Speech-Language Pathologists Training and Supervising Other Professionals in the Delivery of Services to Individuals With Swallowing and Feeding Disorders
ASHA Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training
About this Document
This technical report was developed by the American Speech-Language-Hearing Association (ASHA) Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia) Committee on Cross-Training. Members of the committee included Caryn Easterling, Maureen Lefton-Greif, Paula Sullivan, Nancy Swigert, and Janet Brown (ASHA staff liaison). Celia Hooper (vice president for professional practices in speech-language pathology, 2003–2005) served as monitoring vice president. This technical report was approved by ASHA's Executive Board in October 2003.
Increased demand for providers of swallowing and feeding services has arisen in various settings (e.g., health care, schools, and early intervention programs). Some institutions have responded to this demand by developing and implementing models designed to cross-train clinical skills to another profession to allow them to provide the services independently. Cross-training models conflict with ASHA's 1997 policy on Multiskilled Personnel, which states that “…cross-training of clinical skills is not appropriate at the professional level of practice….” ASHA's 1999 subcommittee report on “Educating Other Professionals About What Audiologists and Speech-Language Pathologists Do” cautions about the potential dangers of teaching or educating other professions in the delivery of services which require the unique foundation acquired by SLPs in their professional education and training. The report distinguishes between providing information about the role of SLPs versus teaching other professionals how to perform services provided by SLPs. The following information supports ASHA's policy statement Speech-Language Pathologists Training and Supervising Other Professionals in the Delivery of Services to Individuals With Swallowing and Feeding Disorders: Position Statement (2004) that SLPs are primary providers of dysphagia services and that the foundation of their knowledge and skills in swallowing and feeding is not transferable to other professions.
Return to Top
Approximately 300,000 to 600,000 older Americans with neurologic disorders are identified with dysphagia annually (AHCPR, 1999). Although comparable data on the incidence and prevalence of dysphagia in the pediatric population are limited, anecdotal reports suggest an increase in the incidence of pediatric dysphagia as a result of improved survival rates for infants born prematurely and with life threatening illnesses.
Multi- or interdisciplinary teams models are often used to provide comprehensive delivery of services to the individuals with impairments in swallowing and feeding. Nonetheless, SLPs are primary providers of clinical services because of the highly specialized knowledge base and clinical skills which are unique to SLPs' education and training, and differ from experiences required by other disciplines. These clinical services include evaluation, treatment, and management of oropharyngeal dysphagia, and minimizing compromises in respiratory or nutritional status associated with impairments in swallowing and feeding.
Return to Top
Service delivery in the area of swallowing and feeding (i.e., dysphagia) makes up a significant portion of the caseload of speech-language pathologists, particularly in health care settings. Respondents to the 2002 ASHA Omnibus Survey reported that dysphagia services are provided by 90% of SLPs in residential health care, 84% in hospitals, 50% in non-residential health care, and 11% in schools. In the most recent ASHA Speech-Language Pathology Health Care Survey (2002), respondents in adult health care settings reported spending 31% of their time in the delivery of services related to dysphagia.
Return to Top
In Standards and Implementation for the Certificate of Clinical Competence in Speech-Language Pathology (effective January 1, 2005), specific knowledge in the area of swallowing (i.e., “oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction”) is required by Standard III-C. Swallowing has been identified as one of nine major areas of practice in which knowledge and skills must be demonstrated by formative and summative assessment. 
Additionally, the certification standards that will be implemented in 2005 require knowledge of the “nature of speech, language, hearing, and communication disorders and differences and swallowing disorders, including the etiologies, characteristics, anatomical/physiological, acoustic, psychological, developmental, and linguistic and cultural correlates” (Standard III-C). These requirements for SLPs illustrate some of the unique knowledge and skills that provide the foundation for competency in the area of swallowing and swallowing disorders. This combination of academic and clinical requirements provides a fund of knowledge that is not duplicated by any other profession, and forms the basis of ASHA's policy against cross-training of professional skills. Furthermore, each SLP is ethically responsible for achieving the appropriate level of training to provide these services competently.
ASHA's policy documents related to dysphagia, which include knowledge and skills and a graduate curriculum, provide guidelines for the knowledge and skills which must be acquired through continuing education programs and mentored clinical experiences for SLPs earning the Certificate for Clinical Competence before 2005. ASHA members have access to a large number of professional education programs in the area of dysphagia through ASHA-approved CE sponsors. In 2001, more than 262 professional education programs on dysphagia were offered. Specific portions of the program for ASHA's annual national convention are devoted to submissions in the area of swallowing and swallowing disorders.
Return to Top
Speech-language pathologists became actively engaged in research in dysphagia in the 1970's and 1980's, and addressed specific questions such as temporal measures of normal and abnormal oropharyngeal swallowing, relationships of pressure generation and structural function in oropharyngeal and cervical esophageal swallowing, and the impact of texture and volume characteristics on normal and abnormal swallowing physiology. Speech-language pathologists introduced instrumental assessment techniques that revolutionized the diagnosis and management of swallowing disorders using the videofluoroscopic swallowing study (or modified barium swallow), fiberoptic endoscopic evaluation of swallowing, and ultrasound.
Speech-language pathologists were co-founders of the Dysphagia Research Society, a multidisciplinary professional organization that publishes the research journal Dysphagia. Since its inception in 1991, SLPs have held many of the leadership positions of the society, and make up approximately two-thirds of its membership. The Dysphagia Research Society serves as a primary forum for stimulating new research in swallowing and feeding through its annual meeting and journal. In addition, under the auspices of ASHA, the Communication Sciences and Disorders Clinical Trials Research Group obtained grant support from the National Institutes of Health for a clinical trial examining aspiration in the elderly using different thicknesses of liquid boluses, and a second randomized trial comparing two behavioral interventions for oropharyngeal swallowing disorders.
Return to Top
ASHA has been actively engaged in developing policy documents to guide SLPs' practice using evidence-based information. The first practice policy document devoted to dysphagia was published in 1987. It has since been updated by the position statement and technical report on Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders (ASHA, 2002), which provide the latest evidence about diagnosis, treatment, and management of swallowing and feeding disorders with a broader range of populations and disorders. Among the roles of the SLP stated in the position statement are:
Teaching and counseling individuals and their families about swallowing and feeding disorders
Educating other professionals regarding the needs of individuals with dysphagia, and the speech-language pathologist's role in evaluation and management of swallowing and feeding disorders
Serving as an integral part of a multidisciplinary and/or interdisciplinary team as appropriate.
To assist members in developing competencies in swallowing and feeding, a number of other documents have been developed: Knowledge and Skills Needed by Speech-Language Pathologists Performing Videofluoroscopic Swallowing Studies (ASHA, 2004); Guidelines for Speech-Language Pathologists Performing Videofluoroscopic Swallowing Studies (ASHA, 2004); Knowledge and Skills Needed by Speech-Language Pathologists Providing Services to Individuals with Swallowing and Feeding Disorders (ASHA, 2002a); Knowledge and Skills for Speech-Language Pathologists Performing Endoscopic Assessment of Swallowing (ASHA, 2002b). For students and graduate programs, Graduate Curriculum on Swallowing and Swallowing Disorders (Adult and Pediatric Dysphagia) (ASHA Special Interest Division 13, 1997) provides guidelines for coursework in this area. Currently available guidelines to assist SLPs in achieving best practice based on current evidence include Clinical Indicators for Instrumental Assessment of Dysphagia (ASHA, 2000).
Return to Top
In 1992, ASHA's Special Interest Division 13 (Swallowing and Swallowing Disorders) was formed to provide a mechanism for communication and interaction among ASHA members sharing a specific interest in this area of practice. Members who join Division 13 receive a quarterly newsletter of evidence-based research and practice and advocacy information about the delivery of service to individuals with dysphagia, across work settings and age groups. Affiliates of Division 13 may earn continuing education credits from newsletter articles. The Division also offers participation in an e-mail list and committees.
SLPs can also apply to become a Board-Recognized Specialist in Swallowing and Swallowing Disorders (BRSS) through the recently approved Specialty Board in Swallowing and Swallowing Disorders. This process was developed to help consumers identify SLPs who chose to be recognized by their peers as specialists in this area of practice. Application to this voluntary program is the choice of the individual SLP and independent of membership in any professional organization.
Return to Top
The profession of speech-language pathology has made significant, unique, and ongoing contributions in the delivery of clinical services and advancement of the knowledge in the area of swallowing and feeding. Multi- and interdisciplinary team involvement enhances outcomes in many settings, and SLPs are an integral part of such teams. SLPs are primary providers of evaluation and treatment of feeding and swallowing disorders. The unique foundation acquired by SLPs in their professional education and training provides the basis for the integration of the highly specialized knowledge and skills necessary for this role and is not transferable to members of other professions. Speech-language pathologists (SLPs) should not train, via professional education courses or on-the-job training, or provide direct clinical supervision to individuals or groups of individuals from other professions in the delivery of evaluation and treatment for infants, children, and adults with swallowing and feeding disorders.
Return to Top
Agency for Health Care Policy and Research. (1999). Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Rockville, MD: Author.
ASHA Special Interest Division 13: Swallowing and Swallowing Disorders (Dysphagia). (1997). Graduate curriculum on swallowing and swallowing disorders (adult and pediatric dysphagia). ASHA Desk Reference, 3, 248a–248n.
American Speech-Language-Hearing Association. (1992, March). Instrumental diagnostic procedures for swallowing. Asha, 34(Suppl. 7), 25–33.
American Speech-Language-Hearing Association. (1997, Spring). Position statement: Multiskilled personnel. Asha, 39(Suppl. 17), 13.
American Speech-Language-Hearing Association. (1999). Executive Board subcommittee report: Educating other professionals about what audiologists and speech-language pathologists do. In Rockville, MD: Author.
American Speech-Language-Hearing Association. (2000). Clinical indicators for instrumental assessment of dysphagia (guidelines). ASHA 2002 Desk Reference, 3, 225–233.
American Speech-Language-Hearing Association. (2000). Roles of the speech-language pathologist and otolaryngologist in the performance and interpretation of endoscopic examinations of swallowing (position statement). ASHA Supplement, 20, 17.
American Speech-Language-Hearing Association. (2001). Roles of speech-language pathologists in swallowing and feeding disorders: Technical report. ASHA 2002 Desk Reference, 3, 181–199.
American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2001, December 26). Code of ethics (revised). The ASHA Leader, 6(23), 2.
American Speech-Language-Hearing Association. (2002a). Knowledge and skills for speech-language pathologists performing endoscopic assessment of swallowing. ASHA Supplement, 22, 107–112.
American Speech-Language-Hearing Association. (2002b). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders. ASHA Supplement, 22, 81–87.
American Speech-Language-Hearing Association. (2002c). 2002 Omnibus survey: Frequency report. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2002d). Report on the ASHA speech-language pathology health care survey. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2002e). Roles of speech-language pathologists in swallowing and feeding disorders: Position statement. ASHA Supplement, 22, 73.
American Speech-Language-Hearing Association. (2004). Guidelines for speech-language pathologists performing videofluoroscopic swallowing studies in press. ASHA Supplement, 24.
American Speech-Language-Hearing Association. (2004). Knowledge and skills for speech-language pathologists performing videofluoroscopic swallowing studies in press. ASHA Supplement, 24.
American Speech-Language-Hearing Association. (2004). Speech-language pathologists training and supervising other professionals in the delivery of services to individuals with swallowing and feeding disorders: Position statement in press. ASHA Supplement, 24.
American Speech-Language-Hearing Association Council on Professional Standards in Speech-Language Pathology and Audiology. (2000). Standards and implementation for the certificate of clinical competence in speech-language pathology. Rockville, MD: American Speech-Language-Hearing Association.
Return to Top
 Other major areas of practice include articulation, fluency, voice and resonance, receptive and expressive language, hearing, cognitive aspects of communication, social aspects of communication, and communication modalities.
Return to Top
© Copyright 2004 American Speech-Language-Hearing Association. All rights reserved.
Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.