Ethics for Speech-Language Pathologist

1. Ethics for Speech-Language Pathologist Code of Ethics and Relevant Topics to for Speech Language Pathology

2. TOPICS OF DISCUSSION: • Definition of Ethics • The Relationship of Ethics and the Law • The ASHA Code of Ethics-4 Principles • The Texas Code of Ethics • Sanctions for Ethical Violations • Steps in Submitting an Ethics Complaint • Common Ethical Dilemmas • Ethics in CFY Year

3. WHAT IS ETHICS? • The discipline dealing with what is good and bad and with moral duty and obligation. • A set of moral principles • A theory or system of moral values

4. WHAT IS ETHICS? • The principles of conduct governing an individual or a group • A guiding philosophy • A consciousness of moral importance • A set of moral issues or aspects (rightness)

5. WHAT ETHICS IS NOT • Ethics is NOT feelings • Ethics is NOT a religious belief • Ethics is NOT following culturally accepted norms • Ethics is NOT following the law • Ethics is NOT science

6. The Law vs. Ethics • Usually ethical principles and laws will be closely related. • Ethical duties take one’s responsibilities one step further and exceed legal duties. • Sometimes a law may allow or mandate unethical conduct. This creates a conflict between the law and ethics. • Ethical responsibilities should supersede legal obligations in the exceptional circumstances of unjust laws.

7. ASHA-Code of Ethics • ASHA has outlined 4 Ethical Principles with rules for which the profession must follow. • Every member and certificate holder must adhere by these standards. • Ethical standards were revised and updated in March 2010. • All members have the right to bring allegations and evidence of ethical misconduct to ASHA’s Board of Ethics. • ASHA has the ability to impose sanctions on those who violate the Code of Ethics.

8. 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.

9. Principle of Ethics II • Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

10. Principle of Ethics III • Individuals shall honor their responsibility to the public by promoting public understanding of the professions, by supporting the development of services designed to fulfill the unmet needs of the public, and by providing accurate information in all communications involving any aspect of the professions, including the dissemination of research findings and scholarly activities, and the promotion, marketing, and advertising of products and services.

11. Principle of Ethics IV • Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines.

12. TYPES OF SANCTIONS ASHA CAN IMPOSE: • Reprimand (a private reprimand disclosed only to complainant and person in violation) • Censure (public reprimand) • Suspension of Membership and/or Certification • Revocation of Membership and/or Certification • Withholding of Membership and/or Certification

13. How Do The ASHA Code of Ethics Apply In Texas? • Texas has its own code based on the ASHA Code of Ethics • State Board of Examiners for Speech-Language Pathology and Audiology • Powers/duties are to administer, coordinate and enforce this chapter under Texas Occupations Code CH 401. • 22 Texas Administrative Code Chapter 741 Subchapter D.

14. Steps in Filing an ASHA Ethics Complaint • A Complaint must be filed in writing. The required forms can be found on the ASHA website. • Complaints cannot be anonymous. The person filing the complaint must provide a signature on the complaint document. • The complainant does not have to be a member of ASHA. • Complaints are only accepted via mail and cannot be accepted via email or facsimile.

15. Steps in Filing an Ethics Complaint • The ASHA Board of Ethics will review each case and supporting evidence. • The ASHA Board of Ethics does NOT have the ability and jurisdiction to conduct further investigation!!!!! • All evidence must be given to the Board because this is all they will review. • The Board will make an “Initial Determination” and sanctions may be imposed. • Individuals found in violation of the Code may request a “Further Consideration Hearing” and provide additional evidence in their defense. • The Board then renders a “Final Decision.” • The “Final Decision” may be appealed to the ASHA Board of Ethics.

16. COMMON ETHICAL DILEMMAS According to ASHA, there are some common ethical inquiries and complaints that ASHA encounters.

17. COMMON ETHICAL DILEMMAS • Documentation Lapses • High Employer Demands • Use and Supervision of Support Personnel • Accepting Referrals for Private Practice from Primary Place of Employment • Reimbursement for Services • Cultural and Linguistic Competence • Impaired Practitioner • Clinical Fellowship Mentoring and Supervision

18. Common Ethical Dilemmas • Documentation Lapses • Practitioners have an increased burden in the amount of paperwork they are required to complete and often voice concern over it. • Members express discomfort in signing off on client documentation on client’s they did not supervise. • Employer Demands • Increasing caseloads and tighter time constraints are increasing areas of concern among professionals. • There is pressure to provide services without adequate training.

19. Common Ethical Dilemmas 3. Use and Supervision of Support Personnel • Use of SLP assistants is a growing trend as the need for SLPs continues to grow • A common dilemma is determining the correct amount of supervision for SLP assistants • ASHA does not have jurisdiction over SLP assistants, only over members, certified members or applicants. • SLPs might be vicariously liable for unethical behavior on the part of their assistants.

20. Common Ethical Dilemmas 4. Accepting Referrals for Private Practice from Primary Place of Employment • ASHA does not automatically preclude referrals for a practitioner’s private practice. • You must first check with your primary place of employment or local school district to see if it is a violation of their policy or there is a conflict of interest. • Practitioner must inform their primary place of employment of their intent. • The costs of services at the private practice and at the primary place of employment must be made clear to the client.

21. Common Ethical Dilemmas • Reimbursement for Services • Misrepresenting of information to obtain reimbursement, scheduling services more often than necessary and providing services when there is no expectation of benefit are common problems. • Misrepresentation may be an ethical violation as well as insurance fraud with criminal penalties. • Examples: • A professional may not ethically select an insurance code for a patient for the sole purpose of obtaining reimbursement. • Using an individual therapy code for treatment groups (if no group treatment code exists) may be a violation of the Code of Ethics. • To obtain insurance coverage not otherwise available, a professional may not ethically report the name of the patient's physician as a referral source (generally required for reimbursement), when the physician did not refer the patient.

22. Common Ethical Dilemmas 6. Impaired Practitioner • This issue may be a legal and ethical one. • Impairments range from alcohol/substance abuse to challenges to mental illness. • This is a complex ethical dilemma that cannot be handled by one individual. • Reports should be made to proper supervisors and/or law enforcement.

23. Common Ethical Dilemmas • Cultural and Linguistic Competence • Discrimination against clients based on culture is both unethical and potentially illegal

24. Common Ethical Dilemmas • Clinical Fellowship Mentoring and Student Supervision • This is usually an individual’s first working experience as an SLP. • It is important that that both the mentor and Clinical Fellow (CF) be aware of their responsibilities in order to obtain clinical competency.

25. Common Ethical Dilemmas Responsibilities of mentor/supervisor: Responsibilities of clinical fellow: • Must comply with all requirements in order NOT to jeopardize the certification or licensure of the CF • Must comply with the ASHA code of ethics and Certification and Membership Handbook • Must provide adequate supervision of CF • Must not misuse power over the CF • It is the responsibility of the CF to verify certification of the mentoring SLP through the ASHA National Office. Do NOT rely on the word of the supervisor. • 36 weeks of full-time (35 hours per week) experience (or the equivalent part-time experience), totaling a minimum of 1260 hours. Part-time work can be completed, as long as the clinical fellow works more than 5 hours per week

26. Mentorship Situations That May Give Rise to Ethical Issues: • Arbitrary termination of CF mentor-supervisor relationship • Failure to report a CF’s noncompliance with the Code of Ethics or applicable law • Failure to provide the required amount of supervision • Assignment of excessive nonclinical duties to the detriment of the clinical fellows’ clinical experience • Mentoring an excessive amount of clinical fellows • Failure to complete and sign the CF report or failure to do so in a timely fashion

27. References • American Speech-Language-Hearing Association. (2010r). Code of ethics [Ethics]. Available from www.asha.org/policy • http://www.txsha.org/About_TSHA/code_of_ethics.asp • Bupp, H. (2012, November 20). 9 Upsetting Dilemmas. The ASHA Leader. • http://www.txsha.org/About_TSHA/code_of_ethics.asp • http://www.asha.org/slp/schools/prof-consult/EthicsFAQsForSchools/#1 • http://www.asha.org/Practice/ethics/Accepting-Referrals-for-Private-Practice-From-Primary-Place-of-Employment/ • http://www.asha.org/Practice/ethics/Representation-of-Services/ • http://www.asha.org/Practice/ethics/Responsibilities-of-Individuals-Who-Mentor-Clinical-Fellows-in-Speech-Language-Pathology/ • http://www.asha.org/certification/Clinical-Fellowship.htm