chapter 1 Flashcards
The American Speech-Language-Hearing
Association (ASHA)
- Professional scientific and credentialing association
- Disseminate standards of ethical conduct
- Publishes original research in its journals
- Provides continuing education programs
- Political advocacy Provides networking opportunities
ASHA Provides
Provides standards for earning Certificate of Clinical Competence CCC. These standards
change regularly
2. Multicultural initiatives
3. Technical assistance relevant to the profession
4. Referral lists of clinical programs and private practitioners
5. Offers employment services
6. Supports credentialing of specialty recognition
7. Maintains 19 special interest groups
Scope of Practice
List of professional activities that define the range of services offered within
the profession of speech-language pathology
Preferred Practice Patterns
Statements that define generally applicable characteristics of activities
directed toward individual patients/clients and that address structural
requisites of the practice, processes to be carried out, and expected outcomes.
– World Health Organization’s International Classification of Functioning,
Disability and Health (WHO, 2001)
Ethical Practice
Moral and/or civil code of conduct for a person, situation,
community, religious group, organization or society
* Codes evolve:
– What values and behaviors regarded as good, honest, proper and
respectable Personally? Collectively?
Personal and Professional Ethics
Personal ethics can differ from person to person
* Professional ethics publicly state
– common core values
– collective obligations
* ASHA’s code of ethics
– includes tangible expectations
– defines acceptable contact
– defines conscientious judgment
Four principles
Principle of ethics I
– Safeguarding the welfare of clients and
research participants
* Principle of ethics II
– Providing the highest level of service
possible
* Principle of ethics III
– Interaction with the public
* Principle of ethics IV
– Standards and responsibilities to the
profession
* Within each principal the rules specify
acceptable and restricted actions
ASHA Board of Ethics
Maintains and administers the code of ethics
* Jurisdiction limited to members and certificate holders
– Does not actively initiate investigations (only state licensure boards can investigate)
– No subpoena power, forcing witnesses to testify or produce evidence
– No anonymous complaints accepted
* Sanctions imposed may be private or public
*
Important Core Principles
Safeguarding the client welfare
* Beneficence and nonmaleficence
* Nondiscrimination
* Referral
* Informed consent
* Confidentiality
* Prognosis and cures
1. Infection control
2. Competence
3. Acting without conflict of interest
4. Acting without misrepresentation
* Professional supervision and instruction
* Professional relationships
Evidence-Based
Practice
Evidence based practice ensures that clients receive services that are be
based on reliable and valid research and sound clinical judgment.
Ideally, we should use only treatment procedures that’s a proven better
than no treatment, and that has been replicated in different conditions
and with a different population.
In reality, “not all research has been created equal”. So we need to use
the BEST research evidence combined with clinical expertise and
sound judgment.
EBP is always
EBP is always client/family centered
* EBT is ethno-culturally sensitive
* Some evidence-based approaches could be unacceptable for the
people we treat
* Therefore, clinicians make a choice of assessment and
treatment according to
– Best research evidence
– AND what they perceive is best for the client /family
– AND the client’s/family’s preferences
Gather evidence
Internal evidence
– Objective performance data,
– Subjective observation of the client, the sessions, …
– Process information using your clinical expertise
* External evidence from scientific literature
Assess the evidence
Internal evidence:
– What is my client’s response to intervention?
– Should I change technique, goal, frequency …?
* External evidence:
– Is this study relevant and comparable to my client?
* Limitations:
– Shortcomings that could not be controled
– Is there a bias or conflict of interest?
– Are the results applicable to my client?
Hierarchy of Evidence (Hedgem 2003)
Levels of evidence:
– Framework for classifying research on any number of criteria, including
study design, validity, and/or methodological quality.
* There are 7 levels of evidence,
– Highest: high quality meta-analyses, systematic reviews of RCTs, or
RCTs with a very low risk of bias,
– Lowest: expert opinion
The 7 Hierarchy of Evidence
1 lowest and 7 highest
7 systematic reviews
6 randomized controlled trials
5 cohort studies
4 case control studies
3 case reports and case series
2 animal and cell studies
1 anecdotal and expert opinion
