Competency is the foundation of the work of the practicing speech-language pathologist (SLP). The American Speech-Language-Hearing Association (ASHA) Code of Ethics requires it, as do many state and accrediting agencies. How one attains, maintains, and records competencies is of great concern to many SLPs today.
The Certificate of Clinical Competency
ASHA-certified SLPs hold the Certificate of Clinical Competence (CCC), which is awarded after successful completion of 1) a master's degree in communication disorders, 2) a nine-month clinical fellowship, and 3) a passing score on a national examination (Praxis). The CCC indicates that the SLP has the basic knowledge and experience necessary to begin independent practice. It does not render all holders competent to practice in all areas of speech-language pathology that are outlined in the ASHA Scope of Practice for Speech-Language Pathology.
ASHA's Code of Ethics
The ASHA Code of Ethics specifically addresses the issue of competency. Principle of Ethics I, Rule A states that "Individuals shall provide all services competently." Principle of Ethics II states that "Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence" and further states in Rule B that "Individuals shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience." In addition, Principle of Ethics II, Rule E mandates that "Individuals shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's competence, level of education, training, and experience."
Many health care facilities are accredited by state agencies or external organizations such as Joint Commission (formerly referred to as the the Joint Commission on Accreditation of Healthcare Organizations) or CARF (The Accreditation Commission). These organizations establish broad standards of care to which the facility must adhere to earn or retain accreditation. These standards are designed to facilitate quality care in all health care organizations.
Joint Commission defines competency as "a determination of an individual's capability to perform up to defined expectations" (2002 Hospital Accreditation Standards Manual). Competency standards are addressed in the Human Resources chapter of Joint Commission accreditation manuals. For example, Standard HR.3 in the 2002 Hospital Accreditation Standards Manual states "The leaders ensure that the competence of all staff members is assessed, maintained, demonstrated, and improved continually" (page 235). Although many facilities choose to measure and record staff competencies via checklists, such as those included in this book, Joint Commission does not specify how competencies are assessed. This is clarified in the hospital manual in the following way:
"A hospital can assess competence objectively in many ways. The hospital decides how to structure its assessment, evaluation, or appraisal process. If the hospital constructs its own competence-assessment process, it meets the following criteria:
- The hospital uses a combination of ongoing competence assessment and educational activities to maintain staff competence; and
- An objective, measurable system is used periodically to evaluate job performance, current competencies, and skills" (page 236).
CARF also includes competency standards in the Human Resources chapter of its standards manuals. The 2001 Medical Rehabilitation Standards Manual states that "The organization:
- Establishes the competencies needed by personnel related to the needs of the persons served
- Assesses the competencies of personnel annually
- Establishes a mechanism to demonstrate the level of competency achieved
- Provides opportunities to improve the competencies of personnel
- Allocates resources to meet the competency needs of personnel" (section 1.L, page 28)
CARF goes further to state that "competencies should be established that are discipline specific, relevant to the unique needs of the persons served, and relate to the job duties of the individual." Like Joint Commission, CARF does not specify how competencies are measured, but include examples of how to demonstrate competency, such as written exams, demonstration, simulation, or direct observation.
ASHA Practice Policy Documents
Many ASHA Practice Policy documents were developed to identify specific knowledge and skills needed to provide services competently in a particular area of practice. Clinicians may use these documents to determine their readiness to provide services in these areas of practice. Supervisors or managers may use these standards as part of a performance appraisal system, professional development program, or to identify program needs. Each clinician has an ethical responsibility to become competent in any given practice area before working within that area independently. Managers are also held accountable for the competency of their staff. The knowledge and skills statements found in 16 of ASHA's policy documents have been adapted into competency checklists for the purpose of assisting clinicians and managers to fulfill these responsibilities. These checklists can be found in "Guidelines for Verifying Competencies in Speech-Language Pathology", which is available through email@example.com.
Specialty Recognition as a Measure of Competency
ASHA's Legislative Council approved the Specialty Recognition program in 1994. Specialty recognition boards currently exist in the areas of fluency, child language, and dysphagia. Specialty recognition is a voluntary program by which clinicians who have advanced knowledge and skills in a particular area can become board-recognized specialists in that area. The intent of specialty recognition is not to exclude those who do not apply for specialty recognition from practicing in any area of speech-language pathology. For those clinicians, however, who have extensive experience in a practice area, specialty recognition could be considered the ultimate competency level. Our Web site contains more information on ASHA Specialty Recognition.
Commission on Accreditation of Rehabilitation Facilities. (2001). Medical rehabilitation standards manual . Tucson, AZ: Author.
Joint Commission. (2002). Hospital accreditation standards: Accreditation policies, standards, intent statements. Oakbrook Terrace, IL: Author.
ASHA Practice Policy
"Assessing staff competencies" [PDF] by Deborah Carlson (June, 2000 issue for Division 11)
"Developing, evaluating, and managing competencies across work settings" [PDF] by Tom Ehren, Nancy Lefkowitz, and Carole Roth (October 1997 issue for Division 11)