Training Support Personnel:
A Collaborative Model
Sharon Ross, M.S.
University of Central Arkansas
Daniel Tullos, Ph.D.
This session will focus on how the speech-language pathologists in Arkansas have approached the use and training of support personnel. While this topic may not be among your favorites, the use of support personnel will significantly impact this profession and possibly your academic programs. Many professionals may see the use of support personnel as a step back in trying to promote individuals with a master's degree as the highest qualified provider. We found in Arkansas that aggressively moving toward advocating the use of support personnel (regulated and controlled by our profession) was one important strategy used in our attempts to maintain the master's as the entry level degree in all settings in our state.
To help you understand why we found it necessary to advocate the use of support personnel, we will begin by describing the steps taken by institutions of higher education, the Arkansas Speech Language Hearing Association (ArkSHA), the Arkansas Board of Examiners in Speech-Language Pathology and Audiology (ABESPA), and the Arkansas Department of Education (ADE) to upgrade and maintain the master's degree as entry level in speech-language pathology in all settings. We established licensure in 1975 for professionals in other settings but exempted school personnel. This allowed individuals with a bachelor's degree to continue to work in schools. A two tiered system of school certification was approved in 1977 and implemented in 1981. This included a six-year non-renewable certificate at the bachelor's degree level (Level I) and a ten-year renewable certificate at the master's degree level (Level II). In 1992, the state board of education approved a resolution that eliminated the issuance of teaching certificates at the bachelor's degree level. Teaching certificates of all who hold a bachelor's degree in speech-language pathology will expire in 2010. This process of upgrading standards for speech-language pathologists in the schools was undertaken in stages to work with school officials to ensure that large numbers of children would not be without speech therapy services. We also had to educate consumers and legislators about why those with a bachelor's degree were not adequately trained to serve the changing population in the schools. During two legislative sessions, members of our state association continued to lobby against efforts to abolish licensure and reduce standards primarily because of the reported shortages of qualified providers in the schools.
While faculty from university training programs felt that there was an adequate supply of master's level speech-language pathologists graduating from the four Arkansas programs to meet the school demand, other employment opportunities were more appealing to new graduates. The superintendents, special education supervisors and state department officials continued to report shortages of personnel particularly in the rural parts of the state. In 1989, the University of Central Arkansas secured funding from the Office of Special Education Programs for a distance education grant. The focus of this grant was to make graduate education accessible to bachelor's level public school practitioners in the rural parts of the state. During the fall and spring semesters, students in this program took graduate courses by viewing videotaped classes with opportunities for contact with instructors by telephone. During the summer sessions, students completed course work and clinical practicum on two different college campuses in different parts of the state. Twenty students completed a master's degree through this program. This was but a first step to encourage bachelor's level practitioners in schools to pursue a master's degree and to eliminate shortages.
In 1993, ArkSHA passed a resolution, initiated by the state's university training programs, that resulted in collaborative efforts to work toward eliminating the shortages of qualified providers in the schools. Training programs worked with local districts to help in the development of recruitment strategies. School personnel were invited to college campuses and speech-language pathology departments to recruit. ArkSHA initiated a job fair held at the annual convention and an ongoing job placement service used by school-based recruiters. University faculty conducted and distributed research on effective recruitment and retention strategies. Some districts are now looking at ways to remove speech-language pathologists from the teacher salary scale, to increase fringe benefits such as paying certification and licensure fees, to support continuing education and to extend contract periods to ten or eleven months so that annual salaries would be more competitive. These recruitment/retention activities were helpful, but the superintendents and special education supervisors continued efforts to lower standards for speech-language pathologists in the schools.
Accessibility of Graduate Education
Again accessibility of graduate education became an issue. The training programs acting as a consortium submitted a grant for funding to the Arkansas Department of Education for a distance learning program to make graduate degree programs accessible to bachelor's level public school practitioners. Students on this tract had to meet admission requirements and were accepted into the program closest to their home. Some courses were taught through telecommunications by a faculty member from each institution on a rotating basis. These courses were accepted through transfer credit agreement among the four institutions. School superintendents allowed these individuals to leave school early one afternoon each week so they could attend the telecommunication class. These students enrolled at their matriculating institution for the summer terms. The Arkansas Department of Education provided funding for line charges, for stipends to students who completed the courses successfully, and for salaries of adjunct faculty in the summer so that an appropriate faculty/student ratio could be maintained.
To date the ADE has invested $130,935 for tuition reimbursement, $96,000 to graduate programs for hiring faculty, and $14,150 for line charges for distance learning classes.
These initiatives did not produce an adequate pool of qualified applicants for the schools. In August of 1995, the State Director of Special Education, representatives of ArkSHA and university training programs were successful in petitioning the state board of education to make another change in certification requirements. This proposal eliminated the requirement of 15 hours of additional course work in education. Graduates of accredited master's degree programs in speech-language pathology who passed the national exam met the requirements for teacher certification. Therefore, if graduates meet requirements for licensure from ABESPA, then they can apply for and receive school certification. This increased the pool of individuals who could be employed as speech-language pathologists by schools under a teacher contract rather than a professional services contract.
In 1992, ArkSHA established a task force to study the issue of support personnel. In July of 1994, the task force recommended the establishment of requirements for speech-language support personnel in Arkansas. At this time the Director of Special Education knew that support personnel were being used in other states and that an ASHA task force was developing guidelines for support personnel. She was convinced that this service delivery model should be considered as an option that might alleviate shortages and increase the frequency of service to students with speech-language disabilities. Therefore, ArkSHA, in collaboration with the ADE, began a pilot project to study the use of speech-language assistants in Arkansas schools. The ADE provided a grant to the University of Central Arkansas (UCA) to provide technical assistance to districts involved in the pilot project, and to train speech-language pathologists (SLPs), superintendents, special education administrators, and speech-language assistants. Graduate students were provided research stipends to assist the UCA faculty in collecting and analyzing data about the use of support personnel. After the initiation of the pilot project, it was discovered that the project could be in violation of the licensure law. During the 1995 legislative session, the ArkSHA Board introduced a bill to add a provision to the current law that would allow for the use of support personnel. It also established that ABESPA would be the body to develop and monitor the rules and regulations for the use of support personnel in ALL settings. This law was passed through the collaborative efforts of ArkSHA, ABESPA, the Hospital Association, ADE, university programs, and the Department of Human Services. This provision also allowed for the continuation of the pilot project.
Pilot Project for the Use of Support Personnel
The guidelines used for the pilot project was the draft of the ASHA guidelines that was being considered and reviewed. We initiated an application and approval process that involved three UCA faculty members, the State Consultant for Speech-Language Pathology, and the Associate Director of Special Education who was also a speech-language pathologist. Technical assistance for proposal development involved four areas: 1) encouraging SLPs to be involved in the proposal development, 2) being sure there was a manageable caseload which belonged to the SLP, 3) making sure the service delivery plan maintained SLP contact with clients and insured adequate supervision, and 4) helping districts with creative ways to provide services even if it meant contracting with other SLPs for some services such as evaluations.
During the 1995-96 school year each pilot project site submitted data on the approximately 1700 students being served. The following is a brief summary of data in a few key areas as it relates to the utilization of support personnel in Arkansas schools (Ross & McNiece, 1996).
Training. Training was a major component of this project. All personnel were required to be trained prior to implementation of this service delivery model. School administrators and SLPs had to understand that this was not a way to make individuals with bachelor's degrees independent practitioners. The caseload belonged to the SLP who only delegated tasks to the assistant. In fact, the bachelor level assistants had to be retrained to insure that they had a full understanding of their role as an assistant. The SLPs were required to develop and implement a training plan based on competencies demonstrated by the support personnel. A total of 14 training sessions were held during the 1995-96 school year. Approximately 165 speech-language pathologists, 40 speech-language assistants, and 19 others attended the sessions. Sessions were held at eight different locations across the state. Training topics included: pilot project sites and proposal development, ASHA guidelines, ethics, roles and responsibilities, licensure regulations, ongoing training, supervision issues, data collection, response discrimination and language stimulation.
Pilot sites. The number of approved pilot sites during the second year of the project increased from 15 to 33. Of the original sites, 11 chose to continue during the second year. Two of the four sites not continuing were able to employ master's level speech-language pathologists. There were 22 new sites approved for the 1995-96 school year. Two sites received approval but chose not to implement. The pilot project sites served 25 school districts, 9 early childhood programs, and 2 developmental disabilities services (DDS) facilities in 29 counties primarily in the rural parts of the state.
Models of service delivery. The most common service delivery model used by 23 sites was one supervising speech-language pathologist and one speech-language assistant either working together serving one district or traveling together to serve multiple schools or early childhood sites. There were four sites in which two speech-language pathologists shared one assistant and five sites where one speech-language pathologist had two assistants. In two different sites, three speech-language pathologists shared one assistant with each assistant primarily providing clerical support. Allowing flexibility in designing a service delivery system was important to meet the unique needs of each district. As new proposals were developed, information on service delivery models that had been found to be effective was provided by the technical assistance team.
Level of education for speech-language assistant. There were 41 speech-language assistants employed at 31 sites. Almost one-half of the speech-language assistants in the pilot project had a high school diploma (14) or a bachelor's degree in a related field (6). The other assistants held a bachelor's degree in speech-language pathology. Many districts could not find assistants who had bachelor's degrees in speech-language pathology or chose to use personnel who had experience in the district.
Caseload. Sites that utilized support personnel were allowed to exceed the individual caseload maximum of 50 students. Information regarding the caseloads of 28 speech-language pathologists was collected. All students served by the speech-language pathologist during the school year were included in caseload size. This caseload fluctuated significantly during the school year. The average caseload for 13 speech-language pathologists serving school districts with one assistant was 62 ranging from 23 to 89 students. The caseloads of two speech-language pathologists were below the recommended maximum. Nine caseloads exceeded the maximum by 15 students or less. The average caseload for five speech-language pathologists with two assistants serving school districts or early childhood programs was 65 and ranged from 50 to 79. Three sites exceeded the maximum. The average caseload of ten speech-language pathologists employed in DDS facilities or early childhood programs with one or two assistants was 45 and ranged from 24 to 77. Seven caseloads were below the maximum. While the use of support personnel allowed districts to exceed the maximum caseload of 50 students, the majority of sites were within 15 students of the maximum.
Amount of supervision. An analysis of information from 18 sites with 22 speech-language pathologists was completed. Sites with complete information and 18 weeks or more in the project were selected for analysis of amount of direct supervision provided to the assistants. The speech-language pathologists were divided into two groups. Twelve speech-language pathologists with assistants who had a bachelor's degree in speech-language pathology were included in Group 1. Seven speech-language pathologists with assistants who had a college degree in a related field or a high school diploma were included in Group 2. Each site submitted a weekly record of service delivery/supervision form which documented the number of minutes each child received services from the SLP, the assistant or both during supervision activities. The percentage of supervision for Group 1 ranged from 21% to 78% with an average of 46%. The percentage of supervision for Group 2 ranged from 29% to 91% with an average of 66%.
During the first eighteen weeks of the project, all speech-language pathologists provided more than the required 10% of direct supervision. The average supervision provided by speech-language pathologists who had assistants with a high school diploma or a degree in a related field was higher than the supervision provided by speech-language pathologists with assistants who had a bachelor's degree in speech-language pathology. However, the percentage of weekly supervision varied significantly among speech-language pathologists in both groups. Speech-language pathologists utilizing support personnel may have considered other factors besides level of training of the assistant when providing direct supervision. A flexible schedule of service provision seemed to be the best way to insure that adequate supervision is provided and students needs are met.
Lastly, we analyzed the amount of direct contact time the speech-language pathologists had with the children. We selected cases who were involved in the project for 34 weeks, were seen 40 minutes weekly for therapy and were dismissed from or continued in therapy. These children were divided into two groups. Group 1 had 89 cases who had received services from a speech-language pathologist and an aide who had a high school diploma or bachelor's degree in a related field. Group 2 had 78 cases who had received services from a speech-language pathologist and an assistant with a bachelor's degree in speech-language pathology. The speech-language pathologists with aides spent twice as much direct contact time with children than the speech-language pathologists with assistants.
Rules and Regulations
Data from the pilot project and the guidelines for the use of support personnel (ASHA, 1996) were used by the licensure board in promulgating the rules and regulations. These rules and regulations defined educational training for an assistant as a bachelor's degree in speech-language pathology or the equivalent of an associate's degree. Regulations for responsibilities of the speech-language assistant, responsibilities of the speech-language pathologist and amount of supervision were taken from the current guidelines (ASHA, 1996). A speech-language pathologist and assistant providing services outside of the public school setting must register with the licensure board.
The rules and regulations also stated that guidelines for the use of support personnel in public agencies serving children birth to 21 must be submitted by the ADE and approved by the licensure board. Any revisions to these guidelines must be submitted annually and approved by ABESPA. The guidelines established a two-tiered system of support personnel. It allowed for a speech-language assistant with a bachelor's degree or the equivalent of an associate's degree and a speech-language aide with a high school diploma and 40 clock hours of training during the first year of employment. Both the assistant and the aide are required to obtain 12 clock hours of training annually. The ADE assumed the responsibility of registering speech-language pathologists, assistants, and aides because the licensure board did not have the manpower or resources to do this. The ADE must provide ABESPA, upon request, with any reports and/or records with regard to the individuals involved in this service delivery model to ensure compliance with established standards. The supervision requirements for the assistant are consistent with the rules and regulations for assistants in other settings. The supervision requirements for aides are as follows: 1) 100% supervision during the first 10 clock hours of student contact time, 2) 50% supervision (30% direct and 20% indirect) during the first 90 workdays and 3) thereafter, 40% supervision (30% direct and 10% indirect).
Since the pilot project, there has been an increase in the number of school districts, early childhood programs, and DDS facilities utilizing support personnel. There has also been an increase in the number of SLPs and assistants implementing this service delivery model while we have seen a slight decrease in the number of aides being employed.
The ADE continues to provide funding for training and research. Current research topics include use of support personnel with severe populations, SLPs' perceptions of this service delivery model, the effectiveness of this model, and salaries. This research will be used by ABESPA and the ADE to make changes in the rules and regulations if needed. The use of support personnel has increased the frequency and the availability of services to children in the rural parts of the state. In Arkansas, this service delivery model has helped to maintain individuals with a master's degree in speech-language pathology as the highest qualified provider.
American Speech-Language-Hearing Association. (1996). Guidelines for the training, credentialing, use, and supervision of speech-language pathology assistants. Asha, 38, (Suppl. 16) 21-34
Ross, S., & McNiece, E. (1996). Status report following the second year of a pilot project for use of speech-language assistants in Arkansas public schools. Conway: University of Central Arkansas, Department of Speech-Language Pathology.