ASHA Scope of Practice

Question 1

Communication and Swallowing

Answer 1

Communication and swallowing are broad terms encompassing many facets of function.

Question 2

What is communication?

Answer 2

Communicationincludes: speech production and fluency, language, cognition, voice, resonance, and hearing.

Question 3

What is swallowing?

Answer 3

Swallowingincludes all aspects of swallowing, including related feeding behaviors.
- A guide for SLPs across all clinical and educational settings to promote best practice.
- The termindividualsis used throughout the document to refer to students, clients, and patients served by the SLP.

Question 4

Service Delivery & Professional Practice

Answer 4

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Question 5

What is the 8 domains of SLP service delivery?

Answer 5

1. Collaboration
2. Counseling
3. Prevention and Wellness
4. Screening
5. Assessment
6. Treatment
7. Modalities, Technology, and Instrumentation
8. Population and systems

Question 6

Service delivery areas include all aspects of communication and swallowing and related areas that impact communication and swallowing. What are they?

Answer 6

Speech production
Fluency
Language
Cognition
Voice
Resonance
Feeding
Swallowing
Hearing.

Question 7

What are the 5 domains of professional practice that are delineated?

Answer 7

1. Advocacy and outreach
2. Supervision
3. Education
4. Research
5. Administration/leadership

Question 8

Evolving Field

Answer 8

The practice of speech-language pathology continually evolves.
- SLPs play critical roles in health literacy; screening, diagnosis, and treatment of autism spectrum disorder;

Use of theInternational Classification of Functioning, Disability and Health(ICF;World Health Organization [WHO], 2014) to develop functional goals and collaborative practice

As technology and science advance, the areas of assessment and intervention related to communication and swallowing disorders grow accordingly.

Clinicians should stay current with advances in speech-language pathology practice by regularly reviewing the research literature, consulting thePractice Management section of the ASHA website, including thePractice Portal, and regularly participating in continuing education to supplement advances in the profession and information in the scope of practice.

Question 9

Purpose of Scope of Practice Document

Answer 9

Delineate areas of professional practice;

Inform others
- (e.g., health care providers, educators, consumers, payers, regulators, and the general public) about professional roles and responsibilities of qualified providers;

Support SLPs in the provision of high-quality, evidence-based services to individuals with communication, feeding, and/or swallowing concerns;

Support SLPs in the conduct and dissemination of research

Guide educational preparation and professional development of SLPs

Question 10

Collaboration & IPP

Answer 10

Thisinterprofessional collaborative practiceis defined as “members or students of two or more professions associated with health or social care, engaged in learning with, from and about each other” (Craddock, O’Halloran, Borthwick, & McPherson, 2006, p. 237).

Similarly, “interprofessional education provides an ability to share skills and knowledge between professions and allows for a better understanding, shared values, and respect for the roles of other healthcare professionals” (Bridges et al., 2011, para. 5).

Question 11

Superseded by law

Answer 11

This scope of practice does not supersede existing state licensure laws
- However, it may serve as a model for the development or modification of licensure laws.

Finally, in addition to this scope of practice document, other ASHA professional resources outline practice areas and address issues related to public protection (e.g., A guide to disability rights law and the Practice Portal).

Question 12

What is an SLP? Definition 2

Answer 12

Professionals who hold the ASHA Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP), which requires a master’s, doctoral, or other recognized postbaccalaureate degree.

Complete a supervised postgraduate professional experience and pass a national examination as described in the ASHA certification standards, (2014).

Demonstration of continued professional development and other required credentials where applicable (e.g., state licensure, teaching certification, specialty certification).

Question 13

What is the Overall Objective of SLP

Answer 13

To optimize individuals’ abilities to communicate and to swallow, thereby improving quality of life.

To the highest extent possible, decisions are based on best evidence.
- ASHA definesevidence-based practicein speech-language pathology as an approach in which current, high-quality research evidence is integrated with practitioner expertise, along with the client’s values and preferences (ASHA, 2005).
- ASHA has provided a resource for evidence-based research via thePractice Portal.

Question 14

Autonomy?

Answer 14

SLPs are autonomous professionals who are the primary care providers of speech-language pathology services

Speech-language pathology services are not prescribed or supervised by another professional.
- Additional requirements may dictate that speech-language pathology services are prescribed and required to meet specific eligibility criteria in certain work settings, or as required by certain payers.

SLPs use professional judgment to determine if additional requirements are indicated

Question 15

What is the Responsibility to diagnose (?)

Answer 15

The diagnostic categories in the speech-language pathology scope of practice are consistent with relevant diagnostic categories under the:
- WHO’s (2014)ICF,
- American Psychiatric Association’s (2013)Diagnostic
- Statistical Manual of Mental Disorders,
- The categories of disability under the Individuals with Disabilities Education Act of 2004 (see also U.S. Department of Education, 2004)
- and those defined by two semiautonomous bodies of ASHA:
- the Council on Academic Accreditation in Audiology and Speech-Language Pathology
- and the Council for Clinical Certification in Audiology and Speech-Language Pathology.

Question 16

International Classification of Functioning, Disability and Health

Answer 16

The domains of speech-language pathology service delivery complement theICF,the WHO’s multipurpose health classification system (WHO, 2014).
- The classification system provides a standard language and framework for the description of functioning and health.
- The ICF framework is useful in describing the breadth of the role of the SLP in the prevention, assessment, and habilitation/rehabilitation of communication and swallowing disorders
- and the enhancement and scientific investigation of those functions.

The framework consists of two components: health conditions and contextual factors.

Question 17

ICF

Answer 17

The health condition component is expressed on a continuum of functioning.

On one end of the continuum is intact functioning; at the opposite end of the continuum is completely compromised function.

The contextual factors interact with each other and with the health conditions and may serve as facilitators or barriers to functioning.
- SLPs influence contextual factors through education and advocacy efforts at local, state, and national levels.

Question 18

Health Conditions

Answer 18

Body Functions and Structures:These involve the anatomy and physiology of the human body.
- craniofacial anomaly, vocal fold paralysis, cerebral palsy, stuttering, and language impairment.

Activity and Participation:Activityrefers to the execution of a task or action.Participationis the involvement in a life situation.
- difficulties with swallowing safely for independent feeding, participating actively in class, understanding a medical prescription, and accessing the general education curriculum.

Question 19

Contextual Factors

Answer 19

Environmental Factors:physical, social, and attitudinal environments in which people live and conduct their lives.
- Relevant examples include the role of the communication partner in AAC, the influence of classroom acoustics on communication, and the impact of institutional dining environments on individuals’ ability to safely maintain nutrition and hydration.

Personal Factors:internal influences on an individual’s functioning and disability and are not part of the health condition. Personal factors may include age, gender, ethnicity, educational level, social background, and profession.
- Relevant examples in speech-language pathology might include an individual’s background or culture, if one or both influence his or her reaction to communication or swallowing.

Question 20

Collaboration - I

Answer 20

Collaboration requires joint communication and shared decision making among all members of the team,
- including the individual and family, to accomplish improved service delivery and functional outcomes for the individuals served.
- When discussing specific roles of team members, professionals are ethically and legally obligated to determine whether they have the knowledge and skills necessary to perform such services.

Question 21

Collaboration - Examples

Answer 21

educate stakeholders regarding interprofessional education (IPE) and interprofessional practice (IPP)(ASHA, 2014);

partner with other professions/organizations to enhance speech-language pathology services;

share responsibilities to achieve functional outcomes;

consult with other professionals to meet the needs of clients;

serve as case managers, service delivery coordinators, members of collaborative and patient care conference teams;

serve on early intervention and school pre-referral and intervention teams to assist with individualized family service plans (IFSPs) and individualized education programs (IEPs).

Question 22

Counselling - persons with communication and feeding and swallowing disorders and their families

Answer 22

empower the individual and family to make informed decisions

educate the individual, family, and related community members about communication and swallowing disorders.

provide support for individuals with disorders and their families.

provide individuals and families with skills to enable self-advocacy

discuss, evaluate, and address negative emotions and thoughts related to communication and swallowing disorders.

refer individuals with disorders to other professionals when counseling needs fall outside communication and swallowing.

Question 23

Prevention & Wellness

Answer 23

reducing the incidence of disorder or disease,

identifying disorders at an early stage,

decrease the severity or impact of a disability associated with disorder or disease.

directed toward individuals at risk for limited participation in communication, hearing, feeding and swallowing, and related abilities.

directed toward enhancing or improving general well-being and quality of life.

Education focuses on identifying and increasing awareness of risks that lead to communication disorders and swallowing problems.

promote programs to increase public awareness

Question 24

Examples of Prevention

Answer 24

Language impairment:Educate parents, teachers and other school-based professionals about the markers of language impairment and how these impairments can impact a student’s reading and writing to facilitate early referral

Feeding:Educate parents of infants at risk for feeding problems about techniques to minimize long-term feeding challenges.

Stroke prevention:Educate individuals about risk factors

Genetic counseling:Refer individuals to appropriate professionals and professional services if there is a concern or need

Environmental change:Modify environments to decrease the risk of occurrence (e.g., decrease noise exposure).

Vocal hygiene:Target prevention of voice disorders (e.g., encourage activities that minimize phonotrauma and curb the use of smoking and smokeless tobacco products).

Many more – see document

Question 25

Screening

Answer 25

SLPs are experts at screening individuals for possible communication, hearing, and/or feeding and swallowing disorders.

SLPs have the knowledge of-and skills to treat-these disorders;
- they can design and implement effective screening programs and make appropriate referrals.
- These screenings facilitate referral for appropriate follow-up in a timely and cost-effective manner.

Question 26

Responsibilities in Screening

Answer 26

select and use appropriate screening instrumentation;

develop screening procedures and tools based on evidence;

coordinate and conduct screening programs in a wide variety of educational, community, and health care settings;

participate in public school MTSS/RTI team meetings to review data and recommend interventions to satisfy federal and state requirements (e.g., Individuals with Disabilities Education Improvement Act of 2004 [IDEIA] and Section 504 of the Rehabilitation Act of 1973);

review, analyze, and make appropriate referrals based on results of screenings;

consult with others about the results of screenings conducted by other professionals; and

utilize data to inform decisions about the health of populations.

Question 27

Assessment - I

Answer 27

Expertise in the differential diagnosis of disorders of communication and swallowing
- SLPs can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions.

The assessment process can include, but not limited to standardized and/or criterion-referenced tools; use of instrumentation; review of records, case history, and prior test results; and interview of the individual and/or family
- Collaboration and cultural/linguistic appropriate approaches often involved

Question 28

Treatment - I

Answer 28

Speech-language services are designed to optimize individuals’ ability to communicate and swallow, thereby improving quality of life.

SLPs develop and implement treatment to address the presenting symptoms or concerns of a communication or swallowing problem or related functional issue.

Treatment establishes a new skill or ability or remediates or restores an impaired skill or ability.

Question 28

Assessment - Examples

Answer 28

administer standardized and/or criterion-referenced tools;

review medical records to determine relevant health, medical, and pharmacological information;

interview individuals and/or family to obtain case history to determine specific concerns;

engage in behavioral observation to determine the individual’s skills in a naturalistic setting/context;

diagnose communication and swallowing disorders;

use endoscopy, videofluoroscopy, and other instrumentation to assess aspects of voice, resonance, velopharyngeal function and swallowing;

participate in meetings adhering to required federal and state laws and regulations (e.g., IDEIA [2004] and Section 504 of the Rehabilitation Act of 1973).

document assessment results, including discharge planning;

formulate impressions to develop a plan of treatment and recommendations; and

discuss eligibility and criteria for dismissal from early intervention and school-based services.

Question 29

Treatment - Examples

Answer 29

design, implement, and document delivery of service in accordance with best practice appropriate to the practice setting;

provide culturally and linguistically appropriate services;

integrate the highest quality available research evidence with practitioner expertise in establishing treatment goals;

utilize treatment data to guide decisions and determine effectiveness of services;

deliver the appropriate frequency and intensity of treatment utilizing best available practice;

engage in treatment activities that are within the scope of the professional’s competence;

collaborate with other professionals in the delivery of treatment

Question 30

Modalities, Technology, and Instrumentation

Answer 30

SLPs use advanced instrumentation and technologies in the evaluation, management, and care of individuals with communication and swallowing disorders.

SLPs are also involved in the research and development of emerging technologies

SLPs apply their knowledge in the use of advanced instrumentation and technologies to enhance the quality of the services

Question 31

Examples

Answer 31

AAC technologies to help individuals who have impaired ability to communicate verbally on a consistent

Endoscopy, videofluoroscopy, fiber-optic evaluation of swallowing (voice, velopharyngeal function, swallowing) and other instrumentation to assess aspects of voice, resonance, and swallowing;

telehealth/telepractice technology;

ultrasound and other biofeedback systems for individuals with speech sound production, voice, or swallowing disorders;

Question 32

Population and Systems

Answer 32

(a) managing populations to improve overall health and education,

(b) improving the experience of the individuals served,

(c) reducing the cost of care.

SLPs also have a role in improving the efficiency and effectiveness of service delivery

Question 33

Population and Systems Examples

Answer 33

use plain language to facilitate clear communication for improved health and educational outcomes;

collaborate with other professionals to improve communication with individuals who have communication challenges;

improve the experience of care by improving communication environments;

reduce the cost of care by designing and implementing case management strategies;

serve in roles designed to meet the demands and expectations of a changing work environment;
contribute to the management of specific populations by enhancing communication between professionals and individuals served;

coach families and early intervention providers about strategies and supports for facilitating prelinguistic and linguistic communication skills of infants and toddlers; and

support and collaborate with classroom teachers to implement strategies for supporting student access to the curriculum.

Question 34

Speech-Language PathologyService Delivery Areas

Answer 34

Fluency: Stuttering & Cluttering

Speech Production: Motor planning and execution, Articulation, Phonology

Voice: Phonation quality, Pitch, Loudness, Alaryngeal voice

Resonance: Hypernasality, Hyponasality, Cul-de-sac resonance, Forward focus

Swallowing: Oral phase, Pharyngeal phase, Esophageal phase, Atypical eating

Auditory Habilitation/Rehabilitation: Speech, language, communication, and listening skills impacted by hearing loss, deafness; Auditory processing

Language:Spoken and written language (listening, processing, speaking, reading, writing, pragmatics) - Phonology, Morphology, Syntax, Semantics, Pragmatics (language use and social aspects of communication), Prelinguistic communication (e.g., joint attention, intentionality, communicative signaling), Paralinguistic communication (e.g., gestures, signs, body language), Literacy (reading, writing, spelling

Cognition: Attention, Memory, Problem solving, Executive functioning

Question 35

Etiologies of communication and swallowing disorders include

Answer 35

1. Neonatal problems (e.g., prematurity, low birth weight, substance exposure);
2. developmental disabilities (e.g., specific language impairment, autism spectrum disorder, dyslexia, learning disabilities, attention-deficit disorder, intellectual disabilities, unspecified neurodevelopmental disorders);
3. disorders of aerodigestive tract function (e.g., irritable larynx, chronic cough, abnormal respiratory patterns or airway protection, paradoxical vocal fold motion, tracheostomy);
4. oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral motor dysfunction);
5. respiratory patterns and compromise (e.g., bronchopulmonary dysplasia, chronic obstructive pulmonary disease);

Question 36

Etiologies continued

Answer 36

6. pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal insufficiency/incompetence);
7. laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis);
8. neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebrovascular accident, dementia, Parkinson’s disease, and amyotrophic lateral sclerosis);
9. psychiatric disorder (e.g., psychosis, schizophrenia)
10. genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome, velocardiofacial syndrome); and
11. Orofacial myofunctional disorders (e.g., habitual open-mouth posture/nasal breathing, orofacial habits, tethered oral tissues, chewing and chewing muscles, lips and tongue resting position).

Question 37

Elective services include

Answer 37

Preventive vocal hygiene;

Business communication;

Accent/dialect modification

Professional voice use.
- Transgender communication (e.g., voice, verbal and nonverbal communication);

Question 38

Domains of Professional Practice

Answer 38

advocacy and outreach,

supervision, education

research,

administration and leadership.

Question 39

Advocacy and Outreach Examples

Answer 39

Advise regulatory and legislative agencies about the continuum of care. Examples include telehealth and support personnel,

Engage decision makers at the local, state, and national levels for improved administrative and governmental policies affecting access to services and funding.

Advocate at the local, state, and national levels for funding for services, education, and research.

Participate in associations and organizations to advance the profession.

Promote and market professional services.

Help to recruit SLPs with diverse backgrounds.

Question 40

Advocacy and Outreach Examples Continued

Answer 40

Serve as expert witnesses.

Educate consumers about communication disorders and SLP services.

Advocate for fair and equitable services for all individuals

Inform state education agencies and local school districts about the various roles and responsibilities of school-based SLPs
- Including direct service, IEP development, Medicaid billing, planning and delivery of assessment and therapy, consultation with other team members, and attendance at required meetings.

Question 41

Supervision

Answer 41

Supervision is a distinct area of practice;

crosses clinical, administrative, and technical spheres.

SLPs are responsible for supervising Clinical Fellows, graduate externs, trainees, speech-language pathology assistants, and other personnel (e.g., clerical, technical, and other administrative support staff).

SLPs may also supervise colleagues and peers.

Supervision is integral in the delivery of services and advances the discipline.
- Involves education, mentorship, encouragement, & counseling

Question 42

Examples (read after class)

Answer 42

possess service delivery and professional practice skills necessary to guide the supervisee;

apply the art and science of supervision to all stakeholders (i.e., those supervising and being supervised), recognizing that supervision contributes to efficiency in the workplace;

seek advanced knowledge in the practice of effective supervision;

establish supervisory relationships that are collegial in nature;

support supervisees as they learn to handle emotional reactions that may affect the therapeutic process; and

establish a supervisory relationship that promotes growth and independence while providing support and guidance.

Question 43

Supervision Examples

Answer 43

SLPs serve as educators in academic institutions and through continuing education in professional development formats. (in addition to the education that SLPs provide to individuals, families, caregivers, decision makers, and policy makers)

serve as faculty at institutions of higher education, teaching at undergraduate, graduate, and postgraduate levels;

mentor students at all levels;

provide academic training to students in related disciplines and speech-language pathology assistants; and

provide continuing professional education to SLPs and to professionals in related disciplines

Question 44

Research

Answer 44

Conduct and participate in research related to cognition, verbal and nonverbal communication, pragmatics, literacy (reading, writing and spelling), and feeding and swallowing.

This research may be coordinated across multiple settings.

comply with Institutional Review Boards and international laws pertaining to research.

SLPs also collaborate with other researchers and may pursue research funding through grants.

Question 45

Administration & Leadership

Answer 45

SLPs administer programs in education, higher education, schools, health care, private practice, and other settings.

In this capacity, they are responsible for making administrative decisions related to fiscal and personnel management;

Leadership; program design; program growth and innovation; professional development; compliance with laws and regulations; and cooperation with outside agencies in education and healthcare.

Their administrative roles are not limited to speech-language pathology, as they may administer programs across departments and at different levels within an institution.

In addition, SLPs promote effective and manageable workloads in school settings, provide appropriate services under IDEIA (2004), and engage in program design and development.