SpeechLanguage Pathology Assistants

1
Speech-Language Pathology Assistants

• Melissa Corcoran
• Nehal Kothari
• Samantha Sefton

2
What is an SLPA?

• Speech Language-Pathology Assistants are support
  personnel who, following academic and/or
  on-the-job training, perform tasks prescribed,
  directed, and supervised by ASHA certified
  speech-language pathologists.
• (http//www.asha.org/about/membership-certificaito
  n/faq_slpasst.htm)

3
What can SLPAs do?

• According to ASHA (2007)
• Assist speech-language and hearing screenings
  (without interpretation)
• Assist with informal documentation as directed by
  the speech-language pathologist
• Follow documented treatment plans or protocols
  developed by the supervising speech-language
  pathologist
• 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 supervision
  speech-language pathologist
• Assist the speech-language pathologist during
  assessment of patients/clients

4
What can SLPAs do?

• Assist with clerical duties such as preparing
  materials and scheduling activities as directed
  by the speech-language pathologist
• Perform checks and maintenance of equipment
• Support the supervising speech-language
  pathologist in research projects, in-service
  training, and public relations programs
• Assist with departmental operations (scheduling,
  record keeping, safety/maintenance of supplies
  and equipment)
• Collect data for monitoring quality improvement
• Exhibit compliance with regulations,
  reimbursement requirements, and speech-language
  pathology assistant's job responsibilities
• (http//www.asha.org/about/membership-certificatio
  n/faq_slpasst.htmb1)

5
What duties are outside their scope of practice?

• According to ASHA (2007), an SLPA
• May not perform standardized or nonstandardized
  diagnostic tests, formal or informal evaluations,
  or clinical interpretation of test results
• May not screen or diagnose patients/clients for
  feeding/swallowing disorders
• May not participate in parent conferences, case
  conferences, or any interdisciplinary team
  without the presence of the supervising
  speech-language pathologist or other
  ASHA-certified speech-language pathologist
  designated by the supervising speech-language
  pathologist
• May not write, develop, or modify a
  patient/client's individualized treatment plan in
  any way

6
What duties are outside their scope of practice?

• May not assist with patients/clients without
  following the individualized treatment plan
  prepared by the speech-language pathologist or
  without access to supervision
• 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)
• May not select patients/clients for service
• May not discharge a patient/client from services
• May not disclose clinical or confidential
  information either orally or in writing to anyone
  other than the supervising speech-language
  pathologist

7
What duties are outside their scope of practice?

• May not make referrals for additional service
• May not counsel or consult with the
  patient/client, family or others regarding the
  patient/client status or service
• May not use a checklist or tabulate results of
  feeding or swallowing evaluations
• May not demonstrate swallowing strategies or
  precautions to patients, family, or staff
• May not represent himself or herself as a
  speech-language pathologist
• (http//www.asha.org/about/membership-certificatio
  n/faq_slpasst.htmb1)

8
Are SLPAs certified?

• ASHA does not certify SLPAs but has had a
  voluntary registration program in the past which
  required SLPAs to have an associates degree in
  SLPA form a technical training program.
• However this registration program and the SLPA
  program approval process was discontinued in
  December of 2003 due to financial constraints.

9
Are SLPAs licensed?

• In some states (i.e., Texas)
• In other states such as Ohio, SLP Assistants are
  not licensed or permitted to practice
• Ohio does license Speech-Language Pathology Aides
• SLP-Aides typically have less education than
  assistants (HS diploma), may not function without
  direct supervision, and may not perform therapy
  or evaluations
• (Ohio Board of Speech-Language Pathology and
  Audiology, 2007)

10
Facts about SLPAs

• Used and regulated in many states since the 1970s
• 16.4 of ASHA certified speech language
  pathologists reported that at least one SLPA
  worked in their facility
• In schools, 25.4 said SLPAs worked in this
  setting
• ASHA recommends that SLPAs be supervised at least
  30 weekly (20 direct) for the first 90 days of
  employment and 20 (10 direct) after that
• Other assistants, such as in the Occupational and
  Physical Therapy professions, make about 60-70
  of the salary of a professional (ASHA has not
  collected data on SLPA salaries)
• There are currently 19 operational associate
  degree programs for SLPAs
• ASHA, 2007
• http//www.asha.org/about/membership-certificatio
  n/faq_slpasst.htmb1

11
Academic and Clinical Requirements

• ASHA recommends that those interested must have
  completion of an associate's degree from a
  technical training program with a program of
  study designed to prepare the student to be a
  speech-language pathology assistant. (ASHA, 2004)
  
• Various programs across the country have
  different academia as well as clinical
  requirements.

12
Academic and Clinical Requirements

• Florida Board of Speech Language Pathology
  requires
• A Bachelor's degree from a college or university
  (accredited by a regional association of colleges
  and schools recognized by the Department of
  Education)
• Includes at least twenty-four (24) semester hours
  of course work
• Additional requirements Participation in a
  supervisory plan (2 hours) Prevention of Medical
  errors
• (Florida Department of Health, 2007)
• North Carolina Community Colleges offer
  comprehensive academic coursework.
• The coursework involves classes on subjects such
  as Basic Anatomy and Physiology, Oral
  Communication, Normal Communication,
  Interpersonal Communication and Ethics and
  Standards of SLPA.
• (NCSHLA, 2006)

13
Academic and Clinical Requirements

• State of California requires training in the
  following areas
• SLPA associate of arts or sciences degree program
  approved by the Board.
• Equivalent SLPA degree program (out-of-state
  training) as approved by the Board
• Bachelors degree program in Speech-Language
  Pathology or Communicative Sciences, including 70
  hours of clinical experience.
• (California Speech-Language Pathology and
  Audiology Board, 2007)
• Thus, different state agencies (licensure boards)
  currently regulating support personnel have
  different training requirements

14
The Pros

• Growing shortage of SLPs in all the settings
• Field of Speech Language Pathology is very broad.
• Probable reason Court decision to mandate
  Masters degree for SLP certification.
  (Williamson, 2001).
• Employers perspective (more economical)
• Growing Caseloads
• Hiring two SLPAs may be more economical than
  hiring two additional SLPs

15
The Pros

• Patients perspective
• May benefit by obtaining more number of service
  hours. (especially for busy settings like public
  schools).
• SLPA can provide basic therapeutic services such
  as, drill work for articulation disorder.
• Frequency and intensity of services may increase.
• SLPs perspective
• Sharing workload may yield additional time to
  work on professional- level tasks, such as,
  creating patient specific material and
  researching new treatment protocols.

16
The Pros

• According to the ASHA 2000 Schools Survey
• 47.3 of respondents indicated that the use of
  SLPAs led to more time for direct service
• 23.1 indicated that use of SLPAs led to more
  time for planning/consultation with teachers
• (as cited in ASHA, 2004).
• Thus, appropriate use of SLPAs may be beneficial
  for all three SLP, employer and the patients.

17
The Cons

• Will SLPAs threaten the field of speech-language
  pathology in any way?
• Direct to manage service provision
• Will it become a backdoor into the profession
  of SLP?
• Can the SLP/SLPA model really be based of the
  PT/PTA model?
• Standard mobility protocols
• Administrators unclear of the role of an SLP
• Medicare reimbursement

18
The Cons

• Is it effective/efficient when direct supervision
  is required?
• Are SLPs clear on their legal and ethical
  obligations/responsibilities as a supervisor?
• What will be the required knowledge level of
  SLPAs?
• Lack of consistency across programs
• No CEU requirement
• Does this move the field away from comprehensive
  patient care? Does it create a lack of
  continuity?

19
The Cons

• Is it appropriate to address the effects of the
  SLP shortage before addressing the cause(s)?
• This is a backwards approach to solving the
  problem!
• Even though SLPAs could lead to more efficient
  and effective use of time and resources, it
  should not be considered a cure

20
How does this affect us?

• The issue of using SLP assistants hit home when a
  legislative study on how to solve personnel
  shortages concluded that licensed SLP assistants
  should be used to provide services to students in
  the schools under the direction of a licensed SLP
• The legislature then approached Ohio Department
  of Education about licensing assistants
• This committee soon grew to professional stake
  holders who did not feel that using SLPAs was a
  solution for Ohios Shortages
• (Boswell, 2007)

21
How does this affect us?

• In response to shortages OMNIE instead has
  developed programs that allow graduate interns to
  staff schools or complete a distance learning
  masters degree program, provide financial
  incentives to SLPs who take jobs in the schools,
  ease licensure requirements for serving students
  in the school systems, and include the use of SLP
  aides. (Boswell, 2007)

22
References

• American Academy of Physical Medicine and
  Rehabilitation (2005). Medicares New Policy on
  Supervision of Incident To Therapy Services.
  Retrieved April 26, 2007 from http//www.aapmr.or
  g/hpl/pracguide/pmrprac/newpolicy.htm
• American Speech-Language-Hearing Association
  (2004). Guidelines for the Training, Use, and
  Supervision of Speech-Language Pathology
  Assistants Guidelines. Available at
  http//www.asha.org/members/deskref-journals/desk
  ref/default
• American Speech-Language-Hearing Association
  (2007). Speech Language Pathology Assistant
  Frequently Asked Questions. Retrieved April 23,
  2007 from http//www.asha.org/about/
  membership- certification/faq_slpasst.htmb1
• Boswell, Susan. Ohio Grant Addresses Personnel
  Shortage. Innovative Strategies Meet Short- and
  Long-Term Goals. The ASHA Leader, 12 (3),
  114-15.
• California Speech-Language Pathology and
  Audiology Board (2007). Speech- Language
  Pathology Assistants (SLPA). Retreived April 29,
  2007 from http//www.slpab.ca.gov/ assistant.htm

23
References

• Florida Department of Health (2007). Board of
  Speech-Language Pathology and Audiology
  Application Materials for Assistant
  Certification. Available at http//www.doh.state
  .fl.us/mqa/speech/ap_assistantCert.pdf
• Northam, A., McGraw, P., Alarcon, N., McNeilly,
  L. (2006). Report of Ad Hoc Committee on
  Appropriate Use of Assistants. Retrieved April
  23, 2007 from http//www.asha.org/NR/
  rdonlyres/CB2F8CE4-473A- 41B2-941E-B0886CA945E3/0/
  AHCSLPAsReport.pdf
• North Carolina Speech, Hearing, Language
  Association (2006). SLP Assistant Programs in
  North Carolina. Retrieved April 29, 2007 from
  http//www.ncshla.org/students/ slpaprograms.php
• Ohio Board of Speech-Language Pathology and
  Audiology (2007). The Laws and Regulations
  Governing the Ohio Board of Speech-Language
  Pathology and Audiology. Retrieved April 23,
  2007 from http//slpaud.ohio.gov/pdfs/RC4753.pdf
• Williamson, D. (July 17, 2001). Public Schools
  May Face Shortage of Speech- Language
  Pathologists. UNC News Services. Available at
  http//www.unc.edu/news/archives/jul01/
  fra071901.htm