I feel the strong need to preface this post, mainly because I suspect it will anger many people. However, before you get too angry, please read all the way to the end…and then if you want to comment – walk away for a few minutes before you hit send. I’d love a discussion, but don’t really want a debate, and I won’t argue. I’ve been considering this post for a while and I’ve resisted it for a couple of reasons. One, I’m not sure I’ve fully considered all aspects. Two, I’m not sure I have a solution (and I hate to be a part of a problem with out a solution). And three, the alternatives suck. If that hasn’t scared you off… Like many SLPs, I receive emails from the American Speech Language Hearing Association (ASHA) announcing the need to support various lobbying efforts they are doing on our behalf. The latest one was regarding adding language in the Student Success Act (which would replace No Child Left Behind) to include using “specialized instructional support personnel (including audiologists and speech-language pathologists)” to have an expanded role in teaching reading curriculum in schools.
Lurking on the Facebook pages, I often see SLPs asking questions about social cognition, social thinking, executive function, literacy, reading, etc. Yet, many schools SLPs are no longer allowed to work on articulation errors. This made me think…are we, as a profession, over-reaching and diluting our effectiveness? Have we stepped up to the place and filled in gaps? Or have we stepped on toes and crowded other professionals? If we look at the ASHA Scope of Practice for SLPs, we are able to address and serve (never service, that’s illegal in most states), the following areas:
- Speech Sound Production (articulation, apraxia, dysarthria, ataxia, dyskinesis)
- Resonance (hypernasality, hyponasality, cul-de-sac resonance, mixed resonance)
- Voice (phonation quality, pitch, loudness, respiration)
- Fluency (stuttering, cluttering)
- Language (phonology, morphology, syntax, semantics, pragmatics*, literacy*, prelinguistic communication*, paralinguistic communication)
- Cognition (attention, memory, sequencing, problem solving, executive functioning)
- Feeding and Swallowing (oral, pharyngeal, laryngeal, esophogeal; orofacial myology including tongue thrust, oral-motor functions).
*The list further breaks down pragmatics to include language and social aspects of communication; literacy as reading, writing, and spelling; and prelinguistic communication as joint attention, intentionality, and communicative signaling. There is a whole list of potential etiologies of disorders that we may be involved with that includes everything from birth to death.
These are all important elements – and I’m in complete agreement that they are all vital. They are all things that we, as SLPs, are uniquely trained to support.
But the question has to be asked…Are we the best person to support them? Are we the only people who can support them?
Let’s take reading. Now, please don’t get me wrong, I’m not saying we shouldn’t work on reading. I am saying, we need to look at if we are the best person to work on it. Would a child be better served by an SLP or by someone who is trained specifically to work on READING strategies, skills, etc. I don’t know about all programs, but I can tell you my grad program did NOT prepare me to teach reading. Yes, I learned about the importance of phonological awareness and I learned different strategies for helping with reading comprehension. We even had a whole course in adolescent literacy…but not once did we learn about how to TEACH reading skills. I am many things, but I am not a reading specialist. I cannot teach a student WHY some words end in “ck” and some words end in “k” or why a “C” says /s/ sometimes and a /k/ other times. Could we be harming those students if I insisted on taking them on without adequate training. Could I get training to be able to do that??? Sure… but in the meantime, wouldn’t it be better to let the reading specialists actually work with those kids?
Social skills…Again, yes…I acknowledge that social skills are definitely a form of communication and I work on them with every one of my kids (not just those that are diagnosed with a social skills disorder). Am I the only one in my school who can work on those? Absolutely not. SPED teachers are also trained in how to work with social skills training. Is it the same? No…and while some kids would be better served by me – some would be better served by the SPED teachers. If a student has an emotional disorder and is already seeing the SPED teacher for supports – why not let them continue with the social skills training as well? They are qualified.
Executive Functioning…is certainly not only the jurisdiction of the SLP. Imagine how many kids could be helped if *gasp* the classroom teacher helped with EF skills…or the SPED teacher. I have yet to see a single student (and many adults) who wouldn’t benefit from some EF skills support.
Response to Intervention…don’t get me started. Yes, I recognize that we are in a unique situation to help (and I do a lot with RTI)…but for many SLPs, students that are helped through RTI are not recognized as being on a caseload/workload and caseloads are not adjusted accordingly…so it’s entirely possible to have a caseload of 70 or more and still be expected to do RTI for another 10-30 students (can you say ludicrous? I knew you could).
I recognize that SLPs are a helping profession. We see a problem and we want, desperately, to help…and I am right there with you. I know that’s how I am. I tend to get protective of my kids and, I have a really hard time letting someone else help (because we all know we can do it better…except when we can’t). But…perhaps…it’s time to start saying no. To letting others pick up the slack and let those specialties shine. Maybe…just maybe…there’s someone who can do it just as good…and we can focus on someone else.
In so many ways, we are our own worst enemies. Not only do we not advocate for ourselves (hello janitor’s closet!), we don’t advocate for our students (how do you effectively work with 80 students?). Are we (and this is a true question, I’m not passing judgment), hurting ourselves (and our students) by over-reaching our scope of practice and not allowing others to help?
With the increased need for EBP, research practices, etc. we must be careful with how we allocate our time and services. Of course we want to help everyone, at least, I know I do. But, just like being on a falling plane and putting your air mask on first…we can’t help others if we don’t help ourselves first. If we continue to take on more roles, increase our scope of practice, without the proper support, we will burn out and be of no use to anyone.
A recent discussion with some university faculty shed light on some things for me. We have moved from being articulation and language specialists, to being a jack-of-all-trades. Our expected skill sets have moved beyond what can be reasonably taught in a master’s program. Yes, we have the basics…we know what it all is…but we only touch on a small part of the skills necessary for many of those expected roles.
Universities expect students to learn those skills during their externship or on their CFY…but in some areas CFYs are (largely) unsupervised. Some states don’t require SLPs to have their CCCs and therefore don’t offer a CFY necessarily.
Those elements that are in our scope of practice are critical. I know that. I know that in many schools, we are the only people who are willing (or able) to step up and support those skills. But, where does the line get drawn? If we are so busy working on reading, EF, social skills, and RTI that we can no longer support basic language development and articulation skills – have we really made anything better? Are we in danger of phasing out the Speech-Language pathologist and introducing the class tutor with a master’s degree? Are we violating our Code of Ethics when we take on a role, even if it’s in our scope of practice, for which we are inadequately trained?
In all honesty, I don’t know what the answer is. I’d love to hear your thoughts on this issue. Please, leave a comment.
Until then…Adventure on.