Monthly Archives: February 2014

18. ASHA Curriculum Schism Explored in 2014

When one goes through ASHA posts, policies and public records there is the impression all committees and functions are all equal in their representational connection to the membership. But underlying “ASHA” are intentional authority disjunctions which disrupt the development of the educational foundations of school speech-language pathology — curriculum!

Federal Reserve

Consider the U. S. Federal Reserve to understand the problem

In grammar school we learned the U. S. government represents us democratically. “Write your congressman if you want change” But the federal reserve is a different animal (Wikiepedia):

“The Federal Reserve System…was designed to serve the interests of both the general public and private bankers. The Federal Reserve System has a “unique structure that is both public and private”[54] and is described as “independent within the government” rather than “independent of government”.[55]

….The authority of the Federal Reserve System is derived from statutes enacted by the U.S. Congress and the System is subject to congressional oversight. The members of the Board of Governors, including its chair and vice-chair, are chosen by the President and confirmed by the Senate.”

While on paper it appears the president and congress supervise the Federal Reserve, the Fed has its own expansive power which in real financial circumstances out controls the U. S. government and operates independently.

Amazon: “The Creature from Jekyll Island: A Second Look at the Federal Reserve by G. Edward Griffin (Sep 11, 2010).”

The Founder’s Legacy

In 1910, speech-language pathology was flourishing in American schools. Immigrant children were coming and they required speech correction. Training was received in the colleges of education — normal schools. In 1930, a small group of speech professors took control over speech pathology to enhance their status on college campuses. They did not especially like school clinicians but they saw the political and financial benefits of capturing on-campus training programs, effectively taking them away from education.

In the 1950s the burdens of training therapists mounted. Supervision demands and certification paperwork grew. The ASHA organization was moved from one university to another and the clerical work had to be shared. The founders wanted to retain control of the organization but wanted to shed the demands of the burgeoning national organization.

Off to Washington

The tight-knit group of professors and their students hired an executive director and moved ASHA to Washington, D.C. from Wayne State University in Detroit. Two aims evolved:

1. retain tight control over the core mission and authority.

2. organize a practical system for ASHA’s housekeeping.

The first strategy was to ensure control over credentialing — accreditation of institutions and certification of students. Education had already been pushed out of the picture. Now ASHA must be the sole provider of certified professions, establishing a training cartel. Training increased on campus and off campus revenues. The executive director through a small group of hand-picked doctoral-level men embracing the founder’s vision ran the show. The director was Kenneth O. Johnson (1958-1980), a disciplined administrator who pushed hard for control of accreditation.

Like the federal reserve, a “semi-autonomous body” was formed, The Council on Academic Accreditation (CAA).

The public side of ASHA became a successful non-profit organization widely respected as a non-profit. It became a polished public relations organ for ASHA and built a large continuing education system. CCC graduates were required to sign up for continuing education. As to collaboration, the deficiencies carried over from graduate education might be addressed through the continuing education channel.

Whereas the Executive Director played a strong role in providing administrative support for credentialing, the elected ASHA president became the figurehead for the non-profit organization with public relations affairs.

Hence the schism was formed with tacit understandings that CAA business was largely off-limits. The powerful position of the Board of Directors represented in the bylaws was diluted by the need to continue on with historical separations.

When the CAA announced “accreditation decisions” for academic programs, it did so in a manner suggesting ASHA is a separate distant entity:

“Below is a list of recent accreditation decisions made by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) of the American Speech-Language-Hearing Association (ASHA).”

http://www.asha.org/academic/accreditation/caaDecisions/

In all aspects of public affairs, ASHA proper should be the face of the organization. It carries the authority to change CAA.

17. ASHA Curriculum Schism Part II

While ASHA officials publicized the importance of collaboration in The ASHA Leader, members of the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) worked on new certificate standards. CFCC members…”Define the standards for clinical certification and apply those standards in the certification of individuals…” “The CFCC is a credentialing body of the American Speech-Language-Hearing Association.”

http://www.asha.org/About/governance/committees/Council-for-Clinical-Certification-in-Audiology-and-Speech-Language-Pathology/

Study

In 2009, under the auspices of the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA), a study was initiated to evaluate current practice and curriculum. Input from the ASHA membership was invited.The new standards go into effect September 2014. Update reports have been published online.

http://www.asha.org/uploadedFiles/Side-by-Side-Comparison-Implement-Changes-Jan-2014.pdf

Passe and Waguespack provided an update on the new standards in Chicago in 2013. No mention of collaboration was made. Review of several related documents indicated collaboration is a non-issue. Most changes in the “standards” entail changes in procedure and definition. The level of discourse amounts to lists of things to do. Reflections on the state of the art do not appear.

http://www.asha.org/uploadedFiles/CFCC-Update.pdf

ASHA Directors

Thus for 2014 CFCC takes the position that collaboration is not a demonstrable “knowledge” component of CCC preparation (even though ASHA’s policy statement of 1991 approved by BOD describes the scientific basis for collaboration). Instead, it is a “skill” that only requires exposure to collaboration clinically for the acquisition of collaborative interaction and behavior.. Two standards offer only a vague expectation as difficult to confirm:

1. planning intervention with parents and clients

2. case management with other professionals

Comment

Our understanding suggests an irony of organizational perspectives.

On the one hand, the Board of Directors approves the special edition of the ASHA Leader. Experts highlight the great importance of collaboration but wonder how to get universities to change their training. There is a sense of helplessness as to what can be done.

On the other hand, the Board of Directors approves the CFCC study of standards but does not urge CFCC to act on collaboration. The BOD remains silent letting the status quo roll forward. CFCC says nothing about it.

ASHA maintains a double standard. It advocates for collaboration via its powerful public relations mechanisms but fails to use its authority to address the issue. It has the authority not only to address the issue but to restructure CFCC if it fails to act.

July 1, 2014

This post is critical to understanding the necessity of reforming the ASHA presidency. The ASHA president because of its legal position must exercise authority to advance curriculum.

International School Speech-Language Pathology

USA

We take the position here that school speech-language pathology is a separate discipline overlapping with hospital speech-language pathology. It is not just “another context” as many Americans believe. The educational context creates a different theory of communication and learning. School communication is a part of learning and disability is inter-related.

Welcome to friends in many countries, especially, South Africa, Colombia, Canada, Saudi Arabia, Australia, France and Ireland.

Welcome members of the International Association of Logopedics and Phoniatrics (IALP). I am happy to have delivered a paper at the IALP in Scotland.

UK

UK

Dire Straits Sultans Of Swing Lyrics

You step inside, but you don’t see too many faces.
Comin’ in out of the rain to hear the jazz go down.
Competition in other places…
But the horns, they blowin’ that sound.
Way on down south,
Way on down south, London-town….

And a crowd of young boys, they’re fooling around in the corner,
Drunk and dressed in their best brown baggies and their platform soles.
The don’t give a damn about any trumpet playing band.
It ain’t what they call rock and roll.
And the Sultans,
Yes the Sultans play Creole.

Sidewalk artist, Montmartre, Paris.

Sidewalk artist, Montmartre, Paris.

16. ASHA Curriculum Schism Uncovered

We are working on defining a deep historical schism within the American Speech-Language-Hearing Association, one that impairs performance to keep the Association up-to-date in school curriculum and related clinical activities.

In the sleekly new designed ASHA Leader, editors published a special edition (Vol 18, No 6 June 2013) — “The Power of Interprofessional Education and Practice; Full Team Ahead” — highlighting the importance of SLP clinical collaboration in medical settings. Interprofessional Education (IPE) is an important new trend and ASHA should address it! Some 20 notes, reports and articles were prepared for the issue.

Prasad (p. 28) outlines the many advantages of collaborative practice: “Ultimately the ideas that drive interprofessional teaming are cooperation, coordination, collective identity, shared responsible and, of course, high quality care.”

Rogers and Nunez (p. 8) describe six areas where academic programs can voluntarily begin educational preparation for students. The job is up to the faculties to train for collaboration.

According to Prelock (p. 5), academic institutions in the U. S. are beginning IPE programs, but, she asks, “Are we educating our students to function in more flexible and very different practice environments than when we were trained?” Prelock concludes: “To accomplish our desired collaboration, we need to adjust our training and practice” (p. 6).

Rogers and Nunez saw the difficulties (p. 7): “So, as interest in interprofessional teaming grows, with ASHA and other professional associations pushing to move it forward, programs grapple with how to surmount these challenges and actually make it happen. How do you change an entrenched system and culture?”

Pickering and Embry, in their paper “So Long, Silos” (p. 38), say preservice students need training in medical collaboration but getting it done in academic settings is tough sledding: “… academic programs are usually organized in silos, independent of other disciplines in administrative function and curriculum. Coursework is often disorder-specific, with awkward separation between knowledge and clinical skills” (p. 42). Offered are 10 steps to cultivate collaboration in the classroom, clinic and community.

Fagan (p. 48) admits getting preservice graduate training in clinical collaboration is difficult or insufficient. She says using continuing education programming is a good solution.

Rogers and Nunez suggest ASHA perhaps should change accreditation standards (p. 8). “Should preparation or demonstrated competencies with interprofessional skills be a part of certification and/or licensure?”

15. “Knowledge” of Collaboration Ignored

Here we repost part of a prior appeal to significant reform in the preparation of school SLPs.

“The American Speech-Language Hearing Association is presently soliciting comments on its revised clinical certification standards. Presently it is not possible to generalize about SLP academic preservice preparation in America. But we can posit the obligatory background knowledge SLPs need in 2011. Accordingly, we are impressed with the opportunities graduates of the Brooklyn College (New York) have to take on-target coursework in special education supporting modern practice in schools. Every school speech-language pathologist should have the topical experiences described.

Educ 7672T Teaching in Least Restrictive Environments

30 hours plus conference; 3 credits

Strategies to integrate and support students with special needs in least

restrictive environments. System and organizational change theories and

strategies for developing models of inclusive education. Focus on curriculum

and collaborative processes with other professionals including co-teaching,

consultative, and itinerant models. Engagement of family members in

collaborative efforts. Students will implement a consultative/collaborative

project. Field experiences in a variety of school and community settings.

“Knowledge Ignored”

For the new 2014 ASHA has ignored the rich content on collaboration for inclusion in certification standards.

Why?

It has been over 20 years since ASHA itself published its own policy on collaboration, one showing it is a serious topic?

14. ASHA Collaboration Preservice Education Standards Amazingly Indequate

We have seen collaboration curriculum standards for students in American accredited college and university programs are negligible, impoverished of the “knowledge” required for other standards.

What is the target? The right framework? The science foundation?

In 1991 ASHA published a seminal expert panel study demonstrating the nontrivial content to be mastered by SLP students. (“American Speech-Language-Hearing Association. (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools [Relevant Paper]. Available from http://www.asha.org/policy.”)

Collaboration is For Real

A report written in Urban Perspectives (winter 2006), ” Adapting Speech Therapy Service Delivery through Data-Based Decision- Making and Response to Intervention (Lori Carmichael-Howell and Jennifer Dezarn-Lynch, Metropolitan School District of Wayne Township, Indianapolis, IN)  gets at issues critical to the future of school speech-language pathology. 

The SLPs were frozen in a survival mode: “They were not satisfied with the progress in student achievement; services were delivered separate from the curriculum, and large amounts of time were focused on assessment and placement rather than intervention.” 

A district-wide improvement project was developed. “When data was examined during this project, a lack of consistency was found not only in identification of disabilities but also in service delivery methods, use of evidence-based practices, and SLP involvement in the general education curriculum.” 

Service delivery was made more flexible, adapted to children and SLPs, and RTI was interfaced with therapy services. Collaboration and generalization goals were important.  Aggregate data were collected to evaluate progress, and phonological process instruction was incorporated into the program.  The need for pull out therapy was reduced. 

The program has become a model for Indiana.

Comment

In one fell swoop the Indiana project demonstrates how SLPs can plan for systemic change addressing a wide range of issues including SLP overload and burnout.

http://www.urbancollaborative.org/sites/urbancollaborative.org/files/winter-spring-2010-issue.pdf

13. ASHA Thread to BOD for Collaboration

We can see in our last post the minimization of a meaningful collaboration standard for clinical certification and the preparation of school SLPs for whom collaboration is an essential method. We have also established that decision-making hierarchy for standards:

“Members —>
Board of Directors —>
Chief Executive Officer —>
ASHA Employees

The Vice President for Speech-Language Pathology Practice has the special responsibility of tracking and recommending changes in practices.”

Additionally, the Vice Presidents for Standards and Ethics in Audiology and Speech-Language Pathology works with the Council for Clinical Certification in Audiology and Speech-Language Pathology composed of 20 members with chair and an ASHA liaison officer.

Finally, we have the The Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) and Academic Accreditation in Audiology and Speech-Language Pathology (CAA).

http://www.asha.org/About/governance/committees/Council-for-Clinical-Certification-in-Audiology-and-Speech-Language-Pathology

12. ASHA Standards for Clinical Collaboration

With reference to descriptions of official ASHA CAA and CFFA standards plus scope of practice guidelines, a composite description of collaboration standards is presented here.

USA

Collaboration refers to a skill reflecting “interaction and personal qualities.” It is a skill similar to “prevention, treatment, documentation, diagnosis, referral, counseling, ethical practice, and professional behavior.”

Accredited colleges and universities must provide educational opportunities for certification students to acquire collaboration skills, two in particular:

1. planning intervention with parents and clients.
2. case management with other professionals.

11. ASHA CFCC Standards for Collaboration

“The Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) is a semi-autonomous credentialing body of the American Speech-Language-Hearing Association.” Its charge includes defining and enforcing clinical certification in cooperation with the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). New standards formulated for clinical certification will start September 1, 2014. Consider current standards for collaboration.

Collaboration Standards

Certificate standards for 2014 are of two types, knowledge and skill.

Knowledge

Standard IV-C covers demonstrated basic clinical skills, including, for example, articulation, fluency, language, hearing, swallowing, cognition, social aspects and augmentative / alternative communication.
They must be demonstrated and presumably documented in some fashion. Clinical collaboration is not included as a knowledge component.

Skill

Standard V: Skills Outcomes is where clinical collaboration is found, under Standard V-B:

“The applicant for certification must have completed a program of study that included experiences sufficient in breadth and depth to achieve the following skills outcomes:”

1. Evaluation
2. Intervention
3. Interaction and Personal qualities

Collaboration is not mentioned as a skill area under evaluation. Collaboration is mentioned once under intervention:

“Collaborate with clients/patients and relevant others in the planning process.”

Collaboration is mentioned once under interaction and personal qualities:

“Collaborate with other professionals in case management.”

http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards/

Citation

Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association. (2012).

10. ASHA CAA, Scope of Practice and Collaboration

CAA standards are synchronized with scope of practice standards. The purpose is to “… provide guidance for educational preparation and professional development of speech-language pathologists.”

1. In the first section called Professional Roles and Activities (voice, speech sound production, language, cognition, swallowing) collaboration is not included.

2. It is mentioned in the next section called Clinical Services (prevention,treatment, documentation, diagnosis, referral)

An example is given: “collaborating with other professionals (e.g., identifying neonates and infants at risk for hearing loss, participating in palliative care teams, planning lessons with educators, serving on student assistance teams)…”