Knowledge and Skills for Supervisors of Speech-Language Pathology Assistants

Preamble

Dramatic changes have occurred over the last decade in the manner in which speech-language pathology services are delivered due to the challenges of health care finance reform, public school caseloads, scientific and technological advances, and an expanding scope of practice for members of the profession. As one response to these challenges, the profession's governing bodies now recognize the role of SLPAs who can support ASHA-certified speech-language pathologists (LC 1-95). Assistants are individuals who, following academic coursework, clinical practicum, credentialing, and perhaps voluntary registration by ASHA, can perform tasks prescribed, directed, and supervised by ASHA-certified speech-language pathologists (ASHA, 1996; ASHA 2000).

The use of credentialed and supervised SLPAs is one way to increase the frequency of services to clients while maintaining service quality and controlling cost. The decision to shift responsibility for some aspects of speech-language pathology service delivery to assistants should only be made by ASHA-certified speech-language pathologists and only when the quality of care to patients/clients will not be compromised. In addition to direct patient/client contact, SLPAs may also assist service delivery by preparing materials, performing clerical duties associated with program or case management, or working on other appropriate assignments that fall within their defined scope of responsibilities (ASHA, 1996). Whatever tasks are assigned to SLPAs, implicit in the decision to use them is the ethical commitment by the ASHA-certified speech-language pathologist to provide appropriate supervision in order to ensure quality of care. It must be clear to all parties involved that the use of an SLPA is not meant to replace the work of a speech-language pathologist but, rather, to effectively extend it.

Using an SLPA as an interpreter/translator requires additional knowledge and skills that are not addressed in this document. ASHA's Multicultural Issues Board is developing guidelines to address this.

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Introduction

In 1985 the ASHA Legislative Council adopted the position statement Clinical Supervision in Speech-Language Pathology and Audiology (ASHA, 1985). This document formally recognized the importance of the supervisory process in the clinical education of speech-language pathologists and audiologists as a fundamental mechanism to ensure quality service to clients. The position paper also outlined 13 tasks that are basic to effective clinical supervision and identified supervisor competencies that implement each task.

The importance of supervision in the competent and ethical use of SLPAs requires that the profession now identify and define the knowledge and skills necessary for supervisors of SLPAs. This document identifies the knowledge and skills that are consistent with the 13 tasks of supervision identified in the 1985 position statement, as well as those tasks identified in the ASHA Guidelines for the Training, Credentialing, Use, and Supervision of Speech-Language Pathology Assistants (ASHA, 1996). These tasks make it clear that the ASHA-certified supervisor retains legal and ethical responsibility for all aspects of case management and service delivery while at the same time helping assistants refine their skills within their scope of responsibilities and assigned tasks.

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Role of the Supervisor

Direct and indirect supervision of SLPAs by speech-language pathologists expands the speech-language pathologists' role as a service provider to include responsibility for the work of support personnel (ASHA, 1996). This broadened role demands that members of the profession who might supervise SLPAs understand the complexity of the supervisory process and be prepared to meet its challenges. The knowledge and skills delineated in this document are the first steps in that preparation.

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Terminology

Clinical Supervision:: Clinical supervision refers to the tasks and skills of clinical teaching related to the interaction between the client and the service provider.

Direct Supervision:: Direct supervision means onsite, in-view observation and guidance by the speech-language pathologist while an assigned activity is performed by support personnel.

Indirect Supervision:: Indirect supervision means those activities other than direct observation and guidance conducted by a speech-language pathologist. These may include demonstrations, record review, review and evaluation of audio- or videotaped sessions, and/or interactive television.

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Knowledge and Skills

Supervisors of SLPAs have the knowledge and skills to:

1. Select and assign appropriate patients/clients to the SLPA.

   Knowledge required:

   1. Understand the ASHA Guidelines for the Training, Credentialing, Use and Supervision of Speech-Language Pathology Assistants (ASHA, 1996), including:

      • ethical and legal responsibilities of the ASHA-certified speech-language pathologist

      • scope of job responsibilities of the SLPA

      • exclusive responsibilities of the ASHA-certified speech-language pathologist

      • appropriate amount of direct and indirect supervision

      • ratio of supervisors to SLPAs

      • SLPA access to supervisor

   Skills required:

   1. Assess the patient/client's disorder and concomitant needs in order to determine if use of an assistant is appropriate.

   2. Determine those tasks that the SLPA has the training and expertise to perform.

   3. Assign tasks to the SLPA that are within the scope of the SLPA's job responsibilities and are consistent with his/her knowledge and skill.

2. Determine the nature of supervision that is appropriate for each SLPA.

   Knowledge required:

   1. Understand supervisory processes and practices, including strategies for direct and indirect supervision.

   Skills required:

   1. Determine the amount of supervision required based on the needs of the client, the experience of the SLPA, the service delivery setting, the task assigned, and other pertinent factors.

   2. Design and implement supervisory procedures that ensure patient/client confidentiality and quality of care.

   3. Determine when it is necessary to alter the amount and type of supervision in response to changes in client/patient status and/or service delivery models, use of equipment, or assigned tasks.

3. Establish and maintain an effective relationship with the SLPA.

   Knowledge required:

   1. Understand components of an effective supervisory relationship with the SLPA.

   2. Understand the dynamics of various learning styles.

   3. Understand diverse styles of interpersonal communication.

   Skills required:

   1. Facilitate the SLPA's understanding of assigned tasks and the supervisory process.

   2. Accommodate a variety of learning styles in the supervision of the SLPA.

   3. Use effective interpersonal communication skills to maximize communication effectiveness in the supervision of the SLPA.

   4. Facilitate problem-solving of tasks assigned by the SLPA.

   5. Maintain a professional and supportive relationship that allows for both supervisor and SLPA growth.

   6. Interact with the SLPA in an objective manner.

   7. Establish joint communications regarding expectations and responsibilities in assigned tasks and the supervisory process.

   8. Evaluate the SLPA and the effectiveness of the supervisory process.

   9. Guide the SLPA in developing appropriate interpersonal skills (e.g., collaborative teamwork and conflict resolution), with patients/clients, family members, staff, and others).

4. Direct the SLPA in following screening protocols:

   Knowledge required:

   1. Understand speech-language screening tools and protocols, including how to administer them and document the results.

   Skills required:

   1. Teach the SLPA to administer and score appropriately the assigned screening tools, including:

      • differentiation of correct versus incorrect responses

      • accurate completion of protocols

      • accurate collection/scoring of patient/client screening data

   2. Direct the SLPA in managing assigned screening protocols and documentation.

      • Seek the supervisor's guidance if the administration of screening tools is in question

      • Report any difficulty in screening

      • Schedule screenings

      • Organize screening tools

   3. Assist the SLPA in accurately communicating screening results, without interpretation to the SLP, including descriptive behavioral observations that enhance the clarity of results.

5. Demonstrate for and participate with the SLPA in the clinical process.

   Knowledge required:

   1. Understand best practices in speech-language pathology, dynamics of patient/client-clinician relationships, clinical techniques, clinical materials and equipment, and behavioral management techniques.

   Skills required:

   1. Demonstrate best practices for the SLPA.

   2. Demonstrate an effective client-clinician relationship.

   3. Demonstrate a variety of clinical techniques.

   4. Demonstrate the use of client-specific materials and equipment.

   5. Instruct the SLPA in the performance of tasks as outlined and demonstrated by the speech-language pathologist and to implement activities that use procedures prescribed by the speech-language pathologist.

   6. Assist the SLPA in developing skills to maintain patient/client on-task behavior.

   7. Teach the SLPA how to provide appropriate feedback regarding the accuracy of the patient/client response.

   8. Teach the SLPA to use feedback and reinforcement that is consistent, discriminating, and meaningful to the patient/client.

   9. Instruct the SLPA in giving directions and instructions that are clear, concise, and appropriate to the patient/client's age and level of understanding.

   10. Instruct the SLPA in applying behavior management techniques and basic instructional strategies (e.g., asking questions, giving directions, providing positive reinforcement of desired behaviors) that are specific to the patient/client.

   11. Teach the SLPA how to provide appropriate cuing strategies to assist the patient/client in approximating accurate responses.

6. Direct the SLPA in following individualized treatment plans that have been developed by the speech-language pathologist.

   Knowledge required:

   1. Understand communication disorders and the design of individualized treatment plans.

   Skills required:

   1. Instruct the SLPA in understanding a patient/client's disorders and communication needs.

   2. Develop an individualized treatment plan for each client for the SLPA to follow:

      • Direct the SLPA to execute clinical goals and objectives in the specified sequence

      • Instruct the SLPA in description and data collection to measure patient/client behavior change

      • Instruct the SLPA in documenting patient/client outcomes

   3. Teach the SLPA how to describe patient/client progress.

7. Direct the SLPA in the maintenance of clinical records.

   Knowledge required:

   1. Understand clinical recordkeeping procedures.

   2. Understand principles and procedures for maintaining client confidentiality.

   Skills required:

   1. Assist the SLPA in maintaining accurate clinical records.

   2. Assist the SLPA to effectively document clinical interactions, including:

      • individual treatment plans and protocols

      • patient/client performance

      • other information on patient/client charts

   3. Assist the SLPA in organizing records to facilitate easy retrieval of information concerning clinical interactions.

   4. Assist the SLPA in following policies and procedures to protect the confidentiality of clinical records.

8. Interacts with the SLPA in planning and executing supervisory conferences.

   Knowledge required:

   1. Understand components of both the supervisory process and supervisory conferences.

   2. Understand strategies for observation and analysis of supervisory conferences.

   Skills required:

   1. Establish a regular conference schedule.

   2. Plan a supervisory conference agenda.

   3. Involve the SLPA in a joint discussion of previously identified clinical or supervisory data or issues.

   4. Adjust supervisory style and interact with the SLPA in a manner that facilitates the SLPA's self-exploration and problem-solving within assigned tasks.

   5. Adjust supervisory conference content based on the SLPA's level of training and experience.

   6. Encourage and maintain SLPA motivation for continuing self-growth and development of job skills.

   7. Assist the SLPA in making commitments for changes in job skills.

9. Provide feedback to the SLPA regarding skills.

   Knowledge required:

   1. Understand the skill level of the SLPA.

   2. Understand the tools used for evaluation of SLPA clinical skills.

   3. Understand effective supervisory communication styles.

   Skills required:

   1. Develop and use clinical skill evaluation tools.

   2. Assist the SLPA in the description and measurement of his/her progress and achievement of job skills.

   3. Assist the SLPA in developing strategies for self-evaluation and documentation of job performance.

   4. Use supervisory feedback to modify interactions with patients/clients.

10. Assist the SLPA in developing skills of verbal reporting and assigned informal written reporting to the SLP.

    Knowledge required:

    1. Understand standards and strategies for effective oral and written communication.

    Skills required:

    1. Assist the SLPA in identifying appropriate information to be included in oral reports.

    2. Teach the SLPA how to present verbal and written information in a logical, concise, and sequential manner.

    3. Instruct the SLPA in the use of appropriate professional terminology.

11. Assist the SLPA in effectively selecting, preparing, and presenting treatment materials and organizing treatment environments.

    Knowledge required:

    1. Understand appropriate treatment materials for specific populations.

    Skills required:

    1. Assist the SLPA in choosing appropriate materials from an approved materials list to be used to implement the assigned treatment plan.

    2. Assist the SLPA in effectively organizing the clinical setting to meet the needs of the client and obtain optimal patient/client performance.

    3. Assist the SLPA in selecting materials that are age and culturally appropriate as well as motivating.

    4. Assist the SLPA in efficiently preparing and selecting treatment materials in a timely manner.

12. Share information regarding ethical, legal, regulatory, and reimbursement aspects of professional practice.

    Knowledge required:

    1. Understand ethical, legal, regulatory, and reimbursement aspects of professional practice.

    2. Understand the scope of practice in speechlanguage pathology.

    Skills required:

    1. Communicate professional codes of ethics and conduct (e.g., ASHA, state licensure boards, other professional legal bodies) to the SLPA.

    2. Communicate an understanding of legal and regulatory requirements and their impact on the practice of the profession (e.g., licensure, IDEA, ADA, Medicare, Medicaid) to the SLPA.

    3. Communicate an understanding of reimbursement policies and procedures of the work setting to the SLPA.

    4. Communicate due process policies and procedures in the work setting to the SLPA.

    5. Articulate clearly the speech-language pathologist's scope of practice and exclusive responsibilities of the SLPA.

13. Model and facilitate professional conduct.

    Knowledge required:

    1. Understand appropriate professional standards and conduct.

    Skills required:

    1. Assume ethical and legal responsibility for all patient/client care.

    2. Analyze, evaluate, and modify own behavior.

    3. Model ethical and legal conduct.

    4. Meet and respect deadlines.

    5. Provide current information regarding professional standards.

    6. Assist the SLPA in demonstrating appropriate conduct, including

       • Respect/maintain confidentiality of patient/client information

       • Dress appropriately for the work setting

       • Use appropriate language for the work setting

       • Recognize own job limitations and perform within the boundaries of training and job responsibilities (e.g., refer the patient/client family and other professionals to the speech-language pathologist for any information regarding screening and treatment).

    7. Assist the SLPA to effectively address patient/client attitudes and behaviors.

14. Direct the SLPA in the implementation of research procedures, in-service training, and public relations programs.

    Knowledge required:

    1. Understand research projects and their procedures, in-service training activities, and public relations programs.

    Skills required:

    1. Teach the SLPA how to complete assigned research tasks.

    2. Teach the SLPA how to complete assigned in-service training responsibilities.

    3. Teach the SLPA how to complete assigned public relation program activities.

15. Train the SLPA to check and maintain equipment and to observe universal precautions.

    Knowledge required:

    1. Understand operational procedures for equipment, including performance checks and maintenance.

    2. Understand universal precautions policies and procedures.

    Skills required:

    1. Instruct the SLPA in maintaining and performing assigned checks of equipment.

    2. Assist the SLPA in the completion of universal precautions protocols.

16. Assist the SLPA in using appropriate language (oral and written) when interacting with patients/clients and others.

    Knowledge required:

    1. Understand appropriate oral and written language skills to use when interacting with patients/clients and others.

    Skills required:

    1. Model and instruct the SLPA with regard to the awareness of and sensitivity to cultural and linguistic needs of each client.

    2. Model and instruct the SLPA to adapt language according to the patient/client's age, culture, and linguistic, cognitive, and educational level.

    3. Model and instruct the SLPA to be courteous and respectful at all times.

    4. Model and instruct the SLPA in maintaining appropriate pragmatic skills, such as eye contact, body language, facial expression, and conversational turn-taking, as well as topic initiation, maintenance, and closure.

17. Establish a system of accountability for document use and supervision of the SLPA.

    Knowledge required:

    1. Understand accountability systems for documentation of supervision of the SLPA.

    2. Understand supervision requirements for the SLPA.

    3. Understand due process rights and procedures.

    4. Understand conflict resolution strategies, including referral, as appropriate.

    Skills required:

    1. Document the type and amount of supervision provided to the SLPA.

    2. Develop conflict resolution strategies that protect due process of the SLPA and patient/client quality of care.

    3. Prepare summary reports regarding use of the SLPA, including accessibility of services to patients/clients, utilization cost-benefit analysis, and quality of service measures to administrators, patients/clients, and payers.