Speakup Blog

Introduction

For speech-language pathologists (SLPs) in the United States, meeting the need of individuals who use augmentative and alternative communication (AAC) is one of nine clinical topics and areas of clinical practice ("The Big Nine") for which SLPs provide evaluation and intervention (American Speech-Language-Hearing Association, 2000). AAC assessment, trials, and treatment are included in the SLP scope of practice as specified by the American Speech-Language-Hearing Association (ASHA), the certifying body for SLPs in the United States (ASHA, 2016). SLPs contribute communication expertise to the interprofessional AAC team, applying this knowledge to AAC decision making and advocating for the rights of individuals using AAC. However, SLPs' confidence and competence to deliver these services are frequently reported as a limitation to AAC services. Graduate programs report SLP students are not adequately prepared for AAC service delivery at the time of graduation (Johnson & Prebor, 2019). Practicing SLPs describe lack of knowledge and skill to effectively deliver AAC services (e.g., Assistive Technology Industry Association, 2017; De Bortoli et al., 2014; Ratcliff et al., 2008). This leaves the availability and quality of SLPs' AAC services in question.

In an effort to address these concerns, the American Board of Augmentative and Alternative Communication (AB-AAC) is developing a specialty certification in AAC. This petitioning group is currently in Stage 2 of the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) application process (ASHA, n.d.). The specialty certification aims to recognize SLPs with training and expertise for AAC service delivery. The AB-AAC has hosted information sessions at American Speech-Language-Hearing Association (ASHA) Conventions and Assistive Technology Industry Association (ATIA) Conferences to disseminate status updates and answer questions. Attendees have shared both support and concern about the introduction of an AAC specialty certification for SLPs and the long term impact on individuals using and receiving AAC services in the United States.

Two surveys support the implementation of an AAC specialty certification for SLPs. In a 2016 survey of the 4,111 ASHA Special Interest Group (SIG) 12 Augmentative and Alternative Communication members, 82.7% of the 1,507 respondents supported clinical specialty certification in AAC. In a 2018 survey of ASHA SIG 12 affiliates and ASHA-certified SLPs with AAC as an area of expertise fielded by CFCC's Committee on Clinical Specialty Certification (CCSC), 82.9% of the 3,875 respondents supported the development of an AAC specialty certification. However, the Stop AAC Specialty Certification work group, a collection of individuals involved in AAC service delivery, described concerns regarding the surveys, including statistical validity of the survey and the demographics of participants (Stop AAC Specialty Certification, n.d.). Did enough respondents complete the survey to make the data valid? Is it appropriate to only survey SLPs currently involved in AAC service delivery? Did respondents have access to proposed risks and benefits at the time of survey distribution? Are the surveys available for review and replication? What were the other survey questions?

Updates on AAC specialty certification

The AB-AAC and other AAC-related groups have shared the following updates and information about the proposed AAC specialty certification for SLPs

What is the purpose of the AAC specialty certification?

According to the AB-AAC, the purpose of the AAC specialty certification is to recognize ASHA-certified SLPs with specialized knowledge, skills, and training in the area of AAC.

What is the AAC specialty certification process?

The certification process will involve an application, collection of artifacts (clinical hours form, letters of recommendation, continuing education transcript, and CV/resume), the successful completion of a standardized test, and payment of fees. Certification will be maintained through a renewal application.

What is the timeline of AAC specialty certification?

As a result of pandemic-related delays, applications will be accepted mid-2023 and certifications will be awarded beginning in 2024. The standardized test, operations manual, specification of AAC-related competencies, and the fees for initial and ongoing certification are undergoing development.

What is the potential impact of the AAC specialty certification?

The potential impact of the AAC specialty certification remains largely unknown. AAC stakeholders have argued this remains a critical detail that requires resolution before moving forward with the AAC specialty certification for SLPs.

The AB-AAC proposed benefits of AAC specialty certification include reduced time, effort, and money required for the identification of qualified SLPs for AAC service delivery. Proponents suggest that through the development of AAC-related competencies, AAC specialty certification may contribute to a clearer distinction between AAC specialists and general practice SLPs, offering a streamlined process to access AAC specialists and increasing patient satisfaction with their AAC services. For AAC specialists, AAC specialty certification may be advantageous on the job market. General practice SLPs may identify specialist practitioners with greater ease, resulting in a streamlined referral process and an improved avenue for general practitioners to direct questions. Generalists may also more readily find AAC-related continuing education developed by AAC specialist SLPs to increase their knowledge and skill.

Critics, however, suggest that the distinction will likely decrease the availability of SLPs willing and able to work with individuals using AAC. General practice SLPs may decline AAC service delivery due to preference, lack of skill or competence, and/or funding restrictions. In my clinical practice, I've encountered many SLPs who "don't do AAC." If an AAC specialty certification exists, will these clinicians decline to provide AAC service delivery regardless of the availability of an AAC specialist in their geographic region? In the absence of SLP-provided AAC services, SLPs are at risk for encroachment on this area of practice by other members of the AAC team very willing to fill a critical gap in service delivery.

Unlike other board certifications for SLPs, the field of AAC requires both reimbursement for services as well as funding of equipment. After the implementation of the AAC specialty certification, payers may require this credential, mirroring the requirement for Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Assistive Technology Professional (ATP) credentials for funding of mobility equipment. The Stop AAC Specialty Certification work group described examples in which insurers have already required a specific level of AAC expertise to fund speech-generating devices, limiting access for individuals who use AAC to a much needed service and equipment (Stop AAC Specialty Certification, n.d.).

What have AAC-related groups shared about the AAC specialty certification?

Both The United States Society for Augmentative and Alternative Communication (USSAAC) and The National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) have written opposition statements to specialty certification. USSAAC calls for the AAC specialty certification development to be stopped due to the (1) absence of a statement of need or benefit, (2) the dismissal of potential harm following AAC specialty certification, (3) lack of consideration of alternative solutions with greater benefits and lesser risk, and (4) lack of transparency in the AAC specialty certification development process. The NJC describes the risk of decreased availability of AAC services and interprofessional practice following implementation of the AAC specialty certification. The NJC also requested that the CFCC withdraw the AB-AAC's approval to more thoroughly evaluate the need and potential impact of AAC specialty certification. The full statements are available here: https://www.stopaaccertification.org/stop-aac-specialty-certification/ussaac-opposition-statement/ and https://www.stopaaccertification.org/stop-aac-specialty-certification/njc-opposition-statement/

Conclusion

The field of AAC and the role of SLP in AAC service delivery is rapidly changing. Many questions remain about the rationale and potential repercussions as the result of the implementation of an AAC specialty certification for SLPs.

We are charged to advocate for the communication rights of all. This responsibility requires awareness of the AAC specialty certification development and thoughtful consideration of the risks and benefits of certification. I encourage you to remain aware of the status of the SLP AAC specialty certification in the coming months. Consider the information shared here and share your insight with USSAAC as a comment on this post or with the AB-AAC at info@aacspecialist.org. In addition, we must also be invested in the other potential avenues to improve SLPs' AAC service delivery in the United States, including preprofessional training and education, access to high quality and evidence-based post-professional training, and increased availability of funding for AAC services and speech-generating devices.

References

American Board of Augmentative and Alternative Communication (n.d.) The AB-AAC. www.aacspecialist.org

American Speech-Language-Hearing Association. (n.d.). Establishing a new clinical specialty area. https://www.asha.org/certification/establish-a-clinical-specialty-area/

American Speech-Language-Hearing Association. (2000). 2020 standards and implementation procedures for the certificate of clinical competence in speech-language pathology. https://www.asha.org/certification/2020-slp-certification-standards/

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. www.asha.org/policy/

Assistive Technology Industry Association. (2017). The critical need for knowledge and usage of AT and AAC among speech-language pathologists.https://www.atia.org/wp-content/uploads/2018/12/ATIA-SLP-Survey-2011.pdf

De Bortoli, T., Arthur-Kelly, M., Mathisen, B., & Balandin, S. (2014). Speech-language pathologists' perceptions of implementing communication intervention with students with multiple and severe disabilities. Augmentative and Alternative Communication, 30(1), 55–70. https://doi.org/10.3109/07434618.2014.881916

Johnson, R. K., & Prebor, J. (2019). Update on preservice training in augmentative and alternative communication for speech-language pathologists. American Journal of Speech-Language Pathology, 28(2), 536–549. https://doi.org/10.1044/2018_AJSLP-18-0004

Ratcliff, A., Koul, R., & Lloyd, L. L. (2008). Preparation in augmentative and alternative communication: An update for speech-language pathology training. American Journal of Speech-Language Pathology, 17(1), 48–59. https://doi.org/10.1044/1058-0360(2008/005)Stop AAC Specialty Certification (n.d.) Stop AAC specialty certification. https://www.stopaaccertification.org/