What Makes an SLP an SLP?

Dr. Jeanette Benigas and Megan Berg get clarification from CARF about if the CCC is required for SLPs working at CARF accredited facilities. They re-envision what it could look like to become a licensed SLP, exploring options of splitting the field into tracks, ditching a national exam, and focusing on competency checklists during grad school training.

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Creators & Guests

Host

Jeanette Benigas, PhD, SLP

Host of Fix SLP

What is Fix SLP?

Fix SLP is grassroots advocacy firm here to challenge the status quo in speech-language pathology by driving real change—from insurance regulations to removing barriers to full autonomy like the CCC. This podcast is your space to learn, engage and take action in the field of SLP. We don’t wait for change, we make it. So let’s fix SLP!
Hosted by Jeanette Benigas, PhD, SLP

Megan Berg 0:00
Hi, everyone. I'm Megan Berg

Jeanette Benigas 0:02
and I'm Dr. Jeanette Benigas.

Megan Berg 0:04
And we are here to fix SLP.

Jeanette Benigas 0:06
We are discussing the biggest challenges that are currently holding back the field of speech language pathology.

Megan Berg 0:12
We present the issues with facts and invite you to be part of joining our movement to make things better one conversation at a time.

Jeanette Benigas 0:19
Let's fix SLP.

CARF 0:31
Thank you for calling karf International for general information about accreditation or certification. Press for warning perfect.

Megan Berg 0:41
Kristen, my name is Megan and I have a question about what's required of speech language pathologist. Can you help me?

CARF 0:49
I personally can't I can. Somebody who can.

Megan Berg 0:53
Hi, Juliana. Hi, Juliana. My name is Megan Berg and I have a question about the credentialing requirements for speech language pathologists.

CARF 1:05
Well, so I am a speech pathologist.

Yeah. All right. So all of us in this role of resource specialists here at heart, we our background is from the field. So we are speech pathologist, physical therapists, for other manuals, social workers and things like that.

So yeah, you'll know and don't have any standards, specific for speech pathology or physical therapy, our standards are much more broad, and we accredit a rehab program.

So we don't ask for any credit about individuals, although an individual would seek accreditation if they wanted or needed to.

And then we would kind of frame it as like your clinic would be applying as a, an outpatient program. Can I Okay. Okay. So yeah, that's, I think that answers my question, because, as you know, there's a lot of confusion around the certificate of clinical competence that Asha sells, if required. And so we're getting a lot of questions just about if it's required to be part of karf. And my understanding is that an SLP just needs to meet the qualifications to be a speech pathologist in that state. So basically a state license.

Megan Berg 2:40
Okay, and not have to pay for the CCC.

CARF 2:44
Yeah, so like our standards would say something along the lines that your personnel have to be confident operating, or I'm working from home.

So competent, working within your scope of practice, and meeting any requirements that are set by a regulatory body or state licensed for things like that, like, and honestly, like, we don't even necessarily look into what individual state requirements are like, we go to a survey. And we trust that the organization is going to tell us and abide by those regulations and state laws.

Because we're not a regulatory body, we're just accreditation. We don't haven't been status, and things like that. So, you know, we kind of just put it back on the organization that you should be following any other requirements that are put on you by anybody else?

Megan Berg 3:49
Yeah. No, that makes sense. Yep.

CARF 3:53
All right. Any any other questions for me?

Megan Berg 3:57
I don't. I appreciate your time. Thank you so much.

CARF 4:01
Anytime, all right. Thank you. Bye. Bye.

Megan Berg 4:07
I was like, should I have asked her for permission to I was, I was wondering that and I was also thinking you should tell her to fix SLP

Jeanette Benigas 4:17
I think we're okay. I think yeah, I don't think they're gonna I think she was giving, like standard information.

And so if she wasn't, it matches what's in the manual. Yeah, if she was giving wrong information, then someone needs to call her out from their organization. Anyway, so there we are. Look at that. Jayco we'll get to that next but CARF not required.

Megan Berg 4:46
PS Welcome back to fix SLP everybody. I am.

I'm Megan. We thought we would just start off with that phone call because we've been getting a lot of questions about if the CCC is

required for these accreditation processes, mostly for rehab facilities, right? Like these are these are the big name accreditations that facilities will seek out. Yeah. We've specifically gotten this question twice about car now at hospital systems looking to remove the CCC. And so we thought if two hospitals have already had this question, there's going to be more. So let's just get the information together for you. Obviously, your superiors probably want to confirm it. But all we did, right there was make a phone call and talk to a person. But it is also in writing correct, Megan? That's what it says. Yeah, so I'm pulling it up. This is the CARF manual that you can find it's the 2023 CARF standards manual supplement for networks. And on page 81, it talks about how to verify that providers are following the rules and like have the credentials necessary. And there's nothing specific in there. It says the participating provider demonstrates how each of the areas listed is verified.

And they are aware of and adhere to any external requirements like funders, regulatory entities, contractual agreements, etc. So again, like what she said on the phone call phone call, they're not regulating anything, they're leaving it up to the facility to decide

what credentials are required for their staff.

Jeanette Benigas 6:36
And what she said was interesting, she said their standards say the personnel has to be competent within the scope of practice, which we prove through our state license. And meet requirements set by a regulatory body. Asha is not a regulatory body. So the CCC has absolutely nothing to do with it. Because Asha can't even count for that. It's a certificate, not a regulatory body, it has to be the state license.

There's nothing else that your employer could use.

Right now, does that make sense? Did I say something? Just like they can't use the CCC? Because it's not a regulatory body? Yeah, can it's just a certain cap.

That would be why they'll get on fixers go get him.

Megan Berg 7:22
And again, this gets in, we'll be talking a lot more about like, what shouldn't be required of SLPs. But I think what Asha thinks they're doing is protecting SLPs from a bunch of certifications, a bunch of other certifications, that give the illusion of speech pathology credentials.

But there's really no way to protect the field from that other then, if all of us decide that certifications are bullshit, and state licensing is legitimate, the more certifications that are out there, and the more we're buying into the system, the more likely it is for a bogus certification to mimic the qualifications of a speech pathologist. And then somebody could eventually just pay for that certification and look like they

are speech therapists, but they're not.

We also wanted to play a voicemail from a listener. Should we do that right now before we dig even deeper into this topic?

Jeanette Benigas 8:28
Yeah, let's do it.

Anna from Colorado 8:30
Hi, there. This is Ana from the state of Colorado. And I just thought I'd leave a voicemail about my experience with the licensure process and the lack of straightforwardness that is present because is confused both myself three different contract companies. And then on top of that, I contacted my state's Department education and twice they gave me an unhelpful answer. So essentially, yeah, I've been estranged for six months. No one told me a certificate. I missed the deadline for that twice. Okay, great. Nice.

And I just find the patchwork of just licensure requirements on ashes website to be so profoundly confusing.

And also quite horrible. Because if I decided to move from one state to the other, I may have to pay up to $3,000 Just to be able to work in another state. And I don't understand why we don't have federal licensure that standardized across the entire US. Because I know BCBAs, once they had their board certification, they can operate internationally. And why don't we have that sort of freedom, especially since there's a global shortage of us? Because I really feel like it would incentivize health care systems to be more functional if they understood the value that we have on the global scale. So I hope this asks a pretty cool questions. Thank you.

Megan Berg 9:51
So I have a few thoughts. I when I first started listening to her message, I was like, Oh, she must be a school based SLP to get the certification.

thing from the school system. But now, I'm also remembering that in Colorado, I think they call it a certification instead of a license, which is extra confusing.

And so she makes a good point about how confusing this all is because we're here talking about state licensing. And there's a state out there that doesn't even call it a license. She also mentioned ashes website, Ash, it does have a place on their website where they link to all of the state regulations. And they have kind of a summary table for each state about what's required. But I will say that that information is not always up to date. So things are always changing with licensing boards. And it's not clear to me that Asha keeps up with that. So if so, for example, when we were working on the spreadsheet, to help everybody see which states require the CCC to get licensed, if we were to rely on the information on Asher's website, it would not be accurate. And then also, she's talking about this federal license. And I think that's the interstate compact that's coming up. That will hopefully resolve this. So if your state is not passing legislation to be a part of that, they just know that you're going to be years behind everybody else getting involved in it. But that could be something that you could go on to Bumble and connect with others and start to get that legislation rolling so that in the next few years, you can join that interstate compact, which so far is not requiring the Cs to be an SLP to be a part of. And that would allow you to work across multiple states with both your state license and your interstate compact license. Jeannette, what are your thoughts? Yes,

Jeanette Benigas 11:45
I would I just want to say about the interstate compact. So we started recording with seat membership associations this week. And the one that I spoke with Hawaii is trying to adopt the compact, but they're having some trouble with legislation. So just know that just because they get it, like in the conversation or whoever needs to look at it doesn't necessarily mean it's going to just be passed. So it like failed or whatever. And they have to try again. So just because you get it in front of people doesn't mean it's going to pass. So this can be a long process that will take time. So be patient. Yeah.

Megan Berg 12:32
Yeah.

Okay,

we got another email from someone named Jess. And she says, Hi, I think you two are doing a fabulous job. Thank you so much for digging into all of this. I so desperately want to quit Asha. But I'm considering paying the mafia. Again, just because I don't think my current job is where I will stay long term. And I worry about being stuck in a situation where the next job requires it. But I was just listening to your episode with the 12 other professions and you briefly mentioned an SLP that called Asha to keep her CCC but cancel her membership. Is that something we can do? Do you know what the cost difference is for that would love to know more about this? I'm also going to join Bumble but thought this was important and interesting enough to go right to the source.

Jeanette Benigas 13:26
welcome new members. Yeah,

there is an alternative option. And we just explored this through discussion, I think either on Facebook or Instagram this past week. So if you are already a holder of the CCC,

you have to call the Action Center to renew your CCC and request to renew without membership. That will save you $26 So it will be 199 US dollars. And that will take away your access to the journals and the ASHA leader. Anything else Megan that we know of that they lose access to?

Megan Berg 14:14
I'm assuming like you can't get the ASHA ace award. Yes. Well during the cigs, did you already say that?

Jeanette Benigas 14:21
I that? Well, yes, but those are add ons. So I want Asha doesn't want to lose money. So you get the ASHA ace award by paying for the CEU tracker. So it would be interesting to know if we have a fixer out there who doesn't have membership and when they go to renew, you know what?

You can because the next thing I was going to say was

if you are already a non member when you renew your renewal comes to just renew

Who as a non member, so someone asked about this on social and I dug into it with her because she said, Wait, I Why is mine cheap and she had all you know how Asha Loves to like pre check all of the boxes to donate to the pack and get the the thing to track the CEE is.

All of hers were pre checked, and she was renewing as a non member. So this is her first renewal. And we dug in, I couldn't. So I pulled up mine, because I haven't renewed yet. And I couldn't figure out why hers was giving her non member status, but mine was member status. And as it turns out, as a fellow, she chose non member to save money. So from the gate, like last year, when she paid she didn't pay for the CCC. So it seems like the initial application might give fellows the option as a non member, so they're member or non member, and then when they renew, they're renewing as a non member, but the pack donation and the CEE registry, were still there as options. Because so many, I don't know if the stakes were not, she didn't show a screenshot that low, but you can still pay them $28 If you're a non member to get that seat. Now, I don't know if you qualify for the ACE award. I don't know if you have to have this. But here's the thing with Ace Ace award, I have been reading tons of resumes.

Megan Berg 16:34
Just stop stop with the ACE award, just put, like I've taken 70 hours of continuing education a year like that anymore.

Jeanette Benigas 16:44
I paid $48 I made $47,000 for 70 credit hours.

I paid all my money, give me your job so I can make more. The only reason people care about the ACE award is because we all know what it is. Nobody else knows what the hell that is. Or it is. Especially people reading resumes, like I know what it is because I'm gonna sell Pete but a lot of jobs. These aren't SLPs reading your resume, they have no idea an ace award could be like

Megan Berg 17:18
anything like they have no idea. So just put the number of hours if that's what really matters to you, and you really want to show off that you take so many hours, just put the hours

Jeanette Benigas 17:26
i i I don't call it winning. I earn the ACE award every year. And now that I imagined it on your resume, we I put it on my CV now that I'm at a university pursuing tenure, but I actually explain what it is. But I just had to giggle because last year when I got Like My Review back, they commended it they commended earning the award and commended my commitment to continuing education. Why do we need other awards? I think that's the bottom line here. We need other award.

Yes, who does the most fixing?

We'll send it in the mail that you can send us money. You can pay for it. Because if you want the actual certificate printed, you have to pay for that. And it's not just like five bucks. It's like 30 bucks or something ridiculous that you could go to like the print shop and get or do yourself. But well, we'll tell you that. No. What's what's above an ace? There's Is there anything above an ace?

Megan Berg 18:33
A joker, the Joker award?

We could call it the mace award.

The I don't know. Anyway. But also Okay, so what I was gonna say if people want to switch to a certified non member, what they call it, you have to call the ASHA people to do that. Yeah. Unless you joined unless you did it or yours. Yeah.

Jeanette Benigas 18:59
Oh, the ACE is okay. The rank of each card in Texas Hold'em.

highest to lowest is Ace King. So ace is the highest.

Now thinks about the ACE if you're playing Texas Hold'em. That's just what Google told me.

Megan Berg 19:16
We can call it the full House award

flush flush,

Jeanette Benigas 19:25
wash it all down the toilet.

Bless your career life, etc. See, live on the street.

Megan Berg 19:35
I just I don't like the ACE award because it continues to give validation in meaning to Asha. The first time I ever got it. I was like what is this? And then I I got excited because I never really paid attention. I just do my thing. And I got the letter and I was like What even is this? And for a minute. I thought that like I had done something amazing. And then I read what it was and I said oh

Jeanette Benigas 19:59
All this means is that I spent a crapload of money in this cycle. And now like, now the next two years, I've gotten one, I'm like, This is dumb. It's like getting a Fitbit like I am, I will refuse to get a Fitbit. Because I will be one of those people that has to get like 60,000 steps in. And like once you reach that goal, you're like, Oh, I got to do it. The next year, I got to do it the next year. And it's great. Like learning is wonderful. We should all be learning all the time. Yeah. But giving credit to Asha and giving meaning to their awards and their system. It's just not something that I personally want to paint.

Megan Berg 20:38
Yeah. Okay. One more email, and then we'll move on to talking about our topic. Okay. Okay, this is from Jessica. She said, Hi, I'm an SLP in Indiana with 18 years of experience, and I haven't had my CCC since 2020.

And that is a story on its own. She says, I just signed a contract with VOCO vision for a teletherapy position. And I'm now in the onboarding process. So just to reiterate, I've already interviewed with the school system accepted the position and signed the contract. When their onboarding specialist sent me an email with a list of things they need for me, I noticed they wanted a copy of my Asha membership card. This was the first time I had ever seen or heard the word Asha throughout the process. I replied to the email and asked if a current Asha membership was required since Indiana does not require that membership in order to be licensed as an SLP. Smart SLP she did her homework. She replied, saying that I needed to schedule a clinical quote orientation and to quote make sure my facilitator knows that I do not have an ASHA membership.

I then received an email from a clinical facilitator saying, quote, VOCO vision requires the clinical interview for anyone who does not meet vocal visions, minimum teletherapy requirements and quote, When I clicked on the link to schedule the interview, I was given this information. Your recruiter has recommended you for a clinical interview. Please be prepared to answer questions like these during the clinical interview. What have you done to prepare yourself for working with students? Have you done continuing education in this area? Have you looked for information on special education at the state and federal level? Have you researched telepractice? guidance from your professional organizations? Have you prepared yourself to do interventions and assessments with students via telepractice? I don't think any of these questions would have been inappropriate during an interview for the position. But I am pretty offended that they're asking me on the basis that I no longer subscribe to Asha. I don't know if I should say something at this point, or if I'd be better to let it play out. But I wanted to share this with you all thank you for everything you guys are doing. Just go.

Because we all know that Asha is making sure that we have telepractice guidance, and

preparing us to work with students and giving us information on special education at the state federal like we know those are all specific requirements that Asher requires to get.

Jeanette Benigas 23:07
I mean, they require it, the CA requires it. No, they don't. They don't. I mean, very specifically, ASHA has recently come out with

like rules regarding the hours that students and fellows can have for telepractice that was based on a survey that they sent out, which I think was actually a useful thing. But again, that all ties into their CCC product. It doesn't.

It doesn't apply if you're not going to get the CCC, you know, if you're just getting your state license. It doesn't even matter. It just matters if your state has requirements surrounding that. But other than that.

That might be it.

Megan Berg 23:53
Yeah, I would just say if anyone from vocal vision is listening, like stop offending your staff like this, it's very rude and insensitive. And there is no difference between a licensed SLP and an SLP. Who who who pays for the CCC?

Okay with that? Oh, yes, I'm gonna share because one of these hospitals that was concerned about karf started messaging me while we were on the phone with Carl.

Jeanette Benigas 24:29
And I just want to tell you, I just wanted like, just so you're prepared. If this is something you want to take to your employer. I just want to share what this SLP is saying.

She said she emailed

she said I met with our leadership.

This was funny. I think this was from the other day. She said I met with our leadership and she acted like I was asking why we can't come to work naked. What I brought up the value they the CCC. So very shocked.

But then she did say I need to research it more. But she mentioned how the CCC is helpful for the hospital Joint Commission, which is Jayco. To show competency, she said I hadn't heard that one. So we are going to be looking at the Jayco. Two we started with car because there's again, I there's other hospitals that had asked about car.

She went on to say that JACO The Joint Commission requires the CCC to measure competency and that without that we would have to do internal competency checks, which is interesting, because our hospital already has these internal competencies. If you want to see any specialty patient such as AAC, dysphasia, voice, dyslexia, et cetera. So she might have just been scrambling when she said that.

She said plus, and this is literally when we were on the call. She said plus the regulatory body would be the Ohio Board. So our Ohio license, I'd imagine would suffice for an internal competency check. And I said it has to be the state license. There's no other regulatory body.

I said we'll call Jayco. Next, but maybe not today. And she she said, I honestly feel that she was so floored that she was scrambling and trying to find reasons other than her personal positive feelings towards Asha, she made comments about how the hospital pays Asha 1000s and 1000s of dollars each year and how they closely support them. And it was digressing into a whole we'll have Asha, what do you mean you don't conversation, she also made a comment that I wouldn't want an SLP that didn't value their CCC working here, which in retrospect was very alarming. I'd be happy to help lay out all of this. If say,

x, you can respond with y based on my experience. She said I was not expected. She said I was not expecting a very non confrontational, polite and professional discussion to be taken so personally by someone in upper management. And so I asked a couple questions. I said, How old is she? Because I'm expecting like someone like 60s?

How old is she does she have a PhD because this is a very academic SLP type of conversation. So she is in her mid 40s.

Doesn't sound like she has a PhD. But

that's what this person is experiencing. We're gonna help her put together some information from car hopefully from Jayco. So she can take your black and white commission customer service department. He said not to call today, but let's do it. Standard was not our episode. But here we are. If you are calling to file a safety complaint for an accredited organization, press two for instructions.

JCHAO 27:57
If you would like to speak to your account executive, press three. For all other inquiries. First Four.

We're sorry, we're unable to answer the phone right now. Please leave a message after the tone.

Megan Berg 28:16
Hi, my name is Megan Berg, I have a question about the requirements for speech language pathologist for accredited facilities. If you could call me back, my number is 403. Thank you.

So we'll see if they call us back. Um, what we were intending to talk about today is taking a few steps back and being like, Okay, if we were to like, start from the ground up and define what should be required to be a speech pathologist, what would that be? And so I invite everybody listening to just kind of release and let go of the existing system in your mind. And just be like, Okay, we're looking at a blank slate, a blank canvas. And now that we know like now that this profession has been around for a little over 100 years and has evolved significantly in that time.

What do we want it to look like?

And what should be required of a human being to get a state license? Or should it be a state license at all?

So this is something that we posed in the stories on Instagram.

So lots of people had different ideas, should we just go through the different ideas?

So some, somebody said, annual competency checks at work, so that would be like supervision or note reviews. Specialized

grad program based on school versus medical, and then just a state license.

Passing a specialized exam with some sort of supervision for the first six months.

Lots of people have different thoughts around like, including specific topics like neurodiversity affirming and autism, instrumental exams counseling.

Somebody mentioned that the degree should be three years, not two years, plus the clinical fellowship year because we know too many stories of CF SMA learning.

Somebody mentioned the idea of just keeping the standards of the CCC but keep keep it as a one and done milestone. So you just pay that fee once. And that indicates that you've met all those requirements.

Kara said a rich spouse.

Jeanette Benigas 31:01
I'll take that.

Megan Berg 31:07
Yeah, there's a lot to unpack there where we have a field of 96% women with a stagnant salary.

And not a lot of growth options in our careers. I would challenge what you said and say not stagnant, but declining, because then no one gets raises and the cost of living goes up. That is actually less income, even though the number stays the same.

Yeah.

Jeanette Benigas 31:43
Yeah.

Megan Berg 31:46
And to add to that, I think that I think that women are treated differently. And there's evidence to back this up where

it's assumed that women are going to marry and rely on a heterosexual sort of relationship to bring in the bulk of the family income.

Emily says a fellowship year with whatever age you're working with. So if at any point in your current career you want to work with kids or adults, your first year on the job needs to be a fellowship, so you'd have mentorship. I think it's crap that someone could spend 20 years working with adults and then decide to take a school SLP position or vice versa and not receive any mentorship. Absolutely.

Sophia said similar requirements to PT and OT.

A cu on what to unlearn as an SLP.

Somebody said a master's degree with continuing education knowledge on laws that are related to our profession.

When he said praxis and a practicum, possibly split between adults and pediatrics,

somebody else's 5050 Split CCC covers state and national certifications state takes half and Asha takes half.

That's interesting. I'll just say as a side note, in Montana, I have not paid my state licensing fee for a couple of years because the state association started asking questions about their budget in it turns out that they were taking in way more money than it cost to regulate the licenses.

And so there was some transparency around that. So I just have questions about like, who gets to define what that is and

in you can't have

you can't have a split between a regulatory body and a membership association.

Somebody said a specialist degree instead of a master's

so I don't know if that would be like

an associate's degree.

Jeanette Benigas 34:19
I don't know what else what other kind of degree you would get in just a state license. Well, like a like a DSL P.

Megan Berg 34:28
Okay, so going the other day? Yeah. SLPD.

Precious Daffodil said Bachelor's in Communication Science disorders with more rotations as senior specialized masters.

Dr. Morris speech said, OTs and PTs do not require a clinical fellowship year Why is it required for SLPs and that's because it's built into the training program

and why their programs are a little longer.

In somebody said,

I feel like you should read this one Jeanette, number 23.

Jeanette Benigas 35:09
I can definitely read this with some, some passion. There's capital letters. Here we go. Also, for the love of all things holy, there needs to be considerably more dementia education in grad school, not just learning about the different types of dementia, but the stages of dementia, how each stage impacts our treatment plan, et cetera. Dementia literally guides every single clinical decision I make in my st. senior living communities. And I was wholly unprepared.

I responded back to this clinician, and I said, as the literal protege of Michelle bourgeois, I concur.

Which is how I ended up working with Michelle because I've shared on the pod before I had no idea what I was doing with dysphasia. But was equally as unprepared for dementia. I had a fabulous aphasia professor, but just less education on dementia.

Agree, which is really what every SLP needs, who's working in an elementary school?

So I think that's a great universal standard to pull, obviously, obviously, which is why like these people who are, you know, saying, like, maybe we need tracks or something like that, or some kind of fellowship or supervised experience in what you're working in makes a ton of sense. You have some sense.

So I,

I teach overlap classes, though, too. So I teach AAC, you can have AAC with pediatrics, or adults, I treat dysphasia. You can have dysphasia with pediatric or adults, I treat motor speech, which covers pediatric and adults. So there are some topics that cover both. But I would argue, even in those topic areas, my classes lean very heavy adult, because that's what I do. And they're very light on the pediatric info like so for dysphasia, I have to bring in guest speakers because I'm not going to pretend to be competent in those areas.

So I bring in people who can do a better job than me, but even some of those clashes. classes, I think need to be split. Mm hmm.

Megan Berg 37:41
Yeah, so I have some thoughts.

And, and they're kind of all over the place. So we'll just see what you think Jeanette. But

I personally think a national exam is redundant, if we have competency check offs from supervisors. And the reason I think it's not only redundant, but a national exam isn't, it doesn't really fit with our profession. So like, I understand an exam for architecture, engineering, I could see it for respiratory therapy.

I could see it for I don't know, just something that's a little more cut. And dry speech pathology is an art and a science. And it has just as much to do with bedside manner in counseling skills, and all that. And so

if if we have a curriculum at the grad school level, and we're taking the exams for that specific content, and then we're having really good universal competency check offs, from supervisors, I don't think we even need a national exam because exams, like people who do well on tests, are people who do well on tests, like the test oftentimes isn't checking people's knowledge. It's just like, does this person's brain do well, with multiple choice questions. And in some people's brains do well, and some people don't. And you could have somebody that gets an A plus on the test, but then you put them in a patient's room and in the bomb. So I think it's not fair to SLPs and it's not fair to consumers to rely on a national exam.

Jeanette Benigas 39:32
This almost reminds me of what we went through 15 years ago in this field, following

a time where lots of people were looking for jobs, and we had a nationwide shortage of speech therapists and we had the recession or whatever, and people wanted to be sure that they were going to get a job when they were done with college. So at that time,

Many people were entering the field of speech pathology as students. And we really bottleneck we had hundreds and hundreds and hundreds and hundreds of students entering undergraduate programs. And there weren't enough master's programs to accommodate all of these students, which is why now like Pennsylvania, between the accredited programs and the programs who are candidate programs, we have like 27 programs now in Pennsylvania, which is wild. So now we're like, seeing the pendulum swing, shift swing the other way. But this reminds me of that time,

when we had all of these applicants, you know, when I was at Ohio State, during this time, I think I heard the number we would get, like

600 applicants for like 30 master's degree places, it was wild. And what we started to see, so you know, then I graduated, and then I went off to my first faculty position. And what we were seeing was that people could get a 4.0 very easily, and maybe not be involved in anything like extracurricular, maybe not have good interpersonal skills, maybe just not be a good person and so many programs at that time, were admitting people to their programs just based on GRE scores,

GPA, things like that, and weren't having actual interviews. So, and we were seeing this, we didn't, I don't think we were doing interviews where I was at at the time. But I had to counsel someone out of the master's program, my second year, because she, she, when she got into the room with a client, she just completely broke down. And I mean, we remediated her every week, I was remediating and trying to help her and I'd meet with her one on one, and we'd have a plan and like, it was so much extra work for her. And she still couldn't rise to the occasion of like having these interpersonal skills to like, help this patient, it was just, it was hard to watch, it had to be hard for her to adore. And, you know, eventually, like we had a couple come to Jesus moments where I'm like, Are you sure this is what you want to do? Are you sure you want to keep putting money into this and all this time and effort and she ended up leaving the program. But it's that same kind of thing that you just said, like, you can be great on paper,

but really not have the clinical skills and, or the emotional intelligence, a lot of programs have moved to that's why there's interviews now to get into grad school, because of that time where it's just like, we got a lot of 4.0 out, you know, if you weren't getting a three, nine or four out, you weren't getting into grad school, right, like three eighths got waitlisted. And even then you might not get in.

But yeah, it's that same kind of thing. Just because you have it on paper doesn't mean you have the skill.

And my concern would be who is writing these competencies to check off to make sure that the person is competent, because we all especially again, like this person just said in dementia, there is a gross lack of education on how to assess how to treat what's appropriate, what's not appropriate.

If you have the supervisor checking off the competencies, who doesn't have this skill? Are we helping anyone same thing with dysphasia, there are so many practitioners out there who haven't kept up.

Megan Berg 43:43
And I think that's what Asha was trying to resolve. And that's why they were like in order to supervise a student, you have to have a seat because they were trying to control that control for that factor that you really can't control for in a lot of ways. And so I think I would love to see us shift again away from a very hierarchical controlling authoritative body to a free market system where SLPs are just more aware of

like, they just have more options. So they get to kind of decide in this. You're gonna hear this and be like, that's completely unreasonable, but

students could say the supervisor wasn't helpful, and the university would take it seriously and stop using that super well. I completely agree with that. I completely agree with that.

Jeanette Benigas 44:42
I loathe

these programs and I get it you guys. I did the externship placement job. It is hard. But if our students are coming back and saying this was not a good experience with wit for me, this was

not in line with the evidence based practice that I was learning in your class. We need to take them seriously. They aren't preschool children. They are adults who are about to be our colleagues. Stop sending these students to these crappy placements, where they're unlearning everything. We just spent 16 weeks trying to pull them into their head. And then yeah, I mean, we just need to stop, we need to stop the madness. Stop. Yes, no, I, I think you're right.

We are aligned.

Megan Berg 45:35
But I think what's happening now is like, well, they have the CCC and like, there's a shortage of people who are willing to do this. And so we're just gonna keep quietly sending students that way. And so the CCC isn't accomplishing what it's trying to do.

Jeanette Benigas 45:54
I know we've talked about Calypso, I don't know if it's privately or on here. But Calypso actually has a place where the students can rate their supervisors. And I've never worked at a university who actually uses that function. And as a, as an externship coordinator, I have actually been asked, Will your students be rating our, our clinician, and what will you do with that information, because they didn't want us to do that. Oh, my God.

Megan Berg 46:25
That is so power over dynamics. And it just fits with our current culture. I now have like one group of people controlling another group of people, and it's so oppressive. And it's like our last episode, and we're gonna talk more about the history of Asha. But Asha has a very, very, very dark history, like the founders have. I mean, you can go read all the papers, they wrote, they're incredibly racist, incredibly elitist. People who just felt like words needed to be spoken a certain way with a certain accent, in a certain flow or whatever. And like, if people didn't talk that way, that was a problem. And that was bringing down society in general. And it was up to speech therapists to fix it and go around and fix everybody, like make them talk like all the white people. And like, this is the culture and so we can't stand it, we are so uncomfortable, as a group having to weigh dialogues or, or understanding that somebody might disagree with us, or what we perceive as, quote, wrong is really just different. And I think that's why it's taken so long for speech pathology, to understand autism, and to understand what autistic people have been trying to say to us for decades. And it's like, it's, yeah, we could go on and on. But

you have to give students you have to have feedback mechanisms in students have to be taken seriously. And we have to have this freer market, that where there's more checks and balances, where students are getting what they need, and what they're paying for. And we're not just like, relying on this dumb certification to, quote, regulate everything when it's not doing any of that. And I also want to just circle back the CCC standards, as well as the CEA standards are based on the practice analysis. And we've talked briefly about this, and we'll talk more about it. But basically, this is a survey, it just went out recently, where Asher was asking people to take this, it was going to take like an hour. And they're trying to get enough people to respond to this. And what they do is they hire a statistician, basically, to look at the answers of the survey and be like, Okay, these are the things, these are all the skills and knowledge points that working SLPs need right now. And then that gets applied to the curriculum standards. And, and then they conflate the curriculum standards with the CCC standards, even though they're the same thing. And they're redundant. But the going back to what you said, Jeanette about, like, who's writing the competency standards, that could be an alternative, like, get rid of the CCC, and just turn it into a competency standard program. And if ain't good enough, and universities are like, Oh, that that really does reflect reality. And students agree with that, too, then we can all choose to opt into that system. And use that as a universal checklist and then get to a point where it's like, okay, you've been through this entire process with competency check offs in grad school, and the degree should be enough there doesn't have to be another certification or another layer after that. It should all be packaged up into this degree that people are paying 10s of 1000s of dollars for Yeah, and one way we could do that. I want to just because people I know sometimes hear us and agree with us, but like what would that look like you have a hard time

Jeanette Benigas 50:00
I'm like, figuring that out, what that would look like is something that I do in my dysphasia class. And I just want to preface this, I did not come up with this, although I did give it my own twist. I modified this from my mentor, Pam Smith. So this wasn't my idea. She taught several dysphasia courses at her university, she just retired.

And so she had like, different versions of this, I think, but I only have one dysphasia class, so I had to put everything in it. But I arrived home last night at 10pm. Because I was giving oral I call them oral competencies. All day I've been to we're recording on a Friday, I've been doing these since last week, I scheduled 45 minutes for each student, and I get them into my office and we sit in the dark. And the first thing I do is I put up a still shot of an MBS in front of them. And I make them tell me landmarks, I say what's a what's b which g what's K, and they have to tell me what the landmarks are. If I had more time, I would also do it with us a still frame from bees, but I don't have enough time. Then I hand them an HMP that I've written. And so it's a history and physical, and they read it. And they tell me based on the history and physical which means what's going on with this patient? What's the history, what's currently happening? What are the patient preferences and choices? What does the family say? What's their current diet? What's the prop presenting problem, they have to read that and tell me five things that they could reasonably expect on an instrumental examination. And then they have to watch an instrumental examination. And they have to tell me five things that are happening, or like going wrong in the instrumental, they have to tell me the pathophysiology of why it was happening. And then they have to tell me if they are going to treat that issue, considering the issue of the pathophysiology and the case. So you can't just tell me if you see Piriform sinus residue, you can't tell me there was a UEs distension problem, because it might be a weak base of tongue problem. And you might not use a liquid wash, if it was a UEs distension problem, because, you know, you might just be adding to the residue. So or, you know, maybe there's a dementia issue severe dementia, you're not going to do a Mendelson to fix that problem, because can they follow those instructions? So they have to take the case into consideration the pathophysiology, they have to tell me what they're going to do. And there if they say, No, they have no, I'm not going to treat that they have to tell me why. And they're only allowed to say no one time, and they're only allowed to use each treatment one time because you can't just say effortful swallow for everything, you have to be competent, then they have to pretend like I'm the family member. And tell me what happened, why it happened, what the plan is, they have to make an et Cie diet recommendation and have a reason for the diet and liquid that they chose. And then as part of the assessment, I consider how much help they had to have, you know, they lose points if there's too much cueing, and they have to have shown me that in each section, the HMP recommend predictions, the middle part where they're watching the MBAs and the family conversation, they have to show evidence that they have considered the case throughout the entire process. And that is what looking competent in my class looks like you have to know assessment you have to know treatment, you have to have a person centered plan. And you have to understand all of it. Can you imagine if you did that in every class.

Megan Berg 53:55
So here's my like, that's amazing. And like you're an amazing professor, where I have hired Megan to the chair. I'm to, like lay this out. So let's say that that was sort of that became the standard

competency checkoff. My argument then or my question would be what path do students have to give feedback that they've been given enough opportunities in training to succeed in that? Because I can tell I was in. Okay, well, yeah, I know you. I know you.

Were out there. But I was in a situation in grad school where I was getting all A's, and then I had an oral exam, and I failed it. And it was so frustrating to me, because I was like, I'm showing up here every day. I'm paying the 10s of 1000s of dollars. I've gotten A's the entire way through, and all of a sudden out of fucking nowhere. I'm failing and it was so humiliating and so frustrating and

I had no recourse. Like I went to the chair and it was sort of like, oh, yeah, like we're getting this feedback, but nothing was done. And so I agree that there needs to be really high competency checkouts, and that one sounds amazing. But there also needs to be a respect to students. But I also understand that sometimes students will use that feedback system to say that they didn't give, get the opportunities when they really did.

Jeanette Benigas 55:23
So it can be it can be very abusive towards the professor, that feedback system. So here's what I do. And I know that there is a power dynamic that sometimes students will still feel uncomfortable, but I try to foster these relationships throughout. So by the end, they're comfortable talking to me, but on the first day, I let them know, look, you know nothing about any of this, and I am walking on a path with you, we are walking down a path that is step by step by step. And I am going I'm going through this with you and I will be here with you. And my my purpose is not to fail you which I've never done, it is to help you at the end, be so amazed and so proud of yourself with what you are going to accomplish. And then I briefly tell them, there will be an oral final, we're not going over it now. Because you will freak out there'll be an oral competency, you will freak out, but just know we're walking on this path. And so I remind them of that. And then at the end, one of the reasons it's a 45 minute session, because they have to do all of that in 25 minutes. For the last 20 minutes, we talk about the class and I invite them to, they have to come prepared with a couple things that they loved about the class that they thought were great that were helpful that I should definitely keep. And a couple of things about the class that they didn't like, or they think that need modified or change. And I invite them to tell me these things respectfully. So before we start, I tell them, You're not going to hurt my feelings, I am inviting this verbal feedback. And the negative is just as important as the positive. And you've already earned your grade, right. So they've this is after the World Cup, which is the last thing all the grades are in so nothing they say is going to change their grades, they know what they're getting in my class.

And I just say like, I want to hear a couple, you have to give me something from both, because nothing's perfect. And this is how my class has grown to, you know, people used to fail this oral comp all the time. But from this feedback that I've been able to get from them, I've been able to make my class better to better prepare them, you know, teach them better to have more meaningful and valuable assignments, that they're responding better to you. And you have all kinds of learners. So you know, kind of hitting like those people who are better with written or hands on or lecture or guided notes. And you have to be an educator who wants to do that, though. And so there is still that competency issue that if you don't have someone like me, and I do this for all of my classes, I don't give an oral comp in every class. But I do invite this feedback at the end of every class. So I can just have this like, my goal is by the time I read tire for them to sit there and tell me don't change anything. Dr. Bet, I guess this was amazing. And I have started getting that a couple times now. dysphasia. But this is like after seven years of trying. So you know, I'm getting there used to be way more complaints than positive. But that's that's a good feedback. But I've had to earn that trust from them, too. And people have sat there and attacked my character. And I've sat in taken.

But that's, you know, I invite that and that's not really the norm, but it's so much better than those student go student reviews that they write at rate because people are just nasty on those. This is like a respectful conversation where I can then ask questions to like, Oh, that's a really good idea. What would you think if I did it this way? Or okay, you don't like that? I hear you. But I still have to hold you accountable. So what's another way I could do this? That would work? And

Megan Berg 59:06
yeah, I mean, I hope that's how our field can evolve, we can move away from power over and it sounds like you've worked really hard to create a system that's power with and empowering and we both have to wrap this up because we're meeting with an attorney in a few minutes. But I just like to wrap it up. I think it's interesting because whenever we talk about

requirements to be an SLP it always the conversation always comes back to grad school standards. And that's where I'm like the degree should be enough and all of the conversations that we're having come back to clarifying curriculum and what the process is for getting a degree. Again, I personally think that the degree needs to be specialized. So there needs to be a school based program in the medical based in programs you

universities could offer one or both, and students could choose one or both. But then there needs to be a difference. And then there needs to be a school based license and a medical base license. But ultimately, the degree itself is enough. We're not adding certifications on whatever else. On top of that, we're going back to the curriculum, we're getting that strengthened. or figuring out these competency checkups. were figuring out like, dumb rules, like you have to have so many PhD people in your program like, I personally think you should have more adjunct people like those are the people in the trenches that know the current knowledge, like there should be requirements about getting practicing SOPs, teaching in the program. And then having support systems and courses in place for those instructors so that they can fast track what you already have taken the time to learn. And so that students aren't having to learn from people who aren't even exposed to the things, the kinds of things that you've taken the time to figure out. I would even say, even then, if it's school and medical, then even if you want both, you are not doing that in the same amount of time. So you've now entered a longer program, almost like a doctor who wants to like, specialize in something, you are a doctor and then you become a surgeon, you're not a pediatrician and an oncologist. Yeah.

Jeanette Benigas 1:01:22
But I would even say in the medical, there's a lot of medical knowledge, hold on, I need to pause.

Megan Berg 1:01:33
She muted just in time to cough.

All the germs, all the germs are going around right now, I think I'm on virus number three for the last two months. Okay?

Jeanette Benigas 1:01:43
I didn't even aspirate, it was just like a scratch that went up into my eye, it was so bad.

Oh, my goodness, okay. Even with medical, there even needs to be more specialized pediatric and adult. So even that track needs to split a little bit, because in dysphasia, kids are not little adults, they're completely different issues. And so, you know, if you're going medical, you're still not across the scope prepared across the scope to work in any hospital or any, you know, pediatric setting. So I think there would be some specialization there. And I know my academic SLP friends will hate this because it will upset our lives and cause us to have to move and stuff like that. But I think that this would even fix some of these issues where there's 20 Something programs in Pennsylvania, not every university is going to offer the school track or the medical track or the medical peds or the medical adult. And there's probably not currently enough of us to like figure all of this out. But our programs should advertise these specialty tracks. And so that would again, split us up like I'd be going to an adult MediCal program. I wouldn't be teaching on a place that is solely advertising like school track or school peds track and then you would need you know, some of these bigger universities like Penn State Ohio State, Pitt that you know, these big programs, where there's enough faculty at the University where then you could offer all the tracks, but some smaller programs like mine, there's we have two PhDs, an EDD and a Masters, and all but one of us are medical adult SLPs. So, you know, that's what up. And I just want to say again, like we're not saying that medical SLP is more advanced, or school SLP is more advanced. All we're saying is that they're very different skill sets, very different settings, very different challenges, different billings setups, I mean, there's just so much information that is unique to each of those separate settings, and even paperwork, you know, paper. An IEP is different than writing it's for sentence progress note in my chart, right? It's completely different. Different writing style, different abbreviations, it's just everything different. Yeah. So okay, in case you missed it, in case you missed the key word that may have said earlier, we are reading with an attorney so we have got to go.

thing more to come. So

we are signing off. Thanks for listening, and thanks for fixing it. i Bye everybody.