The American Speech-Language-Hearing Association (ASHA) has a Speech-Language Pathology Assistant Scope of Practice document, and a Practice Portal page regarding the Professional Issues Related to Speech-Language Pathology Assistants (SLPAs). SLPAs are to be used only to supplement—not supplant—the services provided by ASHA-certified speech-language pathologists. SLPAs are not trained for independent practice.
Speech-language pathology assistants are support personnel who, following academic coursework, fieldwork, and on-the-job training, perform tasks prescribed, directed, and supervised by ASHA-certified speech-language pathologists.
There are typically two levels of support personnel— aides and assistant, but the definitions of aides and assistants vary from state to state. ASHA distinguishes between these two levels based on level of training and responsibilities. Aides, for example, have a different, usually narrower, training base and more limited responsibilities than speech-language pathology assistants. States may use different terminology to refer to support personnel in speech-language pathology (e.g., communication aides, paraprofessionals, service extenders).
Speech-language pathology assistants (SLPAs) have been used and regulated by many states since the 1970s. ASHA has had guidelines for the appropriate use of support personnel since 1969. In January 2002, ASHA implemented an approval process for associate degree SLPA training programs. In January 2003, ASHA implemented a registration process for SLPAs. However, at its spring 2003 meeting, ASHA's Legislative Council voted to discontinue both programs, primarily for financial reasons. Because of this decision, ASHA did not register any SLPAs and only approved one SLPA training program.
In 2011, ASHA launched the Associates Program. The ASHA Associates Program encompasses an affiliation category for individuals who work as support personnel in speech-language pathology and audiology. This process began in 2009, when the Board of Directors (BOD) passed a motion to establish an affiliation category for support personnel in both professions.
The Associate category is open to individuals who work in a support position under the supervision of an ASHA-certified speech-language pathologist or audiologist. Applicants assert that they will adhere to ASHA's guidelines for speech-language pathology assistants (SLPAs) or support personnel in audiology, perform only tasks that are appropriate for SLPAs or audiology assistants, adhere to state laws and state licensure requirements for SLPAs and audiology assistants, and pay the requisite annual fees.
Associate applicants are required to have their ASHA-certified supervisors attest to the fact that they have the necessary skills to work in a support position. An applicant who is not employed must have his or her college or university program director sign the application to affirm that the applicant has the necessary skills to function as a support person in speech-language pathology or audiology. The supervising SLP or audiologist will verify that the applicant's job duties are being performed under direct supervision of an ASHA-certified SLP or audiologist.
No. Assistants cannot replace qualified speech-language pathologists. Rather, they can support clinical services provided by speech-language pathologists. ASHA guidelines were developed to ensure that speech-language pathology services provided to the public are of the highest quality and that speech-language pathologists continue to be responsible for maintaining this quality of service. According to ASHA’s scope of practice for speech-language pathology assistants and state licensure laws, no one can employ a speech-language pathology assistant without a speech-language pathologist as supervisor. ASHA and most states limit the number of speech-language pathology assistants a speech-language pathologist may supervise and define boundaries for how assistants are used.
To serve a growing and more diverse client base and an expanding scope of practice, more service providers are needed. In an era of heightened demand for cost efficiency, some tasks may be more appropriate for support personnel than for professional-level providers. The use of assistants may allow ASHA-certified speech-language pathologists to focus more on professional-level clinical services (i.e., those that require ongoing clinical judgment) rather than on routine day-to-day operational activities. Access the U.S. Bureau of Labor Statistics national job outlook for the professions of speech-language pathology and audiology. Access information on state occupational projections.
Forty-two percent of school-based SLPs and 32% of health-care based SLPs reported that there was one or more SLP support personnel employed at their facility (ASHA 2009 Membership survey). For those currently using one or more support person, the median number reported was two for both school-based SLPs and SLPs based in health care settings. These SLPs indicated that support personnel assist primarily in the following five ways: 1) assist with clerical duties (56%), 2) follow treatment plans or protocols developed by the SLP (48%), 3) assist with informal documentation as directed by the SLP (48%), 4) document client performance (45%), and 5) collect data for monitoring quality improvement (40%).
It is difficult to discern clear-cut trends in employment rates of support personnel for SLP assistants. The use of SLP assistants in the schools appears to have remained stable between 1999 and 2006. At least one SLP assistant was reported in their employment facility by 21%, 18%, and 20% of the school-based SLPs according to the, respectively, 1999 ASHA Omnibus survey, 2003 ASHA Omnibus survey, and 2006 ASHA Schools survey. Apparently, an increase in the use of SLP assistants occurred in 2009, based on the ASHA Membership survey when 42% of SLPs in school settings reported using SLP support personnel.
A stable pattern of use also appears between 1999 and 2003 for health care-based SLPs. At least one assistant was reported to be employed by 16% and 14% of health care-based SLPs according to the 1999 ASHA Omnibus survey and 2003 ASHA Omnibus survey, respectively. According to the ASHA SLP Health Care survey in 2002, 2% of SLPs in health care settings reported there were from one to five full-time SLP assistants working in their department. One percent reported there were from one to five part-time SLP assistants working in their department. Between 8% and 13% reported that they employ other full- or part-time support personnel, such as rehabilitation technicians, which may help to account for the difference in percentages compared with the other years. Similar to school settings, it appears that use of support personnel may be increasing in health care settings, based on the 32% in these settings who indicated on the ASHA 2009 Membership survey that they employ one or more SLP support personnel. Likewise, in the 2012 ASHA dues renewal survey, more than 17,000 members who responded to the survey reported that they currently supervise support personnel in audiology or speech-language pathology.
The ASHA-certified speech-language pathologist may extend services (i.e., increase the frequency and intensity of services to patients or clients on his/her caseload), focus more on professional-level tasks, increase client access to the program, and achieve more efficient/effective use of time and resources. According to the ASHA 2000 Schools Survey, 47.3% of respondents who reported that speech-language pathology assistants were employed at their facility indicated that the use of speech-language pathology assistants led to "more time for direct service," while 23.1% reported that the use of speech-language pathology assistants led to "more time for planning/consultation with teachers."
According to the 2012 ASHA Schools survey, 45.1% of respondents who reported there was a shortage of clinical service providers in their type of school setting and geographic area indicated that “increased use of support personnel/contracted service providers or noncertified SLPs or audiologists was one impact of the shortage of SLP clinical service providers in school settings. In 2010, 23.4% of respondents reported that “increased use of support personnel” was one impact of the shortage.
Survey data were reviewed to determine the use of SLP assistants in educational and health care settings. According to the 2009 ASHA membership survey, having more time to work with clients/patients with more complex needs (36% of SLPs) and having fewer clerical duties (33% of SLPs) were two of the primary effects reported from the use of support personnel . Approximately one quarter of the SLPs who reported that they currently employ one or more support person at their facility indicated that other effects were to increase frequency or intensity of service and respond to personnel shortages. The main reasons reported for not using support personnel were that they were not budgeted or not needed. Also, some SLPs (29%) indicated that larger caseloads or workloads were an effect of using support personnel.
According to ASHA's Speech-Language Pathology Assistant Scope of Practice, which applies across all practice settings, a speech-language pathology assistant may conduct the following tasks under the supervision of a speech-language pathologist. The supervising SLP retains full legal and ethical responsibility for the students, patients, and clients he or she serves, but may delegate specific tasks to the SLPA. The SLPA may execute specific components of a speech and language program as specified in treatment plans developed by the SLP. Goals and objectives listed on the treatment plan and implemented by the SLPA are only those within their scope of responsibilities and are tasks the SLP has determined the SLPA has the training and skill to perform. The SLP must provide at least the minimum specified level of supervision to ensure quality of care to all persons served. The amount of supervision may vary and must depend on the complexity of the case and the experience of the assistant. Under no circumstances should use of the ASHA Code of Ethics or the quality of services provided be diluted or circumvented by the use of an SLPA. Again, the use of an SLPA is optional, and an SLPA should be used only when appropriate.
Provided that the training, supervision, and planning are appropriate, the SLPA may perform certain tasks under the circumstances described below:
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State laws vary and may differ from ASHA’s guidelines and requirements. Check specific state regulations to determine which tasks are outside the scope of responsibilities for assistants in a particular state.
According to ASHA's Speech-Language Pathology Assistant Scope of Practice, which applies across all practice settings, a speech-language pathology assistant should NOT engage in the following:
State laws vary and may differ from ASHA’s guidelines and requirements. Check specific state regulations to determine which tasks are outside the scope of practice for assistants in a particular state.
At this time, ASHA collects salary data only on ASHA-certified speech-language pathologists and audiologists. Occupational and physical therapy data show that assistants in those fields make about 60% to 75% of professional-level salaries.
Recently, Payscale.com published salary data for audiologist assistants and SLPAs. Although the data are not exhaustive (this is based on a survey of individuals currently working in the position that respond to a salary survey), the information can still provide a sense of the overall trends of salaries in the states that utilize support personnel.
The fully qualified, ASHA-certified supervising speech-language pathologist is responsible for the services provided by assistants. In states that regulate speech-language pathology assistants, speech-language pathologists who hold full, unrestricted licenses assume these responsibilities for persons working under their direction.
As has always been the case, caseload size of ASHA-certified speech-language pathologists may or may not increase depending on client needs and the nature of the services provided. If speech-language pathology assistants are used appropriately, and if they are adequately supervised, ASHA-certified speech-language pathologists' caseloads may decrease to permit sufficient time to supervise staff working under their direction; however, workload may increase as the speech-language pathologist assumes responsibilities for training and supervising assistants. Speech-language pathology assistants do not carry their own caseloads. Assistants help to provide services as directed for the caseloads of speech-language pathologists.
According to ASHA's Speech-Language Pathology Assistant Scope of Practice, which applies across all practice settings, the minimum qualifications for an SLP who will supervise an SLPA include:
Additional resources related to supervision include the following:
The ASHA Speech-Language Pathology Assistant Scope of Practice states the minimum requirements for the frequency and amount of supervision of support personnel as follows:
The first 90 workdays: A total of at least 30% supervision, including at least 20% direct and 10% indirect supervision, is required weekly. Direct supervision of student, patient, and client care should be no less than 20% of the actual student, patient, and client contact time weekly for each SLPA. This ensures that the supervisor will have direct contact time with the SLPA as well as with the student, patient, or client. During each week, data on every student, patient, and client seen by the SLPA should be reviewed by the supervisor. In addition, the direct supervision should be scheduled so that all students, patients, and clients seen by the assistant are directly supervised in a timely manner. Supervision days and time of day (morning/afternoon) may be alternated to ensure that all students, patients, and clients receive some direct contact with the SLP at least once every 2 weeks.
After the first 90 workdays: The amount of supervision can be adjusted if the supervising SLP determines the SLPA has met appropriate competencies and skill levels with a variety of communication and related disorders.
Minimum ongoing supervision must always include documentation of direct supervision provided by the SLP to each student, patient, or client at least every 60 calendar days.
A minimum of 1 hour of direct supervision weekly and as much indirect supervision as needed to facilitate the delivery of quality services must be maintained.
Documentation of all supervisory activities, both direct and indirect, must be accurately recorded.
Further, 100% direct supervision of SLPAs for medically fragile students, patients, or clients is required.
The supervising SLP is responsible for designing and implementing a supervisory plan that ensures the highest standard of quality care can be maintained for students, patients, and clients. The amount and type of supervision required should be consistent with the skills and experience of the SLPA; the needs of the students, patients, and clients; the service setting; the tasks assigned; and the laws and regulations that govern SLPAs. Treatment of the student, patient, or client remains the responsibility of the supervisor.
Direct supervision means on-site, in-view observation and guidance while a clinical activity is performed by the assistant. This can include the supervising SLP viewing and communicating with the SLPA via telecommunication technology as the SLPA provides clinical services, because this allows the SLP to provide ongoing immediate feedback. Direct supervision does not include reviewing a taped session at a later time.
Supervision feedback should provide information about the quality of the SLPA's performance of assigned tasks and should verify that clinical activity is limited to tasks specified in the SLPA's ASHA-approved responsibilities. Information obtained during direct supervision may include, but is not limited to, data relative to (a) agreement (reliability) between the assistant and the supervisor on correct/incorrect recording of target behavior, (b) accuracy in implementation of assigned treatment procedures, (c) accuracy in recording data, and (d) ability to interact effectively with the patient, client, or student during presentation and application of assigned therapeutic procedures or activities.
Indirect supervision does not require the SLP to be physically present or available via telecommunication in real time while the SLPA is providing services. Indirect supervisory activities may include demonstration tapes, record review, review and evaluation of audio- or videotaped sessions, and/or supervisory conferences that may be conducted by telephone and/or live, secure webcam via the Internet. The SLP will review each treatment plan as needed for timely implementation of modifications.
An SLPA may not perform tasks when a supervising SLP cannot be reached by personal contact, phone, pager, or other immediate or electronic means. If for any reason (i.e., maternity leave, illness, change of jobs) the supervisor is no longer available to provide the level of supervision stipulated, the SLPA may not perform assigned tasks until an ASHA-certified and/or state-licensed SLP with experience and training in supervision has been designated as the new supervising SLP.
Any supervising SLP who will not be able to supervise an SLPA for more than 1 week will need to (a) inform the SLPA of the planned absence and (b) make other arrangements for the SLPA's supervision of services while the SLP is unavailable or (c) inform the clients/student/patients that services will be rescheduled.
State laws vary and may differ from ASHA’s guidelines and requirements. Check specific state regulations to determine amount of supervision required and qualifications for supervisors of assistants in a particular state.
No. In January 2002, ASHA implemented an approval process for associate degree SLPA training programs. In January 2003, ASHA implemented a registration process for SLPAs. However, at its spring 2003 meeting, ASHA's Legislative Council voted to discontinue both programs, primarily for financial reasons. Because of this decision, ASHA did not register any SLPAs and only approved one SLPA training program.
Although ASHA no longer has these credentialing programs, ASHA does have resources for support personnel, supervisors, and educators. These include the ASHA Associates Program, a recommended curriculum for training programs, a checklist for supervisors of SLPAs that can assist in the verification of technical proficiency of the assistant [PDF], and a Speech-Language Pathology Assistant Scope of Practice.
ASHA’s Speech-Language Pathology Assistant Scope of Practice provides minimum recommended qualifications, which include completion of an approved course of academic study, field work under the supervision of an ASHA-certified and/or licensed SLP, and on-the-job training specific to SLPA responsibilities and workplace behaviors. The academic course of study must include or be equivalent to an associate's degree from a technical training program with a program of study designed to prepare the student to be a speech-language pathology assistant or a bachelor’s degree in a speech-language pathology or communication disorders program. The fieldwork includes successful completion of a minimum of one hundred (100) hours of supervised field work experience or its clinical experience equivalent. Also included in the minimum qualifications is a demonstration of competency in the skills required of an SLPA. Because the requirements for speech-language pathology support personnel vary across the country, persons interested in serving as speech-language pathology assistants should check with the state of intended employment for that state's specific requirements. State agencies (licensure boards) currently regulating support personnel have training requirements that range from a high school diploma to a baccalaureate degree plus graduate credit hours, as well as a variety of differing requirements for those supervising these individuals. In addition to state regulatory agencies, state education agencies may credential support personnel to work solely in schools to support service delivery provided by a qualified speech-language pathologist. Several states do require annual continuing education for assistants.
No. Some states that regulate speech-language pathology do not permit the use of speech-language pathology support personnel. In addition, state departments of education may credential speech-language pathology support personnel. Some school districts hire assistants under the classification of teacher assistants. If a state regulates speech-language pathology support personnel (i.e., under the term of assistant, aide, paraprofessional, apprentice, etc.), then individuals who wish to become employed in that state must meet the state requirements for practice under a licensed and ASHA-certified speech-language pathologist. Call the state licensure board or department of education for specific state regulations. Addresses and phone numbers can be obtained through the ASHA State-by-State page.
There is the potential for a career continuum—from SLPA to SLP—depending on the state and work setting regulations in place for the intended state of practice. Traditionally, the support personnel career continuum has not been specifically intended as such because the associated course work and field work experiences required in the SLPA program may differ from those at the bachelor's, pre-professional, or master's levels.
Anyone interested in pursuing academic course work and field work as an assistant prior to entering the field of speech-language pathology should check with bachelor's degree programs and master's degree programs in speech-language pathology in his or her state to determine if any courses taken in the associate degree speech-language pathology assistant program will be credited for future studies.
The Practice Portal page regarding Professional Issues related to Speech-Language Pathology Assistants includes a sample curriculum and information for field work for training of speech-language pathology assistants.
Such decisions are under the purview of state agencies that have degree-granting authority and that regulate the professions. Consult with the appropriate state entity that performs such oversight to determine if starting such a program is permissible under postsecondary requirements in place and whether the program would be at variance with state law and regulations for the profession.
Call states that regulate them. Addresses and phone numbers of state licensure boards and regulatory agencies can be obtained from the ASHA State-by-State page. Another option is to call associate’s degree programs and institutions that train and graduate speech-language pathology assistants. A list of speech-language pathology assistants who are ASHA Associates may be obtained via the mailing list requests page.
As of March 2013, ASHA is aware of 25 operational associate’s degree programs for speech-language pathology assistants. Some of these programs offer training opportunities through distance learning and collaborations between community colleges and institutions of higher education. For a list of self-identified speech-language pathology assistant training programs: please visit Technical Training Programs for Speech-Language Pathology Assistants.
Medicare policy currently does not recognize speech-language pathology assistants, regardless of the level of supervision, and does not reimburse for speech-language pathology assistant services. Private insurers may cover licensed or registered speech-language pathology assistants. One must query each payer to verify coverage. Private insurers may or may not provide a different rate of reimbursement for services provided by a speech-language pathologist as opposed to a speech-language pathology assistant.
Medicaid reimbursement of speech-language pathology assistants varies from state to state. It is suggested that you contact the National Association of Medicaid Directors [PDF] to determine coverage in your state.
The questions and answers below are provided to assist technical training programs for speech-language pathology assistants in establishing fieldwork arrangements that provide speech-language pathology assistant students with the technical skills for supervisors to verify their technical proficiency. This section is applicable to speech-language pathology assistant student trainees, not necessarily assistants in the employment setting.
ASHA does not specify types of settings for fieldwork or distribution of hours, but recommends that the fieldwork provides speech-language pathology assistant students with a variety of experiences with individuals with communication disorders. The intent is for training programs to have flexibility in arranging their fieldwork, and to provide speech-language pathology assistant students with experience with both children and adults in more than one setting; however, ASHA policies do not suggest a specific distribution.
No. ASHA guidelines recommend a minimum of 100 clock hours of fieldwork that includes direct and indirect client contact activities covering all of the job responsibilities of a speech-language pathology assistant, but no observation hours. ASHA recommends that observation hours be undertaken before starting the 100 fieldwork hours. It is up to the training program to set the appropriate number of observation hours.
When speech-language pathology assistant students are engaged in patient/client contact, does ASHA recommend that they receive direct supervision or indirect supervision for the specified minimum of 50% of the time?
When students are engaged in patient/client contact, ASHA recommends that the speech-language pathology assistant student be supervised a minimum of 50% of the time. The patient/client contact refers to direct supervision of the speech-language pathology assistant student, which is defined as on-site, in-view observation and guidance.
Yes. ASHA recommends that each speech-language pathologist supervising the student complete a technical proficiency or skills competency checklist [PDF] (or whatever specific format your institution uses for fieldwork assessments) for that particular student.
Should the supervisor of a speech-language pathology assistant student in an external fieldwork placement hold a current Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) from ASHA, or can he/she hold state licensure only?
ASHA recommends that an ASHA-certified speech-language pathologist supervise the first 100 clock hours of fieldwork for each speech-language pathology assistant student. Any fieldwork hours completed that are more than 100 clock hours may be under the supervision of a qualified speech-language pathologist who is either state-licensed or ASHA-certified.
According to ASHA's new Speech-Language Pathology Assistant Scope of Practice, a speech-language pathologist may supervise support personnel if the SLP is certified by ASHA and has been practicing for at least 2 years following ASHA certification, has completed not less than ten(10) hours of continuing professional development in supervision training prior to supervision of an SLPA, and is licensed and/or credentialed by the state (where applicable) in which the SLP is employed.