Clinical Linguistics & Phonetics, July–August 2014; 28(7–8): 627–638

ß 2014 Informa UK Ltd.

ISSN: 0269-9206 print / 1464-5076 online
DOI: 10.3109/02699206.2014.927002

‘‘Measuring up’’ to ethical standards in service delivery to college

students on the Autism Spectrum: A practical application of
Powell’s model for ethical practices in clinical phonetics and
linguistics

AMY L. WEISS1 & PAMELA ROHLAND2

1
Department of Communicative Disorders, University of Rhode Island, Kingston, RI, USA and
2
Disability Services for Students, Office of Student Life, University of Rhode Island, USA

(Received 6 January 2014; accepted 23 March 2014)

Abstract
This paper examined an interdisciplinary college-based support programme, the Communication Coaching
Program (CCP), designed for students diagnosed on the autism spectrum in light of six ethical constructs
described by Powell. Collecting data to monitor the successes and ongoing needs of individual participants in
the programme is of vital importance, of course, but only addresses a portion of the efficacy question. In
addition, the authors, who co-direct the programme and represent different professional expertise and
perspectives, recognize the importance of determining whether their evolving intervention model has also
been successful in meeting the ethical standards of their respective professions. Careful review of the 4 years
of the CCP’s operation in terms of ethical constructs has yielded evidence that the CCP, although based on
sound principles of theory and scholarship, should be further individualized to meet the particular needs of
participants diagnosed with deficits in social communication and executive functioning skills.

Keywords: Autism, ethical standards, intervention

Introduction
There are few professionals providing support services in educational settings today who have not
had to deal with the specialized needs of individuals, both children and adults, diagnosed with
autism spectrum disorders (ASD). The diagnosis of ASD has received worldwide attention not
only because of the potentially devastating effects the disorder can have on those diagnosed and
their families but also because of the increasing evidence that there is an ongoing upswing in the
prevalence of the disorder.
Current estimates from the US Centers for Disease Control (CDC) place the prevalence of
autism spectrum disorders at 1 in 88 births in the United States; occurrence in males is
approximately five times that of females with 1:54 males affected and 1:252 females affected
(CDC, 2012). Periodic surveillance data published by the CDC has demonstrated an increase in

Correspondence: Amy L. Weiss, Ph.D., CCC-SLP, Department of Communicative Disorders, University of Rhode Island, Kingston, RI
02881, USA. Tel: +1 401-874-9071. Fax: +1 401 874 4404. E-mail: weissa@mail.uri.edu
628 A. L. Weiss & P. Rohland

the frequency of identified children with ASD from 1:150 in 2002 to the current 1:88 ratio
reported 10 years later. The most recent report also yielded evidence that ASD is identified across
racial, ethnic, and socio-economic groups although prevalence data for individual groups has
differed, with white children having the highest prevalence of the five racial and ethnic groups
considered. Note that the World Health Organization (WHO) has estimated that the prevalence of
ASD worldwide is approximately 1:160, somewhat smaller than the prevalence of the diagnosis is
in the United States (http://www.who.int/features/qa/85/en/, Retrieved 1/6/14).
In this paper, we specifically focus attention on a college-based programme for students diag-
nosed with autism spectrum disorders as children. These individuals represent a portion of the ASD
population that is far less often considered in the ASD literature although it is a growing segment
of the population (Hewitt, 2011). Those persons with diagnoses of ASD who pursue college
degrees tend to be those who earlier on were referred to with the terms ‘‘Asperger Syndrome’’ or
‘‘High Functioning Autism.’’ They are now referred to as demonstrating characteristics of
the higher-functioning, milder end of the autism spectrum as per changes to the Diagnostic and
Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).
When the American Psychiatric Association published the DSM-5, one immediate impact was
experienced in the terminology which is now used to identify persons on the autism spectrum.
Although the fourth edition of the DSM had divided the diagnosis of autism into four possible sub-
diagnoses including both ‘‘autistic disorder’’ and ‘‘Asperger’s disorder,’’ the DSM-5 uses ‘‘autism
spectrum disorder’’ as the singular term used to describe the disorder that typically includes
communication deficits, an over-dependence on routines, and over-sensitivity to environmental
changes, and an intense interest in inappropriate items (www.Dsm5.org/Autism Spectrum
Disorder Fact Sheet.pdf, Retrieved December 31, 2013).
Citing confusion in the diagnostic identification process, the committee that produced the
revised DSM-5 suggested that the use of a unifying term, ‘‘autism spectrum disorder,’’ would
facilitate recognition that ASD exists along a continuum of disability from mild to severe.
Similarly, the use of a single term should facilitate the implementation of individualized treatment
programmes. Given that this transition in terminology is in its nascent period, much of the
literature that has been written about college students on the autism spectrum, as limited as it is,
still refers to persons with diagnoses of ‘‘Asperger Syndrome’’ or ‘‘High Functioning Autism.’’

College students with ASD

Asperger Syndrome was first described in 1943 by Hans Asperger and, as noted above, was coded
in the DSM-IV published in 1994. Brown, Wolf, and Bork (2009) described a wide array of
symptoms and behaviors that impact academic and social success of individuals diagnosed with
Asperger Syndrome; their work has influenced many higher education practitioners. Kaufman and
Lord (2005) described students with ASD as cognitively high functioning, but having more
difficulty making friends, or navigating typical classroom learning environments where social
knowledge is critical. Attending college may present a significant set of social, and therefore,
educational challenges for the student with ASD. These authors delineated the expectations and
challenges both in terms of social competencies and in terms of academic achievements for
success in secondary and post-secondary education that are needed but often missing or
inconsistently applied by students with ASD. Many of the academic achievement skills needed
include executive functioning skills (e.g. organization, prioritization, goal setting).
Hewitt (2011) discussed her experiences working with college-age students diagnosed with
ASD and emphasized that programming must focus on both executive functioning and social
communication competencies to meet these students’ needs. If social interaction is difficult for
 Practical application of Powell’s model for ethical practices 629

students with ASD one might assume that a virtual college experience through online learning
might be a perfect solution where students can write and respond in privacy without the stress of
interpersonal communication. However, online learning also requires organization, planning, self-
directedness, and the ability to respond quickly. When executive functioning skills are deficient,
online learning can also be a very difficult learning environment.
Given the reported increase in the prevalence of children identified with ASD, it should not be
surprising that university personnel have noted a similar increase in the numbers of individuals
diagnosed with ASD entering post-secondary school. The web site www.collegeautismspec-
trum.com (retrieved 1/4/14) lists 25 colleges and universities in the United States with specialized
programmes designed to integrate students with ASD with one programme listed on this site
offered fully on-line. A variety of programmes have been developed to meet the special needs of
these students to increase retention as well as to serve as a recruitment tool. However, successful
inclusion of this population of students in college settings remains elusive. In a recent study,
Shattuck et al. (2012) reported that within the first 2 years following secondary education more
than 50% of students with ASD had not participated in post-secondary education (e.g. college,
vocational education) or employment. This percentage increased somewhat 6 years after
secondary school, with 35% of the same students having attended at least some college and more
than 55% having been employed for a period of time.

Providing support for students with ASD

The Disability Services for Students (hereafter DSS) office at the University of Rhode Island, an
institution of approximately 13 000 students, had seen an increase in students diagnosed and self-
disclosed to be on the autism spectrum, from one student in the year 2000 to more than 30 students
in the fall, 2013 semester. Similar to many other post-secondary schools, the DSS does not offer
testing for autism diagnosis; students must receive their diagnosis from appropriate personnel
outside of the university setting. Further, students must be willing to self-disclose their diagnosis.
Under the Family Educational Rights and Privacy Act (FERPA), a student reaches eligible status
for the transfer of the protection of his or her educational records at age 18, meaning that it is not
within the jurisdiction of other family members to share information about the student, including
diagnostic information, without the student’s explicit permission. Thus, it is possible that our
census of students enrolled at URI with diagnoses of ASD is somewhat underestimated because
students may not want to disclose this information.
Prior to the development of a specific programme to deal with the needs of students diagnosed
with ASD, it became apparent that this growing group of students had different needs than many
of the other students provided with supports through the DSS. For example, independent
navigation of a complex university campus and bureaucracy was extremely challenging and
sometimes incomprehensible to students with ASD. Their transition to the college setting whether
living on campus or commuting was both difficult and frightening for the students and often
equally difficult for their parents. Parents of students with ASD frequently are used to being their
children’s guides and advocates and they sometimes need assistance in transition as well. That is,
they must allow the student to handle interactions with college professors and administrators;
whereas previously parents had access to their children’s day-to-day performance and they were
easily able to speak to instructors and administrators on the student’s behalf, the student was now
expected to take responsibility to handle day-to-day academic needs.
New students were easily overwhelmed by novel academic demands, their inability to handle
multiple tasks simultaneously, as well as communication demands with new classmates, resident
advisers, professors, and teaching assistants. Their evident lack of social awareness, the presence
630 A. L. Weiss & P. Rohland

of social anxiety, and their inability to navigate new situations often meant that they had multiple
support needs and those needs were immediate. Most distressing to DSS personnel was that many
of the students with ASD identified themselves to the DSS office at the end of the student’s first
semester. By that time, some of the students may have been failing most or all of their courses and
were in danger of probationary status or dismissal from the university. Even students who had
identified themselves when they first entered the university were not being provided with
systematic, comprehensive services that took advantage of the expertise of other personnel on
campus. Thus, 5 years ago, plans were made for a new clinical programme that would be a joint
venture between the DSS and speech-language pathologists at the University of Rhode Island
Speech and Hearing Center.

A description of the communication coaching programme (CCP)

The mission statement of the CCP is to support and maximize the academic and social success of
University of Rhode Island students with a diagnosis of autism spectrum disorder through a multi-
faceted programme designed to meet individual student’s needs. In the 4 years since its inception,
we have provided support services to more than a dozen students on the autism spectrum through a
treatment model that we call ‘‘coaching’’ rather than ‘‘therapy’’. This terminology distinguishes
the programme from the type of supports many students have received for most of their lives and
reflects our attempts to involve the students as collaborators in gaining a new skill set better suited
for the academic and social expectations of a university setting. As already noted, Hewitt (2011)
reported that the college students with whom she has worked have presented with both social
communication deficits and executive functioning deficits. Her observations matched our own and
thus our students receive supports in both areas unless an individual student demonstrates
adequate abilities in one or the other area.

Components of the programme

All the students enrolled in the CCP participate in regularly scheduled appointments with
academic counselors employed by the DSS. Usually these meetings are held once a week and
students use these meetings as opportunities to discuss immediate academic needs (e.g. accessing
tutoring assistance through the Academic Enhancement Center, planning and registering for their
courses, applying for on-campus housing, discussing any difficulties encountered with professors,
other students, etc.). In addition, each student participates in 1 or 2 h of communication coaching
held at the URI Speech and Hearing Center in the Department of Communicative Disorders. A
graduate student in the MS training programme provides a weekly individual and group session for
the student clients; these sessions occur one after the other. Graduate students providing these
services are referred to as ‘‘communication coaches’’ and they are charged with assessing each
client for the appropriateness of his or her academic and social skill sets to meet the challenges of
university life. The actual individual and group coaching sessions focus on facilitating changes in
the student clients’ ability to augment or refine their skill sets. For example, many of our students
with ASD do not use e-mail regularly or at all. Given that professors often rely on e-mail to
communicate with their students, students not versed in using this communication medium may
miss review sessions, changes in assignments, and other important messages. Communication
coaches may work with students to plan consistent, daily checks of their e-mail account as well as
construction of appropriate e-mail messages for receipt by professors. Coaching sessions may also
target conversation management rules, strategies for requesting clarification from instructors,
interpretation of non-verbal social cues, and prioritizing study times for upcoming assignments.
 Practical application of Powell’s model for ethical practices 631

Graduate students who participate as communication coaches are earning practicum hours toward
their speech-language pathology certification in the area of adult language disorders (ASHA,
2012). Feedback from graduate students who have participated in the CCP has indicated that they
have found the experience rewarding as well as challenging. Many of the graduates expect to work
in schools and this practicum setting has made clear to them the critical role that SLPs can play in
preparing secondary school students with diagnoses of ASD for a successful transition to college.
Each student client is also assigned a ‘‘peer coach,’’ another student majoring in
communication disorders, usually an undergraduate student, who will work on communication
coaching goals on campus but outside of the clinic for 1 h per week. The purpose of a peer
coaching session is to help the student–client generalize what is targeted within communication
coaching sessions in a more natural campus setting. Peer coaches may help students set up their
weekly schedules so that study time between classes is utilized effectively. Some peer coaches
have assisted students in preparing scripts for academic advising meetings, finding and using quiet
study areas on campus, practicing conversation turn taking, or figuring out how to use the
university’s library system for research purposes, among other activities. At all times, the peer
coaching interfaces with communication coaching sessions. Peer coaches observe all the
communication coaching sessions and must have their peer coach session plans approved, just as
the communication coaches must have their session plans approved, by their clinical instructor.
A recent addition to the CCP is an optional communication group session held once weekly for
students enrolled in the CCP as well as others with diagnoses of ASD who for one reason or
another are not participating in the communication coaching and peer coaching components of the
CCP. The goal is to have the participants in this group select particular issues of college life for
discussion (e.g. meeting people with similar interests, making friends, dealing with increased
freedoms of campus life), describe their experiences and where appropriate, problem solve. This
group was originally facilitated by a veteran client of the CCP under the direction of the DSS
director; more recently, personnel from the DSS have been responsible for organizing the
conversation group meetings.

Evaluating the programme after four years

Four years (i.e. eight semesters) after its inception, the CCP has provided support services to more
than a dozen different students diagnosed with ASD. Note that several students have attended the
programme for more than one semester. In the last clinical week of each semester, all student
participants in the programme, student–clients, communication coaches, and peer coaches, are
asked to provide written feedback to the co-directors regarding their learning over the semester.
This information is compiled into a report that is discussed during a final debriefing session
conducted with all personnel at the end of each semester. It is from these discussions of feedback
that changes to the programme have been considered, developed, and later implemented.
Student–clients have noted consistently that they have learned the most in the areas of
conversation strategies (e.g. finding common topical ground, preparing for interviews, using
prosody for emphasis), perspective taking, understanding body language cues (e.g. cues signaling
interest versus disinterest), academic skills (e.g. note taking, e-mail communication, scheduling
their weeks to account for all assignments), setting attainable goals, as well as coping in a socially
acceptable way with feelings of frustration and anger. From the written feedback submitted as well
as the less formal conversations conducted among the co-directors, communication coaches, peer
coaches, academic counselors and student–clients, a number of changes to the CCP have been
instituted. For example, student–clients are now provided coaching in both individual and group
sessions instead of individual sessions only. The collective observations and experiences of all
632 A. L. Weiss & P. Rohland

CCP participants had indicated that the more opportunities students with ASD had to negotiate
conversation roles and responsibilities, the more naturalistic practice they had in implementing the
conversation strategies taught during individual sessions. In another example, although student–
clients had originally been given the choice about whether to participate in academic counseling
through the DSS when enrolled in the CCP, all students must now have regular contact with an
academic counselor. This change was made because without regular contact with an academic
counselor, student–clients were not as likely to reveal present difficulties they were having and it
was then also less likely that proactive measures could be taken to meet a particular challenge a
student was experiencing.
Although we have observed gains in the independence and adaptation to college life
experienced by most of our student–clients from semester-to-semester or year-to-year of their
participation, we have not systematically considered the CCP’s mission, components, and
processes against standards of ethical and professional conduct. This process is made more
compelling by the fact that the CCP is an inter-disciplinary programme representing professionals
from two different fields of expertise as well as consumer and provider perspectives. In addition,
the CCP is used as a teaching venue for graduate and undergraduate students studying in the area
of communication disorders. It is for this reason that we have used Powell’s (2007) ‘‘model for
ethical practices in clinical phonetics and linguistics’’ as a framework for investigating the status
of our programme to determine where we are meeting the demands of ethical practice and where
we may need to make substantive changes in programming to do so.

Powell’s six constructs of ethical practice

Beneficence
Powell’s (2007, p. 852) discussion of six constructs germane to ethical practices in clinical
phonetics and linguistics began with consideration of beneficence, the attempt to ‘‘do good’’ or act
in the best interest of others. Although Powell’s view of beneficence does not require that there
always be a direct benefit from the clinical services we provide, the mission of the CCP is clear in
its purpose to provide needed supports to students-clients who participate so that they can be
successful in their college experience both academically and socially. In fact, our overall goal is
the retention of these students and their eventual graduation from the university.
Student-records data compiled by the University of Rhode Island’s DSS have shown that
university students who receive support services through the DSS, including but certainly not
limited to participation in the CCP, are just as bright as other students in the university. In fact,
they were admitted under the same set of requirements. URI students with disabilities have
demonstrated similar patterns of academic performance (as compared with non-disabled peers)
especially when the academic ‘‘playing field’’ has been leveled by reasonable accommodations.
Often misinterpreted, ‘‘reasonable accommodations’’ are designed to remove disability-impacting
barriers in the academic environment. Students with disabilities, using accommodations, are able
to fulfill the same requirements in their college programmes and demonstrate the same
competencies as students without disabilities. That is, the essential requirements of the
programme remain the same. Examples of ‘‘leveling’’ might include providing note takers to
enhance a student’s ability to concentrate on a class lecturer only, increasing the time permitted for
test taking, or allowing a student to take an exam in a separate room from classmates to decrease
potential distractions.
Our purpose in developing the CCP has been to provide a seamless transition from secondary
school support services to college-level support services. Many of the students we work with have
histories of multiple academic supports (and social supports to a lesser extent) throughout
 Practical application of Powell’s model for ethical practices 633

elementary and secondary school. Generally, these services have been provided free of charge
through the student’s school district following evaluation of the student’s needs and over many
years both parents and children have become used to a proactive service delivery model. Once the
student enters college, however, the legal umbrella is different; instead of being covered by the
Individuals with Disabilities Education Act (2004), service delivery is a function of the Americans
with Disabilities Act (1990). This change signifies a paradigm shift in how the student is viewed
by the academic institution. Services now have to be sought out by the student who has reached
legal majority and who is now in charge of the release of his or her educational records. Thus,
although our definition of ‘‘doing good’’ is to enroll students in the CCP as early in their college
careers as possible to best enhance success, we cannot solely depend on students’ caregivers to be
the primary motivators to do so. Instead we have to be sure to reach both students and families
prior to the student’s entrance into the university and maintaining contact with the family during
the student’s transition to university.

Evaluation of beneficence
Despite our belief that the needs of our students are best met through enrollment in support
services at the beginning of the college career, we have met with some resistance to our attempts
at beneficence. We believe that this may stem from the following scenario. When students who are
eligible for disability services enter college, as noted above, they may have already spent much of
their elementary and secondary school lives with multiple supports and with an identity of
disability. Entering college may represent a new chapter in students’ lives and they may want to
transition to their lives at college without a safety net of supports, as well as their prior identity as
persons with disabilities. Unfortunately, the anecdotal evidence we have collected following
students’ rejection of our offers of support has demonstrated that those who do not avail
themselves of available resources often have a less than successful experience transitioning to
college. In some cases, the difficulties they encounter in both social and academic arenas may be
so great that they may need to transfer to another institution or give up the idea of an on-campus
learning experience. To counter the negative image that support services in college may have for
students on the autism spectrum, we are currently working to increase the visibility of the CCP on
campus through the university web site and its use as a recruiting tool for prospective students
diagnosed on the autism spectrum but we have to do more in this regard. Having incoming
students explicitly confronted with the changing expectations that await them in a university
setting before their arrival may increase the likelihood that we will have a larger proportion
enrolled in the CCP from the beginning of their freshman years. Methods useful for partnering
with secondary school-based SLPs and academic advisers to be sure that our prospective students
are introduced to the differences in academic expectations and social lives in university settings
several years before their transitions are also being explored.

Non-maleficence
Powell’s (2007, p. 852) second construct, non-maleficence, requires that we both evaluate the
benefits and minimize risks of exploitation when involving our clients or patients in our
programming. We have tried to think beyond our usual safeguards of client confidentiality and
anonymity for the clinical placement represented by the CCP. That is, this clinic represents the
only time when clients receive services in the URI Speech and Hearing Center and we do not
permit anyone to observe them except for those individuals who are directly involved with the
programme (e.g. peer coaches, supervisors, communication coaches). This procedure has been
634 A. L. Weiss & P. Rohland

adopted to ensure that other college students who may be observing clinic sessions cannot
accidentally compromise the confidentiality of our programme participants because of the
likelihood that they will see these students elsewhere on campus. Similarly, communication
coaches and peer coaches are not allowed to use the names of their student clients outside the
clinic or in e-mail communication except when contacting the students to remind them of
appointments or sending them assignments. This is all explained to the clients at the first clinic
meeting and carried out with their permission. Initials are used to refer to clients in all
communications about lesson planning and the writing of post-session notes (e.g. SOAP notes,
supervisors’ feedback notes). Further, the communication coaches and peer coaches are given
explicit instructions not to acknowledge the presence of any of the participants in the CCP on
campus unless the student first acknowledges them.
We always ask early on in the clinical process which type of communication mode is preferred
by the student (e.g. phone call, text, e-mail). In fact, by doing so we have discovered that one
common deficit these students have in fulfilling academic expectations appears to be their neglect
of the importance of using e-mail and the university web site as well as related Internet sites. That
is, they do not tend to use e-mail in any regular way although their professors assume that all
students are e-mail savvy. Many professors prefer e-mail and web-based course materials for
communicating about assignments with students. Almost all of our students have started their
college experiences not knowing when review sessions were to be held, when their assignments
were due or how to access, and interpret the syllabi provided on the course sites. As a result, our
clients who typically have a difficult time exercising executive function strategies needed for
planning their day-to-day and week-to-week academic lives anyway, start their college careers
clueless about why their classmates appear to be so much more aware of requirements than they
are. Now we begin all new clients in the CCP with a session related to the importance of checking
e-mail accounts on a daily basis as well as constructing appropriate text for sending e-mail
messages to professors.

Respect
Powell’s (2007, p. 852) third construct is respect, not only in terms of respect for participants’
confidentiality but also for the opinions of others, students’ autonomy in decision-making, and
respect for the linguistic and/or cultural differences represented by the client population. This is a
particularly interesting construct to consider in light of the population of students served by the
CCP with regard to diversity of opinion. For some student participants on the autism spectrum,
rigidity and inflexibility are key characteristics of their behavior. Many have their rule sets and
stereotypical ways of approaching problems; even if these ways of dealing with problems are not
yielding success, these students are often loathe to consider changing familiar patterns of behavior
regardless of how unproductive they might be. We have learned to accept this perspective on
viewing the world as a part of the nature of ASD and we do not expect lasting change to be easily
achieved or quickly achieved. In response, we have adopted a strategy of gentle persistence. For
example, it is not at all uncommon for freshman students in our programme to insist that new
strategies are unnecessary, since the old strategies of high school worked well. Pointing out that
the requirements of college are quite different from those in secondary school rarely facilitates
change until the student experiences failure. We have tried to adopt a framework of comparisons,
pointing out what is working and where some tweaking to a pattern could be attempted. We
always seek the student’s input to see whether our suggestions for tweaking would take the student
outside of his/her comfort zone. This is not to suggest that we never address adopting new patterns
of behavior that are uncomfortable but nevertheless must be changed.
 Practical application of Powell’s model for ethical practices 635

For example, more than one student has displayed poor hygiene (not an uncommon characteristic
of students with ASD at the college level according to Brown et al., 2009) and each has been told that
all meetings with academic counselors were cancelled unless the student showered at least every
other day. For some students, a cultural difference might have been at work here if Americans seem
to be obsessive about bathing/showering frequency. If that had been the case, the stipulation of
showering every other day might have been inappropriate. However, as of this writing all our
students presenting this behavior were from mainstream American families. One particular student
client expected to get a job as a data analyst after graduation so his adherence to mainstream
standards of hygiene was a necessary pre-requisite for his achievement of employment goals.
For another student, the communication coaches’ attire (wearing lab coats during sessions) was
problematic. To her, lab coats represented a medical setting and seeing her communication coach
wearing a lab coat elicited an anxiety response. Communication coaches wear lab coats for the
same reason that all our graduate student clinicians wear lab coats: to be sure that they are
appropriately dressed for professional service delivery. Once this client expressed her concerns,
the communication coach received dispensation to remove her lab coat during her sessions with
this student.
The topic of multicultural competence in higher education, as described by Pope, Reynolds and
Mueller (2004), is also an essential consideration when working with students with disabilities and
to the CCP programme. Multicultural competence involves a distinct set of skills that develop
awareness of and respect for differences in our society. Usually discussed in relation to racial and
ethnic differences, at URI, we also apply this concept to people with disabilities. Cultural
competence is relevant to faculty development and to the training of the CCP student practitioners
to work with their adult students with disabilities. The concepts of equality and equal opportunity
are cornerstones in Higher Education Disability Services programmes. In this construct of
disability, for example, barriers are viewed as dwelling in the environment, not in the person.
Personal differences may manifest as specific disabilities but are accepted as personal difference
and normal human variation. Practitioners, faculty, and administrators who are culturally
competent strive to prepare curricula that will engage, include and respect people from many
different backgrounds and experiences, including the experience of disability.

Integrity
A fourth construct in Powell’s model refers to integrity, specifically fidelity and honesty when
reporting the outcomes of a study as well as the potential risks to participants as well as the
avoidance of conflicts of interest and disclosure (Powell, 2007, pp. 852 and 853). We believe that
we address this construct in several ways. Twice per semester we evaluate each student’s
achievement in the programme during the convening of our interdisciplinary team. Team meetings
include the academic counselors, communication coaches, peer coaches, and co-directors of the
programme. At the end of the semester, the team has the benefit of reading through a summary of
the students’ self-evaluation of their progress. It is at the end of the second team meeting that we
make consensus recommendations for each student with respect to ongoing supports needed.
After 4 years, we still consider the CCP to be in the process of development. Each participant
(e.g. clients, communication coaches, peer coaches) completes a survey at the end of each
semester that requests that they specify aspects of their learning over the semester. These results
are carefully considered and used to make changes to the programme where indicated. Since
beginning the CCP, we have added an optional conversation group with a facilitator with expertise
in the psychology of group dynamics to the programme options, decreased the number of different
peer coaches in the programme each semester to promote cohesiveness of programme delivery,
and have instituted both individual and group communication coaching sessions for the students.
636 A. L. Weiss & P. Rohland

Evaluation of programme integrity

Despite our best efforts, not every student reports having found what she or he believes is useful
support in the CCP. In contrast, we have had several students who have continued with the
programme for a year or more, building competencies needed for academic and/or social success.
Others have achieved what they believe they need for success in one semester and prefer not to
trade the number of hours of participation required (academic counselor + communication
coaching + peer coaching ¼ 4 h of contact) for study time. At times, we have supported their
decisions to leave the CCP and, at other times, we have lobbied on behalf of continuation in the
program. Some students, typically those with more debilitating forms of ASD, decide that the
programme asks too much of them and they are not willing to comply with making changes to a
daily routine that is highly routinized, stereotypical, and a social existence that is limited at best.
This decision is respected and other support services that are not perceived as overwhelming to the
student may be arranged through DSS. We have not viewed students who decide that the CCP is
not appropriate for them as failures but rather as a mismatch for the programme mission. In all
areas of therapeutic endeavor, the motivation of the client is essential for success and, in instances,
where motivation is missing, separation from the programme is the best solution. We have
maintained an open-door policy, meaning that if the student has a change of heart as he or she
progresses in college, we will consider the student’s re-entry into the CCP.
We also recognize that not every student will derive the intended benefits from the CCP or the
same degree of benefits. This information is conveyed to both students and their families, the latter
with the student’s permission. Families (students and parents) are never promised specific results
or academic success as a result of participation. That is, we endeavor to provide realistic, balanced
expectations and goals. The services that can be provided are explained as are some of our success
stories and stories of other students who did not find the programme something they wanted to
continue perhaps because of the time commitment or perhaps due to a realization that friendships
were not anything that they truly wanted to pursue (i.e. ‘‘I know I am supposed to want friends but
I really don’t.’’).

Compliance
Powell (2007, p. 853) also included compliance, the ‘‘ethical imperative to work within the
boundaries’’ specified by policies set out by professional bodies governing service delivery. The
Code of Ethics of the American Speech-Language-Hearing Association (ASHA, 2010) must be
followed when service delivery is provided by the communication coaches (graduate students
completing a master’s degree in speech-language pathology). These students receive supervision
from a state-licensed, nationally certified SLP (the first author) as per the rules and regulations of
clinical supervision for ASHA certification. The supervisor is present for all hours of clinic
scheduled each week. At present, this translates to supervising two graduate students
simultaneously for a 50% supervision rate per student, more than the ASHA minimum. The
Knowledge and Skills Assessment standards that form the basis of training speech-language
pathologists for national certification in the United States (ASHA, 2012) are used for mid-
semester and end-of-semester evaluation for the communication coaches. Although the
undergraduate students who have served as peer coaches are not evaluated in the same manner
(they are not earning practicum hours towards national certification), both of the programme
co-directors approve each peer coaching session and help to debrief the peer coaches following
each of their weekly sessions.
As already noted, clients seen in our clinic are protected by a variety of procedures aimed at
maintaining their anonymity and the confidentiality of their participation. Adherence to clinic
 Practical application of Powell’s model for ethical practices 637

regulations regarding record keeping (e.g. signing of release of information forms, completion of
progress notes, filing of progress reports written at the end of the semester) as well as compliance
with US federal law (e.g. HIPAA and FERPA) is mandatory for all participants in the CCP.
In addition, the Association for Higher Education and Disability (AHEAD) Code of Ethics
dictates that DSS professionals carry out responsibilities in accordance with AHEAD professional
standards, including confidentiality and ethical/legal conduct at the highest levels of competence
and integrity (AHEAD, Professional Standards, 2014).

Competence
Powell’s (2007, p. 853) sixth and final constructs of ethical consideration are competence from the
perspective of adhering to a professional scope of practice by monitoring the abilities of the persons
providing service delivery whether we are providing the services ourselves or supervising others in
that task. As already mentioned, the pre-professional training of graduate and undergraduate
students studying speech-language pathology requires supervisory personnel who follow the
training rubric set forth in the KASA standards as described by the ASHA (2012). The scope of
practice documents for the field of speech-language pathology provides evidence that provision of
services by SLPs to persons on the autism spectrum can include targeting both communication skills
and executive functioning competencies (ASHA, 2006). Furthermore, the personnel who provide
academic counseling for the student clients who receive services in the CCP are likewise competent
to do so. As noted above, postsecondary disability service providers are guided by the AHEAD code
of ethics and as such are committed to facilitating the highest levels of educational excellence and
potential quality of life for postsecondary students with disabilities. DSS providers must be
knowledgeable and competent to engage in the application of state and federal laws and policies to
the service delivery of students with disabilities and must maintain integrity in all areas of support to
adult students with disabilities (AHEAD, 2014).
Perhaps most relevant to the CCP, however, is the component of competence that includes
recognition ‘‘when a situation exceeds our own abilities’’ (Powell, 2007, p. 853). The CCP was
developed to be an interdisciplinary programme from the beginning because the co-directors
recognized that no one professional embodied the expertise needed by college students with
autism spectrum disorders. There have been a number of clients who have needed support beyond
the CCP. For example, a number of our clients have needed psychological counseling for anxiety
and/or depression that served as a barrier to success in the CCP. This particular need resonates
with recent findings regarding the high co-morbidity of ASD and anxiety (White, Olendick, &
Bray, 2011). Other students needed specific assistance with accessing tutoring in mathematics or
physics. Providing these types of services is beyond the scope of practice of the professionals
represented in the CCP and these students have been referred to other campus services (e.g. the
Counseling Centre, the Academic Enhancement Centre, the Writing Centre) or beyond campus for
neuropsychological testing or occupational and financial support.

Summary
Utilizing Powell’s (2007) model to evaluate our college-based programme designed to provide
support services to students with ASD has been a helpful adjunct to the collection and
consideration of feedback from the participants. Three ongoing challenges were made clearer
when viewing the CCP in terms of the ethical expectations of our clinical practice. Perhaps
foremost was that we must determine how to best individualize the programme for each student to
maximize his or her success in college in the most efficient and effective manner. Constraints to
the programme’s design are financial (i.e. cost of additional personnel) and temporal (i.e. aligning
638 A. L. Weiss & P. Rohland

schedules of participants); removing these constraints is a daunting proposition. A second

challenge is to finesse the efforts already underway to recruit students with ASD into the
programme prior to the start of their first semester. This will involve developing greater statewide
and perhaps nation-wide visibility of the CCP and more aggressive outreach to potential students
and their families. The third challenge is related to the second and this is to address the adequacy
of transition services already available to prospective college students with diagnoses of ASD in
secondary schools. That is, can the scope of the CCP extend beyond its college setting to make
recommendations for how support personnel can best help their students make a successful
transition to college? This is an important question and one that will require further consideration
of resources.

Declaration of interest
The authors report no conflict of interest.

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