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

 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 Disclosures 2

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 Session Objectives 3

 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) Ethics- What is it? 4

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) 5

 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 Why ? 6

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 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 Ethical Requirements Keep Calm, Carry On and Act Ethically 8

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 unlicensed practice; From Ohio’s Licensing Act for SLPs and AuDs 9

(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. From Ohio’s Licensing Act for SLPs and AuDs 10

 (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; From Ohio’s Licensing Act for SLPs and AuDs 11

 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. From Ohio’s Licensing Act for SLPs and AuDs 12

 (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; From Ohio’s Licensing Act for SLPs and AuDs 13

 (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 From Ohio’s Licensing Act for SLPs and AuDs 14

  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. ASHA’s Code of Ethics 15

 Competence  Discrimination  Misrepresenting credentials  Delegation only as appropriate  No guarantee  Securing records  Client abandonment Principle I 16

 Principle of Ethics II  Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. ASHA’s Code of Ethics 17

 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 Principle II 18

 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. ASHA’s Code of Ethics 19

 Misrepresentation of credentials, competence, education…  Conflict of interest  Referrals not based on financial interest  Fraud  Public statements Principle III 20

 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. ASHA’s Code of Ethics 21

 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 Principle IV 22

 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 DepartmentComplaint Form for Alleged Violation of the Code of Ethics  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 Ethics Process for Alleged Violations 23

 Possible outcomes:  In sufficient information – matter closed  Reprimand  Censure  Withholding  Suspension or revocation of membership and/or CCC  Various notifications depending on the ruling Ethics 24

 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  Published May, 2015 Board of Ethics Decision 25

 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,  Published September 2015 Board of Ethics Decision 26

 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,  Published July, 2014 Board of Ethics Decision 27

 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,  Published October 2013 Board of Ethics Decision 28

 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,  Published May, 2015 Board of Ethics Decision 29

 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 speech- language 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,  Published March, 2015 Board of Ethics Decision 30

 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 Board of Ethics Decisions 31

 Documentation lapses  Employer Demands  Use and Supervision of Support Personnel  Clinical Fellowship mentoring and student supervision  Client abandonment Bupp, H. (2012) Most Common Ethical Complaints 32

 Reimbursement  Business competition  Impaired practitioners  Affirmative disclosures Bupp, H, (2012) 9 Upsetting Dilemmas, ASHA Leader, Vol 17, NOTE: cultural competence is another common issue Most Common Ethical Complaints 33

 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. What are Your Ethical Issues? 34

 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 Is it an Ethical Dilemma? 35

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 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? If it is an Ethical issue, then What? 37

 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. Ten Step Resolution Process 38

 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. Ten Step Resolution Process 39

 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. Ten Step Resolution Process 40

 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. Avoiding Ethical Dilemmas 41

 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.) Strategies 42

 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. Scenarios – Ethical Issue? 43

 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. Scenarios 44

 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. Scenarios 45

 ASHA Board of Ethics Complaint Form 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 EthicsComplaint Adjudication Process and the Board of Ethics Reporting Potential Ethical Violations 46

Help is Available  ASHA  Technical assistance  Online resources  Professional development  ASHA Community  State licensing boards  Colleagues  Supervisors  Unions and other professional organizations 47

 ASHA Code of Ethics ASHA Code of Ethics  Medicaid Guidance for School-Based Speech- Language Pathology Services: Addressing the “Under the Direction of” Rule- Guidelines Medicaid Guidance for School-Based Speech- Language Pathology Services: Addressing the “Under the Direction of” Rule- Guidelines  Issues in Ethics: Cultural and Linguistic Competence Issues in Ethics: Cultural and Linguistic Competence  Frequently Asked Questions: Speech-Language Pathology Assistants (SLPAs) Frequently Asked Questions: Speech-Language Pathology Assistants (SLPAs)  When Clinician and Parent Disagree by Polly Pooser When Clinician and Parent Disagree by Polly Pooser  Issues in Ethics Statements Issues in Ethics Statements ASHA Resources 48

 Bupp, H. (2012). 9 Upsetting Dilemmas. The ASHA Leader, 17(14) Upsetting Dilemmas  Chabon, S., Brown, J.E., & Gildersleeve-Neumann, C. (2010). Ethics, equity and English Language Learners: A Decision Making Framework. The ASHA Leader, 15 (9), 10-13Ethics, equity and English Language Learners: A Decision Making Framework  Haven,L, & Bupp, H (2012). Navigating Medicaid Services in Schools. The ASHA Leader Vol  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, Ethical Issues in Providing Services in Schools to Children With Swallowing and Feeding Disorders ASHA Resources 49

 Jakubowitz, M. & Schill. M. J. (2008). Ethical Implications of Using Outdated Standardized Tests. Perspectives, School Based Issues, 9 (2) 7-83.Ethical Implications of Using Outdated Standardized Tests  Moore, B,(2010). Ethics: If It’s Not Documented, It Didn’t Happen. SIG 11 Perspectives on Administration and Supervision, October 2010, Vol. 20, Ethics: If It’s Not Documented, It Didn’t Happen  McCarthy, M.P. & Schaffer, E. (2007). Responding Ethically to Controversial Treatment Practices. Perspect Admin Sup, 17(2) 304.Responding Ethically to Controversial Treatment Practices. References 50

 Mustain, W. (2003). The Ethics of Competence. The ASHA Leader, 8(12) 14.The Ethics of Competence  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) Legal, Ethical and Financial Aspects of Providing Services to Children With Swallowing Disorders in the Public Schools References 51

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 Deborah Dixon  or   Heather Bupp, ASHAs Director of Ethics  Thank you 53