The effort to achieve licensure for speech-language pathologists in South Dakota began almost 40 years ago—when some of today's state leaders were themselves receiving speech-language services in rural schools, sometimes in repurposed janitors' closets or locker rooms. Some of today's leaders weren't yet born.
More than 35 years later, the face of speech-language pathology in South Dakota was changing. A new generation was entering the field as many of the SLPs from the 1970s retired. The materials, techniques, and treatment rooms had improved with advances in technology, an emphasis on evidence-based practice, and consumer awareness of the effectiveness of speech-language pathology services. But one thing remained the same: In 2009, speech-language pathology still was not a licensed profession.
Determined to keep the field moving forward, the South Dakota Speech-Language-Hearing Association (SDSLHA) decided in 2010 to push—once again—for universal state licensure after three previous failed attempts, convinced that the adults and children of South Dakota deserved to have qualified licensed practitioners providing services. What happened next provides a useful lesson in what determined grassroots advocacy—without assistance from paid lobbyists—can accomplish.
Road to Licensure
SDSLHA had spearheaded state licensure efforts before. In 1976 and 1991, licensure legislation passed the Senate but failed in the House because of opposition from the Association of Small Schools, which feared that licensure would prevent small school districts from being able to hire providers.
A 1994 effort attempted to combine speech-language pathology oversight with the existing Board of Examiners for Hearing Aid Dispensers and Audiologists. Supporters accepted a concession bill that grandfathered in SLPs who did not meet the master's degree requirement. But because of an amendment that would have exempted school-based SLPs from licensure, the bill failed in committee before ever reaching the Senate or House floor.
Ruth Samuelson, an SLP at Rapid City Regional Hospital, was the driving force behind the earlier attempts and a strong supporter of the current effort. According to Samuelson, four factors were key stumbling blocks: opposition from administrators of the small schools; lack of support from SLPs who believed licensure was unnecessary; the expense of forming and maintaining a licensure board and procedures; and a state administration that opposed licensure boards in general.
Then, in the mid-2000s, SDSLHA added increased licensure advocacy to its strategic plan. The effort began in earnest in 2010 with an information table at the South Dakota capitol building during the legislative session. SDSLHA members gave lip-shaped cookies and ear plugs to legislators, staffers, and community members, and told surprised recipients that South Dakota was one of only two states without SLP licensure. Throughout 2010, SDSLHA held town hall meetings across the state to gather input from SLPs, legislators, school administrators, special education directors, and department of education staffers, and created a Licensure Committee.
The committee identified a sponsor in the House of Representatives—Fred Romkema, a former SLP who was part of the 1970s licensure effort. He worked closely with the committee, providing valuable information about the legislative process. The committee also identified a Senate sponsor—Jean Hunhoff—at the first annual Speech-Language Pathology Day at the Capitol in January 2011.
In February 2011, a bill requiring licensure for SLPs sailed through the House, passing 67-1, only to stumble in the Senate. Special education directors and school administrators opposed the bill, reacting to a limited grandfather statue that would require all SLPs to have a master's degree by 2020, and to language requiring practicing SLPs to be continuously employed. Some special education administrators wanted more information placed into statute instead of rule; Senator Hunhoff advised shortening the bill and placing more language into rule. Other school officials opposed more state governance. SDSLHA withdrew the bill.
Both sides, however, agreed to collaborate on a new bill to be introduced the following year. The Licensure Committee spent the rest of 2011 in more stakeholder meetings to answer questions, gather information, and address concerns. The committee also reduced the length of the bill (from 23 pages to 13), placing more content into rule.
Persistence, cooperation, and collaboration paid off. During the 2012 legislative session the bill passed the Senate and House with minimal opposition, and was signed into law on March 19.
This victory was based in the well-organized licensure efforts of past decades. SDSLHA built its advocacy plan on lessons learned, continuing previous successful strategies, and adding new plans to meet new challenges. Several factors contributed to the success of this final push.
- The committee and SDSLHA members maintained contact with legislators who supported licensure in 2011 via thank-you letters, phone calls, and e-mails, keeping the issue in legislators' minds as they prepared for the 2012 legislative session.
- The SDSLHA Licensure Committee listened to special education directors' concerns about a shortage of master's-level SLPs and made compromises in the proposed legislation. As a result, the special education leaders removed their opposition to licensure.
- With a larger Licensure Committee, SDSLHA was able to make more contacts with SLPs, education and health care administrators, and legislators in support of licensure.
- SDSLHA reached out to a new speech-language pathology assistant training (SLPA) program in South Dakota. With the anticipated graduation of the first SLPA class, the program's president and instructors supported the licensure bill.
- The Licensure Committee successfully demonstrated to special education administrators and legislators that SLP licensure decreases the shortage of qualified service providers by defining the role of SLPAs and ensuring they are appropriately supervised. This educational effort increased statewide support for SLP licensure.
- SLPs and special education administrators who had lobbied against licensure in 2011 changed their position after learning of situations in which uncertified individuals were providing speech-language treatment services without appropriate oversight.
- Physician groups and health care systems did not oppose the legislation. In fact, representatives from one health care system testified in support of the legislation, indicating broad-based support for regulation of speech-language pathology as an allied health profession.
- SDSLHA received a 2010 ASHA personnel grant to help in licensure efforts. This grant funded Licensure Committee teleconferences, statewide informational sessions, travel to the state capital of Pierre, SLP Day, and other initiatives.
- ASHA staff, led by Director of State Advocacy Janet Deppe, provided significant help, including guidance on how to begin the licensure push, help drafting the initial bill, input from other state licensure bills, advice throughout the legislative process, help creating informational documents, and more.
New Advocacy Priorities
When SDSLHA first began the advocacy process, SDSLHA members had many questions and comments: "It can't be done without a lobbyist!" "How much money do you have?" "Who is going to write this bill?" "Why do we need this bill?" With the legislative success, South Dakota SLPs have gained not only licensure, but also a renewed sense of empowerment. They know how to make their voices heard on issues such as accountability in education and health care, development of new job opportunities, and maintaining open communication with educational specialists, administrators, teachers, physicians, and other health care professionals.
For example, H.B. 1234—one of the state's largest educational initiatives—was signed into law this year. It calls for increased teacher accountability and stepped-up recruitment and retention of highly qualified personnel in education. The SLPs in South Dakota are looking forward to conveying to all administrators the importance of SLPs' specialized skills and the unique role an SLP can play in the education of each child.
This fall, the first class of SLPAs will graduate from Mitchell Technical Institute. The new licensure law includes SLPA training requirements and scope of practice rules, as well as supervisory responsibilities for SLPs. As the SLPA program continues to grow, SDSLHA will work and advocate for its success by establishing internship sites, serving on the program's advisory board, and providing a sound model of professionalism.
Last, through the advocacy process, SDSLHA heard concerns about the shortage of school-based SLPs. SDSLHA, along with state's Council of Administrators in Special Education and its Department of Education, has formed an SLP Shortage Committee that will identify contributing factors and regions with the most significant shortages, and recommend strategies to reduce the shortage—including training program options and alternative service delivery models.
In South Dakota, the advocacy experience yielded a new licensure law, engendered better communication and understanding among all stakeholders, and provided SDSLHA and its members a voice in the future of speech-language pathology services.