Discussion on SLP State Licensure Seeks Momentum

Katheryn Boada of Children's Hospital & CSHA Licensure Committee (bio at end of article)

Discussion regarding the need for new state licensure for SLP’s is percolating through Colorado work settings. An interview with Katheryn Boada, Director of Audiology, Speech Pathology and Learning Services at The Children's Hospital, brought critical aspects of the debate to light. Kathy has served as past president of the Colorado Speech Hearing Association (CSHA) and is currently an active member of CSHA’s licensure committee.

At the 2010 Metro Speech Language Conference in Denver, Kathy presented an overview of the licensure issue for Colorado. She related that, as of 2009, 48 states and the District of Columbia license their speech/language pathologists. Colorado and South Dakota do not license SLPs aside from the public school endorsement issued by the Department of Education. Basic issues faced by Colorado SLPs include: 1. whether or not Colorado should have licensure for SLPs in all settings, and 2. which format licensure should take--it can take two forms, a universal or dual system.

A universal system would require all Colorado SLPs to obtain a license under similar standards. For example, Michigan is a state that requires universal licensure for all SLPs, except for those not involved in practice such as researchers, college teachers and others employed by the department of community health or SLPs operating in other health professions. The dual, or “two pronged” system is practiced in Minnesota. There, school personnel are licensed by the state board within the scope of their school license that makes them exempt from obtaining the state SLP license. All other SLPs who graduate from a master’s program accredited by the Council on Academic Accreditation (CAA) are required to obtain general state licensure, along with ASHA clinical experience and successful passage of the National exam in SLP or Audiology. SLPs who practice in schools and other settings are required to obtain 2 licenses. Of 48 states and 1 district that have licensure in the US, 12 operate within a universal system, 37 within a dual system.

Kathy revealed what might be a more critical incentive in that the American Medical Association (AMA) could possibly step in and define licensure for SLPs. (continued) The AMA has already released a scope of practice document for audiologists. ASHA responded tersely to the AMA document in January of 2010. Clarifying AMA’s position, ASHA President Tommie L. Robinson, Jr. stated that the AMA "has developed an audiology scope of practice document and intends to develop scope of practice documents for other health-care professions. The audiology document has been released and the AMA has invited comments. The PDF version of the document can be found on the Audiology Online website link http://www.audiologyonline.com/news/news_detail.asp?news_id=3953 AMA's intention is for the document, 'to serve as a resource for state medical associations, national medical specialty societies and policymakers.’

Robinson didn’t mince words regarding AHSA’s response. “ASHA does not believe that AMA is the appropriate source of audiology scope of practice information, or for scope of practice information for other independent health-care professions [such as speech language pathology]. Rather, we believe that experts within the appropriate professions should be the source of this information. We believe that this document does not serve the interests of audiologists or those with communications disorders. With that in mind, we have submitted a response, and we have included the names of organizations that decided to endorse our response. You can read details of ASHA's response by accessing a PDF version of it at this link http://www.asha.org/uploadedFiles/ASHAResponsetoAMAScopeofPracticeAudiol...

Robinson further stated that “in addition to our direct response to AMA, ASHA provided feedback to AMA through the Coalition for Patient Rights (CPR), an organization that ASHA helped establish in 2006 and that includes more than 35 organizations representing more than one million non-physician, health-care providers.” Robinson added, “If readers have questions or comments about the document, they are encouraged to share them with ASHA's Chief Staff Officer for Audiology Vic Gladstone (vgladstone@asha.org). “

Although the degree of urgency this places on the licensure decision-making process in Colorado is not clear, it is obvious that CSHA's position mirrors ASHA's. Kathy explained that originally, the licensure issue arose via other concerns. In 2008, the Boards of Cooperative Educational Services (BOCES) directors proposed reduction of degree standards for practicing SLPs from MA to BA to help recruit for unfilled vacancies. Some of CSHA’s membership and the CSHA Board of Directors’ voiced concerns regarding the lowering of standards, and a Licensure Committee was re-established in January of 2009. Later that same year, the committee launched a survey of their membership and SLP professionals at large regarding the need for state licensure. The survey was sent to 1700 ASHA members in Colorado and the CSHA membership using a Colorado Department of Education listserv and listservs from other organizations including the Metro Study group.

Of the 500 responses received, 85% of SLPs surveyed favor licensure. Of those approving licensure, 65% were school SLPs, 90% were health care respondents, and 95% were SLPs in private practice. Of the total, 13% were opposed and 2% were undecided. 80% of those in favor of licensure held licenses in other states.

Supportive comments from the survey included the fact that SLPs are the only discipline not currently licensed by the state. Some respondents felt that there was a need for Colorado to further professionalize their practice by taking control of their own licensure standards. Grandfathering in qualified professionals was encouraged to soften the transition. It was also mentioned that since 49 states already have licensure, greater reciprocity with them would result. Licensure would also help to define the scope of practice for SLP Assistants and Speech Aides. A key point was also made regarding the lack of the profession’s political presence at the State Capitol to monitor and influence bills that impact SLPs. It’s felt by some that licensure might strengthen our voice as part of legislative action.

Kathy said that concerns about new licensure rules among survey respondents are being seriously considered. They include redundancy in rules and requirements, extra fees and paperwork and the need for better coordination with Colorado Department of Education on those issues. Some respondents also voiced their concern to fill SLP positions when there is a shortage of licensed personnel, along the administrative burden of adding ASHA CCC requirements to school based SLPs. When asked if school administrators have formally addressed the issue she responded that they hadn’t “however the Colorado Department of Education is well represented on the Licensure Committee by members Cindy Millikin and Fran Herbert. Kathy said that they will “create a plan to involve/inform all interested and relevant groups as the process moves forward”. The committee has been invited to present at several school districts (Harrison District in CO Springs, Cherry Creek School District and JEFFCO).

When asked if she felt that school-based SLPs were well represented in the CSHA survey, Kathy provided a breakdown of the respondent data stating “it is clear that a large portion of the responses were from school based SLPs. As you can see over 40% of our members work in the schools as a primary setting.” (See respondent data below)

Survey Respondents

Kathy encouraged SLPs to follow the process and/or become involved, Kathy offered 3 ways interested parties can enter the process.
1. Become a part of the Licensure Committee (contact Terry Eberly – teslp77@comcast.net , Liz Peterson – lizslp@flash.net or Kathy - Boada.katheryn@tchden.org)
2. Attend meetings in person or via phone (they will call participants so no long distance charges are necessary).
3. CSHA members can check for regular updates to the CSHA website under the Licensure link. http://www.cshassoc.org/licensure.html
4. Watch for a discussion board on CSHA’s website in the near future. They are currently testing the software and the BOD will decide when to launch at an upcoming meeting.
5. Read the specifics of the draft when it becomes available to understand it's intent and impact.

In the process of drafting licensure language the CSHA Licensure Committee has sought input from a broad base of Colorado SLP work settings which include schools, hospitals, home health agencies, adult rehab providers, private practitioners and universities. They hope to engage other service providers and professionals to further understand the response across Colorado.

Possibly the AMA could take a hint from CSHA's approach and collaborate with ASHA's professional and governance entities before presenting initiatives that place SLPs on the defensive.

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--C.A. Gray, 2010

Kathy's Bio:
Katheryn L. Boada, M.A., CCC-SLP, is the Director of Audiology, Speech Pathology and Learning Services at The Children's Hospital (TCH) in Aurora, Colorado and a Past-President of the Colorado Speech-Language Hearing Association (CSHA). She holds a B.A. in Psychobiology (University of Virginia) and a M.A. in Communication Disorders (University of Pittsburgh). Kathy has been an active member of CSHA since 1994 and of the Colorado Department of Education’s (CDE) Speech-Language Advisory Committee (SLAC) since 2003. Clinical interests include childhood language development and disorders, traumatic brain injury, fluency disorders, parent education & training and clinical leadership development. She current serves on several committees for CSHA (specifically licensure, website & conference) and is active in statewide clinical training and advocacy efforts. Her passions include improving communication, collaboration and coordination among the wide variety of professional groups across Colorado, increasing state-wide accessibility to quality continuing education via video-linked offerings, improving training opportunities for SLP students and advocating for children’s healthcare and speech-language pathology interests both at the state and national level.