SPEECH-LANGUAGE PATHOLOGY ASSISTANTS (SLPAS):GUIDELINES, TRENDS AND RESOURCES

Sandra Nettleton, Ph.D., CCC-SLP

University of New Mexico

NMSHA President-Elect

DISCLOSURESSANDRA NETTLETON

I have no relevant financial or nonfinancial relationship(s) within the products or services described, reviewed, evaluated or compared in this presentation.

PRESENTATION HANDOUT AND CEUS

This power point presentation is available on a link below the video.

CEUs:• Watch full content of training video.• Click link to take test for Assessment of Learning (below

video).• Take test unlimited number of times.• Once completed, a certificate will be emailed to you.• Complete course feedback (following test).• NMSHA will submit credit information to ASHA for CEU

credit(s).

RESOURCES AND REFERENCES

ASHA Speech-Language Pathology Assistant Scope of Practice. 2013

ASHA Frequently Asked Questions: Speech-Language Pathology Assistants. 2013

ASHA Speech-Language Pathology Assistants: Overview, Key Issues, Resources, References. 2013

ASHA Issues in Ethics: Speech-Language Pathology Assistants. 2014

Speech-Language Assistants (SLPAs): Current Trends. Presentation by Jennifer A. Ostergren and Sara Aguilar. California.

Technical Training Programs for SLPAs. ASHA

RESOURCES AND REFERENCES

Ostergren, J. & Aguilar, S. (2012). A Survey of Speech-language Pathology Assistants in California: Current Trends in Demographics, Employment, Supervision and Training. Contemporary Issues in Communication Science and Disorders, 39, 121-136.

Ostergren, J. and Aguilar, S. (2015). Speech-Language Pathology Assistant Supervisor Survey. Contemporary Issues in Communication Science and Disorders, 42, 226-245.

WHO ARE SLPAS?(ASHA, 2013, FREQUENTLY ASKED QUESTIONS)

“Speech-Language Pathology Assistants are support personnel who, following academic coursework, fieldwork, and on-the-job training, perform tasks prescribed, directed, and supervised by ASHA-certified speech-language pathologists.” (ASHA, 2013).

States will use different terminology to refer to assistants in Speech-Language Pathology including aides, assistants, and paraprofessionals.

THE DIFFERENCE BETWEEN SLP APPRENTICES AND SLP ASSISTANTS

Apprentices

Currently licensed in New Mexico.

Temporary License with supervision from a licensed SLP.

Must have a BA degree in SLP or 30 hours of course credit in communication disorders

Must be enrolled in a Master’s Program in SLP or will enter a program within 2 years of initial licensure

Must have Grade Point Average of 3.0 or above.

Assistants

• Currently NOT licensed in NM, although state licensing board is proposing an SLPA license to the NM Legislature.

• Are currently hired as licensed school-based paraprofessionals.

• Permanent license with supervision by a licensed SLP.

• May have a BA in Communication Disorders plus 100 hours of clinic experience or an SLPA Associate Degree.

USE OF SLPAS

(ASHA, 2013 EXECUTIVE SUMMARY)

“Some tasks, procedures, or activities used to treat individuals with communication and related disorders can be performed successfully by individuals other than SLPs if the persons conducting the activity are properly trained and supervised by ASHA-certified and/or licensed SLPs.”

USE OF SLPAS

“The utilization of evidence and ethical and professional judgment should be at the heart of the selection, management, training, supervision, and use of support personnel.”

SLPA: PRACTICE SETTINGS(ASHA, 2013)

Under the specified guidance and supervision of an ASHA-certified SLP, SLPAs may provide services in a wide variety of settings, which may include:

public, private, and charter elementary and secondary schools;

early intervention settings, preschools, and day care settings;

hospitals (in- and outpatient);

residential health care settings (e.g., long-term care and skilled nursing facilities);

nonresidential health care settings (e.g., home health agencies, adult day care settings, clinics);

private practice settings;

university/college clinics.

AGENCIES AND SUPERVISORS MUST ASSURE COMPLIANCE WITH THE FOLLOWING:

1) SLPAs need to identify themselves as an SLP Assistant (not a licensed SLP).

• Name badge with qualifications.

• Written qualifications provided to other professionals, clients and families.

• Qualifications verbally expressed as introduced to professional, clients and families.

2) SLPAs must exhibit compliance with HIPAA and FERPA regulations, reimbursement requirements, and responsibilities of the SLPA.

SLPA SCOPE OF PRACTICE: SERVICE DELIVERY

(ASHA SLPA SCOPE OF PRACTICE, 2013)

“Provided that the training, supervision and planning are appropriate, tasks in the following areas of focus may be delegated to an SLPA (this is not a complete list):

Assist the SLP during assessment of students, patients and clients exclusive of administration and/or interpretation.

Follow documented treatment plans and protocols developed by the SLP.”

Document student, patient and client performance (e.g. tallying data for SLP use, preparing charts and graphs) and report this information to the SLP.

Program and provide instruction in the use of AAC devices

USING THE SLPA AS AN INTERPRETER

SLPAs who have the skills in a second language may serve as interpreters when needed.

Additional training is required and ASHA provides the following resources:Knowledge and Skills Needed by Speech-language Pathologists and Audiologists to

Provide Culturally and Linguistically Appropriate Services (ASHA, 2004).

ASHA Practice Portal: Cultural Competence.

Tips for Working with an Interpreter (ASHA).

SLPA SCOPE OF PRACTICE: ADMINISTRATIVE SUPPORT(ASHA SLPA SCOPE OF PRACTICE, 2013)

Assist with preparation of materials and scheduling activities, as directed by the SLP.

Perform checks and maintenance of equipment.

Assist with departmental operations (recordkeeping, safety/maintenance of supplies and equipment).

SLPA SCOPE OF PRACTICE: PREVENTION/ADVOCACY(ASHA SLPA SCOPE OF PRACTICE, 2013)

Present primary prevention information to individuals and groups known to be at risk for communication disorders.

Advocate for individuals and families through community awareness and education.

SLPA SCOPE OF PRACTICE: PREVENTION/ADVOCACY(ASHA SLPA SCOPE OF PRACTICE, 2013)

Advocate at the local, state and national levels for improved public policies.

Participate actively in professional organizations such as NMSHA and ASHA.

OUTSIDE THE SCOPE OF AN SLPA(ASHA SLPA SCOPE OF PRACTICE, 2013)

The SLPA should NOT engage in the following:

Represent himself or herself as an SLP.

Perform standardized or non-standardized diagnostic tests, formal or informal evaluations, or swallowing screenings/checklists.

Perform procedures that require a high level of clinical and technical skills (e.g., vocal tract imaging and oral pharyngeal swallowing treatment).

Provide interpretative information to the student/patient/client, family, or others regarding the patient/client status or service.

OUTSIDE THE SCOPE OF AN SLPA(ASHA SLPA SCOPE OF PRACTICE, 2013)

The SLPA should NOT engage in the following:

Participate in formal parent conferences, case conferences, or any interdisciplinary team without the presence of the supervising SLP or other designated SLP.

Write, develop or modify a student’s, patients, or client’s treatment plan in any way.

Sign any formal documents (e.g., treatment plans, reimbursement forms, or reports)

The SLPA should sign or initial informal treatment notes for review and co-sign with the SLP.

OUTSIDE THE SCOPE OF AN SLPA(ASHA SLPA SCOPE OF PRACTICE, 2013)

The SLPA should NOT engage in the following:

Assist with student, patients, or clients without following the individualized treatment plan prepared by the certified SLP and/or without access to supervision.

Select students, patients or clients for service.

Discharge a student, patient or client from services.

Make referrals for additional service.

Develop or determine the swallowing strategies or precautions for patients, family or staff.

OUTSIDE THE SCOPE OF AN SLPA(ASHA SLPA SCOPE OF PRACTICE, 2013)

The SLPA should NOT engage in the following:

Disclose clinical or confidential information either orally or in writing to anyone other than the supervising SLP (the SLPA must comply with current HIPAA and FERPA guidelines) unless mandated by law.

Treat medically fragile students/patients/clients independently.

Design or select augmentative and alternative communication systems or devices.

Note: State laws vary and may differ from ASHAs guidelines and requirements for tasks outside of the SLPA Scope of Practice.

WHAT ARE THE ADVANTAGES TO THE SLP IN USING AN SLPA IN PRACTICE?

• Results of surveys and report indicate that the SLP may increase the frequency and intensity of services to patients or clients on his/her caseload/workload with assistance by an SLPA.

• SLP may focus more on professional-level tasks and achieve more efficient/effective use of time and resources.

• ASHA 2000 Schools Survey: 47.3% of respondents reported that use of SLPA lead to more time for service; 23% said that use of SLPAs led to more planning time and consultation with teachers.

• ASHA 2009 Membership Survey: 36% of SLPs had more time to work with complex clients; 33% reported less clerical duties; 29% indicated a higher caseload or workload with SLPAs.

WILL SLPAS BE USED TO REPLACE SLPS? (ASHA, SLPA FREQUENTLY ASKED QUESTIONS)

NO. SLPAs support clinical services provided by SLPS.

SLPAs do not carry their own caseloads.

ASHA and most states limit the number of SLPAs an SLP can supervisor as well as their scope of service.

REIMBURSEMENT FOR SLPA SERVICES

(SLPA FREQUENTLY ASKED QUESTIONS, ASHA 2013)

MEDICARE. Services of SLPAs are NOT recognized by Medicare. Services provide by SLPAs will be considered unskilled services and defined as not reasonable and necessary if they are billed as therapy services within Medicare.

PRIVATE INSURANCE: may not cover licensed or registered SLPAs. New Mexico does not reimburse SLPAs for services.

MEDICAID reimbursement of SLPAs varies from state to state. Contact the “National Association of Medicaid Directors” to determine coverage in each state. New Mexico does not reimburse SLPAs for services.

EDUCATIONAL AND TRAINING REQUIREMENTS FOR SLPAS(SLPA EDUCATIONAL AND TRAINING REQUIREMENTS, ASHA 2013)

Educational requirements and preparation for SLPAs vary considerably from state to state and by practice setting.

ASHA does not accredit or approve SLPA education or training programs.

27 programs are currently reported including Arizona State University, Northern Arizona University, University of Colorado, University of Northern Colorado, and University of Houston.

Currently, there are no SLPA training programs in the state of New Mexico.

ASHA SUGGESTED MINIMAL QUALIFICATIONS (ASHA 2013)

Degree Requirement

An Associate’s degree in an SLPA program; or

A Bachelor’s degree in a speech-language pathology or communication disorders program

Clinical Experience

Successful completion of a minimum of 100 hours of supervised field experience or its clinical experience equivalent.

(At least 1 hour of direct supervision weekly and as much indirect supervision as needed.)

Observation Experience

Include direct on-site or video observation of an ASHA certified SLP.

SUGGESTED GENERAL EDUCATION COURSES (ASHA, 2013)

Oral and written communication, including grammar and usage, composition and business writing.

Mathematics including business mathematics, accounting, algebra.

Technology: computer literacy, word processing, web-based applications, digital audio and video files.

Social and natural sciences: psychology, sociology, anatomy and physiology.

SUGGESTED TECHNICAL COURSES (ASHA, 2013)

Overview of normal processes of communication, including normal speech, language and hearing development

Overview of communication disorders, including introduction/survey to communication disorders in both speech and language.

Overview of anatomy and physiology of the speech and hearing mechanism.

Instruction in assistant-level service delivery practices (e.g. technical procedures for SLPAs and ethics in SLP).

INSTRUCTION IN WORKPLACE BEHAVIORS (ASHA, 2013)

Relating verbally and nonverbally to client-caregivers in a professional manner.

Accepting and implementing supervisor feedback.

Maintaining confidentiality and security of client information.

Following health and safety precautions.

Communicating effectively in oral and written formats that are consistent with federal and state regulations.

CULTURAL AND LINGUISTIC FACTORS IN COMMUNICATION(ASHA, 2013)

Language and Culture

Interpersonal Communication

Sign language or other manually coded systems

Bilingualism

Multicultural Issues

ADDITIONAL CURRICULUM AND EXPERIENCES

Should include:

Training in therapy techniques and strategies such as treatment plans, data collection.

Training in specific populations (e.g., autism, cerebral palsy).

Documentation ( SOAP notes, data collection).

Once employed, training on tasks and populations specific to their work employment.

ASSOCIATES IN ASHA

ASHA has established an associate affiliation program for support personnel initiated to improve the use of support personnel in speech-language pathology and audiology.

Source: Robinson, Jr., T (2010 August). Associates in ASHA: A New Initiative. ASHA Leader.

ASHA ASSOCIATE ELIGIBILITY• Associates must meet the state licensing, certification, or registration

requirements as an assistant (if applicable).

• Associates must agree to adhere to ASHA policies pertaining to support personnel.

• There is an annual fee.

• If currently employed as an SLPA, the supervising SLP must attest to the competence of the SLPA.

• If not currently employed as SLPA, the college or university program director attests to competence of SLPA.

ASSOCIATE BENEFITS

• Professional Development hours

• Networking opportunities with other Associates

• Access to on-line career center

• Affinity benefits such as insurance, credit card offers, car rental

• Liability insurance at a group rate

SLPA SUPERVISOR QUALIFICATIONS(ASHA SCOPE OF PRACTICE, 2013)

Current ASHA certification and/or state licensure.

Completion of at least 2 years of practice following CF Year.

Completion of an academic course or at least 10 hours of continuing education credits in the area of supervision.

RECOMMENDED AMOUNT OF SUPERVISION: FIRST 90 DAYS

A total of at least 30% supervision weekly, including at least 20% direct and 10% indirect supervision.

During each week, data on every student, patient and client seen by the SLPA should be reviewed by the supervisor.

Supervision days and time of day (morning/afternoon) may be alternated to ensure that all students, patient and clients receive some direct contact with the SLP at least once every 2 weeks.

RECOMMENDED AMOUNT OF SUPERVISION: AFTER FIRST 90 DAYS

• Amount of supervision can be adjusted if the supervising SLP determines that the SLPA has met appropriate skill levels with a variety of communication and related disorders.

• Minimum ongoing supervision must include documentation of direct supervision provided by the SLP to each student, patient or client at least every 60 calendar days.

• At least one hour of direct supervision weekly.

• As much indirect supervision needed to assure maintenance of quality services.

• 100% supervision of medically fragile clients.

MAXIMIZE SUPERVISION AND EFFECTIVENESS

1) ASHA (2013) suggests no more than 2 full time equivalent (FTE) SLPAs in any setting.

2) Ensure good (not just minimal) contact with clients. Supervision days (and time of day) should be altered so that clients receive some direct contact time with SLP at least once every 2 weeks.

CASELOAD-WORKLOAD MANAGEMENT

It takes time to adequately supervise an SLPA. Consider caseload-workload formulas.

Resource: ASHA (2002). A workload analysis approach for establishing speech-language caseload standards in the school position. Www. Asha.org/policy

SLPAs do not carry their own caseloads; rather they help to provide services to the SLPs caseload as directed by the SLP.

ASHA CODE OF ETHICS: SLPASASHA (2013). ISSUES IN ETHICS: SLPAS

It is imperative that the SLPs and SLPAs behave in a manner that is consistent with the ASHA Code of Ethics.

The amount and type of supervision should meet the minimal requirements and be increased based on the experience and needs of the SLPA, student and clients, service setting, the tasks assigned and other factors.

The SLP must ensure that roles and responsibilities are clearly delineated and that task assignments are commensurate with level of training.

SLPAs must be appropriately identified to consumers, employers, colleagues and regulatory and funding agencies.

ASHA PRINCIPALS AND RULES THAT MOST APPLY TO SLPAS

• Principle of Ethics 1: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally.

• Principle of Ethics 1, Rule D: Individuals shall not misrepresent the credentials of assistants, technicians, support personnel, and students.

• Principles of Ethics 1, Rule E: SLPs shall not delegate tasks that require the unique skills, knowledge and judgment that are within their scope of practice to assistants….

• Principle of Ethics 1, Rule F: SLPS may delegate tasks related to provision of clinical services to assistants only if those services are appropriately supervised…

ASHA PRINCIPALS AND RULES THAT MOST APPLY TO SLPAS

• Principle of Ethics II: Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance.

• Principle of Ethics II, Rule D: Individuals shall not require or permit their professional staff to provide services… that exceed the staff member’s competence..

• Principle of Ethics II, Rule E: Individuals shall ensure that all equipment used to provide services is in proper working order and calibrated.

• Principle of Ethics IV: Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students and members..

• Principle of Ethics IV, Rule A: Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessionalrelationships….

SUPERVISION AND SLP ASSISTANT RESOURCES

ASHA. Practical Tools and Forms for Supervising Speech-Language Pathology Assistants.

Ostergren, J. (2014). Speech-Language Pathology Assistants (SLPAs): A resource manual. San Diego. CA. Plural Publishing.

ASHA teleseminars and conferences on supervision as listed on the Continuing Education page.

ASHA eWORKSHOP: Effectively Using SLP Assistants to Support Quality Service Delivery.

McCready, V. (2007). Supervision of SLPAs: A Reciprocal Relationship. ASHA Leader, May, Vol. 12, 10-13.

IN CONCLUSION

• As ASHA and states move forward in recognizing the use of support personnel for the provision of speech-language pathology services more resources, training and regulation is needed.

• I hope that this presentation has given you some preliminary and informative guidelines and resources so that you can move forth in your employment of SLPAs and/or make an educated decision about whether the employment of SLPAs is the right decision for you and your agency.

• Thank you for your attention!!