Support personnel assist speech-language pathologists (SLPs) in providing a variety of services in different work settings. Titles used to identify speech-language pathology support personnel vary by state and include, but are not limited to, speech-language pathology assistant (SLPA), SLP-Assistant, paraprofessional, speech aide, therapy assistant, and communication aide.
Differing levels of support personnel (e.g., aide, assistant, associate) may exist within and across work settings, states, or organizations. ASHA uses the term SLPA to refer to one category of support personnel with a specific scope of practice as detailed below. The SLPA Scope of Practice defines aides/technicians and assistants; these may not be consistent with the definitions used in individual states.
While ASHA endorses the use of trained and supervised support personnel, ASHA does not require the use of support personnel. SLPs should not be expected to use support personnel, particularly if they feel that quality of service may be compromised. ASHA expects SLPs to use support personnel in accordance with the ASHA Code of Ethics and may impose sanctions on SLPs if assistants are used inappropriately.
SLPAs and supervising SLPs are required to determine the specific requirements in their respective work settings and states. See ASHA's State-by-State page for the Summary of State Requirements for Support Personnel. ASHA's Model Bill for State Licensure (2012) [PDF] includes provisions relating to audiology and speech-language pathology assistants.
SLPs should consider the following when hiring or working with an SLPA:
- Appropriate training and supervision of SLPAs is to be provided by SLPs who hold ASHA's Certificate of Clinical Competence (CCC) in Speech-Language Pathology.
- An SLP should not supervise or be listed as a supervisor for more than two full-time (FTE) SLPAs in any setting or combination thereof.
- Activities may be assigned only at the discretion of the supervising SLP and should be constrained by the Scope of Practice for SLPAs.
- The best interest and protection of the consumer should be paramount at all times.
- The purpose of the SLPA should not be to increase or reduce the caseload size for SLPs, but rather to assist SLPs in managing their existing caseloads. SLPAs should not have full responsibilities for a caseload or function autonomously. (ASHA, 2013)
SLPs must inform consumers when services are provided by support personnel. SLPs may delegate certain tasks to support personnel, but the SLP retains the legal and ethical responsibility for all services provided or omitted.
ASHA has established an Associate's Affiliation Program for support personnel in speech-language pathology and audiology open to individuals who
- are currently employed in support positions providing audiology or speech-language pathology services and working under the supervision of an ASHA-certified audiologist (CCC-A) or SLP (CCC-SLP) or have obtained the signature of the program director (or training program instructor) certifying that they are qualified to provide services under the direction of an ASHA-certified audiologist or speech-language pathologist; and
- are qualified to work as audiology or speech-language pathology support personnel in the state and follow the state licensure, registration, or certification rules (if any) that are applicable to them.
Applicants are required to obtain the signature of their ASHA-certified supervisors in order to become ASHA Associates.
Supervising SLPs retain full legal and ethical responsibility for the students, patients, and clients served but may delegate specific tasks to an SLPA. The SLPA may execute specific components of a speech, language, or feeding program as specified in treatment plans developed by the SLP, provided that
- the goals and objectives listed on the treatment plan and implemented by the SLPA are only those within the SLPAs scope of practice and are tasks the SLP has determined the SLPA has the training and skill to perform, and
- the SLP provides at least the minimum specified level of supervision to ensure quality of care to all persons served. The amount of supervision may vary and must depend on the complexity of the case and the experience of the assistant.
ASHA's Speech-Language Pathology Assistant Scope of Practice includes guidance on
Use of SLPAs as Interpreters
SLPAs who have the necessary skills in a second language may serve as interpreters when needed. Bilingual SLPAs providing clinical services in a language other than English may do so within the scope of specified ASHA-approved job responsibilities and under the supervision of an ASHA-certified SLP.
Ethical Obligations of SLPAs
The ASHA Code of Ethics specifies the ethical obligations of SLPs. The Board of Ethics does not adjudicate ethical complaints against SLPAs. The SLP supervisor is responsible for ensuring ethical conduct of the SLPA.
Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the code if adequate oversight has not been provided. Any individual who is working in a support role (technician, aide, assistant) under the supervision of an SLP or speech scientist must be knowledgeable about the provisions of the code.
See ASHA's Issues in Ethics Statement Regarding Support Personnel.
Assistants who affiliate through the ASHA Associates Program agree to
- perform their jobs solely within the appropriate scope of responsibilities described in the ASHA Scope of Practice for SLPAs
- perform only those tasks assigned by a supervising SLP
- work only under the supervision of an ASHA-certified SLP
- adhere to all applicable state or local laws and rules regulating the profession and learn and adhere to all applicable codes of ethics and codes of professional conduct to which the supervisor is subject.
Ethical Obligations of SLPs
Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the SLP or speech scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the code if adequate oversight has not been provided.
See Principles and Rules from the ASHA Code of Ethics that specifically address issues pertinent to when an SLP supervises support personnel in the provision of services or when conducting research.
Individuals who engage in the delivery of services to persons with communication disorders are potentially vulnerable to accusations of engaging in unprofessional practices. ASHA recommends that SLPAs have liability insurance. Some employers provide liability coverage for all employees, while other employers defer to the employee to acquire this insurance independently. Some universities provide coverage for students involved in practicum/field work. SLPAs should check to see if, and to what extent, they are covered by existing liability insurance, prior to providing services.
After evaluating existing coverage, SLPAs should evaluate whether or not to purchase liability insurance as a protection for malpractice. A benefit of the ASHA Associate Program is the ability to purchase liability insurance at a group rate through Marsh Affinity Group.
Educational requirements and preparation of support personnel in speech-language pathology vary considerably from state to state and by practice setting.
ASHA does not accredit or approve SLPA education or training programs, nor does ASHA review, evaluate, or rank them in any way; however, it does maintain a list of self-identified technical training programs for SLPAs. Placement on this list does not indicate any endorsement by ASHA, nor is this list meant to be exhaustive.
Sample course work and field work for the SLPA bachelors or associate degree programs include
- general education
- technical content
- field work experiences.
General education: The general education sequence typically includes, but is not limited to, course work in
- Oral and written communication, including grammar and usage, composition or business writing, and public speaking. Such communication skills must be demonstrated to meet the level of workplace standards expected for the field of speech-language pathology.
- Mathematics, including at least one course in general mathematics, business mathematics, accounting, algebra, or higher level mathematics.
- Technology, including computer literacy, word processing, other software applications, web-based applications, and managing digital audio and video files.
- Social and natural sciences, including psychology, sociology, biology, and/or human anatomy and physiology; physics or other sciences, as applicable.
Technical content: Course content provides students with background information in communication disorders and technical knowledge to assume the job responsibilities and core technical skills for SLPAs and typically includes these categories:
- Overview of normal processes of communication, including normal speech, language, communication, and hearing development; phonetics; and communication across the life span.
- Overview of communication disorders, including introduction/survey to communication disorders and coursework in both speech disorders and language disorders.
- Overview of the anatomy and physiology of the speech and hearing mechanism.
- Instruction in assistant-level service delivery practices, including technical procedures for SLPAs, ethics for the practice of speech-language pathology, and procedures and processes about assisting the SLP in service delivery.
- Instruction in workplace behaviors, including
- relating verbally and nonverbally to clients/caregivers in a pragmatic, supportive, and appropriate manner that considers the developmental, educational, cultural, and communication needs of these individuals;
- accepting and implementing the supervisor's feedback and instructions and seeking clarification as needed;
- maintaining confidentiality and ensuring the security of client information and records at all times;
- communicating effectively in oral and written formats that conform to speech-language pathology workplace standards of intelligibility and legibility and are consistent with state and federal regulations and instructions from the supervising SLP;
- following health and safety precautions, including universal precautions and other workplace procedures designed to provide a safe environment for clients and others.
- Cultural and linguistic factors in communication, including one or more of the following: language and culture, interpersonal communication (verbal and nonverbal), sign language and other manually coded systems, bilingualism, or other multicultural issues.
Observation: Observation experiences include direct, on-site observation of an ASHA-certified SLP. Additional observation experiences may include pre-approved (by the supervising SLP) on-site or video observation of an ASHA-certified SLP.
Field work experiences (a minimum of 100 clock hours is recommended): Field work provides appropriate experiences for learning the job responsibilities and workplace behaviors of the SLPA, under the supervision of an ASHA-certified SLP. These experiences are not intended to develop independent practice.
Verification of Technical Proficiency of SLPAs
In addition to employer-provided assessment tools, ASHA offers a verification of technical proficiency of SLPAs [PDF], which can be used to verify achievement of core skills in the areas of clinical/administrative skills, conduct in work setting, and technical skills as prescribed by the supervising SLP.
There is the potential for a career continuum - from SLPA to SLP - depending on the state and work setting regulations in place for the intended state of practice. Traditionally, the support personnel career continuum has not been specifically intended as such because the associated course work and field work experiences required in the SLPA program may differ from those at the bachelor's, pre-professional, or master's levels.
Anyone interested in pursuing academic course work and field work as an assistant prior to entering the field of speech-language pathology should check with bachelor's degree programs and master's degree programs in speech-language pathology in his or her state to determine if any courses taken in the associate degree speech-language pathology assistant program will be credited for future studies.
The Speech-Language Pathology Assistant Scope of Practice includes specific guidance for supervisors of SLPAs, including
Regulations for speech-language pathology support personnel in educational and other practice settings vary from state to state. Differences may be reflected in a number of requirements, including education, supervision, continuing education, titles used for support personnel, or the lack of regulation or laws.
ASHA's state-by-state pages provide summaries of state requirements for support personnel. For the most current information, prospective SLPAs should check with the state licensure board and department of education for the requirements for specific practice settings.
Issues may arise when SLPAs or other support personnel travel across state lines. Their activity may not be recognized by various funding sources, and different states may not recognize the SLPA's credentials.
The Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004): Section 300.156(b)(2)(iii) of the IDEA 2004 "allows paraprofessionals and assistants who are appropriately trained and supervised, in accordance with State law, regulation, or written policy,…to be used to assist in the provision of special education and related services… to children with disabilities."
Elementary and Secondary Education Act (ESEA): Title I of ESEA, designed to help disadvantaged children, also allows the use of "properly trained paraprofessionals" who work under the direct supervision of highly qualified teachers and who may be used to "reinforce and augment a teacher's effort in the classroom." The role and use of paraprofessionals is defined in this non-regulatory guidance paper [PDF].
The use of assistants can improve access to and reduce costs of quality services. It is appropriate to bill for the service provided; however, Medicaid reimbursement of SLPAs varies from state to state. To determine coverage in a specific state, consult the website National Association of Medicaid Directors (NAMD) [PDF].
Medicare policy currently does not recognize SLPAs, regardless of the level of supervision and does not reimburse for SLPA services.
Private insurers may cover licensed or registered SLPAs. One must query each payer to verify coverage. Private insurers may or may not provide a different rate of reimbursement for services provided by an SLP as opposed to an SLPA.
ASHA's Associate Center
Frequently Asked Questions: Speech-Language Pathology Assistants
Knowledge and Skills for Supervisors of Speech-Language Pathology Assistants
Tips for Working With Interpreters
American Speech-Language-Hearing Association. (n.d.) ASHA's Associate affiliation category. Available from www.asha.org/Members/Associate-Affiliation/.
American Speech-Language-Hearing Association. (n.d.) ASHA state-by-state. Available from www.asha.org/advocacy/state/.
American Speech-Language-Hearing Association. (n.d.) Technical training programs for speech-language pathology assistants. Available from www.asha.org/SLP/SLPA-Technical-Training-Programs/.
American Speech-Language-Hearing Association. (2004). Support personnel [Issues in Ethics]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2012 ). Model bill for state licensure of audiologists, speech-language pathologists, and audiology and speech-language pathology assistants. Retrieved from www.asha.org/uploadedFiles/State-Licensure-Model-Bill.pdf.
American Speech-Language-Hearing Association. (2013). Scope of practice for speech-language pathology assistants [Scope of practice]. Available from www.asha.org/policy.
U. S. Department of Education. (2004). Elementary and Secondary Education Act (ESEA). Available from www.ed.gov/esea.
U. S. Department of Education. (2004). Elementary and Secondary Education Act (ESEA): Title I Paraprofessionals Non-Regulatory Guidance. Retrieved from www.k12.wa.us/TitleI/TitleI/pubdocs/TitleIParaprofessionalsNon-RegulatoryGuidance.pdf.
U. S. Department of Education. (2004). Individuals with Disabilities Education Improvement Act (IDEA 2004). Retrieved from http://idea.ed.gov.
U. S. Department of Education. (2004). Individuals with Disabilities Education Improvement Act (IDEA 2004): Section 300.156(b)(2)(iii). United States Department of Education. Available from http://idea.ed.gov.
National Association of Medicaid Directors (NAMD).(n.d.) Retrieved from http://medicaiddirectors.org/about.