By the Division of Professional Licensure

10.01: Definitions

Supervising Speech-Language Pathologist. A Speech-Language Pathologist licensed by the Board, in good standing, who has been practicing for at least two years following licensure.

Supervising Audiologist. An Audiologist licensed by the Board, in good standing, who has been practicing for at least two years following licensure.

Direct Supervision. Direct supervision means on-site and in-view observation and guidance of an assistant who is performing an assigned activity during patient/client contact time. The supervisor will review data for all patients/clients seen by the assistant.

Indirect Supervision. Indirect Supervision means the oversight of activities, other than direct observation, performed by an assistant in order to provide guidance. These activities may include demonstration; record review; review and evaluation of recorded sessions; and supervisory conferences that may be conducted by telephone.

Screening. A pass-fail procedure to identify people who may require further assessment.

Plan of Care (Treatment Plan). This terminology includes, but is not limited to, the "Plan of Care," "Individualized Education Program (IEP)," or "Individualized Family Service Plan (IFSP)," and other titles that outline the care of the patient/client.

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10.02: Supervision and Documentation

(1) A Supervising Speech-Language Pathologist is required to inform patients/clients when services are to be provided by Speech-Language Pathology Assistants, before such services commence. A Supervising Audiologist is required to inform patients/clients when services are to be provided by Audiology Assistants, before such services commence.

(2) The supervisor is responsible for the services provided by assistants.

(3) A supervisor must verify that an assistant holds a current, valid license from the Board prior to the commencement of services.

(4) The supervisor must not delegate services requiring licensure to anyone not licensed by the Board.

(5) The amount and type of supervision should be based on the skills and experience of the Speech-Language Pathology Assistant or Audiology Assistant, the needs of patients/clients being served, the service setting, and the tasks assigned.

(a) At least 10% of services rendered by Assistants each month must be provided under Direct Supervision. An additional 10% of services must be supervised, either directly or indirectly.

(b) Additional direct and indirect supervision, beyond the minimum 20% required may be necessary depending on the skills of the assistant and the needs of the patient/client. The supervisor will review each plan of care as needed for timely implementation of modifications.

(c) The amount and type of supervision must be documented. Documentation must include hours of employment per month, and the date, type, and duration of supervision. The name, signature, and license number of the supervisor must appear on the form.

(d) It is the responsibility of the assistant to maintain a record of such supervision and provide a copy of this record to the Board upon request, or for audit or license renewal purposes.

(6) A supervisor may not supervise more than three assistants at any given time.

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10.03: Scope of Practice

(1) A Speech-Language Pathology Assistant or Audiology Assistant may perform the following tasks under the supervision of a Supervising Speech-Language Pathologist or Supervising Audiologist:

(a) Assist speech-Language and hearing screenings (without interpretation);

(b) Assist with informal documentation as directed by the supervisor;

(c) Follow documented treatment plans or protocols developed by the supervisor;

(d) Document patient/client performance ( e.g., tallying data for the Speech-Language Pathologist to use; preparing charts, records, and graphs) and report this information to the supervisor;

(e) Assist the speech-Language Pathologist or Audiologist during assessment of patients/ clients;

(f) Assist with clerical duties such as preparing materials and scheduling activities as directed by the supervisor;

(g) Perform checks and maintenance of equipment;

(h) Collect data for monitoring quality improvement.

(2) A Speech-Language Pathology Assistant or Audiology Assistant may not perform tasks beyond the scope of his/her education and experience. A Speech-Language Pathology Assistant or Audiology Assistant:

(a) May not interpret results of standardized or nonstandardized diagnostic tests or formal or informal evaluations;

(b) May not screen or diagnose patients/clients for feeding/swallowing disorders;

(c) May not write, develop, or modify a patient's/client's individualized treatment plan in any way;

(d) May not assist with patients/clients without following the individualized treatment plan prepared by the Speech-Language Pathologist/Audiologist, or without access to supervision;

(e) May not sign any formal documents (e.g., treatment plans, reimbursement forms, or reports; the assistant should sign or initial informal treatment notes for review and co-signature by the supervising professional);

(f) May not select patients/clients for service;

(g) May not determine case selection;

(h) May not interpret observations or data into diagnostic statements of clinical management strategies or procedures;

(i) May not compose clinical reports except for progress notes to be reviewed by the supervisor and held in the patient/client records;

(j) May not discharge a patient/client from services;

(k) May not disclose clinical or confidential information either orally or in writing to anyone without a supervisor's approval;

(l) May not make referrals for additional service;

(m) May not consult with the patient/client, family or others, or participate in parent conferences, case conferences, or any interdisciplinary team meetings, regarding the patient/client status or service received without the Supervisor's approval;

(n) May not develop, alter, or initially demonstrate swallowing strategies or precautions to patients, family, or staff;

(o) May not represent himself or herself as a Speech-Language Pathologist or Audiologist orally or in writing;

(p) May not perform tasks when a Supervising Speech-Language Pathologist or Supervising Audiologist cannot be reached by personal contact, phone, pager, or other immediate means or until a licensed Speech-Language Pathologist or licensed Audiologist with at least two years of experience has been designated as the supervisor.

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10.04: Code of Ethics

(1) Licensees shall provide all services competently.

(2) Licensees shall not discriminate in the delivery of professional services or the conduct of research and scholarly activities on the basis of race or ethnicity, gender, age, religion, national origin, sexual orientation, or disability.

(3) Licensees shall adequately maintain and appropriately secure records of professional services rendered, research, and scholarly activities conducted.

(4) Licensees shall not reveal, without authorization, any professional or personal information about identified persons served professionally or identified participants involved in research and scholarly activities unless required by law to do so, or unless doing so is necessary to protect the welfare of the person or of the community or otherwise required by law.

(5) Licensees shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training and experience.

(6) Individuals shall not misrepresent their credentials, competence, education, training, experience or scholarly or research contributions.

(7) Licensees shall not participate in professional activities that constitute a conflict of interest.

(8) Individuals shall not engage in dishonesty, fraud, deceit, misrepresentation, sexual harassment, or any other form of conduct that adversely reflects on the professions or on the individual's fitness to serve persons professionally.

(9) Licensees shall not engage in sexual activities with patients, clients, or students over whom they exercise professional authority.

(10) Licensees shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.

(11) Licensees shall not discriminate in their relationships with colleagues, students, and members of allied professions on the basis of race or ethnicity, gender, age, religion, national origin, sexual orientation, or disability.

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REGULATORY AUTHORITY
260 CMR 10.00: M.G.L. c. 23, §§ 86 and 87 and c. 112, § 139.