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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


Ethics today

Pretest


Moral principals that govern a person s or group s behavior

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


Ethics today

  • How easy is it for you to feel responsible for maintaining the rules that govern an organization of which you are a member?

    0______________________________10


Ethics today

Do you always follow every rule?

If not can you be ethical?


Value differences

Value Differences

  • What shapes our values?

    • __________________

    • __________________

    • __________________

    • __________________


Value differences1

Value Differences

What shapes our values(basic principals)?

  • Religious beliefs

  • Cultural sensitivity

  • Life experiences

  • Family beliefs


What are our

What Are Our

Guiding principals

Values

Ethics


Ethics today

We are governed by several entities

?


Ethics today

HIPPA/IDEA/FERPA

Medicare/Medicaid

State Commissioner Rules

Employer/Campus

Facility

ASHA

Tx State Board of Examiners


Asha code of ethics

ASHA CODE OF ETHICS

  • First written in 1930

  • Revised 14 times

  • Revised 5 times in 1990’s

  • Revised in 2001

  • Revised in 2003


Why revise

WHY REVISE?

TABLE FEUD

Top 4 Reasons


Top four

TOP FOUR

  • Expanded scopes of professional practice

  • Expansion of client populations & practice settings

  • Technology

  • Past ethical misconduct


Principle of ethics 1

Principle of Ethics -1

Welfare of persons served

  • Professionally

  • Research

  • Humane treatment of animals


Principle of ethics 2

Principle of Ethics - 2

Highest level of professional competence

Proper use and maintenance of equipment


Principle of ethics 3

Principle of Ethics - 3

Promoting public understanding about the profession


Principle of ethics 4

Principle of Ethics - 4

Relationships professional often encounter

Acceptance of the self-imposed standards


State of texas

State of Texas

State Board of Examiners for

Speech-Language Pathology

And Audiology


General ethical issues

General Ethical Issues

  • 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

  • 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

  • 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

  • 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?

Step 1

Identify and gather relevant information

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


Ethics today

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

  • 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.


Ethics today

STEP 2

Possible courses of action

Step 3

Is there a need for consultation?


Ethics today

Step 4

Plan of Action


Fundamental consideration

Fundamental Consideration

Welfare of persons I am serving


Fundamental question

Fundamental Question

Who Am I Serving?


Ethics today

  • Clients

  • Research participants

  • Colleagues

  • Students/SLP-Assistants

  • Supervisors

  • Other professionals


Ethics today

Three scenarios

10 minutes


What a code of ethics is not

What a Code of Ethics is NOT

  • The same as feelings

  • Religion

  • Following the Law

  • Following culturally accepted norms

  • Science

    marva mount, EBS


Challenges and realities

Challenges and Realities

  • 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


Ethics today

  • A Code of Ethics is the road map to avoid such pitfalls.

    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.


Ethics today

Three Scenarios

10 minutes


Ethics today

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.


Ethics today

We will always need to also include:

Good judgment

Sound reasoning

Virtues of good character


Ethics today

“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

  • 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

  • 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

  • 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

  • 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.


Ethics today

Licensees shall not:

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


David s device

David’s Device

  • 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

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


Ken dahl

Ken Dahl

  • 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.


Ethics today

  • 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

  • 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

  • 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

  • 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

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?


Ethics today

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.


Ethics today

$100 Dilemma

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

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

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?

  • 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.


Ethics today

  • 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

  • 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.


Ethics today

Licensees shall not:

  • 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

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??


Ethics today

Licensees shall not:

  • 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 ?

  • 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?

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


Ethics today

  • 741.191 A person wishing to report an alleged violation of 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.


True or false1

True or False?

  • The State Board of Examiners accepts anonymous complaints.


Ethics today

  • 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?

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


Ethics today

  • 741.91 The licensee or person against whom an alleged violation has been filed must respond within 15 working days of the executive director's request.


True or false3

True or False?

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


Ethics today

  • The Executive Director may dismiss the complaint if the issue is non-jurisdictional, or if the matters alleged in the complaint would not constitute a violation of the Act or this chapter.


True or false4

True or False?

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


Ethics today

  • 741.193 The Board may suspend a license on an emergency basis, if continued practice by a licensee would constitute a continuing and imminent threat to the public welfare.


True or false5

True or False?

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

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


Ethics today

  • 741.198 The range of administrative penalties by levels is as follows:

  • (A) Level I--up to $5,000 per day;

  • (B) Level II--up to $2,500 per day;

  • (C) Level III--up to $1,250 per day.


True or false6

True or False?

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


Ethics today

  • 741.199 The following factors are considered:

  • (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?

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


Ethics today

  • 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

  • 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.


Ethics today

Tips

  • 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.


Ethics today

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


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