Wednesday, December 5, 2012

Prescription---and the ASHA code of ethics

Although the title of this post makes it appear as though this will be a tangential blog about  the healthcare part of my field, this posting is a bit different.   I'm writing about school-based speech pathologists being pressured by IEP teams, parents, or physicians into providing services against the SLP's better judgement. 

Here are a couple of scenarios that have actually come up in my school:

  • A child in first grade can not articulate his 'r' sounds.  According to developmental charts, this is not atypical for his age.  Parents and the teacher feel he needs speech therapy, but the SLP feels that he does not have a disability.  

  •  A 5th grade child is in an EC classroom with ability, achievement, and language scores are all delayed more than 2 standard deviations.  His social skills are a strength.  He receives his academic instruction in the EC classroom.  The SLP, after an assessment and observation, feels he does not need speech and language services to access his special education.  His parents feel he needs speech services to 'catch up'.  
  • A child is diagnosed by a private speech pathologist as having auditory processing disorder and recommends school-based speech services.  (Only an audiologist can diagnose an auditory processing disorder.)
Here is the exact quote from the ASHA code of ethics:

Principle of Ethics IV, Rule J of the Code of Ethics of the American Speech-Language-Hearing Association states: 
Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.

Further reading into this reveals that 
     "prescription is often used solely as a request for the initiation or continuation of speech-language pathology and/or audiology services. When that is the case, prescription may be regarded as synonymous with referral, and it is a useful instrument in the total treatment program for a client."

"Prescription" does not need to come from a doctor, but can also include a request from an IEP team.

According to the ASHA code of ethics, if the IEP team (without the SLP) determines that the child needs speech therapy, the SLP is bound to use professional independent judgement as to whether the child, in fact, should receive speech.

My lead SLP has instructed all of the school system's speech pathologists that in the case where an IEP team signs off on speech services overriding the SLP's clinical judgement, the SLP can not ethically provide services for the child.  

The moral of this story is:
     a. The SLP needs to carefully assess a child.
     b. The SLP needs to make a clinically sound determination as to whether the child is eligible for speech.  (If the SLP is unsure, a peer review team can help, or consultation with other district SLPs will assist in making an independent decision.)
     c.  The SLP needs to communicate his or her findings to the parents and the IEP team.
     d.  The SLP ethically can not 'cave in' to outside pressure.  (This is the hard step.)
For new speech pathologists, this is the hardest part of the job.  After 21 years in a school, I think I have it pretty much mastered.....but it's still a bumpy road, and sometimes, it's still hard to go to those difficult meetings without melting inside.

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