Frequently Asked Questions: Speech-Language Pathology
Assistants
The American Speech-Language-Hearing Association (ASHA) has a
position statement
and
guidelines
on the training, use, and supervision of speech-language
pathology assistants. ASHA also has resources for supervisors of
assistants and continues to support the appropriate training,
use, and supervision of speech-language pathology assistants by
ASHA-certified speech-language pathologists. Speech-language
pathology assistants are to be used only to supplement-not
supplant-the services provided by ASHA-certified speech-language
pathologists. Speech-language pathology assistants are not
trained for independent practice.
Defining Speech-Language Pathology
Assistants
Using Speech-Language Pathology Assistants
Supervising Speech-Language Pathology
Assistants
Credentialing Speech-Language Pathology
Assistants
Training Speech-Language Pathology
Assistants
Reimbursing Speech-Language Pathology Assistant
Services
Fieldwork for Speech-Language Pathology Assistant
Student Trainees
Who are speech-language pathology assistants?
Speech-language pathology assistants are support personnel
who, following academic and/or on-the-job training, perform tasks
prescribed, directed, and supervised by ASHA-certified
speech-language pathologists.
Are there other forms of support personnel?
There are typically two levels of support personnel - aides
and assistants. Based on level of training, these support
personnel may have a different scope of responsibilities in the
work setting. Aides, for example, have a different, usually
narrower, training base and a more limited scope of
responsibilities than speech-language pathology assistants.
States may use different terminology to refer to support
personnel in speech-language pathology (e.g., communication
aides, paraprofessionals, service extenders).
Is the use of speech-language pathology assistants new?
Speech-language pathology assistants have been used and
regulated by many states since the 1970s. ASHA has had guidelines
for the use of support personnel since 1969. Attention to the use
of assistants has increased as professionals seek mechanisms for
expanding services and containing costs. In November 2000, ASHA
began development of an approval process for associate degree
speech-language pathology assistant training programs and a
registration process for speech-language pathology assistants.
The approval process was effective January 2002, and the
registration process was effective January 2003. However, at its
Spring 2003 meeting, ASHA's Legislative Council voted to
discontinue both the registration program for speech-language
pathology assistants and the approval process for speech-language
pathology assistant training programs as of December 31, 2003,
primarily due to financial reasons.
Will speech-language pathology assistants be used to replace
speech-language pathologists?
No. Assistants cannot replace qualified speech-language
pathologists. Rather, they can support clinical services provided
by speech-language pathologists. ASHA guidelines were developed
to ensure that speech-language pathology services provided to the
public are of the highest quality and that speech-language
pathologists continue to be responsible for maintaining this
quality of service. According to ASHA guidelines and state
licensure laws, no one can employ a speech-language pathology
assistant without a speech-language pathologist as supervisor.
ASHA guidelines and most state laws limit the number of
speech-language pathology assistants a speech-language
pathologist may supervise and define boundaries for how
assistants are used.
Is there a need for speech-language pathology assistants?
To serve a growing and more diverse client base and an
expanding scope of practice, more service providers are needed.
In an era of heightened demand for cost efficiency, some tasks
may be more appropriate for support personnel than for
professional-level providers. The use of assistants may allow
ASHA-certified speech-language pathologists to focus more on
professional-level clinical services (i.e., those that require
ongoing clinical judgment) rather than on routine day-to-day
operational activities. Access the U.S. Bureau of Labor
Statistics
national job
outlook for the professions. Access information on
state occupational
projections.
What is the demand for speech-language pathology
assistants?
ASHA does not have specific data on the demand for
speech-language pathology assistants; however, 16.4% of ASHA
certified speech-language pathologists reported that at least one
speech-language pathology assistant was employed in their
facilities (2003 ASHA Omnibus Survey). School-based
speech-language pathologists reported a greater use of
speech-language pathology assistants than did speech-language
pathologists in health care facilities. In the school-based
setting, 20% of ASHA-certified speech-language pathologists
indicated that their facilities employed one or more
speech-language pathology assistants (2006 ASHA Schools Survey).
This percentage has decreased over time (i.e., 25.4% in 2000 and
31% in 1995 according to the Schools Surveys in those years).
Only 2% of speech-language pathologists in health care settings
reported using speech-language pathologist assistants (2002 ASHA
Health Care Survey). The demand for speech-language pathology
assistants may grow as the population base for speech-language
pathology services continues to increase.
What are the advantages to the speech-language pathologist in
using speech-language pathology assistants in his/her
practice?
The ASHA-certified speech-language pathologist may extend
services (i.e., increase the frequency and intensity of services
to patients or clients on his/her caseload), focus more on
professional-level tasks, increase client access to the program,
and achieve more efficient/effective use of time and resources.
According to the ASHA 2000 Schools Survey, 47.3% of respondents
indicated that the use of speech-language pathology assistants
led to "more time for direct service," while 23.1%
reported that the use of speech-language pathology assistants led
to "more time for planning/consultation with
teachers."
What may speech-language pathology assistants do?
According to ASHA's
Guidelines for Training,
Use, and Supervision of Speech-Language Pathology Assistants, which apply across all practice settings, a speech-language
pathology assistant may conduct the following tasks under the
supervision of a speech-language pathologist:
- Assist speech-language and hearing screenings (without
interpretation)
- Assist with informal documentation as directed by the
speech-language pathologist
- Follow documented treatment plans or protocols developed by
the supervising speech-language pathologist
- Document patient/client performance (e.g., tallying data
for the speech-language pathologist to use; preparing charts,
records, and graphs) and report this information to the
supervision speech-language pathologist
- Assist the speech-language pathologist during assessment of
patients/clients
- Assist with clerical duties such as preparing materials and
scheduling activities as directed by the speech-language
pathologist
- Perform checks and maintenance of equipment
- Support the supervising speech-language pathologist in
research projects, in-service training, and public relations
programs
- Assist with departmental operations (scheduling, record
keeping, safety/maintenance of supplies and equipment)
- Collect data for monitoring quality improvement
- Exhibit compliance with regulations, reimbursement
requirements, and speech-language pathology assistant's job
responsibilities
State laws vary and may differ from ASHA guidelines. Check
specific state regulations.
What is outside of speech-language pathology assistants'
scope of responsibilities?
According to ASHA's
Guidelines for Training,
Use, and Supervision of Speech-Language Pathology Assistants, a speech-language pathology assistant
may not
perform the following tasks:
- May not perform standardized or nonstandardized diagnostic
tests, formal or informal evaluations, or clinical
interpretation of test results
- May not screen or diagnose patients/clients for
feeding/swallowing disorders
- May not participate in parent conferences, case
conferences, or any interdisciplinary team without the presence
of the supervising speech-language pathologist or other
ASHA-certified speech-language pathologist designated by the
supervising speech-language pathologist
- May not write, develop, or modify a patient/client's
individualized treatment plan in any way
- May not assist with patients/clients without following the
individualized treatment plan prepared by the speech-language
pathologist or without access to supervision
- May not sign any formal documents (e.g., treatment plans,
reimbursement forms, or reports; the assistant should sign or
initial informal treatment notes for review and co-signature by
the supervising professional)
- May not select patients/clients for service
- May not discharge a patient/client from services
- May not disclose clinical or confidential information
either orally or in writing to anyone other than the
supervising speech-language pathologist
- May not make referrals for additional service
- May not counsel or consult with the patient/client, family
or others regarding the patient/client status or service
- May not use a checklist or tabulate results of feeding or
swallowing evaluations
- May not demonstrate swallowing strategies or precautions to
patients, family, or staff
- May not represent himself or herself as a speech-language
pathologist
State laws vary and may differ from ASHA guidelines. Check
specific state regulations to determine which tasks are outside
the scope of responsibilities for assistants in a particular
state.
What is the average salary for speech-language pathology
assistants?
At this time, ASHA collects salary data only on ASHA-certified
speech-language pathologists and audiologists. Occupational and
physical therapy data show that assistants in those fields make
about 60% to 75% of professional-level salaries.
How will this program affect the culturally and linguistically
diverse professional population?
ASHA places great emphasis on attracting individuals from
culturally and linguistically diverse backgrounds into the
speech-language pathology/audiology professions. In related
professions that use assistants, the proportions of minorities to
non-minorities in both the assistant and the professional levels
are similar.
Who is responsible for services provided by a speech-language
pathology assistant?
The fully qualified, ASHA-certified supervising
speech-language pathologist is responsible for the services
provided by assistants. In states that regulate speech-language
pathology assistants, speech-language pathologists who hold full,
unrestricted licenses assume these responsibilities for persons
working under their direction.
Will caseloads expand when assistants are used?
As has always been the case, caseload size of ASHA-certified
speech-language pathologists may or may not increase depending on
client needs and the nature of the services provided. If
speech-language pathology assistants are used appropriately, and
if they are adequately supervised, ASHA-certified speech-language
pathologists' caseloads may decrease to permit sufficient
time to supervise staff working under their direction; however,
workload may increase as the speech-language pathologist assumes
responsibilities for training and supervising assistants.
Speech-language pathology assistants do not carry their own
caseloads. Assistants help to provide services as directed for
the caseloads of speech-language pathologists.
Who can supervise speech-language pathology assistants?
ASHA's guidelines define a supervisor as a speech-language
pathologist certified by ASHA and licensed by the state (where
applicable) who has been practicing for at least 2 years
following ASHA certification and has completed at least one
pre-service course or continuing education unit in
supervision.
Is the speech-language pathologist supervising a
speech-language pathology assistant required to have a course
in supervision?
It is recommended, according to ASHA's 2004 guidelines
(see above).
What resources on supervision does ASHA have
available?
Refer to the
Knowledge and Skills for
Supervisors of Speech-Language Pathology Assistants, which is also available through the ASHA Action Center at
800-498-2071. Additional resource items are available online at
the ASHA
Shop
or by calling 888-498-6699, including "Practical Tools and
Forms for Supervising Speech-Language Pathology Assistants"
and "Working with Speech-Language Pathology Assistants in
School Settings." Finally, professional development
opportunities in supervision are periodically offered as
education programs through ASHA teleseminars and conferences
listed on
our Continuing Education page.
If an ASHA-certified speech-language pathologist with less than
two years' experience joins a program with an experienced
speech-language pathology assistant, should the assistant be
terminated to meet ASHA's 2004 guidelines?
No. However, there should be documentation of the attempt to
hire a qualified speech-language pathologist as supervisor (i.e.,
with more than 2 years' experience post-ASHA certification).
In addition, an alternate plan of supervision should be
developed.
How much supervision is recommended?
The amount and type of supervision required should be based on
the skills and experience of the speech-language pathology
assistant, the needs of patients/clients served, the service
setting, the tasks assigned, and other factors. ASHA's
Code of Ethics
requires certificate holders to provide "appropriate
supervision." In ASHA's speech-language pathology
assistant guidelines, the minimum amount of supervision suggested
is 30% weekly (at least 20% direct) for the first 90 workdays and
20% (at least 10% direct) after the initial work period. Direct
supervision means on-site, in-view observation and guidance by a
speech-language pathologist while an assigned activity is
performed by support personnel. The guidelines also recommend
that a speech-language pathologist supervise no more than three
speech-language pathology assistants.
State laws vary and may differ from ASHA guidelines. Check
specific state regulations to determine amount of supervision
required and qualifications for supervisors of assistants in a
particular state.
Does ASHA credential speech-language pathology assistants?
Not at this time. ASHA had started a voluntary registration
program for speech-language pathology assistants in 2003, of
which one criterion for such registration required an associate
degree from a technical training program for speech-language
pathology assistants. At its spring 2003 meeting, ASHA's
Legislative Council passed a resolution to discontinue the
registration program for speech-language pathology assistants and
the approval process for speech-language pathology assistant
technical training programs as of December 31, 2003, primarily
due to financial reasons.
ASHA no longer has a recognition process for associate degree
technical training programs for speech-language pathology
assistants nor a registration process for speech-language
pathology assistants. ASHA will continue to disseminate the
Guidelines for Training,
Use, and Supervision of Speech-Language Pathology Assistants
,
which were revised in 2004. The revised Guidelines include
recommended curriculum for training programs and a checklist for
supervisors of speech-language pathology assistants that can
assist in the verification of technical proficiency of the
assistant.
How does one become a speech-language pathology assistant?
ASHA's recommends completion of an associate's degree
from a technical training program with a program of study
designed to prepare the student to be a speech-language pathology
assistant. Because the requirements for speech-language pathology
support personnel vary across the country, persons interested in
serving as speech-language pathology assistants should check with
the state of intended employment for that state's specific
requirements. State agencies (licensure boards) currently
regulating support personnel have training requirements that
range from a high school diploma to a baccalaureate degree plus
graduate credit hours, as well as a variety of differing
requirements for those supervising these individuals. In addition
to state regulatory agencies, state education agencies may
credential support personnel to work solely in schools to support
service delivery provided by a qualified speech-language
pathologist. ASHA's
Guidelines for Training,
Use, and Supervision of Speech-Language Pathology Assistants
are national in scope and can serve to promote greater uniformity
in the terms used to identify speech-language pathology support
personnel, training and educational requirements, and job
responsibilities.
Is continuing education required for a speech-language
pathology assistant?
Currently, ASHA does not have a continuing education
requirement for speech-language pathology assistants. State laws
may vary from ASHA's requirements, so check with the state of
intended employment, as several states do require annual
continuing education for assistants.
Is the use of speech-language pathology assistants permitted in
every state?
No. Some states that regulate speech-language pathology do not
permit the use of speech-language pathology support personnel. In
addition, state departments of education may credential
speech-language pathology support personnel. Some school
districts hire assistants under the classification of teacher
assistants. If a state regulates speech-language pathology
support personnel (i.e., under the term of assistant, aide,
paraprofessional, apprentice, etc.), then individuals who wish to
become employed in that state must meet the state requirements
for practice under a licensed and ASHA-certified speech-language
pathologist. Call the state licensure board or department of
education for specific state regulations. Addresses and phone
numbers can be obtained through the
ASHA State-by-State page.
Is this a career ladder?
It could be, but it is not specifically intended as such
because the associated coursework and fieldwork experiences
required in the speech-language pathology assistant program
typically differ from those at the bachelor's,
pre-professional, or master's professional levels. Anyone
interested in pursuing academic coursework and fieldwork as an
assistant prior to entering the field of speech-language
pathology may want to check with bachelor's degree programs
and master's degree programs in speech-language pathology to
determine if any courses taken in the associate degree
speech-language pathology assistant program will be credited for
future studies.
What information is available to help a training institution
start a speech-language pathology assistant training
program?
The 2004 revised
Guidelines for Training, Use, and Supervision of Speech-Language
Pathology Assistants
include curriculum content for training of speech-language
pathology assistants. (See Section G below for more
information.)
Can an institution establish a speech-language pathology
assistant training program in a state that prohibits the use of
speech-language pathology assistants?
Such decisions are under the purview of state agencies that
have degree-granting authority and that regulate the professions.
Consult with the appropriate state entity that performs such
oversight to determine if starting such a program is permissible
under postsecondary requirements in place and whether the program
would be at variance with state law and regulations for the
profession.
How can I find qualified speech-language pathology
assistants?
Call states that regulate them. Addresses and phone numbers of
state licensure boards and regulatory agencies can be obtained
from the
ASHA State-by-State page. Another option is to call associate degree programs and
institutions that train and graduate speech-language pathology
assistants.
How many training programs are there for speech-language
pathology assistants?
As of October 2009, ASHA is aware of 22
operational associate degree programs for speech-language
pathology assistants. Some of these programs offer training
opportunities through distance learning and collaborations
between community colleges and institutions of higher
education. For a self-identified list of speech-language
pathology assistant training programs:
Speech Language Pathology Assistants 2008 Training Programs
[PDF].
Reimbursing Speech-Language Pathology Assistant Services
Can speech-language pathologists receive reimbursement for
speech-language pathology assistant services?
Medicare policy currently does not recognize speech-language
pathology assistants, regardless of the level of supervision and
does not reimburse for speech-language pathology assistant
services. Private insurers may cover licensed or registered
speech-language pathology assistants. One must query each payer
to verify coverage. Private insurers may or may not provide a
different rate of reimbursement for services provided by a
speech-language pathologist as opposed to a speech-language
pathology assistant.
Medicaid reimbursement of speech-language pathology assistants
varies from state to state. It is suggested that you contact your
National Association of State Medicaid Directors
[RTF] to determine coverage in your state.
Fieldwork for Speech-Language Pathology Assistant Student
Trainees
Introduction
The questions and answers below are provided to assist
associate degree technical training programs for speech-language
pathology assistants in establishing fieldwork arrangements that
provide speech-language pathology assistant students with the
technical skills for supervisors to verify their technical
proficiency. This section is applicable to speech-language
pathology assistant student trainees, not necessarily assistants
in the employment setting.
Should the fieldwork hours completed by speech-language
pathology assistant students be performed at specific types of
settings or distributed across specific age groups or
disorders?
ASHA does not specify types of settings for fieldwork or
distribution of hours, but recommends that the fieldwork provides
speech-language pathology assistant students with a variety of
experiences with individuals with communication disorders. The
intent is for training programs to have flexibility in arranging
their fieldwork, and to provide speech-language pathology
assistant students with experience with both children and adults
in more than one setting; however, ASHA policies do not suggest a
specific distribution.
Does the minimum of 100 clock hours of fieldwork include
observation hours?
No. ASHA guidelines recommend a minimum of 100 clock hours of
fieldwork that includes direct and indirect client contact
activities covering all of the job responsibilities of a
speech-language pathology assistant, but no observation hours.
ASHA recommends that observation hours be undertaken before
starting the 100 fieldwork hours. It is up to the training
program to set the appropriate number of observation hours.
When speech-language pathology assistant students are engaged
in patient/client contact, does ASHA recommend that they
receive direct supervision or indirect supervision for the
specified minimum of 50% of the time?
When engaged in patient/client contact, ASHA guidelines
recommend that the speech-language pathology assistant student be
supervised a minimum of 50% of the time. The patient/client
contact refers to direct supervision of the speech-language
pathology assistant student, which is defined as on-site, in-view
observation and guidance.
When speech-language pathology assistant students are placed in
fieldwork settings, can they be supervised by more than one
speech-language pathologist?
Yes. ASHA recommends that each speech-language pathologist
supervising the student complete a technical proficiency or
skills competency checklist (or whatever specific format your
institution uses for fieldwork assessments) for that particular
student.
Should the supervisor of a speech-language pathology assistant
student in an external fieldwork placement hold a current
Certificate of Clinical Competence in Speech-Language Pathology
(CCC-SLP) from ASHA, or can he/she hold state licensure
only?
ASHA suggests that an ASHA-certified speech-language
pathologist supervise the first 100 clock hours of fieldwork
defined in ASHA guidelines for each speech-language pathology
assistant student. Any fieldwork hours completed that are more
than 100 clock hours may be under the supervision of a qualified
speech-language pathologist who is either state-licensed or
ASHA-certified.
How many years' experience does the supervisor need to have
to supervise a speech-language pathology assistant
student?
The
Guidelines for Training, Use, and Supervision of Speech-Language
Pathology Assistants
specify that the speech-language pathology assistant must be
supervised by a speech-language pathologist who has practiced
speech language pathology for at least 2 years following ASHA
certification.
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