American School Speech Pathology Blog 2015

Thank you to all those who have given us comments and encouragement. We have taken a public policy viewpoint as well as methodological. Methods clearly derive from the cultures of institutions. To unravel the history of past decisions is no easy task but worth it.

Summer day, Canal St. Martin, Paris

Summer day, Canal St. Martin, Paris

Dr. John M. Panagos

Professor Emeritus
Editor

John Panagos

John Panagos

“”In art there is only one thing that counts; the thing you can’t explain.”
Georges Braque

“For the mind does not require filling like a bottle, but rather, like wood, it only requires kindling to create in it an impulse to think independently and an ardent desire for the truth.” ~Plutarch

“Everything has its wonders, even darkness and silence, and I learn, whatever state I may be in, therein to be content.” Helen Keller.

”Until we can comprehend the beguiling beauty of a single flower, we are woefully unable to grasp the meaning and potential of life itself.” Virginia Woolf

“A walk about PARIS will provide lessons in history, beauty, and in the point of Life.”
-Thomas Jefferson

“L’absurde, c’est la raison lucide qui constate ses limites.” (“The absurd is lucid reason that sees its limits.”) –Albert Camus, Le Mythe de Sisyphe, Le suicide philosophique

“Plus ca change, plus c’est la meme chose” (The more things change the more they stay the same.) Alphonse Karr, Les Guepes, 1849

The pursuit of truth and beauty is a sphere of activity in which we are permitted to remain children all our lives. – Albert Einstein

“…I am the immense shadow of my tears” Federico Garcia Lorca

“Nothing is absolute. Everything changes, everything moves, everything revolves, everything flies and goes away.” Frida Kahlo

* I am not young but I feel young. The day I feel old, I will go to bed and stay there. J’aime la vie! I feel that to live is a wonderful thing.” Coco Chanel

Market in Paris.

Market in Paris.

Construction

Construction

Conclusion

The outcome of the conference was to create a business and political framework for SLP curriculum rather than to sustain the academic model. The business model was implemented through the CAA accreditation regulations. The business model established a deep division between the aims of academic programs and non-profit business goals. For example, it is good business to promote an expanded scope of practice to support employment and revenues, whereas the academic approach seeks to limit the scope of practice precisely according to research and promulgation of best-practice nomenclature.

The strand model later incorporated into accreditation standards created a mish-mash of curriculum content statements diluting academic standards and confusing graduates as to what “courses” are accepted within scope of practice. Now so many SLPs write in to ASHA raising questions about what is and what is not a work duty; e.g., reading. School SLPs want ASHA to limit scope of practice for clarity and workload considerations. At the same time the public relations department highlights countless courses that “appear” to be duty course. This is more a revenue approach than an academic approach, one leading to the sale of continuing education credits. It is in the non-profit’s best interest to push SLPs to take on as many different disabilities as possible. SLPs see the ethical problems with this business approach. SLPs complain they shouldn’t have to accept assignments outside scope of practice. Thus one sees the long-term consequence of Dr. Spahr’s business model of SLP practice, creating an unfortunate conflict of interest between academic and business viewpoints.

Other odd contradictions prove the point. While the Board of Directors tries to solve old and nagging workload problems, the ASHA non-profit is out there selling as much scope of practice it can sell. Workload expands as scope of practice expands.

Cartel

The careful reader of ASHA history should recognize an undercurrent of political activity dating all the way back to 1930 when the founders captured the field from education. It has been suggested that ASHA management maintains an accreditation cartel held against all competitors which might seek to impair it.

Again, Dr. Spahr was concerned competitors could take over licensing SLPs. “We should not make the mistake of believing that our professional services will be worth more in the market as a result of specialization.” There are strong indications that in 1994 encroachment was a threatening prospect. The academics were entrenched and had their own ideas about organization. Language had made major inroads in the academic programs and was capable of breaking away. Dissatisfied employers might start preparing SLPs. Audiology independence was a strong influence. Swallowing advocates pressured to be included in the core curriculum. Other new topics push to be included. A central aim of reorganization was protecting the ASHA non-profit.

Construction

A second point is that ASHA has not reconsidered the claims used to justify a business approach. The idea students are “not ready” as defined by employers is an unsettled position. The problem has been reported in several disciplines without final resolution. An article published in the Washington Post speaks to the issues:

http://www.washingtonpost.com/…/grade…/why-are-so-many-college-students- failing-to-gain-job-skills-before-graduation/‎

ASHA Philosophy of Curriculum Turned Upside Down. 4jjj

ASHA’s Mixed Curriculum Approach

Our analysis posits two competing models for understanding curriculum organization and study.  They were brought into contrast my the 1994 meeting to advance a “new agenda” for graduate education. The two are revealed when discrepant interpretations arise for curriculum decision-making.

Mixed Messages

Within the organizational structure of ASHA, where professional public communication occurs, the two models are mixed in one melange of notions. It is impossible to communicate clearly issues and decisions accordingly. Members cannot sort out issues because they do not have intellectual control of how conflicts of interest occur, and why they occur. History advances. Institutional memories fade. Members are left with an Irish stew of options on which to base policy directions. Members talk past one and another without knowing how history is selecting their words.  Members grow older, retire and die.

Business-Academic Conflicts

In 2008, approximately, SLPs reported ASHA was not supporting Scope of Practice practice in the school setting. Other school specialists were “encroaching” on SLP clinical standing. ASHA took the business approach, leaving scope of practice wide open for employer convenience:

“It is ASHA’s position that SLPs do not “own” any aspect of their scope of practice, nor can they dictate what another profession can or cannot do. Clearly, speech-language pathology shares professional boundaries with related professions, and SLPs need to understand other team members’ expertise while articulating the value of their own unique knowledge and skills.”

This view fits exactly into the Spahr framework, point-for-point.

However ASHA’s school SLPs countered scope of practice is defined and should be recognized as such.  Ellen Estomin (ASHA Leader, April 6, 2010) on behalf of the ASHA’s school-based SLPs said they agree with the part that says SLPs cannot dictate what other professionals do, or do not do, but they disagree with the part that says SLPs do not “own” aspects of scope of practice. Having an ethical code of conduct, extensive training, defined scope of practice and prescribed roles and responsibilities, SLPs should confidently communicate their strengths to the public.

This is, of course, made Dr. Spahr’s point, that SLPs were demonstrating expert standing and resisting employer assignments. SLPs do want a clear and well defended scope of practice because they can control caseload size and concentrate on mastery of best practice expectations.

Many more examples of ASHA’s preference for business principles over academic.  In this instance there was quite a bit of public dispute over the “encroachment” problem.

http://www.asha.org/policy/SP2007-00283/‎

Scope of Practice

CEO Spahr advanced his “New Academic Agenda,” implementing it through ASHA committees. In 2001 the Ad Hoc Committee on Scope of Practice in Speech-Language Pathology with approval by ASHA Legislative Council carried out the Spahr theme of the business oriented approach to SLP practice and graduate education:

“Speech-language pathology is a dynamic and continuously developing profession; listing specific areas within this scope of practice does not exclude emerging areas of practice. Although not specifically identified in this document, in certain instances speech-language pathologists may be called on to perform services (e.g., “multiskilling” in a health care setting, collaborative service delivery in schools) for the well-being of the individual(s) they are serving. In such instances it is both ethically and legally incumbent upon professionals to determine that they have the knowledge and skills necessary to conduct such tasks.”

So we see clearly the scope of practice forces maximum SLP adaptability and holds SLPs responsible for their decisions.  But ASHA takes little responsibility while meeting the expectations of impatient employers.  ASHA protects the non-profit legally when curriculum policies are discussed.

Knowledge-Skill Structure

We see in the statement above how the knowledge-skills paradigm supports the business approach in marketing SLP services to employers and consumers.  Statements of knowledge can be connected to hundreds of skills in a manner approaching arbitrary practices.  A a cognitively impaired (knowledge) child (autistic) who repeats words can receive a fluency treatment (skill).  An academic approach seeks to avoid the faulty connection imagined.  Yet the special education supervisor might be pleased the SLP is trying to correct word repetitions.

Academics believe the SLP must have a course in stuttering and autism to understand the underlying causes of the symptoms considered.  One cannot just connect bits of knowledge and bits of skill and have a valid treatment plan.

Why Does My Child With Autism Repeat Words and Phrases?
autism.about.com/od/childrenandautism/f/echolalia.htm‎

UK

UK

Dr. Spahr retired in 2003 (Dec., 31) and passed the baton to Dr. . The two CEO’s at times working together advanced the Spahr position. During the period the ASHA legislative Council was dropped preventing membership review. From 1994 there have been 23 different presidents with oversight responsibilities. Meanwhile the accreditation body (ACC) operated apart from the direct supervision of the ASHA Board of Directors, claiming to be an autonomous unit. One almost sees a secretive method of operation to push through the Spahr agenda.

http://www.asha.org/…/ASHAs-Arlene-Pietranton-Named-Professional-Society- CEO-of-the-Year.htm

UK

UK

A second point is that ASHA has not reconsidered the claims used to justify a business approach. The idea students are “not ready” as defined by employers is an unsettled position. The problem has been reported in several disciplines without final resolution. An article published in the Washington Post speaks to the issues:

http://www.washingtonpost.com/…/grade…/why-are-so-many-college-students- failing-to-gain-job-skills-before-graduation/‎

ASHA Philosophy of Curriculum Turned Upside Down. 3

Curriculum Redesign

According to Dr. Spahr, a new SLP “product” should be graduated.  Cost-containment is a factor.  Here are the keys to reform of the traditional curriculum:

1. The curriculum should be designed for “competency-based” practice. The number of courses taken is not that important. SLPs should not strive to be experts in narrow areas.  Knowledge and skill should be adapted to the cases assigned.

2. The curriculum focus should be on “knowledge, skills and attributes.” The approach decategorizes the traditional knowledge base in favor of “strands” of information (my term). Traditional course titles are less important. The “knowledge-skill paradigm” (my term) should be essential  to coursework.

3. The curriculum should be designed to graduate “multiskilled, multifunctional, [and] cross-trained” SLPs.”  Cross-training allows employers to place SLPs in any service delivery configuration.

4. The curriculum should be designed to support broad scopes of practice. SLPs should be ready to take on all disabilities as assigned in a flexible and adaptive manner.

Which Curriculum Model?

When I look over the Spahr proposal for curriculum modification I am aware of my own background.  It is academic and my instructional framework is to conduct research to support best practice.  An academic framework for curriculum looks something like this:

Academic: Courses are summaries of knowledge and experience known to be effective via textbooks and research articles. Courses achieving long-term status remain in the course inventory and must be justified to curriculum committees. Courses lacking best practice status and scientific backing are gradually dropped from the course inventory. New courses must be tested for science value. The use of best-practice courses along with scientific study create valid and reliable practice standards. Clinical supervisors work with professors to apply course principles. Efforts are made to achieve precise nomenclature, again under review and approval. Valid courses are carefully placed in the scope of practice. SLPs are encouraged to use methods meeting best practice standards, and to avoid methods regarded as unscientific.  The scope of practice governs the range of clinical conditions treated by SLPs.

On the other hand, Dr. Spahr advocated what I would call a business view of curriculum development, defined this way:

Business:  Courses are products to be marketed for revenue advantages. Courses marketed for continuing education are exciting. Building the brand requires a variety of products responding to customer demands. The more acceptable courses placed in the scope of practice, the better. Variety satisfies a range of employers and customers.  Shredded courses reduced to knowledge-skill strands let SLPs service more disabilities and clients in different settings. Strands are desirable to place in collaborative programs making SLP services more useful to employers. Fixed service boundaries make it difficult to squeeze SLPs into different service categories. Where curriculum selections are unpopular, they are placed on the bottom shelf, e.g. articulation. Where they are popular, they can be marketed effectively, e.g. autism.  SLPs are encouraged to use methods desired by employers, and to show less favor for courses not meeting employer desires. ASHA should view SLP graduates as “products” to be marketed to potential employers.

When I worked in schools, I read about a trend for special education directors to move away from support of articulation disorders in favor of more complex language disorders (Marshalla, 2007).  Whereas in 1930 articulation treatment was the essence of SLP practice, i.e. “speech correction,” it became one of many treatment categories listed in the ASHA scope of practice document.  Interpreted, articulation is no longer a successful product.  It is better to market it as “speech-sound disorders, or phonology, or apraxia of speech, or articulation” all.

“The more hooks in the water, the better chance of catching fish,” the saying goes.

Marshalla, P. (2007). Letters. A travesty! The ASHA Leader, Aug. 24.

Role

1980 – Dr. Spahr begins as ASHA Director

1992 – Standards for Accreditation of Educational Programs in Speech-Language Pathology and Audiology implemented by ESB

1994 New Academic Agenda – Dr. Spahr

1996 – Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) established

1999 – First set of CAA Standards for Accreditation implemented

1999- Transition to CAA semi-autonomous  status

2001 – SLP Scope of Practice approved, ASHA Legislative Council

2001 – New Standards for the Certificate of Clinical Competence

2002 (DEC) Dr. Spahr retires as ASHA Director
USA

2007 -Step by Step, ASHA Begins Governance Change

2007 governance Structure and Process Committee Report

ASHA Philosophy of Curriculum Turned Upside Down. 2

Search for Causes

Under the leadership of Dr. Fred Spahr, Director, ASHA in the 1990s sought to re-organize governance as a result of various complaints about efficiency and communication.  Dr. Spahr took the lead in addressing issues of change to the profession.

The Colloquy of 1994

In 1994 ASHA sponsored and held a pivotal three-day colloquy: “Blueprint for a New Academic Agenda.” Included were 50 trusted invited participants who provided lectures, ideas, organizational perspectives and commentary. The program agenda listed “…external and internal influences that are changing our professional environment…” Goals to implement outcomes were presented. ASHA president, Dr. Jeri Logemann, was a prime mover. She spoke on current practice issues. ASHA director Dr. Fred Spahr delivered a key paper on the challenges facing the profession.

The tone of the conference was urgency. Changes impacting ASHA were coming from all directions. Decision-makers in higher education and clinical practice were feeling pressures. National health care reform was impacting training programs. Academic administrators questioned costs. Technology was coming.

Working SLPs and audiologists faced expanding scopes of practice. They needed special new skills required for health-care and school settings. Employers complained SLPs were not ready upon graduation. SLPs cost too much to employ and they were inflexible in their work contributions. They should be able to handle a wider scopes of practice to cover emerging clinical issues.

Barriers blocking change stood in the way. Academic training models were behind the times. Costs prevented program innovations. Deans were reluctant to approve binding accreditation requirements. Faculty resisted change.  Denial was a problem. Faculty need to be re-oriented.

Many attendees were ASHA employees and officers.  There must be follow-through plans adopted to ensure policy redirection. A document was created to “provide guidance to ASHA.” The current record shows the New Agenda  was followed until now, 2015.

The colloquy was not widely publicized nor approved by the Legislative Council.

Leadership Position

Dr. Spahr’s paper was central to the new agenda. He took a business orientation for ASHA’s future, deferring to employer evaluations as to the deficiencies of SLP graduates.

Employers were dissatisfied with SLP “products.” They were unprepared for immediate service. There were signs employers wanted to train their own SLPs, particular in medical settings. SLPs should be trained to understand costs and performance requirements.

Dr. Spahr was concerned competitors could take over licensing SLPs. “We should not make the mistake of believing that our professional services will be worth more in the market as a result of specialization.” SLPs do not have to be experts; they need to deliver the services expected. SLPs were pushing back on the assignments and needed to be collaborative.

Academic programs must contribute “…professionals capable of delivering services to meet the needs of today’s consumers (patients, students, clients) of our services.” Perhaps employers should be involved in helping form program training goals. “What steps in the program to determine what is needed in the product (student) of the program in the future?”

Curriculum must be reshaped. Simply taking courses is not enough.  “Employers want value-added professionals. They want professionals whose scopes of practice are wide and flexible.”

“Our education and training programs must ensure the relevance of course instruction to the workplace.”

Department administrators have a difficult time changing faculty approaches.

Status Quo Position

Dr. Spahr made no effort to point out the successes of the traditional academic model. Nor was there anyone placed on the program to do so. One could have said course and clinic based procedures plus research opportunities, professional supervision and individualized study held up well for 70 years. Participants at the meeting were educated according to traditional standards but they did not speak up to defend it.  The New Agenda moved forward.

Major successes were skipped over to make the argument against the status quo.

1. Language as a major area of study had emerged and was spreading around the nation. When Dr. Spahr retired he acknowledged language had been an important bridge to other areas of disability, such as learning disabilities. In 1978 ASHA added the word Language to the Association name. Students were required to take language courses growing in sophistication. Students from other departments took language courses promoting interdisciplinary ties.  A productive era of new research findings was witnessed.

2. There was no mention of the continued growth of ASHA as a wealthy national organization with a large capable staff and suitable headquarters in Washington, D. C. More and more academic units were applying for accreditation and the accreditation list was growing. Member volunteers filled the ranks of administrative programs. A public relations department was established along with continuing education offerings. ASHA lobbied Congress. Growth rate was predictably strong. ASHA had the size and means to combat employer complaints utilizing appropriate public relations campaigns.

3. The Spahr argument excluded remarks on the great success of school SLPs. School SLPs had overcome radical changes in practice by way of federal IDEA legislation and were in high demand for employment. Their numbers were growing and school SLPs were injecting fresh money into the ASHA coffers from several sources. ASHA was becoming a wealthy professional organization fully capable of setting the agenda for status quo programs.  By 2005 the ASHA membership continued to grow, according to CEO Pietranton (100,000 SLPs; 13,000 Audiologists; 2,000 Speech and Hearing Scientists)

Construction

construction

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