Question: I’m an ASHA-certified speech-language pathologist who has been practicing in my school district for more than 15 years. A parent of one of my students approached me about providing additional services to their child outside of school. I’ve been considering opening my own private practice—are there ethical concerns about me privately treating students on my school caseload?
Your question is frequently asked by school-based SLPs—and practitioners in other workplace settings. The key issue to think through is whether seeing a student on your caseload outside the school setting as a private patient is a conflict of interest under the ASHA Code of Ethics.
What is a conflict of interest?
Conflict of interest is defined in the Code as “an opposition between the private interests and the official or professional responsibilities of a person in a position of trust, power, and/or authority.” Principle III, Rule B of the Code states you should avoid engaging in such conflicts “whereby personal, financial or other considerations have the potential to influence or compromise professional judgment and objectivity.”
How do I know if a conflict of interest exists?
Determining if a conflict of interest exists is tricky. But if whatever situation you’re considering clearly demonstrates the following, it probably doesn’t present a conflict of interest:
- Primarily contributes to the welfare of your clients, students, or patients.
- Doesn’t seem to bias your professional judgment.
- Enhances your professional knowledge and skills.
- Doesn’t diminish the dignity or autonomy of the professions.
In your situation, your student’s parent asked you to treat their child outside of school as a private patient. On the one hand, you can view your continued treatment of the student as contributing to the patient’s welfare by providing consistent treatment across settings (Principle I, Rule K).
On the other hand, this private arrangement might appear to others like you’re taking advantage of your primary place of employment and so potentially cloud your professional judgment so you can earn more money.
You should also be aware of another potential conflict of interest that may flow from such an arrangement: Concern that you will provide “preferential treatment” at school to the student you see outside of school—and, in so doing, disadvantage the other students on your school caseload.
Must I tell my school I’m starting a private practice and plan to treat my student as a client?
Most likely, yes. Check your employment contract, your school district policies, any collective bargaining agreement, and your public employee laws. Some school districts and states explicitly prohibit such arrangements. Other districts require you to provide your supervisor or principal notice of such plans and/or get their approval. And some employment contracts include non-compete clauses.
More on starting a private practice after school…
An SLP shares the questions—and answers—she asked herself when launching a part-time private practice.
How can I avoid a possible conflict of interest?
Assuming your employment agreement allows for treating students outside of school, you can take steps to minimize risking behavior that might be a real or perceived conflict of interest. These actions also maintain transparency with families of students you may treat outside of school:
- Discuss services the student already gets at school and provide potential alternatives besides yourself. Highlight any free or low-cost services, such as university clinics.
- Clearly state the costs of treating their child as a private client.
- Explain your distinct role as private practitioner versus school-based SLP. Also discuss personal and professional boundaries for private clients.
- Explain to families the possible outcomes from additional treatment, as well as outcomes for continuing only school sessions. Don’t forget to get written informed consent from the family before seeing their child as a private patient. (Principle I, Rule H).
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