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A Glimpse into the World of Speech-Language Pathology Assistants in the Health Care Setting

by Jeneane Douglas

I hear the question often from my physical therapy and occupational therapy co-workers (and even a few speech-language pathologists) in the hospital where I work: "Just what is a speech-language pathology assistant (SLPA), anyway?" As a licensed physical therapist assistant (LPTA) for 22 years, and an SLPA (with Oregon state certification) for four, I answer with the comparison of the certified occupational therapist assistant (COTA) and LPTA.

ASHA describes SLPAs as "support personnel with academic and/or on the job training who carry out tasks prescribed, directed, and supervised by ASHA certified speech-language pathologists." However, unlike assistants in occupational and physical therapy, education and training requirements, certification/licensure, and scope and complexity of practice for SLPAs vary greatly across the United States. ASHA's Associates Program may be instrumental in providing national advocacy and awareness of the SLPA as a distinct and valuable occupation.

The first recipients of associates' degrees in occupational therapy graduated in 1956; physical therapy assistants followed suit in 1969. SLPA-specific educational programs with practical and thorough coursework did not graduate its first class until 2002 from Pasadena City College. Today, there are approximately 21 training programs in the United States and seven in Canada.

Each state has its own licensure or certification requirements. In 2006, for example, Oregon mandated a curriculum for SLPAs, who require certification by the state Board of Examiners for Speech-Language Pathology and Audiology. Oregon's two-year program culminates in either a certificate or associate's degree in speech-language pathology. Individuals with a bachelor's degree in communication sciences and disorders may also apply for certification if they complete coursework commensurate with an SLPA program and a 100-hour practicum with 100% direct (line of sight or sound) supervision provided by an ASHA-certified SLP. Oregon also requires certification renewal every two years and continuing education.

In the medical rehabilitation setting, SLPAs carry out a variety of duties. At Providence Neurodevelopmental Center and Center for Medically Fragile Children, a long-term pediatric skilled nursing facility in Portland, Oregon, the day begins with consultation with nursing, medical, and therapy staff. The supervising SLP outlines which patients may require direct treatment time and provides recommendations for those sessions. Plans may include AAC instruction (for patients and center staff) as well as joint treatment sessions with occupational and physical therapy staff. Each child in the facility has a communication and medical need to be addressed. Patients range in age from infancy to 21 years and have complex diagnoses, including genetic syndromes, epilepsy, and cerebral palsy that can lead to significant disabilities and communication needs. Elin Bishop, a state-certified SLPA, is one of many SLPAs in Oregon and other states who provide medically based speech-language services under the guidance of their supervising SLPs. Bishop has chosen the medical speech-language pathology because of its many rewards. The most enjoyable part of her job, she says, is "being with the children. It is so rewarding and inspiring to see how far some of these kids have come."

At my facility—the Easter Seals Children's Therapy Center in Salem, Oregon—children with complex medical diagnoses, are at the forefront of concern and care. Some of these diagnoses are the subjects of investigations at the Centers for Disease Control and Prevention's Undiagnosed Diseases Program.

In the course of my day, I might be with children climbing up the outdoor play structure (and discussing locative basic concepts and working on gross motor skills); discussing types of snacks during imaginative play; working on stance activities at the toy kitchen; using augmentative and alternative communication during play with wind-up cars, a doll house, or many other toys in a speech-treatment room; selecting books from the book nook; or even playing cotton-ball hockey and having a kazoo and whistle jam session with a client working on oral motor skills.

My two fellow SLPAs at the Children's Therapy also confer with supervising SLPs, attend meetings with other medical discipline staff and AAC support providers, and attend multiple continuing education courses for keep on the many diagnoses of center patients. Children may present with articulation, phonology, fluency or other communication disorders as well as needs related to cleft lip and palate, pragmatic and other communication concerns related to autism, Down syndrome, epilepsy, Rett's syndrome, and other diagnoses.

Medical SLPAs may require medically based continuing education. They also maintain consistent communication with the supervising SLP as well as with other members of the multidisciplinary rehabilitation team, service providers in school settings, and primary physicians and specialists. They also consult with AAC providers on acquiring equipment and follow-through. We also communicate with parents, who often attend outpatient visits and are eager to comply with home program recommendations.

My SLPA responsibilities are quite different, in that all of my documentation requires input from my supervising SLP; assessments and plans are to be completed solely by the SLP, who also attends meetings and confers with other providers and parents/caregivers. Supervision requirements are also vastly different; the SLPA requires line-of-sight or sound supervision for 10% of all client interaction and 10% indirect (assistance with home programs, case conferences, etc.). Supervision records must be stored for three years in case of audit.

SLPAs are assets to clinicians in health care and in schools. Revonda Miller, an SLPA in North Carolina, explains that "we are a great addition to an SLP's practice by extending the amount of treatment (and billables) provided. We can provide all services except swallowing. Our training is directly in service provision, not theory and diagnosis, which are the responsibility of the supervising SLP."

Despite the similarities in education and treatment abilities for SLPAs and LPTAs, the occupational outlook, employment opportunities, and salaries for SLPAs lag behind their LPTA counterparts. Mary Pitt, an SLPA in Texas, moved away from family and friends in Florida because of the dearth of job opportunities in her home state. It is my hope that the ASHA Associate Membership program will assist with advocacy so that one day, my fellow acute-care medical rehabilitation staffers in occupational and physical therapy will no longer ask, "What is an SLPA anyway?" but instead say, "Welcome to the PT/OT/SLP team, SLPAs!"

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