Ethics and Scope of Practice

Scope of Practice for the SLP

Introduction

• The speech-language pathologist (SLP) is defined as the professional who engages in professional practice in the areas of communication and swallowing across the life span
  • Communication: includes speech production and fluency, language, cognition, voice, resonance, and hearing
  • Swallowing: includes all aspects of swallowing, including related feeding behaviors
• Speech-language pathologists are professionals who hold the ASHA Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP), which requires a master’s, doctoral, or other recognized post-accelerate degree.
• ASHA-certified SLPs complete a supervised postgraduate professional experience and pass a national examination as described in the ASHA certification standards
  • Pass the Praxis Exam in SLP: end of graduate program
  • Clinical Fellow Year (CFY): following graduation from graduate school
• Demonstration of continued professional development is mandated for the maintenance of the CCC-SLP
  • In Texas, 10 hours every year
• SLPs hold other required credentials where applicable (e.g., state licensure, teaching certification, specialty certification)
• Each practitioner evaluates his or her own experiences with preservice education, practice, mentorship and supervision, and continuing professional development
  • As a whole, these experiences define the scope of competence for each individual
• The SLP should engage in only those aspects of the profession that are within his or her professional competence.
• SLPs are autonomous professionals who are the primary care providers of speech-language pathology services
• Speech-language pathology services are not prescribed or supervised by another professional
• The overall objective of speech-language pathology services is to optimize individuals’ abilities to communicate and to swallow, thereby improving quality of life.
• The scope of practice in speech-language pathology comprises five domains of professional practice.
• Professional Practice Domains:
  • Advocacy and Outreach
  • Supervision
  • Education
  • Administration/Leadership
  • Research

Advocacy and Outreach

• SLPs advocate for the discipline and for individuals:
  • Community Awareness
  • Prevention Activities
  • Health Literacy
  • Academic Literacy
  • Education
  • Political Action
  • Training Programs
• Ex. Community activities to encourage wearing a bike helmet reduces the risk for brain injuries
• SLPs perform a variety of activities, including:
  • Advocate for fair and equitable services for all individuals, especially the most vulnerable
  • Advocate at the local, state, and national levels for funding for services, education, and research
  • Help to recruit and retain SLPs with diverse backgrounds and interests

Supervision

• Supervision - a distinct area of practice/the responsibility of SLPs
• SLPs are responsible for supervising Clinical Fellows, graduate externs, trainees, speech-language pathology assistants, and other personnel.
• Supervision includes education, mentorship, encouragement, counseling, and support
  • Establish supervisory relationships that are collegial in nature
  • Support as they learn to handle emotional reactions that may affect the therapeutic process
  • Establish a supervisory relationship that promotes growth and independence while providing support and guidance

Education

• SLPs serve as educators, teaching students in academic institutions and teaching professionals through continuing education in professional development formats
  • Serve as faculty at institutions of higher education, teaching courses at the undergraduate, graduate, and postgraduate levels
  • Mentor students who are completing academic programs at all levels
  • Provide academic training to students in related disciplines and students who are training to become speech-language pathology assistants

Research

• SLPs conduct. and participate in basic and applied research relating to cognition, vernal and nonverbal communication, pragmatics, literacy (reading, writing, and spelling), feeding and swallowing
• SLPs engage in activities to ensure compliance with Institutional Review Boards and International Laws pertaining to research

Administration and Leadership

• SLPs administer programs in education, higher education, schools, health care, private practice, and other settings,
• In this capacity, they are responsible for making administrative decisions related to fiscal and personnel management; leadership; program design; program design; program growth and innovation; professional development; compliance with laws and regulations; and cooperation with outside agencies in education and healthcare

Service Delivery Domains

1. Collaboration

• SLPs share responsibility with other professionals for creating a collaborative culture
• Collaboration requires joint communication and shared decision making among all members of the team, including the individual and family
• When discussing specific roles of team members, professionals are ethically and legally obligated to determine whether they have the knowledge and skills necessary to perform such services.
• TL;DR: share responsibilities to achieve functional outcomes

1. Counseling

• SLPs counsel by providing education, guidance, and support
• Individuals, their families and their caregivers are counseled regarding acceptance, adaptation, and decision making about communication, feeding and swallowing, and related disorders
• The role of the SLP in the counseling process includes interactions related to emotional reactions, thoughts, feelings, and behaviors that result from living with the communication disorder, feeding and swallowing disorder, or related disorders.

1. Prevention and Wellness

• SLPs are involved in prevention and wellness activities that are geared toward reducing the incidence of a new disorder or disease, identifying disorders at an early stage, and decreasing the severity or impact of a disability associated with an existing disorder or disease
• involvement is directed toward individuals who are vulnerable or at risk
• Activities are directed toward enhancing or improving general well-being and quality of life
• Education efforts focus on identifying and increasing awareness of risk behaviors that lead to communication disorders and feeding and swallowing problems
• SLPs promote programs to increase public awareness, which are aimed at positively changing behaviors or attitudes

1. Screening

• SLPS are experts at screening individuals for possible communication, hearing, and/or feeding and swallowing disorders.
• SLPs have the knowledge of-and skills to treat-these disorders; they can design and implement effective screening programs and make appropriate referrals.
• These screenings facilitate referral for appropriate follow-up in a timely and cost-effective manner

1. Assessment

• SLPs have expertise in differential diagnosis of disorders of communication and swallowing
• Communication, speech, language, and swallowing disorders can occur:
  • Developmentally
  • As part of a medical condition
  • In isolation, without an apparent underlying medical condition
• Competent SLPs can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions

1. Treatment

• Speech-language services are designed to optimize individuals’ ability to communication and swallow, thereby improving quality of life.
• SLPs develop and implement treatment to address the presenting concerns of a communication or swallowing problem.
• Treatment establishes a new skill or restores an impaired one.
• The ultimate goal of therapy is to improve an individual’s functional outcomes.

1. Modalities, Technology, and Instrumentation

• SLPs use advanced instrumentation and technologies in the evaluation, management, and care of individuals with communication, feeding and swallowing, and related disorders.
• Some examples of services that SLPs offer in this domain include, but are not limited to, the use of
  • the full range of AAC technologies to help individuals who have impaired ability to communicate verbally
  • endoscopy
  • videofluoroscopy
  • fiber-optic evaluation of swallowing (voce, velopharyngeal function, swallowing)
  • other instrumentation to assess aspects of voice, resonance, and swallowing
  • telehealth/telepractice to provide individuals with access to services or to provide access to a specialist

1. Population and Systems

• In addition to direct care responsibilities, SLPs have a role in
  • Managing populations to improve overall health and education
  • Improving the experience of the individuals served
  • Reducing the cost of care

Scope of Practice for an Audiologist

• Audiologist - Any person who engages in the practice of audiology
• An audiologist is a person who, by virtue of academic degree, clinical training, and license to practice is uniquely qualified to provide a comprehensive array of professional services related to the identification, diagnosis and treatment of persons with auditory and balance disorders, and the prevention of these impairments.
• Audiologist serve a number of roles including primary service provider, clinician, therapist, teacher, consultant, researcher and administrator.
• In addition, the supervising audiologist maintains legal and ethical responsibility for all assigned audiology activities provided by audiology assistants and audiology students.
• The scope of practice of audiologists is defined by the training and knowledge base of professionals who are licensed to practice as audiologists
• The audiologist is an independent practitioner who provides services in hospitals, clinics, schools, private practices and other settings in which audiological services are relevant.
• Areas of practice include identification, diagnosis and treatment of individuals with:
  • auditory and balance disorders
  • prevention of hearing loss
  • research in normal and disordered auditory and balance function
• The central focus of the profession of audiology is concerned with all auditory impairments and their relationship to disorders of communication.
• Audiologists identify, diagnose, evaluate, and treat individuals with either peripheral or central auditory impairments, and strive to prevent such impairments.
• In addition, professional activities related to diagnosis and treatment of persons with balance disorders are within the scope of practice of audiologists.
• Audiologists provide clinical and academic training to students in audiology.
• Audiologists teach physicians and medical students about the evaluation of hearing and balance disorders, prevention of hearing loss, and diagnosis and treatment of persons with hearing and balance impairment.
• They provide information and training on all aspects of hearing and balance to other professions including psychology, counseling, rehabilitation, education and other related professions.
• Audiologists provide information on hearing and balance, hearing loss and disability, prevention of hearing loss, and rehabilitation to business and industry.
• They develop and oversee hearing loss prevention programs in industry.
• Further, audiologists serve as expert witnesses within the boundaries of forensic audiology.

Compliance with Health Laws and Regulations

• Compliance: acting in accordance with laws and with a company’s rules, policies, and procedures

HIPAA

• A major part of compliance in health care is protecting the confidentiality of patient medical records via HIPAA regulations
• Signed into law in February 2009
• Violating a patient’s right to privacy is a very serious offense
  • Ex. Discussing a patient’s condition with an unauthorized person
  • Ex. Releasing the name or address of a patient without permission
• Kinds of information protected by HIPAA:
  • Information in medical records
  • Conversations between health care providers about patient care or treatment
  • Health insurance information
  • Patient billing information
  • Most other information about a patient’s health
• Certain types of information may be considered exempt from HIPAA regulation:
  • Suspected fraud
  • Births and deaths
  • Injuries caused by violence, including child abuse
  • Drug abuse
  • Communicable diseases
  • Sexually transmitted diseases

Ethics

• Ethics: the principles of conduct that govern an individual or a group
  • “right thing to do”
• The American Speech-Language Hearing Association has an official code of ethics, and members can be censured, or they can lose their membership in the association for ethical violations
• Provider (SLP/audiologist) activities must be in the best interest of the consumer and not themselves
  • An audiologist may recommend a hearing aid that he thinks is the most appropriate for the type and dress of hearing loss the patient is experiencing
  • An audiologist may not recommend a particular hearing aid for a patient based on the knowledge that one more sale of a certain brand of hearing aid will result in a free trip to Aruba for the audiologist
• Code of Ethics are subject to change as new issues arise or as views as to what constitutes ethical behavior are modified
  • At one time it was considered unethical for speech language therapy to be provided solely by correspondence (over the phone, with written documents only)
  • Today, SLPs services are frequently provided via telecommunication
  • Ethical considerations regarding the extent to which services may be provided via telepractice are still developed
  • Is it ethical to provide all assessment and intervention services to patients who demonstrate a significant swallowing difficulty via telepractice?
  • Some would argue that there is safety issues with regard to chocking the precludes SLPs from providing dysphagia services except in face-to-face contexts. (Others would disagree)
• Once a code of ethics has been adopted by the membership, the organization must assume the responsibility of enforcing the code.
• The Ethical Practices Board (EPB) of ASHA is charged with enforcing the ASHA Code of Ethics
• If an individual member has been judged to be in violation of the code, a number of disciplinary actions are available to the EPB
  • These include reprimands, censures, or revocation or licenses