using professional judgment in recommending and providing services

15. Ethics: School-Based Service Delivery Individualize service delivery for students Consider: • Treatment Setting (therapy room, classroom, school-based community outings ) • Format (pull-out model: small groupor individual; collaborative consultation, classroom-based intervention, self-contained intervention) • Intensity (amount of time during treatment) • Frequency (number of treatment sessions over time) • Duration (treatment length) ASHA Code of Ethics: Principle of Ethics I, Rule B (Quality service)

16. Ethics: Service Delivery Considerations Services (frequency, location, intensity, duration) should be reviewed and revised based on factors throughout the school year: • Student progress and needs • Cultural considerations • Environmental demands • Promotion of skills • Access to state standards & curriculum • Decisions made by IEP team ASHA Code of Ethics: Principle of Ethics I, Rule B (Quality service)

17. Ethics: Evidence-Based Practice • Classroom-based models (co-teaching) are effective for language lessons • Greater increases in speech intelligibility during classroom-based services vs. pull-out services • Vocabulary and generalization increases within classroom-based services • Preschool children generalize new words more effectively during classroom-based services • ASHA Code of Ethics: Principle of Ethics I, Rule B (Quality service)

18. Ethics: Confidentiality • Protect confidential data collection and records (O) • Only share student information with persons who are authorized (P) • ASHA Code of Ethics: Principle of Ethics I- Rules O, P

19. Ethics: Cultural and Linguistic Considerations • Gather student information from parents and teacher. • Observe student. • Consult with ELL (English Language Learners) teacher. • Discriminate: Are communication problems relative to learning English as a second language or are they possibly due to the presence of a speech-language disorder? (Difference vs. Disorder) • Arrange for a bilingual SLP to conduct an evaluation in the student’s native language. .

20. Ethics: Cultural and Linguistic Considerations • Bilingual service delivery (ASHA website) • “Acquiring English as a Second Language: What’s Normal, What’s Not.” (ASHA) • Self –Assessment for Cultural Competence (ASHA) • ASHA Code of Ethics: Principle of Ethics I-Rule A (Provide competent services), B (Quality service), and C (non-discrimination) • Additional information may be obtained from ASHA’s office of Multicultural Affairs

21. Ethics: Clinical Documentation • Keep clinical documentation: a record of quality of clinical service and student progress. • Documentation serves as a basis for treatment plan/care ,for the continuation of services, or for the discharge of services. • Documentation justifies clinical decisions. • Documentation protects legal interests and may serve as evidence. • Documentation supports reimbursement. • ASHA Code of Ethics, Principle of Ethics I, Rule Q (Maintain timely records…bill for services...) E

22. Ethics: Medicaid • Acquire a thorough understanding of state Medicaid policies and procedures • Keep complete and accurate student therapy data • Must have legal authorization/qualifications to bill for services • Services billed must be accurate • ASHA Code of Ethics, Principle of Ethics I, Rule Q (Maintain timely records…bill for services...)

23. Ethics: Reimbursement, Funding, or Payment • Provide services which yield benefit (ASHA Principle of Ethics I, Rule I) • Present information accurately, do not alter diagnosis or treatment plan to increase funding (Principle of Ethics III, Rule D). • Shall not charge for services not rendered nor misrepresent services…( Principle of Ethics I,Rule O) • Shall not engage in dishonesty, deceit, fraud, or misrepresentation (Prnciple of Ethics IV, Rule C)

24. Ethics: Current Standardized Tests • ASHA does not have a policy addressing using older test versions, but current versions are recommended. • Current tests should be used to determine qualification for services ( new norms, best practice, ensures students’ welfare) • ASHA: • Principle of Ethics I, “… hold paramount the welfare of persons they serve...” • Principle of Ethics I, Rule B, “…use every resource to ensure high-quality service...” • Code of Ethics:

25. Ethics: Private Clients • Must have state licensure. • Inform clients of all providers in the area. • Inform your school administration about private services. Document and follow regulations. • Choose clients from other school districts, if possible. • Maintain confidentiality. • ASHA’s Code of Ethics, Principle III, Rule B: “..avoid engaging in conflict of interest…,” Principle I..”hold welfare of students...,” Principle I, Rule I: ...confidentiality...,” Principle of Ethics II, “...maintain highest level of professional competence...” • Code of Ethics:

26. Ethics: Swallowing and Feeding Services • Students may be eligible for dysphagia services under “Other Health Impaired (OHI).” • According to recent ASHA surveys, 10% of school-based SLPs provide services to children with dysphagia. • Dysphagia management teams: school nurses, SLPs, OTs, PTs, and other school personnel. • Team activities: interpreting medical records, creating educational materials and feeding treatment plans, organizing continuing education

27. Ethics: Swallowing and Feeding Services (Schools) • ASHA Code of Ethics: • Principle I, Rule A: “Individuals shall provide all services competently.” • Principle I, Rule B: “Individuals shall use every resource, including referral and/or interprofessional collaboration, when appropriate, to ensure quality service is provided.” • Principle II, Rule B: “Individuals shall engage in only those aspects that are within their scope of competence, considering their level of education, training, and experience.”

28. Social Media Can improper use constitute an ethical violation? https://www.asha.org/Practice/ethics/Ethical-Use-of-Social-Media/

29. Answer

30. References • Social Media Etiquette for Professionals • Social Media: To Friend or Not to Friend (The ASHA Leader, February 2012) • https://www.asha.org/Practice/ethics/Ethical-Use-of-Social-Media/

31. Supervision Requirements • Supervisors of student clinicians should have competency in the area of practice • Supervisors must hold CCC’s in the area of practice • *Supervision: Professional Development Requirements-Effective 1-1-20 • Complete professional development in the area of supervision/clinical instruction (minimum of 2 hours credit) • After being awarded the CCC-A or CCC-SLP. • One time requirement. • https://asha.org • https://www.asha.org/slp/supervisionfaqs/

32. Ethics: Can I do that? Can I sign off on a clinical fellow’s treatment plan for Medicaid?

33. Answer

34. Can I do that? Do billing codes matter? Can’t I just choose a code?

35. Answer

36. Can I do that? I have been asked to add additional billing codes/service for more revenue. Can I do that?

37. Answer

38. Ethics: What should I do? My co-worker has been under a great deal of personal stress, and told me that she takes anxiety medicine with many drinks at night. I have observed her unsteadyand disoriented while working with patients. She also has fallen in the hallway. What should I do?

39. What should I do? ASHA Code of Ethics, Principle I, Rule S: “Individuals who have knowledge that a colleague is unable to provide professional services…shall report this information to the appropriate authority.”

40. Ethics: Question I often disagree with parents about the amount of service needed for their child. What should I do?

41. Ethics: Answer

42. Ethics: Question Do I obtain a substitute when I am ill?

43. Ethics: Answer • ASHA Code of Ethics, Principle of Ethics, I, Rule A. “…shall provide all clinical services…competently.”

44. Ethical Scenarios • https://www.youtube.com/watch?v=rnNaJCzcCZU

45. Ethics: Be Aware and Knowledgeable of: • Cultural competence • Reimbursement for services • Professional ethics • Supervision requirements/guidance • Http//:www.asha.org/policy

46. Why we do what we do… • We share what is needed to help others • “Sharing is Caring” • https://youtu.be/iXel1Vmvmhw

47. Questions??? DrJillCWilliamson@Yahoo.com

48. References American Speech-Language-Hearing Association. (2015). Can they make me do it? Is it even ethical? The ASHA Leader, 20,doi:10.1044/leader.OV. 20032015.np American Speech-Language-Hearing Association. (2016). Code of ethics. Retrieved from http: www.asha.org/policy American-Speech-Language Hearing Association. (n.d.). Ethics Q&A for school-based speech language pathology practice. Retrieved from http: www.asha.org/SLP/schools/prof-consult/

49. References American Speech-Language-Hearing Association (2013). Issues in Ethics: Cultural and linguistic competence. Retrieved from http:// www.asha.org/Practice/ethics/Cultural -and Linguistic Competence/ American Speech-Language-Hearing Association (n.d.). Issues in Ethics: Representation of services for insurance reimbursement, funding, or private payment. Retrieved from http:// www.asha.org/etics/Representation-of-Services/

50. References American Speech-Language-Hearing Association (n.d.). Medicaid guidance for school-based speech-language pathology services. Retrieved from http://www.asha.org/policy/KS2005-00083.htm American Speech-Language Hearing Association (n.d.). Medicaid guidance for school-based speech- language pathology services: Addressing the “Under the direction of” rule. Retrieved from: http://asha.org/KS2005-00083.htm