Ethics and Speech-Language Pathology Assistants (SLPAs):
Consensus building in real-world applications
Ethics Across the Curriculum 2013
Jennifer A. Ostergren, PhD, CCC-SLP
Department of Communicative Disorders
California State University, Long Beach
LECTURE
Integrity

Adherence to high moral standards (Horner,
2003)
◦ A person with professional integrity is
someone who adheres to ethical principles in
the execution of their professional duties.
Ethics

“The discipline dealing with what is good
and bad and with moral duty and
obligation” (http://www.merriam-webster.com/dictionary/ethic)

The study of the morality, or what is
good/bad and right/wrong (Horner, 2003)
Laws versus Morals
Laws dictate what we must do.
 Morals (and thereby ethics) address what
we should do.

Why Study Ethics?
 “Ethics
is really about helping
one to make good decisions”
(Carbon and Morris, 2004, para. 2)
 Ethical
principles can serve as a
compass in performing your
duties as an SLPA.
American Speech-Language-Hearing
Association (ASHA) Code of Ethics

“Preservation of the highest standards of integrity and
ethical principles is vital to the responsible discharge of
obligations by speech-language pathologists, audiologists,
and speech, language, and hearing scientists. This Code of
Ethics sets forth the fundamental principles and rules
considered essential to this purpose.” (ASHA, 2010, para 1)

Not directly applicable to SLPAs (ASHA, 2013)
Applicable to:
◦ A member of ASHA, whether certified or not
◦ A nonmember holding the ASHA Certificate of Clinical Competence
◦ An applicant for membership or certification
◦ A Clinical Fellow seeking to fulfill standards for certification.
American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from www.asha.org/policy
ASHA Code of Ethics (2010)
Four Basic Principles
Principle 1 (Responsibility to Clients Served and Research Participants)

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.
Principle 2 (Responsibility for Maintaining Professional Competence)

Individuals shall honor their responsibility to achieve and maintain the highest level of
professional competence and performance.
Principle 3 (Responsibility to the Public)

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.
Principle 4 (Responsibility to Other Members, Students, and Other
Profession and Disciplines)

Individuals shall honor their responsibilities to the professions and their relationships
with colleagues, students, and members of other professions and disciplines.
Principle IGuidance for SLPA Supervisors

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.
Guidance (ASHA, 2013):
The supervising SLP remains responsible for the care and
well-being of the client or research subject. If the supervisor fails to
intervene when the assistant's behavior puts the client or subject at
risk or when services or procedures are implemented inappropriately,
the supervisor could be in violation of the Code of Ethics.
Principle I, Rule A –
Guidance for SLPA Supervisors
Individuals shall provide all services competently.
Guidance (ASHA, 2013):

The supervising SLP must ensure that all services, including
those provided directly by the assistant, meet practice
standards and are administered competently. If the supervisor
fails to intervene or correct the actions of the assistant as needed, this
could be a violation of the Code of Ethics.
Principle I, Rule D –
Guidance for SLPA Supervisors
Individuals shall not misrepresent the credentials
of assistants, technicians, support personnel, students,
Clinical Fellows, or any others under their supervision,
and they shall inform those they serve professionally of
the name and professional credentials of persons
providing services.
Guidance (ASHA, 2013):

The supervising SLP must ensure that clients and subjects are
informed of the title and qualifications of the assistant.This is
not a passive responsibility; that is, the supervisor must make this
information easily available and understandable to the clients or
subjects and not rely on the individual to inquire about or ask directly
for this information. Any misrepresentation of the assistant's
qualifications or role could result in a violation of the Code of Ethics by
the supervisor.
Principle I, Rule F –
Guidance for SLPA Supervisors

Individuals who hold the Certificate of Clinical
Competence may delegate tasks related to
provision of clinical services to assistants,
technicians, support personnel, or any other persons
only if those services are appropriately
supervised, realizing that the responsibility for client
welfare remains with the certified individual.
Guidance (ASHA, 2013):

The supervising SLP is responsible for providing appropriate
and adequate direct and indirect supervision to ensure that
the services provided are appropriate and meet practice standards.
The SLP should document supervisory activities and adjust the
amount and type of supervision to ensure that the Code of Ethics is
not violated.
Applicable Principle I Rules –
Compass for SLPAs
A.
Individuals shall provide all services competently.
C.
Individuals shall not discriminate in the delivery of professional services
or the conduct of research and scholarly activities on the basis of race or
ethnicity, gender, gender identity/gender expression, age, religion, national origin,
sexual orientation, or disability.
M.
Individuals shall adequately maintain and appropriately secure records of
professional services rendered, research and scholarly activities conducted, and
products dispensed, and they shall allow access to these records only when
authorized or when required by law.
N.
Individuals shall not reveal, without authorization, any professional or
personal information about identified persons served professionally or
identified participants involved in research and scholarly activities unless doing
so is necessary to protect the welfare of the person or of the community or is
otherwise required by law.
O.
Individuals shall not charge for services not rendered, nor shall they
misrepresent services rendered, products dispensed, or research and scholarly
activities conducted.
Q.
Individuals whose professional services are adversely affected by substance
abuse or other health-related conditions shall seek professional assistance
and, where appropriate, withdraw from the affected areas of practice.
Principle II, Rule B –
Guidance for SLPA Supervisors

Individuals shall engage in only those aspects of
the professions that are within the scope of
their professional practice and competence,
considering their level of education, training, and
experience.
Guidance (ASHA, 2013):
 The supervising SLP is responsible for ensuring that he or
she has the skills and competencies needed in order to
provide appropriate supervision. This may include seeking
continuing education in the area of supervision practice.
Principle II, Rule D –
Guidance for SLPA Supervisors

Individuals shall not require or permit their
professional staff to provide services or conduct
research activities that exceed the staff member's
competence, level of education, training, and
experience.
Guidance (ASHA, 2013):
 The supervising SLP must ensure that the assistant only
performs those activities and duties that are defined as
appropriate for the level of training and experience and
in accordance with applicable licensure laws. If the assistant
exceeds the practice role that has been defined for him or her,
and the supervisor fails to correct this, the supervisor could be
found in violation of the Code of Ethics.
Applicable Principle II Rules –
Compass for SLPAs
B.
Individuals shall engage in only those aspects of the
professions that are within the scope of their professional
practice and competence, considering their level of
education, training, and experience.
C.
Individuals shall engage in lifelong learning to maintain and
enhance professional competence and performance.
E.
Individuals shall ensure that all equipment used to provide
services or to conduct research and scholarly activities is in
proper working order and is properly calibrated.
Applicable Principle III Rules –
Compass for SLPAs
A.
B.
D.
E.
F.
G.
Individuals shall not misrepresent their credentials,
competence, education, training, experience, or scholarly
or research contributions.
Individuals shall not participate in professional activities
that constitute a conflict of interest.
Individuals shall not misrepresent research, diagnostic
information, services rendered, results of services rendered,
products dispensed, or the effects of products dispensed.
Individuals shall not defraud or engage in any scheme to defraud
in connection with obtaining payment, reimbursement, or
grants for services rendered, research conducted, or products
dispensed.
Individuals' statements to the public shall provide accurate
information about the nature and management of communication
disorders, about the professions, about professional services, about
products for sale, and about research and scholarly activities.
Individuals' statements to the public when advertising, announcing,
and marketing their professional services; reporting research results;
and promoting products shall adhere to professional standards
and shall not contain misrepresentations.
Principle IV, Rule B –
Guidance for SLPA Supervisors

Individuals shall prohibit anyone under their
supervision from engaging in any practice that
violates the Code of Ethics.
Guidance (ASHA, 2013):
 Because the assistant provides services as “an extension” of
those provided by the professional, the SLP is responsible
for informing the assistant about the Code of Ethics
and monitoring the performance of the assistant.
Failure to do so could result in the SLP's being found in
violation of the Code.
Applicable Principle IV Rules –
Compass for SLPAs
A.
Individuals shall uphold the dignity and autonomy of the professions,
maintain harmonious interprofessional and intraprofessional
relationships, and accept the professions' self-imposed standards.
C.
Individuals shall not engage in dishonesty, fraud, deceit, or
misrepresentation.
D.
Individuals shall not engage in any form of unlawful harassment,
including sexual harassment or power abuse.
E.
Individuals shall not engage in any other form of conduct that
adversely reflects on the professions or on the individual's fitness to
serve persons professionally.
I.
Individuals' statements to colleagues about professional services,
research results, and products shall adhere to prevailing professional
standards and shall contain no misrepresentations.
K.
Individuals shall not discriminate in their relationships with
colleagues, students, and members of other professions and
disciplines on the basis of race or ethnicity, gender, gender identity/gender
expression, age, religion, national origin, sexual orientation, or disability.
Ethical Decision-Making Worksheet

Step 1: Gather/Clarify Facts
◦ Who is involved in this situation?
◦ Who is impacted by this situation?
◦ What are the motives and roles of those involved in this situation?
◦ List applicable ASHA Ethical Principles and Rules of Ethics (if any).

Step 2: Action Analysis
◦ Possible Courses of Action?
 Benefits?
 Risks?
 Ethical Resolution? Yes or No

Step 3: Action Implementation
◦ What action was implemented?
◦ What was the outcome of that action?
CLASS DISCUSSION:
ETHICAL WORKSHEET
APPLIED/SAMPLE CASE
Worksheet Applied: Case Example

Julie is an SLPA employed in a large, urban high school setting. Julie is
bilingual and frequently assists her supervisor as an interpreter during
assessment. Julie has worked in this setting for more than a year. She is
currently supervised by an experienced SLP with her ASHA CCCs. Julie’s
supervisor has one of the highest caseloads in their district. Next week, her
supervisor has several Individualized Educational Plan (IEP) meetings
scheduled. She has expressed to Julie that she is behind schedule in writing
documentation for these meetings and in performing follow-up assessments.
Julie’s supervisor asked her to perform an assessment on a bilingual client in
preparation for an upcoming IEP meeting. Julie is concerned because
performing diagnostic assessment is outside the scope of her practice, as
per both ASHA recommendation and state licensing standards.
STEP 1: Gather/Clarify Facts

Who is involved in this situation?

Who is impacted by this situation?

What are the motives and roles of those
involved in this situation?

List applicable ASHA Ethical Principles and
Rules of Ethics (if any).
Step 2: Action Analysis

Possible Courses of Action?
◦ Benefits?
◦ Risks?
◦ Ethical Resolution? Yes or No
Step 3: Action Implementation
What action was implemented?
 What was the outcome of that action?
----If ethical dilemma has not resolved, start
again

SMALL GROUP
DISCUSSION (CASE
ANALYSIS)
GROUP
PRESENTATIONS
(CASE ANALYSES)
SLPA Ethics Case #1
Jonathan is a newly hired SLPA, working in an elementary school
setting. This is his first SLPA position and his first job in a public
school. His supervisor trained him for approximately 1 week,
consisting of showing him paperwork and having him observe her
providing services to students. She then became seriously ill and
has taken an extended medical leave. The district supervisor has
asked Jonathan to work until they can find a replacement supervisor
for him, including providing treatment services to the students on
the supervisor’s caseload.
__________
Are there any potential conflicts with ASHA’s Code of Ethics?
Which ethical principles are involved? Why?
What is a potential resolution to this situation?
SLPA Ethics Case #2

Susan is an SLPA working in a private practice setting while
attending graduate school to become an SLP. She has been
employed as an SLPA for approximately 2 years, under the
supervision of an ASHA certified SLP. There is an opening for a SLP
position at the site where she works. The owner of this site told
her they would like to hire Susan for this position. The owner
indicated that Susan could be begin working in this position
immediately because she is in school to become an SLP. Further,
the owner states that they would list her title on official records as
an SLP, because clients prefer to be seen by an SLP.
__________
Are there any potential conflicts with ASHA’s Code of Ethics?
Which ethical principles are involved? Why?
What is a potential resolution to this situation?
SLPA Ethics Case #3

Edith is an SLPA working in a medical setting that bills Medicare for
services provided to patients. During Edith’s initial training, her
supervisor mentioned that SLPA services are not “billable” under
Medicare, unless the paperwork indicates that the SLP provided the
services. Because of this, Edith’s supervisor instructed Edith that
she is not to record anything in official records. Her supervisor
instructed Edith to tell her verbally the outcome of the treatment
so that she can enter that information into the billing system as if an
SLP provided the services.
_______
Are there any potential conflicts with ASHA’s Code of Ethics?
Which ethical principles are involved? Why?
What is a potential resolution to this situation?
SLPA Ethics Case #4

Leena is an SLPA working in a private practice. Her
supervisor has trained her to work with individuals in
this setting and she feels competent in doing so with the
supervision. She is assigned a new client to work on
treatment goals addressing memory and attention.
When Leena reads the client’s chart, she sees that the
client is HIV positive. Leena is concerned that she will
contract HIV/AIDs so she tells her supervisor that she
does not want to provide services to this client.
_______
Are there any potential conflicts with ASHA’s Code of Ethics?
Which ethical principles are involved? Why?
What is a potential resolution to this situation?
SLPA Ethics Case #5

Bill is an SLPA working in a public school setting. He has
been working in this setting for 6 months. Thus far, he
has received excellent training. There is a particular
student’s mother that does not get along with his
supervising SLP. As a result, the student’s mom asks Bill
questions about the student’s goals, progress, results of
assessment, and future recommendations for services.
She tells Bill, “I trust you” and as such she wants to
know his opinion about her daughter’s disorder and
treatment.
__________
Are there any potential conflicts with ASHA’s Code of Ethics?
Which ethical principles are involved? Why?
What is a potential resolution to this situation?
CASE CREATION AND
PRESENTATION
LESSONS LEARNED