REGULATION OF SLPAs

1
REGULATION OF SLPAs

• By Gail Rothwell
• for the
• Washington Speech-Language Hearing Association
• WSHA
• August 22, 2007

2
Roles of SLPs and SLPAs

• SLPAs work under the supervision of SLPs.
• SLPs and SLPAs treat those with communication
  disorders including articulation, language,
  AAC, fluency, voice, cognitive, swallow-SLPs
  only.
• SLPs and SLPAs may work in the following
  settings schools clinics various other
  medical settings.

3
Credentialing and Standards

• SLPAs have no regulation in WA State via
  national, state, local organizations. There are
  no standards for SLPAs in Washington. SLPAs are
  regulated in 35 other states.
• SLPs have differing credentials including
  Certificate of Clinical Competency from the
  American Speech-Language Hearing Assoc. (ASHA),
  Licensure from the DOH and ESA certification from
  OSPI.
• SLPs have a graduate degree.

4
National Severe Shortage of SLPs

• ASHA reports a severe shortage of SLPs.
• ASHA and the U.S. Dept. of Labors Bureau
  indicate that this is also a growing profession
  as the needs grow.
• OSPI reports that SLPs are 3rd in demand for
  educational staff needed.
• WSHA reported that there were 187 SLP vacancies
  2003-2004.

5
Effects of SLP Shortage

• ASHA reports unmanageable caseloads.
• ASHA reports that 10 of students have
  articulation and 7 have language disorders.
  Intervention increases future social and
  vocational success.
• Autism Society of America reports 1 out of every
  150 children has autism. These students
  generally need ongoing speech and language
  therapy.

6
More ASHA Concerns

• One in every 6 Americans has a communication
  disorder and this is expected to grow with the
  aging baby boomers.
• Severity of caseloads is increasing.
• SLPAs are need to support SLP workloads.
• Unfilled SLP vacancies exist the needs of the
  population increases.

7
Positive Impact of SLPAs

• SLPAs positively impact caseload/workload of
  SLPs.
• SLPAs may be able to offer more therapy for some
  students/clients.
• SLPAs can fill in the gap of the SLP shortage.
• SLPAs provide therapy to work toward exit of
  student/client.

8
WSHA Seeks Licensure of SLPAs

• Lack of regulation of SLPAs No credentialing of
  SLPAs locally or nationally.
• Lack of supervision of SLPAs ASHA recommends
  10 direct and 10 indirect.
• SLPAs in Washington have differing
  education/training

9
Education of SLPAs

• Shoreline CC SLPA Program-2 year degree and one
  year certificate
• Four Washington Universities offer BA/BS degrees
• On the job training and in house classes
• May have a degree in a related field

10
Consumer Protection

• Increase safety as SLPAs would be required to
  work under the supervision of an SLP
• SLPAs would need to follow the scope of practice
  Shall not conduct evaluations, diagnoses, write
  therapy plans, select clients/students, complete
  official and legal paperwork, consult with other
  professionals and families, etc.
• Students are at risk if state mandated therapy is
  not provided because of a lack of SLPs.

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Examples of Harm to the Public

• Working with too many students
• Lack of indirect and direct supervision
• Requests to perform tasks outside of the SLPA
  scope of practice
• Asked to do tasks without training
• Asked to work with medically fragile students and
  clients
• SLPAs should not treat swallow

12
Efforts to Address The Problem by ASHA and WSHA

• Presentations at WSHA conventions and at the
  University of Washington
• Article in the WSHA Communique newsletter
• WSHA support to establish the Shoreline CC SLPA
  Program
• ASHA has guidelines for working with SLPAs
• ASHA and WSHA have codes of ethics that state
  that appropriate credentials are needed by SLP
  supervisor.

13
Alternatives to DOH Regulation

• ASHA abandoned credentialing of SLPAs. However,
  ASHA is exploring again. But this is a time
  consuming process with an uncertain outcome.
• Employer responsibility-All employers may not
  enforce or be aware of the SLPA scope of
  practice.
• OSPI does not regulate SLPAs.

14
Implications if There is No Regulation

• SLPAs without adequate training and education
  will provide therapy and harm the public.
• The severe shortage of SLPs makes it difficult
  for SLPs to provide adequate services to students
  and this service is mandated by law.
• Therapy would be provided only by SLPs which is
  more costly and unattainable.

15
Why Licensure Not Registration or Certification

• Registration is only a database of SLPAs
  practicing.
• Certification is voluntary. Very few SLPAs may
  apply and this will cause harm to the public.
• When SLPs were certified fewer SLPs renewed their
  DOH certification each year.

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Benefit of SLPA Regulation to the Public

• Standards for training, experience and education
  can be regulated, enforced and monitored.
• Consumers may have better billing with insurance.
• SLPAs will be able to be regulated as COTAs and
  PTAs and be in more similar working environments.

17
Consumer Protection With Licensure

• Scope of Practice for SLPAs will be apparent.
• Consumers will have a means to report complaints.
• Licensure will have educational requirements
  including continuing education.
• An SLPA will be on the Board of Hearing and
  Speech.
• Supervision by SLPs will be apparent.

18
Regulation Of SLPAs

• Thirty-five states have regulation.
• Western states with regulation include Alaska,
  California, Idaho, Oregon, Montana.
• Most states require a 2 or 4 year degree in
  speech-language pathology.

19
HB 2372 Sponsored by Rep. Kelli Linville

• New section for SLPAs would be added to existing
  law for AUDs, hearing aid dispensers and SLPs.
• A 2 year, SLPA certificate or 4 year degree would
  be required.
• SLPA would provide service under direct and
  indirect supervision of an SLP.
• An SLPA would serve on the Board of Hearing and
  Speech.
• Grandfathering would occur.

20
Education of SLPAs in Washington

• Shoreline CC-Two year SLPA program and one year
  certificate On campus degree/certificate as
  well as interactive TV (ITV) classes throughout
  the state
• BA/BS programs Eastern WA U U of W WSU WWU

21
Maintenance of Standards

• SLPs would be required to supervise SLPAs.
• After grandfathering, a degree or certificate in
  the field will be required.
• Continuing education can be required.
• Board of Hearing and Speech would be able to
  discipline an SLPA as necessary under the Uniform
  Disciplinary Act.

22
Organizations Involved with Regulation of SLPAs

• ASHA-Over 120,000 AUD and SLP members
• WSHA-approximately 586 members AUDs (29) SLPs
  (535) SLPAs (22)
• SLPA-NW-29 members and 25-30 affiliate members

23
Expected Cost of Regulation

• All costs borne by the SLPAs
• There will be no cost to the public.
• SLPA salaries will remain about the same. Speech
  and language therapy services expenses may
  decrease as SLPAs have lower salaries than SLPs.
• Medicaid has been billed for some SLPA services.
  Other insurance is unknown.

24
Major Functions Performed by SLPAs

• Provide therapy to students as directed by SLP.
• Support development of speech and language in the
  classroom, community and vocational settings.
• Produce therapy materials.
• Preparation and organization of therapy room.

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• Maintain speech files, notebooks, programs and
  other forms.
• Take and record data.
• Compile data for SLP.
• Schedule students and clients for therapy.
• Communicate all relevant information to the SLP.

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Summary

• SLPAs need regulation. There are no standards
  for SLPAs in Washington. It is guesstimated that
  at least 150 employees work as SLPAs at this
  time.
• Consumers are at risk with no guarantee of the
  education and training of SLPAs. SLPAs may not
  be adequately supervised by SLPs.
• There is no continuing education for SLPAs.
• The shortage of SLPs is severe. SLPAs are needed
  to support SLPs workloads and caseloads.
• SLPAs should be able to migrate from other
  western states.
• Licensure is the level of regulation needed. It
  will provide mandated supervision of SLPAs,
  continuing education and disciplinary action when
  needed by the Board of Hearing and Speech.