Medical speech pathology

I am evolving new ideas. My pride in speech language pathology has increased.

American School Speech Pathology

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

Summer day, Canal St. Martin, Paris

Dr. John M. Panagos

Professor Emeritus
Editor

John Panagos

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

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

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

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

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

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

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

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

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

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

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

“I believe in deeply ordered chaos.” -Francis Bacon –

Market in Paris.

ASHA Board Fails to Produce Excellent Mission Statement

In the last post we found the ASHA Board of Directors floundered in publishing the mission statement for our organization. Board members are confused about the topic, and fail to take a scholarly approach. How can they guide the Association without authoritative mission statement? How can the Board set operational priorities for program activities and budget allocations? How does it prevent mission creep? How can it foster proper personnel decisions for leadership excellence? How can it define a forward-thinking vision for the profession.

Clearly “fostering excellence in professional practice” is at the heart of the profession.

Mission of the American Speech Language Hearing Association

In the 1990s, I retired from college teaching in speech-language pathology and began working in Arizona schools. I reported on my blog and in publications that there were widespread problems with school practice. I asked who was responsible and wondered about the mission of the American Speech-Language-Hearing Association (ASHA). My first impression was there must be something lacking in ASHA management.

2011

In 2011 ASHA published its Mission Statement in Encyclopedia of Clinical Neuropsychology:

“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”

It emphasized ADVOCACY in a way consistent with the rapid growth of a Washington-based non-profit charitable organization.

May 2012

The ASHA Board considered adding swallowing 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….”

ASHA floundered responding to a small pressure group.

August, 2012

The mission statement remained the same:

“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.”

2013

The ASHA Board of Directors revised the mission statement to include”setting standards.” In this blog we raised issues about accreditation.

“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.”

April 1, 2015

On FACEBOOK ASHA posts another version of the mission statement, this time without without mention of setting.

“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”

April 2, 2015

For the Toolkit, the mission is published as follow:

“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 ”

February, 2016

ASHA’s Marketing Department published this mission statement. Setting standards reappears.

“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.”

Conclusions

We see why ASHA seems to wander in its administrative actions, especially those affecting school practice. The Board of Directors is a failing governing body in giving clear direction to the membership. My experience and investigations convince me ASHA does not well”serve” school members beyond selling them products.

When one surveys for the ASHA mission statement one finds it varies wildly in form and content as though no one is home minding the store. Hundreds of variations exist on the internet confusing members and citizens about what ASHA does. In one google search the mission statement had 593,000 mentions.

The Board of Directors is in charge and should monitor ASHA documents for consistency and clarity so everyone knows the facts. And without a comprehensive, consistent, clear and carefully distributed mission statement, how can the Board hope to function properly and effectively?

American School Speech Pathology Blog 2016

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

Summer day, Canal St. Martin, Paris

Dr. John M. Panagos

Professor Emeritus
Editor

John Panagos

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

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

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

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

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

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

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

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

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

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

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

“I believe in deeply ordered chaos.” -Francis Bacon –

Market in Paris.

ASHA Philosophy of Curriculum Turned Upside Down. 5

Shredding the Traditional curriculum

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

Knowledge-Skill

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

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

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

Construction

Cartel

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

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

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

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

ASHA Philosophy of Curriculum Turned Upside Down. 6

https://www.insidehighered.com/.

Urgent Agenda: 1994

We saw how Dr.Spahr proposed an urgent agenda to improve academic preparation for audiology and speech-language pathology.    “He took a business orientation for ASHA’s future, deferring to employer evaluations as to the deficiencies of SLP graduates.  Employers were dissatisfied with SLP “products. They were unprepared for immediate service. There were signs employers wanted to train their own SLPs, particular in medical settings. SLPs should be trained to understand costs and performance requirements.”

The Colloquy held addressing a monumental change in academic preparation had two characteristics:

1. It was initiated in semi-darkness with only token publicity to the membership.  The program was subsequently submerged as a part of the accreditation process, where CAA claimed to be an autonomous council existing as in a “silo” with marginal oversight by the Board of Directors.

2. It did not present a general context for the non-academic positions taken.  It did not speak to the origins of the business approach launched aggressively in higher education.  No significant evaluation of the business approach was ever taken.  It was institutionalized without comment, assumptions and all.

Context Issue

The context issue is now more critical than ever.  It turns out here in 2015 college graduates in many fields — e. g., psychology, business, education, engineering — are being criticized for not pleasing the expectations of employers.  Urgency still abounds because colleges desperately need to change to support economic outcomes, according to critics.

In an article, Qualified in Their Own Minds (October 29, 2013) by Allie Grasgreen sums up the school to work issue:  “As more students have struggled to find a place in a depressed job market and questions about the employment value of a college degree have intensified, so too has concern that new graduates are not equipped to function in the work place and are not meeting employers’ expectations.”  She writes about a recent Chegg study: “In the report, “Bridge That Gap: Analyzing the Student Skill Index,” only half of college students said they felt very or completely prepared for a job in their field of study. But even fewer employers – 39 percent of those surveyed – said the same about the recent graduates they’d interviewed in the past two years.”

An article published in the Washington Post speaks to the readiness issue. One learns there are several factors influencing learning outcomes. http://www. washingtonpost.com/…/grade…/why-are-so-many-college-students- failing-to-gain-job-skills-before-graduation/‎

The topic of work readiness among others was taken up this summer by the nation’s governors,  NGA Vice Chair Colorado Gov. John Hickenlooper. The conference emphasized getting results in government. As to higher education, programs should be easily accessed and prepare students for work.  www.nga.org/chs/… /governors-select-west-virginia-f.html‎

Conclusion

We have here independent verification of the business implications of SLP / Student Readiness for employment.  There is a larger national movement across fields, one which has gone on without ASHA comment, self-study and follow-up.  This movement carries with it a political weight  characteristic of conservative thought and the belief  the purpose of higher education is to prepare students for jobs and profits in the workplace.  It sweeps aside any idea of “The Educated Man” having a role in society.

In my opinion, the work readiness movement is profit driven and anti-intellectual.  It parallels the movement to install core curriculum nationally, whether schools want it or not.  Diane Ravich – The Death and Life of the Great American School System (2010) – shows how corporate entities push behind the scenes.

ASHA Philosophy of Curriculum Turned Upside Down. 4

Mixed Curriculum Approach

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

Within ASHA, where professional public communications occurs, the two approaches are mixed freely.  Members cannot sort out issues because they do not have intellectual control of how conflicts of interest occur, and why they occur. History advances. Institutional memories fade. Members are left with an Irish stew of options on which to base policy directions. Members talk past one and another without knowing how history is selecting their words.  Members grow older, retire and die.

Example

In the 2000s, SLPs reported ASHA was not supporting Scope of Practice in schools. IDEA had brought more disabled children into schools and caseloads grew.  Other school specialists were “encroaching” on SLP assignments. ASHA took the business approach, leaving scope of practice wide open for employer convenience.  This view fits exactly into the 1994 Spahr playbook, point-for-point:

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

ASHA’s school group countered, saying scope of practice is professionally defined and should be recognized as such.  Ellen Estomin (ASHA Leader, April 6, 2010) said they agree with the part that says SLPs cannot dictate what other professionals do, or do not do, but they disagreed with the part saying SLPs do not “own” their scope of practice. Having a code of ethics, extensive training, a defined curriculum and prescribed roles, SLPs should confidently communicate their strengths to the public and employers.

Scope of Practice Leverage

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

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

ASHA Administration Protected

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

“Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.” (2015)

In another version of the same disclaimer is attached to the guidelines on collaboration: “Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.”

Spahr Strategy

We notice that the business-legal approach advances in the dark, with no public ASHA debate, often with edits of old texts made without comment, or conflicting texts.  In the end school SLPs are pushed to the end point of practice behavior, even if they have not had the relevant course work and must pay for continuing education.  They cannot count on their professional organization to step up to the plate, to advocate for graduates placed in work settings where they have to be their own advocates.  It’s a shame!

Plus who has time to figure out in each and every case whether one’s qualifications can be defended, when scope of practice expands whimsically to the benefit of employers who advocate for their own preferences?  Talk about “hung out to dry.”

ASHA Philosophy of Curriculum Turned Upside Down. 3

Curriculum Redesign

According to Dr. Spahr, a new SLP “product” should be graduated.  Cost-containment should be a factor.  SLPs should follow practices suitable for immediate application and revenue generation.

Here are the keys to reform of the traditional curriculum:

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

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

3. The curriculum should be designed to graduate “multiskilled, multifunctional, [and] cross-trained” SLPs.”  Cross-training allows employers to place SLPs in any service delivery configuration.  SLPs should work outside of their therapy rooms doing articulation therapy.

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

Translated into accreditation and certification standards, the new curriculum forced academic programs out of old patterns dating back to 1930.  It gave ASHA great leverage to control academic programs.  It also gave more control to marketplace pressures facing ASHA politically in 1994. The “New Agenda” weakened the strong case made over the years for full academic status of speech-language pathology in the United States.  As in other countries, speech-language pathology — speech therapy — can be viewed as a service program placed in medicine for example.  ASHA has similarly weakened the clinical doctorate, making it a non-research  degree.  It’s all about marketing and sales.

Which Model?

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

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

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

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

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