I am a Speech-Language Pathologist (SLP) by training. I think SLPs are great! But I strongly believe that for children with hearing loss, not just any SLP will do. Why?
Speech-language pathology training programs in the United States are governed by the American Speech-Langauge Hearing Association’s Council on Academic Accreditation (ASHA CAA). In other countries with developed communication disorders professions, similar organizations exist (for example, SAC-OAC in Canada). Over the course of a prospective SLP’s training, the student must take coursework and participate in clinical experience related to the prevention, screening, assessment, and treatment of all communication disorders in all age groups. It’s a massive amount of information, and I believe that, by and large it’s an incredibly useful and well done way to train future leaders in our profession. However, at the end of the day, these programs produce SLPs who are generalists.
During my undergraduate and graduate career, I benefitted from a variety of clinical placement experiences. I spent time feeding babies in a NICU and feeding elderly stroke patients at a VA hospital. I assessed preschoolers for stuttering disorders and school children who couldn’t pronounce their /r/s. All of those placements taught me something, but none of them made me an expert.
Yet all SLPs graduate with the same degree — a Master’s of Science of Master’s of Arts (or, in some places, a Master’s of Education) in Speech-Language Pathology (or Communication Sciences and Disorders). All earn the same Certificate of Clinical Competence (CCC-SLP) from ASHA (or whatever their country’s accrediting agency is). That CCC-SLP says that the holder is qualified, within her scope of practice, to diagnose and treat disorders of speech, language, voice, feeding, fluency (stuttering), etc. etc. etc. Because of this, in theory, ALL SLPs can claim that they “have experience with hearing loss.”
And yes, to be certified as a Speech-Langauge Pathologist, graduates must have had experience in the prevention, screening, assessment, and treatment of hearing disorders. But what exactly does that “experience” entail? In some graduate programs, this may mean a bare minimum of required hours, and those hours could be spent working in a manual communication mode. It could also mean hours spent learning listening and spoken language techniques and practicing them under the guidance of a Listening and Spoken Language Specialist. All SLP graduate students will take at least one class on “aural rehabilitation” or “speech for the hearing impaired,” but who is teaching that course, and what is the outlook that is being presented? Preparation varies so wildly between programs. But they all get the same CCCs at the end. How is a consumer to know?
And this is where I think that schools, early intervention agencies, and private practices can sometimes start to pull the wool over parents’ eyes…
Schools will often argue that their staff SLP is qualified to work with a child with hearing loss to fulfill IEP goals because, after all, she “has experience working with children with hearing loss.” The school SLP, often a lovely but insanely overburdened woman, most often sees students in mixed groups assigned not by need, but by convenience. (Have you ever thought about the logistics of pulling a caseload of roughly 80+ children a week from their classes while making sure they don’t miss important academic material? It’s enough to make you pull your hair out.) A child with hearing loss may be placed in a group with a child who has articulation difficulties, a child with autism, and a child who stutters. Is this the ideal environment for growing listening and spoken language? And even if the child is fortunate enough to snag a coveted one-on-one session with the school SLP, did her one course in “speech for the hearing impaired” in graduate school prepare her to meet the needs of today’s child with hearing loss in the 21st century?
Early interventionists are also generalists by necessity. They travel to the homes of children ages birth to three and may visit the home of a child with Down syndrome, then to the house of a child with cerebral palsy, and then to the house of a child with a cochlear implant. Technically, yes, they are qualified to work with all three. But those three children have very, very different needs. Is one early interventionist just as good as the next?
SLPs in private practice can be guilty of this as well. If I had a dollar for every private practice SLP’s website with a “my specialties” tab that, when opened, reads like the index of a Communication Disorders 101 textbook, I’d be a millionaire many times over. How on earth am I supposed to believe that you have “expertise” in virtually every disorder under the sun?
So I am biased, but not out of lack of respect. I think there are really good professionals doing really good things for children and families all over the world. But I do not think that all of them are qualified to meet the needs of children with hearing loss and their families who choose listening and spoken language. I think it’s unethical and disingenuous for them to claim they can, just as it would be unethical and disingenuous for me to claim that my limited time spent observing swallow studies qualifies me to make life and death decisions for feeding patients about what is safe for them to eat.
Why do I believe that the services of a Listening and Spoken Language Specialist Certified Auditory Verbal Therapist are necessary?
LSLS Cert. AVTs go above and beyond the basic qualifications for a generalist SLP by participating in 900 hours of mentored auditory verbal practice and 80 additional hours of continuing education coursework. They are also required to keep up their continuing education hours to remain certified. This means that LSLS Cert. AVTs have demonstrated a commitment to furthering their knowledge in the field of listening and spoken language not once, but on a continual basis, so that their knowledge and skills keep pace with the rapidly-changing world of information about hearing loss. You want someone who is LSLS certified or who is in the process of certification under the guidance of a highly qualified mentor.
During their training, LSLS Cert. AVTs practice under the guidance of a mentor. They are constantly evaluating their own skills as well as working with seasoned, experienced AVT mentors who guide and coach them to improve their practice. You can’t be a “lone wolf” practicing whichever way feels best to you, whether or not it is based in research and evidence based practice.
To earn the LSLS Cert. AVT credential, applicants must pass a rigorous test. This standardized assessment gives families assurance of the quality of this professional’s knowledge and skills. Any SLP can claim “experience with hearing loss.” How many can prove it?
We know that it takes approximately 10,000 hours of practice to be able to perform a task or skill effortlessly, to really master something. If a generalist SLP is spending only a small portion of her day working with children with hearing loss, how is she accumulating those 10,000 hours of practice to become an “expert”? I simply don’t believe that you can be a jack of all trades AND a master of all trades. The field of speech-language pathology is HUGE, and only by focusing on a specialty can one truly excel for that patient population.
Study after study confirms that PARENTS are the key to successful outcomes for children with hearing loss. Listening and Spoken Language Specialists undergo hours of training on adult learning styles, parent coaching, and family-centered intervention. These topics are only briefly touched upon in a general SLP training program. You want someone who is going to train YOU to be the champion your child needs to succeed.
There are some SLPs who have been practicing in the field of hearing loss for years but have not earned the LSLS certification. They may claim that they do this exclusively and have continuing education in this field, but my question for them is… “Why haven’t you earned the credential yet? To whom are you accountable?” These people may be wonderful at what they do, but there’s no objective way to verify this without going through the LSLS Cert. AVT process. If they have been practicing in this field for years, the application process and test should be a snap. This attitude of “I’ve been doing it forever, I see no need to change” does not speak to the forward-thinking, research-driven mentality I feel that families deserve.