What’s My Scope? Some employers may ask SLPs to perform tasks outside their training or scope. Here’s what you need to know. On the Pulse
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On the Pulse  |   August 01, 2017
What’s My Scope?
Author Notes
  • Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org×
Article Information
Practice Management / Professional Issues & Training / On the Pulse
On the Pulse   |   August 01, 2017
What’s My Scope?
The ASHA Leader, August 2017, Vol. 22, 40-41. doi:10.1044/leader.OTP.22082017.40
The ASHA Leader, August 2017, Vol. 22, 40-41. doi:10.1044/leader.OTP.22082017.40
Many job descriptions include the vague inclusion of “other duties as assigned”—but when it comes to health care, speech-language pathologists may have legitimate concerns about some tasks that fall to them.
In today’s health care climate, with an intensified focus on cost reduction, many health care administrators look at personnel costs and seek ways to save. If one of those strategies is to reduce staffing of other professions, SLPs may feel the effects on tasks that support, overlap or interface with their roles.
Multi-skilling
This challenge is not new: In 1997, ASHA developed a document on multi-skilling, a term describing the addition of functions to a professional’s role. The professional is cross-trained to provide more than one function, often in more than one discipline.
Multi-skilling in health care, for example, might include performing activities that require “cross-training of basic patient care skills,” according to the document. SLPs may be asked to perform an activity typically performed by another profession, such as:
  • Taking blood pressure.

  • Completing the OASIS (Outcome and Assessment Information Set), a Medicare assessment for adult home health patients that includes documenting wounds and medications.

  • Assisting with toileting and transferring patients to help get them to treatment on time.

  • Suctioning.

SLPs may feel the effect of reduced personnel on tasks that support, overlap or interface with their roles.

ASHA’s Code of Ethics, Principle I, Rule A, states, that “Individuals shall provide all clinical services and scientific activities competently,” but also makes clear in Principle II, Rule E, that, “Individuals in administrative or supervisory roles shall not require or permit their professional staff to provide services … that exceed the staff member’s certification status, competence, education, training, and experience.”
Thus, SLPs may need training to be competent in specific basic patient-care skills. Ideally, SLPs should undergo a prescribed training protocol and receive written documentation attesting that they have demonstrated competency in performing that activity. Obtaining training is consistent with Principle of Ethics II, Rule D, which states, “Individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning applicable to their professional activities and skills.”
Delivering services in the home, either through early intervention or adult home health, often creates expectations to gather data or perform activities that are typically performed by other professionals. Some administrators assume that these activities are routine for SLPs because occupational and physical therapists are comfortable performing them. However, SLPs should indicate when they lack the knowledge and experience and ask to receive sufficient training to become competent, if appropriate.

Delivering services in the home often creates expectations to gather data or perform activities that are typically performed by other professionals.

Role extensions
Employers may also ask SLPs to perform clinical tasks that are related to their skills, but that are not explicitly included in ASHA’s “Scope of Practice for the Profession of Speech-Language Pathology” or Code of Ethics. Examples include:
  • Performing oral-motor exercises to reduce snoring.

  • Passing scopes for esophageal pH testing.

  • Managing tracheostomy weaning and care, even if the patient has no swallowing or speech goals.

If treatment goals are focused on activities that are not specified in the scope of practice, it can be challenging to judge the appropriateness of the activity, the SLP’s competence in performing the activity, and the available evidence to support its benefit to the patient.
Another consideration is payment: A health insurer may not reimburse for activities that are not considered part of SLPs’ traditional roles. In some cases, the activity may be prohibited by a state licensing board’s explicit rule or interpretation of a rule.
Whether clinicians should take on multi-skilling or newer areas of practice may depend on the their comfort level, the size of their workload, and the specific activity. In considering additional responsibilities, clinicians may want to ask themselves:
  • Am I trained to perform this task competently? Am I comfortable performing this activity?

  • What is my liability?

  • How does this affect my productivity? Am I spending time doing work that cannot be counted as treatment?

  • If this is a skilled activity for which I am billing, can I demonstrate that it will benefit the patient?

Collaboration
The increasing emphasis on interprofessional collaborative practice can also challenge these boundaries. When professionals collaborate closely, supporting one another’s goals and activities can lead to questions of overlap. Highly collaborative practice settings—such as early intervention and neonatal intensive care—have long been examples of “role release” that can create some ambiguity around the scope of each practitioner.
As a dynamic profession, speech-language pathology continues to evolve, and the scope of practice evolves with it. SLPs on the leading edge extend those boundaries with a commitment to evidence, training, and full understanding of ASHA’s scope of practice and code of ethics, as well as state licensure laws and regulations.
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August 2017
Volume 22, Issue 8