Issues in Ethics: Responsibilities of Individuals Who Mentor Clinical Fellows in Speech-Language Pathology

• About This Document
• Issues in Ethics: Definition
• Introduction
• Discussion
• Guidance

About This Document

Published 2017. This Issues in Ethics statement is a revision of Responsibilities of Individuals Who Mentor Clinical Fellows in Speech-Language Pathology (2013), which revised Responsibilities of Individuals Who Mentor Clinical Fellows (2007) and Clinical Fellowship Supervisor's Responsibilities (2004). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.

Issues in Ethics: Definition

From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.

Introduction

The Clinical Fellowship (CF) mentor assesses the Clinical Fellow in the demonstration of the skills and knowledge appropriate for independent practice and provides professional support and personal guidance to the Clinical Fellow across the period of the CF. Mentors of a clinical fellow play a critical role in the preparation of speech-language pathologists (SLPs). The ASHA speech-language pathology certification standards and information for CF mentoring of SLPs on ASHA's website list supervisory functions; however, mentors should be aware that they also have ethical obligations to Clinical Fellows.

They hold positions of power over Clinical Fellows—power to delay or deny the completion of a requirement for certification and, sometimes, power to affect an individual's immediate or subsequent employment. Moreover, individuals who mentor Clinical Fellows should recognize that they may at times encounter potential conflicts of interest in reconciling professional and workplace demands with the ethical duties they owe to employees who are in their CF.

Mentoring Clinical Fellows requires an extraordinary commitment of time and talent. Mentors share in the responsibility of preparing future professionals for a lifetime of ethical conduct. Although the Code does not apply to the Clinical Fellow until they are applicants for ASHA certification, the fundamental principles and rules will be an essential part of their professional future. As such, the mentor/supervisor must both model the Code and teach its significance.

Discussion

Mentors of speech-language pathologists should be familiar with their obligations as described in the Code and certification standards, as well as with all supervisory obligations in the pertinent sections of their respective state licensure laws. The CF mentor cannot assume that ASHA's supervisory requirements for the Clinical Fellow are the same as the supervisory requirements for an individual with the same level of education and training as mandated by the state's licensure law. Further, in those states where the requirements for licensure mirror and/or accept ASHA's Clinical Fellow requirements, the mentor must not jeopardize the state licensure of the Clinical Fellow (albeit separate and apart from ASHA's certification) by providing supervision without being licensed in that state.

The vast majority of Clinical Fellows report successful experiences under the appropriate mentoring and supervision of competent, dedicated professionals. Although the number of reports alleging detrimental supervisory practices is comparatively small, the fact that such incidents occur at all must be addressed. The consequences of inappropriate mentoring/supervision can be severe for the Clinical Fellow and the mentor/supervisor. For example Clinical Fellows have received no credit or only partial credit for the CF experience such that their certification was delayed or employment opportunities were lost; Clinical Fellows have filed an ethics complaint against the mentor whose negligence or unprofessional behavior rose to the level of a violation of the Code. For more information about complaints like these, contact ASHA Ethics at ethics@asha.org.

Examples of situations that may give rise to ethical issues and/or misconduct include the following:

• arbitrary termination of the CF mentor-supervisory relationship
• termination of the CF mentor-supervisory relationship such that client abandonment occurs
• failure to establish outcomes and performance levels or failure to do so in a timely fashion
• failure to complete and sign the CF report or failure to do so in a timely fashion
• withholding paperwork for the benefit of the employer and to the detriment of the Clinical Fellow
• failure to provide the required amount of supervision
• mentoring/supervisory responsibility for an excessive number of Clinical Fellows
• assignment of excessive nonclinical duties to the detriment of the Clinical Fellows' clinical experience
• recruitment of Clinical Fellows to function as independent practitioners without appropriate supervision
• failure to report a Clinical Fellow's noncompliance with the Code or applicable law
• failure to fulfill the responsibilities of CF mentoring/supervision as agreed
• acceptance of compensation for the CF mentorship or supervision from the Clinical Fellow being mentored or supervised, except reasonable reimbursement for direct expenses, which does not include paying the mentor/supervisor's ASHA certification dues/fees or certification application dues/fees
• delegation of tasks for which the Clinical Fellow is inadequately prepared

The Board acknowledges that Clinical Fellows may also bear some responsibility for the occasional difficult situations that occur. Differing personal styles, cultural differences, and/or conflicting personalities may be at the root of some of the occurrences reported. It is suggested that the Clinical Fellow select their mentor carefully and follow the suggestions provided in Selecting a Clinical Fellowship (CF) Setting on the ASHA website.

Typically, the CF is the Clinical Fellow's first employment within the profession, bringing with it new challenges of time management, workplace dynamics, and employer expectations. Whether the employment setting is in the public or private sector, the recent graduate may not be aware of the realities of working within a professional practice. Mentors of speech-language pathologists should be mindful that these new challenges may create ethical dilemmas for which the mentor has the opportunity to guide the Clinical Fellow in their understanding of ethical decision making.

The mentoring speech-language pathologist is a role model for the beginning professional. Mentors have influence that lasts beyond the term of intensive contact, because new certificate holders may subsequently mentor and supervise others. Mentors are expected to adhere to standards of fairness. This requires, at a minimum, that mentoring speech-language pathologists understand their responsibilities, make good-faith efforts to carry them out, and immediately address issues of concern. It is also highly recommended that mentors advance their knowledge of supervisory techniques, practices, and principles through continuing education. Likewise, mentors must know whether their state licensure requires continuing education specific to supervision. Mentors are the key to a successful certification program and provide invaluable services to the public and the profession.

Guidance

The Code includes principles and rules with direct implications for the speech-language pathologist mentoring the Clinical Fellow. They include the following.

Principle of Ethics I

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.

Under this principle, there are several rules which apply to mentoring responsibilities. These include:

Rule A. Individuals shall provide all clinical services and scientific activities competently.

• The mentor has the responsibility to assist the Clinical Fellow in the development of competent delivery of services, and ultimately has the responsibility to evaluate the clinical competence of the individual. It is wise to keep in mind that the successful completion of the CF is the final assessment for independent clinical practice.

Rule D. Individuals shall not misrepresent the credentials of aides, assistants, technicians, support personnel, students, research interns, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name, role, and professional credentials of persons providing services.

• It is important for the mentor to demonstrate appropriate sharing of the credentials of the Clinical Fellow with the consumer.

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.

• Circumstances where professional practice is adversely affected by substance abuse, addiction, or other health-related conditions are atypical, but of the utmost importance to address, no matter the setting or mentoring environment.

Principle of Ethics II

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

Under this principle, there are several rules which apply to mentoring responsibilities. These include:

Rule D. Individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning applicable to their professional activities and skills.

• With state licensure boards across the nation and ASHA either requiring or considering requiring ethics and/or supervision specific continuing education credits, mentors could benefit from areas of training explicitly focused on supervision of Clinical Fellows.

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.

• In situations where the mentor becomes aware that the Clinical Fellow needs additional education, training, or experience in a particular practice area, it is the responsibility of the mentor to facilitate the fellow's acquisition of such education, training, or experience. Rule E may apply when both the mentor and the Clinical Fellow are employed within the same entity and the Clinical Fellow is considered a member of the professional staff.

Principle of Ethics III

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.

Under this principle, there are several rules which apply to mentoring responsibilities. These include:

Rule A. Individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly contributions.

• It is the ethical responsibility of the mentor to maintain professional credentials throughout the supervision for all Clinical Fellows. The mentor must also prohibit the Clinical Fellow from providing services for which they are not qualified and assure they do not misrepresent their professional services to the public.

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.

Rule C. Individuals shall not misrepresent research and scholarly activities, diagnostic information, services provided, results of services provided, products dispensed, or the effects of products dispensed.

• The mentor needs to provide ethical guidance to assure that the Clinical Fellow understands how to identify a conflict of interest and does not engage in inappropriate activities.

Principle of Ethics IV

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.

Under this principle, there are several rules which apply to mentoring responsibilities. These include:

Rule G. Individuals shall not engage in any form of harassment, power abuse, or sexual harassment.

Rule L. Individuals shall not discriminate in their relationships with colleagues, assistants, students, support personnel, and members of other professions and disciplines on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, dialect, or socioeconomic status.

• According to Rules G and L, the mentor has the responsibility to treat the Clinical Fellow with dignity and respect at all times, allowing the Clinical Fellow to develop professionally without intimidation or fear of reprisal.

Rule R. Individuals shall comply with local, state, and federal laws and regulations applicable to professional practice, research ethics, and the responsible conduct of research.

• A mentor who allows a Clinical Fellow to provide clinical services under their supervision when the Clinical Fellow is not properly licensed as required by the applicable state, aids in the misrepresentation of services provided as well as the misrepresentation of the Clinical Fellow's credentials.