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Ethics Today. Beat the Heat Conference June 26, 2013 Paula Chance,MS CCC/SLP. Pretest. Moral principals that govern a person’s or group’s behavior. How easy is it for you to feel responsible for maintaining the rules that govern an organization of which you are a member?

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Ethics today

Ethics Today

Beat the Heat Conference

June 26, 2013

Paula Chance,MS CCC/SLP



Moral principals that govern a person s or group s behavior

Moral principals that govern a person’s or group’s behavior



Do you always follow every rule? the rules that govern an organization of which you are a member?

If not can you be ethical?


Value differences
Value Differences the rules that govern an organization of which you are a member?

  • What shapes our values?

    • __________________

    • __________________

    • __________________

    • __________________


Value differences1
Value Differences the rules that govern an organization of which you are a member?

What shapes our values(basic principals)?

  • Religious beliefs

  • Cultural sensitivity

  • Life experiences

  • Family beliefs


What are our
What Are Our the rules that govern an organization of which you are a member?

Guiding principals

Values

Ethics


We are governed by several entities the rules that govern an organization of which you are a member?

?


HIPPA/IDEA/FERPA the rules that govern an organization of which you are a member?

Medicare/Medicaid

State Commissioner Rules

Employer/Campus

Facility

ASHA

Tx State Board of Examiners


Asha code of ethics
ASHA CODE OF ETHICS the rules that govern an organization of which you are a member?

  • First written in 1930

  • Revised 14 times

  • Revised 5 times in 1990’s

  • Revised in 2001

  • Revised in 2003


Why revise
WHY REVISE? the rules that govern an organization of which you are a member?

TABLE FEUD

Top 4 Reasons


Top four
TOP FOUR the rules that govern an organization of which you are a member?

  • Expanded scopes of professional practice

  • Expansion of client populations & practice settings

  • Technology

  • Past ethical misconduct


Principle of ethics 1
Principle of Ethics -1 the rules that govern an organization of which you are a member?

Welfare of persons served

  • Professionally

  • Research

  • Humane treatment of animals


Principle of ethics 2
Principle of Ethics - 2 the rules that govern an organization of which you are a member?

Highest level of professional competence

Proper use and maintenance of equipment


Principle of ethics 3
Principle of Ethics - 3 the rules that govern an organization of which you are a member?

Promoting public understanding about the profession


Principle of ethics 4
Principle of Ethics - 4 the rules that govern an organization of which you are a member?

Relationships professional often encounter

Acceptance of the self-imposed standards


State of texas
State of Texas the rules that govern an organization of which you are a member?

State Board of Examiners for

Speech-Language Pathology

And Audiology


General ethical issues
General Ethical Issues the rules that govern an organization of which you are a member?

  • Time constraints making it difficult to perform administrative duties and provide services

  • Delivering less service than specified in the plan

  • Plans developed without input from the appropriate people

  • Disagreement about eligibility for services


General ethical issues1
General Ethical Issues the rules that govern an organization of which you are a member?

  • Pressure to go along with a team recommendation

  • Inappropriate use of assistants and paraprofessionals

  • Asked to provide services outside of scope of competence

  • Failing to confirm approval of supervisor


School ethical issues
School Ethical Issues the rules that govern an organization of which you are a member?

  • Pressure to diagnose a disability

  • Use of Medicaid leads to conflict between medical and educational models

  • Torn between advocating for the child and advocating for the district

  • Evaluating second language learners without theoretical or practical knowledge


School ethical issues1
School Ethical Issues the rules that govern an organization of which you are a member?

  • Told by administrator not to make a recommendation because of cost (e.g., outside assessment, technology)

  • Asked to perform other school duties, resulting in cancellation of services

  • Conflict between “educational needs” and providing services and products we believe a child needs


Recognize an ethical decision
Recognize An Ethical Decision? the rules that govern an organization of which you are a member?

Step 1

Identify and gather relevant information

(try to get feelings for parent or supervisor out of the picture)


A supervisor is concerned about the accuracy of a graduate student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

WHAT ARE THE FACTS?


Facts
FACTS student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

  • Accuracy of the student’s phonetic transcription may or may not be adequate.

  • The supervisor is concerned about transcription adequacy.

  • Transcription errors could compromise quality of services.

  • Transcription adequacy can be evaluated objectively.


STEP 2 student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

Possible courses of action

Step 3

Is there a need for consultation?


Step 4 student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

Plan of Action


Fundamental consideration
Fundamental Consideration student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

Welfare of persons I am serving


Fundamental question
Fundamental Question student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

Who Am I Serving?


  • Clients student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

  • Research participants

  • Colleagues

  • Students/SLP-Assistants

  • Supervisors

  • Other professionals


Three scenarios student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

10 minutes


What a code of ethics is not
What a Code of Ethics is NOT student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

  • The same as feelings

  • Religion

  • Following the Law

  • Following culturally accepted norms

  • Science

    marva mount, EBS


Challenges and realities
Challenges and Realities student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

  • Expected ethical behavior is consistent across all employment settings and with all clients

  • Employers often make demands in conflict with ethical behavior

  • Professional sometimes develop bad habit or use of bad judgment or make mistakes


  • A Code of Ethics is the road map to avoid such pitfalls. student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

    Miller, T (2007). Professional Ethics. In R.Lubinski L. Golper, &C. Frattali (Eds.) Professional Issues in Speech-Language Pathology and Audiology. Clifton Park, N.Y: Thomas Delmar.


Three Scenarios student’s phonetic transcription, which could result in inaccurate information being used and possibly resulting in an incorrect diagnosis.

10 minutes


When we have a problem or dilemma the ethical principals addressed today will not solve the problem

BUT

They will provide guidelines for looking at each case or problem closely.


We will always need to also include: addressed today will not solve the problem

Good judgment

Sound reasoning

Virtues of good character


“Sometimes ethical behavior is not the difference in right and wrong. It is the difference in right and more right.”

Stuart Finder

Vanderbilt University


Your two cents
Your Two Cents and wrong. It is the difference in right and more right.”

  • Do you consider this an ethical dilemma?

  • Do you think the code of ethics has been or may be violated?

  • What would you advise a colleague in this situation?


Auditory verbal therapy
Auditory Verbal Therapy and wrong. It is the difference in right and more right.”

  • At an IEP meeting, a parent requests auditory verbal therapy for her child. No one in the school district is trained in AVT. What are your ethical obligations?


Doctor s orders
Doctor’s Orders and wrong. It is the difference in right and more right.”

  • Nea is a 6-year-old with severe cerebral palsy and cognitive impairment, who is fed with a PEG. Nea’s mom really wants her to be able to eat and her teacher presents you with a prescription from Nea’s doctor ordering oral feeding at school.


Delegating dilemma
Delegating Dilemma and wrong. It is the difference in right and more right.”

  • An SLP has worked with an assistant for several years and decides that the assistant is now qualified to administer diagnostic tests, interpret them, and determine eligibility for services.


Licensees shall not: and wrong. It is the difference in right and more right.”

  • delegate any service requiring professional competence of a licensee to anyone not licensed to perform that service;


David s device
David’s Device and wrong. It is the difference in right and more right.”

  • David’s team believes that he would benefit from AAC, but there is a difference of opinion about what to purchase. Since there currently is money available, one team member wants to buy a high tech costly device with “room to grow.” You think David could use a light tech solution.


Sharing the load
Sharing the Load and wrong. It is the difference in right and more right.”

  • You have a large caseload. Your principal suggests that your assistant assume responsibility for half your caseload.


Ken dahl
Ken Dahl and wrong. It is the difference in right and more right.”

  • Fall semester begins with 6 new referrals! Thankfully, Ken has an assistant whom he asks to start testing the 3 “easiest” referrals while he sees the children with autism, cochlear implant, or cleft palate.


  • 741.64 (g) Initial contacts directly with the client shall be conducted by the supervising speech-language pathologist.

  • Following the initial contact, the supervising speech-language pathologist shall determine whether the licensed assistant has the competence to perform specific duties before delegating tasks.


Not enough time
Not Enough Time be conducted by the supervising speech-language pathologist.

  • You plan to supervise your assistant with each individual she sees. However, your schedule becomes increasingly hectic, so you are only able to supervise from 1:00-3:00 every Thursday.


Lunch date
Lunch Date be conducted by the supervising speech-language pathologist.

  • You have several individuals with feeding and swallowing problems on your caseload. You ask your assistant to help at lunchtime, which she does. When you aren’t available, she also advises other staff and answers family members’ questions about feeding techniques.


Jumping ship
Jumping Ship be conducted by the supervising speech-language pathologist.

  • Your CF site has had a low census recently and it looks like you will not get the hours you need. Another facility makes a great job offer, so you take it and give your current facility two weeks’ notice. Your employer files a complaint.


Mary gold
Mary Gold be conducted by the supervising speech-language pathologist.

Mary Gold has had a bad day – an unusual number of challenging cases were scheduled that day. After work, Mary goes to get her hair cut. Mary unwinds as she tells her hairdresser about her day, but she is careful to disguise names and identifying information about specific clients. Has anything unethical occurred?


Sally’s small school district had no summer program, so she maintained a private practice during the summer and treated several children for a fee. The next school year, the school district hired Chris, and began offering services during the summer. Chris ran the summer program, while Sally maintained her private practice. Chris reported Sally to the State Board claiming she was unprofessional for seeing children for a fee when

Services were available through the

school for free.


$100 Dilemma she maintained a private practice during the summer and treated several children for a fee. The next school year, the school district hired Chris, and began offering services during the summer. Chris ran the summer program, while Sally maintained her private practice. Chris reported Sally to the State Board claiming she was unprofessional for seeing children for a fee when

At the annual convention of the state professionalassociation , an exhibitor with a table set up in the registration area makes a cash gift to each association member at the time of registration. The note on the little card attached to the $100 bill says, “We just want you to know you are important to us.” Is this ethical??

Adapted from Resnick, 1993


Alison wonderland

Alison Wonderland she maintained a private practice during the summer and treated several children for a fee. The next school year, the school district hired Chris, and began offering services during the summer. Chris ran the summer program, while Sally maintained her private practice. Chris reported Sally to the State Board claiming she was unprofessional for seeing children for a fee when

Alison Wonderland is about to finish her CF and open her own private practice. She was scheduled to attend a final conference with her CF supervisor, but missed the meeting. Her supervisor refuses to sign the completed CF form because Alison missed the final conference. To make matters worse, the new telephone directory has been published, and Alison is listed as: Alison Wonderland, AuD, CCC-A.” Another audiologist in the community sees the listing and reports Alison for violating the rules dealing with misrepresentation, deception, and fraud.


Bill board
Bill Board she maintained a private practice during the summer and treated several children for a fee. The next school year, the school district hired Chris, and began offering services during the summer. Chris ran the summer program, while Sally maintained her private practice. Chris reported Sally to the State Board claiming she was unprofessional for seeing children for a fee when

Bill Board fits a programmable hearing aid for a patient whose services are being paid for by contract arrangement with an HMO. The programmable hearing aid selected to fit the patient exceeds the agreed-upon limit for a single hearing aid by nearly $400. What are Bill’s options??

Adapted from Resnick, 1993


Is it remuneration
Is It Remuneration? she maintained a private practice during the summer and treated several children for a fee. The next school year, the school district hired Chris, and began offering services during the summer. Chris ran the summer program, while Sally maintained her private practice. Chris reported Sally to the State Board claiming she was unprofessional for seeing children for a fee when

  • You have made several referrals to a local ENT this year. When you go in for treatment of a sinus infection, the doctor tells you that your co-pay will be waived.

  • You have made several referrals to a local ENT this year. When you go in for treatment of a sinus infection, the doctor tells you that your co-pay will be waived.


  • A licensee shall not intentionally or knowingly offer to pay or agree to accept any remuneration directly or indirectly, overtly or covertly, in cash or in kind, to or from any person, firm, association of persons, partnership, or corporation for securing or soliciting clients or patronage for or from any health care professional.


Impaired provider
Impaired Provider or agree to

  • Your assistant is taking Oxycodone for pain management during treatment for cancer. Lately, she has put an incorrect date on several daily notes, misplaced records, and missed appointments without notice. You try to talk to her, but she denies any problem.


Licensees shall not: or agree to

  • use alcohol or drugs when the use could adversely affect the licensee's provision of professional services

    A licensee shall:

  • inform the board of violations of this code of ethics or of any other provision of this chapter.


Marsha mellow
Marsha Mellow or agree to

Marsha Mellow is under the scrutiny of the ethics review committee after it was reported that she was selling bricks from a home remodeling project to a client. Is this ethical??


Licensees shall not: or agree to

  • use their professional relationships with clients, interns, assistants, or students to promote for personal gain or profit any item, procedure, or service;


Supervisor responsible
Supervisor Responsible ? or agree to

  • An SLPA finishes her graduate school work and neglects to file for change of license with the board after her intern license expires.

  • Is the SLP who has been supervising her responsible for the mistake?


True or false
True or False? or agree to

  • Complaints to the State Board of Examiners must be made in writing.



True or false1
True or False? the Act or the rules by a licensee or other person shall notify the executive director. The initial notification may be in writing, by telephone, or by personal visit to the board office.

  • The State Board of Examiners accepts anonymous complaints.


  • 741.191 The executive director shall send an acknowledgment letter and an official form which the complainant must complete and return to the board before further action may be taken. The executive director may accept an anonymous complaint if there is sufficient information for the investigation.


True or false2
True or False? letter and an official form which the complainant must complete and return to the board before further action may be taken. The executive director may accept an anonymous complaint if there is sufficient information for the investigation.

  • Once informed that a complaint has been filed, the licensee has 30 days to respond to the Board.



True or false3
True or False? violation has been filed must respond within 15 working days of the executive director's request.

  • All complaints filed with the State Board must be investigated.



True or false4
True or False? issue is non-jurisdictional, or if the matters alleged in the complaint would not constitute a violation of the Act or this chapter.

  • A license may be suspended without prior notice to the licensee and without a hearing.



True or false5
True or False? basis, if continued practice by a licensee would constitute a continuing and imminent threat to the public welfare.

  • The administrative penalty applied by the Board is $500 per day.

  • The administrative penalty applied by the Board is $500 per day.



True or false6
True or False? as follows:

  • Accepting responsibility for a violation can lessen the administrative penalty.


  • 741.199 The following factors are considered: as follows:

  • (A) admission or wrong or error, and acceptance of responsibility;

  • (B) appropriate degree of remorse or concern;

  • (C) efforts to ameliorate the harm or make restitution;

  • (D) efforts to ensure future violations do not occur; and

  • (E) cooperation with any investigation or request for information.


True or false7
True or False? as follows:

  • Supervisors must develop and maintain a written document specifying the tasks that their assistants are allowed to perform, within the scope of practice.


  • 741.64 The licensed speech-language pathology supervisor of the licensed assistant shall:

  • (A) in writing, determine the skills and assigned tasks the licensed assistant is able to carry out within the licensed assistant's scope of practice. This document must be agreed upon by the licensed assistant and the supervising speech-language pathologist;

  • (B) notify the client or client's legal guardian(s) that services will be provided by a licensed assistant;

  • (C) develop the client's treatment program in all settings and review them with the licensed assistant who will provide the service; and

  • (D) maintain responsibility for the services provided by the licensed assistant.


Seeking solutions
Seeking Solutions the licensed assistant shall:

  • Identify the problem as you see it.

  • Is this a regulatory issue? An ethical issue? A workplace issue?

  • Identify what is within your control and what is not.

  • Identify your resources—Colleagues? Supervisor? State Board?

  • Create a plan that is ethically and professionally responsible and defensible.


Tips the licensed assistant shall:

  • Discuss the code of ethics and explain your professional dilemma.

  • Make your goal consensus building instead of whistle-blowing.

  • Resolution without going outside the organization is desirable.


It is our responsibility to be knowledgeable about ethical principles and rules that govern our practice


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