Introduction and Overview
I appreciate you taking time out of your busy schedules to take this course. In addition to the learning objectives outlined above, my hope is that you find something that you can take back and use with renewed enthusiasm for taking on the challenge of being a supervisor. It can be very challenging, but it also can be very rewarding. I also want to share some of my experiences, and some things that have been very effective, as well as some things that have not be so effective, because you can learn from both of those experiences.
To really understand how this course will look, I should share that one of my biggest pet peeves is attending a conference or seminar where the presenter shows slides with all of this text and proceeds to read each and every word to me. That is not an engaging or effective way for me to learn, and as a result, it influences the way I present. While I do not know you individually, I am really confident that you can read. So, although there is a lot of text on the slides I don’t plan to read it all to you.
Rules, Requirements and Terminology – Including State Differences
The purpose of this course is to discuss the supervision of SLP Assistants (SLPAs). At this time, we do not have a standardized type of credential, curriculum or licensure for SLPAs across the board. ASHA started looking at the role SLPAs could play in our profession back in the late 1960s, so you would think that we would have something a bit more standardized by now. However, we do not. ASHA is saying that within the next two to three years they will have a standardized curriculum to move us forward in that direction. In the meantime, we have is a range. Depending on where you are, the person that you will be supervising as an SLPA may range from someone with a high school diploma all the way up to someone with a Bachelor’s in speech-language pathology, and that is quite a range. What ASHA is targeting, going forward, is something that looks like an Associate in Arts degree. That is what they are going to be promoting as the national standard or the national credential. As I said, they hope to have that within the next two to three years.
When looking at the person you are going to be supervising, it is important to first know what your state says about that. There are some states that do not regulate at all. Now, just because your state says it does not regulate, all that really means is that they do not issue a license or a certificate. It does not mean that they are not paying attention to what is going on. They may still monitor whether or not you are supervising an SLPA through your license. But it means that the person you will be supervising does not have a license or certificate or anything like that. So, be aware that we could spend a whole day talking just about the variability that exists between states, in terms of the training and background different individuals have.
In addition to the different levels of training, there are almost as many different titles that are currently assigned to someone that you may be supervising. These terms range from “SLPAs” to “clerks” to any number of things. The following is certainly not a comprehensive list:
- SLP Aides
- SLP Technicians
- SLP Assistants
- SLP Implementers
- SLP Associate
- SL Intern
In some states - Missouri and Idaho, for example- there are actually three tiers of service. They have someone that they actually identify as a clerk, who does the clerical piece, as well as someone who may work more directly with clients. One of your first responsibilities, and one of the most important responsibilities when taking on the supervisor role for an SLPA, is to make each client, family member, and colleague aware that you are providing a “tiered service.” The tiered service will consist of you, as the supervisor, and the SLPA who has a different role with different responsibilities. You and your client are now engaging in what we call a tier of service. That term is important for several reasons. First, in terms of transparency and your license, it is important to make it very clear to clients and families who they will address questions to, who is responsible for what portion of their care, and who is making clinical decisions. Your most critical responsibility is to make sure that everyone is on the same page and is aware of these factors when you initiate this type of supervisory relationship.
ASHA’s website does a great job of breaking down what is currently required from state to state (www.asha.org/advocacy/state/default). They indicate what is currently accepted, and what is currently looked at in terms of licensure, across all states. Having said that, websites do not operate in real time. So I encourage you to be involved at the state level. It is always better to have your input and be involved in the process of getting regulations or requirements in place before they happen.
On their website, what ASHA is actually reporting are the rules that have been imposed and are already in place. Again, be involved at the state level for two reasons: 1) perhaps you can influence changes that you feel are important as your state starts looking at implementing the use of SLPAs; and 2) because you will probably know of the changes before they actually get posted and updated on the ASHA website. Keeping track of those kinds of things in your state is very important.
One term that you will hear a lot, particularly from ASHA, is “support personnel.” They use that term because they are not only looking at SLPAs, but audiology assistants, audiology technicians, etc. So, they group them all together. I am not a big fan of the term “support personnel,” and here is why. At each facility or entity where I have worked, we have had support personnel who were really critical to us being successful. They were really important folks. Those support personnel included everybody from the receptionist who scheduled appointments to the janitor who kept the rooms clean. If it was a school, there was a crossing guard, and maybe somebody who did data entry. All of those people were really important to keep us moving forward and allowing us to do our jobs. But I think that if we group SLPAs into that support personnel category, it is a disservice, because it makes it sound as though they have not had the very specific, specialized training needed to do the tasks assigned to them. It gives our clients the impression that SLPAs do not have the specialized skills that they need to work with the clients and do the tasks we want them to do. I know that there is certainly a range out there, but even if your SLPA has a high school diploma, they still had specialized instruction. And I know that because you are the one who is going to give them that specialized instruction. That is your role. Therefore, the term I use more consistently is “SLPA” or “speech implementer,” because those are the models and terms with which I have worked more extensively. Again, I think it is important to separate them out from other elements of support personnel within our agencies or offices.
If there is one thing you are probably going to get tired of hearing me say, it is that this is your license. That is important for a number of reasons, but the first is that it is mutually necessary. It is your license that allows you to work, for starters. It is your license that allows you to supervise. And it is your license that is on the line and in jeopardy if that supervisory relationship, and the work being done by you and your SLPA, do not go well. Therefore, it is very important to know what your state requires for your license and for the SLPA license.
I tell you that for a very important reason. A few years ago, I was contacted by a parent whose child was receiving services from an SLPA. The parent was concerned; she was just not sure that things were happening the way they should be happening. Because she had a right to that SLPA's resume, she went and asked for a copy of it. She brought it to me, and I made two phone calls and found out that the SLPA had never had a license issued. When the clinic hired her, they assumed that because she said she had a license, she must have a license. I encourage you to always take it another step and never presume that just because you have been told someone has what she needs, that you can count on that. It is your license that is ultimately signing off on their work, so you want to be very sure that your supervisee has what is required in your state.
Necessary Skills for Supervising SLPAs
Let’s talk about what supervision is and the responsibilities you have as a supervisor. Most of us, during our academic preparation, had little or no instruction on how to supervise. We were probably told we would be supervised during our clinical fellowship year, but beyond that there was not a lot of instruction on how to supervise. That is beginning to change a bit and we are seeing some additional formal education in that area, but it is not quite fully there yet. Some of us have probably even supervised clinicians in their clinical fellowship year.
However, there is a very big difference between supervising someone completing his clinical fellowship year, and supervising someone who is an SLPA. When you supervise clinical fellows, you are preparing them to go out and work independently; that is the goal. That relationship is defined by the clinical fellowship period as being fairly short term - somewhere between nine months to a year. After that period, the person is going to be working independently. When you are supervising an SLPA, the expectation is that that SLPA will never work completely independently. The level of supervision may change over time, but it is never expected that the SLPA would work completely independent of a supervisor; that is not their role. In addition to that, the relationship you establish with an SLPA may be long-term. I have had speech implementers that I worked with for over eight years. You need to have a relationship with that person such that the supervision can continue and be ongoing. You need to feel confident and capable of providing the supervision going forward, and you also need to establish a relationship where the SLPA feels comfortable and accepting of that supervision on an ongoing basis.
I was given a plaque that had a picture of a wolf on it by a team that I supervised, and the caption below said, “The strength of the leader determines the speed of the pack.” That team included a speech implementer and other professionals I was charged with supervising at the time. That quote was a really good reminder for me that you can be really good at your job and you can be really skilled as a therapist, but if you are charged with supervising someone, it is important that you also recognize where he or she is. You cannot bring them along faster than they are able to keep up. You also cannot patronize them and make them feel less capable simply because you have more, and different, skills. It is a balance. Recognize that you can have all the strength you want, but if you run off and leave your supervisee in the dust, then you are not really doing a service to your clients, and you are certainly not doing a service to your supervisee. Likewise, you cannot be so lax that you are not presenting what the supervisees need to increase their skills and improve the working relationship that is going to benefit everyone involved.
ASHA Guidelines vs. State Regulations
As I stated earlier, at this point, what we have from ASHA are guidelines. What we have at the state level are regulations, and ASHA recognizes that. They recognize that your license is issued by your state, and those regulations, for the most part, supersede what ASHA says because that license is critical to your ability to supervise. Hopefully we will see those line up a bit more in the future.
We are going to look at a few areas where you are likely to see some overlaps and some discrepancies in terms of what is currently in place from ASHA and from individual states. This is by no means an exhaustive list, but it includes some of the more key elements.
One area that is pretty consistent is that ASHA recommends, and most states require, that if you are going to be supervising, you need to have had your Certificate of Clinical Competency (CCC) for at least two years. Some states require a third year, but the rule of thumb is that at least two years with your CCC is what most states are looking for before they permit you to supervise an SLPA.
In the interest of full transparency, I will tell you that I had not had my CCC for even a full year when I began supervising. Missouri did not have any requirement related to this, and I had the opportunity to supervise in my previous career, but I had not had my CCC for two years when I started. In hindsight, I think this is a very important and valid aspect of what ASHA is recommending; there is good reason for it. Here is an example of why. One of my first implementers was great, and we worked well together. She was new, but everything was going great. One morning she said, “We have a new student.” She had put together the student file with the individualized education program (IEP), and everything looked good. Keep in mind, I had not had my CCC for even a year yet. I brought the student in to do a screening and I noticed nasality, so I took a peek in the student's mouth, and I noticed the largest bifid uvula I have ever seen. I did not have a lot of experience yet. I had seen them in books and videos, but I thought, “This is a great teaching moment.” So I called the implementer over and I put the tongue depressor in the student's mouth. The implementer took one look, ran from the room and proceeded to get sick in the hallway.
What I learned from that teachable moment was that, first of all, not everybody is that excited about a bifid uvula. The second thing I learned was that you cannot bring them along faster than they are ready. If I had had more experience, I would have recognized that. I would have known that the strength of the leader does indeed determine the speed of the pack, but you cannot increase their speed just because you think it is time. So it was a very teachable moment, and one that has stuck with me for many, many years.