Nancy A. Creaghead: A Professional of Many Facets Nancy A. Creaghead, professor and head of the department of communication sciences and disorders at the University of Cincinnati, holds a bachelor’s degree from Denison University, a master ’s from Purdue University, and a doctorate from the University of Cincinnati. An ASHA member for 30 years, she’s also a speech-language ... President's Interview
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President's Interview  |   January 01, 2002
Nancy A. Creaghead: A Professional of Many Facets
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School-Based Settings / Practice Management / Professional Issues & Training / ASHA News & Member Stories / President's Interview
President's Interview   |   January 01, 2002
Nancy A. Creaghead: A Professional of Many Facets
The ASHA Leader, January 2002, Vol. 7, 4-13. doi:10.1044/leader.PRI.07012002.4
The ASHA Leader, January 2002, Vol. 7, 4-13. doi:10.1044/leader.PRI.07012002.4
Nancy A. Creaghead, professor and head of the department of communication sciences and disorders at the University of Cincinnati, holds a bachelor’s degree from Denison University, a master ’s from Purdue University, and a doctorate from the University of Cincinnati. An ASHA member for 30 years, she’s also a speech-language pathologist in private practice. She’s served as ASHA’s vice president for professional practices in speech-language pathology, was a Legislative Councilor for six years, was president of the Council of Academic Programs in Communication Sciences and Disorders and the Ohio Speech-Language-Hearing Association, and has provided over 275 workshops, conference presentations, and publications for the benefit of her colleagues.
Add to all that her newest role—president of ASHA—and you have a highly dedicated member of our Association who wears her many hats with grace and professionalism.
Literacy is part of ASHA’s focused initiative on schools and is also one of your own interests as an SLP. You recently attended a White House conference on the subject —“Early Childhood Cognitive Development: Ready to Read, Ready to Learn.” What was that experience like? Based on what you learned from the discussions at the conference, do you foresee any changes in the way the federal government views the subject? Any increases in schools funding in the offing?
Helping children learn to read is one of the many areas in which we play a critical role in collaborating with families, other professionals, and policy makers in meeting an important local, state, and national challenge. The White House conference demonstrated the enormous need to begin in early childhood to provide children, especially children of poverty, with the language skills and experiences to prepare them to read. I was struck by a number of observations at this conference:
  • The contributions that we can make in this area given our expertise in language. Information about language and learning provided by presenters from other disciplines is a core part of what we know and use in our practice.

  • The innovative programs that we can develop in our schools and practices. SLPs and audiologists around the country have developed programs similar to those mentioned at the conference. For example, SLPs are collaborating with Head Start teachers to develop language- and literacy-rich classrooms. One SLP I know has developed a Mentor Mom program in a community health clinic where moms who bring their babies for medical care can learn about language development from a peer in the waiting room. The ASHA Leader (May 1, 2001) ran an article about SLPs reading to children in their local libraries.

  • The commitment of President and Mrs. Bush to the literacy effort. Mrs. Bush attended almost all of the two days of the conference, and the president stayed at the White House reception long enough to meet just about every one of the 300-plus conference attendees.

Given the tragic events that occurred after this conference, the opportunities for national efforts in the area of literacy may, for the time being, be reduced. However, the role that Reid Lyon of the National Institutes of Health plays as advisor to the president and the selection of respected researchers in reading, such as Steve Whitehurst and Susan Neuman, to hold key positions in the Department of Education suggest that literacy will continue to receive attention during this administration. In addition, congressional support for education still seems strong as shown by the FY 2002 increases for the Individuals with Disabilities Education Act.
Do you see any other major issues in the area of early childhood that will come to the fore in the immediate future? Do we have enough professionals with the skills necessary to take on the challenges?
In the area of early childhood, I think the most critical issue is assuring that children of poverty come to school prepared to learn. This was a major theme of last summer’s White House conference. The statistics are staggering regarding lack of access to print for children of poverty and subsequent school failure and school dropouts—the Hart and Risley book, Meaningful Differences (1995), illustrates the problems clearly.
At the conference, Neuman reported her own research that examined the opportunities for literacy experience found in different neighborhoods. In one low-income neighborhood with 10,000 children, she found only four places to buy books with an average of one book available for purchase for every 353 children. ASHA’s guidelines on the Roles and Responsibilities of Speech-Language Pathologists With Respect to Reading and Writing in Children and Adolescents elucidate the important skills that we can bring to supporting children’s early language and literacy development to enable them to enter school ready to learn. It is critical that we bring our efforts to solving this problem.
A second important issue for young children is identification of services for children with hearing loss. Currently, 40 states have enacted mandatory infant hearing screening programs. The increase in the number of states that develop these programs will produce an increase in the need for services for young children with hearing impairment. Our members have the knowledge and skills to provide early amplification as well as speech and language intervention for these children. Advances in technology will provide even greater opportunities for these children to hear and develop language.
The challenge is to assure that services are available in all settings, including rural and inner-city areas where there are shortages of qualified personnel. In addition, we must assure that services are available for children of poverty. We have a further challenge presented by the recent publication of the U.S. Preventative Service Task Force study of newborn hearing screening. The task force asserts that there is insufficient research evidence that children whose hearing loss is detected and treated earlier have better speech and language outcomes. Our challenge is both to provide the research that supports the value of early hearing screening and make the case that early detection and intervention is important for speech and language development.
In addition to your busy academic career, you’re also a private practitioner and have served as chair of ASHA’s Committee on Private Practice. How does that part of your life mesh with your lives as academic/researcher and now as ASHA president?
One of the major focuses of our practice is providing services to children in Head Start programs. This allows me to be involved in what I noted earlier to be a critical issue in which our professions must participate—the education of children of poverty. As the staff in our practice know, my broken record is that, in addition to meeting the needs of those children with communication disorders, we can play an important role in supporting teachers, families, and administrators in creating a language- and literacy-rich environment for these children. In many cases, we are right there in the Head Start building serving specific children. Imagine the impact we can make if we spread our expertise to all of the children!
Managing a private practice certainly keeps one in touch with the realities of providing services in our professions. Dealing with reimbursement issues, governmental requirements including Medicare and Medicaid reimbursement, the impact of the $1,500 caps and PPS, personnel issues, and civil rights requirements not only helps me see the needs of many of our members, but also more clearly links the requirements of graduate education to the needs of the practitioner.
I believe that the health of our professions is partly tied to our success in building our roles in the private sector. Reducing our relative dependence on government sources of support for services and building our skills in accessing patient and insurance reimbursement require enhanced marketing and public relations skills. Efforts by members in these areas help all of us.
The issue of professional preparation to which you allude raises other questions: Do you have any solutions to the problem of recruitment and retention of graduate students that will head off future shortages in the professions and in teaching and research? A shortage of researchers threatens to erode the intellectual base of the professions and, of course, reduce the number of professionals involved in the training of clinicians.
The shortage of doctoral students and faculty and researchers is one of the most critical problems facing our discipline. As you noted, the potential impact is the inability to educate future audiologists and SLPs due to faculty shortages and possible reduction in number of programs, as well as the erosion of research to advance clinical practice. ASHA and the Council of Academic Programs in Communication Sciences and Disorders developed a Joint Committee on Doctoral Shortages. This group met in Cincinnati in early December to develop a plan to recruit and retain doctoral students and faculty/researchers. Their report provides valuable ideas for action, but the problem is not easily solved.
You were instrumental in setting up a major program in distance education at the University of Cincinnati. How does it function? Do you see this form of education as becoming increasingly significant?
Our department at UC has been involved in several outreach and distance learning programs to provide master’s-level education to clinicians working in the schools with a bachelor’s degree. Like other similar programs, ours were designed in collaboration with our state department of education specifically to meet this need. We have provided programs in Colorado and Maine and have been a part of another in Ohio where eight universities collaborated to award the master’s degree to practicing clinicians who lack geographical access to our programs.
UC began to provide distance education in 1993 when we initially set up video cameras in our classrooms to make videotapes and communicated with students via mail, phone, FAX, and, later, email. Students were not required to have computers until the third year of the program! Now, email and listservs have replaced paper, taping occurs in electronic distance learning classrooms, courses are on the Web, and we rarely make a long distance call. We have, however, always had some on-site and face-to-face contact with our students. It is clear that distance education is going to become increasingly significant. A number of AuD programs also demonstrate this trend by providing distance learning opportunities for post-master’s audiologists who wish to gain doctorates.
My involvement in these programs has led me to two conclusions. First, distance education can be very effective and meet important needs for some groups of students. The educational experience can be excellent—especially for mature students who have experiences that they can bring to the classroom. Second, collaborative efforts among programs can meet a need that one program cannot meet alone, as well as provide an even stronger curriculum for students and a rewarding experience for faculty.
Distance education and collaborative efforts among programs may provide some help in meeting the doctoral shortages, but we cannot assume it is the answer to the problem. Research mentoring and lab experiences are difficult to accomplish at a distance. We need creative ideas.
There is an initiative in your state of Ohio on the issue of reimbursement. Is this a model that would affect ASHA professionals working in other states?
The Insurance Advocacy Initiative in Ohio is a great example of a grassroots effort to meet a professional need. The initiative is dedicated to improving private insurance coverage for children, especially those with developmental disorders. This effort was initiated by a group of practitioners who serve children in Cincinnati, including people who have private practices and those who work in hospitals and other clinical settings. Ann Kummer, director of the speech pathology department at Children’s Hospital Medical Center, determined to “do something about the problem,” pulled us all together. Subsequently, the group received support from the Ohio Speech-Language-Hearing Association (OSLHA) in the form of an Affiliate Grant and is now further supported by OSLHA. We moved from Cincinnati to the state of Ohio to the national scene through collaboration with ASHA on developing brochures to inform clients and families about accessing insurance coverage. Most recently, initiative members drafted a document supporting insurance coverage for children with developmental delays that was given to a California health plan contacted by ASHA.
Our local focus this past year largely has been advocating for families by providing workshops to help them choose among insurance plans to obtain the best coverage, and we have given them information on what to do if none of the plans provides coverage. We have also targeted human resources directors of local medium-size and large businesses, as well as local hospitals and clinics, to share with them the common limitations of speech, language, and hearing coverage and advise them on how they can offer improved benefits for their own employees at reasonable costs. (As an aside, anyone who would like to work on this issue at the local level can obtain further information by contacting Katrina Zeit by email at zeir7L@chmcc.org or Steve White at ASHA by email at swhite@asha.org.)
What do you foresee as the issues that you will find most challenging during your tenure as president?
The issues that challenge us today are those that have faced us in the recent past. I put shortages of PhD faculty/researchers as well as research doctoral students at the top of the list. This crisis is even more acute in audiology. In addition, we will continue to be challenged by the working conditions for SLPs and audiologists in many environments. We have recently made some excellent progress in the schools based on the efforts resulting from the focused initiative, but we must continue to address caseload and service delivery issues as well as salaries. Audiologists continue to feel the need for increased autonomy, including limited licensed practitioner status.
Legislation regarding service provision and reimbursement will continue to be a challenge. In audiology, enactment of laws mandating newborn hearing screening has been a success, but there are 10 states where screening is not yet mandatory. Reimbursement by Medicare for aural rehabilitation services provided by audiologists must remain a high priority for ASHA advocacy. In the speech-language pathology health care arena, we have been successful in delaying the $1,500 cap and in increasing the codes for augmentative communication, but reimbursement is a continuing problem and is likely to be an increased challenge in the current economy. For example, we need permanent removal of the $1,500 cap, additional billing codes for our services, increased insurance coverage for all types of services, increased reimbursement rates, and less dependence on contract services in health care settings.
Finally, I hope audiologists will come together to work on those issues that face the profession and its clients. We need to examine how we can make the best decisions in an environment of varying views and needs. During the past year we have been challenged by differing views on whether it is in audiologists’ best interests to join a coalition with the American Academy of Otolaryngology–Head and Neck Surgery. We will continue to face the need to examine whether such collaborative efforts are in the best interests of our clients and the profession. A second example of a difficult decision is whether or not our clients’ needs will best be met by supporting Medicare reimbursement for hearing aids. There are innumerable challenges that can be met most effectively by a unified effort that includes all audiologists and organizations that support efforts to better serve individuals with hearing loss and serve the 80% of these people who do not now receive services.
When Nancy Creaghead is not being president of ASHA or a professor or a professional in private practice, what does she do?
I really love to cook and it’s hard to keep me out of my yard in the summer. I also enjoy the arts and used to do a lot of volunteer work for the Cincinnati Symphony Orchestra before my appointment to the ASHA Executive Board. My volunteer time with the CSO is on hold right now—it’s hard enough just to get to the concerts!
There’s no way this interview can be complete without your response to these two final questions: What motivated you to become president of ASHA? And what is your vision for the future of ASHA, and how do you see your role in the realization of the vision? Sorry—that’s three questions.
I was motivated to become ASHA president because of my previous rewarding experiences in working on ASHA councils, committees, and boards, as well as previous volunteer work with OSLHA, my local association, and other related volunteer organizations like the Council of Academic Programs in Communication Sciences and Disorders.
I see the vision of ASHA as the stated purposes in our bylaws:
To encourage basic scientific study of the processes of individual human communication with special reference to speech, language, and hearing;
To promote appropriate academic and clinical preparation of individuals entering the discipline of human communications sciences and disorders and promote the maintenance of current knowledge and skills of those within the discipline;
To promote the investigation and prevention of disorders of human communication;
To foster improvement of clinical services and procedures concerning such disorders;
To stimulate exchange of information among persons and organizations thus engaged, and to disseminate such information;
To advocate for the rights and interests of persons with communication disorders; and
To promote the individual and collective professional interests of the members of the Association.
The president plays a role, along with the Legislative Council and the Executive Board, in setting policies and establishing focused initiatives to support these purposes whereas other committees and boards, as well as the National Office staff, are responsible for actions that help us fulfill them. These leaders and every member have a role in creating the vision of ASHA as an organization that carries out our stated purposes.
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January 2002
Volume 7, Issue 1