ethical practice what is it? how do i do it? what are the pitfalls?€¦ · ·...

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Ethical PracticeWhat 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

violations3

Session Objectives

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Ethics

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* 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

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*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.

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GSHA Code of Ethics

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* PRINCIPLE OF ETHICS I:* Individuals shall honor their responsibility to hold paramount the

welfare of persons served professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.

* PRINCIPLE OF ETIHCS II:Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence.

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GSHA Code of Ethics

*Mandated by ASHA Code of Ethics - Principal IV, Rule M*Protects the profession/ organization * Impacts student outcomes * Impacts organizational efficiency/effectiveness* Enhances public trust

Why is ethical reporting important

• Documentation lapses* Employer demands* Use and supervision of support personnel* Impaired practitioner/professional* Reimbursement for services* Client abandonment* Professional vs. business ethics* Clinical fellowship supervision* Disclosures (past misconduct and conviction)

Most common ethical topics of inquiry

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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

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*The fundamental purpose of the Code

• Underlying philosophy

http://www.asha.org/uploadedFiles/ET2016-00342.pdf

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Changes to ASHA’s Code of Ethics

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* 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 describedby Principles of Ethics and by Rules of Ethics

• Principles of Ethics form the underlyingphilosophical basis for the Code of Ethics

• Rules of Ethics are specific statements of minimallyacceptable as well as unacceptable professional

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How is the Code Organized?

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• First code of ethics was formalized in 1952• Intended to ensure the welfare of the consumer and to protect the reputation

and integrity of the professions• Those in the following categories are under the jurisdiction of the Board of Ethics

• Members holding Certificate of Clinical Competency (CCC)• Members not holding the CCC • Nonmembers holding the CCC• Applicants for certification or membership and certification• Note: Clinical Fellows are only covered if they have begun the application process for

CCC or membership

Preamble

Terminology • ASHA Standards and Ethics • Advertising • Crime• Conflict of interest• Diminished decision-making ability • Fraud• Impaired practitioner• Individuals • Informed consent • Jurisdiction• Know, known or knowingly

• Misrepresentation• Negligence• Nono contendere • Plagiarism• Publically sanctioned • Reasonable or reasonably• Self-report• Shall vs may • Support personnel• Telepractice, teletherapy• Written• May versus shall

Principle I

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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.

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Principle II

Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

Revisions in Principle III

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OLD: Individuals shall honor their responsibility to the public by promoting public understanding of the professions, by supporting the development of servicesdesigned to fulfill the unmet needs of the public, and by providing accurateinformation in all communications involving any aspect of the professions,including the dissemination of research findings and scholarly activities, and thepromotion, 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

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OLD: Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions anddisciplines.

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

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* 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

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*Principle I Rule R -Individuals whose professional practice is adversely affected by substance abuse, addiction, or other health-related conditions are impaired practitioners and shall seek professional assistance and, where appropriate, withdraw from the affected areas of practice.

Obligation to Report Substance Abuse

Client abandonment

Principle I Rule TIndividuals shall provide reasonable notice

and information about alternatives for obtaining care in the event that they can no

longer provide professional services.

*Principle III Rule B* Individuals shall avoid engaging in conflicts of interest

whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity.

Conflict of Interest

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* 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.

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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?

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*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.


*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.


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What are the Pitfalls? Principle IV Rule O

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

*Principle II Rule F* Individuals in administrative or supervisory roles shall

not require or permit their professional staff to provide services or conduct clinical activities that compromise the staff member's independent and objective professional judgment.


*Principle IV Rule A * Individuals shall work collaboratively, when

appropriate, with members of one's own profession and/or members of other professions to deliver the highest quality of care.


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*Principle IV Rule I*Individuals shall not knowingly allow

anyone under their supervision to engage in any practice that violates the Code of Ethics.


* 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.

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* 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

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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

ScenariosAn 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.

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ScenariosSLP declines to provide services based on religious

beliefs: e.g., a scenario where a devout fundamentalist Christian declines to provide voice

therapy to a transgender student

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What ethical issues do you face in your practice?

Board of Ethics Decisions

Rationale: Pled no contest in the District Court of Oklahoma County for falsely billing the Oklahoma Medicaid program for therapy sessions not provided.Violations (2010r): I, I-O, III, III-E, IV, IV-CSanctions: Revocation of membership and certification from May 12, 2016, through June 18, 2020

Ethical Disclosure, Misrepresentation, and Conflict of Interest

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* 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


* 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.


* 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.


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* 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.


* 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-language pathology assistant without completing the required practicum hours and 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.


* 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-report her professional discipline to ASHA Standards and Ethics.

* 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.


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* Rationale: Allowed staff under her supervision to communicate misleading information to clients regarding a clinical fellow’s professional experience.

* Code (2010r): I, I-D, III, III-F, IV, IV-B* Sanction: Censure, effective Aug.

25, 2017.

* Rationale: Falsified documentation of services and practiced speech-language pathology without a South Carolina license for approximately two months in 2001.

* Code (2003): I, I-K, I-M, III, III-A, III-D, IV, IV-B* Sanction: Censure, effective Aug. 29, 2017.



* Rationale: Publicly disciplined by the South Carolina Board of Examiners in Speech-Language Pathology and Audiology because she failed to properly document and provide services based on students’ individualized educational plans; failed to accurately document therapy sessions; and falsely documented therapy sessions that were not conducted.

* Code (2010r): I, I-A, I-M, II, III, III-D, IV, IV-E* Sanction: Censure, effective Aug. 29,

2017.

If you didn’t document you

didn’t do it

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• 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 only has jurisdiction to receive, deliberate, and act upon complaints filed against

ASHA members or individuals who hold the Certificate of Clinical Competence; • 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

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Review Board Outcomes

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* 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

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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.

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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

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Relativity applies to physics, not ethics” Albert Einstein

An ethical person ought to do more than he's required to do and less than he's allowed to do

unknownNotice that "I" is at the center of the word "ethical."

There is no "they." Achieving the ethics of excellence is our individual assignment.

— Price Pritchett

* ASHA* Technical assistance (live and online) * Online resources * Professional development * ASHA Community

* State licensing boards * State speech-language-hearing organizations * Colleagues * Supervisors * Unions and other professional organizations

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Help is Available

* Code of Ethics, effective 3/1/2016 * Navigating the Revised Code of Ethics(2016)-webchat* Doing the Right Thing After School –Leader* Can I? Should I? – Leader * Sorting through the Gray – Leader * Issues in Ethics Statements * Ethics: If it’s Not Documented, It Didn’t happen * Ethics: SLP Role in Audiologic Screenings * Ethical Disclosure, Misrepresentation, and Conflict of Interest* Required Ethical Reporting in the Professions

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ASHA Resources

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Issues in Ethics Statements

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* ASHA Board of Ethics Jurisdiction (2016)* Audiology Assistants (2017)* Client Abandonment (2017)* Clinical Practice by Certificate Holders in the

Profession in Which They Are Not Certified (2017)

* Clinical Services Provided by Audiology and Speech-Language Pathology Students (2017)

* Competition in Professional Practice (2017)* Confidentiality (2013)* Conflicts of Professional Interest (2011)* Cultural and Linguistic Competence (2017)* Ethics in Research and Scholarly Activity (2014)* Obtaining Clients for Private Practice From

Primary Place of Employment (2017)

Prescription (2017)Protection of Human Subjects (2014)Public Announcements and Public Statements (2018)Misrepresentation of Services for Insurance Reimbursement, Funding, or Private Payment (2018)Responsibilities of Individuals Who Mentor Clinical Fellows in Speech-Language Pathology (2017)Speech-Language Pathology Assistants (2017)Supervision of Student Clinicians (2017)Use of Graduate Doctoral Degrees by Members and Certificate Holders (2018)

Questions/Comments

American Speech-Language- Hearing AssociationEmpowering audiologists,speech-language pathologists, and supporting speech, language, and hearing scientists.The ASHA Action Center welcomes questions and requests for information from members and non-members.

Available 8:30 a.m.–5:00 p.m. ET

Monday–Friday

Members: 800-498-2071

Non-Member: 800-638-8255

[email protected]

[email protected]

[email protected]

ABOUT ASHA

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Thank you for your time and attention, your dedication and all of the wonderful work you do with children!

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ethical practice what is it? how do i do it? what are the pitfalls?€¦ · ·...

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