Scope and Practice

            The Scope of practice has changed over the years. Currently SLPs serve individuals from infancy through geriatrics with a mission to improve their communication and/or swallowing. SLPs engage in the assessment, intervention, education, prevention, advocacy activities, and research pertaining to typical, atypical, delays and/or disorders of speech sound, resonance, voice, fluency, language, cognition, and feeding and swallowing. SLPs work in various settings/locations (e.g., schools, universities, hospitals, rehabilitation centers, behavioral/mental facilities, research facilities, corporate and industrial).

            There are many laws, related to general and special education, which have been enforced due to changes in legislature. Below is a list of laws and when they were implemented:  

  

1973: Rehabilitation Act: The Rehabilitation Act, Public Law (PL) 93-112

1974: Rehabilitation Act Amendments, PL 93-516

1975: Education for All Handicapped Children Act, PL 94-142

1986: Education for All Handicapped Children Act Amendments, PL 99-457

1990: Individuals with Disabilities Education Act (IDEA), PL 101-476 (reauthorized and

          renamed as PL 94-142)

1990: Americans with Disabilities Act (ADA), PL 101-336

1997: Individuals with Disabilities Education (IDEA), amended and reauthorized

2001: No Child Left Behind (NCLB), PL 107-110

2004: Reauthorization of IDEA

These laws were the result of people pushing for change due to some form of injustice or likely injustice of its absence. For example, according to Tiegerman-Faber and Radziewicz, the 1973 Rehabilitation Act was “enforced by the Office of Civil Rights under guidelines of the Department of Education” (p. 9). The NCLB was enforced so that “all children have an opportunity to obtain a high-quality education” (13). These educational reforms led to movements which established plans and phylosophies within the education setting:   

Free and Appropriate Public Education (FAPE)

Individualized Educational Program (IEP)

Least Restrictive Environment (LRE)

Response to Intervention (RTI)

            Without getting into a detailed analysis of each law, act, method, and philosophy, I feel at this point I should mention that the main purpose of this entry is to reveal what I, as an up and coming SLP, think about why and how these changes came about. Briefly and to reiterate, I believe educational reforms, which are enforced by laws, come from advocating for change. People, who see a need for change, advocate through the judicial process/system for change. These types of changes cause a change to the SLP’s scope and practice.

            The professional organization of SLPs is the American Speech-Language-Hearing Association (ASHA). This organization compiles various resources which are available to the public, professionals in the field, and its member base. The resources include articles, journals, research, intervention strategies, standards, and guidelines for the audiologist’s and SLP’s scope of practice. Research, articles, and events spark changes in the scope and practice. In my opinion, practice changes first, because it is within the realm of the SLP’s ability to decide what and how to apply changes. Licensed/certified SLPs are autonomous, meaning not supervised or in need of permission to make changes to their practice. However, SLPs still have a standard to uphold, must continue their education to maintain certification, and can lose their license for malpractice.

            Let’s use my areas of interest as an example, bilingualism and biculturalism. To date there are debates of overidentification and overrepresentation of minority students and culturally and linguistically diverse students in special education and with IEPs. This topic highlights whether such students have a language disorder or if there are biases held against them for lack of understanding of dialectal differences (from the standard American English), cultural differences, and/or language acquisitional patterns of second language learners. I imagine that bilingual SLPs recognized accents, cultural practices, and values within their clients of similar backgrounds. They were able to communicate in the student’s home language and with family members. Through practice and research these SLPs came to realize that few if any of their bilingual clients had true “disorders”. Instead they realized that the language difference present in English was reflective of second language acquisition. Although civil rights movements occurred in the 1960s, the NCLB act in 2001, ASHA did not implement a change to the scope of practice until 2007.

               In its most recent revision, September 4, 2007, ASHA has delineated the SLP’s scope to include cultural and linguistic diversity (CLD). Among the CLD changes, evidence based research was also added. I believe the scope of practice has changed due to research findings and advances in technology.

            I believe the scope and practice will continue to change. Research will continue to occur, technology will continue to advance, lifestyles will change, and medical advancements will require continuous changes to our scope and practice. Accent modification, transgender voice, care and improvement of the professional voice (e.g., singers, teachers), dialectal differences, implementation of educational reform (i.e., RTI), autism spectrum disorder, and telepractice are just some topics that I can see causing additional revisions to ASHA’s document covering the SLP’s scope of practice.  

References

Tiegerman-Farber, E. & Radziewicz, C. (2008). Language disorders in children; Real families, real issues, and real interventions. Upper Saddle River, NJ: Pearson Education (pp. 9-20).