Let’s get ethical.wav

Liz Watson, MA, CCC-SLP

MA, CCC-SLP

General

Ethics

You may have had to memorize the <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/code-of-ethics/">ASHA Code of Ethics</a> (or your country’s equivalent) in school, but how many times have you consulted it since then? In our line of work, ethical quandaries are bound to come up. Leaders from ASHA recently published a series of papers to give you the tools you need when confronted with an ethical dilemma. The <a target="_blank" rel="noopener noreferrer" href="https://pubs.asha.org/toc/persp/7/1">full texts</a> (five papers in all) are very readable, with a connecting storyline about “María,” a lead SLP for a school district. But for those of you who enjoy the CliffNotes version, this review is for you.&nbsp;&nbsp;<h2>What SLP Ethics Resources Should I Know About?</h2>&nbsp;To start, take a gander at the <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/code-of-ethics/">ASHA Code of Ethics</a> and the <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/policy/assistants-code-of-conduct/">ASHA Assistants Code of Conduct</a> (VERY relevant if you supervise an SLPA!). These guiding principles and rules dictate the expected ethical behavior of SLPs, audiologists, and SLPAs. It’s also important to know your own state’s <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/advocacy/state/">laws and licensing requirements</a>. The authors strongly recommend checking out the <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/practice/ethics/">Ethics Resource Page</a>, especially <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/practice/ethics/ethics_issues_index/">Issues in Ethics Statements</a>, which covers common ethical issues like client abandonment, ethical use of social media, telepractice, and conflicts of interest.&nbsp;Although these resources are US-specific, the basic ethical principles are universal. An important distinguisher, however, is that ethical violations are different from legal violations (e.g., being in violation of IDEA or HIPAA) and may differ from moral violations (i.e., doing something that is “wrong”) which are more subjective and may or may not be considered “unethical.” For instance, sending friend requests to clients from your personal Facebook account is definitely unethical, but it’s not illegal, and whether it’s immoral is up for debate. Got that?&nbsp; &nbsp;<h2>What Ethics Violations are Common?</h2>&nbsp;It’s our responsibility to ensure that we are practicing ethically. What should we be on the lookout for? How do we know if we are toeing the line?&nbsp;&nbsp;<h2>Improper documentation and misrepresentation</h2>&nbsp;Documentation issues are rampant in the healthcare industry these days, especially with the ease of EMRs. Misrepresenting your services, whether by accidentally billing a no-show session or by providing more services than necessary when pressured by your supervisor, can easily turn into cases of fraud. And of course, intentionally misrepresenting or falsifying records would be a major violation. Read <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/practice/ethics/misrepresentation-of-services/">this article from ASHA</a> for more on this topic. &nbsp;<h2>Unlicensed Practice</h2>&nbsp;This type of violation is almost always the result of a lapsed license. <a target="_blank" rel="noopener noreferrer" href="https://leader.pubs.asha.org/do/10.1044/everyday-ethics-state-licensing-and-practicing-speech-language-pathology-in-schools/full/">One clinician</a> practiced for 12 years without realizing her license lapsed because she expected her office to notify her, and they didn’t. Maintaining your license is your responsibility! This might seem like a minor violation, but licensing systems are in place to keep clients safe and ensure all clinicians have the appropriate education and qualifications.&nbsp;<h2>Use of Social Media</h2>&nbsp;Oh, social media. It has given our field so many positive things: increased awareness, collaboration, learning opportunities, etc. However, &nbsp;things can go wrong when SLPs misuse social media when providing client services. Some obvious violations would include posting pictures of clients without their permission or describing a client in enough detail that someone could recognize them. Others could include misrepresenting yourself, your expertise, or your products and services—think: “Cure your child’s language delay with this book!” Moral of the story: be careful what you post, and assume anyone could find it regardless of privacy settings. For more on this topic see <a target="_blank" rel="noopener noreferrer" href="https://www.asha.org/practice/ethics/ethical-use-of-social-media/">here</a> and <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1002/hast.975">here</a>. &nbsp;<h2>Practitioner Impairment &amp; Mental Health</h2>&nbsp;This one gets… interesting. Historically, <a target="_blank" rel="noopener noreferrer" href="https://leader.pubs.asha.org/do/10.1044/2020-0713-ethics-impaired-practitioner/full/">practitioner impairment</a> referred specifically to substance abuse. Don’t drink and drive a FEES scope, friends. According to <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00175">Gleason</a> (a former ASHA Board of Ethics member), however, this category has broadened to include mental health issues like anxiety, depression, PTSD, chronic pain, and… burnout. Just gonna let that one simmer for a second. Yeah.&nbsp;&nbsp;The author cites technology and the evolution of telehealth/home health as the reason SLPs have “little ‘down time’ for self care,” leading to burnout and increased risk of ethical violations. Not sure about you, but I can think of a few other reasons many of us feel burnt out. Gleason advises SLPs experiencing burnout to let their supervisors know if they’re unable to carry out their job duties adequately, which feels like a conversation that would rarely end well. As uncomfortable (infuriating?) as it is to think that our individual licenses and CCCs are ultimately on the line when systemic factors create unsustainable work conditions, that’s the reality.&nbsp;<h2>Navigating Ethical Issues</h2>&nbsp;Not every ethical issue is black and white, nor does it require an immediate report to ASHA. Key steps of ethical decision making, according to <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00244">Weichmann</a>, include collaborating with others, consulting resources and individuals with knowledge about the issue, and brainstorming the most ethical and feasible solutions. There are currently many active ethical debates within our professional community. Let’s discuss.&nbsp;The rapid rise of <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00211">telepractice</a> (thanks, COVID) is one area that has raised lots of ethical questions. Are telepractice services equivalent to face-to-face services? (<a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/reviews?tagfilters=59">Research</a> can help us here!) Is it ethical to provide virtual services to only some students or schools within one school district? What happens when certain students or clients aren’t good candidates for telepractice? If given the choice, what if SLPs choose (intentionally or not) to offer virtual services (rather than in-person) to schools in lower-income communities or those with more children of color. How can we ensure discrimination and bias are not factors in decisions made around telepractice?&nbsp;Working with <a target="_blank" rel="noopener noreferrer" href="https://doi.org/10.1044/2021_PERSP-21-00261">culturally and linguistically diverse clients</a> presents many points of debate as well. The concept of Ethics itself varies from culture to culture. What happens when a clinician and client’s thoughts on an ethical dilemma clash? Is it possible for one to become “competent” in a culture that is not their own? (Many say no, and use the term <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/am-i-qualified-let-s-talk-about-moving-from-cultural-competence-to-cultural-humility">cultural humility</a> instead). Is it possible for one to deliver truly unbiased services, or is bias always inherent in everything we do? What is the most ethical way to evaluate a client from a different cultural background?&nbsp;&nbsp;While these questions might seem philosophical, we encounter them regularly in our profession. Some of TISLP’s reviews on <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/reviews?tagfilters=59">telepractice</a> and <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/reviews?tagfilters=37&amp;tagfilters=69">multilingual clients</a> may help you make an informed decision about these topics. There are so many more ethical discussions in our community that we can’t possibly cover them all here, but <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/am-i-qualified-let-s-talk-about-ableism">ableism</a>, <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/gender-neutral-pronouns-yes-we-should-go-there">gender-neutral pronouns</a>, <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/accent-expansion-not-accent-modification-an-important-shift-in-terminology">accent services</a>, and <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/review/end-of-life-feeding-considerations-for-people-with-dementia-part-tu-be">end of life considerations</a> all come to mind.&nbsp;<h2>Conclusion</h2>&nbsp;We hope reading this has added more tools to your toolbox for approaching ethical dilemmas that come up throughout your career. (If you’re like me, you just triple-checked that your license and CCC are in good standing). We won’t ever have foolproof answers for every situation; the best we can do is stay informed on current topics, collaborate and discuss, and approach our work with an ethical mindset.&nbsp;&nbsp;<figure class="image"><img src="https://tislp-bucket-assets.s3.amazonaws.com/review_image_6b2bdca0_4579_4bd9_8b9c_7e12d9f733c9_55b2937fdf.png" alt="PPA, SLP CEUs, The Informed SLP"></figure>Are you new to The Informed SLP? Access our evidence database of over 3000 research reviews and earn CE credit as you go, starting at just $9/month. <a target="_blank" rel="noopener noreferrer" href="https://www.theinformedslp.com/">Learn more about The Informed SLP here</a>.

Professional Issues

If you are unsure if a situation involves an ethical violation, you should immediately submit a complaint to ASHA just to be safe.

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Preschool & School-Age (ARC-002)

Preschool through Adults (Annual, without CE hours)

Preschool & School-Age (ARC-Annual-009)

Preschool & School-Age (ARC-009)

STUDENT GROUP: University of Oklahoma Health Sciences Center

STUDENT GROUP: Worcester State University

GROUP: Great Ormond Street Hospital (n=4; Birth through High School)

Preschool & School-Age (Annual-ARC-002)

Birth through High School (Annual-ARC-001)

Preschool & School-Age (without CE hours)

Preschool & School-Age (Annual-ARC-006)

Preschool & School-Age (Annual-ARC-001)

STUDENT GROUP: Western Washington University

Birth through High School (Annual-ARC-004)

Birth through High School (Annual-ARC-005)

GROUP: MHealth Fairview (n=10; Birth through High School)

GROUP: UGDSB CLSS (n = 12; Preschool & School-Age)

Preschool through Adults (without CE hours)

GROUP: DIGNA

Birth through Adults w/ Courses (Annual-ARC-001)

Birth through Adults (without CE hours)

GROUP: Berns Therapy Solutions

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GROUP: Capital Area Intermediate Unit (n=4; Birth through High School)

STUDENT GROUP: Gallaudet University

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Survey Guest Pass

GROUP: Oceanside Unified School District (n=18; Birth through High School)

STUDENT GROUP: Florida State University

STUDENT GROUP: St. Ambrose University

GROUP: Preschool & School-Age Access

GROUP: CUSD201 (n = 4; Preschool & School-Age)

STUDENT GROUP: Old Dominion University

Preschool & School-Age (ARC-008)

GIFT TO: Preschool & School-Age (without CE)

GROUP: Full Access

Birth through High School (without CE hours)

GROUP: Albemarle County Public Schools (n=15; Preschool & School-Age)

GROUP: Birth through High School

GROUP: The Lab School of Washington (n = 7, Preschool & School-Age)

STUDENT GROUP: California State University, Sacramento

STUDENT GROUP: Northeastern State University

GROUP:  Elk Island (n=15; Preschool & School-Age)

GROUP: Holland Bloorview (Birth through High School)

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Preschool through Adults (Annual)

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GROUP: University of South Carolina (n= 9; Full Access)

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STUDENT GROUP: St. John's University

One Month Free

Birth through Adults (Annual, without CE hours)

Birth through High School (Annual, without CE hours)

GROUP: Hudson School District (n=11; Birth through High School)

Preschool & School-Age (ARC-006)

GROUP: Naperville School District 203 Group C (n=4; Preschool & School-Age)

GROUP: Harford Academy SLPs (n=1; Birth through Adults)

Preschool & School-Age (Annual, without CE hours)

GROUP: San Diego USD  (n=173; Full Access)

GROUP: AnthroMed Education (n=14; Preschool & School-Age)

GROUP: St Charles CUSD303 (n=27; Preschool & School-Age)

GROUP: DCIU Schools (n = 10; Preschool & School-Age)

GROUP: SPEECH for Kids (n=7; Birth through High School)

Birth through High School (Annual-ARC-CE-a)

Birth through High School (Annual-ARC-003)

GROUP: West Fargo Public Schools (n=37; Birth through Adults)

Preschool & School-Age 

GROUP: Alexandra Hills (n=13; Birth to Five and Preschool & School Age)

Author Access (CE)

Preschool & School-Age (ARC-CE)

GROUP: Sunnyside USD (n=27; Preschool & School Age)

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Preschool & School-Age (Annual-ARC-CE)

Birth through High School (Annual)

Preschool through Adults

Birth through Adults

6 months free

Birth through High School

Preschool & School-Age (Annual)

Birth through High School (ARC-CE)

Archived Membership w/ CE 2021

Birth through Adults (Annual) 

Birth through High School (Annual-ARC-CE-b)

GROUP: ECM- Hudson (n=3; Full Access)

GIFT TO: Preschool & School-Age

STUDENT GROUP: University of Illinois at Urbana-Champaign

GROUP: Professional Speech Therapists (n=15; Birth through High School)

GROUP: Millcreek (n = 2, Birth through High School)

STUDENT GROUP: University of Arizona

STUDENT GROUP: Penn State University

GROUP: Emilia's Kids (N=14; Birth through High School)

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Birth through Adults (ARC-001)

Preschool & School-Age

Adults (Annual-ARC-Honeycomb)

Adults (Annual, without CE hours)

Adults (without CE hours)

Adults (Annual-ARC-001)

Infants and Adults (without CE hours)

Infants and Adults (Annual, without CE hours)

Infants and Adults

Infants and Adults (Annual)

Adults

GIFT TO: Adults

Adults (Annual)

STUDENT GROUP: Appalachian State University

GROUP: University of Wisconsin-Madison (n=8; Full Access)

GROUP: Sound Speech & Hearing Clinic (n = 4; Full Access)

Adults (ARC-001)

Adults (ISHA)

GROUP: Big Stone Therapies (n=3; Full Access)

STUDENT GROUP: Marshall University

Gift to the Grad

STUDENT GROUP: Northern Arizona University

Test free trial plan

STUDENT GROUP: Texas Tech University Health Sciences Center

STUDENT GROUP: Supervising Faculty

Staff Gift

STUDENT GROUP: Abilene Christian University

Gift to the Grad 2023

GROUP: Vista Unified School District (n=36; Full Access)

Free April Trial (MNSHA)

STUDENT GROUP: Bloomsburg University

STUDENT GROUP: Brigham Young University

STUDENT GROUP: Bob Jones University

Birth through Adults (ISHA)

Trial Test

Special: SPA 2022 Free Pass

STUDENT GROUP: Maryville University

ImpSci Guest Pass

STUDENT GROUP: San Jose State University

Adults (SLPShareASale)

GROUP: Staunton City Schools (n=5; Full Access)

One Year Free

GROUP: Boys Town National Research Hospital (n=13; Full Access)

GROUP: THKMC SLT (n=10; Full Access)

STUDENT GROUP: University of New Haven

STUDENT GROUP: The University of Toledo

GROUP: Naperville School District 203 Group B (n=3; Adults)

STUDENT GROUP: Harding University

GROUP:  Mudgeeraba Creek State School (n=4; Full Access)

STUDENT GROUP: Calvin University

STUDENT GROUP: Eastern Illinois University

STUDENT GROUP: University of Memphis

GIFT PAYMENT: Full Access

GIFT PAYMENT: Adults

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GIFT TO: Birth to Five

Birth to Five (Annual-ARC-CE)

Birth to Five (Annual)

Birth to Five

Birth to Five (ARC-CE)

GROUP: Talk with Me (n=6; Birth to Five)

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Birth to Five (ISHA)

GROUP: Cajon Valley USD (n=9; Birth through High School)

GROUP: Interior Health ECD SLPs (n= 11; Birth to Five)

Karen Evans, MA, CCC-SLP

Get the 411 on all things SLP ethics, including common violations, navigating ethical dilemmas, and current ethical debates in our community.

Let's get ethical