Inside SLP

In the early 1960s, SLP leaders described trips to Capitol Hill as terrifying, migraine-inducing encounters with a world they didn’t yet understand. A few decades later, the profession had built enough political infrastructure to partner with McDonald’s and influence federal definitions of disability.

This episode traces how speech-language pathology moved from academic outsider to institutional insider and what was gained, lost, and locked into place along the way.

We explore:
  • How federal rehabilitation funding after WWII and Vietnam reshaped who counted as a “qualified provider.”
  • The quiet fight to keep language from being absorbed into the definition of Specific Learning Disability and why that boundary still causes friction today.
  • How the CCC shifted from a professional marker to a billable requirement in Medicare and Medicaid.
  • What it actually takes, organizationally, to put accessibility tools into 8,700 restaurants nationwide.
Sources:
  • Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.
Connect:

Creators and Guests

Producer
Megan Berg, SLP
Megan is an SLP based in Montana and owner of Therapy Insights.

What is Inside SLP?

Inside SLP is a limited series podcast that reveals how our profession came to be and why it functions the way it does. Most clinicians work inside a system they were never taught to see, shaped by decades of history, policy, economics, and unspoken assumptions. This show offers lightbulb moments that bring clarity to the structures beneath our everyday work and opens space for thoughtful, grounded understanding of the field we share.

Megan Berg:

Welcome to Inside SLP. This is a limited series podcast about how our profession came to be and where it's heading. Most of us work inside a system we were never taught to see. This podcast is about slowing down enough to understand that system with clarity, calm, and context. Before we dive in, just a reminder: Understanding a system does not require you to fix it, challenge it, or carry it.

Megan Berg:

Depending on where you are in your career, this history will feel different. All perspectives are valid. Today's episode is about a shift. Not a scandal, not a villain, a shift. It's the moment when speech language pathology stopped being a profession that hoped policy would notice it and became a profession that learned how to operate inside power.

Megan Berg:

Picture this: You're a clinician in 1962. Your schedule is full, your caseload is heavy, and you've agreed to do something that makes your stomach drop. You're going to Capitol Hill. One ASHA member later described the experience as terror accompanied by a whopping migraine and then unexpectedly, the trip was exhilarating. That emotional whiplash tells us something important.

Megan Berg:

ASHA did not start as a politically confident organization. It was an academic club that had to be dragged into the terrain of government. In the early 1960s, ASHA was only beginning to think about legislation. One former president described chairing the very first committee meant to track the law. For a long time, he was the committee.

Megan Berg:

He once invited a state legislator to speak to clinicians about licensing and he recalled, you never saw so many yawns. Nobody gave a damn. This wasn't laziness or apathy on the part of SLPs. It was just distance. Government didn't feel like our terrain yet.

Megan Berg:

We were scientists and clinicians. We weren't power brokers. Today, advocacy seems like such an important part of our work, especially as we watch the dismantling of the systems that provide the legal framework for our services. But back then, we were naive. But that naivety was about to meet a massive financial reality.

Megan Berg:

ASHA leaders look back on this era and said there was money around. They weren't talking about a lucky break that brought in massive funds for ASHA specifically, they were talking about a massive post World War two crisis. Thousands of veterans were returning home with head injuries, aphasia, and profound hearing loss from the front lines. The federal government didn't just have cash to throw out, they had a contract for care they needed to fulfill. Coordinated federal investment in rehabilitation became a national necessity.

Megan Berg:

But federal money always comes with definitions. If the government is going to pay for rehab, they need to know exactly what rehab is and who is qualified to provide it. This was the moment that the profession realized that if they weren't in the room while those definitions were being written, they would be defined out of existence. This brings us to the most consequential room in our history, the drafting of Public Law ninety four-one hundred forty two which we now know as IDEA. In the mid 1970s, as the law was being written, different interest groups were staking their claims.

Megan Berg:

ASHA fought hard to ensure speech and hearing were included but while our leaders were focused on securing our space as a related service, another group was building a massive room next door called Specific Learning Disability. Catherine Butler and Ken Johnson later reflected on a realization that came too late. The definition of SLD which focused on reading, writing and thinking overlapped almost entirely with the definition of a language disorder. It was a professional land grab. The SLP architects had built a sturdy communication room but the special education architects had effectively claimed the language hallway to use as the foundation for their own territory.

Megan Berg:

This is why for decades school clinicians have felt a strange friction. When a team argues about whether a child has a language impairment or a specific learning disability, they aren't arguing about the child's brain. They are arguing about a map that was drawn poorly in a Washington office in 1975. Once the concrete of federal law is poured, the walls are nearly impossible to move. After this moment, Catherine Butler wanted language added to our association's name specifically so we wouldn't disappear into that overlap.

Megan Berg:

By the late 1970s, the terror and migraines of visiting Capitol Hill had turned into a machine. ASHA realized that to protect the profession, advocacy couldn't be a hobby for volunteers. It had to be an infrastructure. They stopped relying on occasional visits and started building repeatable pathways to influence. They hired professional staff.

Megan Berg:

They created the Congressional Action Contact Network, members in every state who maintained constant relationships with legislators. By 1992, they added a subtle but powerful tool, the ability to contribute to a political action committee while paying annual dues. Political engagement was normalized. By 1998, member contributions reached nearly $187,000 We weren't just a group of clinicians anymore. We were a political army.

Megan Berg:

Lobbying wasn't dirty. It was the only way to ensure that when a staffer turned over in a congressional office, the definition of an SLP stayed the same. In March 1992, ASHA partnered with McDonald's and the American Foundation for the Blind to introduce picture based and braille menus in more than 8,700 restaurants nationwide. Think about the sheer scale of that coordination. It required thousands of hours of staff expertise in Rockville to navigate corporate legal terms, design experts, and distribution chains.

Megan Berg:

It meant creating recommendations for training thousands of teenaged employees on how to communicate more effectively with customers who had communication differences. Writing in the ASHA Journal at the time, Charles Diggs noted that while MCC milestones weren't traditionally included in developmental charts, by age two most children already recognized that logo. By putting ASHA's endorsement in those menus, the profession was signaling that accessibility isn't just a clinical goal, it's a civil right in the places where people actually live their lives. This is the institutional muscle we often take for granted. President Anne Carey urged state associations to take those menus and walk them into their local franchises to offer further training.

Megan Berg:

It proved that the association had the infrastructure to show up in a boardroom, stay in the room for years of development and eventually put a tool directly into the hands of clinicians free of charge. It's a vivid reminder of what we can build up when we stop policing the small things and start leveraging our collective capacity to move the giants. This infrastructure allowed the profession to show up in places that had nothing to do with hospitals or schools, like that partnership with McDonald's, but this created a double edged sword because that capacity, the lobbyists, the staff, the nationwide networks required a massive stable engine of funding. The CCC wasn't just a certificate of clinical excellence anymore. It became the financial anchor of the entire political machine.

Megan Berg:

Think about how school districts work. Teachers have a clear pathway for raises, national board certification. When ASHA went to state legislatures, they used the CCC as our version of that gold standard. They marketed the CCC as the benchmark that guaranteed a higher level of service which successfully secured salary supplements in many states. If you've ever received a $3,000 or $6,000 stipend in your school district for having your CCC, you are seeing the result of that marketing.

Megan Berg:

But the marketing didn't stop at school stipends. The CCC CCC was baked into the very definition of qualified provider for insurance companies and Medicare. Several states today continue to require the CCC to bill Medicaid. By convincing payers and regulators that the CCC was the only reliable indicator of competence, ASHA effectively created a brand that clinicians had to buy if they wanted to get paid. As ESHA learned how to operate inside power, something important happened.

Megan Berg:

Advocacy stopped being a choice and became a durable obligation. When you build a machine this large, a machine that secures your seat in federal law and your picture menus at McDonald's, you also build a machine that is legally bound to survive. This requires staff salaries, long term benefits and fiduciary duties that don't bend easily even when the profession wants to head in a new direction. Capacity creates constraint. Many of our modern frustrations with ASHA come from a misunderstanding of this reality.

Megan Berg:

We talk about what ASHA should do without understanding what it is allowed to do. We assume control where there is only influence. We expect a fix when there are, in fact, strict legal limits. Next time we're stepping directly into that boundary. We're going to untangle the difference between power, permission, and responsibility and find out exactly what ASHA can't legally do.

Megan Berg:

I'm Megan Berg. This is inside helpful, please leave it a rating in a written review. This helps other people find the show. My intention with these episodes is to help us all move forward If as a profession and the more we all understand how the system works, the more we can move forward together. If you you'd like me to present this information to your workplace, grad program, or SLP book club, please contact me at therapyinsights dot com slash insideslp.

Megan Berg:

I've also put that link in the show notes for easy clicking. If you want to understand this system more deeply, I invite you to learn about the PACT survey, a national effort to capture how SLPs, audiologists, employers, and consumers experience our profession. You can sign up for updates at pactsurvey.com. That's p a c t survey dot com. PACT stands for perspectives in accountability credentialing and training.

Megan Berg:

This podcast reflects my own research, analysis, and interpretation. It is not affiliated with, endorsed by, or produced in collaboration with ASHA or any other professional association. Historical information referenced in this episode is drawn from publicly available sources, including the book The First seventy five Years and Oral History of the American Speech-Language-Hearing Association (1999), by Russ Malone, former Public Information Director for ASHA, along with publicly available legislative records and archival materials. Any errors or interpretations are my own.