Week 1.1 An Orientation to Medical SLP Scope of Practice and Ethics - PDF

Why SLP services meet the definition of medical necessity? Speech-language pathology services are medically necessary to treat speech-language, swallowing, and cognitive-communication disorders. “Many of these disorders have a neurological basis such as head injury, Parkinson’s disease, stroke, auti...

Why SLP services meet the definition of medical necessity? Speech-language pathology services are medically necessary to treat speech-language, swallowing, and cognitive-communication disorders. “Many of these disorders have a neurological basis such as head injury, Parkinson’s disease, stroke, autism, and cerebral palsy. Determining medical necessity takes into consideration whether a service is essential and appropriate to the diagnosis and/or treatment of an illness, injury, or disease, which Stedman’s medical dictionary (2000) defines as an “interruption, cessation, or disorder of body function.” Impaired speech and language, loss of hearing, and swallowing difficulties all reflect a loss of body functions and, therefore, services to treat such impairments meet the definition of medical necessity” Date Your Footer Here 1 SLP associations and schools 1. American Speech-Language-Hearing Association (ASHA) 2. International association of Logopedics phoniatrics ( IALP) 3. Saudi Society of Speech-language pathology and Audiology (SSSPA) Date Your Footer Here 2 1. ASHA Date Your Footer Here 3 2. International Association of Logopedics Phoniatrics (IALP) Date Your Footer Here 4 3. Saudi Society of Speech-Language Pathology and Audiology (SSSPA) Date Your Footer Here 5 The scope of medical speech-language pathology according to ASHA - SLPs are autonomous professionals - SLPs services are not supervised or prescribed by another professional (with exceptions in some settings) - SLPs can work collaboratively with other professionals to provide services for communication and swallowing disorders Date Your Footer Here 6 The scope of medical speech-language pathology Speech-language pathology practice: Professional domains Service delivery domains Date Your Footer Here 7 The scope of medical speech-language pathology Speech-language pathology practice: Date Professional domains Service delivery domains - - Advocacy and outreach Supervision Education Administration/leadership Research Collaboration Counseling Prevention and Wellness Screening Assessment Treatment Modalities, Technology, and Instrumentation Population and Systems Your Footer Here 8 Before we continue with SLP scope of practice and the model we currently follow… Let’s have a look at the previous models that explain disease and health Date 9 The scope of medical speech-language pathology SLP practice is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) framework (WHO, 2001) What is ICF? ICF is a framework for describing and organising information on functioning and disability. It provides a standard language and a conceptual basis for the definition and measurement of health and disability. Date Your Footer Here 10 The scope of medical speech-language pathology Date Your Footer Here 11 The scope of medical speech-language pathology Service delivery domains: 1-Collaboration: It occurs across all speech language pathology practice. Examples: - Cochlear implant team - Interdisciplinary Rehab. team ( working with physiatrists, PT, and OT) - Serve as a case manager - Early intervention team Date Your Footer Here 12 The scope of medical speech-language pathology Service delivery domains: 2- Counseling: Examples: - Empower the individual and family to make informed decision related to communication and swallowing issues - Educate (individual, family, and community) about communication and swallowing disorders - Discuss, evaluate, and address negative emotions and thoughts related to communication or swallowing disorders (e.g., stuttering) - Refer individuals with disorders to other professionals as needed Date Your Footer Here 13 The scope of medical speech-language pathology Service delivery domains: 3- Prevention and wellness: SLPs are involved in prevention activities that aim to: - Reducing the incidence of a new disorders or disease - Identifying disorders at an early stage - Decreasing the severity or impact of a disability Examples: -Stroke prevention program -Vocal hygiene -Genetic counseling -Concussion/traumatic brain injury awareness - Environmental change - Swallowing Date Your Footer Here 14 The scope of medical speech-language pathology Service delivery domains: 4. Screening: select and use appropriate screening instrumentation; develop screening procedures and tools based on existing evidence; coordinate and conduct screening programs in a wide variety of educational, community, and health care settings. utilize data to inform decisions about the health of populations. Examples of screening programs: 1. Neonatal screening program 2. Autism Spectrum Disorder (ASD) program (recently approved in KSA) Date 15 The scope of medical speech-language pathology Service delivery domains: 5. Assessment: Speech-language pathologists have expertise in the differential diagnosis of disorders of communication and swallowing. Communication, speech, language, and swallowing disorders can occur developmentally, as part of a medical condition, or in isolation, without an apparent underlying medical condition. Competent SLPs can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions SLP follow ICF model, so they can evaluate activities and participation, and all associated personal, environmental, cultural, and linguistic factors Date Your Footer Here 16 The scope of medical speech-language pathology Service delivery domains: 5. Assessment: Examples of things SLP are responsible for as part of the assessment process: administer standardized and/or criterion-referenced tools to compare individuals with their peers; review medical records to determine relevant health, medical, and pharmacological information; interview individuals and/or family to obtain case history to determine specific concerns; utilize culturally and linguistically appropriate assessment protocols; engage in behavioral observation to determine the individual’s skills in a naturalistic setting/context; diagnose communication and swallowing disorders; use endoscopy, videofluoroscopy, and other instrumentation to assess aspects of voice, resonance, velopharyngeal function and swallowing; document assessment and trial results for selecting AAC interventions and technology, including speechDate generating devices (SGDs) Your Footer Here 17 The scope of medical speech-language pathology Service delivery domains: 6. Treatment: Speech-language services are designed to optimize individuals’ ability to communicate and swallow, thereby improving quality of life. SLPs develop and implement treatment to address the presenting symptoms or concerns of a communication or swallowing problem or related functional issue. Treatment establishes a new skill or ability or remediates or restores an impaired skill or ability. The ultimate goal of therapy is to improve an individual’s functional outcomes. Date Your Footer Here 18 The scope of medical speech-language pathology Service delivery domains: 6. Treatment: Examples of things SLP are responsible for as part of treatment process: design, implement, and document delivery of service in accordance with best available practice appropriate to the practice setting; provide culturally and linguistically appropriate services; integrate the highest quality available research evidence with practitioner expertise and individual preferences and values in establishing treatment goals; utilize treatment data to guide decisions and determine effectiveness of services; deliver the appropriate frequency and intensity of treatment utilizing best available practice; engage in treatment activities that are within the scope of the professional’s competence; Date Your Footer Here 19 The scope of medical speech-language pathology Service delivery domains: 7. Modalities, technology and instruments the full range of AAC technologies to help individuals who have impaired ability to communicate verbally on a consistent basis—AAC devices make it possible for many individuals to successfully communicate within their environment and community; endoscopy, videofluoroscopy, fiber-optic evaluation of swallowing (voice, velopharyngeal function, swallowing) and other instrumentation to assess aspects of voice, resonance, and swallowing; telehealth/telepractice to provide individuals with access to services or to provide access to a specialist; ultrasound and other biofeedback systems for individuals with speech sound production, voice, or swallowing disorders Date Your Footer Here 20 The scope of medical speech-language pathology Service delivery areas: 1. Fluency Stuttering Cluttering 2. Speech production Motor planning and execution Articulation Phonological 3. Language –Spoken and written language (listening, processing, speaking, reading, writing, pragmatics) Phonology Morphology Syntax Semantics Pragmatics Prelinguistic communication Literacy Date 4. Cognition Attention Memory Problem solving Executive functioning 5. Voice Phonation quality Pitch Loudness Alaryngeal voice 6. Resonance Hypernasality Hyponasality 7. Feeding and Swallowing Oral phase Pharyngeal phase Esophageal phase Atypical eating (e.g., food selectivity/refusal, negative physiologic response) 8. Auditory Habilitation/Rehabilitation Speech, language, communication, and listening skills impacted by hearing 21 loss, deafness Auditory processing The scope of medical speech-language pathology Elective Service delivery areas: Examples: Preventive vocal hygiene Business communication Accent/dialect modification Professional voice use. Date Your Footer Here 22 Medical Ethics and SLP Date Your Footer Here 23 What is Ethics? And how it is different from morals? Ethics and morals relate to “right” and “wrong” conduct. While they are sometimes used interchangeably, they are different: - Ethics: refer to rules provided by an external source, e.g., codes of conduct in workplaces or principles in religions. - Morals: refer to an individual's own principles regarding right and wrong. Date Your Footer Here 24 Code of Ethics from Saudi commission of Health Specialties (SCHS) Date Your Footer Here 25 Code of Ethics by ASHA Four main principles: I. Responsibility to persons served professionally and to research participants, both human and animal. II. Responsibility for one’s professional competence. III. Responsibility to the public. IV. Responsibility for professional relationships. Date Your Footer Here 26 Code of Ethics by ASHA 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 ❖Activity: Look at the roles in the ASHA code of ethics document and think of examples of acts that are against this principle Date Your Footer Here 27 Code of Ethics by ASHA PRINCIPLE OF ETHICS II Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. Examples of acts that are against this principle? Date Your Footer Here 28 Code of Ethics by ASHA 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. Examples of acts that are against this principle? Date Your Footer Here 29 Code of Ethics by ASHA 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. Examples of acts that are against this principle? Date Your Footer Here 30 Code of Ethics by ASHA 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. Examples of acts that are against this principle? Date Your Footer Here 31 Code of ethics by American Medical Association Beneficence—to do good or to provide benefit to those who are treated Nonmaleficence—to do no harm, including personal, financial, or social damage Fidelity—to be truthful and one whom the patient can trust Responsibility—to adhere to principles that serve the patient’s best interests Integrity—to be honest, accurate, and truthful, and to protect the patient’s well-being Justice—to practice with fairness and to provide access to ser-vices without discrimination Respect for rights and dignity—all people have worth and rights that must be protected, including the autonomy to make decisions about their own care Date Your Footer Here 32 Process of making ethical decisions Awareness—Is there an ethical issue here? What is its nature? How important? What are the facts? What are the issues? What rules or values apply here? To whom or what do I owe a duty? How should they be applied? Who needs to decide and act? Who ought to? To what am I obligated because of role/position? What are the consequences? What are the options?! Date 33 Process of making ethical decisions Chabson&Morris, 2005 Date 34