Category Archives: SLP issues

Assorted professional issues

Repost: ASHA Governance and School Speech Pathology Practice

After a full career in higher education, my subsequent work in Arizona schools convinced me school practice was behind the times and ASHA was failing to effectively address school practice issues. Why I asked? I read, observed, interviewed and wrote on issues to come up with answers. In 2012 I published the opinion below on how breakdowns were occurring. Since then, my focus has been on decision-makers. Who is responsible at ASHA’s under-performance?

I studied ASHA administrative documents and came up with two essential views:

1. The ASHA Board of Directors (BOD) is solely responsible for all programs and personnel according to the bylaws.

2. The BOD abdicates its responsibilities, serving as a ceremonial body deferring widely to the ASHA professional staff, in some cases leaving critical ASHA components of unexamined. Poor supervision of accreditation is a striking example, and accreditation is the arena in which curriculum must improve.

2012 Post

—————————————————–

Tracing through the history of  The American Speech-Language-Hearing Association gives one ideas and impressions about governance and organization shaping school practices in American schools.

Governance is the act of governing. It relates to decisions that define expectations, grant power, or verify performance. It consists of either a separate process or part of management or leadership processes…In the case of a business or of a non-profit organisation, governance relates to consistent management, cohesive policies, guidance, processes and decision-rights for a given area of responsibility… ” (Wiki)

“The duty of decision-making is a cornerstone of professional associations, entrusted to the those elected to the organization’s governing body — in ASHA’s case, the Board of Directors” (Chabon & Pietranton, ASHA Leader, 2012, March 13).

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

Over more than 100 years of organizational activity, capture of  school speech pathology by a small group of academic speech therapists in 1925 established organizational bias against those who did not want to work in hospitals and clinics, and who wanted to work with school children. School practice was flourishing up to 1925, whereas speech therapy practice was almost non-existent. Medical-model thinking was imposed on school speech pathology by the careful selection of executive directors, central organization in Washington, D. C., and non-profit status. Medical model leaders used the rapid growth of school speech pathology as a revenue base for continued funding of narrow and often arcane speech therapy research, teaching and practice.  It took until 1970 for ASHA governors to take even a modest step toward supporting school functions by way of a small office for school issues and programs, an office which remains virtually the same today even though more than half of ASHA members work are in education.

The production of doctoral graduates preparing for leadership in schools  was  nil. Doctoral education was heavily invested in medical-model research and coursework.  The rapidly growing school section of ASHA went without leadership in school speech-language pathology.

In the meantime ASHA was flat-footed when it came to addressing the effects of the civil rights movement and federal legislation on school practice, beginning especially in 1975.  The small office struggled to address issues but was overwhelmed and under staffed.  ASHA governance continued to be biased toward medical model thinking, leaving preservice training in status quo.  A whole generation of graduates completed their careers with insufficient background with respect to the massively changing school environment.  The  deep bias favoring medical-model thinking blinded governors as to trends in school practice..  It is difficult to govern something one does not understand, if one has not practiced in schools.

Executive Director Position:    Speech correctionists were excluded a priori from the position of Executive Director of ASHA. A direct chain  from the male founders to the present day promulgated medical model thinking: Wendell Johnson (1931-1941, Iowa, de facto);  D. W. Morris (1941-1948, Ohio State):  George A. Kopp (1948-1957, Wayne State University); Kenneth O. Johnson  (1958-1980, Stanford Medical);  Frederick T. Spahr (1980-2003, Pennsylvania State). The last in the chain is a woman but no language specialist has ever  been selected, nor a doctoral-level professional with extensive school background.”  (Women Lost)

A clown on mainstreet.

Adopting the non-profit  structure imposed greater inflexibility on ASHA.  Whereas universities up to 1970 provided the fire power for organizational growth of the young profession, executive directors put their energies into the non-profit mission.  University programs lost their influence while sustaining “speech therapy” training.  ASHA became less nimble because it was investing both in gaining control of credentialing and establishing the non-profit base in Washington.  Becoming a strong national cartel for speech therapy services was the larger agenda.  From the beginning, the school  segment of the profession was the profit center to fund organizational growth.

With status quo operating unquestioned, and academic control diminished, ASHA governance took professional leadership in the direction of service to the non-profit medical model credential-control mission, a mission heavily influenced by director Kenneth O. Johnson, 1958-1980. The role of president of the association continued to be eroded giving executive directors greater de facto power and influence.  Presidents rotated through on one year appointments, insufficient time to produce lasting results, while allowing the one-size-fits-all training plan to carry on with little or no innovation to support school clinicians.  To bring the cognitive-linguistic model into training in the 1970s, no small amount of resistance operated.  Even now the literacy domain as an extension of language pathology has fallen years behind in development though it is central to emerging school practice demands.  Attention to literacy training in the university programs languishes. Upon his retirement Frederick T. Spahr, 1980-2003, admitted language had been a vital step forward for the profession although the movement had not received wide support.

For school speech-language pathology to receive full support for its changing mission,  it needs to be a separate ASHA division with separate graduate school major to rectify the historical mistakes by ASHA governors and to break away from cartel strategies.  We have developed here the rationale for  “educational speech pathology” parallel to educational audiology, pointing out repeatedly that school pathologists are half the ASHA membership.

Yet school speech-language pathology continues to be submerged in current institutional thinking: “ASHA exists to enhance the professional lives of audiologists, speech-language pathologists, and speech, language and hearing scientists, and through us, the lives of individuals with communication disorders”   (Chabon & Pietranton, ASHA Leader, 2012, March 13).  Science and  audiology get separate billing following old-line preferences dating back to D. W. Morris, 1941-1948 and George A. Kopp, 1948-1957.  These narrow technical areas receive support from the school SLPs who provide the force behind the profession. Under the present structures, there is not way to give full billing to school SLPs. School practice is just another practice area, “school-based” versus “prison-based” for example.

The Board of Directors should seek to overhaul speech-language pathology to include a separate ASHA division, properly supported in concept, advertising and funding. Policy should reflect changes in curriculum knowledge unique to educational settings.  Students going into school work should all have the background described in the course description developed at the Brooklyn College (New York):

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.

Such preparation should be incorporated into clinical clock hour experiences in university speech and language training centers.  IDEA -2004 procedures should become a part of the work with those school children who have educational plans (IEPs). Proper diagnostic experience should  reinforce educational principles, and CCC training hours should be granted for such training.  One way or another, the Board of Director must make sure preservice training is appropriate for school clinicians.  One cannot count on colleges of education to provide linkages to IDEA requirements.

Window looking out.

The ASHA Board of Directors is soliciting input. President  Chabon has approved input to the Board, using an InTouch form for this purpose.

We advocate an overhaul of school speech-language pathology to remove historical bias favoring medical speech pathology.  The bias started in 1925 with the capture of school speech correction, and the “FOUNDER’S SYNDROME’ has operated ever since:

Founder’s syndrome is an issue organizations face as they grow. Dynamic founders with a strong vision of how to operate the project try to retain control of the organization, even as new employees or volunteers want to expand the project’s scope or change policy.”  (Wiki)

The cognitive-linguistic model was eventually accepted in the 1970s but never allowed to blossom fundamentally in support of language, culture and learning in schools.

Prior  comment:  “Consider the size of the National Association of School Nurses.  In 1968 NASN started with NEA as a department. In 1979 it became a separate non-profit organization.  Today it lobbies in Washington, has a national network of state organizations, advertising plans, board members, annual conference, two publications, radio service, bookstore, national president, and a full-service web site.  All of this is accomplished with 14,500 members.”

http://nasnupgrade.nasn.org/”

John M. Panagos

ASHA Board of Directors Ignores School Practice

In prior posts we have said the ASHA Board of Directors neglects school speech-language pathology as to long-term programs (e.g., collaboration) and curriculum (phonology). To investigate further, 2013 BOD records were examined to identify directional patterns of administrative activity. (http://www.asha.org/about/governance/bod/) When BOD members meet, do they deliberate on school issues, or do they dwell on other topics? How important is school practice to board members? Does the BOD make sure graduate students are educated for school service?

Board Meetings

In 2013, BOD members (16) met for five meetings (January, March, June, July and October). Agenda items were organized by the President and the Chief Executive Officer (CEO). The board approved their responsibilities for addressing ASHA business:

“The Board’s responsibilities are broken into four areas: planning, operations, audit, and communications. After considering some suggestions for adding clarifying language to the procedures, the Board agreed that the document effectively captures the Board’s operating methods and procedures for working with the National Office staff.”

Board Actions

A total of 82 actions (resolutions, motions) were studied. The Board voted positively 81 times. Ninety percent of the votes were unanimous. A motion on behalf of the American Academy of Audiology was voted down 0-15. Twice two negative votes were cast.

The analysis indicated seven types of administrative activity consistent with Board responsibilities. They are presented in rank order of occurrence.
___________________________________________
Committees (council, board) (20)– E.g. health care economics
Appointments (14)– E.g. pioneer network
ASHA Policy (13)–E.g. operational guidelines
Awards (12)–E.g. association honors
Funding (9)–E.g. travel expenses
Affiliations (8)–E.g. craniofacial association
Practice (6)–E.g. study evidence-based practice
___________________________________________

Approved were funding proposals, professional affiliations, awards, appointments, practices and policy initiatives. Board members approved several committee, board and council actions (n=20). Practice items were the fewest in number (n=6).

Speech-language pathology was mentioned 34 times and Audiology 10. There was one incidental mention of “school based” speech-language pathology. There were no mentions of service delivery models, caseload problems, school SLP satisfaction, reading, RTI, encroachment, preschool, paperwork, scope of practice demands.

The CAA is responsible for curriculum standards. There was one action appointing two people to the council.

Practice Decisions

Seven percent of the business items related to general SLP professional practice. Decisions made were at the operational level. The word “curriculum” was never used. There were incidental mentions of traditional clinical categories:
________________________________________
Swallowing (1)
Stuttering (1)
Voice (1)
Aphasia (1)
Cleft Palate (1)
Autism (0)
Language (0)
articulation (0)
Augmentative Communication (0)
Response to Intervention (0)
________________________________________

Two Board projects were approved.

First, a vote was cast to support the Practice Resource Project Portal. However, the Portal is non-binding and not for school SLP practice per se.

Second,BOD members voted unanimously for a special committee to provide planning input to ASHA on school matters:

“RESOLVED, That the American Speech-Language-Hearing Association (ASHA) establish, for a 2-year period, the Speech-Language Pathology School Issues ad hoc committee, charged to provide leadership, guidance, and strategic planning in developing, recommending, implementing, and reviewing ASHA policies, procedures, programs, and resources relative to speech-language pathology practice in k-12 schools…”

Discussion

We asked whether the ASHA Directors at their yearly meetings address school issues and curriculum needs. The answer is no. The Board restricts its work to ASHA operational concerns. It does not address issues of academic and accreditation systems where curriculum is a central component. It’s scope is narrow and voting perfunctory.

Puzzling is why the Board restricts its deliberations to operational business. By so doing, it effectively abdicates its responsibility to the membership. The BYLAWS clearly demand far-ranging oversight of all ASHA affairs.

June, 2015

Changes in governance dating back to 2007 were meant to make ASHA a more responsive and efficient organization.  This post suggests this  has not come to pass, and if anything decision-making is more confusing than ever.  It was supposed to be different:

The move to one governing body streamlines decision-making and allows the new BOD more time to gather member input and respond more quickly to member needs. With more time, the board can engage in extended consideration of high-priority issues and gain deeper understanding, which more likely will result in effective decisions. There will also be greater accountability for decisions—an important factor in this era of heightened scrutiny and transparency. A strong emphasis also will be placed on ensuring that qualified members are nominated and elected to the BOD.

Marat Moore
The ASHA Leader, July 2007, Vol. 12, 16-30. doi:10.1044/leader.AN4.12092007.16

“School Based” SLPs Can’t Count on ASHA Board

We who work in American schools are at risk for neglect by the Board of Directors on whom we depend for policies favorable to our professional success. We are under-represented in ASHA governance following a pattern dating back to 1930 when the “founders” captured and dismantled our programs. The founders made sure we could not easily participate in leadership roles by setting standards to favor themselves and doctoral level professionals. That pattern persists today.

Here I examine the authority structure of ASHA –both formal and informal — to show you how it works against school members and favors the elite non-school members. The facts are hidden in plain sight.

Elections

ASHA controls every stage of BOD elections and this filters out school SLPs. There is no write-in ballot for us. We are allowed to nominate Board nominees but nominees are screened. Nominees cannot campaign for school reform: E.g., “Production and use of campaign paraphernalia including, but not limited to: buttons, fliers, balloons, display booths, stickers, ribbons, or other give-aways.”

http://www.asha.org/About/governance/election/Election-Practices/

Just as in the 1940s, elite non-school doctoral members dominate the nomination process. Of the current list of 17 Board Members for 2014, 15 have doctoral degrees. Most certified working school SLPs with graduate degrees and outstanding academic records do not get elected to the Board of Directors. They trust those they elect to represent them.

Authority

According to ASHA Bylaws, the Board has full legal authority to govern on behalf of school SLPs:

“4.1.2. The Board of Directors is the single governing body of the Association and shall actively promote the objectives of the Association, operating in accordance with and administering and implementing the programs and policies established by these Bylaws and by the Board of Directors. Members of the Board of Directors are elected to serve by and are accountable to the members of the Association.”

But this proclamation is only appearance. In our study of 2013 Board actions (ASHA Board of Directors Ignores School Practice) we learned the BOD deferred to the “national office staff” and voluntarily restricted its operating authority to matters of operational housekeeping:

“The Board’s responsibilities are broken into four areas: planning, operations, audit, and communications. After considering some suggestions for adding clarifying language to the procedures, the Board agreed that the document effectively captures the Board’s operating methods and procedures for working with the National Office staff.”

The phrase “…working with the National Office staff…” signals an attitude of co-equal authority. In fact, BOD is likely a pleasant supportive group but it does not “work with” the National Office Staff; it supervises same. Such statements blur authority lines.

BOD Activities

BOD members spend relatively little time in meetings conducting essential ASHA business, meeting only five times in 2013. BOD members typically have regular jobs back home to maintain. BOD members need time to know how to function as board members and membership constantly turns over.

When members arrive for meetings, the National Office Staff has already set the agenda for meetings (although the president is said to assist the Staff). Agenda items emphasize housekeeping matters and operations.

BOD members rubber stamp the resolutions recommended by the ASHA National Office Staff. Of the 82 motions examined, BOD voted affirmatively 81 times. All but a few votes recorded were unanimous. Real debate is not evident in the records. The BOD behavior is that of a ceremonial body deferring to the National Office Staff.

President

The authority relationship between the ASHA President and CEO is established by what we call the “Appearance-of-Co-Equal-Authority Rule.” The bylaws are written subtlety in way to make it impossible to know who exactly is in charge of Association policy and actions. Of course, when one cannot tell who is in charge, there is no accountability.

Look at what the bylaws say about presidential authority:

“President, who shall serve as Chair of the Board of Directors and coordinate the functions of the Board of Directors, and who shall automatically become Immediate Past President at the end of his or her term as President.”

Elsewhere the president’s job is described this way:

“…The President works in partnership with the Chief Executive Officer to achieve the mission of the Association and to optimize the relationship between the Board and staff.”

In another statement, co-authority swings toward the CEO:

“ASHA is governed by a Board of Directors and led by Chief Executive Officer Arlene A. Pietranton, PhD, CAE. To date, ASHA has approximately 250 employees at its national office.”

http://www.asha.org/about/history/

The President is not the leader of ASHA?

Considering the legal authority of the Board of Directors over ASHA affairs, the President nonetheless is portrayed as a chairperson, collaborator and coordinator, a misleading representation. School members need to count on the president to represent them with authority.

http://www.asha.org/About/governance/BOD/President/

Old stone dwelling near stream

Old stone dwelling near stream

Chief Executive Officer

The bylaws state the Chief Executive Officer legally plays a service role:

“7.2.1. The Chief Executive Officer shall be appointed by the Board of Directors and shall serve at the pleasure of the Board….and “serves as the chief administrative officer of the Association….”

This too is misleading. Informally the CEO has enormous procedural authority to control ASHA affairs. The CEO monitors everything:

“7.2.2. The Chief Executive Officer (or designee) shall serve as an ex officio nonvoting member, unless otherwise stipulated, of all committees, boards, and councils established by the Board of Directors.”

The CEO is a year-round full-time employee, where as the Board of Directors meets only a few times a year and turns over at regular intervals. “ASHA is governed by a Board of Directors and led by Chief Executive Officer Arlene A. Pietranton, PhD, CAE. To date, ASHA has approximately 250 employees at its national office.” http://www.asha.org/about/history/

Discussion

My purpose has been to examine the ASHA authority structure with respect to support of school-based SLPs. There is a historical pattern of neglected issues of school practice, especially improvements in the graduate curriculum (the portal not withstanding). The findings indicate the Board of Directors abdicates oversight responsibilities. It largely ignores the scope and content of authority as stated in the bylaws. The president voluntarily accepts a diminished role of facilitator of ASHA business. BOD agrees to limit its authority in conducting yearly ASHA business. It defers informally to CEO and the ASHA staff which administers innumerable areas of operation without BOD involvement. As we have pointed out in other posts, it ignores accreditation functions (CAA) where curriculum is key. The CEO outside of Board meetings functions as the face of ASHA in the operation of ASHA. The Board of Directors is a ceremonial body with the president servicing as the titular head.

The ASHA authority structure should be clear and faithfully respected. The bylaws should show the respective roles of the president and the CEO so that overlap is avoided. An annual report should be filed by the CEO with a “State of the Association” address delivered at the ASHA conference. Business meeting minutes should be published to the membership verbatim. All business records must be archived for public access without pay-wall barriers. Proposed outcomes must be evaluated for success. We need much more public information about inner workings when BOD is not in Washington. ASHA accountability to the membership is lacking. The president should be elected for three years and must take authoritative actions based on member concerns rather than ASHA operational minutia. The bylaws must state who is actually in charge and responsible when issues arise. Without a clear picture of ASHA decision-making, cronyism and preferential thinking will return to the ASHA administration.

“The duty of decision-making is a cornerstone of professional associations, entrusted to the those elected to the organization’s governing body — in ASHA’s case, the Board of Directors” (Chabon & Pietranton, ASHA Leader, 2012, March 13).

July, 2015

Clearly ASHA promised more from the Board, dating back several years:

“The move to one governing body streamlines decision-making and allows the new BOD more time to gather member input and respond more quickly to member needs. With more time, the board can engage in extended consideration of high-priority issues and gain deeper understanding, which more likely will result in effective decisions. There will also be greater accountability for decisions—an important factor in this era of heightened scrutiny and transparency. A strong emphasis also will be placed on ensuring that qualified members are nominated and elected to the BOD.”

Marat Moore
The ASHA Leader, July 2007, Vol. 12, 16-30. doi:10.1044/leader.AN4.12092007.16

leader.pubs.asha.org/article.aspx?articleid=2288162

ASHA BOD Should Evaluate CAA Policies and Procedures

We urge the ASHA Board of Directors to evaluate the administrative policies and procedures of CAA in consideration of school programs and curriculum development necessary for modern school practice.

Something doesn’t compute!

The BOD represents the only legal authority of ASHA. Specifically, the Bylaws say:

“4.1.2. The Board of Directors is the single governing body of the Association and shall actively promote the objectives of the Association, operating in accordance with and administering and implementing the programs and policies established by these Bylaws and by the Board of Directors. Members of the Board of Directors are elected to serve by and are accountable to the members of the Association.”

The ASHA mission statement includes “setting standards” and “fostering excellence in professional practice…”  The CAA is not mentioned.

The Board has full authority to address issues facing CAA:

“4.9.1. The Board of Directors may establish and dissolve standing committees, boards, councils, ad hoc committees, working groups, and other entities necessary to conduct the Association’s business, and designate and change their charges and determine their size, member qualifications, and terms.”

In 2013 the Board voted to approve two CAA members appropriately. It also voted to waive evaluation of CAA, exercising its authority to do so. If it can waive evaluation, it can initiate evaluation.

The ASHA Board of Directors must ignore claims by the CAA to stand alone, as an independent authority. It is responsible to the voting and paying membership via the Board, and half the membership works in schools.

The “autonomy” claim simply does not hold water: In the Bylaws 8.2 this claim is not affirmed:

“The Association, by action of the Board of Directors, shall establish and maintain a program of academic accreditation. The Association shall establish the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA), which shall define the standards for the accreditation of graduate education programs and apply those standards in the accreditation of such programs…”

 

 

Department of EducationDSC00166

The U. S. Department of Education recognizes ASHA for accrediting speech-language pathology and audiology:
“AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION– 
Council on Academic Accreditation: Candidate Status”

CAA is the sub-agency of ASHA. The Department of Education recognizes ASHA as the accrediting agency, and the BOD is responsible for ASHA.

CAA is not self-supporting. ASHA members pay for space, personnel and funds to support CAA operations. Such facts do not support the claim of autonomy.

The U. S. Department of Education is presently accepting ASHA’s application for renewal.

“American Speech-Language-Hearing Association, Council on Academic Accreditation in Audiology and Speech-Language Pathology 
1967/2010/F2015”

ASHA Board Shifts Mission for Improving Accreditation

We are happy to see the Board of Directors has shifted the ASHA mission to include accreditation and educational preparation. The CAA (Council on Academic Accreditation) should be drawn out of its silo to address school speech-language pathology curriculum development.

The new mission includes “setting standards” and “fostering excellence in professional practice, and advocating for members and those they serve.”

ASHA Studies Mission in 2012 Update

In 2012 we began to examine how the ASHA Board of Directors views the mission of the American Speech-Language-Hearing Association with reference to curriculum development for school speech-language pathology students and employees. Here was the first post:

2012

The Board of Directors of the American Speech-Language-Hearing Association has announced for its August 2012 meeting interest in soliciting input on the Mission of the Association:

The current mission:

“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.”

Purpose

“A mission statement is a statement of the purpose of a company or organization. The mission statement should guide the actions of the organization, spell out its overall goal, provide a path, and guide decision-making. It provides “the framework or context within which the company’s strategies are formulated.”[1]  Wikipedia”

http://en.wikipedia.org/wiki/Mission_statement

Kids stuff for school.

Swallowing

In May of 2012 the Board considered a proposal adding a medical component to the mission statement:

“A group of members, who are board-recognized swallowing specialists, asked the Board to consider changing ASHA’s mission statement to include swallowing…. 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….”

2013 Update

The ASHA Board of Directors approved the following mission statement:

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

advancing science,

setting standards,

fostering excellence in professional practice, and
advocating for members and those they serve.”

http://www.asha.org/ResolutionMotion.aspx?status=considered&year=2013

April 1, 2015

Now on FACEBOOK ASHA posts another version of the Mission Statement:

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

* Advocating on behalf of persons with communication and related disorders
* Advancing communication science
* Promoting effective human communication”

“Setting Standards” disappears.

April 2, 2015

For the 2015 Toolkit, we learn the mission is as follows:

“Empowering and supporting speech-language pathologists, audiologists, and speech, language,
and hearing scientists by:
 Advocating on behalf of persons with communication and related disorders
 Advancing communication science
 Promoting effective human communication ”

No mention of “setting standards”

ASHA Accreditation CAA Calls for Input

Kids stuff for school.

Kids stuff for school.

In June of 2014 ASHA released a call for CAA input:

Call for Comment: Standards for Accreditation

The Council on Academic Accreditation (CAA) is seeking comment on its current Standards for Accreditation. Input received from the community will be reviewed carefully as the CAA considers changes to the standards for entry-level graduate education programs.”

Comment

A call for member ideas is a welcome turn of events. Let’s see how this information is processed? We hope it does not disappear into a black hole of poor feedback communication.

The CAA has a policy of “autonomy” and private decision-making insulated from the membership. In fact it claims to have no influence from “ASHA”:

“CAA is completely autonomous in accreditation decision-making, standards-setting, and policy issues – distinctly separate and without influence of ASHA or staff in these areas “

http://www.capcsd.org/conference/2014Handouts/CAPCSD%202014%20CAA%20Update%20FINAL_OK.pdf

Reforming the ASHA Presidency for Progress

Tracing through the history of ASHA’s questionable curriculum leadership for school speech-language pathology, it becomes clear the Board of Directors has the final authority to make corrections when it wants to.

“Key to reform is to create a different role for the president of ASHA. Deep historical uncertainty over the roles of the director and the president lingers. We must have leadership accountability. Someone must be clearly in charge of all business on behalf of the membership. The notion of mutual cooperation masks the authority issue. Kenneth Johnson did much as the strong executive leader but that role turned out to be inappropriate for the Association. The president must have full authority and responsibility so we know where the buck stops. All this is clear and central to reform.”

Strong Leadership

The relationship with the Chief Executive Officer must continue to evolve leaving behind fully the era of authoritative leadership by Kenneth Johnson. The President must not accept the role of “chief coordinator:”

“The President works in partnership with the Chief Executive Officer to achieve the mission of the Association and to optimize the relationship between the Board and staff.”

http://www.asha.org/About/governance/BOD/President/

The president should function in the manner of the president of the National Education Association. The NEA president as described in its documents has strong authority to conduct business, including representing the Association in policy matters, preparing the agenda for governing bodies and appointing chairpersons and committee members.

Vision

The president must shed his or her agenda of idiosyncratic personal interests and address the concerns of all members. There must be a well articulated vision of how to move the Association forward philosophically, scientifically and operationally.

Who have we been and where are we going?

The president should deliver a yearly “state of the union” address at the national convention in a large ballroom where many members can come and ask questions. We should hear about the issues of the year, challenges and new directions the president has crystalized for us.

http://www.nea.org/assets/docs/2013-NEA-Handbook-Bylaws.pdf

Focus

The president should serve for one or two three-year terms and be paid very well. The silly rotation of three presidents for one year stints should be abandoned to combat leadership by committee and second-guessing. The Board of Directors must be streamlined to support the president’s authority and range of activities. There should be a vice president to serve when necessary and a secretary who furiously tracks Association business. The president should manage ongoing business, making sure THINGS GET DONE!

Mission creep must be addressed to focus on the most important business. Now ASHA sprawls in so m any directions accountability requires a fortune-teller.

Accountability

Members should be able to vote to recall the president.

ASHA Has No Way of Addressing Second-Order Curriculum Change

Our review suggests the CAA is incapable of second-order change:

“Any change which takes place at a higher logical level than the problem state. This allows the change to affect the system, thereby rendering the erstwhile problem harmless, irrelevant or useful.” (http://www.inspiritive. com.au/glossary.htm)

Second-order change requires “new ways of thinking, shifting gears, transformation to something quite different, an informal beginning, new learning and a new story told.”

http://www.thenationalacademy.org/ready/change.html

CAC dwells on first-order thinking — lists of procedures and curriculum strands.

Collaboration

Let’s return to collaboration.

On the public relations / marketing side ASHA experts have launched a campaign, “The Power of Interprofessional Education and Practice; Full Team Ahead” published in the ASHA Leader (Vol 18, No 6 June 2013),collaborative practice associated with medical settings. But CAA treats collaboration as a listed behavior and nothing more. After years of study, the new standards starting in September of 2014 ignore “Interprofessional education and practice.”

The deep reason, of course, is CAA cannot create curriculum programs effecting second-order change. Academic programs would be required to retrain and retool to support collaboration in training programs, and they are said to exist in silos.

In the meantime ASHA proper marches forward with dramatic calls for collaborative education for SLPs.

Notes on ASHA Organizational Bias

Yes, clearly “school-based” speech-language pathology is buried in an organizational system to be compared to “prison-based” speech-language pathology. We repost the “Events” post to document concerns:

History

We offer a summary perspective on the history of American school speech-language pathology as a component of the broader profession.

Girl Scouts Marching on Main Street.

It might seem that school practice is defined naturally by general practice, delineated by the requirements of the certificate of clinical competence as understood in the United States.  One national association, one certificate!  In fact, one can imagine many configurations for professional preparation, organization and certification.  Whereas speech-language pathology in the U. S. falls under a single umbrella organization, school psychology and school nursing are managed by separate organizations.  Psychology is hard to put under one umbrella — I.E., clinical, experimental, industrial, mathematical, educational, academic, etc.  It seems early on school psychologists adopted the idea that the education setting required specialization with respect to learning ability and teaching.  A clinical psychologists would have some skills for school children but would lack many others.

Indeed, speech pathology tried different organizational patterns from its start in 1910.  It was a part of different academic disciplines and influences before it pushed to become independent.  It moved forward through the war years under the influence of many strong personalities and competing visions.   In 1960 the nascent organization moved to Washington, D.C., and thereafter organized as a non-profit group legally distinguishing it from universities charters.  A series of professional managers put their stamps on planning and development.  Primary goals were to keep the organization intact, grow the membership, develop a management system, and control accreditation and certification.

From 1960 to 2000 energy was put into assuring independence academically and professionally.  School speech pathology was not well adapted for the civil rights and federal influences coming into focus in 1960, and therefore stresses were placed on SLPs to acquire far-reaching new skills through continuing education and school inservice.  At the same time the parent organization was investing resources equally  in “medical speech pathology,” as some have called it, and other divisions nurtured under  the organization umbrella.  Adhering to non-profit rules grew in importance and diminished the direct influence of academics.  Resources for public relations, advertising, website management, legal support, human resources, facilities, editors and administrators were shared across departments.   Priorities did not give emphasis to school speech-language pathology though school SLPs amounted to half the membership.  An organization of global design tended to fold all specialities into one institutional system more easily communicated to the professionals and the general public.  On the other hand, it diluted interests in school forecasting, accommodation to change and preservice education.

The dominant organizational philosophy was to view speech-language pathology according to the “medical model” with special emphasis on medical science and instrumentation.  The dominant organizational philosophy was not to view speech-language pathology according to educational principles and practices.  A paradox ensued, namely, the numbers of school practitioners came to be greater than the hospital practitioners when the medical model was central to academic preparation and association priorities.

Beginning 1905

School speech-language pathology began as an organized activity in roughly 1905, when surveys of speech problems in schools established a significant need. Before, individuals studied speech defects in hospitals but “speech correction” within education established educational and service programs within schools.  New york, San Francisco, Chicago and Detroit were among the early schools to sponsor speech corrections services.  The “pull out” service model was developed as an extension of extra help for children with speech defects.  The idea of  one-on-one “lessons” helped define remedial methods we still use today.  Speech correctionists improved letters children could not pronounce.  Most were female.

Speech correction departments were formed at the University of Wisconsin, Ohio State University, University of Iowa and Wayne State University.  In larger perspective, these early academic and school programs established the profession we now see around the world, in Europe, India, South America, Japan, Canada, South Africa and Australia for example.

Take Over 1931

Speech correction within education was organized and growing nationwide when a small group (n = 25) of midwestern college professors agreed to capture speech correction to increase membership in their new organization.  They wished to break away from speech and drama departments and have greater status on campus.  Their interests were heavily influenced by medical thinking associated with explanations of stuttering.  They saw  themselves as researchers originating methods in college clinics.  Whereas school speech correction teachers were women, the professors and associated physicians were men.  The professors set up their own standards and practices effectively excluding speech correction teachers from significant status in their organization.  Yet the professors’ organization absorbed speech correction methods, incorporating them into a “speech therapy” framework and creating ambiguity as to what was educational methodology and what was clinical.

A two-tier status system put school practice at the lower level.  This bifurcation has been sustained until now.  It pervades policy formation in ways current leaders do not grasp for lack of historical analysis.  It has made school practice a second priority.

Move to Washington, D. C. 1960

The professors’ organization prior to 1960 was managed by the professors in their various roles as members of the organization.  The University of Iowa, The Ohio State University, and Wayne State Universities provided voluntary locations for the American Speech and Hearing Association.  Professors volunteered to handle treasurer duties.  In 1960 ASHA moved to Washington, D.C. renting a modest space for association headquarters.   A full-time executive director was hired.   There was no change in the status of school speech-langauge pathology.  Training remained the same with coursework taken in education to allow speech graduates to practice in the school setting.  The medical model was solidly in place, and implicitly reinforced neglect educational speech-language pathology.

Old stone dwelling near stream

Master’s Degree Required 1965

To become a certified speech pathologist, the American Speech-Language-Hearing Association increased academic requirements to include graduate education.  However, with the growth of credit hours available, no increase in school SLP preparation was defined and implemented.  The medical model curriculum was sustained but on a larger scale. School preparation continued to be accomplished through elective coursework in colleges of education, a pattern of academic preparation carried over from the 1930s.

Language Counter Position 1968

Activist mounted an independent movement to bring language assessment and intervention into the field.  There was resistance from the medical model establishment whose advocates traced back to the founders’ vision for the field.  For schools the language movement brought into practice cognitive-linguistic models having greater value in educational settings.  The speech therapy tradition was closer to the non-cognitive positions of physical therapy in schools.  Cognitive-linguistic models set the stage for interfacing with reading and academic programs.  In the face of overwhelming evidence, academic programs added language work to the curriculum and the name of the profession was changed to the American Speech-Language-Hearing Association.  Director Spahr upon his retirement noted  that the Association had been fortunate to have language brought into the field.  Nonetheless, educational speech-language pathology did not receive the attention it required to avoid stunted development.  It stayed in its second-rate position.

Non-Profit Status (date unknown)

The Association became a non-profit organization and that move was a game-changer.  One can compare the change of status to formation of the National Collegiate Athletic Association, establishing authority over college sports competition but sharing authority with universities whose interests were not always the same.  The NCAA came to be challenged by the courts over anti-trust issues.  Universities had their own legal status and responsibilities to state constitutions.  ASHA likewise became a legal entity as well as a professional organization.  Much money and energy was put into creating a successful non-profit organization apart from professional affairs.  This organizational challenge did not favor fundamental changes such as shifting the mission to provide greater support for school SLPs.  Support continued to be folded into the overall mission with shared resources.

School Office 1970

ASHA established a school office and publication to highlight school issues.  School SLPs gained some recognition but the office organizational structure remained static in relation to the overall growth in the numbers of school SLPs.  It did not evolve to become a major division of ASHA.  The staffing level (doctoral vs. master’s) was inconsistent and the voice of the school office was advisory only.  It shared resources with smaller programs contributing less financially to the overall budget.

IDEA Breakdown 1975

While focus continued on organizational improvements and medical model thinking for academic training, civil rights issues brought on changes in American education for handicapped persons.  The SLP role was changed by state and federal mandates but the certification curriculum did not prepare SLPs for this new role and content demands.

Continuing Education 1980

Rapid change in schools tied to the inclusion of disadvantaged children, and rapid change in the scope of speech-language pathology theory and intervention, produced rapid growth in school scope of practice.  IDEA required consultation and collaboration, with cognitive-linguistic programming tied to progress in the general curriculum.  Assessment changed radically to include assessing impact on academic improvement.  Though the academic credits in speech-language pathology doubled in 1965, only through general language courses added in the 1970s were the content deficiencies of school practice addressed.  Somehow feedback to the academic centers to update their programs was a non-factor.  Hence, the field turned to continuing education programming to address fast-moving school content.  Only a few strident voices spoke to the growing imbalance between preservice and inservice demands.  Rather than to address the substance of the scope of practice issue, it  was allowed to play out as a workload issue, to be resolved through required continuing education.

Directions

Dr. Jean Blosser has adopted an outlook favorable to school reform along the lines of our historical sketch here.  Her work has been updated in a 5th edition of  an important book:

“Nearly 55% of ASHA-certified speech-language pathologists work in school settings. The numbers are even higher when non-ASHA certified pathologists are considered. There are only a few resources that address service delivery, as opposed to assessment or treatment of specific communication disorders. School Programs in Speech-Language Pathology is designed to provide both new and experienced practitioners with solutions and strategies for the challenges they face in the complex and ever-changing world of school-based delivery.

Most books for school-based speech-language pathologists focus on different types of intervention and diagnoses. School Programs in Speech-Language Pathology focuses on service delivery, program design, and how to organize and manage an effective program. Additionally, this resource covers meeting state and national standards, following federal mandates, and how to relate to and communicate with colleagues and parents.

The organization, questions at the end of each chapter, real-life examples, collaborative strategies, research foundation, and usable forms all make this book very practical for university students, existing school-based practitioners, and program administrators.”

School Programs in Speech-Language Pathology Organization and Service Delivery

Fifth Edition, 464 pages, Illustrated (B/W), Softcover, 7 x 10″ N/A , ISBN10: 1-59756-403-6, ISBN13: 978-1-59756-403-8,  11.14.2011

Jean Blosser, EdD, CCC-SLP

Money and Organization

What Dr. Blosser does not address is the hidden issue of what responsibility professional organizations play in advocating the right public policies to foster appropriate school practices, particularly the American Speech-Language-Hearing Association.  There is a blank spot in most accounts of what clinicians should to do in schools, where policy formation comes in.

Clearly, school practice is at the heart of American SLP practice.  It should receive more funding and mission support within ASHA, counteracting biases favoring the medical viewpoint.  There  must also be a recasting of  the university curriculum to support the fancy trends Dr. Blosser identifies, such as collaboration.  “Be professional and get out there and do wonderful things.”  The “wonderful things” should be grounded in ASHA policy and preservice preparation.  Awareness of federal trends is not enough.

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