Category Archives: SLP History

ASHA Accreditation Standards and the CAA

The CAA focus is on procedures without curriculum reform. It is a tin man without a soul.

Consider professional nomenclature to parse speech-language pathology according to science rather than political fads.In 1947 Samuel Robbins wrote a scholarly paper on the “Principles of Nomenclature and of Classification of Speech and Voice Disorders” (Journal of Speech Disorders March 1947, Vol.12, 17-22). He argued precise formal classification is essential for speech science.

Now jump forward to 2011 to the ASHA Summit on “Clarifying and Promoting the Regulation of Clearly Differentiated Provider Roles.” The panel came up with this proposal:

“To address the misunderstanding and misalignments that can result from the lack of a shared nomenclature,
ASHA should develop (or revise) and publish a lexicon for the field of speech-language pathology. Where
necessary, the lexicon may acknowledge the range of terms now in use, but the intent should be to promote
a shared vocabulary…”

CAA must deal with such fundamentals in a scholarly fashion. It must do more than administer accreditation applications.

http://www.asha.org/uploadedFiles/2011-SLP-Summit-Report.pdf.

The Kennedy family advocated for retarded citizens.  This is Mrs. Kennedy. Her husband was President John Kennedy, and he too advocated for rights of children.

The Kennedy family advocated for retarded citizens. This is Mrs. Kennedy. Her husband was President John Kennedy, and he too advocated for rights of children.

Here is a prior post on the subject of roles and classifications:

Prior Post

As we have pointed out in a prior post, more often web authors use “speech therapy” to refer to speech-language pathology.   The following search hit rates were presented:

Speech therapy—–8,320,000

Speech pathology—–1,222,000

Speech-language pathology—–943,000

Speech therapy reflects medical- diagnostic and programmatic thinking rather than scientific.  The speech therapy era effectively ended in 1960 when the field of communication disorders experienced a burst of scientific activity and moved toward language foundations.

A Parallels Universe exists.   For example, across clinical service domains phonology, articulation and oral motor training are regarded as separate treatment foci.  Hence, theory integration is being held back by the misuse of terminology.

A lack of integration is also blocking the proper growth of “educational speech-language pathology,” wherein hybrid school criteria are developing for special education placement and intervention models tied to IDEA 2004.

“Speech therapy” notions are not suitable for school settings.  The most obvious failing is that modern language theory is excluded and there is no concern for the overidentification of  non-disabled minority children and the stigma of going to “speech therapy” as a factor in high school success.

More subtle are the effects of social expectations for types of treatment.  Those who speak of “speech therapy” come to expect oral-motor practice and sound-by-sound content, i.e. “bottom up” methods.  Administrators and teachers believe they know what good “speech therapists” do.  They anticipate seeing “therapists” in a small room guiding clients to produce sounds accurately.  Administrators advertise for “speech therapist”   employment.  State and federal government documents mention “speech therapy.”

Mr. Chang, swan-goose and friend, Lakeside, Arizona

Needless fragmentation of the discipline occurs when “Speech Therapy” holds sway over “Speech-Language Pathology.”

Post Script

A reader writes in to provide this experience:

“Our school district’s IEP computer based program defaults to Speech Therapist. After many requests the tech dept added Speech Pathologist. Getting close aren’t we? Now I am trying to get the original request of Speech/Language Pathologist. I have to routinely go into this computer based program and change Speech Therapist to Speech/Language Pathologist.”

Update

We have since noticed that 11,900,000 pages are  found for “MEDICAL SPEECH PATHOLOGY.”  A further sign of fragmentation of the field of speech-language pathology?

Another interpretation is the field is naturally evolving with sub-specialties whose missions are tied to unique contexts, thereby stretching “one-size-fits-all” certification pushed forward from the 1930s.  Is the medical model obsolete?  Or is it perfect for “medical speech pathology” and imperfect for school speech-language pathology?

What kinds of organizational structure is needed to accommodate expanded  knowledge, policy formation, standards and communication?  Does the non-profit model under a single umbrella function to support mature  growth in the school setting?  Does  the pattern of conflicting terminology reflect a breakdown in the model?

July 2012 update

One of our most popular posts.  It  is more than just a terminology issue.

Dr. John Muma adds a scientific perspective to the problem (ASHA Leader, June 5 2012).  Whereas academic programs have settled on “communication disorders” to refer to the specialty, ASHA continues to cling to an “arcane” modalities approach.  Language theory makes this approach obsolete.  “Just as professionals are charged by the ASHA Code of Ethics to be up to date with developments in the field, the professional association (ASHA) should also reflect an up-to-date perspective.”

 http://journals.asha.org/misc/ifora.dtl#mission

Dr. Muma’s comment is confirmed looking at ASHA’s research mission statement:

“ASHA’s mission is to promote the interests of and provide the highest quality services for professionals in audiology, speech-language pathology, and speech and hearing science, and to advocate for people with communication disabilities. To help fulfill our mission and support science and research in the discipline of communication disorders, we publish four peer-reviewed scholarly journals” (my emphasis).

School speech pathology is buried another level down in “speech-language pathology.”

The more one parse this topic, the more one wants to ask, “Who’s in charge of ASHA to fix these things?  Doesn’t this confuse our publics?”

http://journals.asha.org/misc/ifora.dtl#mission

Mission Statement

ASHA’s mission statement   places emphasis on communication:

“Empowering and supporting speech-language pathologists, audiologists, speech, language and hearing scientists by:

Advocating on behalf of persons with communication and related disorders;

Advocating communication science;

Promoting effective human communication.”

Sloppy Administration

Another explanation of a confusing and obsolete  professional nomenclature as promulgated by the American Speech-Language-Hearing Association is sloppy management of ASHA information systems, especially on the ASHA website.  There should be a clear  and valid conceptual model for professional programs and terminology, and consistent usage across all platforms of public communication.

In May of 2012 at the ASHA Board meeting a proposal which would strengthen the medical outlook was made and approved:

“A group of members, who are board-recognized swallowing specialists, asked the Board to consider changing ASHA’s mission statement to include swallowing. President Chabon led the Board in a discussion concerning altering the mission statement. Following discussion, it was decided that ASHA should consider adding the words swallowing and balance to ASHA’s mission statement, while maintaining the original sense of the mission. A team, including Vice President for Planning Barbara Moore and ASHA staff, will draft language for the Board to discuss at a future meeting.”

This provides more evidence of how terminology is fractionated as Dr. Muma’s model predicts.  When medical thinking is elevated as a mission focus we are keenly aware of how school practice languishes in the backwaters of the field.

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4. 2014b. ASHA Council on Academic Accreditation (CAA)

2014: ASHA reaffirmed the 1994 principles for AUTHORITY OF OPERATION

“The CAA is recognized by the Council for Higher Education Accreditation and by the U.S. Secretary of Education as the accrediting agency for the accreditation and preaccreditation (accreditation candidate) of education programs leading to the first professional or clinical degree at the master’s or doctoral level and for the accreditation of these programs offered via distance education, throughout the United States.”

“The CAA was established by ASHA and is authorized to function AUTONOMOUSLY in setting and implementing standards and awarding accreditation.”

“The institution must indicate by its administrative structure that the program’s faculty is recognized as a body that can initiate, implement, and evaluate decisions affecting all aspects of the professional education program, including the curriculum. The program’s faculty has reasonable access to higher levels of administration.”

“The CAA may also develop standards and processes for approval for programs that prepare support personnel. Members of the CAA shall be appointed following policies established by the CAA, and the CAA shall have final authority to establish the standards and processes for academic accreditation. Subject to the application of established appeal procedures, the decisions of the CAA concerning the award, withholding, or withdrawal of academic accreditation shall be final.” (Bylaws)

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

“The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) is composed of 18 members identified below, including at least 11 individuals from CAA-accredited programs, 5 clinical practitioners who are employed full-time in non-academic settings, and 1 public member.”

Market in Paris.

Market in Paris.

Perspective

The CAA draws authority from important U.S. accreting agencies. Curriculum is less important in accreditation than policy and procedure,review suggests.

The CAA expanded accreditation while achieving greater autonomy from ASHA proper.

Membership in CAA is not subject to input from the general membership. There is an element of the “smoke-filled room” in the selection process.

The drive to organize CAA came in good measure from Director Kenneth Johnson:

“Johnson focused on building the visibility and autonomy of communication disorders and the national organization, and set in place the pillars that would define the value of both: a clinical certificate based on a master’s degree; effective governance structures including the Legislative Council; a governmental relations department; ASHA Magazine; the National Student Speech-Language Hearing Association; and enhancement of the science base of the discipline.”

http://www.hearingreview.com/2006/07/article-16303/

3. 2014. ASHA Council on Academic Accreditation (CAA)

When we search for curriculum responsibility, we reach the CAA’s doorstep:

2014: ASHA reaffirmed the 1994 principles for CURRICULUM:

“The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) of the American Speech-Language-Hearing Association (ASHA) accredits graduate 1 programs that prepare individuals to enter professional practice in audiology and/or speech-language pathology.”

“Curriculum (academic and clinical education)” is one of six essential components of “quality education.”

“The curriculum (academic and clinical education) is consistent with the mission and goals of the program and prepares students in the full breadth and depth of the scope of practice in speech-language pathology.”

Perspective

History shows CAA very protective of its prerogatives, and it has staked out curriculum.

Prerogative–“An exclusive right or privilege held by a person or group, especially a hereditary or official right.” Free Dictornary

Curriculum is interwoven with the policies and practices of approving programs by de facto authority.

Curriculum adequacy, according to the CAA, is a quality indicator.

When CAA fails to keep pace with curriculum trends, it is reducing the quality of school speech-language pathology practice.

2. 1994: ASHA Council on Academic Accreditation (CAA)

In this period along with rapid growth in the numbers of accreditation and certification actions significant decisions to revamp accreditation procedures were recorded.

1994: “The CAA is guided by a set of principles first developed in 1994 by the Ad Hoc Joint Committee on Academic Accreditation Issues, which included representatives of ASHA, the Council on Academic Programs in Communications and Disorders (formerly the Council on Graduate Programs in Communication Sciences and Disorders) and representatives from the ASHA standards committees.”

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

Girl Scouts Marching on Main Street.

Girl Scouts Marching on Main Street.

“CAPCSD is an organization of more than 250 member programs that offer undergraduate and/or graduate degrees in Communication Science and Disorders (CSD). When founded in 1978, the overall goal was to enhance the quality of education in CSD.”

1996: “…Educational Standards Board was replaced by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). having responsibility for oversight of the accreditation and preaccreditation of graduate education programs that prepare entry-level professionals in audiology and speech language pathology…”

2007: “ASHA fully recognizes and supports the autonomy of the standards and operations of the CAA which enable it to promulgate best practices in the accreditation of audiology and speech-language pathology programs. Additionally, ASHA looks forward to continuing to work with the CAA and the CAPCSD and its members on all matters pertaining to the educational preparation of our future professionals.” (ASHA president)

https://www.capcsd.org/reports/ASHA_EB_White_Paper_response_8-07.pdf

“the Legislative Council voted itself out of existence in 2007 in favor of a new governance structure that includes the Board and two Advisory Councils.”

http://www.asha.org/Publications/leader/2012/120828/From-the-President–You-Have-a-Steak-in-ASHAs-Continued-Success.htm

Perpective

The entity called “CAA” and the entity called “ASHA” are carefully distinguished to assure the point of view the two are separate. The CAPCSD is in fact a separate organization for academic programs but is grouped inclusively to give the impression of central authority.

CAPCSD has struggled to gain a degree of control over accreditation matters but is unable to overcome ASHA’s great power with respect to national visibility, finances, professional staff and historical structure. Its final say on national curriculum is negligible. It is a double-bind. CAA has the power but does little to nothing to foster curriculum development, to say nothing about curriculum vision.

The Legislative Council representing members to CAA deliberations drops out of the picture in favor of elaborate reorganization approved by ASHA. CAA progressively becomes an entity unto itself.

The pattern is reorganization to gain strong control over accreditation activities while giving token input to the process. For example, the Bylaws say: “An Audiology Advisory Council and a Speech-Language Pathology Advisory Council shall be established to identify and discuss issues of concern to members and provide advice to the Board of Directors. The Advisory Councils and its members shall not make any public statement or take positions on behalf of the Association or the Advisory Council without having obtained approval from the Board of Directors.”

Controls creep into undergraduate and doctoral education.

1. 1930: ASHA Council on Academic Accreditation (CAA)

We find the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA)is central to ASHA curriculum development, or the lack thereof. Accreditation policy evolved primarily during the tenure of executive director Kenneth Johnson.

http://www.asha.org/Academic/accreditation/AccHstry/

1925: ASHA (i.e., American Academy of Speech Correction) was established as a parlour-room organization. After 1930, developing organizational structure excluding school SLPs was the main goal. The group of speech professors was too small to address standards and accreditation, and the founders were not in full agreement what speech therapy was all about.

1947. Incorporation in Kansas (Bylaws)

1959: National accreditation and educational standards were established:

“ASHA established the American Board of Examiners in Speech Pathology and Audiology (ABESPA) in 1959 to foster the goals of the Association and to ensure the provision of quality services to persons with communication disorders. ABESPA designated the Educational Training Board…to evaluate programs that offered master’s degrees in audiology and speech language pathology and that submitted voluntary applications for accreditation.”

“ASHA first awarded accreditation to graduate education programs in audiology and speech-language pathology in 1965.”

1980: ABESPA was replaced by the Council on Professional Standards in Speech-Language Pathology and Audiology (the Standards Council) by the elected members of the legislative Council.

The Standards Council was established as a “SEMI-AUTONOMOUS” entity and was “… responsible for establishing and monitoring all standards programs of the Association.”

“The standards were implemented by three operating boards—the Educational Standards Board, the Professional Services Board, and the Clinical Certification Board. The Standards Council also arbitrated appeals of decisions rendered by the operating boards.”

Perspective

Director Kenneth Johnson was the key person in setting up accreditation:

“Johnson, who directed ASHA’s national office from 1958 until his retirement in 1980, oversaw the organization during a period of enormous growth. During his 22 years at the helm, ASHA’s membership reached 37,000, a nearly tenfold increase. And, when he retired, the association and its staff of 75 were preparing to move into a spacious new headquarters in Rockville, MD, a far cry from the two rented rooms in Washington, DC, where he began his tenure” (http:// journals.lww.com/thehearingjournal).

During Johnson’s tenure several administrative decisions continue to influence ASHA curriculum:

1. In the tradition of Wendell Johnson, Johnson made the position of executive director autocratic. Membership input was controlled. The elected president’s role was ceremonial. The executive director ran ASHA and accreditation.

2. The notion of “standards” was established as a self-evident truth, and to this day no one questions what a standard is. It is put forward by authority if not fiat — an order.

3. Institutional accreditation was made voluntary, suggesting that ASHA did not have to have strong responsibility for national enforcement. The standards for curriculum were made as non-intrusive as possible. Today, curriculum standards are so vague as to give institutions maximum latitude for doing what they want. That angle made today’s enforcement of curriculum requirements nearly impossible.

4. Requiring students to earn a graduate degree added requirements but did not necessarily improve the curriculum. Faculty moved their SLP courses to the graduate level, often duplicating content from undergraduate courses. Although language was added there was resistance to new content. Language was forced in by grassroots demand. Adding more courses did not guarantee a modern curriculum but it did ensure greater revenue to the Association.

19. The ASHA Curriculum Process In Summary-a

“We continue to explore how ASHA’s “curriculum process” works or is supposed to work to keep school practice up-to-date.”

A series of 18 posts bring the problem into focus. To explore the “process” the curriculum topic of collaboration has been employed in the manner of case study testing.

Window looking out.

Window looking out.

Collaboration enjoys a long modern history in ASHA as an important curriculum trend for school SLPs but ASHA standards trivialize collaboration training. Failure to actualized substantive collaboration training for American graduate students raises questions about ASHA authority, structure and leadership. Clearly the bylaws indicate the Board of Directors is responsible for this poor showing.

A tentative first theory to explain ASHA’s faulty curriculum process, namely, a poorly understood division between accreditation and public relations components, is sketched. Current talk of collaboration has been assigned to the public relations side to stimulate interest in continuing education programming. It is not directed toward the elaborate and well-funded accreditation committee. In various meetings of accreditation officials, collaboration is a non-topic. New certificate standards are coming to us in September of 2014, with no indication collaboration training has been upgraded.

Therefore the Board of Directors systematically promulgates a mixed message about collaboration, that it is a “HOT TOPIC” but not enough so to bring to preservice education.

“A house divided against itself cannot stand.” 1859, Abraham Lincoln.

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.

4. The Future of School Speech-Language Pathology

We have found through our series,”The History of  School Speech Pathology,” that history does repeat itself.  Our history follows a pattern where school speech-language has not matured as a discipline because of  the long shadows of clinical tradition.  

In an analysis of how 1975 changes in public policy were processed, we identified basic issues. They did not involve funding. Rather, they involved problems of perspective, organization and problem solving. To this day, we still talk about “speech therapy” in the school setting.

We saw how workload was the pivotal issue of the latter part of the 20th century. One whole generation wrestled with it.   The future, we argue, now revolves around the role of the school speech-language pathologist. It transcends workload management and reflects advancing American public policy issues in this century.

A clown on mainstreet.

30. The History of School Speech Pathology

Does history repeat itself?

In the last post we looked at IDEA issues as they have been folded into caseload debates.  One generation of school SLPs is now retiring without resolution of the problem.

Now the process is repeating itself.  

In several posts the topics of collaboration and response to intervention have been examined.  We are following the same patterns as before with no end in sight. 

As beloved Dick Vitale might say, “Burn out city, Baby!”