Bachelor s-level Speech-Language Pathology Assistants in California: A Clinical Practicum Course

Transcription

1 Bachelor s-level Speech-Language Pathology Assistants in California: A Clinical Practicum Course Jennifer A. Ostergren California State University, Long Beach S peech-language pathology assistants (SLPAs) are defined by the American Speech- Language-Hearing Association (ASHA) as support personnel who, following academic and/or onthe-job training, perform tasks prescribed, directed, and supervised by ASHA-certified speech-language pathologists (ASHA, n.d.b., para. 2). SLPAs differ from aides in their degree of training and, correspondingly, in the types of responsibilities that can be assigned to them (ASHA, 2004b, p. 4). Table 1 contains a summary of the job duties detailed by ASHA (2004b) as within and outside the scope of responsibility of an SLPA. Although there is a paucity of published research on the use of SLPAs, ASHA s 2009 membership survey indicated that 37% of speech-language pathologists (SLPs) reported employing support personnel in their facility (ASHA, 2009). A median number of three support personnel were reported per facility. In this same survey, 52% of SLPs in the Pacific regions of the United States (including California) indicated that one of the side effects of a shortage of qualified SLPs was increased use of support personnel. Those members who employed one or more support personnel reported that the top two effects of working with support personnel were (a) more time to work with ABSTRACT: Purpose: This article discusses the development and implementation of a course that was designed to meet clinical practicum requirements for bachelor slevel speech-language pathology assistant (SLPA) registration in California, including the results of 2 surveys that addressed (a) the type of employment (if any) obtained by students after course completion and (b) student perceptions about the clinical practicum associated with the course and their suggestions for speech-language pathologists (SLPs) who supervise new SLPAs. Method: Both qualitative and quantitative data were collected using surveys. One hundred and thirty-three students completed this course and were administrated an employment and/or opinion survey following course completion. Results: Results of an employment survey revealed that a large number of respondents applied for and were successful in obtaining SLPA registration in California after completing the course. A large percentage of these individuals were also able to obtain employment as an SLPA following course completion. Students completing the course indicated that direct contact with clients, exposure to a variety of types of clients and disorders, and practice in data collection were valuable aspects of the clinical practicum associated with the course. In terms of recommendations for ways SLPA supervisors could assist new SLPAs, the majority of students who completed the opinion survey associated with the course suggested that SLPA supervisors could (a) provide clear and consistent feedback to the SLPA, (b) be clear in their expectations of the SLPA, (c) be available and approachable to the SLPA, (d) share insider tips and rationales with the SLPA, and (e) allow the SLPA to observe them providing services and work in tandem with the SLPA during treatment activities (e.g., co-treat). Conclusion: The results of this study are discussed as they pertain to SLPAs, SLPA supervisors, SLPA training programs, and governing agencies responsible for setting policy relative to SLPA use and training. KEY WORDS: speech-language pathology assistant (SLPA), supervision, support personnel CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Ostergren: Spring 2012 Bachelor s-level NSSLHA SLPAs in California /12/

2 Table 1. Job duties detailed by the American Speech-Language-Hearing Association (2004b, pp. 5 6) as being within and outside the scope of responsibility of a speech-language pathology assistant (SLPA). Job responsibilities for an SLPA Provided that the training, supervision, and planning are appropriate (i.e., consistent with the guidelines), the following tasks may be delegated to a speech-language pathology assistant: 1. assist the speech-language pathologist with speech-language and hearing screenings (without clinical interpretation of results) 2. assist with informal documentation as directed by the speechlanguage pathologist 3. follow documented treatment plans or protocols developed by the supervising speech-language pathologist 4. 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 supervising speech-language pathologist 5. assist the speech-language pathologist during assessment of patients/clients 6. assist with clerical duties such as preparing materials and scheduling activities as directed by the speech-language pathologist 7. perform checks and maintenance of equipment 8. support the supervising speech-language pathologist in research projects, in-service training, and public relations programs 9. assist with departmental operations (scheduling, record keeping, safety/maintenance of supplies and equipment) 10. collect data for monitoring quality improvement 11. exhibit compliance with regulations, reimbursement requirements, and speech-language pathology assistant s job responsibilities Activities outside of job responsibilities for an SLPA The speech-language pathology assistant: 1. may not perform standardized or nonstandardized diagnostic tests, formal or informal evaluations, or clinical interpretations of test results 2. may not screen or diagnose patients/clients for feeding/swallowing disorders 3. 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 4. may not write, develop, or modify a patient s/client s individualized treatment plan in any way 5. may not assist with patients/clients without following the individualized treatment plan prepared by the speech-language pathologist or without access to supervision 6. 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 speech-language pathologist) 7. may not select patients/clients for services 8. may not discharge a patient/client from services 9. may not disclose clinical or confidential information either orally or in writing to anyone other than the supervising speech-language pathologist 10. may not make referrals for additional service 11. may not counsel or consult with the patient/client, family, or others regarding the patient/client status or service 12. may not use a checklist or tabulate results of feeding or swallowing evaluations 13. may not demonstrate swallowing strategies or precautions to patients, family, or staff clients/patients with more complex needs (36%) and (b) fewer clerical duties (33%) (ASHA, 2009). The services reported as currently provided by support personnel were (a) assisting with clerical duties (56%) and (b) following treatment plans or protocols developed by the SLP (48%). The top two services that ASHA members would like to see provided by support personnel in the future were (a) assisting with clerical duties (79%) and (b) documenting client performance (67%). Over the years, ASHA has provided its members with several guidelines and supplemental resources specific to SLPA use and training (ASHA, 2002, 2004a, 2004b). However, agencies at the state level continue to implement and monitor licensure, certification, or registration of SLPAs, with varying degrees of coursework and clinical practicum required (ASHA, n.d.d.). Recently, ASHA announced plans to create an associates program, offering ASHA affiliation to support personnel in audiology and speech-language pathology (Robinson, 2010). Scheduled to launch formally in September 2011, the program is designed for individuals who are currently employed and are working under the supervision of an ASHA-certified audiologist (CCC-A) or SLP (CCC-SLP), allowing them to apply for affiliation as an associate of ASHA (ASHA, n.d.a.). ASHA associates would be required to agree to and follow ASHA policies related to the responsibilities of support personnel, working only under the supervision of a CCC-A or CCC-SLP. They would also need to have been qualified to practice in their state and follow state requirements. An annual fee would be required; in exchange, ASHA associates would have access to several ASHA-affiliated benefits and opportunities, including mentoring programs, scholarly journals, professional development hours, and other ASHA benefits (ASHA, n.d.a.). ASHA cited as a need for this new program inconsistencies nationally in terms of licensing and support personnel use (Robinson, 2010). Currently, 35 states license, register, or certify support personnel; however, the training and academic coursework required for support personnel vary greatly from state to state (ASHA, n.d.d.). According to March 2011 data, ASHA reported that 19 states require a bachelor s degree or equivalent, and five states require a bachelor s degree (or equivalent) plus additional graduate hours, for support personnel licensure, registration, or certification (ASHA, n.d.d.). At present, 21 training programs are reported by ASHA to offer technical training for SLPAs (ASHA, n.d.c.). In California, the California Speech-Language Pathology and Audiology Board (CASLPAB) issues registration for SLPAs. In 2006, the CASLPAB changed regulations to allow individuals with a bachelor s degree in communicative disorders (CD) to pursue SLPA registration (CASLPAB, 2 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Spring 2012

3 n.d.). Previously in California, only individuals who were trained within associate s-level programs could apply for SLPA registration. CASLPAB regulations now state that an applicant with a bachelor s degree in CD (or the equivalent) can apply for registration following completion of a minimum of seventy (70) hours of field work experience or clinical experience (CASLPAB, n.d., p. 4, section b). This change in regulations created the need for supervised clinical practicum experiences for SLPA applicants with a bachelor s degree in CD. As of 2010, 5 years after implementation of bachelor slevel SLPA registration in California, the number of registered bachelor s-level SLPAs exceeded that of associate slevel SLPAs by more than twofold. According to CASLPAB, as of May 1, 2010, there were 326 associate s-level SLPAs and 738 bachelor s-level SLPAs (including those with a bachelor s degree in CD or the equivalent coursework; CASLPAB, personal communication, June 16, 2010). Unfortunately, there remains a significant paucity of research relative to support personnel in the field of speechlanguage pathology in general, and specifically to SLPAs, bachelor s level or otherwise. SLPs who supervise SLPAs, the governing agencies who establish requirements for SLPA training and use, and SLPAs themselves can benefit from information about SLPA training. As such, the purpose of this article is to describe a clinical practicum course that was developed and implemented at a 4-year, Council on Academic Accreditation (CAA)-accredited university that was designed to provide bachelor s-level clinical practicum for SLPA registration in California, including the results of two surveys that were conducted on students who completed the course, surveying (a) the type of employment obtained (if any) in the field of speech-language pathology after course completion (and graduation with a bachelor s degree in communicative disorder or completion of equivalent coursework), and (b) their perceptions about the course and their suggestions for SLPs who supervise this level of SLPA. METHOD Course Development, Design, and Implementation A clinical practicum course for undergraduate students in CD was the first of its kind at California State University, Long Beach (CSULB). Before this course, clinical practicum was only offered at the graduate level for students who were training to become SLPs. CSULB is a 4-year, CAA-accredited university, graduating ~70 80 undergraduates and graduate students in CD per year. California state regulations (CASLPAB, n.d.), as well as University curriculum and educational policies, were reviewed in consideration of course development. ASHA s documents on the training and use of SLPAs were reviewed (ASHA, 2002, 2004a, 2004b, ASHA, n.d.b.). A comprehensive literature review was performed to obtain relevant sources pertaining to the topics of SLPAs, supervision in general, clinical training models, introductory topics in speech-language pathology, treatment topics specific to SLPAs, as well as any related topics. Not surprisingly, few empirical studies could be found relative specifically to SLPA training or supervision. In addition, only one recent text specifically for SLPAs was identified (Moore & Pearson, 2003). The CD faculty discussed the logistics of the proposed clinical practicum, course objectives, recommended text, and required readings. It should be noted that CASLPAB regulations do not specify that a course with a given number of units specific to clinical practicum is required for bachelor s-level SLPAs in California. The CD faculty agreed, however, that a course with core learning objectives was required for two reasons. First, University policies prohibit students from engaging in clinical practicum without enrollment to ensure that minimal supervision and contractual obligations are met, hence ensuring student safety and the highest quality of clinical practicum. Second, for successful transition to SLPA employment, the CD faculty felt that additional instruction for bachelor s-level students would be required in several core areas, including direct instruction in: CASLPAB bachelor s-level SLPA requirements, CASLPAB SLPA scope of practice, including extended discussion of the limitations of SLPA registration and its distinct difference from that of SLP licensure; The differences between bachelor s-level SLPA registration and credential waivers issued by some school districts in California to work as an SLP without a master s degree in CD; and Ethical paradigms uniquely associated with SLPA practice A three-unit course was developed, which included 15 hr of lecture/didactic-based instruction and 70+ hr of supervised clinical practicum. ASHA s guidelines for the training and use of SLPAs (ASHA, 2004b) were used as a benchmark for finalizing core learning activities within the lecture/didactic portions of the course. Table 2 contains a summary of the initial course objectives for the lecture/didactic portion of instruction. Table 2. SLPA course objectives. 1. Explain California state laws, regulations, and procedures to become an SLPA. 2. Describe in detail the roles and responsibilities of a speechlanguage pathologist (SLP). 3. Describe in detail the roles and responsibilities of an SLPA. 4. Describe in detail those activities that are not to be performed by an SLPA. 5. Explain the level and type of supervision required for SLPAs, as recommended by the American Speech-Language-Hearing Association (ASHA) and the California Speech-Language Pathology and Audiology Board. 6. Describe the minimum qualifications and recommended skills and knowledge of an SLP responsible for supervising an SLPA. 7. Discuss ASHA s Code of Ethics as it pertains to employment as an SLPA. 8. Explain ASHA s confidentiality statement as it pertains to employment as an SLPA. Ostergren: Bachelor s-level SLPAs in California 3

4 The SLPA course was officially adopted into the CD curriculum effective Spring At the time of this article, a pilot course and five additional sections of the course had been offered, with a total of 133 students who had completed the course between Spring 2008 and Spring 2011 semesters. On average, 16 students were enrolled in the course per semester. All students who completed the course met the minimum 70 hr of clinical practicum as required by CASLPAB (n.d.). It should be noted that, although the course is offered within the undergraduate program at CSULB, three groups of students are allowed to enroll in the course; namely, (a) undergraduate students who are nearly finished with a bachelor s degree in CD (undergraduate student), (b) individuals with a bachelor s degree in another field who are completing undergraduate prerequisite coursework (postbaccalaureate students), and (c) graduate students who have already completed a bachelor s degree in CD (or equivalent coursework) and are currently enrolled in a master s program at CSULB to become an SLP (graduate students). Table 3 contains a summary of the total number of students who were enrolled in each of these categories. For those students who were enrolled as graduate students, the primary reason given for enrolling was to obtain employment as an SLPA while completing graduate coursework to become an SLP. Surveys Two surveys were conducted on students who were enrolled in or who had completed this course; namely, (a) an employment survey and (b) an opinion survey. Employment survey. Students who completed the course between the semesters of Spring 2008 and Summer 2011 were asked a series of questions using Survey Monkey ( 6 8 months following course completion. Table 4 lists the survey questions and the nature of response. All responses for the employment survey were transcribed. Frequency counts were obtained, and overall percentages were calculated for all binary and forced-choice responses. For open-ended narrative questions, responses were subjected to a content and theme analysis in which subordinate categories were selected and examples within each category were presented. First, all responses were entered into an Excel spreadsheet. Each response was then coded by the researcher with a phrase code that attempted to describe the main theme of the response. In instances in which responses contained more than one theme, responses were divided and were coded based on multiple themes. Following initial Table 3. Student enrollment categories. Student status Total enrolled when enrolled between Spring 2008 Spring 2011 Undergraduate student 86 Postbaccalaureate student 35 Graduate student 12 Total 133 coding of all responses, phrase codes were consolidated and each response was reanalyzed to ensure that consolidated phrase codes still adequately captured the main element(s) of each response. As needed, additional phrase codes were created and responses were again analyzed for subdivision. Throughout this process, phrase codes remained connected to original participant responses so that detailed analysis could be performed, as needed. Frequency counts and percentages using each phrase code were then obtained. Opinion survey. Students who were enrolled in the five most recent sections of the course (i.e., Spring 2009, Spring 2010, Summer 2011, Sessions 1 and 2, and Spring 2011) were given a survey regarding their perceptions about the nature of their clinical practicum specific to the course and their suggestions for future SLPA supervisors. This survey was part of a module on self-reflection/selfassessment within the course itself in which the students were asked to (a) identify their strengths and weaknesses as a future SLPA; (b) establish a set of future expectations for themselves and their SLPA supervisor; and (c) evaluate their clinical performance to date, as it related to additional training needed in the future. A self-appraisal questionnaire was developed based on the work of McLead (1994, as cited in Meyers, 1998) for use within this module. The complete self-appraisal questionnaire used within this course module is provided in the Appendix. For the purpose of this study, only a portion of this questionnaire was analyzed, as listed in Table 5. The remaining portions of the questionnaire are under analysis, to be published at a later date in conjunction with a discussion about self-assessment and the use of reflection journals in clinical practicum at CSULB. Similar to the open-ended narrative questions provided in the employment survey, responses across questions in the opinion survey were subjected to content and theme analysis in which frequency counts and percentages for coded phrases were obtained. Refer to the earlier discussion under Employment Survey for a detailed description of the method used for this purpose. RESULTS Employment Survey A total of 67 students who completed the course between Spring 2008 and Spring 2011 completed this survey, equivalent to a response rate of 50% (67/133). Application for SLPA registration. As can be seen in Figure 1, 56/67 respondents (83.6%) indicated yes when asked if they applied for SLPA registration after course completion (Question 1). Respondents who indicated no to Question 1 were asked to indicate if they planned to apply in the future (Question 3). Eight of the 11 respondents (72%) indicated that although they had not yet applied, they planned to do so in the future. In terms of why some individuals had not applied, those individuals who responded no to Question 1 (11, 16.4%) were asked to indicate in a short narrative the reasons for not applying for SLPA registration after course completion (Question 2). Narrative analysis revealed two primary reasons that respondents did 4 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Spring 2012

5 Table 4. Employment survey questions. Question Decision tree Question Nature of response 1 All participants After SLPA course completion, did you apply for Binary yes or no SLPA registration? 2 Participants who answered Why have you not applied for SLPA registration? Open-ended narrative no to Question 1 3 Participants who answered Do you plan to do so in the future? Open-ended narrative no to Question 1 4 Participants who answered Were you successful in obtaining SLPA registration? Binary yes or no yes to Question 1 5 Participants who answered If you applied and were not successful in obtaining Open-ended narrative no to Question 4 SLPA registration, please briefly explain why. 6 Participants who answered Did you obtain employment as an SLPA after Binary yes or no yes to Question 4 obtaining SLPA registration? 7 Participants who answered Describe why you did not obtain employment Open-ended narrative no to Question 6 after obtaining SLPA registration. 8 Participants who answered Describe the nature of your SLPA employment Open-ended narrative yes to Question 6 after obtaining registration. 9 All participants Are you currently employed as an SLPA? Binary yes or no 10 Participants who answered Are you employed on a full- or part-time basis? Binary full-time yes to Questions 9 or part-time 11 Participants who answered Which setting is most applicable to your Forced choice (school, yes to Questions 9 employment as an SLPA? medical setting, School district private practice or Medical setting other [specify]) Private practice Other (specify) Note. In initial surveys, the term license or licensure was used. However, following conferral with the California Speech-Language Pathology and Audiology Board (CASLPAB), this terminology was changed to register and registration to more accurately describe SLPA status in California. not apply for SLPA registration after course completion. Seven individuals (63%) indicated that some additional requirements needed to be completed before they could apply (e.g., I am waiting for my diploma to be conferred so I can send it in to the board, I needed to complete a course in order to receive my degree, or I have not graduated yet, etc.). The remaining four respondents (36%) indicated that SLPA registration was not required for current employment (e.g., I had already been volunteering at a hospital and did not intend to work as a SLPA, did not need it for my current job, currently, I have a stable job., etc.). Success in obtaining registration. Those respondents who indicated that they applied for SLPA registration were also asked to indicate their success at obtaining registration (Question 4). As can be seen in Figure 2, of the 57 respondents who applied, at the writing of this article, 52 (91.2%) indicated that they had successfully obtained SLPA registration. Respondents who indicated no relative to success in obtaining registration were further asked to indicate in a short narrative (Question 5) the reasons for not successfully obtaining registration. Of the five individuals who had not obtained SLPA registration after application, 100% of their responses indicated in some fashion that the individual was either awaiting notification or awaiting completion of additional paperwork required for the application (e.g., I m still in the process of turning all important documents to slpab, I just recently sent in my application after waiting for my degree to be posted so my license is still pending, etc.). SLPA employment after course completion and registration. Respondents who were successful in obtaining SLPA registration (Question 4) were also asked to indicate if they obtained SLPA employment after registration (Question 6). As can be seen in Figure 3, of the 52 respondents who obtained SLPA registration, 39 (75%) indicated that they were successful in obtaining employment as an SLPA. Those Table 5. Opinion survey questions. Question 4 Question 11 What was the most valuable aspect of your clinical practicum? List 5 things you think SLPs can do to assist NEW bachelor s-level SLPAs to be successful at their job. Ostergren: Bachelor s-level SLPAs in California 5

6 Figure 1. The percentage of students who indicated on the employment survey that they had applied for speech-language pathology assistant (SLPA) registration after course completion. Figure 3. The percentage of students who indicated on the employment survey that they were able to obtain employment after SLPA registration. who indicated that they were not successful in obtaining SLPA employment were asked to indicate in a short narrative the reasons they did not obtain employment (Question 7). Analysis of these responses revealed that the largest percentage of these individuals (6/13, 46%) indicated that they were attending graduate school and selected to pursue that over SLPA employment (e.g., focused on graduate school processes and tests, went onto graduate school instead of working, I have not applied as I am putting my full attention on grad school and family, etc.). The next largest percentage (5/13, 38%) indicated that they were unable to find preferred employment (e.g., I couldn t find a lot of openings for SLPA position in the area I live in, although SLPA employment was sought, I was unable to find an employer who would allow me to work part-time, difficulty looking for employment in preferred locations, I moved to Northern California (Chico) and they have not really implemented the use of SLPAs yet, etc.). Current employment. Respondents were also asked to indicate if they were currently employed as an SLPA (Question 9), as well as a series of questions pertaining to the nature of this employment (Questions 10 and 11). Thirty-eight (38) individuals responded to this question. As can be seen in Figure 4, 30 (78.9%) indicated that they were currently employed as an SLPA. Of those who were employed, 17/30 (56.6%) indicated that they were employed part time, 12/31 (40%) indicated that they were employed Figure 2. The percentage of students who indicated on the employment survey that they were successful in obtaining SLPA registration after course completion. full time, and 1/30 (3%) indicated that he or she had a variable schedule. As can be seen in Figure 5, the largest percentage of respondents (51.4%, 18/35) indicated that they were employed as an SLPA in a private practice, followed by a school setting (28.6%, 11/35) and a medical setting (5.7%, 2/35). For those respondents who indicated other in terms of setting (4/35, 1.1%), two responses indicated a combination of settings (school and private practice, school and medical), and two responses listed an early intervention setting. Opinion Survey A total of 59 students completed the course during the four more recent semesters (Spring 2010, Summer 2010: Session 1, Summer 2010: Session 2, and Spring 2011). Fifty (50) of these students (84% response rate) completed questions 4 and 11 of the opinion survey. Most valuable aspect of clinical practicum. Narrative responses to the question, What was the most valuable aspect of your clinical practicum (Question 4) were analyzed. Fifty (50) respondents generated 59 distinct responses to this question. It should be noted that statements that contained more than one conceptual theme were divided and categorized accordingly in order to accurately Figure 4. The percentage of students who indicated on the employment survey that they were currently employed as an SLPA. 6 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Spring 2012

7 Figure 5. The percentage of students who indicated on the survey the type of SLPA employment setting. reflect the content of the entire statement. For example, one respondent indicated direct contact with the clients and getting to know myself as a clinician. This was divided and coded as direct content and self-exploration/self-assessment. A total of 48/59 (81.3%) responses could be coded into one of three categories. Figure 6 displays the distribution across these three categories. The remaining 11 responses (18.6%) were coded within categories with <5% of the total responses. As can be seen, the largest percentage of responses (27/59, 45.8%) was characterized within a category labeled direct contact. This category consisted of responses in which the respondent indicated that some type of direct experience with a client was the most valuable aspect of his or her clinical practicum. Examples included being able to work one on one with certain patients on an on-going basis, actual clinical experience, carrying out therapy plans that had been designed and directly modeled, when I actually interacted with the clients and played some part in helping the clinician implement therapy, just being able to help her take over several sessions, or hands on experience helping with the students. The next largest percentage of responses (15/59, 25.4%) were categorized as exposure. This category included responses that indicated that exposure to a wide variety of clients, disorders, and techniques was the most valuable Figure 6. Most valuable aspects of the clinical practicum reported by the students on the survey. aspect of the clinical practicum. Examples included experience with different types of patients with different problems, the opportunity that I was given to observe, listen and contribute to daily didactic about all the clients seen that day, being exposed to various therapy environments and disorders, comparing the progress I saw and treatment techniques in several clients, observing different clinicians every day and learning from their different ways in carrying out treatment on different types of clients, or seeing such a variety of patients. The remaining category, data collection, accounted for 10.2% (6/59) of the responses. Responses within this category consisted of statements in which students indicated that practice scoring, writing notes, and/or collecting data were the most valuable aspects of their clinical practicum. Examples of responses within this category were practice with multi-dimensional scoring, taking notes has been a good experience, aiding in the collection of language samples, writing SOAP notes, learning how to score behaviors, collecting data, or practice at scoring what I see the client doing. Five things an SLP can do to assist a new bachelor slevel SLPA. Narrative responses were also analyzed to the question, List five things you think SLPs can do to assist NEW bachelor s-level SLPAs to be successful at their jobs (Question 11). Fifty (50) students completed this question, generating a total of 242 responses. Of these responses, 177 (73.1%) could be categorized into five distinct categories. Figure 7 displays the distribution across these five categories. The remaining 65 responses (26.8%) were classified within categories with <5% of the total responses. As can be seen in Figure 7, the largest percentage of responses (73/242, 30.2%) was characterized within a category labeled feedback. This category consisted of responses such that SLPs could assist new SLPAs by providing feedback about their performance. Examples included give clear positive feedback on specific clinical behaviors that SLPAs are performing well, give lots of good feedback (constructive criticism), positive and negative feedback is encouraged to let the SLPA know what type of progress is being made, give useful feedback, or give written feedback and on-the-spot feedback during a therapy session. Figure 7. Five things students indicated an SLP can do to assist a new bachelor s-level SLPA. Ostergren: Bachelor s-level SLPAs in California 7

8 The next two categories of highest percentage of responses were categorized as related to expectations and approachability. Expectations consisted of 12.4% of the responses (30/242). Approachability also consisted of 12.4% of the responses (30/242). In terms of expectations, respondents indicated that SLPs could assist new SLPAs by letting them know what was expected of them. Examples included be clear and upfront with your expectations so that the SLPA is able to keep to your standards, make a list of the things the SLPA is supposed to do, clearly define all responsibilities that the SLPA will be expected to perform, clear instructions about duties the SLPA is responsible for, or tell the SLPA specifically what you want. Relative to approachability, respondents indicated that SLPs could assist new SLPAs by making themselves available to the SLPA. Examples included be open and willing to answer any questions that the SLPA may have, have a willingness to teach with patience, allow time for questions and answers after sessions, open communication, be available to meet with the SLPAs privately to discuss any concerns, or let me ask you questions. A little more than 10% of responses (10.3%; 25/242) were categorized as insider tips. In this category, respondents indicated that SLPs could assist new SLPAs by sharing details with the SLPA they may not already know and/or explaining the rationale behind the SLP s decision. Examples included provide the SLPA with useful approaches and techniques to use in practice or for the future, explain why you are doing something (e.g., not just what and how), giving helpful tips about the clients the SLPA will be seeing or treatment they will be performing, tell me why, share with them things they might not know, but would like to know to keep clients interested during therapy, give them ideas for managing behavior, or share the secrets of the trade. Lastly, 7.9% of the responses (19/242) could be classified into the category of co-treat/observe. Responses within this category indicated that SLPs could assist new SLPAs by either co-treating with the SLPA and/or allowing the new SLPA to observe the SLP while he or she is providing services. Examples included conduct role-play or co-therapy sessions with the SLPA, do a lot of modeling and cotreatment with clients, model good examples of therapy etiquette and professionalism, allow the SLPA to observe if possible, or let us observe them in action. DISCUSSION Employment Survey The SLPA course described here, at a 4-year, CAA-accredited university, was one of the first of its kind at CSULB and was specifically developed to meet the needs of students with a bachelor s degree in CD (or equivalent coursework) who were interested in obtaining SLPA registration in the state of California. A large percentage of individuals who completed this course and the employment survey associated with this study applied for and were successful in obtaining SLPA registration from the CASLPAB. For those who did not obtain SLPA registration, the largest percentage listed factors related to timing of course completion relative to not applying for SLPA registration (e.g., awaiting degree to be posted, completing coursework, etc.), but indicated that they planned to apply in the future. Importantly, the employment survey associated with this course also found that a high percentage of individuals who obtained SLPA registration also obtained SLPA employment after receiving registration. In terms of the reasons SLPA employment was not obtained, the largest percentage of respondents indicated that they were pursuing graduate school instead of employment as an SLPA. Five respondents indicated that they were unable to find preferred employment, but these responses suggested that specific factors, such as location and number of hours required, may have been involved. These registration and employment trends are positive findings for students who completed this course. In terms of current employment, for respondents who indicated that they were currently employed as an SLPA, the largest percentage were employed part time, working largely in private practices, followed by school districts and then medical settings. Opinion Survey A portion of students completing the most recent semesters of this course also completed an opinion survey. Findings relative to this survey may be of interest to SLPAs and the SLPs who supervise them, as well as to governing agencies that determine policy relative to SLPA training and use. When asked about the most valuable aspect of clinical practicum within this course, the largest percentage of responses could be classified into the category of direct contact. These were activities in which the SLPA student indicated that working directly with clients in some fashion was the most valuable aspect of clinical practicum training. These findings are perhaps what one might expect from individuals who are new to the field with presumably limited exposure or clinical experience working directly with clients under the scope of practice of an SLPA. However, this is a fact worth considering relative to assigning students to clinical practicum activities. SLPA scope of practice consists of direct contact activities, such as assisting the supervisor with assessment or screenings and implementing treatment plans developed by the supervisor, as well as indirect contact activities, such as assisting with clerical duties; performing checks and maintenance of equipment; and assisting with scheduling, record keeping, and stimulus creation (ASHA, 2004b; CASLPAB, n.d.) Neither ASHA (2004b) nor CASLPAB (n.d.) dictate that during clinical practicum/fieldwork experience SLPAs in training should obtain a minimum amount of exposure in direct contact activities. ASHA recommends that fieldwork provides appropriate experiences for learning the job responsibilities and workplace behaviors of a SLPA (p. 15). Hence, clinical practicum coordinators must strike a balance in assigning clinical practicum to ensure that SLPAs obtain a rich experience in both direct and indirect contact activities. 8 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Spring 2012

9 The aspect rated the next most valuable in terms of clinical practicum experience was coded within a category titled exposure. Students commented about the ability to observe, work with, or learn about a variety of clients as the most valuable aspect of their clinical practicum. These findings are a reminder that variety in clinical placement may also be a key factor in clinical practicum assignments (at least from the student s perspective). Currently, neither CASL- PAB (n.d.) nor ASHA (2004b) prescribe or recommend hour minimums in terms of experience with given populations or disorders. Hence, when assigning students to clinical practicum, clinical practicum coordinators may want to consider the variety of the disorders, populations, and ages within a student s clinical practicum. Lastly, the final category noted in terms of the most valuable aspects of clinical practicum was data collection. Within this category, students commented that practice scoring, writing notes, and collecting data were the most valuable aspect of clinical practicum. This was a smaller percentage than the other categories, but comments are worth noting in planning for clinical practicum training and the supervision process. Relative to this category, informal comments from the students during lecture portions of the course also indicated that data collection and note-taking could be highly challenging. Some students expressed concern at not collecting and summarizing information that would be valuable to an SLPA supervisor. In response to these comments, an additional emphasis in the lecture portion of the course was added relative to data collection and record keeping unique to an SLPA. Students were assigned a learning exercise to select several written goals and objectives currently addressed with a client being seen during their clinic practicum. They were then further required to devise a system (including score sheet) to accurately observe and score a client s responses as was required for the goal/objective. Students were instructed in using multidimensional scoring techniques. This was followed by an exercise in which students wrote a detailed note about the specific behaviors they observed. It should be noted that all of the students had previous coursework on these topics; however, as is often the case in clinical skills training, complex topics are synthesized best during actual clinical application. Findings from the opinion survey that was completed at the end of the course may also suggest additional areas for SLPA supervisors to consider when supervising similar students. When asked to indicate the five most important things SLPA supervisors could do to assist a new bachelor s-level SLPA, the largest percentage of student responses was categorized under the area of feedback. The responses in this category indicated that students felt that supervisors could assist new SLPAs by giving feedback that was constructive, consistent, and positive. These findings are consistent with both ASHA (2002) and ASHA (2008), which also suggest that feedback to the supervisee is an important aspect of supervision. In a recent article by the current author (Ostergren, 2011), feedback, and in particular, positive feedback, was also raised as an important factor for SLPs in their first year of professional service. Hence, feedback appears to be a key factor in supervisee/ supervisor dyads across the spectrum in the field of speechlanguage pathology and a factor to consider in training both supervisors and SLPAs. In terms of resources in this area, Dowling (2001), in her book entitled Supervision: Strategies for Successful Outcomes and Productivity, includes an excellent chapter on maximizing feedback in supervision, including a discussion about the nature of effective feedback and the importance of incorporating the supervisee s perspective within the feedback process. In a similar vein, the two categories with the next highest percentage of responses on the opinion survey also had to do with the nature of supervisee/supervisor interaction. The categories of availability and expectations had a similar percentage of responses. In the category of availability, survey responses indicated that supervisors could assist new SLPAs by presenting themselves as approachable and available for comments, questions, and concerns. The current author also found similar results relative to SLPs who were engaged in their first year of professional service. In Ostergren (2011), SLPs in their first year of professional service also reported value in having a supervisor who was approachable and open in his or her interactions. ASHA (2004b) also acknowledged the importance of establishing an effective supervisor supervisee relationship, stating that clinical supervisors need to maintain a professional and supportive relationship that allows for both supervisor and SLPA growth (p. 4). Clinical practicum coordinators may want to take this into consideration when assigning students to a supervisor. SLPAs and their supervisors can also address this when planning for SLPA employment. Convenience in interaction and the time pressures of a setting, as well as the desire of a supervisor to provide supervision, may all be factors to consider in this respect. In the category of expectations, respondents to the opinion survey indicated that supervisors could assist new SLPAs by letting them know what is expected of them. ASHA (2004b) also highlighted the importance of expectations, stating that the supervisor should establish joint communications regarding expectations and responsibilities in assigned tasks and the supervisory process (p. 4). In addition, in one of the few textbooks that was developed specifically for SLPAs, Moore and Pearson (2003) also discussed this issue and recommended that SLPAs should clearly understand what is expected of them. A valuable resource in the area of expectations may be Tihen s Expectations Scale (Tihen, 1984, reproduced in McCrea & Brasseur, 2003). This scale can be used to rate both the student s and the supervisor s expectations in terms of a variety of elements in the supervision process. It can be easily modified to address SLPA interface. A joint discussion of these expectations before and throughout the supervisory process may be of value in reducing conflicts associated with differences in expectations between the supervisor and the supervisee. The next highest percentage of responses on the opinion survey was classified as insider tips. Within this category, student responses indicated that supervisors could assist new SLPAs by sharing their experience and/or their rationales for why clinical decisions are made. These responses appeared to refer to details beyond the mechanics of a task, Ostergren: Bachelor s-level SLPAs in California 9

10 and more to the real-world decision-making involved in clinical interface. One student commented share the secrets of the trade and another said explain why you are doing something (e.g., not just what and how). These comments hint at the desire from a student s perspective to better understand the decisions/choices an SLP makes. This may be a factor for supervisors to consider when developing goals for the content of supervisory conferences. The final category of responses was classified as co-treat/ observe. In this category, student responses indicated that supervisors could assist new SLPAs by allowing them to work in tandem with the SLP during service delivery (e.g., co-treat) or allowing the SLPA to observe the supervisor providing services (e.g., observe). This type of interface is specifically addressed within ASHA s recommendation for SLPA supervisors (ASHA, 2002, 2004b). It should be noted too that the students completing this survey had not yet been employed as an SLPA. Hence, their responses are perhaps reflective of a new SLPA s need for an extended period of modeling and observation of the supervisor during the initial phase of training. Limitations More research on SLPA use and training is needed. Future studies can yield valuable information for individuals who train SLPAs, those who supervise SLPAs, and SLPAs themselves, as well as regulating agencies that make policy decisions specific to SLPAs. The results of this study are specific to only one course, offered at one university, relative to one state s requirements. Rigid generalization of these results across all SLPAs is not suggested, nor recommended. It is likely that other courses, offered in other programs, consistent with different requirements, may yield different outcomes and suggestions. Future research that addresses similarities, differences, and outcomes specific to a variety of training programs is needed before confirmed trends can emerge. In addition, it would be highly valuable to obtain a larger scope of SLPA employment demographics, both nationally and at the individual state level. The current study only requested information about full-time versus part-time status and employment settings (e.g., school, private practice, or medical setting). Additional details about employment duties, level and nature of supervision, and satisfaction with training could be used by training programs and regulating agencies to further refine SLPA training and use policies. Lastly, the suggestions generated in this study were from the perspective of the SLPA student, and in the case of the opinion survey, before actual work as an SLPA. Research is needed addressing the perspectives of SLPA supervisors and employers in terms of training needs of SLPAs. With this information, training programs can more effectively prepare students for future employment as an SLPA. Information from individuals who are currently employed as an SLPA is also needed relative to learning needs and applicable aspects of clinical training. Perceptions of SLPAs who are employed are likely to differ from the individuals in this study who responded to the opinion survey before actual employment as an SLPA. Future Research In closing, two additional areas arose in the implementation of this course that warrant further discussion in terms of future research. High-quality clinical practicum remains the core emphasis of this course. One factor that became evident in developing and implementing this course was variability in supervisor skills, knowledge, and training in terms of SLPA use and supervision, as well as a fair amount of confusion between ASHA guidelines (2004b) and CASLPAB laws and regulations (CASLPAB, n.d.). Many supervisors also expressed a need for clarification in distinguishing how their supervision interface would differ in comparison to the supervision of individuals who are engaged in clinical practicum requirements of a master s degree in speech-language pathology. In response, summary guidelines reiterating these differences were developed unique to this course. These guidelines continue to be under revision to provide specificity in the areas of suggested training and formal feedback mechanisms for SLPA students, including the addition of ASHA s verification of technical proficiency of SLPAs document (ASHA, 2004b). An online training protocol is planned for use in future courses. More direct research on the topic of supervision across all levels of support personnel is critically needed in this respect. An additional area in need of resources and research pertains to ethical issues specific to SLPAs. During instruction on ethics for this course, it became evident that many resources on this topic were from the perspective of the SLP supervisor and not the SLPA or the SLPA in training. As such, a learning module was developed in which students were required to analyze ethical principles in general and the ASHA Code of Ethics (ASHA, 2010) in particular as it pertains to ethical issues that SLPAs may actually face in real-world settings. The students were further required to present an ethics case in which they describe a hypothetical ethical dilemma that could happen to either an SLPA or an SLPA in training, including core ethical conflicts and recommended resolution. These scenarios and training module elicited many highly interactive discussions. However, more research and resources for SLPAs and their supervisors are needed in this area Conclusion As ASHA moves forward in recognizing support personnel as associates within ASHA, additional resources are needed across a wide variety of issues and topics. More published research in this area of supervision, training, and use of SLPAs will allow SLPAs, their supervisors, training programs, and the governing agencies that set policies pertaining to SLPAs to make informed decisions and further shape knowledge pertaining to the use of support personnel in the field of speech-language pathology. REFERENCES American Speech-Language-Hearing Association. (n.d.a.). ASHA to launch new associate affiliation associates program overview. 10 CONTEMPORARY ISSUES IN COMMUNICATION SCIENCE AND DISORDERS Volume Spring 2012

11 Retrieved from American Speech-Language-Hearing Association. (n.d.b.). Frequently asked questions: Speech-language pathology assistants (SLPAs). Retrieved from faq_slpasst.htm. American Speech-Language-Hearing Association. (n.d.c.). Operational technical training programs for speech-language pathology assistants. Retrieved from Operational-Technical-Training-Programs/. American Speech-Language-Hearing Association. (n.d.d.). Support personnel trends. Retrieved from American Speech-Language-Hearing Association. (2002). Knowledge and skills for supervisors of speech-language pathology assistants [Knowledge and Skills]. Available from org/policy. American Speech-Language-Hearing Association. (2004a). Guidelines for the training, use and supervision of speech-language pathology assistants [Guidelines]. Available at org/docs/html/gl html. American Speech-Language-Hearing Association. (2004b). Training, use, and supervision of support personnel in speech-language pathology [Position Statement]. Available from org/policy. American Speech-Language-Hearing Association. (2008). Knowledge and skills needed by speech-language pathologists providing clinical supervision [Knowledge and Skills]. Available from American Speech-Language-Hearing Association. (2009) membership survey summary report: Number and type of responses. Rockville, MD: Author. American Speech-Language-Hearing Association. (2010). Code of ethics [Ethics]. Available from California Speech-Language Pathology and Audiology Board. (n.d.). Excerpts from the California business and profession code of speech-language pathology assistants. Retrieved from Dowling, S. (2001). Supervision: Strategies for successful outcomes and productivity. Needham Heights, MA: Allyn & Bacon. McCrea, E., & Brasseur, J. (2003). The supervisory process in speech-language pathology and audiology, Boston, MA: Pearson Education. Meyers, S. (1998). Survival guide for the beginning speech-language clinician. New York, NY: Aspen. Moore, S. M., & Pearson, L. (2003). Speech-language pathology assistants. Clifton Park, NY: Thomas Delmar Learning. Ostergren, J. (2011). The first year of professional services in speech-language pathology: Supervisory role, working relationships, and satisfaction with supervision. Contemporary Issues in Communication Sciences and Disorders, 38, Robinson Jr., T. (2010, August 3). Associates in ASHA: A new initiative. The ASHA Leader. Retrieved from org/publications/leader/2010/100803/from-president htm. Contact author: Jennifer A. Ostergren, California State University, Long Beach, Department of Communicative Disorders, 1250 Bellflower Boulevard, Long Beach, CA jennifer. ostergren@csulb.edu. APPENDIX. COURSE QUESTIONNAIRE SPECIFIC TO SELF- APPRAISAL MODULE 1. What have been the most positive aspects of your SLPA experience? 2. What have been the most challenging aspects of your SLPA experience? 3. What have been the high points of your SLPA experience? 4. What was the most valuable aspect of your clinical practicum? 5. What other tasks or roles would you like to try as a SLPA? 6. What are the particular difficulties/frustrations you have encountered in your SLPA placement? a. What have you done to improve them? b. What else can be done? 7. What further ways could you see your SLPA clinical supervisor facilitating your clinical work and satisfaction? 8. What further ways could you see your SLPA instructor supervisor facilitating your clinical work and satisfaction? 9. Comment on the opportunities that have been provided for your on-going education and self-development during for SLPA experience. 10. Discuss any other aspects of concern. 11. List 5 things you think SLPs can do to assist NEW Bachelor s level SLPAs to be successful at their job. Note. Questions 1 10 were based on McLeod (1994, as cited in Meyer, 1998). Questions 11 was developed specifically for this study. Ostergren: Bachelor s-level SLPAs in California 11