(Updated 9/26/08)
The American Speech-Language-Hearing Association (ASHA) has a position statement and guidelines on the training, use, and supervision of speech-language pathology assistants. ASHA also has resources for supervisors of assistants and continues to support the appropriate training, use, and supervision of speech-language pathology assistants by ASHA-certified speech-language pathologists. Speech-language pathology assistants are to be used only to supplement—not supplant—the services provided by ASHA-certified speech-language pathologists. Speech-language pathology assistants are not trained for independent practice.
Defining Speech-Language Pathology Assistants
Using Speech-Language Pathology Assistants
Supervising Speech-Language Pathology Assistants
Credentialing Speech-Language Pathology Assistants
Training Speech-Language Pathology Assistants
Reimbursing Speech-Language Pathology Assistant Services
Fieldwork for Speech-Language Pathology Assistant Student Trainees
Who are speech-language pathology assistants?
Speech-language pathology assistants are support personnel who, following academic and/or on-the-job training, perform tasks prescribed, directed, and supervised by ASHA-certified speech-language pathologists.
Are there other forms of support personnel?
There are typically two levels of support personnel – aides and assistants. Based on level of training, these support personnel may have a different scope of responsibilities in the work setting. Aides, for example, have a different, usually narrower, training base and a more limited scope of 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).
Is the use of speech-language pathology assistants new?
Speech-language pathology assistants have been used and regulated by many states since the 1970s. ASHA has had guidelines for the use of support personnel since 1969. Attention to the use of assistants has increased as professionals seek mechanisms for expanding services and containing costs. In November 2000, ASHA began development of an approval process for associate degree speech-language pathology assistant training programs and a registration process for speech-language pathology assistants. The approval process was effective January 2002, and the registration process was effective January 2003. However, at its Spring 2003 meeting, ASHA's Legislative Council voted to discontinue both the registration program for speech-language pathology assistants and the approval process for speech-language pathology assistant training programs as of December 31, 2003, primarily due to financial reasons.
Will speech-language pathology assistants be used to replace speech-language pathologists?
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 guidelines and state licensure laws, no one can employ a speech-language pathology assistant without a speech-language pathologist as supervisor. ASHA guidelines and most state laws limit the number of speech-language pathology assistants a speech-language pathologist may supervise and define boundaries for how assistants are used.
Is there a need for speech-language pathology assistants?
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. Access information on state occupational projections.
What is the demand for speech-language pathology assistants?
ASHA does not have specific data on the demand for speech-language pathology assistants; however, 16.4% of ASHA certified speech-language pathologists reported that at least one speech-language pathology assistant was employed in their facilities (2003 ASHA Omnibus Survey). School-based speech-language pathologists reported a greater use of speech-language pathology assistants than did speech-language pathologists in health care facilities. In the school-based setting, 20% of ASHA-certified speech-language pathologists indicated that their facilities employed one or more speech-language pathology assistants (2006 ASHA Schools Survey). This percentage has decreased over time (i.e., 25.4% in 2000 and 31% in 1995 according to the Schools Surveys in those years). Only 2% of speech-language pathologists in health care settings reported using speech-language pathologist assistants (2002 ASHA Health Care Survey). The demand for speech-language pathology assistants may grow as the population base for speech-language pathology services continues to increase.
What are the advantages to the speech-language pathologist in using speech-language pathology assistants in his/her practice?
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 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."
What may speech-language pathology assistants do?
According to ASHA's Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants, which apply across all practice settings, a speech-language pathology assistant may conduct the following tasks under the supervision of a speech-language pathologist:
- Assist speech-language and hearing screenings (without interpretation)
- Assist with informal documentation as directed by the speech-language pathologist
- Follow documented treatment plans or protocols developed by the supervising speech-language pathologist
- Document patient/client performance (e.g., tallying data for the speech-language pathologist to use; preparing charts, records, and graphs) and report this information to the supervision speech-language pathologist
- Assist the speech-language pathologist during assessment of patients/clients
- Assist with clerical duties such as preparing materials and scheduling activities as directed by the speech-language pathologist
- Perform checks and maintenance of equipment
- Support the supervising speech-language pathologist in research projects, in-service training, and public relations programs
- Assist with departmental operations (scheduling, record keeping, safety/maintenance of supplies and equipment)
- Collect data for monitoring quality improvement
- Exhibit compliance with regulations, reimbursement requirements, and speech-language pathology assistant's job responsibilities
State laws vary and may differ from ASHA guidelines. Check specific state regulations.
What is outside of speech-language pathology assistants' scope of responsibilities?
According to ASHA's Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants, a speech-language pathology assistant may not perform the following tasks:
- May not perform standardized or nonstandardized diagnostic tests, formal or informal evaluations, or clinical interpretation of test results
- May not screen or diagnose patients/clients for feeding/swallowing disorders
- May not participate in parent conferences, case conferences, or any interdisciplinary team without the presence of the supervising speech-language pathologist or other ASHA-certified speech-language pathologist designated by the supervising speech-language pathologist
- May not write, develop, or modify a patient/client's individualized treatment plan in any way
- May not assist with patients/clients without following the individualized treatment plan prepared by the speech-language pathologist or without access to supervision
- May not sign any formal documents (e.g., treatment plans, reimbursement forms, or reports; the assistant should sign or initial informal treatment notes for review and co-signature by the supervising professional)
- May not select patients/clients for service
- May not discharge a patient/client from services
- May not disclose clinical or confidential information either orally or in writing to anyone other than the supervising speech-language pathologist
- May not make referrals for additional service
- May not counsel or consult with the patient/client, family or others regarding the patient/client status or service
- May not use a checklist or tabulate results of feeding or swallowing evaluations
- May not demonstrate swallowing strategies or precautions to patients, family, or staff
- May not represent himself or herself as a speech-language pathologist
State laws vary and may differ from ASHA guidelines. Check specific state regulations to determine which tasks are outside the scope of responsibilities for assistants in a particular state.
What is the average salary for speech-language pathology assistants?
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.
How will this program affect the culturally and linguistically diverse professional population?
ASHA places great emphasis on attracting individuals from culturally and linguistically diverse backgrounds into the speech-language pathology/audiology professions. In related professions that use assistants, the proportions of minorities to non-minorities in both the assistant and the professional levels are similar.
Who is responsible for services provided by a speech-language pathology assistant?
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.
Will caseloads expand when assistants are used?
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.
Who can supervise speech-language pathology assistants?
ASHA's guidelines define a supervisor as a speech-language pathologist certified by ASHA and licensed by the state (where applicable) who has been practicing for at least 2 years following ASHA certification and has completed at least one pre-service course or continuing education unit in supervision.
Is the speech-language pathologist supervising a speech-language pathology assistant required to have a course in supervision?
It is recommended, according to ASHA's 2004 guidelines (see above).
What resources on supervision does ASHA have available?
Refer to the Knowledge and Skills for Supervisors of Speech-Language Pathology Assistants, which is also available through the ASHA Action Center at 800-498-2071. Additional resource items are available online at the ASHA Shop or by calling 888-498-6699, including "Practical Tools and Forms for Supervising Speech-Language Pathology Assistants" and "Working with Speech-Language Pathology Assistants in School Settings." Finally, professional development opportunities in supervision are periodically offered as education programs through ASHA teleseminars and conferences listed on our Continuing Education page.
If an ASHA-certified speech-language pathologist with less than two years' experience joins a program with an experienced speech-language pathology assistant, should the assistant be terminated to meet ASHA's 2004 guidelines?
No. However, there should be documentation of the attempt to hire a qualified speech-language pathologist as supervisor (i.e., with more than 2 years' experience post-ASHA certification). In addition, an alternate plan of supervision should be developed.
How much supervision is recommended?
The amount and type of supervision required should be based on the skills and experience of the speech-language pathology assistant, the needs of patients/clients served, the service setting, the tasks assigned, and other factors. ASHA's Code of Ethics requires certificate holders to provide "appropriate supervision." In ASHA's speech-language pathology assistant guidelines, the minimum amount of supervision suggested is 30% weekly (at least 20% direct) for the first 90 workdays and 20% (at least 10% direct) after the initial work period. Direct supervision means on-site, in-view observation and guidance by a speech-language pathologist while an assigned activity is performed by support personnel. The guidelines also recommend that a speech-language pathologist supervise no more than three speech-language pathology assistants.
State laws vary and may differ from ASHA guidelines. Check specific state regulations to determine amount of supervision required and qualifications for supervisors of assistants in a particular state.
Does ASHA credential speech-language pathology assistants?
Not at this time. ASHA had started a voluntary registration program for speech-language pathology assistants in 2003, of which one criterion for such registration required an associate degree from a technical training program for speech-language pathology assistants. At its spring 2003 meeting, ASHA's Legislative Council passed a resolution to discontinue the registration program for speech-language pathology assistants and the approval process for speech-language pathology assistant technical training programs as of December 31, 2003, primarily due to financial reasons.
ASHA no longer has a recognition process for associate degree technical training programs for speech-language pathology assistants nor a registration process for speech-language pathology assistants. ASHA will continue to disseminate the Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants, which were revised in 2004. The revised Guidelines include recommended curriculum for training programs and a checklist for supervisors of speech-language pathology assistants that can assist in the verification of technical proficiency of the assistant.
How does one become a speech-language pathology assistant?
ASHA's recommends completion of 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. 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. ASHA's Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants are national in scope and can serve to promote greater uniformity in the terms used to identify speech-language pathology support personnel, training and educational requirements, and job responsibilities.
Is continuing education required for a speech-language pathology assistant?
Currently, ASHA does not have a continuing education requirement for speech-language pathology assistants. State laws may vary from ASHA's requirements, so check with the state of intended employment, as several states do require annual continuing education for assistants.
Is the use of speech-language pathology assistants permitted in every state?
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.
Is this a career ladder?
It could be, but it is not specifically intended as such because the associated coursework and fieldwork experiences required in the speech-language pathology assistant program typically differ from those at the bachelor's, pre-professional, or master's professional levels. Anyone interested in pursuing academic coursework and fieldwork as an assistant prior to entering the field of speech-language pathology may want to check with bachelor's degree programs and master's degree programs in speech-language pathology to determine if any courses taken in the associate degree speech-language pathology assistant program will be credited for future studies.
What information is available to help a training institution start a speech-language pathology assistant training program?
The 2004 revised Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants include curriculum content for training of speech-language pathology assistants. (See Section G below for more information.)
Can an institution establish a speech-language pathology assistant training program in a state that prohibits the use 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.
How can I find qualified speech-language pathology assistants?
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 degree programs and institutions that train and graduate speech-language pathology assistants.
How many training programs are there for speech-language pathology assistants?
As of August 2008, ASHA is aware of 23 operational associate 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 self-identified list of speech-language pathology assistant training programs: Speech Language Pathology Assistants 2008 Training Programs [PDF].
Reimbursing Speech-Language Pathology Assistant Services
Can speech-language pathologists receive reimbursement for speech-language pathology assistant services?
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 your National Association of State Medicaid Directors [RTF] to determine coverage in your state.
Fieldwork for Speech-Language Pathology Assistant Student Trainees
Introduction
The questions and answers below are provided to assist associate degree 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.
Should the fieldwork hours completed by speech-language pathology assistant students be performed at specific types of settings or distributed across specific age groups or disorders?
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.
Does the minimum of 100 clock hours of fieldwork include observation hours?
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 engaged in patient/client contact, ASHA guidelines recommend 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.
When speech-language pathology assistant students are placed in fieldwork settings, can they be supervised by more than one speech-language pathologist?
Yes. ASHA recommends that each speech-language pathologist supervising the student complete a technical proficiency or skills competency checklist (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 suggests that an ASHA-certified speech-language pathologist supervise the first 100 clock hours of fieldwork defined in ASHA guidelines 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.
How many years' experience does the supervisor need to have to supervise a speech-language pathology assistant student?
The Guidelines for Training, Use, and Supervision of Speech-Language Pathology Assistants specify that the speech-language pathology assistant must be supervised by a speech-language pathologist who has practiced speech language pathology for at least 2 years following ASHA certification.
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