American Speech-Language-Hearing Association

Frequently Asked Questions about Student Supervision

General

Health Care

Schools

General

For individuals that seek the Certificate of Clinical Competence (CCC) in Speech-Language Pathology, the certification standards provide guidance on:

  • Qualifications for service as a supervisor to allow student clinicians to count clinical hours towards their CCC applications
  • Basics about observation and practicum hours required for the CCC by the student
  • Guidelines for critical aspects of supervision

Are there requirements to supervise student clinicians?

Yes. Supervisors should have established competency in any area of practice in which the supervisor or student may engage (e.g., supervisors without experience and competency working with pediatric populations should not supervise a student who is working with a child). The Issues in Ethics Statement on Supervision of Student Clinicians includes further discussion of this issue.

To meet ASHA's Standards for the Certificate of Clinical Competence (CCC), student clinicians must be supervised by an individual who holds the CCC in the appropriate area of practice (see Standard IV-E of speech-language pathology standards). University programs also may require the supervisor to hold the necessary state credential to practice in their setting, i.e. license and/or teacher certification.

Is there a requirement about the number of years one needs to be ASHA-certified before supervising a graduate student?

No. However, the supervisor should have acquired sufficient knowledge and experience to mentor a student and provide appropriate clinical education. Obtaining knowledge and skills related to principles of student assessment and pedagogy of clinical education is encouraged

Is there special "training" you need?

As with any area of practice, SLPs who are clinical educators should have established competency in supervision. There are a number of ways one can establish and maintain competency in this area. ASHA's position statement on clinical supervision outlines the competencies needed and training options.

How do I find an academic program that will send me student clinicians to supervise?

A list of graduate programs in speech-language pathology is available on ASHA's Web site. You can speak with the department chair, graduate program director, or clinic director for further information.

How much of the practicum has to be directly supervised?

According to Standard IV-E of the SLP Certification Handbook:

"Direct supervision must be in real time and must never be less than 25% of the student's total contact with each client/patient and must take place periodically throughout the practicum. These are minimum requirements that should be adjusted upward if the student's level of knowledge, experience, and competence warrants."

The implementation language further states that "The amount of supervision must be appropriate to the student's level of knowledge, experience, and competence. Supervision must be sufficient to ensure the welfare of the client/patient."

Also see the ASHA document, Quality Indicators for Professional Service Programs in Audiology and Speech-Language Pathology, which includes information about supervision.

In addition, facilities, payers, and other regulatory agencies may have requirements regarding supervising student clinicians that may impact the amount of supervision provided.

Can I supervise more than one student at a time?

Yes. Supervisors often find that they are called upon to supervise more than one student at a time. There is no language within the standards that specifies the number of students that can be supervised by one person.

Do I have to be on-site when the student is on-site? Is it okay to have other SLPs on-site?

As noted in the question above, the amount of direct supervision provided must be appropriate to the student's needs and ensure the welfare of the client. If the primary supervisor cannot be on site, another clinician may supervise the student, if needed. It is important to note that all persons who take on supervisory responsibilities must hold the appropriate CCC in the professional area in which the clinical hours are being obtained in order for the graduate student clinician to apply those supervised clinical hours towards their own CCC application.

To learn more about payer requirements for reimbursement of services provided by student clinicians and how this may influence the issue of on-site supervision in health care settings, see the first question in the Health care section below.

Am I liable for the treatment provided by the student under my supervision?

As a supervisor, you are responsible for any actions taken by the student while under your supervision. You should ensure that the amount of supervision provided is appropriate to the needs of the client/patient and for the graduate student's experience and skill.

Do I have to co-sign all notes, such as treatment plans and IEPs, written by the student? Can anyone else sign the student's notes?

The supervisor of record for the case would be expected to sign all treatment documentation, in accordance with the facility's policies.

How many minutes are in a clinical practicum hour?

The Council For Clinical Certification defines one (1) clinical practicum hour as equal to 60 minutes. When counting clinical practicum hours for purposes of ASHA certification, experiences/sessions that total less than 60 minutes (e.g., 45 minutes or 50 minutes) cannot be rounded up to count as 1 hour.

What other supervision resources are available?

ASHA has resources for supervisors and those interested in clinical education. These resources include:

Health Care

Can I bill for services provided by a graduate student clinician?

In the ASHA Issues in Ethics statement, Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Students (2013), it states that "the ASHA Code of Ethics [2010] recognizes the professional acceptability of appropriately supervised clinical practice by students; hence, there is no basis for suggesting or requiring that fees charged for services delivered by students differ in any way from the fees typically charged for services provided by certified audiologists or speech-language pathologists." Therefore, billing for such services is allowable, provided those services meet or exceed professional standards of supervision.

Payers differ in their regulations regarding paying for services provided by student clinicians. Medicare coverage of student clinicians differs depending on setting and whether the person is a Part A or Part B beneficiary. To find out the requirements for private payers, it is best to contact them directly as each will differ and may or may not follow Medicare's regulations.

Do I need to supervise the student more for swallowing cases than other disorders?

Supervision requirements do not differ based on disorder or patient population. The amount of supervision provided should meet or exceed minimum requirements and should be based on the individual needs of the student and the welfare of the client/patient being treated. Many student clinicians will come to the facility with minimal experience in swallowing, simply because swallowing disorders are not commonly seen in the university clinic setting. These student clinicians may require additional supervision to develop competencies in this area.

Are criminal background checks required for student clinicians?

The need to conduct a criminal background check depends on state law and the facility's policy. Part of this decision is whether or not the state law specifies student clinicians as a category of personnel who are required to have a background check. The Joint Commission on Accreditation of Health Care Organizations expects background checks to be done in accordance with such laws.

Under HIPAA, can I share personal health information with a student or do I need to get authorization from the patient or family?

HIPAA regulations were designed so as not to impede the provision of normal health care operations. "Health care operations," as defined in regulation, includes "conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers." (retrieved from http://www.hhs.gov/hipaafaq/limited/209/ on June 18, 2007).

Student clinicians will need to learn about HIPAA regulations and should be introduced to the facility's HIPAA policies and procedures. Facilities may require that student clinicians receive HIPAA training as part of their orientation. Student clinicians are expected to abide by the privacy rule regulations just as any employee in the facility.

Do I need to have the patient or family sign a consent form to allow the student to work with them?

Most health care facilities that allow for student trainees include a statement in their consent forms that services may be provided by a student clinician under the supervision of a qualified professional. The inclusion and wording of such statements will be influenced by relevant state laws and facility policies.

The ASHA Code of Ethics stipulates that "individuals shall not misrepresent their credentials, competence, education, training, experience, or scholarly or research contributions (Principle of Ethics III, Rule A [2010])." Student clinicians and supervisors should identify themselves appropriately to patients and families at all times. See the Issues in Ethics statement, Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Students (2013), for more information.

How do I convince my administration to allow me to supervise student clinicians? What are the cost benefits of supervising student clinicians?

ASHA developed Frequently Asked Questions on What Administrators Need to Know [PDF] that can be used to frame discussions with health care administrators about supervising student clinicians.

The main issues have to do with personnel shortages and staff development. If a student is exposed to speech-language pathology services in hospitals, clinics, nursing homes, home care, or private practice, they may become part of the pool of appropriately-trained, qualified professionals from which facilities can recruit when they have open positions. In 2007, ASHA conducted a focus group with SLPs on the topic of externship supervision. Participants generally agreed that externships influenced a student's thinking about job choice and that graduate education programs can be used as a recruiting tool.

Supervising student clinicians also benefits the supervising SLP in a number of way, including:

  • Keeping up with current information in the field
  • Sharpening clinical skills by teaching others
  • Stronger relationships with university programs
  • A sense of "giving back" to the profession

In speech-language pathology, as in any field, it is as important to keep good employees as it is to find new ones. While there may be some impact on the SLP's productivity and the facility's bottom line for speech services when the SLP supervises a graduate student clinician, it is unlikely that the impact will cost as much as recruiting and hiring new staff. Estimates on the cost of personnel turnover run as high as 1/3 of a new hire's annual salary to replace an employee (U.S. Department of Labor, retrieved June 18, 2007). Happy employees tend to stay with an employer. Giving SLPs the opportunity to grow professionally and personally by supervising a student clinician is one way of improving morale and ultimately retaining that SLP.

School Settings

Can I bill Medicaid for services provided by a graduate student?

In the ASHA Issues in Ethics statement, Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Students (2013), it states that "the ASHA Code of Ethics [2010] recognizes the professional acceptability of appropriately supervised clinical practice by students; hence, there is no basis for suggesting or requiring that fees charged for services delivered by students differ in any way from the fees typically charged for services provided by certified audiologists or speech-language pathologists." Therefore, billing for such services is allowable, provided those services meet or exceed professional standards of supervision.

Do I need to supervise the student more for swallowing cases than other disorders?

Supervision requirements do not differ based on disorder or patient population. The amount of supervision provided should meet or exceed minimum requirements and should be based on the individual needs of the student and the welfare of the client/patient being treated. Many student clinicians will come to the facility with minimal experience in swallowing, simply because swallowing disorders are not commonly seen in the university clinic setting. These student clinicians may require additional supervision to develop competencies in this area.

Are criminal background checks required for student clinicians?

The need to conduct a criminal background check depends on state law and organization policy. Part of this decision is whether or not the state law specifies student clinicians as a category of personnel who are required to have a background check. Check with your administrator or contact the State Education agency.

Under The Family Rights and Education Privacy Act (FERPA), can I share student health and education records with a graduate student being supervised by me or do I need to get authorization from the family?

A graduate student being supervised by you may generally be considered a "school official" with a "legitimate educational interest" and, as such, may be provided access to students' education records under FERPA. FERPA requires that schools specify the criteria for determining which parties are school official and what the school considers to be a legitimate educational interest.

However, graduate students should be made aware of their responsibilities under FERPA not to disclose personally identifiable information from education records, unless authorized to do so, either with parental consent or under one of the conditions in FERPA permitting disclosure without consent.

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