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Alcance de la Práctica en Logopedia (traducción) Comité Ad Hoc sobre Alcance de la Práctica en Logopeda Este documento fue aprobado por el Consejo Legislativo de la ASHA en Abril de 2001 (LC 7- 01). Los miembros del Comité Adhoc sobre Alcance de Práctica en Logopedia que desarrollaron este documento son Nicholas Bankson (presidente), Allan Diefendorf, Roberta Elman, Susan Forsythe, Elizabeth Gavett, Alex Johnson (vice presidente de prácticas profesionales en Logopedia), Lori Lombard, Ninevah Murray, Arlene Pietranton (ex officio), y Carmen Vega-Barachowitz. Declaración de Intenciones La misión de este documento es definir el alcance de la práctica en Logopedia para: 1. Delinear las áreas de práctica profesional en Logopedia proporcionadas por los miembros de la American Speech- Language-Hearing Association (ASHA) y clínicos certificados de acuerdo con el Código Ético de la ASHA; 2. Educar a los profesionales de la salud, la educación y otras profesiones; a los consumidores, clientes, reguladores, y miembros de la población en general sobre los servicios profesionales ofrecidos por logopedas de manera cualificada; 3. Ayudar a los miembros de la ASHA y a los clínicos certificados en la provisión de servicios de alta calidad y basados en evidencias a aquellas personas que, durante su ciclo vital, presentan problemas de comunicación, deglución y dificultades aerodigestivas superiores; 4. Proveer guía para programas de educación en el currículum de Logopedia. El alcance de práctica definido aquí y las prácticas detalladas más adelante describen el conjunto de la práctica profesional que se ofrece dentro de nuestra profesión. Los niveles de educación, experiencia, habilidad y efectividad con respecto a las actividades identificadas dentro de este alcance de práctica varían entre los profesionales individuales; un logopeda no practica asiduamente todas las áreas de su campo. Como el Código Ético de la ASHA especifica, un individuo sólo puede practicar en áreas en las que posee competencia de acuerdo a su educación, entrenamiento y experiencia. Sin embargo, los logopedas pueden ampliar su nivel de conocimientos. Ciertas situaciones pueden requerir que los logopedas lleven a cabo educación o entrenamiento adicional para expandir su alcance de práctica personal. Esta declaración de alcance de la práctica no puede imponerse a la legislación actual ni afecta la interpretación o implementación de dichas leyes. Sin embargo, puede servir como un modelo para el desarrollo o modificación de la legislación sanitaria. El esquema de Figura 1 1 representa la relación entre el alcance de la práctica y los documentos de política de práctica, los estándares de certificación, y el Código Ético de la ASHA. Como se ha indicado, los particulares deben completar los estándares de certificación en Logopedia. Los documentos de política de práctica (es decir, los patrones habituales de práctica, las declaraciones de posición, las guías, y las declaraciones de conocimiento y habilidad) recogen las áreas de práctica en Logopedia, tanto las actuales como las que están apareciendo. Estos documentos se basan en los conocimientos, habilidades y experiencias necesarias para la certificación profesional. El Código Ético de la ASHA fija los principios y reglas fundamentales que se consideran esenciales para la presentación de los estándares de integridad y conducta ética a los que los miembros de la profesión logopédica están obligados. La Logopedia es una profesión dinámica y en constante desarrollo; el recoger áreas específicas dentro de este alcance de la práctica no excluye que aparezcan nuevas áreas de práctica. Aunque no se identifican específicamente en este 1 Ver las figuras en el documento original

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Page 1: tema1_a1 logopedia

Alcance de la Práctica en Logopedia (traducción)

Comité Ad Hoc sobre Alcance de la Práctica en Logopeda Este documento fue aprobado por el Consejo

Legislativo de la ASHA en Abril de 2001 (LC 7-

01). Los miembros del Comité Adhoc sobre

Alcance de Práctica en Logopedia que

desarrollaron este documento son Nicholas

Bankson (presidente), Allan Diefendorf, Roberta

Elman, Susan Forsythe, Elizabeth Gavett, Alex

Johnson (vice presidente de prácticas

profesionales en Logopedia), Lori Lombard,

Ninevah Murray, Arlene Pietranton (ex officio), y

Carmen Vega-Barachowitz.

Declaración de Intenciones La misión de este documento es definir el alcance de la práctica en Logopedia para:

1. Delinear las áreas de práctica profesional en Logopedia proporcionadas por los miembros de la American Speech-Language-Hearing Association (ASHA) y clínicos certificados de acuerdo con el Código Ético de la ASHA;

2. Educar a los profesionales de la salud, la educación y otras profesiones; a los consumidores, clientes, reguladores, y miembros de la población en general sobre los servicios profesionales ofrecidos por logopedas de manera cualificada;

3. Ayudar a los miembros de la ASHA y a los clínicos certificados en la provisión de servicios de alta calidad y basados en evidencias a aquellas personas que, durante su ciclo vital, presentan problemas de comunicación, deglución y dificultades aerodigestivas superiores;

4. Proveer guía para programas de educación en el currículum de Logopedia.

El alcance de práctica definido aquí y las prácticas detalladas más adelante describen el conjunto de la práctica profesional que se ofrece dentro de nuestra profesión. Los niveles de educación, experiencia, habilidad y efectividad con respecto a las actividades identificadas dentro de este alcance de práctica varían entre los profesionales

individuales; un logopeda no practica asiduamente todas las áreas de su campo. Como el Código Ético de la ASHA especifica, un individuo sólo puede practicar en áreas en las que posee competencia de acuerdo a su educación, entrenamiento y experiencia. Sin embargo, los logopedas pueden ampliar su nivel de conocimientos. Ciertas situaciones pueden requerir que los logopedas lleven a cabo educación o entrenamiento adicional para expandir su alcance de práctica personal. Esta declaración de alcance de la práctica no puede imponerse a la legislación actual ni afecta la interpretación o implementación de dichas leyes. Sin embargo, puede servir como un modelo para el desarrollo o modificación de la legislación sanitaria. El esquema de Figura 11 representa la relación entre el alcance de la práctica y los documentos de política de práctica, los estándares de certificación, y el Código Ético de la ASHA. Como se ha indicado, los particulares deben completar los estándares de certificación en Logopedia. Los documentos de política de práctica (es decir, los patrones habituales de práctica, las declaraciones de posición, las guías, y las declaraciones de conocimiento y habilidad) recogen las áreas de práctica en Logopedia, tanto las actuales como las que están apareciendo. Estos documentos se basan en los conocimientos, habilidades y experiencias necesarias para la certificación profesional. El Código Ético de la ASHA fija los principios y reglas fundamentales que se consideran esenciales para la presentación de los estándares de integridad y conducta ética a los que los miembros de la profesión logopédica están obligados. La Logopedia es una profesión dinámica y en constante desarrollo; el recoger áreas específicas dentro de este alcance de la práctica no excluye que aparezcan nuevas áreas de práctica. Aunque no se identifican específicamente en este

1 Ver las figuras en el documento original

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documentos, en ciertas circunstancias los logopedas puede ser requeridos para llevar a cabo servicios (por ejemplos, “multihabilidades” en un entorno sanitario, servicios de cooperación con escuelas) para el bienestar de los individuos a los que sirve. En esas ocasiones, es necesario ética y legalmente que los profesionales determinar que realmente poseen el conocimiento y las habilidades necesarias para llevar a cabo esas tareas. Por último, cabría señalar que factores como los cambios en los sistemas de prestación de servicios, el crecimiento proyectado en Estados Unidos de los grupos cultural y lingüísticamente minoritarios, y los avances tecnológicos y lingüísticos requieren que una declaración sobre el alcance de la práctica para la profesión logopédica sea dinámica por naturaleza. Por esas razones, este documento estará sujeto a una revisión periódica y una posible modificación.

Marco para la Práctica El dominio de la Logopedia incluye los comportamientos de la comunicación humana y sus alteraciones, así como la deglución y otras funciones y trastornos aerodigestivos. El objetivo general de los servicios logopédicos es optimizar la habilidad de los individuos para comunicarse y/o lleven a cabo la deglución en sus ambientes naturales, y por tanto mejoren su calidad de vida. Este objetivo se alcanza a través de la administración de servicios integrados en los contextos vitales relevantes. La Organización Mundial de la Salud (OMS) está finalizando un sistema de clasificación multiobjetivo denominado ICIDH-2 [ICF]que ofrece a los profesionales clínicos un marco conceptual reconocido internacionalmente para discutir y describir el funcionamiento y la discapacidad humanas (WHO, 2000). Este marco puede emplearse para describir el papel de los logopedas a la hora de mejorar la calida de vida mediante la optimización de la comunicación humana, la deglución y otras funciones aerodigestivas en distintos ámbitos. El marco de la ICIDH-2 [ICF] tiene dos partes. El primero se denomina Funcionamiento y Discapacidad; el segundo se refiere a Factores Contextuales. Funcionamiento y discapacidad incluye los dos siguientes componentes:

• Funciones y Estructuras Corporales: las Funciones Corporales se refieren a las funciones fisiológicas o psicológicas de los organismos; las Estructuras Corporales se refieren a las partes

anatómicas del cuerpo y a sus componentes.

• Actividad y Participación: la Actividad se refiere al desempeño en una tarea o acción de un individuo determinado; la Participación se refiere a la implicación de una persona en una situación vital. Ambos componentes de actividad y participación están modificados por los calificadores de Capacidad y Rendimiento. El calificador de Capacidad describe la capacidad de una persona de ejecutar una tarea o acción en un ambiente estandarizado o uniforme. El calificador de Rendimiento describe lo que un individuo hace en el medio o contexto actual en el que vive.

La Figura 2 ilustra los componentes de este marco tal y como se aplican a la práctica logopédica. Cada componente puede expresarse como un continuo o función. Un extremo del continuo indica un funcionamiento neutral o intacto; el otro indica una función completamente comprometida o una discapacidad (por ejemplo, incapacidad, limitación de la actividad, o restricción en la participación). Por ejemplo, el componente de Funciones y Estructuras Corporales tiene un continuo que comprende de la variación normal a la incapacidad total; las Actividades varían de la ausencia de limitación a la limitación completa; y la Participación varía de ausencia de restricción a restricción total. La segunda parte del marco del ICIDH-2 [ICF] se refiere a Factores Contextuales. Estos Factores Contextuales puede interaccionar con las Funciones y Estructuras Corporales, la Actividad y la Participación como facilitadores o barreras al funcionamiento. Los Factores Contextuales incluyen los siguientes componentes:

• Factores Ambientales: definidos como el medio físico, social y actitudinal en el que las personas viven.

• Factores Personales: incluyen características de la persona como edad, raza, género, nivel educativo, y estilo de vida. Aunque no están formalmente clasificados en el ICIDH-2 [ICF], los Factores Personales son reconocidos como relevantes para los resultados de la intervención.

El alcance de la práctica en logopedia reúne todos los componentes y factores identificados en el marco de la OMS. Es decir, que los logopedas

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trabajan para mejorar la calidad de vida mediante la reducción de déficits en las funciones y estructuras corporales, de las limitaciones a la actividad, de las restricciones a la participación, y de las barreras ambientales de los individuos a los que sirven. Sirven a personas que sufren enfermedades conocidas (por ejemplo, afasia, problemas en el paladar) así como a otras que sufren limitaciones en la actividad o restricciones en la participación (por ejemplo, personas que necesitan apoyo escolar o educación especial), incluso en el caso de que dichas limitaciones o restricciones ocurran en ausencia de enfermedades o trastornos conocidos (por ejemplo, con personas que posean dialectos diferentes). El papel del logopeda incluye la prevención de los trastornos de la comunicación, la deglución y las funciones aerodigestivas superiores, así como el diagnóstico, la habilitación, la rehabilitación y la mejora de dichas funciones.

Educación y Cualificaciones Los logopedas deben poseer un título de grado, un Certificado de Competencia Clínica (CCC-SLP) de la American Speech-Language-Hearing Association (ASHA), y en ciertas ocasiones, otra credenciales (por ejemplo, licencias estatales, certificación de enseñanza). Como proveedores de cuidados primarios para los trastornos de la comunicación, la deglución y las funciones aerodigestivas superiores, los logopedas son profesionales autónomos; es decir, que sus servicios no necesitan ser prescritos o supervisados por otros profesionales. Sin embargo, en numerosas ocasiones se ayuda mejor a las personas cuando los logopedas trabajan en colaboración con otros profesionales.

Alcance de Práctica La práctica de la Logopedia incluye la prevención, el diagnóstico, la habilitación y la rehabilitación de los trastornos de la comunicación, la deglución y las funciones aerodigestivas superiores; la modificación específica de los comportamientos comunicativos; y la mejora de la comunicación. Eso incluye servicios que responden a las dimensiones de estructura y función corporal, actividad y/o participación definidas por la Organización Mundial de la Salud (WHO, 2000). La práctica de la Logopedia implica:

1. Proveer servicios de prevención, evaluación, consultación, medición y diagnóstico, intervención, tratamiento, asesoramiento y seguimiento para trastornos de:

• El habla (por ejemplo, articulación, fluidez, resonancia y voz, incluyendo los componentes aeromecánicos de la respiración). • El lenguaje (por ejemplo, la fonología, la morfología, la sintaxis, y los aspectos pragmáticos/sociales de la comunicación), incluyendo la comprensión y la expresión en las modalidades oral, escrita, gráfica y manual; el procesamiento del lenguaje; habilidades de lectoescritura basadas en el lenguaje, incluyendo la conciencia fonológica; • La deglución u otras funciones aerodigestivas superiores como la alimentación infantil y los aspectos aeromecánicos (la evaluación de la función esofagal debe realizarse por derivación a profesionales médicos); • Los aspectos cognitivos de la comunicación (por ejemplo, la atención, la memoria, la solución de problemas o la función ejecutiva). • La conciencia sensorial relacionado con la comunicación, la deglución y otras funciones aerodigestivas superiores.

2. Establecer técnicas y estrategias de

comunicación aumentativa y alternativa incluyendo el desarrollo, selección y prescripción de dichos sistemas y dispositivos (por ejemplo, dispositivos de generación de voz).

3. Dar servicio a personas con pérdida auditiva y a sus familias/tutores (por ejemplo, entrenamiento en audición; lectura; intervención en habla y lenguaje secundarios a la pérdida; inspección visual y adaptación de sistemas de amplificación auditiva, incluyendo la verificación del voltaje de batería apropiado).

4. El screening de la audición de personas que pueden participar en métodos convencionales de conducción tonal aérea, así como el screening de patologías del oído medio mediante timpanometrías con el objetivo de derivar a las personas para evaluación adicional.

5. Utilizar instrumentación (por ejemplo, videofluoroscopia, EMG, nasendoscopia, estroboscopia y tecnologías informáticas)

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para observar, recoger datos, y medir los parámetros de la comunicación, la deglución y otras funciones aerodigestivas superiores, de acuerdo con los principios de la evidencia basada en evidencia.

6. Seleccionar, adaptar y establecer el uso efectivo de dispositivos prostéticos o adaptativos para la comunicación, la deglución y las funciones aerodigestivas superiores (por ejemplo, prótesis traqueoesofágicas, válvulas de habla, electrolaringes). No se incluyen aquí los dispositivos sensoriales utilizados por individuos con pérdida auditiva u otros déficits perceptuales auditivos.

7. Colaborar en la evaluación de alteraciones de la audición central y proporcionar intervención cuando existan evidencias de alteraciones del habla, el lenguaje y la comunicación.

8. Educar y aconsejar a individuos, familias, colegas, educadores y otras personas dentro de la comunidad respecto a la aceptación, la adaptación y la toma de decisiones sobre problemas de comunicación, deglución y otras alteraciones aerodigestivas superiores.

9. Apoyar a las personas a través de la concienciación comunitaria, la educación y programas de entrenamiento para promover y facilitar el acceso a una participación total en la comunicación, incluyendo la eliminación de barreras sociales.

10. Colaborar con y proveer información para audiologistas, educadores y profesionales de la salud en función de las necesidades de las personas.

11. Responder a comportamientos (por ejemplo, acciones perseverantes o disruptivas) y entornos que afectan la comunicación, la deglución u otras funciones aerodigestivas superiores.

12. Proporcionar servicios para modificar o mejorar el rendimiento comunicativo (por ejemplo, modificación de acentos, voz transexual, cuidado y mejora de la voz profesional, efectividad comunicativa personal/profesional).

13. Reconocer la necesidad de proporcionar y acomodar servicios diagnósticos y de tratamiento para individuos de distintos marcos culturales, y ajustar el tratamiento y la evaluación apropiadamente.

Roles y Actividades Profesionales Los logopedas ayudan a personas, familias, grupos y el público general a través de un amplio conjunto de actividades profesionales. Ellos:

• Identifican, definen y diagnostican alteraciones de la comunicación y la deglución, y ayudan en la localización y el diagnóstico de enfermedades y condiciones.

• Ofrecen servicios directos empleando una variedad de modelos para tratar o responder a problemas comunicativos, de deglución, o aerodigestivos.

• Llevan a cabo investigación relacionada con las ciencias y alteraciones de la comunicación, la deglución y otras funciones aerodigestivas.

• Educan, supervisan y tutorizan a futuros logopedas.

• Sirven como gestores de casos y coordinadores de servicios.

• Administran y controlan programas clínicos y académicos.

• Educan y proporcionan entrenamiento a familias, tutores y otros profesionales.

• Participan en actividades de evaluación de resultados y utilizan datos para guiar la toma de decisiones clínicas y determinan la efectividad de los servicios proporcionados, de acuerdo con los principios de la práctica basada en evidencias.

• Entrenan, supervisan y controlan a ayudantes de logopedia y a otro personal de apoyo.

• Promueven prácticas saludables para la prevención de trastornos de la comunicación, la audición, la deglución, y otros problemas aerodigestivos superiores.

• Promover la percepción pública de los trastornos del habla, el lenguaje, la audición y la deglución, así como de sus tratamiento.

• Apoyar a nivel local, regional y nacional para conseguir el acceso y la subvención de servicios que permitan responder a problemas de la comunicación, la audición, la deglución, y otros trastornos aerodigestivos.

• Sirven como testigos expertos. • Colaboran con audiologistas para

identificar niños y neonatos en riesgo de pérdida auditiva.

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• Reconocen las necesidades especiales de poblaciones culturalmente diversas mediante la provisión de servicios que están libres de sesgos potenciales, lo que incluye la selección y/o adaptación de los materiales para asegurar una sensibilidad étnica y lingüística.

• Ofrecen servicios a través de medidas diagnósticas y metodologías de tratamiento tele-electrónicas (incluyendo aplicaciones remotas).

Ámbitos de Práctica Los logopedas ofrecen servicios en una amplia variedad de ámbitos, que puede incluir de forma no exclusiva los siguientes:

• Escuelas públicas y privadas. • Entornos médicos (por ejemplo

hospitales, instalaciones de rehabilitación médica, instalaciones de ayuda a largo plazo, agencias de atención a domicilio, clínicas comunitarias, instalaciones de salud conductual/mental).

• Entornos de práctica privada. • Universidades y clínicas universitarias. • Hogares de los pacientes. • Hogares grupales y talleres. • Unidades de cuidados intensivos

neonatales, entornos de intervención temprana, guarderías, y centros de día.

• Agencias e instituciones comunitarias y estatales.

• Instituciones correccionales. • Instalaciones de investigación. • Entornos corporativos e industriales.

Referencias y Lista de Recursos Generales

American Speech-Language-Hearing Association. (1986, May). The autonomy of speech-language pathology and audiology. Asha, 28, 53–57. American Speech-Language-Hearing Association. (1992). Sedation and topical anesthetics in audiology and speech-language pathology. Asha, 34 (Suppl. 7), 41–42. American Speech-Language-Hearing Association. (1993). Definition of communication disorders and variations. Asha, 35 (Suppl. 10), 40–41. American Speech-Language-Hearing Association. (1993). Guidelines for caseload size and speech-language pathology service delivery in the school. Asha, 35 (Suppl. 10), 33–39. American Speech-Language-Hearing Association. (1994). Admission/discharge criteria in speech-

language pathology. Unpublished report. Rockville, MD: Author. American Speech-Language-Hearing Association. (1994). Code of ethics. Asha, 36 (Suppl. 13), 1–2. under revision American Speech-Language-Hearing Association. (1996). Inclusive practices for children and youths with communication disorders. Asha, 38 (Suppl. 16), 35–44. American Speech-Language-Hearing Association. (1996). Scope of practice in audiology. Asha, 38 (Suppl. 16), 12–15. American Speech-Language-Hearing Association. (1997). Position statement and technical report: Multiskilled personnel. Asha, 39 (Suppl. 17), 13. American Speech-Language-Hearing Association. (1997). Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: Author. American Speech-Language-Hearing Association. (1999). Guidelines for the roles and responsibilities of the school-based speech-language pathologist. Rockville, MD: Author. American Speech-Language-Hearing Association. (2000). IDEA and your caseload: A template for eligibility and dismissal criteria for students ages 3 to 21. Rockville, MD: Author. Council on Professional Standards in Speech-Language Pathology and Audiology. (2000). Speech-language pathology certification standards. Rockville, MD: Author. World Health Organization. (2000). International classification of functioning, disability and health: Prefinal draft. Geneva, Switzerland: Author. Comunicación Aumentativa y Alternativa American Speech-Language-Hearing Association. (1989). Competencies for speech-language pathologists providing services in augmentative communication. Asha, 31 (3), 107–110. American Speech-Language-Hearing Association. (1991). Augmentative and alternative communication. Asha, 33 (Suppl. 5), 8. American Speech-Language-Hearing Association. (1991). Report: Augmentative and alternative communication. Asha, 33 (Suppl. 5), 9–12. American Speech-Language-Hearing Association. (1998). Maximizing the provision of appropriate technology services and devices for students in schools. Asha, 40 (Suppl. 18), 33–42. National Joint Committee for the Communicative Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons withsevere disabilities. Asha, 34 (Suppl. 7), 1–8.

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Aspectos Cognitivos de la Comunicación

American Speech-Language-Hearing Association. (1982). Serving the communicatively handicapped mentally retarded individual. Asha, 24 (8), 547–553. American Speech-Language-Hearing Association. (1987). The role of speech-language pathologists in the habilitation and rehabilitation of cognitively impaired individuals. Asha, 29 (6), 53–55. American Speech-Language-Hearing Association. (1988). Mental retardation and developmental disabilities curriculum guide for speech-language pathologists and audiologists. ASHA Desk Reference, vol. 4, 185–189. American Speech-Language-Hearing Association. (1988). The role of speech-language pathologists in the identification, diagnosis, and treatment of individuals with cognitive-communicative impairments. Asha, 30 (3), 79. American Speech-Language-Hearing Association. (1990). Interdisciplinary approaches to brain damage. Asha, 32 (Suppl. 2), 3. American Speech-Language-Hearing Association. (1990). The role of speech-language pathologists and audiologists in service delivery for persons with mental retardation and developmental disabilities in community settings. Asha, 32 (Suppl. 2), 5–6. American Speech-Language-Hearing Association. (1991). Guidelines for speech-language pathologists serving persons with language, socio-communicative and/or cognitive-communicative impairments. Asha, 33 (Suppl. 5), 21–28. American Speech-Language-Hearing Association. (1995). Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Asha, 37 (Suppl. 14), 23. Sordera y Pérdida Auditiva

American Speech-Language-Hearing Association. (1984). Competencies for aural rehabilitation. Asha, 26 (5), 37–41. American Speech-Language-Hearing Association. (1990). Aural rehabilitation: an annotated bibliography. Asha, 32 (Suppl. 1), 1–12. American Speech-Language-Hearing Association. (1994, August). Service provision under the Individuals with Disabilities Education Act–Part H, as Amended (IDEA– Part H) to children who are deaf and hard of hearing ages birth to 36 months. Asha, 36, 117–121. Screening de la Audición

American National Standards Institute. (1996). Specifications for audiometers (ANSI S3.6.-1996). New York: Acoustical Society of America.

American National Standards Institute. (1991). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-1991). New York: Acoustical Society of America. American Speech-Language-Hearing Association. (1994). Clinical practice by certificate holders in the profession in which they are not certified. Asha, 36 (13), 11–12. American Speech-Language-Hearing Association. (1997). Guidelines for audiologic screening. Rockville, MD: Author. Joint Committee on Infant Hearing. (2000). Year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs. American Journal of Audiology, 9, 9–29. Lenguaje y Lectoescritura

American Speech-Language-Hearing Association. (1982). Definition of language. Asha, 24 (6), 44. American Speech-Language-Hearing Association. (1982). Position statement on language learning disorders. Asha, 24 (11), 937–944. American Speech-Language-Hearing Association. (1989). Issues in determining eligibility for language intervention. Asha, 31 (3), 113–118. American Speech-Language-Hearing Association. (1991). A model for collaborative service delivery for students with language-learning disorders in the public schools. Asha, 33 (Suppl. 5), 44–50. American Speech-Language-Hearing Association. (1991). Guidelines for speech-language pathologists serving persons with language, socio-communicative and/or cognitive-communicative impairments. Asha, 33 (Suppl. 5), 21–28. American Speech-Language-Hearing Association Task Force on Central Auditory Processing Consensus Development. (1995). Central auditory processing: Current status of research and implications for clinical practice. Rockville, MD: ASHA. American Speech-Language-Hearing Association. (2000). Guidelines on the roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents. Rockville, MD: Author. American Speech-Language-Hearing Association. (2000). Position statement on the roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents. Rockville, MD: Author. American Speech-Language-Hearing Association. (2000). Technical report on the roles and responsibilities of speech-language pathologists with respect to reading and writing in

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children and adolescents. Rockville, MD: Author. National Joint Committee on Learning Disabilities. (1989). Communication-based services for infants, toddlers, and their families. ASHA Desk Reference, vol. 3, 159–163. Aspectos Multiculturales

American Speech-Language-Hearing Association. (1983). Social dialects (and implications). Asha, 25 (9), 23–27. American Speech-Language-Hearing Association. (1985). Clinical management of communicatively handicapped minority language populations. Asha, 27 (6), 29–32. American Speech-Language-Hearing Association. (1989). Bilingual speech-language pathologists and audiolo- gists. Asha, 31, 93. American Speech-Language-Hearing Association. (1998). Provision of English-as-a-second-language instruction by speech-language pathologists in school settings: Position statement and technical report. Asha, 40 (Suppl. 18), 24–27. Prevención

American Speech-Language-Hearing Association. (1982). Prevention of speech, language, hearing problems. Asha, 24, 425, 431. American Speech-Language-Hearing Association. (1988, March). Prevention of communication disorders. Asha, 30, 90. American Speech-Language-Hearing Association. (1991). The prevention of communication disorders tutorial. Asha, 33 (Suppl. 6), 15–41. Investigación American Speech-Language-Hearing Association. (1992). Ethics in research and professional practice. Asha, 34 (Suppl. 9), 11–12. Habla: Articulación, Fluencia, Voz, Resonancia

American Speech-Language-Hearing Association. (1992). Position statement and guidelines for evaluation and treatment for tracheoesophageal fistulization/puncture. Asha, 34 (Suppl. 7), 17–21. American Speech-Language-Hearing Association. (1992). Position statement and guidelines for vocal tract visualization and imaging. Asha, 34 (Suppl. 7), 31–40. American Speech-Language-Hearing Association. (1993). Position statement and guidelines for oral and oropharyngeal prostheses. Asha, 35 (Suppl. 10), 14–16. American Speech-Language-Hearing Association. (1993). Position statement and guidelines on the use of voice prostheses in tracheotomized persons with or without

ventilatory dependence. Asha, 35 (Suppl. 10), 17–20. American Speech-Language-Hearing Association. (1993). The role of the speech-language pathologist and teacher of voice in the remediation of singers with voice disorders. Asha, 35 (1), 63. American Speech-Language-Hearing Association. (1995, March). Guidelines for practice in stuttering treatment. Asha, 37 (Suppl. 14), 26–35. American Speech-Language-Hearing Association. (1998). Roles of otolaryngologists and speech-language pathologists in the performance and interpretation of strobovideolaryngoscopy. Asha, 40 (Suppl. 18), 32. ASHA Special Interest Division 3: Voice and Voice Disorders. (1997). Training guidelines for laryngeal videoendoscopy/stroboscopy. Unpublished report. Rockville: MD. Author. Supervisión American Speech-Language-Hearing Association. (1985). Clinical supervision in speech-language pathology and audiology. Asha, 28 (6), 57–60. American Speech-Language-Hearing Association. (1989). Preparation models for the supervisory process in speech-language pathology and audiology. Asha, 32 (3), 97–106. American Speech-Language-Hearing Association. (1992). Supervision of student clinicians. Asha, 34 (Suppl. 9), 8. American Speech-Language-Hearing Association. (1992). Clinical fellowship supervisor’s responsibilities. Asha, 34 (Suppl. 9), 16–17. American Speech-Language-Hearing Association. (1996, Spring). Guidelines for the training, credentialing, use, and supervision of speech-language pathology assistants. Asha, 38 (Suppl. 16), 21–34. American Speech-Language-Hearing Association. (in preparation). Knowledge and skills for supervision of speech-language pathology assistants. Deglución/Función Aerodigestiva

American Speech-Language-Hearing Association. (1987). Ad hoc committee on dysphagia report. Asha, 29 (4), 57–58. American Speech-Language-Hearing Association. (1989). Report: Ad hoc committee on labial-lingual posturing function. Asha, 31 (11), 92–94. American Speech-Language-Hearing Association. (1990). Knowledge and skills needed by speech-language pathologists providing services to dysphagic patients/ clients. Asha, 32 (Suppl. 2), 7–12. American Speech-Language-Hearing Association. (1991). The role of the speech-language

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pathologist in assessment and management of oral myofunctional disorders. Asha, 33 (Suppl. 5), 7. American Speech-Language-Hearing Association. (1992). Position statement and guidelines for instrumental diagnostic procedures for swallowing, Asha, 34 (Suppl. 7), 25–33. American Speech-Language-Hearing Association. (1993). Orofacial myofunctional disorders: knowledge and skills. Asha, 35 (Suppl. 10), 21–23. American Speech-Language-Hearing Association. (2000). Clinical indicators for instrumental assessment of dysphagia (guidelines): Executive summary. ASHA Suppl. 20, 18–9. American Speech-Language-Hearing Association. (2000). Roles of the speech-language pathologist and otolaryngologist in the performance and interpretation of endoscopic examination of swallowing (position statement). ASHA Suppl. 20, 17. ASHA Special Interest Division 13: Swallowing and Swallowing Disorders (Dysphagia). (1997). Graduate curriculum on swallowing and swallowing disorders (adult and pediatric dysphagia). ASHA Desk Reference, vol. 3, 248a–248n.

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Scope of Practice in Speech-LanguagePathology

Ad Hoc Committee on the Scope of Practice in Speech-Language Pathology

Reference this material as: American Speech-Language-Hearing Association. (2007). Scope of Practice inSpeech-Language Pathology [Scope of Practice]. Available from www.asha.org/policy.

Index terms: scope of practice

doi:10.1044/policy.SP2007-00283

© Copyright 2007 American Speech-Language-Hearing Association. All rights reserved.

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, oravailability of these documents, or for any damages arising out of the use of the documents and any information they contain.

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About ThisDocument

This scope of practice document is an official policy of the American Speech-Language-Hearing Association (ASHA) defining the breadth of practice withinthe profession of speech-language pathology. This document was developed bythe ASHA Ad Hoc Committee on the Scope of Practice in Speech-LanguagePathology. Committee members were Kenn Apel (chair), Theresa E. Bartolotta,Adam A. Brickell, Lynne E. Hewitt, Ann W. Kummer, Luis F. Riquelme, JenniferB. Watson, Carole Zangari, Brian B. Shulman (vice president for professionalpractices in speech-language pathology), Lemmietta McNeilly (ex officio), andDiane R. Paul (consultant). This document was approved by the ASHA LegislativeCouncil on September 4, 2007 (LC 09-07).

****

Introduction The Scope of Practice in Speech-Language Pathology includes a statement ofpurpose, a framework for research and clinical practice, qualifications of thespeech-language pathologist, professional roles and activities, and practicesettings. The speech-language pathologist is the professional who engages inclinical services, prevention, advocacy, education, administration, and research inthe areas of communication and swallowing across the life span from infancythrough geriatrics. Given the diversity of the client population, ASHA policyrequires that these activities are conducted in a manner that takes into considerationthe impact of culture and linguistic exposure/acquisition and uses the best availableevidence for practice to ensure optimal outcomes for persons with communicationand/or swallowing disorders or differences.

As part of the review process for updating the Scope of Practice in Speech-Language Pathology, the committee made changes to the previous scope ofpractice document that reflected recent advances in knowledge, understanding, andresearch in the discipline. These changes included acknowledging roles andresponsibilities that were not mentioned in previous iterations of the Scope ofPractice (e.g., funding issues, marketing of services, focus on emergencyresponsiveness, communication wellness). The revised document also was framedsquarely on two guiding principles: evidence-based practice and cultural andlinguistic diversity.

Statement of Purpose The purpose of this document is to define the Scope of Practice in Speech-Language Pathology to

1. delineate areas of professional practice for speech-language pathologists;2. inform others (e.g., health care providers, educators, other professionals,

consumers, payers, regulators, members of the general public) aboutprofessional services offered by speech-language pathologists as qualifiedproviders;

3. support speech-language pathologists in the provision of high-quality,evidence-based services to individuals with concerns about communication orswallowing;

4. support speech-language pathologists in the conduct of research;5. provide guidance for educational preparation and professional development of

speech-language pathologists.

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This document describes the breadth of professional practice offered within theprofession of speech-language pathology. Levels of education, experience, skill,and proficiency with respect to the roles and activities identified within this scopeof practice document vary among individual providers. A speech-languagepathologist typically does not practice in all areas of the field. As the ASHA Codeof Ethics specifies, individuals may practice only in areas in which they arecompetent (i.e., individuals' scope of competency), based on their education,training, and experience.

In addition to this scope of practice document, other ASHA documents providemore specific guidance for practice areas. Figure 1 illustrates the relationshipbetween the ASHA Code of Ethics, the Scope of Practice, and specific practicedocuments. As shown, the ASHA Code of Ethics sets forth the fundamentalprinciples and rules considered essential to the preservation of the higheststandards of integrity and ethical conduct in the practice of speech-languagepathology.

Speech-language pathology is a dynamic and continuously developing profession.As such, listing specific areas within this Scope of Practice does not excludeemerging areas of practice. Further, speech-language pathologists may provideadditional professional services (e.g., interdisciplinary work in a health caresetting, collaborative service delivery in schools, transdisciplinary practice in earlyintervention settings) that are necessary for the well-being of the individual(s) they

Figure 1. Conceptual Framework of ASHA Practice Documents

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are serving but are not addressed in this Scope of Practice. In such instances, it isboth ethically and legally incumbent upon professionals to determine whether theyhave the knowledge and skills necessary to perform such services.

This scope of practice document does not supersede existing state licensure lawsor affect the interpretation or implementation of such laws. It may serve, however,as a model for the development or modification of licensure laws.

Framework forResearch and

Clinical Practice

The overall objective of speech-language pathology services is to optimizeindividuals' ability to communicate and swallow, thereby improving quality of life.As the population profile of the United States continues to become increasinglydiverse (U.S. Census Bureau, 2005), speech-language pathologists have aresponsibility to be knowledgeable about the impact of these changes on clinicalservices and research needs. Speech-language pathologists are committed to theprovision of culturally and linguistically appropriate services and to theconsideration of diversity in scientific investigations of human communication andswallowing. For example, one aspect of providing culturally and linguisticallyappropriate services is to determine whether communication difficultiesexperienced by English language learners are the result of a communicationdisorder in the native language or a consequence of learning a new language.

Additionally, an important characteristic of the practice of speech-languagepathology is that, to the extent possible, clinical decisions are based on bestavailable evidence. ASHA has defined evidence-based practice in speech-language pathology as an approach in which current, high-quality researchevidence is integrated with practitioner expertise and the individual's preferencesand values into the process of clinical decision making (ASHA, 2005). A high-quality basic, applied, and efficacy research base in communication sciences anddisorders and related fields of study is essential to providing evidence-basedclinical practice and quality clinical services. The research base can be enhancedby increased interaction and communication with researchers across the UnitedStates and from other countries. As our global society is becoming more connected,integrated, and interdependent, speech-language pathologists have access to anabundant array of resources, information technology, and diverse perspectives andinfluence (e.g., Lombardo, 1997). Increased national and international interchangeof professional knowledge, information, and education in communication sciencesand disorders can be a means to strengthen research collaboration and improveclinical services.

The World Health Organization (WHO) has developed a multipurpose healthclassification system known as the International Classification of Functioning,Disability and Health (ICF; WHO, 2001). The purpose of this classification systemis to provide a standard language and framework for the description of functioningand health. The ICF framework is useful in describing the breadth of the role of

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the speech-language pathologist in the prevention, assessment, and habilitation/rehabilitation, enhancement, and scientific investigation of communication andswallowing. It consists of two components:

• Health Conditionsº Body Functions and Structures: These involve the anatomy and physiology

of the human body. Relevant examples in speech-language pathologyinclude craniofacial anomaly, vocal fold paralysis, cerebral palsy,stuttering, and language impairment.

º Activity and Participation: Activity refers to the execution of a task oraction. Participation is the involvement in a life situation. Relevantexamples in speech-language pathology include difficulties withswallowing safely for independent feeding, participating actively in class,understanding a medical prescription, and accessing the general educationcurriculum.

• Contextual Factorsº Environmental Factors: These make up the physical, social, and attitudinal

environments in which people live and conduct their lives. Relevantexamples in speech-language pathology include the role of thecommunication partner in augmentative and alternative communication,the influence of classroom acoustics on communication, and the impact ofinstitutional dining environments on individuals' ability to safely maintainnutrition and hydration.

º Personal Factors: These are the internal influences on an individual'sfunctioning and disability and are not part of the health condition. Thesefactors may include, but are not limited to, age, gender, ethnicity,educational level, social background, and profession. Relevant examplesin speech-language pathology might include a person's background orculture that influences his or her reaction to a communication orswallowing disorder.

The framework in speech-language pathology encompasses these healthconditions and contextual factors. The health condition component of the ICF canbe expressed on a continuum of functioning. On one end of the continuum is intactfunctioning. At the opposite end of the continuum is completely compromisedfunctioning. The contextual factors interact with each other and with the healthconditions and may serve as facilitators or barriers to functioning. Speech-language pathologists may influence contextual factors through education andadvocacy efforts at local, state, and national levels. Relevant examples in speech-language pathology include a user of an augmentative communication deviceneeding classroom support services for academic success, or the effects ofpremorbid literacy level on rehabilitation in an adult post brain injury. Speech-language pathologists work to improve quality of life by reducing impairments ofbody functions and structures, activity limitations, participation restrictions, andbarriers created by contextual factors.

Qualifications Speech-language pathologists, as defined by ASHA, hold the ASHA Certificateof Clinical Competence in Speech-Language Pathology (CCC-SLP), whichrequires a master's, doctoral, or other recognized postbaccalaureate degree. ASHA-certified speech-language pathologists complete a supervised postgraduateprofessional experience and pass a national examination as described in the ASHAcertification standards. Demonstration of continued professional development is

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mandated for the maintenance of the CCC-SLP. Where applicable, speech-language pathologists hold other required credentials (e.g., state licensure, teachingcertification).

This document defines the scope of practice for the field of speech-languagepathology. Each practitioner must evaluate his or her own experiences withpreservice education, clinical practice, mentorship and supervision, and continuingprofessional development. As a whole, these experiences define the scope ofcompetence for each individual. Speech-language pathologists may engage in onlythose aspects of the profession that are within their scope of competence.

As primary care providers for communication and swallowing disorders, speech-language pathologists are autonomous professionals; that is, their services are notprescribed or supervised by another professional. However, individuals frequentlybenefit from services that include speech-language pathologist collaborations withother professionals.

Professional Rolesand Activities

Speech-language pathologists serve individuals, families, and groups from diverselinguistic and cultural backgrounds. Services are provided based on applying thebest available research evidence, using expert clinical judgments, and consideringclients' individual preferences and values. Speech-language pathologists addresstypical and atypical communication and swallowing in the following areas:

• speech sound productionº articulationº apraxia of speechº dysarthriaº ataxiaº dyskinesia

• resonanceº hypernasalityº hyponasalityº cul-de-sac resonanceº mixed resonance

• voiceº phonation qualityº pitchº loudnessº respiration

• fluencyº stutteringº cluttering

• language (comprehension and expression)º phonologyº morphologyº syntaxº semanticsº pragmatics (language use, social aspects of communication)º literacy (reading, writing, spelling)º prelinguistic communication (e.g., joint attention, intentionality,

communicative signaling)º paralinguistic communication

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• cognitionº attentionº memoryº sequencingº problem solvingº executive functioning

• feeding and swallowingº oral, pharyngeal, laryngeal, esophagealº orofacial myology (including tongue thrust)º oral-motor functions

Potential etiologies of communication and swallowing disorders include• neonatal problems (e.g., prematurity, low birth weight, substance exposure);• developmental disabilities (e.g., specific language impairment, autism

spectrum disorder, dyslexia, learning disabilities, attention deficit disorder);• auditory problems (e.g., hearing loss or deafness);• oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-

motor dysfunction);• respiratory compromise (e.g., bronchopulmonary dysplasia, chronic

obstructive pulmonary disease);• pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal

insufficiency/incompetence);• laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis,

tracheostomy);• neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy,

cerebral vascular accident, dementia, Parkinson's disease, amyotrophic lateralsclerosis);

• psychiatric disorder (e.g., psychosis, schizophrenia);• genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome,

velocardiofacial syndrome).

The professional roles and activities in speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment), preventionand advocacy, and education, administration, and research.

Clinical Services Speech-language pathologists provide clinical services that include the following:• prevention and pre-referral• screening• assessment/evaluation• consultation• diagnosis• treatment, intervention, management• counseling• collaboration• documentation• referral

Examples of these clinical services include1. using data to guide clinical decision making and determine the effectiveness

of services;

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2. making service delivery decisions (e.g., admission/eligibility, frequency,duration, location, discharge/dismissal) across the lifespan;

3. determining appropriate context(s) for service delivery (e.g., home, school,telepractice, community);

4. documenting provision of services in accordance with accepted proceduresappropriate for the practice setting;

5. collaborating with other professionals (e.g., identifying neonates and infantsat risk for hearing loss, participating in palliative care teams, planning lessonswith educators, serving on student assistance teams);

6. screening individuals for hearing loss or middle ear pathology usingconventional pure-tone air conduction methods (including otoscopicinspection), otoacoustic emissions screening, and/or screening tympanometry;

7. providing intervention and support services for children and adults diagnosedwith speech and language disorders;

8. providing intervention and support services for children and adults diagnosedwith auditory processing disorders;

9. using instrumentation (e.g., videofluoroscopy, electromyography,nasendoscopy, stroboscopy, endoscopy, nasometry, computer technology) toobserve, collect data, and measure parameters of communication andswallowing or other upper aerodigestive functions;

10. counseling individuals, families, coworkers, educators, and other persons inthe community regarding acceptance, adaptation, and decision making aboutcommunication and swallowing;

11. facilitating the process of obtaining funding for equipment and services relatedto difficulties with communication and swallowing;

12. serving as case managers, service delivery coordinators, and members ofcollaborative teams (e.g., individualized family service plan andindividualized education program teams, transition planning teams);

13. providing referrals and information to other professionals, agencies, and/orconsumer organizations;

14. developing, selecting, and prescribing multimodal augmentative andalternative communication systems, including unaided strategies (e.g., manualsigns, gestures) and aided strategies (e.g., speech-generating devices, manualcommunication boards, picture schedules);

15. providing services to individuals with hearing loss and their families/caregivers (e.g., auditory training for children with cochlear implants andhearing aids; speechreading; speech and language intervention secondary tohearing loss; visual inspection and listening checks of amplification devicesfor the purpose of troubleshooting, including verification of appropriatebattery voltage);

16. addressing behaviors (e.g., perseverative or disruptive actions) andenvironments (e.g., classroom seating, positioning for swallowing safety orattention, communication opportunities) that affect communication andswallowing;

17. selecting, fitting, and establishing effective use of prosthetic/adaptive devicesfor communication and swallowing (e.g., tracheoesophageal prostheses,speaking valves, electrolarynges; this service does not include the selection orfitting of sensory devices used by individuals with hearing loss or otherauditory perceptual deficits, which falls within the scope of practice ofaudiologists; ASHA, 2004);

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18. providing services to modify or enhance communication performance (e.g.,accent modification, transgender voice, care and improvement of theprofessional voice, personal/professional communication effectiveness).

Prevention andAdvocacy

Speech-language pathologists engage in prevention and advocacy activities relatedto human communication and swallowing. Example activities include

1. improving communication wellness by promoting healthy lifestyle practicesthat can help prevent communication and swallowing disorders (e.g., cessationof smoking, wearing helmets when bike riding);

2. presenting primary prevention information to individuals and groups knownto be at risk for communication disorders and other appropriate groups;

3. providing early identification and early intervention services forcommunication disorders;

4. advocating for individuals and families through community awareness, healthliteracy, education, and training programs to promote and facilitate access tofull participation in communication, including the elimination of societal,cultural, and linguistic barriers;

5. advising regulatory and legislative agencies on emergency responsiveness toindividuals who have communication and swallowing disorders or difficulties;

6. promoting and marketing professional services;7. advocating at the local, state, and national levels for improved administrative

and governmental policies affecting access to services for communication andswallowing;

8. advocating at the local, state, and national levels for funding for research;9. recruiting potential speech-language pathologists into the profession;

10. participating actively in professional organizations to contribute to bestpractices in the profession.

Education,Administration, and

Research

Speech-language pathologists also serve as educators, administrators, andresearchers. Example activities for these roles include

1. educating the public regarding communication and swallowing;2. educating and providing in-service training to families, caregivers, and other

professionals;3. educating, supervising, and mentoring current and future speech-language

pathologists;4. educating, supervising, and managing speech-language pathology assistants

and other support personnel;5. fostering public awareness of communication and swallowing disorders and

their treatment;6. serving as expert witnesses;7. administering and managing clinical and academic programs;8. developing policies, operational procedures, and professional standards;9. conducting basic and applied/translational research related to communication

sciences and disorders, and swallowing.

Practice Settings Speech-language pathologists provide services in a wide variety of settings, whichmay include but are not exclusive to

1. public and private schools;

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2. early intervention settings, preschools, and day care centers;3. health care settings (e.g., hospitals, medical rehabilitation facilities, long-term

care facilities, home health agencies, clinics, neonatal intensive care units,behavioral/mental health facilities);

4. private practice settings;5. universities and university clinics;6. individuals' homes and community residences;7. supported and competitive employment settings;8. community, state, and federal agencies and institutions;9. correctional institutions;

10. research facilities;11. corporate and industrial settings.

References American Speech-Language-Hearing Association. (2004). Scope of practice in audiology.Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Evidence-based practice incommunication disorders [Position statement]. Available from www.asha.org/policy.

Lombardo, T. (1997, Spring). The impact of information technology: Learning, living, andloving in the future. The Labyrinth: Sharing Information on Learning Technologies. 5(2). Available from www.mcli.dist.maricopa.edu/LF/Spr97/spr97L8.html.

U.S. Census Bureau. (2005). Population profile of the United States: Dynamic version. Raceand Hispanic origin in 2005. Available from www.census.gov.

World Health Organization. (2001). International classification of functioning, disabilityand health. Geneva, Switzerland: Author.

Resources ASHA Cardinal DocumentsAmerican Speech-Language-Hearing Association. (2003). Code of ethics (Revised).

Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2004). Preferred practice patterns for

the profession of speech-language pathology. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2005). Standards for the certificate of

clinical competence in speech-language pathology. Available from www.asha.org/about/membership-certification/handbooks/slp/slp_standards.htm.

General Service Delivery IssuesAdmission/Discharge CriteriaAmerican Speech-Language-Hearing Association. (2004). Admission/discharge criteria in

speech-language pathology [Guidelines]. Available from www.asha.org/policy.

AutonomyAmerican Speech-Language-Hearing Association. (1986). Autonomy of speech-language

pathology and audiology [Relevant paper]. Available from www.asha.org/policy.

Culturally and Linguistically Appropriate ServicesAmerican Speech-Language-Hearing Association. (2002). American English dialects

[Technical report]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by

speech-language pathologists and audiologists to provide culturally and linguisticallyappropriate services [Knowledge and skills]. Available from www.asha.org/policy.

Definitions and TerminologyAmerican Speech-Language-Hearing Association. (1982). Language [Relevant paper].

Available from www.asha.org/policy.

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American Speech-Language-Hearing Association. (1986). Private practice [Definition].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (1993). Definition of communicationdisorders and variations [Definition]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (1998). Terminology pertaining tofluency and fluency disorders [Guidelines]. Available from www.asha.org/policy.

Evidence-Based PracticeAmerican Speech-Language-Hearing Association. (2004). Evidence-based practice in

communication disorders: An introduction [Technical report]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Evidence-based practice incommunication disorders: An introduction [Position statement]. Available fromwww.asha.org/policy.

Private PracticeAmerican Speech-Language-Hearing Association. (1990). Considerations for establishing

a private practice in audiology and/or speech-language pathology [Technical report].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (1991). Private practice [Technicalreport]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (1994). Professional liability and riskmanagement for the audiology and speech-language pathology professions [Technicalreport]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2002). Drawing cases for privatepractice from primary place of employment [Issues in ethics]. Available fromwww.asha.org/policy.

Professional Service ProgramsAmerican Speech-Language-Hearing Association. (2005). Quality indicators for

professional service programs in audiology and speech-language pathology [Qualityindicators]. Available from www.asha.org/policy.

Speech-Language Pathology AssistantsAmerican Speech-Language-Hearing Association. (2001). Knowledge and skills for

supervisors of speech-language pathology assistants [Knowledge and skills]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Guidelines for the training, use,and supervision of speech-language pathology assistants [Guidelines]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Support personnel [Issues inethics]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Training, use, and supervisionof support personnel in speech-language pathology [Position statement]. Available fromwww.asha.org/policy.

SupervisionAmerican Speech-Language-Hearing Association. (1985). Clinical supervision in speech-

language pathology and audiology [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Clinical fellowship supervisor'sresponsibilities [Issues in ethics]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Supervision of studentclinicians [Issues in ethics]. Available from www.asha.org/policy.

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Clinical Services and PopulationsApraxia of SpeechAmerican Speech-Language-Hearing Association. (2007). Childhood apraxia of speech

[Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech

[Technical report]. Available from www.asha.org/policy.

Auditory ProcessingAmerican Speech-Language-Hearing Association. (1995). Central auditory processing:

Current status of research and implications for clinical practice [Technical report].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). (Central) auditory processingdisorders [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). (Central) auditory processingdisorders—the role of the audiologist [Position statement]. Available fromwww.asha.org/policy.

Augmentative and Alternative Communication (AAC)American Speech-Language-Hearing Association. (1998). Maximizing the provision of

appropriate technology services and devices for students in schools [Technical report].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2001). Augmentative and alternativecommunication: Knowledge and skills for service delivery [Knowledge and skills].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists with respect to augmentative and alternativecommunication [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists with respect to augmentative and alternativecommunication [Technical report]. Available from www.asha.org/policy.

Aural RehabilitationAmerican Speech-Language-Hearing Association. (2001). Knowledge and skills required

for the practice of audiologic/aural rehabilitation [Knowledge and skills]. Availablefrom www.asha.org/policy.

Autism Spectrum DisordersAmerican Speech-Language-Hearing Association. (2006). Guidelines for speech-language

pathologists in diagnosis, assessment, and treatment of autism spectrum disordersacross the life span [Guidelines]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2006). Knowledge and skills needed byspeech-language pathologists for diagnosis, assessment, and treatment of autismspectrum disorders across the life span [Knowledge and skills]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2006). Principles for speech-languagepathologists in diagnosis, assessment, and treatment of autism spectrum disordersacross the life span [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2006). Roles and responsibilities ofspeech-language pathologists in diagnosis, assessment, and treatment of autismspectrum disorders across the life span [Position statement]. Available fromwww.asha.org/policy.

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Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Dawson, G., et al.(2000). Practice parameter: Screening and diagnosis of autism—report of the QualityStandards Subcommittee of the American Academy of Neurology and the ChildNeurology Society Neurology, 55, 468–479

Cognitive Aspects of CommunicationAmerican Speech-Language-Hearing Association. (1990). Interdisciplinary approaches to

brain damage [Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1995). Guidelines for the structure and

function of an interdisciplinary team for persons with brain injury [Guidelines].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2003). Evaluating and treatingcommunication and cognitive disorders: Approaches to referral and collaboration forspeech-language pathology and clinical neuropsychology [Technical report]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (2003). Rehabilitation of children andadults with cognitive-communication disorders after brain injury [Technical report].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Knowledge and skills needed byspeech-language pathologists providing services to individuals with cognitive-communication disorders [Knowledge and skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Roles of speech-languagepathologists in the identification, diagnosis, and treatment of individuals with cognitive-communication disorders: Position statement. Available from www.asha.org/policy.

Deaf and Hard of HearingAmerican Speech-Language-Hearing Association. (2004). Roles of speech-language

pathologists and teachers of children who are deaf and hard of hearing in thedevelopment of communicative and linguistic competence [Guidelines]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles of speech-languagepathologists and teachers of children who are deaf and hard of hearing in thedevelopment of communicative and linguistic competence [Position statement].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles of speech-languagepathologists and teachers of children who are deaf and hard of hearing in thedevelopment of communicative and linguistic competence [Technical report]. Availablefrom www.asha.org/policy.

DementiaAmerican Speech-Language-Hearing Association. (2005). The roles of speech-language

pathologists working with dementia-based communication disorders [Positionstatement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). The roles of speech-languagepathologists working with dementia-based communication disorders [Technical report].Available from www.asha.org/policy.

Early InterventionAmerican Speech-Language-Hearing Association. Roles and responsibilities of speech-

language pathologists in early intervention (in preparation). [Position statement,Technical report, Guidelines, and Knowledge and skills].

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National Joint Committee on Learning Disabilities (2006). Learning disabilities and youngchildren: Identification and intervention Available from www.ldonline.org/article/11511?theme=print.

FluencyAmerican Speech-Language-Hearing Association. (1995). Guidelines for practice in

stuttering treatment [Guidelines]. Available from www.asha.org/policy.

Hearing ScreeningAmerican Speech-Language-Hearing Association. (1997). Guidelines for audiologic

screening [Guidelines]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2004). Clinical practice by certificate

holders in the profession in which they are not certified [Issues in ethics]. Available fromwww.asha.org/policy.

Language and LiteracyAmerican Speech-Language-Hearing Association. (1981). Language learning disorders

[Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association and the National Association of School

Psychologists (1987). Identification of children and youths with language learningdisorders [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2000). Roles and responsibilities ofspeech-language pathologists with respect to reading and writing in children andadolescents [Guidelines]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2000). Roles and responsibilities ofspeech-language pathologists with respect to reading and writing in children andadolescents [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2000). Roles and responsibilities ofspeech-language pathologists with respect to reading and writing in children andadolescents [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2002). Knowledge and skills needed byspeech-language pathologists with respect to reading and writing in children andadolescents [Knowledge and skills]. Available from www.asha.org/policy.

Mental Retardation/Developmental DisabilitiesAmerican Speech-Language-Hearing Association. (2005). Knowledge and skills needed by

speech-language pathologists serving persons with mental retardation/developmentaldisabilities [Knowledge and skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Principles for speech-languagepathologists serving persons with mental retardation/developmental disabilities[Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Roles and responsibilities ofspeech-language pathologists serving persons withmental retardation/developmentaldisabilities [Guidelines]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Roles and responsibilities ofspeech-language pathologists serving persons withmental retardation/developmentaldisabilities [Position statement]. Available from www.asha.org/policy.

Orofacial Myofunctional DisordersAmerican Speech-Language-Hearing Association. (1989). Labial-lingual posturing

function [Technical report]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1991). The role of the speech-language

pathologist in assessment and management of oral myofunctional disorders [Positionstatement]. Available from www.asha.org/policy.

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American Speech-Language-Hearing Association. (1993). Orofacial myofunctionaldisorders [Knowledge and skills]. Available from www.asha.org/policy.

PreventionAmerican Speech-Language-Hearing Association. (1987). Prevention of communication

disorders [Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1987). Prevention of communication

disorders tutorial [Relevant paper]. Available from www.asha.org/policy.

Severe DisabilitiesNational Joint Committee for the Communication Needs of Persons With Severe

Disabilities. (1991). Guidelines for meeting the communication needs of persons withsevere disabilities. Available from www.asha.org/docs/html/GL1992-00201.html.

National Joint Committee for the Communication Needs of Persons With SevereDisabilities (2002). Access to communication services and supports: Concernsregarding the application of restrictive “eligibility” policies [Technical report].Available from www.asha.org/policy.

National Joint Committee for the Communication Needs of Persons With SevereDisabilities (2003). Access to communication services and supports: Concernsregarding the application of restrictive “eligibility” policies [Position statement].Available from www.asha.org/policy.

Social Aspects of CommunicationAmerican Speech-Language-Hearing Association. (1991). Guidelines for speech-language

pathologists serving persons with language, socio-communicative and/or cognitive-communicative impairments [Guidelines]. Available from www.asha.org/policy.

SwallowingAmerican Speech-Language-Hearing Association. (1992). Instrumental diagnostic

procedures for swallowing [Guidelines]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1992). Instrumental diagnostic

procedures for swallowing [Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (2000). Clinical indicators for

instrumental assessment of dysphagia [Guidelines]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2001). Knowledge and skills needed byspeech-language pathologists providing services to individuals with swallowing and/orfeeding disorders [Knowledge and skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2001). Knowledge and skills forspeech-language pathologists performing endoscopic assessment of swallowingfunctions [Knowledge and skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2001). Roles of speech-languagepathologists in swallowing and feeding disorders [Position statement]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2001). Roles of speech-languagepathologists in swallowing and feeding disorders [Technical report]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Guidelines for speech-languagepathologists performing videofluoroscopic swallowing studies. [Guidelines]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Knowledge and skills needed byspeech-language pathologists performing videofluoroscopic swallowing studiesAvailable from www.asha.org/policy.

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American Speech-Language-Hearing Association. (2004). Role of the speech-languagepathologist in the performance and interpretation of endoscopic evaluation ofswallowing [Guidelines]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Role of the speech-languagepathologist in the performance and interpretation of endoscopic evaluation ofswallowing [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Role of the speech-languagepathologist in the performance and interpretation of endoscopic evaluation ofswallowing [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Speech-language pathologiststraining and supervising other professionals in the delivery of services to individualswith swallowing and feeding disorders [Technical report]. Available fromwww.asha.org/policy.

Voice and ResonanceAmerican Speech-Language-Hearing Association. (1993). Oral and oropharyngeal

prostheses [Guidelines]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1993). Oral and oropharyngeal

prostheses [Position statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1993). Use of voice prostheses in

tracheotomized persons with or without ventilatory dependence [Guidelines]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (1993). Use of voice prostheses intracheotomized persons with or without ventilatory dependence [Position statement].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (1998). The roles of otolaryngologistsand speech-language pathologists in the performance and interpretation ofstrobovideolaryngoscopy [Relevant paper]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Evaluation and treatment fortracheoesophageal puncture and prosthesis [Technical report]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Knowledge and skills forspeech-language pathologists with respect to evaluation and treatment fortracheoesophageal puncture and prosthesis [Knowledge and skills]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists with respect to evaluation and treatment fortracheoesophageal puncture and prosthesis [Position statement]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Vocal tract visualization andimaging [Position statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Vocal tract visualization andimaging [Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). The role of the speech-languagepathologist, the teacher of singing, and the speaking voice trainer in voice habilitation[Technical report]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). The use of voice therapy in thetreatment of dysphonia [Technical report]. Available from www.asha.org/policy.

Health Care ServicesBusiness Practices in Health Care SettingsAmerican Speech-Language-Hearing Association. (2002). Knowledge and skills in business

practices needed by speech-language pathologists in health care settings [Knowledgeand skills]. Available from www.asha.org/policy.

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American Speech-Language-Hearing Association. (2004). Knowledge and skills in businesspractices for speech-language pathologists who are managers and leaders in healthcare organizations [Knowledge and skills]. Available from www.asha.org/policy.

MultiskillingAmerican Speech-Language-Hearing Association. (1996). Multiskilled personnel [Position

statement]. Available from www.asha.org/policy.American Speech-Language-Hearing Association. (1996). Multiskilled personnel

[Technical report]. Available from www.asha.org/policy.

Neonatal Intensive Care UnitAmerican Speech-Language-Hearing Association. (2004). Knowledge and skills needed by

speech-language pathologists providing services to infants and families in the NICUenvironment [Knowledge and skills]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists in the neonatal intensive care unit [Guidelines]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists in the neonatal intensive care unit [Position statement].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Roles and responsibilities ofspeech-language pathologists in the neonatal intensive care unit [Technical report].Available from www.asha.org/policy.

Sedation and AnestheticsAmerican Speech-Language-Hearing Association. (1992). Sedation and topical anesthetics

in audiology and speech-language pathology [Technical report]. Available fromwww.asha.org/policy.

TelepracticeAmerican Speech-Language-Hearing Association. (2004). Speech-language pathologists

providing clinical services via telepractice [Position statement]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Speech-language pathologistsproviding clinical services via telepractice [Technical report]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Knowledge and skills needed byspeech-language pathologists providing clinical services via telepractice [Technicalreport]. Available from www.asha.org/policy.

School ServicesCollaborationAmerican Speech-Language-Hearing Association. (1991). A model for collaborative

service delivery for students with language-learning disorders in the public schools[Relevant paper]. Available from www.asha.org/policy.

EvaluationAmerican Speech-Language-Hearing Association. (1987). Considerations for developing

and selecting standardized assessment and intervention materials [Technical report].Available from www.asha.org/policy.

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FacilitiesAmerican Speech-Language-Hearing Association. (2003). Appropriate school facilities for

students with speech-language-hearing disorders [Technical report]. Available fromwww.asha.org/policy.

Inclusive PracticesAmerican Speech-Language-Hearing Association. (1996). Inclusive practices for children

and youths with communication disorders [Position statement]. Available fromwww.asha.org/policy.

Roles and Responsibilities for School-Based PractitionersAmerican Speech-Language-Hearing Association. (1999). Guidelines for the roles and

responsibilities of the school-based speech-language pathologist [Guidelines].Available from www.asha.org/policy.

“Under the Direction of” RuleAmerican Speech-Language-Hearing Association. (2004). Medicaid guidance for speech-

language pathology services: Addressing the “under the direction of” rule [Positionstatement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Medicaid guidance for speech-language pathology services: Addressing the “under the direction of” rule [Technicalreport]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Medicaid guidance for speech-language pathology services: Addressing the “under the direction of” rule [Guidelines].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2005). Medicaid guidance for speech-language pathology services: Addressing the “under the direction of” rule [Knowledgeand skills]. Available from www.asha.org/policy.

WorkloadAmerican Speech-Language-Hearing Association. (2002). Workload analysis approach for

establishing speech-language caseload standards in the schools [Guidelines]. Availablefrom www.asha.org/policy.

American Speech-Language-Hearing Association. (2002). Workload analysis approach forestablishing speech-language caseload standards in the schools [Position statement].Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2002). Workload analysis approach forestablishing speech-language caseload standards in the schools [Technical report].Available from www.asha.org/policy.

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