Confidentiality, Eligibility/Dismissal,
Supervisory Mandates… What are the
Ethical Considerations for these and other
School-based Practice Issues?
OSSPEAC
October 2015
Deborah Dixon, M.A. CCC-SLP
ASHA, Director of School Services
SLP Practices
1
Disclosures
 OSSPEAC is paying my travel expenses
 I am an employee of ASHA, who is paying for my time
for this presentation
 I am a member of ASHA
2
Session Objectives
The participants will:
 identify situations/actions that put SLPS at risk
for ethical violations
 understand and apply strategies to avoid ethical
violations
 identify and use resources to guide ethical practice
3
Ethics- What is it?
 Ethics is
 a defined code of morality. It relates to principles,
consciences, integrities
 an area of study that deals with ideas about what is
good and bad behavior : a branch of philosophy dealing
with what is morally right or wrong
 A branch of philosophy which involves the study of our
actions, values and the rules of conduct by which we
live.
 Describes actions not people. (Scott, 1998)
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Ethics
 Ethics is not primarily concerned
with getting people to do what
they believe to be right, but
rather with helping them to
decide what is right.
(Jones, Sontag, Beckner, Morton
and Fogelin in Seymour, 2001)
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Why ?
 Promote and preserve high standards of integrity and
ethical principles in the profession
 Protect the interests and well being of the clients,
patients, students and families that are served by the
professions
 Provide guidance to members
 Promote public trust
 Define acceptable professional conduct
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Ethical Requirements
 Ethical practice is required both for maintaining the
ASHA CCC as well as your state license, and most
educational certifications.
 Ohio’s licensing act includes ethical requirements
Keep Calm,
Carry On and
Act Ethically
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From Ohio’s Licensing Act for SLPs
and AuDs
http://codes.ohio.gov/orc/4753
In accordance with Chapter 119. of the Revised Code, the
board of speech-language pathology and audiology may
reprimand or place on probation a speech-language
pathologist or audiologist or suspend, revoke, or refuse to
issue or renew the license of a speech-language pathologist or
audiologist. Disciplinary actions may be taken by the board for
conduct that may result from but not necessarily be limited
to:
(A) Fraud, deception, or misrepresentation in obtaining or
attempting to obtain a license;
(B) Fraud, deception, or misrepresentation in using a license;
(C) Altering a license;
(D) Aiding or abetting unlicensed9 practice;
From Ohio’s Licensing Act for SLPs
and AuDs
(E) Committing fraud, deception, or misrepresentation in the
practice of speech-language pathology or audiology
including:
(1) Making or filing a false report or record in the practice of
speech-language pathology or audiology;
(2) Submitting a false statement to collect a fee;
(3) Obtaining a fee through fraud, deception, or
misrepresentation, or accepting commissions or rebates or
other forms of remuneration for referring persons to others.
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From Ohio’s Licensing Act for SLPs
and AuDs
 (F) Using or promoting or causing the use of any misleading,
deceiving, improbable, or untruthful advertising matter,
promotional literature, testimonial, guarantee, warranty,
label, brand, insignia, or any other representation;
 (G) Falsely representing the use or availability of services or
advice of a physician;
 (H) Misrepresenting the applicant, licensee, or holder by
using the word "doctor" or any similar word, abbreviation, or
symbol if the use is not accurate or if the degree was not
obtained from an accredited institution;
 (I) Committing any act of dishonorable, immoral, or
unprofessional conduct while engaging in the practice of
speech-language pathology or audiology;
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From Ohio’s Licensing Act for SLPs
and AuDs
 J) Engaging in illegal, incompetent, or habitually
negligent practice;
 (K) Providing professional services while:
 (1) Mentally incompetent;
 (2) Under the influence of alcohol;
 (3) Using any narcotic or controlled substance or other
drug that is in excess of therapeutic amounts or
without valid medical indication.
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From Ohio’s Licensing Act for SLPs
and AuDs
 (L) Providing services or promoting the sale of devices,
appliances, or products to a person who cannot reasonably
be expected to benefit from such services, devices,
appliances, or products in accordance with results
obtained utilizing appropriate assessment procedures and
instruments;
 (M) Violating this chapter or any lawful order given or rule
adopted by the board;
 (N) Being convicted of or pleading guilty or nolo
contendere to a felony or to a crime involving moral
turpitude, whether or not any appeal or other proceeding
is pending to have the conviction or plea set aside;
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From Ohio’s Licensing Act for SLPs
and AuDs
 (O) Being disciplined by a licensing or disciplinary
authority of this or any other state or country or
convicted or disciplined by a court of this or any other
state or country for an act that would be grounds for
disciplinary action under this section. After revocation
of a license under this section, application may be
made to the board for reinstatement
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ASHA’s Code of Ethics
 http://www.asha.org/Code-of-Ethics/
 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.
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Principle I







Competence
Discrimination
Misrepresenting credentials
Delegation only as appropriate
No guarantee
Securing records
Client abandonment
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ASHA’s Code of Ethics
 Principle of Ethics II
 Individuals shall honor their responsibility to achieve
and maintain the highest level of professional
competence and performance.
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Principle II
 Scope of professional practice and competence,
considering their level of education, training, and
experience
 Life long learning
 Supervising- requiring staff to provide services within
the individual’s competence, education, training and
experience
 Properly working equipment
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ASHA’s Code of Ethics
 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.
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Principle III
 Misrepresentation of credentials, competence,
education…
 Conflict of interest
 Referrals not based on financial interest
 Fraud
 Public statements
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ASHA’s Code of Ethics
 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.
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Principle IV




Harmonious intra and inter-professional relationships
Harassment
Behaviors that reflect on the profession adversely
Acknowledging contributors in presentations,
publications and products- referencing
 Independent professional judgement
 Filing complaints as reprisal etc.
 Informing the Board of Ethics of violations
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Ethics Process for Alleged Violations
 Who: anyone-board of ethics, members, public etc.
 How: complete Complaint Form for Alleged Violation of the Code
of Ethics and mailed to ASHA’s Ethics Department
 What happens: Notice sent to the individual named in the
complaint along with the copy of complaint and has 45 days to
respond. (You are still a member in good standing until a ruling is
made)
 Board of Ethics review the complaint and reaches an Initial
Determination
 Complainants may appeal
 How long is the process? 6-12 months
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Ethics
 Possible outcomes:





In sufficient information – matter closed
Reprimand
Censure
Withholding
Suspension or revocation of membership and/or CCC
 Various notifications depending on the ruling
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Board of Ethics Decision
 By misrepresenting therapy time to include transitions and
documentation time; being sanctioned by the North Carolina Board
of Examiners for Speech-Language Pathologists and Audiologists for
false recordkeeping; and recording for services that exceeded the
actual amounts of time that services were rendered while employed
as a school-based SLP, SLP X violated the following:
 Principle of Ethics I:
 Principle I, Rule O:
 Principle III: Principle III, Rule E
 The sanction is suspension of membership and certification for 12
months, effective retroactive from June 1, 2014
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 Published May, 2015
Board of Ethics Decision
 The ASHA Board of Ethics found SLP G violation of ASHA’s Code of Ethics (2010).
 By showing no evidence of compliance with orders to seek counseling for alcohol abuse
and to seek help for depression, he violated:
 Principle of Ethics I:
 Principle I, Rule Q:
 By his conviction of cruelty to animals, harassment of his neighbor, intimidation of a
witness, and illegal possession of firearms, he violated:
 Principle of Ethics IV:
 Principle IV, Rule A:.
 As evidenced by violating multiple, explicit court orders, he violated:
 Principle IV, Rule C:
 By having multiple criminal convictions and violating multiple, explicit court orders,
including failure to obtain appropriate treatments, he violated:
 Principle IV, Rule E:
 The sanction imposed is withholding of membership and certification for 10 Years,
effective April 28, 2015.
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 Published September 2015
Board of Ethics Decision
 SLP R , through inappropriate use of the designation
“CCC-SLP” during a period in which she did not
possess certification in speech-language pathology,
violated the following principle and rule of the Code of
Ethics (2003, 2010):
 Principle III, Rule A: Individuals shall not misrepresent
their credentials, competence, education, training,
experience, or scholarly or research contributions.
 The sanction is censure, effective April 16, 2014.
 Published July, 2014
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Board of Ethics Decision
 By keeping inaccurate and inadequate records and admittedly taking
records out of the school building, the respondent violated:
 Principle I, Rule M:
 By submitting billing and keeping therapy notes for dates the children
were not present at school, the respondent violated:
 Principle I, Rule O:
 By the respondent's inability to substantiate the delivery of services
with appropriate documentation, the respondent violated:
 Principle IV, Rule C:
 The sanction imposed is censure, effective Aug. 12, 2013.
 Published October 2013
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Board of Ethics Decision
 By discontinuing service to those she was serving without
appropriate authorization, forging parents’ and school-based
professionals’ signatures, and changing student file contents, SLP
Y , violated the following:
 Principle I
 Principle I, Rule R:
 Principle IV:
 Principle IV, Rule A: .
 Principle IV, Rule C:.
 The sanction is revocation of membership and certification for
three years, effective Feb. 9, 2015.
 Published May, 2015
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Board of Ethics Decision
 The ASHA Board of Ethics has found SLP Y a member
certified in speech-language pathology, in violation of the
association’s Code of Ethics (2010).
 By failing to provide direct (onsite) supervision of speechlanguage pathology assistants, SLP Y violated the
following:
 Principle of Ethics I
 Principle I, Rule F:
 The sanction is withholding of membership and certification
for six months, retroactively effective from July 23, 2014.
 Published March , 2015
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Board of Ethics Decisions
 SLP Z -By failing to properly supervise and to effectively
communicate with a clinical fellow and, ultimately, not
honoring her professional responsibility to the clinical fellow
she agreed to mentor, the respondent violated the following
principles:
 Principle of Ethics IV
 The sanction imposed is censure.
 Published September 2013
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Most Common Ethical Complaints


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
Documentation lapses
Employer Demands
Use and Supervision of Support Personnel
Clinical Fellowship mentoring and student supervision
Client abandonment
Bupp, H. (2012)
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Most Common Ethical Complaints

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Reimbursement
Business competition
Impaired practitioners
Affirmative disclosures
Bupp, H, (2012) 9 Upsetting Dilemmas, ASHA Leader, Vol
17, 10-13.
NOTE: cultural competence is another common issue
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What are Your Ethical Issues?
 Gather in groups of 4-5 and discuss the ethical issues
that concern you.
 In a few minutes, groups will be asked to report out
their top 3 issues.
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Is it an Ethical Dilemma?
 Situations in which ethics may be a dilemma, may be
categorized as one of the following:




Ethical dilemma
Legal issue
Interpersonal /communication problem
None of the above
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If it is an Ethical issue, then What?
 What action is permissible, impermissible or
obligatory?
 What are the benefits and burdens of each action?
 What are the important facts, details and beliefs?
 Who is involved?
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Ten Step Resolution Process
 Identify the problem as you see it.
 Get the story straight - gather relevant data. (Federal,
state, and local regulations, professional practice
documents, ASHA Code of Ethics)
 Ask yourself if the problem is a regulatory issue or a
process issue related to regulatory requirements.
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Ten Step Resolution Process
 Compare the issue to a specific rule in ASHA's Code of
Ethics. Determine if rules the Code of Ethics apply to your
problem and can help develop a course of action for you to
pursue.
 Identify who has the power and control in the situation.
 Identify what is in your control and what is not.
 Identify your resources. These can be a supervisor, special
education director, or colleague. Ask yourself if you need
more information, clarification, or ideas from others who
have had a similar problem.
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Ten Step Resolution Process
 Make a list of possible actions and their positive and
negative consequences.
 Make a plan that you can defend professionally and
ethically and that meets the requirements of the
regulations.
 Take action and evaluate your plan as you proceed.
Determine next steps.
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Avoiding Ethical Dilemmas
 Advocate for best practices.
 Use evidenced-based practices as the basis for decision making.
 Know and understand the ASHA Code of Ethics and your
employer's handbook and guidelines.
 Connect the Code of Ethics with your program's mission
statement, policies and procedures, and performance
evaluations.
 Acquaint supervisors, administrators, and colleagues with the
Code of Ethics, Issues in Ethics Statements, and potential for
ethical conflicts.
 Discuss potential ethical issues before they become a problem.
 Review federal, state, and local regulations and requirements.
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Strategies
 Review federal, state and local regulations and
requirements
 Create an ethics committee or forum for discussing ethical
issues.
 Present in-services on the importance of ethics in your
work setting.
 Develop a library of ethics resources.
(Providing Ethically Responsible Services to Children from
Culturally and Linguistically Diverse Backgrounds. Anderson
and Chabon, Schools 2007 ASHA Conference, Pittsburgh, PA.)
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Scenarios – Ethical Issue?
 Your supervisor asks you to reduce therapy time for a
student who you feel needs to maintain the current level
of service.
 Parents have asked for services that you feel are is not
supported by research, but the supervisor is encouraging
you to provide them.
 I’d like to offer private services to a couple of students on
my current caseload.
 I’m supervising a student clinician . How soon can I allow
the student to treat independently?
 A supervisor has told me NOT to enroll a student because
his language scores are commensurate with his below
average IQ.
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Scenarios
 A first grade student has just come to the USA from
Mexico. Spanish is spoken at home. The teacher suspects
a communication disorder and has referred her for testing.
The monolingual SLP is asked to conduct the evaluation
using the teaching assistant as the interpreter. The
assistant is not a trained interpreter.
 Colleagues have discussed a new research based approach
to treatment and have asked the SLP to implement it. The
SLP feels she has adequate approaches in her repertoire
and is reluctant to learn this new approach.
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Scenarios
 A classroom teacher who does not work with a
student on your caseload asks about her SLP testing
scores.
 SLP has been asked to conduct evaluations using
outdated versions of several standardized tests.
 An SLP is asked to treat a student with dysphagia, but
is not trained to do so.
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Reporting Potential Ethical Violations
 ASHA Board of Ethics Complaint Form
 Can not be anonymous
 Must be mailed
 Must include the form, written statement of complaint, and
supporting documentation which will be provided to the
individual again who the complaint is filed(respondent)
 The person filing (complainant) the complaint does not have
to be an ASHA member
 ASHA’s BOE only has jurisdiction over ASHA members or
those who hold the CCC
 See Complaint Adjudication Process and the Board of Ethics
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Help is Available
 ASHA

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


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
Technical assistance
Online resources
Professional development
ASHA Community
State licensing boards
Colleagues
Supervisors
Unions and other professional
organizations
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ASHA Resources
 ASHA Code of Ethics
 Medicaid Guidance for School-Based SpeechLanguage Pathology Services: Addressing the “Under
the Direction of” Rule- Guidelines
 Issues in Ethics: Cultural and Linguistic Competence
 Frequently Asked Questions: Speech-Language
Pathology Assistants (SLPAs)
 When Clinician and Parent Disagree by Polly Pooser
 Issues in Ethics Statements
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ASHA Resources
 Bupp, H. (2012). 9 Upsetting Dilemmas. The ASHA Leader, 17(14) 1013.
 Chabon, S., Brown, J.E., & Gildersleeve-Neumann, C. (2010). Ethics,
equity and English Language Learners: A Decision Making
Framework. The ASHA Leader, 15 (9), 10-13
 Haven,L, & Bupp, H (2012). Navigating Medicaid Services in Schools.
The ASHA Leader Vol 17 1-2
 Huffmann, N & Owre,D (2008). Ethical Issues in Providing Services
in Schools to Children With Swallowing and Feeding Disorders
Language, Speech, and Hearing Services in Schools, April 2008, Vol.
39, 167-176.
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References
 Jakubowitz, M. & Schill. M. J. (2008). Ethical
Implications of Using Outdated Standardized Tests.
Perspectives, School Based Issues, 9 (2) 7-83.
 Moore, B,(2010). Ethics: If It’s Not Documented, It
Didn’t Happen. SIG 11 Perspectives on Administration
and Supervision, October 2010, Vol. 20, 106-112.
 McCarthy, M.P. & Schaffer, E. (2007). Responding
Ethically to Controversial Treatment Practices.
Perspect Admin Sup, 17(2) 304.
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References
 Mustain, W. (2003). The Ethics of Competence. The
ASHA Leader, 8(12) 14.
 O’Toole, T. J. (2000). Legal, Ethical and Financial
Aspects of Providing Services to Children With
Swallowing Disorders in the Public Schools. Language
Speech and Hearing Serv Sch, 31(1) 56-61.
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Thank you
 Deborah Dixon
 Ddixon@asha.org or schools@asha.org
 301 296 5690
 Heather Bupp, ASHAs Director of Ethics
 ethics@asha.org
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