Clinical Methods

Purpose of ASHA Scope of practice

• Delineates professional services within speech-language pathology.

• Informs others about SLP roles and responsibilities.

• Promotes high-quality, evidence-based services

Domains of Service Delivery: (Scope of Practice)

• Collaboration, counseling, prevention and wellness, screening, assessment, treatment, technology, and population health.

• Domains of Professional Practice: (scope of practice)

• Advocacy and outreach, supervision, education, research, and administration/leadership.

Scope Includes:

• Speech production, fluency, language, cognition, voice, resonance, swallowing/feeding, hearing, and more.

Who follows the code of ethics

All ASHA members, certificate holders, and research participants

What is Principle 1-

 Responsibility to clients and research participants.

What is Principle 2:

• Professional competence.

What is Principle 3:

• Responsibility to the public.

What is Principle 4:

• Professional relationships.

• The code of ethics requires us to honor responsibilities to:

• the persons we serve professionally;

• the establishment and maintenance of our competence as clinicians,  educators, researchers, and mentors;

• the public reputation of our professions, and

• our inter- and interprofessional relationships

• What is HIPAA? And what does it do?

• The Health Insurance Portability and Accountability Act (1996).

• Protects privacy and security of health information (PHI).

HIPPA Privacy Rule

• Protects PHI in all forms and outlines patient rights.

HIPPA Security Rule

• Ensures electronic PHI (ePHI) is safeguarded.

HIPPA Breach Notification Rule

• Requires notification of PHI breaches to affected individuals.

Can Providers withhold Medical Records

No, but they can charge for it

Following HIPPA what can you disclose to law enforcement

 must follow "minimum necessary" standards

• Process if Someone Violates the Code:

• File a complaint via ASHA's process.

• Follow the steps outlined in the Ethics Resource portal.

1. Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP)

• Awarded by ASHA to recognize competency in speech-language pathology.

• Eligibility Requirements: (SLP)

• Graduate Degree: Completion of a master’s or doctoral program accredited by the Council on Academic Accreditation (CAA).

• Clinical Practicum: A minimum of 400 supervised hours, including 25 hours of observation and 375 hours of direct client contact.

• Praxis Exam: Passing the Speech-Language Pathology Praxis Exam.

• Clinical Fellowship (CF): A supervised 9-month (or part-time equivalent) Clinical Fellowship under a CCC-SLP mentor.

• Maintenance:

  • Complete 30 hours of professional development (PDHs) every 3 years, with at least 2 hours focused on diversity, equity, inclusion, and cultural competency.

1. ASHA SLPA Certification:

   • Eligibility Requirements:

• Education:

  • Associate degree in an SLPA program OR a bachelor's degree in communication sciences and disorders (CSD).

• Clinical Practicum:

  • At least 100 hours of supervised fieldwork.

• Certification Exam:

  • Pass the ASHA SLPA Certification Exam.

• Supervision:

  • SLPAs must have ongoing supervision from an SLP.

1. Certificate of Clinical Competence in Audiology (CCC-A)

• Awarded by ASHA to recognize audiologists who meet academic, clinical, and professional standards.

• Eligibility Requirements: (AuD)

• Doctoral Degree: Doctor of Audiology (AuD) or equivalent from a CAA-accredited program.

• Clinical Practicum: Minimum of 1,820 supervised clinical hours.

• Praxis Exam: Pass the Audiology Praxis Exam.

• Maintenance:

  • Complete 30 hours of professional development every 3 years.

1. ASHA Audiology Assistant Certification:

• Eligibility Requirements:

  • Education: High school diploma or equivalent (minimum) or postsecondary education in an audiology assistant program.

  • Clinical Experience: A minimum of 1,000 hours of supervised clinical work under a licensed audiologist.

  • Certification Exam: Pass the ASHA Audiology Assistant Certification Exam.

• Supervision:

  • Must always work under a licensed audiologist who provides direct and indirect supervision.

1. Who is required to follow ASHA's Code of Ethics?

   • A) Only licensed SLPs

   • B) ASHA members and certificate holders

   • C) Only SLP students

ASHA members and certificate holders

1. Which domain is NOT part of the ASHA Scope of Practice?

   • A) Counseling

   • B) Advocacy

   • C) Pharmaceutical consultation

• Pharmaceutical consultation

1. Under HIPAA, which of the following qualifies as PHI?

   • A) A patient's pet name

   • B) A patient's social security number

   • C) A patient's favorite color

Social Security Number

1. What is the main purpose of the ASHA Scope of Practice?

   • A) Limit the range of SLP services.

   • B) Define the breadth of SLP practice.

   • C) Ensure practitioners focus solely on speech disorders.

Define the breadth of SLP practice.

1. What are the four principles of the ASHA Code of Ethics?

•  Responsibility to clients, professional competence, public responsibility, and professional relationships.

1. Explain the role of the "minimum necessary" standard under HIPAA.

• It limits the disclosure of PHI to the smallest amount necessary to achieve the intended purpose.

1. What are the eight domains of service delivery in the Scope of Practice?

• Collaboration, counseling, prevention and wellness, screening, assessment, treatment, use of technology, and population health.

1. How should SLPs respond if faced with unfamiliar clinical challenges?

•  Be honest about their experience, seek additional training, and avoid practicing outside their scope of competence.

• Scenario: Sally withholds a patient’s records because they owe $4,000.

• Question: Is this allowed under HIPAA? Why or why not?

• No, HIPAA prohibits withholding PHI for unpaid bills.

• Scenario: Erika wants to report a former patient to law enforcement due to harassment.

• Question: What HIPAA considerations must she address?

• She must ensure disclosure follows the Privacy Rule’s exceptions, including preventing serious and imminent threats.

1. Ronna Fisher’s Advertising Case:

   • Scenario: Ronna made false claims about dementia and hearing loss in ads.

   • Question: Which principle of the Code of Ethics did she violate?

• Principle III: Responsibility to the public.

An audiologist’s website claims, “We guarantee that our patients will experience improved ability to understand speech in difficult listening environments,” accompanied by testimonials such as, “I can now talk to my husband in noisy restaurants! – Susannah K.”

What Principles were Violated

• Principle III: Responsibility to the public.

  • Rule 3.1: Accurately represent services, products, and research results to the public.

  • Rule 3.3: Avoid conflicts of interest and ensure public statements are not misleading.

  • Rule 3.5: Do not guarantee specific treatment outcomes without evidence.

An audiologist’s website claims, “We guarantee that our patients will experience improved ability to understand speech in difficult listening environments,” accompanied by testimonials such as, “I can now talk to my husband in noisy restaurants! – Susannah K.”

What is the Action Plan

• The audiologist should revise their website to provide evidence-based statements, such as “Our services are designed to improve speech understanding in challenging environments; individual results may vary.”

• Report to ASHA or AAA if revisions are not made.

A clinical supervisor leaves a client’s records in the observation room after a speech and language reevaluation session. The next client’s parent enters, sees the file, and returns it to the supervisor.

What Principle was Violated

• Principle I: Responsibility to persons served professionally.

  • Rule 1.2: Protect the confidentiality of any professional or personal information about persons served.

  • Rule 1.3: Do not reveal professional or personal information unless required by law or necessary for patient welfare.

A clinical supervisor leaves a client’s records in the observation room after a speech and language reevaluation session. The next client’s parent enters, sees the file, and returns it to the supervisor.

What would be an action plan

• Recommend immediate confidentiality training for the supervisor.

• Update clinic policies to reinforce secure handling of client records (e.g., lock files, limit access).

• Report the violation if necessary to the ASHA Ethics Board.

An audiologist places ads claiming a direct link between untreated hearing loss and dementia. The ads use exaggerated or unsupported claims to promote services.

What Principle was Violated

• Principle III: Responsibility to the public.

  • Rule 3.3: Statements to the public must be accurate and evidence-based.

  • Rule 3.5: Do not use misleading or unsubstantiated claims to promote services.

An audiologist places ads claiming a direct link between untreated hearing loss and dementia. The ads use exaggerated or unsupported claims to promote services.

What is the Action plan

• Review the advertisements and revise them to reflect accurate, research-supported claims.

• Educate the audiologist on the importance of adhering to evidence-based advertising practices.

• Address complaints with the ASHA Board of Ethics if the violation persists.

A former patient harasses Erika, an audiologist. She wants to report the patient to the police and include the patient’s medical records to show a history of threatening behavior.

Analysis:
This situation may involve a conflict between ethical responsibilities and legal obligations. HIPAA allows disclosures of PHI to law enforcement if necessary to prevent harm. However, this must be done under minimum necessary standards. Relevant violations if not handled properly:

What potential violations could occur

• Principle I: Responsibility to persons served professionally.

  • Rule 1.2: Maintain confidentiality of professional information unless required by law.

• Principle IV: Responsibility to interprofessional relationships.

  • Rule 4.3: Provide accurate and ethical information about patients to colleagues and authorities.

A former patient harasses Erika, an audiologist. She wants to report the patient to the police and include the patient’s medical records to show a history of threatening behavior.

What should Erika do

• Erika must follow HIPAA’s “minimum necessary” disclosure rule.

• Only share PHI with law enforcement if there is an imminent threat or a legal mandate.

• Seek guidance from the clinic's compliance officer or legal team.

#1 Responsibility to Persons Served Professionally:

• Prioritize the welfare of clients and maintain confidentiality.

• Obtain informed consent for treatment.

#2 Responsibility to Maintain Competence:

• Engage in lifelong learning and provide services within areas of competence.

• Accurately represent credentials and skills.

#3 Responsibility to the Public Reputation of the Professions:

• Refrain from deceptive advertising or making unsupported claims.

• Protect the integrity of the profession.

#4 Responsibility to Inter- and Intraprofessional Relationships:

• Collaborate ethically and respectfully with colleagues.

• Avoid misrepresentation or inappropriate behavior toward colleagues.

1. Which principle of the ASHA Code of Ethics mandates confidentiality of client records?

   • A) Principle I: Responsibility to persons served professionally

   • B) Principle II: Responsibility to professional competence

   • C) Principle III: Responsibility to public reputation

Principle I: Responsibility to persons served Professionally

1. Under HIPAA, when can PHI be disclosed to law enforcement?

   • A) If the patient refuses treatment.

   • B) To prevent imminent harm or comply with legal requirements.

   • C) When it is in the audiologist’s professional interest.

To prevent Imminent harm or comply with legal requirements

1. What rule prohibits audiologists from guaranteeing specific outcomes in advertising?

   • A) Rule 1.2

   • B) Rule 3.5

   • C) Rule 4.3

3.5

1. What principle and rule of ethics are violated when a clinician leaves client records visible to others?

• Answer: Principle I, Rule 1.2: Failure to protect confidentiality of client information.

1. If an audiologist advertises guarantees of improved hearing without evidence, which principle is violated?

• Answer: Principle III, Rule 3.5: Misleading or exaggerated claims in advertising.

1. What is the role of professional judgment in the scope of practice?

• Professionals must ensure competence and seek additional training when facing unfamiliar challenges.

1. What should you do if you suspect an ethical violation?

• Follow ASHA’s complaint process.

What are examples of professional practice domains?

• Advocacy, research, supervision, education.