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Ethical Practice
What is it?
How do I do it?
What are the Pitfalls?
* Deborah Dixon M.A. CCC-SLP
- GOSSLP is paying my travel expenses and providing an honorarium
- I am a member of ASHA
- My bias is that school based SLPs are the very best! Disclosure *Understand the ASHA Code of Ethics *Describe situations that place SLPS at risk for ethical violations *Apply strategies that help to avoid ethical violations 3 Session Objectives
Ethics 4
- 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) Ethical Requirements 5 *Ethical practice is required both for maintaining the ASHA CCC as well as your state license, and most educational certifications.
* PREAMBLE
* The preservation of the highest standards of integrity and ethical
principles is vital to the successful discharge of the professional
responsibilities of all speech-language pathologists and audiologists.
This Code of Ethics sets forth the fundamental principles and rules
considered essential to this purpose. Any action that violates the spirit
and purpose of this code shall be considered unethical. Failure to
specify any particular responsibility or practice in this Code of Ethics
shall not be construed as denial of the existence of such responsibilities
or practices.
6 GSHA Code of Ethics
How many
complaints
are filed
annually?
- Compromising quality of services
- Adhering to administrative and regulatory Mandates
- Completing Medicaid billing
- Supervising support personnel
- Working with unqualified providers
2016 School Survey-Challenging Ethical Issues
What has not changed in ASHA’s
code of ethics
12
*The
fundamental
purpose of
the Code
• Underlying
philosophy
http://www.asha.org/uploadedFile s/ET2016-00342.pdf
Changes to ASHA’s Code of Ethics 13
* Updated Preamble
* New terminology
section
* 15 new Rules of
Ethics
* Revised 2 Principles
of Ethics
Changes related to:
- research conduct
- evidence based and independent clinical judgment
- client abandonment
- impaired practitioner
- work place service delivery coercion
- use of technology
- self-disclosure, financial disclosure, and honesty in reporting
- intra-professional and inter-professional collaboration
- reporting members of other professions
- compliance with local, state, and federal laws and regulations
- Strengthens the need to adhere to the spirit and purpose of the code of ethics
- New terminology section is designed to clarify and improve understanding of terms that are used in the decision making of the board of ethics Additional Changes
- The fundamentals of ethical conduct are described by Principles of Ethics and by Rules of Ethics
- Principles of Ethics form the underlying philosophical basis for the Code of Ethics
- Rules of Ethics are specific statements of minimally acceptable as well as unacceptable professional 15 How is the Code Organized?
19 Principle II Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. Revisions in Principle III 20 OLD: 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. NEW: 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. Revision in Principle IV 21 OLD: Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines. NEW: Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the professions' self- imposed standards
- Principle I , Rule E – Individuals who hold the Certificate of Clinical Competence may delegate tasks related to the provision of clinical services to aides, assistants, technicians, support personnel, or any other persons only if those persons are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served remains with the certified individual.
- Principle I Rule F - Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills, knowledge, judgment, or credentials that are within the scope of their profession to aides, assistants, technicians, support personnel, or any nonprofessionals over whom they have supervisory responsibility.
- Principle IV, Rule I - Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics. Supervision
* Principle II Rule E – Individuals in administrative or supervisory roles
shall not require or permit their professional staff to provide
services or conduct research activities that exceed the staff
member's certification status, competence, education, training,
and experience.
* Principle IV B- Individuals shall exercise independent professional
judgment in recommending and providing professional services
when an administrative mandate, referral source, or prescription
prevents keeping the welfare of persons served paramount
Administrative Rule
- Telepractice and technology – quality of services must be
equivalent to in person services - glossary
- Principle II Rule G - Individuals shall make use of technology
and instrumentation consistent with accepted professional
guidelines in their areas of practice. When such technology is
not available, an appropriate referral may be made.
Telepractice
- Individuals shall report members of other professions who they know have violated standards of care to the appropriate professional licensing authority or board, other professional regulatory body, or professional association when such violation compromises the welfare of persons served and/or research participants.
- Individuals shall not file or encourage others to file complaints that disregard or ignore facts that would disprove the allegation; the Code of Ethics shall not be used for personal reprisal, as a means of addressing personal animosity, or as a vehicle for retaliation.
- Individuals with evidence that the Code of Ethics may have been violated have the responsibility to work collaboratively to resolve the situation where possible or to inform the Board of Ethics through its established procedures. 28 Reporting Ethics Violations
- Principle IV Rule S- Individuals who have been convicted; been found guilty; or entered a plea of guilty or nolo contendere to (1) any misdemeanor involving dishonesty, physical harm—or the threat of physical harm—to the person or property of another, or (2) any felony, shall self-report by notifying ASHA Standards and Ethics (see Terminology for mailing address) in writing within 30 days of the conviction, plea, or finding of guilt. Individuals shall also provide a certified copy of the conviction, plea, nolo contendere record, or docket entry to ASHA Standards and Ethics within 30 days of self-reporting. Self reporting Is it an Ethical Violation? What is the issue? Is it an ethical violation? Is time of the essence? Could the situation be resolved?
*Principle I Rule M *Individuals who hold the Certificate of Clinical Competence shall use independent and evidence-based clinical judgment, keeping paramount the best interests of those being served. What are the Pitfalls?
- Principle I Rule S
- Individuals who have knowledge that a colleague is unable to provide professional services with reasonable skill and safety shall report this information to the appropriate authority, internally if a mechanism exists and, otherwise, externally. What are the Pitfalls? *Principle I Rule T *Individuals shall provide reasonable notice and information about alternatives for obtaining care in the event that they can no longer provide professional services. What are the Pitfalls?
*Principle IV Rule I *Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics. What are the Pitfalls?
* Principle IV Rule N
* Individuals shall report members of other professions who
they know have violated standards of care to the appropriate
professional licensing authority or board, other professional
regulatory body, or professional association when such
violation compromises the welfare of persons served and/or
research participants.
What are the Pitfalls?
- What Is Ethical Disclosure?
- Ethical disclosure is essentially a self-initiated action, with the intent to be honest and complete, to provide personal and professional information in order to remain ethically compliant with the Code.
- Self-reporting is a professional obligation of self-disclosure. ASHA members and certificate holders self-report to ASHA Standards and Ethics through notification and documentation, including mailing a hard copy of any relevant certified documents. Ethical Disclosure, Misrepresentation, and Conflict of Interest
Why is Disclosure Important? The act of disclosure is a process of transparency. Foundational to proper, professional, and ethical conduct is the intent to be honest, accurate, and complete when providing required information. Many clinical, research, and teaching scenarios can potentially foster a natural tension between professional obligation and personal preference/gain. Misrepresentation by both errors of omission and commission, as well as by conflicts of interest, can create ethical violations. Adherence to professional obligations and standards is essential to eliminate the chance of ethical violation *Supervisor requires an SLP to qualify a student for services, though the SLP does not feel services are warranted. Supervisor is a friend of the family. The child is eligible for Medicaid billing. Scenarios Scenarios An SLP new to the district is required to provide 30 minutes of instruction a day to 14 general education students about character and behaviors. She was then was told she would also be providing academic interventions to at risk students in the areas of reading, ELA, and math.
* Rationale: This certified SLP, owner and operator of (XXX)
Inc., did not provide adequate supervision of speech-language
pathology assistants as required by Oklahoma state law,
allowing SLPs under her supervision to provide clinical services
to one client while concurrently directly supervising a speech-
language pathology assistant providing clinical services to a
different client.
* Violations (2010): I, I-F; IV, IV-B
* Sanction: Suspension of membership and certification for one
year, effective Jan. 15, 2016
Board of Ethics Decisions
- Rationale 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, Valerie Jeanne Jaecksch of Charlotte, North Carolina, violated the following
- Violation : (2010) 1, 1-O, III; III E;
- Sanction suspension of membership and certification for 12 months, effective retroactive from June 1, 2014. Board of Ethics Decisions
* Rationale: Failed to return records and complete paperwork
upon termination of employment to ensure continuity of care,
and did not respond to ASHA Ethics correspondence.
* Code (2016): I, I-Q, IV, IV-A, IV-P
* Sanction: Censure, effective Sept. 1, 2017.
Board of Ethics Decisions
- Rationale: Failed to exercise a reasonable degree of skill and care in the delivery of professional services; failed to maintain adequate records, including evaluation reports, plans of care, re-evaluations of patients and discharge summaries; and abandoned patients without providing notice to her employer. These were all evidenced by the North Carolina Board of Examiners for Speech-Language Pathologists and Audiologists, which revoked her license for one year.
- Violations (2010): I, I-A, I-M, I-R; IV, IV-N
- Sanction: Revocation of membership and certification for six months, effective Jan. 5, 2016. Board of Ethics Decisions
- Rationale: Falsified dates, documents, billing, and Individualized Education Program meetings by photocopying and forging signatures, and failing to maintain accurate documentation, as well as working as a speech pathology assistant without completing the required practicum hours and-language practicing as a conditionally licensed speech-language pathologist without supervision for over a year.
- Code (2010r): I, I-M, I-O, II, II-B, III, III-A, III-D, IV, IV-A, IV-C, IV-E, IV-N
- Sanction: Revocation of membership and certification for five years, effective Aug. 23, 2017. Board of Ethics Decisions
- Rationale: Accessed and viewed without authorization electronic health records for patients not on her caseload, capturing screenshots of the records, and failing to secure her medical records system user ID and password, resulting in violations of patients’ privacy and confidentiality necessitating notification of the security breach; violated federal regulations, Health Insurance Portability and Accountability Act (HIPAA), hospital policies, and the Ohio licensure law and regulations leading to revocation of her Ohio audiology license; and failed to self discipline to ASHA Standards and Ethics. -report her professional
- Code (2016): I, I-O, I-P, IV, IV-D, IV-P, IV-R, IV-T
- Sanction: Revocation of membership and certification for 20 years, effective Aug. 23, 2017. Board of Ethics Decisions
- Complete Complaint Form for Alleged Violation for the ASHA Code of Ethics - Written statement of the complaint - Any additional documentation available - If confidential client information is part of the evidence redact all identifying information - Sign and mail the form to ASHA - See additional information on Filing a Complaint of Alleged Violation of the ASHA Code of Ethics Filing and Ethics Complaint
- The Board of Ethics review all of the information submitted
- BOE ASHA members or individuals who hold the Certificate of Clinical Competence; only has jurisdiction to receive, deliberate, and act upon complaints filed against
- person filing the complaint (the "Complainant") does not have to be an ASHA member;
- BOE does not accept anonymous complaints or complaints filed against an organization or employer;
- BOE accepts complaints filed via mail only and will not accept complaints filed via telephone, e-mail or facsimile;
- a copy of the complaint form, a written statement of complaint, and all supporting documentation will be provided to the individual against whom the complaint is filed (hereafter referred to as the Respondent). What Happens when Complaint is Filed?
* In sufficient information – matter closed
* Reprimand
* Censure
* Withholding
* Suspension or revocation of membership and/or CCC
* Various notifications depending on the ruling
* Cease and Desist Orders
57 Review Board Outcomes
- To penalize the person in violation
- To serve as a mechanism to education and rehabilitate
- To protect the public
- To inform other ASHA members and certificate holders that ASHA enforces its ethical standards and imposes penalties for ethical misconduct 58 Purpose of Sanctions
- My school district is in a rural part of the state and has a difficult time recruiting and retaining ASHA certified SLPs. Therefore, by necessity, the district is hiring less qualified clinicians and support personnel and delegating supervisory responsibilities to me. I already have a full caseload and I am worried that I will not be able to provide sufficient supervisory oversight. The Code of Ethics says I must appropriately supervise these support personnel. What does "appropriately" mean?
- I work in the public schools. Medicaid will reimburse my school for speech and language services provided by an ASHA certified SLP and for services "under the direction of a certified SLP." My school district wants me to sign off on Medicaid reimbursement requests for clinicians in other local schools who are not ASHA certified and not supervised by me. My administrator tells me that "under the direction of a certified SLP" does not mean that I have to actually supervise them. I'm skeptical and unsure exactly what my ethical responsibilities are in these circumstances. 59 Examples of Typical Ethics Inquiries
- Always consider the impact on student and family
- Advocate for best practices
- Know and understand your state and ASHA Code of Ethics as well as federal, state and local requirements/regulations
- Acquaint supervisors and colleagues with the Code of Ethics
- Review federal, state and local regulations and requirements
- Connect the Code of Ethics with your program's mission statement, policies and procedures, and performance evaluations
- Discuss and problem solve potential ethical issues before they become a problem Avoiding Ethical Violations
