Maintaining Dysphagia Skills Over a Professional Lifetime

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Maintaining Dysphagia Skills Over a Professional
Lifetime

• Soenke Stanschus
• Karlsbad, Germany
• Janet Brown, ASHA
• Invited SessionDivision 13
• Swallowing and Swallowing Disorders

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Special Interest Division 13Swallowing and
Swallowing Disorders Why join ASHA Division 13
Swallowing and Swallowing Disorders?

• Perspectives Newsletter 4 per year with CEUs
  sent electronically.
• Discounts on Division sponsored short courses at
  the ASHA convention and other ASHA educational
  offerings
• Networking with colleagues through a Division
  listserve and web forum
• Tools to help you advocate for yourself and your
  patients

• Policy documents to guide your practice
• Grants to support your research practice
  including 2 new investigator grants for first
  time presenters at DRS
• Learn about Specialty Recognition in Swallowing
  and Swallowing Disorders
• All this for a remarkably small investment
• 35.00 year
• 10.00 year/students

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Special Interest Division 13 Swallowing and
Swallowing Disorders 2007 ASHA Convention
Activities

• Join Us
• Special Interest Division 13
• Meeting Date 11/16/07
• Time 430pm-530pm
• Location Room
• Boston Convention Exhibition Center, 52B
• Please join us.
• Your input is very important!

Visit us at the Graduate Student Fair Thursday
and Friday afternoon at the ASHA Exhibit
Hall We will have a thank you gift for you at
the Div 13 table
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SLP and Swallowing Past, Present, Future

• Janet Brown
• Director, Health Care Services in SLP
• ASHA
• jbrown_at_asha.org

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How Dysphagia Evolved in SLP

• Early involvement with children with cerebral
  palsy
• 1972 Articles (Larsen, G.)
• 1975 Article on cinefluorography study
  (Blonsky, Logemann, Boshes, Fisher)
• 1983-4 Books by Logemann Groher
• 1988 Endoscopy article (Langmore et al.)

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Dysphagia as Policy

• 1981 Included in Medicare guidelines
• 1987 1st ASHA technical report
• now 15 at www.asha.org/policy
• 1989 Medicare recognizes dysphagia as
  stand-alone service
• 1999 AHCPR (now AHRQ) evidence-based report
• 2005 CFCC Standards for Certification include
  swallowing
• 2007 New ICD-9 codes

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Acquiring and Maintaining Skills Two Early
Approaches

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What Were/Are the Stakes for SLPs?

• Positive perceptions
• Professional credibility
• Good outcomes for patients
• Reimbursement
• Negative perceptions
• Overgeneralized
• One size fits all
• Obstructionist

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Current Practice What are the Standards for
Professional Skills?
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Adult Swallowing Services Percentage of Time
Spent
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Pediatric Swallowing ServicesPercentage of Time
Spent
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Schools Percentage of SLPs Who Treat Swallowing
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Current Standards

• Certificate of Clinical Competence
• Board Recognized Specialist in Swallowing
• (BRS-S)
• Clinical (including supervision)
• Research/Teaching
• www.swallowingdisorders.org
• Affiliations
• Division 13 membership
• Dysphagia Research Society

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ASHA Policy Documents

• Scope of Practice (2007)
• Oral, pharyngeal, laryngeal, and esophageal
• Preferred Practice Patterns
• Position statements, technical reports, knowledge
  and skills
• Evolution toward clinical practice guidelines

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Recommendations for Acquiring Knowledge and
Skills

• Reading, continuing education
• Direct observation
• Practice under direct supervision
• Independent practice with
• indirect supervision

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Continuing Education

• Not all CE programs are created equal
• What ASHA CEU means
• How to evaluate quality of programs
• www.asha.org/members/evaluate

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Transmitting Expertise

• Access to
• clinical experts
• instrumentation
• populations
• Peer learning/mentoring
• Journal study groups
• Hands-on clinical teaching

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Facilitating Peer Learning/Mentoring

• Opportunities for clinical observation,
  shadowing, coaching
• Needed for transitions to new populations
• Adult to pediatric
• Hospital to SNF
• Schools to health care
• Health care to schools

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Challenges for Clinicians

• Training in supervision
• Awareness of resources
• Ability to give feedback
• www.asha.org/members/slp/supervision

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Role of Research

• Demand for evidence to support clinical practice
• Need for greater collaboration, research skills

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Other Influences

• Commercial interests/Public perception

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Other Influences

• Payers
• Medicare, Medicaid
• Private insurance
• State legislatures scope of practice
• Legislative/regulatory
• Other professions

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New Frontiers

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Scope of Practice

• Esophagus
• Instrumentation
• Collaboration vs. encroachment
• Coding (ICD-10 ICF)
• Home environment

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Telepractice

• Assessment
• Supervision
• Unresolved issues
• Licensure
• Reimbursement
• Standardization
• Photo Courtesy of National Rehabilitation
  Hospital, Washington, D.C.

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Specialists or Generalists?

• University programs
• Next generation of SLP clinicians