Significant changes were made in IDEA '04 which are explained in detail below. In short, it may be permissible for a district to hire personnel who do not meet ASHA's requirements to practice speech-language pathology. Here's why:
Under IDEA'97, standards for school-based related services providers must have met the "highest requirement in the state" for a profession or discipline, although "waivers" were allowed on an emergency, temporary, or provisional basis. This linked state education agency personnel standards with standards established by other state agencies or regulatory bodies such as state license boards. Significant changes were made in the law (IDEA '04) which removed this provision.
Under the new law, qualifications for related services personnel, including speech-language pathologists, must now be consistent with ANY state-approved or state-recognized certification, licensing, or other comparable requirement applicable to a specific professional discipline. States are now allowed to establish requirements for school-based personnel which may be significantly less rigorous than qualifications and credentials required for ASHA certification (CCC) and/or state licensure.
The new law also stipulates that personnel must not have had their certification or licensure requirements waived on an emergency, temporary, or provisional basis. Under the previous waiver provision, states could permit schools to depart from personnel standards in the case of personnel shortages. Congress eliminated this option by indicating in its amended law that certification or licensure requirements may not be waived on an emergency, temporary, or provisional basis for related services personnel who deliver services in their discipline or profession. The law does allow paraprofessionals and assistants who are appropriately trained and supervised to assist in the provision of special education and related services to children with disabilities.
The law also requires that States adopt a policy which includes a requirement that local education agencies (LEAs) in the State take measurable steps to recruit, hire, train, and retain highly qualified personnel to provide special education and related services to children with disabilities. Language in Congress' report on the amended law indicated its intent for this requirement.
ASHA considers the requirements for the Certificate of Clinical Competence (CCC) in Speech-Language Pathology to be minimal entry level requirements for SLPs regardless of their work setting. These include an earned Master's or doctoral degree comprising demonstration of required knowledge and skills achieved through coursework and clinical practicum, completion of Clinical Fellowship (CF) and successful completion of the Praxis exam in speech-language pathology.
ASHA also believes that the parameters need to be identified that specify how paraprofessionals and assistants should be trained, utilized and supervised. It is critical that the Department of Education provide the guidance necessary to ensure that, as federal funds are used to implement the provision for utilization of paraprofessionals and assistants, there at least minimum framework for states to use in developing policies related to such personnel.
For additional information, see ASHA's comments: Qualified Providers
"It is the position of the American Speech-Language-Hearing Association that multiskilling is not a one-dimensional concept and that it cannot be evenly applied across the diverse clinical workforce. Specifically, cross-training of clinical skills is not appropriate at the professional level of practice (i.e., audiologists or speech-language pathologists)."
In ASHA's position statement, "Training, Use and Credentialing of Support Personnel in Speech Language Pathology," it is stated that support personnel may be used to perform activities adjunct to the primary clinical efforts of speech-language pathologists. Appropriate training and supervision must be provided by speech-language pathologists who hold ASHA's Certificate of Clinical Competence in Speech-Language Pathology. Activities may be assigned only at the discretion of the supervising speech-language pathologist and should be constrained by the job responsibilities for support personnel. The communication needs and protection of the consumer must be held paramount at all times.
"Cross training of basic patient care skills, professional non-clinical skills, and/or administrative skills is a reasonable option that clinical practitioners at all levels of practice may need to consider depending on the service delivery setting, geographic location, patient/client population and clinical workforce resources." See glossary for definition of terms used in this position statement. For further clarification, please refer to:
Multiskilled Personnel Position Statement (1996)
Multiskilled Personnel Technical Report (1996)
See Speech-Language Pathology Assistant FAQs for additional information including varying levels of support personnel and scope of practice for speech-language pathology assistants.
Regardless of job title, preparation, tasks, and other credentials, all persons who provide support services in audiology and speech-language pathology should be directed and supervised by ASHA-certified audiologists and/or speech-language pathologists. Because the assistant, aide, or technician is an integral figure in many settings, the individual with ASHA certification and the support personnel must work together to help ensure appropriateness in all tasks. These include, but are not limited to, client and task assignment, supervision, competence, accountability, and representation to consumers, employers, and regulatory and funding agencies. The Board of Ethics refers individuals to the following sections of the current Code of Ethics (2003) for specific discussion of these issues; Principle of Ethics I, Rules of Ethics D and E; Principle of Ethics II, Rules A, D, and E; and Principle of Ethics IV, Rule A.
Issues in Ethics: Speech-Language Pathology Assistants
Frequently Asked Questions: Speech Language Pathology Assistants (includes ASHA policy documents)
ASHA is acutely aware of the issues that exist and the challenges that our members are facing in schools. ASHA assists members on an individual basis by providing technical assistance and access to resources and information to help advocate for change. At the state level, ASHA works with state associations on initiatives to affect changes and, at the federal level, ASHA works on issues related to IDEA, Medicaid, and reimbursement for SLP services. ASHA currently is addressing shortages of SLPs in schools and health care settings through the Focused Initiative on Personnel Issues. A Coordinating Committee is also being formed to address the issue of encroachment on the scope of practice of speech-language pathology by other professions.
If you feel that speech-language services are not being provided in an appropriate manner, you can contact your state speech-language-hearing association. Ask them to file a complaint with the state department of special education services under Part B of IDEA.
A copy of the complaint should also be sent to the unit of the U.S. Department of Education that monitors Part B implementation:
US Department of Education, OSERS
Office of Special Education Programs
400 Maryland Avenue SW
Washington, DC 20202
Within 60 days, the designated agency must issue a written decision that addresses each allegation in the complaint.
If the decision is not to your satisfaction, find out when the designated agency will be holding public hearings concerning its Part B application for the next year. Through your state association, organize testimony at these hearings by both professionals and parents. The designated agency must review and consider all public comments before submitting its application.
ASHA has developed a number of resources that can assist you in educating the public and advocating for the profession of speech-language pathology. These resources include: