10 Recommended Clinical Computing Competencies for SLPs With the advent of telepractice and the notion of “cyber clinics” (Tanner, 2001) looming on the horizon, never has it been more important for clinicians to be well informed about the potential benefits and pitfalls of using computers directly with clients. “Clinical computing competency” refers to the effective use of ... Features
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Features  |   May 01, 2004
10 Recommended Clinical Computing Competencies for SLPs
Author Notes
  • Paula S. Cochran, is professor of communication disorders at Truman State University. In 1989 and 1990, she chaired ASHA’s Standing Committee on Educational Technology, where some of the issues in this article were originally discussed. She has published and presented widely on the topics of educational technology and clinical uses of computers. She is the author of the text Clinical Computing Competency for Speech-Language Pathologists (in press). Contact her by e-mail at paula@truman.edu.
    Paula S. Cochran, is professor of communication disorders at Truman State University. In 1989 and 1990, she chaired ASHA’s Standing Committee on Educational Technology, where some of the issues in this article were originally discussed. She has published and presented widely on the topics of educational technology and clinical uses of computers. She is the author of the text Clinical Computing Competency for Speech-Language Pathologists (in press). Contact her by e-mail at paula@truman.edu.×
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School-Based Settings / Professional Issues & Training / Regulatory, Legislative & Advocacy / Telepractice & Computer-Based Approaches / Speech, Voice & Prosody / Features
Features   |   May 01, 2004
10 Recommended Clinical Computing Competencies for SLPs
The ASHA Leader, May 2004, Vol. 9, 6-13. doi:10.1044/leader.FTR2.09102004.6
The ASHA Leader, May 2004, Vol. 9, 6-13. doi:10.1044/leader.FTR2.09102004.6
With the advent of telepractice and the notion of “cyber clinics” (Tanner, 2001) looming on the horizon, never has it been more important for clinicians to be well informed about the potential benefits and pitfalls of using computers directly with clients. “Clinical computing competency” refers to the effective use of technology for diagnostic and intervention purposes. In other words, clinical computing often involves clients directly, as opposed to administrative computing, which involves functions like report writing, billing, or generating an Individual Education Plan (IEP).
In some cases, telepractice involves not only remote services, but also computer-based activities that form part of the intervention plan. In addition to telepractice considerations, therefore, we should be asking what clinicians need to know in order to achieve clinical computing competency. Whether working with a client who is six inches away or 60 miles away, effective clinicians should make use of the same basic principles. It’s time to revisit the topic of what clinicians need to know about using technology for everyday clinical activities.
Members of ASHA have been considering the question of computer competencies for more than 20 years, since the advent of microcomputers made the topic important. At the pivotal 1985 American Speech-Language-Hearing Foundation Leadership Conference in Technology, participants were passionate about the technology skills that would be needed by the next generation of clinicians. Some were focused on “hardware skills” such as how to format a floppy (truly, floppy) disk. Some were focused on “software skills” and fervently debated just which computer programming language(s) clinicians should be required to know.
The cross-fertilization of ideas among early innovators and adopters was crucial, however, for finding a middle ground of use to many. A few years later, a starter set of suggested competencies was published in Asha magazine (Cochran et al., 1993). With this list, the authors took a decisive step in changing the focus away from computer literacy and the hardware versus software dichotomy. Instead, the focus shifted to how a clinician could use technology to fulfill a clinical purpose.
With an emphasis on clinical skills instead of computer literacy, the early list of clinical computing competencies held up remarkably well. The list has since been updated to include the areas of clinical computing competency outlined below. The notable absence of augmentative and alternative communication (AAC) was not an oversight. Clinicians providing AAC services could benefit from many of the competencies listed, but the scope and practice of AAC go well beyond this list and have been outlined by others elsewhere. There are 10 recommended broad clinical computing competencies that individual clinicians might achieve in any of a number of ways, depending upon their caseloads, their own interests, and their access to resources (Cochran, in press).
Clinical computing competency is not about being a computer expert, like good driving is not about being a car expert. Clinical computing competency depends more on sound clinical practices than it does on technical expertise. But this does not mean that we should expect clinicians to intuit what has been discovered by research or established by extensive clinical practice.
Although in-depth knowledge of computers isn’t a prerequisite, there is still much to learn about effective and appropriate use of these tools. New technology products and online innovations face clinicians every day. How can these be evaluated by professionals who may not be familiar with existing technology applications, their strengths and weaknesses, the existing literature, or the ethical considerations that might affect their implementation? As a profession, we must ensure that special measures are taken to prepare and support clinicians in making appropriate, ethical, and effective use of new technologies on behalf of their clients.
How can a clinician go about pursuing some or all of the competencies described below. There are more exciting and effective technology applications available for evaluation and intervention with clients than ever before. As summer approaches, it’s a good time to re-evaluate interests and skills and consider pursuing continuing education opportunities related to clinical computing competency. This might include participation in organized events (see sidebar on the right) and/or designing technology-related independent study plans for ASHA CEUs. State associations hold workshops and conferences, and clinicians should petition these and other continuing education sponsors for more help in this area. Individually, clinicians can share their own technology tips and expertise with colleagues. The Internet also offers ever-increasing information and support for clinicians pursuing clinical computing competency.
This article outlines competencies and provides some direction for clinicians who want to enhance their expertise and knowledge of technology. A decade ago, surveys of academic programs and school clinicians indicated an extensive need for more and better opportunities to acquire these skills (McRay & Fitch, 1996; Walz & Cochran, 1996). According to the U.S. Department of Education, school clinicians continue to report that instructional use of computers with students is an area in which they feel inadequately prepared. Within our field, we must work to address this need.
10 Recommended Clinical Computing Competencies
  1. Using a Computer as a Context for Conversation A computer activity serves as the topic and focus for conversation between the clinician and client(s).

  2. Using a Computer as an Instructor A self-contained computer activity provides instruction and/or practice for a client working independently.

  3. Using a Computer as a Clinical Materials Generator The clinician uses computer resources to develop individualized treatment materials with or without the client’s assistance.

  4. Using a Computer as a Feedback Device The computer provides additional feedback to the client, usually about articulation or voice parameters (e.g., visual biofeedback about pitch) under the supervision of the clinician.

  5. Using a Computer as a Clinical Data Assistant During assessment or intervention activities, the clinician uses a computer-based device to assist with data collection and/or analysis (e.g., handheld device is used to tabulate disfluencies).

  6. Using a Computer as a Diagnostic Tool During or after assessment activities, the clinician uses computer-based tools appropriately to assist with data collection, analysis, and/or interpretation (e.g., language sample analysis).

  7. Basic Computer Operations and Assistive Technology The clinician understands how to operate the software/hardware needed for use with clients and how to adapt computer access for clients who require this accommodation.

  8. Awareness of Relevant Legal and Ethical Issues The clinician abides by the laws and regulations that pertain to all forms of assistive technology and other relevant topics such as copyright law and confidentiality of client information.

  9. Awareness and Use of Technology Resources The clinician knows how and where to find information about new products and procedures, critical reviews, research results, and client support.

  10. Using a Computer as a Productivity Tool The clinician uses technology to maximize the efficiency and quality of clinical paperwork, communication, and client information management.

Based on content from Cochran, P. S. (in press). Clinical computing competency for speech-language pathologists. Baltimore, MD: Paul H. Brookes.

Putting Computing Competencies Into Practice

Most clinicians work in settings where at least some clients require alternatives to the traditional mouse and keyboard in order to use a computer. Competency with assistive technologies, including access alternatives, is a valuable clinical skill. Sometimes the client may have augmentative and alternative communication (AAC) needs as well, but often computer access is desirable primarily for rehabilitation, vocational, educational, or recreational purposes. This was the case for Robin, a 41-year-old traumatic brain injury (TBI) survivor.

Robin had mild-to-moderate dysarthria and extremely limited mobility due to bi-lateral upper and lower extremity weakness. She was anticipating a new wheelchair for improved positioning, but meanwhile she came to the clinic to investigate the use of speech recognition for computer control. Her personal goals for computer use included playing computer games, possible Internet access, and personal writing. Several access alternatives were discussed and attempted with Robin, including speech recognition. Robin had difficulty producing speech with clear phonation and consistent articulation. After several trials, Robin agreed that speech recognition was not going to be a usable alternative for her.

Clinicians often do not know enough about speech recognition technology to understand how valuable their input can be in determining good candidates for this technology. Articulation consistency, vocal stamina, breath support, and adequate loudness are some of the key characteristics that predict success with voice recognition technology.

Unfortunately, some assistive technology teams who might recommend speech recognition do not realize how helpful an SLP could be for commenting on these speaker attributes or predicting whether the client’s performance in speech recognition activities could be improved through speech treatment or other rehabilitation (such as breathing exercises).

Although speech recognition was not ideal for Robin, it was discovered that she had adequate head control to manage one of the many infrared devices that emulate a mouse. A state assistive technology equipment library provided a device for a trial period. Robin’s clinician used the Internet to obtain side-by-side comparisons of features and prices for Robin and her funding sources to consider before purchasing a device. Several clinical computing competencies were involved in managing Robin’s case. Her clinician explored computer access alternatives, used computer-based recreational activities as a context for evaluating access as well as articulation practice with Robin, and located information and resources for Robin via the Internet.

For More Information
Closing the Gap

Publishes a newsletter several times a year with technology updates that includes new product announcements, software reviews, and public policy information regarding technology and persons of all ages who have special needs for home, school, or the workplace. The CTG Web site offers online discussion forums that explore the many ways technology is being used in instruction and rehabilitation, and to enhance the lives of people with special needs. A national conference each fall is a major meeting of professionals, consumers, and developers of new technologies. Closing the Gap, P.O. Box 68, Henderson, MN 56044; 612-248-3294; www.closingthegap.com/.

International Society for Technology in Education

A non-profit organization for professionals interested in the use of technology in all aspects and levels of education. Notable publications include the Journal of Research on Computing in Education, Learning and Leading with Technology, and volumes related to the organization’s special interest groups. The ISTE sponsors the annual National Educational Computing Conference and the annual International Conference on Telecommunications and Multimedia in Education. ISTE, 480 Charnelton Street, Eugene, OR 97401-2626; 800-336-5191; http://iste.org/.

Assistive Technology Training Online Project

Web site provides information on AT applications that help students with disabilities learn in elementary classrooms. Selected special access and communication software, resources, and AT basics are included. Hosted by the School of Public Health and Health Professions and the Center for Assistive Technology at the State University of New York at Buffalo; http://atto.buffalo.edu/.

Simplified Technology by Linda Burkhart

A collection of links related to assistive technology, augmentative and alternative communication, and special populations; www.lburkhart.com/links.htm.

Rehabilitation Engineering and Assistive Technology Society of North America

An interdisciplinary association focused on promoting research, development, education, advocacy, and provision of technology to improve the potential of people with disabilities. The organization provides support for the people engaged in these activities through the Assistive Technology journal and other publications, an annual conference, and a credentialing program. RESNA offers a Fundamentals of Assistive Technology course throughout the year at locations around the country; www.resna.org/.

Center on Disability-California State University at Northridge

Disseminates information about disabilities and assistive technology through training programs, an annual conference, customized workshops, and electronic media. Offers a certificate program (ATACP) through a combination of online/live instruction; www.csun.edu/cod/.

Research Institute for Assistive and Training Technologies: Assistive Technology Training Programs

The National Association of the State Directors of Special Education offers a Competency Certificate program based upon the successful completion of various strands of courses. There are nine certificates focusing on specific areas of study, including a Communication Competency Certificate, intended for speech-language pathologists. Coursework is completed through distance education courses and on-site seminars related to specific assistive technology topics; www.nasdse.org/.

References and Resources

In March 2004, ASHA approved the following practice policy documents related to telepractice issues such as knowledge and skills for clinicians, ethics, licensure, liability, and reimbursement. The documents can be found in Volume III of the ASHA Online Desk Reference.

  • Audiologists providing clinical services via telepractice: Position statement.

  • Audiologists providing clinical services via telepractice: Technical report.

  • Speech-language pathologists providing clinical services via telepractice: Position statement.

  • Speech-language pathologists providing clinical services via telepractice: Technical report.

Cochran, P. S. (in press). Clinical computing competency for speech-language pathologists. Baltimore, MD: Paul H. Brookes.
Cochran, P. S. (in press). Clinical computing competency for speech-language pathologists. Baltimore, MD: Paul H. Brookes.×
Cochran, P. S., Masterson, J. J., Long, S. H., Katz, R., Seaton, W., Wynne, M., Lieberth, A., & Martin, D. (1993). Computer competencies for clinicians. Asha, 35(8), 48–49.
Cochran, P. S., Masterson, J. J., Long, S. H., Katz, R., Seaton, W., Wynne, M., Lieberth, A., & Martin, D. (1993). Computer competencies for clinicians. Asha, 35(8), 48–49.×
McRay, L. B., & Fitch, J. L. (1996). A survey of computer use by public school speech-language pathologists. Language, Speech, and Hearing Services in Schools, 27(1), 40–47. [Article]
McRay, L. B., & Fitch, J. L. (1996). A survey of computer use by public school speech-language pathologists. Language, Speech, and Hearing Services in Schools, 27(1), 40–47. [Article] ×
Tanner, D. C. (2001, Dec. 11). The brave new world of the cyber speech and hearing clinic. The ASHA Leader, pp. 6–7.
Tanner, D. C. (2001, Dec. 11). The brave new world of the cyber speech and hearing clinic. The ASHA Leader, pp. 6–7.×
U.S. Department of Education. (2004). To assure the free appropriate public education of all Americans: Twenty-Fourth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act (Retrieved 2-27-04 from http://www.ed.gov/about/reports/annual/osep/2002/).
U.S. Department of Education. (2004). To assure the free appropriate public education of all Americans: Twenty-Fourth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act (Retrieved 2-27-04 from http://www.ed.gov/about/reports/annual/osep/2002/).×
Walz, J., & Cochran, P. S. (1996). Curricular integration of computers in graduate communication disorders programs. Presented at the annual Convention of the American Speech-Language-Hearing Association, Seattle, WA.
Walz, J., & Cochran, P. S. (1996). Curricular integration of computers in graduate communication disorders programs. Presented at the annual Convention of the American Speech-Language-Hearing Association, Seattle, WA.×
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May 2004
Volume 9, Issue 10