Telepractice and “Code of Ethics” Violations

ASHA’s Code of Ethics is a framework of principles to guide members in support of day-to-day decision making.  “The code educates professionals in the discipline … regarding ethical principles and standards that direct professional conduct.”  After recently reviewing ASHA’s Code of Ethics, various telepractice questions and comments presented on social media came to mind that could be considered violations of ASHA’s professional guidelines.  The purpose of this article is to raise awareness of the seriousness of ethical violations occurring during telepractice service delivery. Specific guidelines that warrant consideration will be discussed, the levels of violation, as well as the consequences of each.

ASHA’s Principle of Ethics II states, “Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.”  In other words, telepractitioners shall continue to reach for and maintain the highest level of skill competence and professionalism.  They should examine the training they have had to prepare for this type of service delivery model from the materials used for each therapy session, the location from which they are providing services, to the quality of their Internet connection. 

Telepractitioners should ask themselves if they have participated in any telepractice trainings to better prepare for professional challenges that may arise during service delivery such as how to quickly resolve technology issues, develop open lines of communication with the school districts you serve, or ensure that HIPAA-Compliance regulations have been met. These professional responsibilities fall upon telepractitioners’ shoulders especially as independent contractors.  If the delivery of telepractice services is such that others question the clinician’s ability to provide services equal to those delivered in-person and/or the clinician’s overall professionalism, know that such concerns may represent a Code of Ethics violation.  

Principle of Ethics IV, Part D states, “Individuals shall not engage in any form of conduct that adversely reflects on the professions or on the individual’s fitness to serve persons professionally.”  This section focuses on behavioral conduct that impacts the profession of Speech/Language Pathology. Possible conduct violations include providing telepractice from a location other than the clinician’s home office.  Posts on social media that report telepractice services occurring from places such as coffee shops or while sitting outdoors are potential conduct violations.  Reports of unmade beds, a stack of items, or pets/people viewable behind the clinician have been shared. HIPAA-compliance/confidentiality violations, along with representing the profession in an improper manner (telepractitioners’ visual background environment), are examples of conduct adversely reflecting on the profession.

Principle of Ethics IV, Part M states, “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.”  When concerns arise, it is recommended to work with the professional to resolve a situation when possible. If unsure whether-or-not conduct is in violation of the Code of Ethics, contact the Board for information and assistance.

When a direct violation has occurred, it is each professional’s responsibility to report it.  ASHA’s Board of Ethics considers each sanction (i.e., consequence) based on the seriousness of the violation, previous compliance, the level of severity necessary to discourage future violations, efforts to correct violations, and any extenuating circumstances.  ASHA’s sanctions include (from least to most restrictive) private reprimand, public censure/reprimand, public suspension for a specified duration, public revocation for a specified duration, and public withholding of credentials for a specified duration – up to life. 

In summary, providing telepractice services that are equal to in-person services is a professional responsibility as stated by ASHA. To ensure that the Code of Ethics is being upheld, telepractitioners should examine how each of the Code’s principles applies to them directly.  The type and amount of training taken for the professional delivery of services, the visible environment from which services are being delivered (i.e., what clients, caregivers, teachers, and administrators see), HIPAA-compliance requirements, and properly representing our profession with appropriate conduct are critical considerations.  When questions of professionalism arise, it is the responsibility of members and nonmembers to discuss the concerns with the telepractitioner involved to resolve the issue or to call ASHA’s Board of Ethics with questions and concerns.

Resources

Ethics Resources: http://www.asha.org/practice/ethics/

Ethics Q&A for School-Based Speech Language Pathology Practice: https://www.asha.org/SLP/schools/prof-consult/EthicsFAQsForSchools/

Ethics and Schools Practice: https://www.asha.org/slp/schools/prof-consult/EthicsSchoolsPractice/

State Codes and Ethical Provisions (ASHA): https://www.asha.org/practice/ethics/state-codes-of-ethics/

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