We are discussing the biggest challenges that are currently holding back the field of speech language pathology.
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.
Let's fix SLP.
All right, Jeanette, so here we are on our first episode of fix SLP. And I think that neither one of us predicted that we would be recording this today, because we've been talking about this project for a while, it was always on our list of things to get to. And at least in my mind, we were gonna, like, figure everything out and make it all perfect and shiny and present this beautiful package to SLPs. To understand. And I feel like what happened in the last few weeks is just like, the information that we had just needed to get out and like needed to be connected to SLPs. And it just kind of started without us. Actually starting it.
Yeah, it. It's pretty messy. But I'm pretty messy. So this is, you know, par for the course. But I think it's good. I know, we we intended to have that plan. And even like topics and episodes laid out. But here we are. Here we are, you're leaving for a trip, I was making the fix slp.com website in like the middle of the night as I was traveling to Virginia. So it's just kind of like we're, we're putting this together, it might not be presented, perfect and shiny. But we're glad that you're all here to have the conversation with us.
Right and right, go ahead. Oh, no, I'm just agreeing with you. So we're going to talk today specifically about this certificate of clinical competency, right. That's what the C stands for vacation of clinical competency, whatever it is. Certificate, okay. And
I want to share like a personal story about the C's, because I'm sure everybody listening kind of has their own story of trying to process how this all works. But for me, like I graduated from CU Boulder in 2015. And I think that was around the time that Colorado was installing a state licensing board. And Colorado was the last state to do so in the United States. And so it was like this weird time where I think when I got my first job as an SLP, working in the schools, I didn't need a state license because it wasn't quite there yet. I do remember, like getting something from the Department of Education in Colorado. And so there was that piece. But I ended up working in the schools for a year. And then I moved to Montana to work in the medical field. And when I got to Montana, I showed up for my first day on the job. And I thought I was all set because I had my CS. And then they asked for a record of my state license. And I was just, I remember being very confused. Like I didn't know that I needed that. I'm sure somebody mentioned it in grad school, and I just wasn't paying attention. But it wasn't. Nothing was clear to me as far as like what I actually needed in order to do my job. And the ironic thing is this company didn't even require the CS, all they wanted was the state license. And so I was like, Okay, I'll just go get my state license real quick. And part of the Montana process was taking a jurisprudence exam. And some states have this and some states don't. And basically, a jurisprudence exam is an open book test, where they're basically trying to make sure that SLPs understand the regulations pertaining to speech pathologist within that state. And so, I took the exam and I failed it. And they wouldn't tell me my score, and they wouldn't tell me which questions I got wrong. And so they're like, you just have to take it again. It's like, okay, so I took it again, failed it again. Again, they didn't tell me what I got wrong, what my score was, they're like, you just have to take it again. Like, okay, I'll just keep taking this until I pass it. And I didn't know at the time that the University of Montana has an SLP grad program. And so what the students were doing was just sharing the answer key. So everybody knew what the answers were because the test was so poorly written. So I took the test again, I failed it again. And then I got an email from the state licensing board and they're like, you're gonna have to come in person to the capitol and plead your case with the board. And our next meeting is was in mid September. So that was like, months away. So I couldn't start my job, I didn't have a place to live. I had two dogs with me, I had my Honda Civic. And so I just lived out of my car for months in Missoula, Montana. And I found like different places where I could camp for free or low cost. And I was just waiting day after day for months, to just show up in Helena and plead my case to be able to take this jurisprudence exam again. And I remember like waking up in September, and there was like frost on my tent. And like, I get into my car, and I drive to Helena, and I get a hotel room. So I could like take a shower, because I hadn't showered in a long time. And then I show up, and it was just the most like humiliating experience to have to go in person to this board and plead my case to take this jurisprudence exam again.
And at that point, I had met enough people in the area that they shared the answer key with me, I took the test again for the fourth time, and I got my state state license. And since then, Montana has gotten rid of this jurisprudence exam, because it's just so poorly written. And so that was like my first experience with understanding the difference between the C's and a state license. And I would say that it wasn't until a couple of years ago that I was really starting to question like, why do we have both? Like this doesn't make any sense. And just talking to friends and family that are in different professions and being like, Do you are you required to pay for a national certification and a state license? And almost everybody was like, No, we don't have to do that. All we need is a state license. And there's like these optional sort of national kind of board certifications that you can opt into if you if that floats your boat, but it's not a requirement.
I'm sorry, would say that's kind of my background and why I'm so interested in this conversation. What about you, Jeanette?
So I live in Ohio, and I went to grad school in Michigan. And, um, OH, for everybody listening who knows what that is, I would not live in Michigan. So I commuted 45 minutes, up to Michigan for grad school. And at the time, Michigan did not have a state license. And so this was in tooth, I graduated from graduate school in 2006. And our professors were very actively lobbying the state for a state license to give us protection as speech language pathologist in the state. I was very aware that I was never going to work in Michigan. So I was very cognizant that I had to pay attention to the Ohio requirements to get licensed. Because I was living in Ohio, I was never leaving. And I certainly was never going to practice in Michigan.
So that was, at the time, you just had to have your seat. So from a very early start in my career, I knew there was a difference between the C's and a state license, mostly because our our professors educated us about that. So what I didn't know at the time was that the seats are a certificate. It says it right in the word, but it never processed in my mind that it wasn't a license. And so for a very long time, I described the seas as the national license.
That's not what it is. Right? So it took a lot of years and learning to know that that's not what it is. So, you know, I practiced in Ohio, I've maintained my seats, but now I'm in a position where you know, just like everybody else, every year when I have to send in that money, I am furious. I I'm furious every time I earn a ASHA ACE Award, which really, people are often proud of that, but all it is is a piece of paper that that says you've paid a lot of money for CEUs use in a very short period of time. And you pay for that piece of paper. Right? That's what I was just about to say for people who don't ever get it good for you. That's awesome. But by nature of my job, I'm, you know, always engaging in this kind of stuff. But what makes me even angrier is that when you earn this quote, award, you have to pay if you want the wall certificate, and I just I just earned it again, let me open it up. Let me let me tell you how much it is. If it's if it's in an email, I'm not going to do okay, I just while you're digging.
I'm gonna also say that ASHA sends the names of the ACE award winners to the state association and encourages them to like publicly announce that. And so it's a way for Asha to promote the ACE award.
But exemplifying people that have it. Okay, so the member price for a professionally printed a certificate is $25. And the non member price is $30. These prices are subject to tax, you can call us at the Action Center at this number between these hours with your credit card.
Okay, can you just get a PDF?
Or like I'm sure is it there is a PDF attached, which I could go print professionally on my own, probably for way less than $25. So you know, it's just and as a professor, there are other things that aren't required, but are expected of me like I need to be active, or at least members of sakes, that's more money, and they just raise the prices of the sick. I don't I don't know if it was last year, in the last few years, the prices of the things have gone up by I think $15, don't quote me on that. But I'm in to six, that's another $30 that I'm paying per CIG every year, it's just so much, it's so much right. And I just get angrier and angrier. And thankfully, as a full time professor now, because I've I've always kind of pieced jobs together. So I was always paying for this out of pocket. As a full time professor. My institution does now pay for my seeds, so that all of that is now covered. But that just started happening last year.
But it also puts me in a position where I can't let my Cs go, I would love to do it. But the way it we'll get into this, as we continue in this episode, the way that our system is structured right now is that in order to supervise students who are going to pursue the CCC, they have to be supervised with someone who has their CCC and part of my job is supervising clinic. And so I can't let my CS GO, or I would probably lose my job. Because we're a small institution, there's three full time faculty members, we are actively involved in the clinic we're not researching. So I'm a clinical educator, I have to keep them. And so I just want to put that out there to that. Well, we're not telling you to keep them or not keep them we really strongly feel like everybody should have a choice that everybody just needs to be educated. But I I'm very feel fearful of appearing like I'm a hypocrite, as I maintain my seeds. I am maintaining my seeds, because at this point I have to and as part of this movement, I think we'll be doing some calls to action that will hopefully cause change in how we're structured and that So someday I can let them go. Because I have a state license. I am licensed in Ohio, I'm licensed in Pennsylvania and when it you know it last year, I got license in the good old state of Michigan.
I live in Columbus and I forgot about the Ohio Michigan. Yeah, I can't you know, right, one of my one of my employers wanted to do some teletherapy wanted me to do some teletherapy at a building they couldn't staff. And so I said I'll do it, but you're going to pay for the license. And they did. So next she's she's going to expire any minute, I'm not renewing that. We're not we're not doing that. So that's where I'm at. That's, that's right, I thought you were talking about the person is going to expire the medical term for this, I'm with you. But I also want to say that things are $45 each. And that's another thing I'll just throw in here is like we are doing our best to provide accurate information. If you hear us say something that is not accurate, please correct us. And we will make that publicly available that we got something wrong. That's something that is super important to us that we're trying to figure this out, we know we're gonna get things wrong, and we always want to correct it as it comes up.
And what we do ask too is that provide us with as much documentation as possible. We are trying to back up what we say with evidence that's really important. We're going to get into these rumors and the only way to dispel these myths is to have something that we can refer to to say this is the truth. And so if we say something wrong, it's not enough to say well in my state, I have to have my C's to credential my employees. Okay, great. That might be a thing but what we would really love for you to do is show us the requirement so we can collect it. And eventually we might make some of this stuff public if we have enough to share. But that would really be helpful because this is just two of us. And, you know, it's a lot, you know, 50 states, a million requirements. It's a lot of information.
Yeah. And I think the reason that the seven rumors that we're going to talk about are so prevalent in our field is because they're there, there's just so much misinformation that gets spread around, that's never verified. So that's what we're trying to do is like, verify information. And if somebody says to us, like, we need to have our seeds to build this insurance, like, we want to see the exact condition of participation that is outlined by that insurance company, in order to believe that because otherwise, it's just a rumor. So yeah, the more that we can document the better.
And really, that will lead to oh, sorry, Megan. No. Okay, that will lead to us being able to take action, if we are informed on what actually is required by all of us, as licensed professionals, then we can have a much clearer picture of what needs to change and what needs to be changed first. Yep. So we need help. Yep. So for a long time, SLPs have thought that the CCC was required. So, again, we said we're talking about today, the fact that the CCC is not, in fact, it's not required to practice as an SLP. So we have all these rumors going around, we're going to address them one by one.
And the reason we're talking about this, and the reason that we have chosen this as the first major conversation we want to have with all of you is because we believe this is a core systemic issue in our field. And because of the relationship between Asha and SLPs, currently, SLPs do not feel seen or heard or valued or respected. But there's a lot of diminishing of the dignity of SLPs that goes on in that relationship. And so I think this creates a lot of issues across the field where people in power, kind of mimic how ASHA treats SLPs. And so if this is an issue that we can address and resolve, I think we're all going to feel like we're we have a voice that we belong in this field, that we're not constantly like looking over our shoulder to make sure we're doing it, right or like checking to make sure that everybody else is doing it right like that we are able to have hard conversations with each other, we're able to disagree, we're able to move forward in that way.
And so that's why we're talking about the C's first.
Right. And I want to mention, too, that as we were thinking about this and thinking about this podcast, and what we might want to do, this is really, you know, we had our podcasts, other SLPs pockets, and that was kind of a filler as we took a look at the bigger picture, but this is really a continuation of the SLP data initiative. So if you haven't had a chance to check out that data, go to the SLPdatainitiative.com Is that what it is Megan? (Megan: Yep).
Okay, you can look at the survey that we did, we had over 7000 responses. I think around 5500 We're in full. So that means people went from question one all the way to the end, but we certainly weren't able to collect information from the other 2000 who didn't complete it in full.
But it gave us a lot of information. It was really one of the biggest surveys that has been done in the field Megan and I were both a part of that with a handful of other really awesome business leaders and SLPs in our our profession. And so what we promised with that was that we were going to use it to make change and so that's really what Megan and I are trying to do here and so we thought we might address all of those issues and you know, go month by month with a different topic. But this one is probably going to take more than a month I would guess this is more than a four episode series. So like we said, It's messy. We're just going to go until it's naturally time to move on to something else it this won't be our entire podcast. There's certainly more to talk about. But like she said, this is where we're going to begin and what I do want to mention is that Megan has done a fantastic job at answering questions finding out all this information. I in no way have been digging into insurance websites, actual website, tax codes, this this I want want to give Megan all of the praise and credit for her amazing brain? She is awesome. She's She is the brains behind the information that has been shared. I don't, I don't want to take any credit for that she's doing amazing work. So this everything that has been shared to this point has been her just digging it. Someone asks a question and like five minutes later, she's like, here's a screenshot, this is the answer. So huge round thanks to Megan, for, for getting us together, I'm just the voice who's giving my voice I want to say social media.
I've said this on Instagram, like, it's scary to have this conversation because I feel like people there's the sense that like, if we talk about this, we're gonna get in trouble. And I'm like, That's exactly why we have to have keep having the conversation and why it's important to do this together. Because there's strength in numbers. And I feel like, again, going back to the idea that SLPs don't feel seen, don't feel heard, like we're not going to feel seen or heard unless we start talking. And so I'm glad that we're doing this together, and the conversation is just going to grow. So let's dive into the seven rumors. I'm just gonna start with number one that the C's are required to build insurance. And so when I started looking to into this, this was a rumor that I heard over and over. And this is truly the reason why I've kept my seats because I was like, I never want to be in a situation where I've built insurance. And then they come back and they're like, where's your sees, and then like, the facility I'm working for has to is in a, you know, a bad situation. So I went directly to CMS, the Centers for Medicare and Medicaid, and I just asked, like, is the CCC required to build insurance? And they said, No, only a state license is required.
And so the other thing that I did, because I can't literally call every single insurance company, although I've tried, but the first thing that they asked you is like what is your provider ID. And so because I'm not registered as a provider with all these insurance companies, I can't get past like their first, you know, dial directory. But I did call the C AQ H, the Council for affordable quality health care. And this is an organization that a lot of private practice SLPs register with, because it makes it much easier to then register with all of the different insurance companies. And they confirmed over the phone that they do not like they have a spot where you can put in the information for your seeds, but they do not require it, they just require your state license. And so we've been getting a lot of comments about this and people saying like in my state, I have to have my C's for Medicaid or in my state, I have to have a C's for these random private insurance companies. And we've been looking into this every time somebody says something, and we're unable to find any documentation that literally spells out that they need their CS, sometimes what will happen is the regulation will say you need one of the following. And it'll say CCC and then the next line, it'll say you'll need to meet the requirements of the CCC. So if you think about that language, from a legal standpoint, it means that you have to have a master's degree, you have to pass the Praxis exam, you have to have completed nine months of supervision in your first job. But it doesn't mean that you have to hold or pay for the CS. And so this is something like people are continuing to send us information we're continuing to investigate. I would say like if you are somebody who builds insurance companies like through your private practice, all you have to do is call up the insurance company and say can I please get a copy of your condition or participation and in that it should outline what you need in order to build them. And then I'll also say that CMS is is sort of the gold standard for a lot of things in insurance and medical healthcare in the United States. And so, most insurance companies are just gonna latch on to whatever CMS says because that's a huge legal safety net for them. So like if they make their own rules, then they're at risk of not following the CMS rules and especially if they're providing supplemental insurance. Having separate roles makes everything more complicated for them. So they know that CMS has already done the work to lay out all of these conditions of participation. And so they're just going to follow as CMS says and follow these codes of federal regulations or CFRs. And so it it would be very odd and very unlikely, but not totally out of the picture that some random small private insurance company has just some oudated policy that requires the cease and they just need to be told, like, hey, all 50 states have licensing boards now, can you please update this? And so that's the kind of work that we want to do with fix SLP is like, find where those gaps are and fix it. Because the CS should ultimately be a choice for SLPs if they want to purchase them or not. And that choice should be based on, you know, what do I get in return? How is this benefiting me? What is this offering above and beyond what my state license is offering, because to clarify state licensing boards, they're there to protect the consumer mostly is what why they're in existence. And so they have a lot of stringent regulations around what SLPs need in order to practice, they can literally criminalize people who try to pretend like they're SLPs who don't have those credentials. And that's a power that Asha or anybody else outside of the government will never have.
They have the ability to process ethics complaints, and and hold SLPs accountable for any ethical violations. So again, these are all things that Asha does with the C's. So the question for SLPs is what is Asha offering above and beyond what state licensing boards are doing.
So that's kind of what we know so far about the C's being required for insurance. And I think a lot of SLPs listening to this are going to be like, there's just enough of a gap of knowledge that I'm going to hedge my bets. And I'm just going to keep paying for the C's, just in case there's this random insurance company that requires it. And I think that's ultimately, the biggest marketing tip that ASHA has is like that seed of doubt, like, as long as that seed of doubt exists, we are going to continue to pay for it. And like, maybe this is too far of an analogy, but it kind of reminds me of like, some of the confusion marketing that happened around like smoking, and like people weren't willing to give up cigarettes because cigarette companies realized that they were in the business of marketing doubt. So as long as they could like plant a seed of doubt, that like, there's no information to disprove that cigarette smoking is bad for you, then we'll keep smoking. And so it's kind of like the same thing here where there's this doubt there's this gap of information, we're not totally sure who to trust or what to do. So we're going to hedge our bets. And we're going to keep paying for the seats.
So much. I should have been writing down my thoughts as I was patiently I'm, I have a crazy brain. So if I don't say say things when I think them, they quickly disappear. But I think it is that fear that you that seed of doubt, I think is the biggest thing. There was also a comment because I am the one monitoring a lot of the socials.
Someone commented, and thank you to everyone who is sharing our stuff on Instagram and Facebook, that is amazing for I just want to put that out there. Because the more people we have that join this conversation, the stronger the movement will be when we have a call to action and there will be a call to action, we can promise you that we've planned out that far enough that we do know, at least one or more of those are coming. But somebody mentioned it's not advisable to not join your state.
Or I'm sorry to not be a part of your national license because it discredits you, and national license or national certification or I'm sorry, yeah, see, look, I'm in that old, that old line of thinking that I did change it a long time ago, I knew it wasn't a license, but my brain still goes there. I'm sorry.
He said it's not advisable to not be affiliated with your national organization, I think is how this gentleman's that it. And a couple people did jump in and like, you know, kind of say I've never had anyone asked me if I'm part of my national organization, certainly if I'm licensed in a state, but you know, so it is that that way of thinking that why isn't it advisable? Why PT has I've never asked a PT or OT if they're part of their national organization. And I think to that, we do still have many people practicing who were at SLP before all of these state licenses existed. And so there's that mentality there too that that needs to be changed.
Ah, because you're right, you're absolutely right. 20 years ago, or 25 or 30 years ago, it might not have been advisable to not be affiliated with our national organization. But our states have done a lot of work to stop that. And so that, yes, it's that fear that people are afraid. And I think we just need to keep sharing and talking about it. So we can kind of overcome that and start start changing things.
Yep. Okay, so that leads us into rumor number two, that the CCC is required to practice as an SLP. And I think this one is maybe the most egregious and the one that's the most difficult to untangle and I, I It has helped me to look back at the history of the field, which is a very, very, very short history, because we are a very, very, very young field.
But basically, before state licensure existed in all 50 states, the seas were the only way to legitimize SLPs. And I've learned that this is a very common growth path for professions. So they're like a national certification will exist until a state licensing until all 50 states have licensing boards. What's weird about the situation for SLPs is Asha is not like they're aware that this is happening, they're aware that the value of the season is gonna go down based on the existence of these licensing boards. But they're not advocating for SLPs, they're not acknowledging that this is the reality, they're kind of like doubling down on the misinformation or like, they're not even they don't even have to lift a finger or really, they just have to not correct information. And so they're contributing to this doubt, and this confusion. And they're not like even the way that the regulations were written into the state licensing boards, a lot of them, not all of them. But a lot of them reference the seas. So they'll say something like,
You need to meet the requirements of the CS or you need to have the CCC or equivalent. And so Asha, you know, was probably involved in writing those regulations, and they haven't really advocated for those regulations to be updated.
And so when we look at the historical framework of Speech Pathology, we can kind of understand how we got to where we are. So, in 1925, Asha is established and between 1925 and 1952, it's really a free for all. So we know that like the profession is coming into existence. SLPs are filling gaps in schools in medical facilities, treating articulation, language, brain injury, all these different things, and they all are calling themselves different names. And so by 1952, Asha started offering a certification and it was initially offered as a basic certification and an advanced certification. And this is all happening in at the same time as universities are really developing their curriculum and we're in or establishing a way to accredit universities and differentiate universities who have accreditation and don't have accreditation.
In 1965, the CCC was established to help differentiate certified speech therapists from people without training, who were opening practices and calling them calling themselves speech therapists. So again, at that time, we didn't have state licensing boards, the C's was, that was the only way to differ differentiate someone who had gone to school to be a speech therapist and somebody who was just calling themselves a speech therapist.
And then, like we've talked about in 2016, Colorado was the last and final state to establish a state licensing board for Speech Language Pathology and Audiology. Thus fully regulating the profession in criminalizing Anyone who attempts to work as an SLP without a state license. So that's how we found ourselves in the situation today, where we're kind of grappling with this idea that certification, while yes, it served a purpose in the 70s 80s 90s and early 2000s is now redundant, or at least SLPs should have the choice to continue paying for it since all 50 states have licensing boards that we are required to pay for a license from so.
So in short, no, you don't need your Cs to practice. But what's happening and we'll talk about this is the C's are so intertwined with everything from the CEA, the Council for academic accreditation and their requirements for grad school curriculum to employer requirements to like we've talked about with the state licensing board language. And so again, part of what fix SLP is trying to do is disentangle all of this. So we need to start removing the CCC language because that's something that's unique to our field is that that national certification is just sort of like embedded and entangled, and all these different things. That's abnormal compared to other professions. And it's just something that we need to fix.
Right, I did take some notes this time. So I spoke at a state convention a couple months ago. And I'd never assume anyone knows anything that I do. But I have a dual specialization both in adult neurology, specifically dementia and dysphasia. And when you take a look at the just seizure trajectory in our field, it really, we really started with instrumentals and digging in with Jerry Logemann, in in the 80s. And so when I was doing this talk, I wanted to talk about the advancement of science. And the closest thing I could come up with was HIV and AIDS care and research. And when you think about HIV, AIDS, Karen research that really started in the 80s. So 1985 was the first clinical trial for HIV medications. And so I did a deep dive like you did with the field of SLP, I did a deep dive into how HIV and AIDS treatment has come such a long way, from 1985 to 2023. And I use that as my example during my talk, because I cannot for the life of me understand why we a speech language pathologists are not allowed to change. We're not allowed to change, nothing changes, right? Like we, we are, and I it's been a long time since I've been a school FLP. So I'm not as deep into those issues, but certainly as a medical SLP, who still practices who owns a mobile fees business and is doing this every week.
We don't allow ourselves to change internally. So we don't allow others to change. We don't allow each other we're not we're not allowing each other to learn and grow. And certainly that isn't all of us, right? So there are these, quote, old school SLPs who have Well, I've always done it this way. And this is what works for me. And they're not open to any education or growth. And it's, it's infuriating. And then because of that, or at least contributing to that I don't get why outside of the field of FLP people aren't allowing us to change. So you're a medical SLP. You can you might be familiar with a statement. Well, the last FLP didn't do it that way. Or the last SLP didn't need these instrumentals. These are things that we hear. And so I so as you were talking, I was sitting thinking about all of this with HIV AIDS. If I needed treatment today, I would never want the treatment from 1985, I would want the one or two pills from 2023, that is going to make me healthy and thriving. Right?
As an SLP. I don't want the way that we did it in 1925, or 1965, or even 1985. I went 2023. And so that's just all in my head. I'm I'm putting it all in that category, that we have all of these states that have now established credentials. Why aren't we allowed to change? Why aren't we allowed? Why aren't we allowing each other to change? What and and I think we need to be agreeable here. And I know you and I are in agreement that if people are considering letting their seas go, we shouldn't be discouraging them. We should be respecting their choice because everybody has a choice and encouraging each other to do what's right for that clinician, and that clinician specific situation and supporting each other and really coming into 2023 and and saying it's okay for us to not do this thing that we were doing in 1985.
That's like a huge soap box for me as a med SLP. But this licensure thing and this certification thing, it's all in that same theme that we are not allowed to change and we have to do it how it's always been done, because that's how we do it. And the truth is things things change. You also brought up, ASHA and then not advocating. They don't do anything, because they don't have to do anything in terms of correcting the record. Because because of this refusal to allow ourselves to change their constituents are doing the dirty work for them. By spreading the lies and spreading the rumors and not understanding the actual information. Asha doesn't have to put anything out either way, because we're just out there spreading it around for them. Right, you know, and why would they then correct the record? Because that means less money for them. And they are there for profit, right? They know, they're nonprofit, no, they're not okay. They're nonprofit. Well, there's, I'd love to know where all that money is. Yeah, that's a really good loving. But yeah, and I'm trying to figure that out. And I, I love what you said. And I'm just gonna latch on to a few ideas. I love the word change. And I think that we can evolve forward. I personally am not anti Asha or trying to like burn anything down. I'm trying to help Asha see why nobody likes them. Like you cannot be a national membership organization that gets money from members, ideally, from their own free will. And have everybody dislike you like, that just doesn't work. And so I know that people who have tried to volunteer with ASHA, people who have tried to get involved, tried to change the conversation or just met with, you know, brick walls, red tape, this is how we've always done it, we're not going to change. Asha is nonprofit, the board members are not paid, they don't get paid anything. It's not like the CEO or the director or getting paid massive amount. I mean, they're getting paid a normal amount for that. What's the industry standard for that?
And I've talked about this on Instagram, we have to look at ASHA as a bureaucratic institution. So it's not a capitalistic organization, there's not a direct tie between the money that we're paying in the pockets of the people that work there, they're not making any more money. Nobody's technically like getting rich off of SLPs through Asha. But the way that bureaucratic organizations work is they have to maintain status quo at all costs. Like when you're trained in how to run a large multimillion dollar nonprofit, you're trained and how to keep that nonprofit afloat, and like not file bankruptcy, and like not rock the boat and not do anything crazy. And you're just trying to maintain the status quo. And I think Asha could hear SLPs better, if SLPs would stop talking about like so much money, like yes, it's weird that there's, you know, $70 million, or whatever flowing through Asha. And nobody can really tell what that's where that's going. That's odd. But like, we need to start talking about, is this ethical? Are they advocating for us? Is there a relationship between the association and members do members have a voice in like, who's elected and the Board of Directors, which currently, the way the system works? Is there's a committee of people that have appoints or decides who's going to be on the board? And then SLPs can either say yes or no. So it's not really a voting system that gives us LPs, a lot of voice. So those are just a lot of thoughts. But I think, throughout this conversation, like I hope that, you know, in 10, or 20 years, we look back at a time where SLPs didn't like Asha. And that was an era that ended and that we can evolve forward, where Asha is truly listening to people truly representing SLPs. Helping make the field better advocating, lobbying, doing all the things that matter to SLPs. And that's, that's the vision that I'm holding on to is that things can change.
So, yeah, and I want to jump into and say, my, my relationship with Asha is like a roller coaster. It's very love, hate up, down, burn it down, lift it up, put out the fire, I don't know. But for me, and you know, make it an eye are two individuals with differing opinions as well. I don't. My Enneagram number is a one. And I with that comes a strong sense of justice and doing the right thing. And I don't like being told what to do. And so I would love to be a part of a national organization that is doing the right thing. And I think it also circles back to that advocacy thing. You know, I'm the med SLP advocate, who advocates for their constituents in ways that are positive, and that are effecting change both for us and the people that we serve. And they might be doing some of that now. But for me, it's just not enough. And I hope that our conversations here and the changes that we would like to see coming from this do and making Asha better. So it is a place like you said, Megan, that we can choose to join and be proud of, and that, you know, we're effecting change for ourselves and the people we serve. If that isn't what happens, then shoot, let's just go burn it down. But I not to today, I'm not burning it down either. Yeah, I think it would be great to, for all of this to, for people to have the choice for us to be have an independent spirit where we can choose or not choose, even potentially, that the cost comes down a little bit. And you know that, that everything lives in harmony, I unfortunately, I also can be pretty negative. And I suspect that Asha isn't going to like what we're doing.
Perhaps they may fight back with their billions and their lawyers. And I think if we get enough, enough traction to hit, there's, this is gonna go downhill before it starts to go uphill. So we'll see. To be continued on that one.
I, so you're in Enneagram. One, I'm an Enneagram. Nine, the peacemaker, like my core fear is conflict. So this is all entirely very uncomfortable for me. But I also have learned that you cannot move forward without conflict, conflict is the best place to learn and grow and figure out where all these cracks are. And so we're kind of in the middle of the conflict. And it just, that's where we're sitting right now. So, rumor number three employers require the CS. And this one was confusing to me, because I've never had to show proof of my C's. So that was different. But I know that I guess this is true of a lot of employers, especially school districts. So I think given the historical framework that we talked about in the fact that state licensing boards were only finalized in 2016, as SLPs, we have to understand that employers enacted this policy probably before 2016. And it was a way for them to make sure that the candidates they were getting had met any kind of standard, because it was the only standard out there that existed. So at this point, employers just need to update their policy to only require state licensure. And this is similar to what's expected of OTs and PTs. There are national board certifications that are completely optional for OTs and PTs. And they get to choose if they get those or not. But they're not required, you know, across the board in a lot of ways for OTs and PTs. So the burden of updating these employer policies is going to fall on SLPs. Again, because Asha, they know what's going on. But they're not investing any money or time into advocating for this for us on our behalf, even though that's what they exist to do. So they're what we're recommending is like if you are currently employed, and you know that your employer has a policy of requiring the CS, just start a conversation with your manager or director or somebody who has the ability, or at least the knowledge of understanding how to change that policy. And just try to provide as much information as possible, we have a template letter that you can use that you can find it fix slp.com.
But the more you can educate them on like the history of the CS and the history of state licensing and comparing it to our kind of sister professions of OT PT, then the more they're going to understand how this is all working. And it's a lot easier to change the policies of your current employer and make it a better situation for the next SLP who shows up than it is to try to get that changed with a potential employer. But if you are interviewing for jobs, and they require the Cs, and you don't have them anymore, it's always a conversation that you can have and the best way to do that is to start asking questions. So instead of right off the bat saying like I don't have my seeds, are you okay with that? Just start to get curious and say like, I see that you have the seeds listed as your requirement. Can you tell me more about why can you tell me when that policy came about? Are you guys aware that all 50 states have licensing boards now? Are you aware that a lot of employers are starting to remove that requirement because they're realizing that they're missing out on a huge number of SLPs, who are very qualified core, just electing not to pay for the CS. So you want to really come at it from a place of curiosity and openness. And you also want to paint a picture of how it's really damaging them by limiting their pool of qualified applicants. Because if we go to employers, and we say, this isn't working for SLPs, that's not really an argument that they're going to be able to hear. And both arguments are true. So we just want to present the one that is more relevant to them.
And rumor number four, did you want to say anything?
Wait, yeah, something quick, I just think this is the easiest, least controversial place for all of us to start.
Especially if you need to hire someone for your team, it's a great time to talk to your employer. And so there may be a call to action coming, something like that. But gathering more information first about some of the state requirements is what we're doing. But we can all start now, we can all start right now, Monday morning, talking to our employers about removing that requirement. And we should because it has to start somewhere. And to me, that's the lowest common denominator starting with these employers not requiring it is the first step to allow us to make the choice.
Okay, rumor number four is similar. It's that state licensing boards require the CS. So we did an official an initial review of all 50 state licensing boards. And that initial review indicates that Nevada Virginia and New Jersey do require the CS. What's weird about Virginia in New Jersey is that you only have to have the C's if you don't work in the schools, which doesn't make any sense. But it does make sense when you look at like right now, school SLPs are treated like teachers. And so they ended up having to get certifications or quasi licenses through the department's of education.
And somehow state licensing boards decided that that was enough. And then the CCC would kind of be the equivalent for anyone not working in the schools. So it's just odd, and it's outdated. And it's confusing. And really, the requirements to be an SLP should be consistent wherever you work unless state licensing boards want to start to differentiate school licenses from medical licenses, but that we're like decades away from being able to accomplish that. The first thing we need to do is just get on the same page that whether you work at a school or in a hospital, you need to meet the same requirements. And unfortunately, state licensing boards sometimes are like, depending on who's on the board, they're gonna be like, Oh, well, let's just use the seas as an easy kind of lazy way to implement requirements.
Every other state tends to use language like CCC or equivalent, or meet the standards of the CCC, a lot of them just outline that you need a master's degree, you need a passing Praxis score, and you need nine months of supervision at your first job. So it's very similar to what's required for the C, but it's spelled out completely separately.
And so what needs to happen and what we're hoping to accomplish is to go to state licensing boards and let them know that this way of doing things is outdated. It's not in the best interest of these licensing boards, because ultimately, it leaves them legally at the whim of these companies that are selling these certifications. So if Asha decided to change their requirements, suddenly the state licensing boards would have to go along with those new requirements, whether that fit the requirements of the state or not. And just to emphasize why it's so dangerous for our field, to be referencing any kind of certification as part of their standards to get a state license. We have to continue to acknowledge that certifications are products. They are sold by companies, whether those companies are for profit or not for profit. So for example, let's just say that hypothetically, somebody created a medical SLP certification. And let's just say again, hypothetically, that this SLP charged $8,000 For this certification. And let's say that this SLP went to state licensing boards and went to employers and they spent a lot of money that they had for charging $8,000 per person to inform these people that their certification is the gold standard for a medical SLPs. And suddenly, you have state licensing boards and employers requiring that medical SLPs pay this person for an $8,000 certification. This is why it's so problematic. And it doesn't matter if it's Asha selling the certification, it doesn't matter if it's another nonprofit sort of board certification, it doesn't matter if it's a private for profit company. Ultimately, these are all products and they can be changed at any time. And requiring them of us LPS is unethical. And again, it puts the state licensing boards in a bind, where they're having to go along with any changes that these companies make to their certification requirements.
Not only that, but it then requires us SLPs to maintain that. So let's say this person who had hypothetically charged $8,000 for a certification decided like, okay, to maintain your status as an active li certified medical speech pathologist with my certification standard, you need to start paying $1,000 a year to maintain this. So then all of a sudden, SLPs are having to pay all these certification renewal fees on top of their state licensing board fee, and it's just suddenly becomes very cost prohibitive to even be an SLP, especially in a field where pay has not gone up or it's gone down. And that's again, something that hasn't been nobody's been advocating for us in that realm. So that's kind of where things do sit with state licensing boards.
State licensing boards are a government entity. They are made up of volunteers who are SLPs audiologists, and the general public, again, because these boards are in existence, mostly to protect consumers.
And so they all these people usually serve some sort of term, a year, two years, three years, and they meet several times a year to discuss issues. So you as an SLP, have every right to volunteer to be on this board, you have every right to bring up issues at the board, you have every right to show up at meetings to get things on the agenda, to be kind of a persistent person who continues to bring this up.
And ultimately, it just ends up being a conversation with this very small group of people. And it's a collaborative approach to holding SLPs accountable and protecting consumers. So again, if you're going to take the time, which is the awesome to go to these board meetings, you really want to do your homework and use language. And we can help you with this. And again, there's a template on SLP or fix slp.com. But you want to use language that helps them understand how this is going to protect consumers, because that's their ultimate goal. And then it will also help SLPs but we want to focus on what the board is trying to focus on.
So that's what Yes, so with boards,
Yeah, we'll share this at the end on how to reach out to us for something like this.
But again, this is another like low hanging fruit, where if you're living in one of those states that does require the CCC, like Megan said, start going to the meeting volunteer for the board. But it would be great to have a couple leaders, people who are in this conversation with us, some leaders in those states who can start organizing movements in those states to get that requirement dropped. It's not something that's going to happen in a week or a month, it will likely be a year or two years or whatever. But it can happen. And so we'll be asking for volunteers. But that is something that we we'd love to work with you on and support you and help you connect with other states that have removed the requirement. So at the end, we'll we'll give you a way to connect if you're interested in something like that.
Okay, moving on to rumor number five, which is I have to have the CCC to teach and or supervise students. The short answer is no. But the long answer is very convoluted. It is definitely a deep dark rabbit hole. And if you try to get information from ashes website, you're gonna get very confused very quickly. So I'm going to just start by distilling kind of the end conclusion that I came to and then we'll kind of unwrap it a little bit. So the important thing to understand is that there's the CCC, which is a product sold by ASHA.
And then there's the CAA, or the Council for academic accreditation, which is also quasi-run by ASHA, the Council for academic accreditation accredits grad school programs. They don't accredit like slpp programs, but they accredit the masters level programs. So they have kind of their set of requirements that a university has to meet, in order to get the stamp of approval of the CA. And like, that's important for us as SLPs, because we have to go to an accredited university to get a state license. So you can't just have a master's degree in speech pathology, it has to have a has to be a master's degree in speech pathology from an accredited university.
So we have the CCC, and we have the CAA. What's very confusing is that the requirements for the CCC often overlap the requirements that the CA enforces for grad school programs. So for example, one of those is the 400 clock hours. So universities are required to ensure that students have 400 clock hours, the CCC like SLPs are required to have 400 hours in order to apply for the CCC. So it's confusing because they're the exact same requirement. But they're two different entities requiring that the only reason that a supervisor would need to have their CS is if they are supervising a graduate student, who knows at that point that they eventually want to pay for the CS. So in essence, you have to buy the product in order to sell the product. What universities need to be doing is saying to SLPs upfront, like, you know, we have a shortage of supervisors, like it's a, it's a challenge to find enough supervisors for all of you, we're doing our best. But we're gonna have a larger pool of supervisors if we don't require the CS. But what that means for you as a graduate student is that you have to decide right now, if you want to eventually pay for the Cs, and then the grad school and the student, like you all have to work together to track if you're getting 400 hours that are supervised by someone with their CS, that can eventually go to help you pay for the fees. Or if you're just getting 400 hours from any supervisor, whether they are there or not, they have their Cs if you get those 400 hours from a mix of supervisors that have their CS, and don't, you'll be meeting the requirements for the CEA, you can get your degree, in most states, you can get your state license, because they just want to see that you have 400 hours, they don't care if they're done by somebody with their CS, they want to see that you are supervised for nine months. And your first job, they want to see that you pass the Praxis all that stuff.
So it's confusing, because when you go to the ASHA website, like the language around it is very hard to decipher. But basically what they're saying is, as a supervisor in a grad school setting, you have to have your CS, if that student eventually wants their CS also.
I think that the reason that this is problematic is because it's a conflict of interest. So there's, I mean, this would never happen. But let's just say my company therapy and sites decided to create an accreditation arm. And so we were going to compete with the CAA we were going to give universities options to decide like I want to be accredited by the CIA, or I want to be accredited by whatever acronym therapy and sites came up with.
We could we couldn't then require faculty to buy our product in order to supervise students. And so that's where it starts to get really messy and hard to untangle is this conflict of interest where the CAA is run by ASHA, who also sells the CCC. But if I talk anymore, it's gonna get more confusing. So Jeanette, what thoughts do you have?
So I have an interesting perspective. I'm also like a very big picture person. And so for me, this is one that I'm very interested in as a full time University professor in an accredited program. First of all, I want to make sure that we are very clear that we support the CIA. We are not suggesting programs not be accredited, that is in no way, part of our conversation or our purpose with fix SLP that is not something we are trying to fix. We need to have accredited programs for licensure purposes.
The CAA is doing a good thing. That being said, like Megan mentioned, the CIA is not the only way. If someone else would like to come up with an accreditation option, that is totally acceptable. That is not what we are doing here.
So like you said, Megan, it is it's a, it's a bit of a conflict. You know, it's, it's, it's a twisted web that ASHA has woven with the CAA and the CCC at all. The thing is, it's just like, untangling it is a mess.
So there's that
Big picture here: I am from.... I'm I, man, I feel young, but I am old. And I am from the licensure time where we had to have 400 hours. But we had to have 50 hours in adult treatment, and 50 hours in adult assessment and 50 hours in pediatric assessment and 50 hours in pediatric atrophic. Treatment. So total, it was 400. But it was defined as 5050 5050. That was very problematic for programs that were in rural areas. For programs that had many schools in one area with a limited number of placements and availability to send students for many reasons, it was problematic.
I don't know when the change happened, I'm suspect at least 10 years ago, but there the CIA is constantly updating the requirements, you know, they are changing things every few years there are there are changes to the rules. And so one of the changes that happened was they changed the requirement from 5050 5050 to a breadth and depth in a number of areas. And it is up to the institution to be able to say what that is. And universities will use that pretty liberally at times. You know, we do the best we can. But they have given the university the freedoms of deciding how those hours are split up, which is a great thing. So when it comes to the CCC, it will be a trickle down effect. I have been an externship coordinator. I've done it for an online program where I had 66 students who all needed five rotations because they were all over the country. I have done it locally in Ohio. I am now helping at my university we sent undergrads out as well. So now I arranged for undergrads in their rotation. I have had a lot of experience doing this. And I think if you are an externship coordinator, you know the hill that I am talking about, okay, this if you don't know this, how be faithful. But finding placements for students is an awful job. And that is with everyone having this CCC. So if our clinicians out there, start letting the CCC go and people like me now have to find placements where the clinician is because the requirement now for the CFX you didn't even mention this is that if the person wants to see Yeah, they also have to be mentored by someone with the CCC.
A student cannot be supervised by someone in their CF, they have to have completed the CF and have nine months of full time work. And of course, a CEU course before someone is eligible to supervise a student. Okay, so that already cuts our pullback. So if we now have to find someone who is out of the CF with nine months of work and has the CCC, but people are letting the CCC go that is going to make an externship coordinators job exponentially harder. But here's the thing. If enough people do it, the CAA will have to remove the requirement of requiring the CCC because if they want so ash, so sorry, just Griffie this Asha will have to remove or I guess universities will have to be more transparent that they're not going to be able to support students who eventually want the CCC.
The CAA doesn't require the CCC is what you said. So I just wanted to correct that.
Oh, okay. Yeah. But similar to what I was going to tie that into was similar how they I guess it is the CAA that had required the 50 50 50 rule. And now it's just breath and up 400 So similar to how that was changed, then
Yes, Asha would have to remove the requirement of being supervised with someone who has the CCC in order to keep these accredited programs, training people for the CCC, because there will there will come a crossroads. If people are letting their CS GO, there is going to become a very difficult crossroad for people like me who are trying to arrange these things for students who want to become clinicians.
I'm sorry, Susie, we just can't find that kind of you can extend your program, you can find the placement yourself, these were all these conversations we were having during COVID to where I'm sorry, you know, when seeking students, you can choose to not graduate on time or, or move or do all these things, it will start to be those kinds of conversations at the university level. And eventually, we will force their hand that there will just not be enough people to fulfill this requirement for all of these students. And Asha would absolutely have to drop the requirement that a student is supervised by someone with the CCC. And as DF is mentored by someone with the CCC to obtain the CCC, we are a long ways away from that. But that is big picture thinking that making the choice to let that go it is there are going to be growing pains, for sure. And it will be there are a small few of us already in that hell that will suffer. But we will force their hand and it will change things it will have to if Asha wants to continue to operate and make money, period. That's all I have to say.
Okay, and we're gonna fly through rumor number six and seven because I know this is getting long, and I'm sure people are listening are like why can't they just make this an hour. But we wanted to do this all in one episode so that the rumors didn't get split up and people were only hearing half of them. So rumor number six is the CCC The only thing regulating our profession. And without it, it would be chaos, and consumers wouldn't know who to trust. And again, I think this goes back to the idea that historically, it's been the only way for people to legitimize themselves as an SLP. But now we're in a place again, where all 50 states have licensing boards. And the they are fully regulating the profession. They make it illegal for anyone without a state license to act as a speech therapist. And like we said, this is a power that Asha or any other company selling certification product will never have.
So it's important and I think for anybody listening to this, if you're just like, confused or like really is this true, like start talking to your friends and family, ask them about their state licensure, doctors, attorneys, architects, engineers, physical therapists, occupational therapists, respiratory therapists, they all have state licenses. Again, if you ask them, Do you have a national certification, and they'll be like, oh, you know, there's like different options and things you can get. But I either choose to do that or not. And that's just where we're trying to go as a field with SLP. And we're just feeling those growing pains. I want to jump in there with something real quick. I am long winded. But I do I do want to say this in terms of regulation, we need to be very careful about the word gold standard, too. I know that the word gold standard is out there in terms of like, who's the best clinician when it comes to gold standard and health care?
The Gold Standard has to be tested, there needs to be research and evidence that one thing is better than the other thing. And again, Megan, and I could be wrong here. But I am fairly certain that there has been no evidence to answer the clinical question, what is the gold standard in terms of certification and licensure for speech language pathology, if that is out there, hey, send it over to us. Let's read it and we will post it. But we have to be very careful saying that the CFTC is the gold standard to practice as a clinician because that evidence does not exist. To my knowledge, there is no answer to that clinical question. And I suspect if we get pushed back Ash is going to be throwing those words around like confetti right? This is the gold standard. If you want respect you need to have this. And so I just want to squash that right now. In terms of like regulation and answering you know, who to trust we can all be trusted. We are all trained at the same with the same accreditation standards. Whether you pay for a product or not, does not mean that you are the gold standard.
Maybe you have a gold star, I don't know, or like, we all like to think that we have a gold star if we have certification. But also, I mean, this brings up a whole other conversation about certifications are a place of privilege, like if you can afford them, if you have the time, you can get them. But it doesn't negate the fact that somebody who has spent just as much time learning and researching and understanding and being mentored does not have the same knowledge or skill set. So certifications are just a ball of what is the phrase a can of worms, a ball of the ball of wax wax that doesn't, I don't know. Okay.
Anyway, rumor, number seven, I need the CCC to become or maintain Asha CE provider status. So this only applies to SLPs, who are also see providers which I am basically looking at the rules like, you don't need to have your C's to be an ASHA CE provider. But you do have to appoint someone who does have the CCC as a consultant. And this person needs to be involved in all C corpse planning, implementation and evaluation. And the ashes the EU situation is a whole other conversation that we will be having in the future. But that kind of wraps up the seven rumors that we wanted to dispel today.
You can find all of this information written out at fix slp.com If you want to share it with people, again, if you read or hear something that's absolutely incorrect, and you can provide direction to where we can read the actual documentation that shows that we are being incorrect. We would love to hear that and correct anything that we've said.
Jeanette you want to talk about action steps at this point.
Sure, because it is our goal to give you something actionable to do, we don't want you to listen and like we want you to take action. So number one is you can start writing and talking to your employer. Now we've already mentioned that earlier in the episode, go to fix slp.com, you will see some templates there, too, you can start writing and engaging with your state licensing board. This is a great way, a great way to do this is through your state association, specifically, in those states that are requiring the CCC for licensure, if you are in one of those states, absolutely start talking to them.
And three, volunteer with us. We again, we said at the top of this episode, this is a bit messy. In something like 15 hours, I am leaving for a nine day vacation to Disney. So if if when you hear this, I am probably not available. But we will we're just gonna throw it out there. Like let's get it going. I'll I'll get on top of this upon my return. But we want you to volunteer with us, we would really like several people from every single state to be volunteering and available with us. When we need you. There's a variety of things that we ways we think we can use you. But one would be to start advocating for change at the state level, particularly in those states where the CCC is required.
Working with employers to get the CCC off, you know off the requirement for the job.
But also when it comes to insurance questions, so especially if you're a business owner who has access to those types of regulations and you understand billing, we are just two people and truly it's more like one and a half people because my brain doesn't work like that. And Megan is taking that load on. Also state licensure requirements I'm leading a team of people are ready who are starting to amass all of that information, the most up to date information. So if we have questions, a person from every state is is a good point for us to start because at least you have networks in your state. So if you don't know someone, there's at least a Facebook page where you can go or you know, people are you know, so we really need volunteers. What we're going to do is I do have I was in charge of the volunteers for the SLP data initiative. We have that link still available. We are going to open it back up. We will link that on our website and in the show notes. If you are willing to volunteer for with us, please fill out the form you do need to fill it out in full we need to know your name. I need to have your phone number so I can contact you I promise we are not selling it using it in any way I but but we want people who are serious. So if you don't fill out the form in full I'm not going to be able to include you when I need you. So fill out the form. I'm the only one who sees it. And please join us in this in this effort, the very last thing you can be doing is liking and sharing our stuff on social media. Because the more numbers that we have when we have an actual call to action, there's power in numbers. And we've seen some of that before when when unjust things have happened to our colleagues or in the field. We are really good at rallying as a group of clinicians. And so when we are ready when Megan and I say, Okay, go, the more people we have already, in this effort, the easier and it'll be in, the more effective it will be. So please be sharing our stuff, inviting people to follow us on Instagram. I've gotten some questions. No, we do not currently have a Facebook group or page, perhaps we'll make a page where all of our stuff is being pushed to that's an easy thing. I don't think either one of us has the capacity to be an admin of an actual group. But maybe that's something for the future. I'm looking at. I'm not on tick tock, but maybe we'll do some tic TOCs. I don't know right now. We're on Instagram. So please follow us. Share our stuff, invite people to join the conversation. That's what we need at this point.
Yeah, and we're gonna wrap it up. And on the next episode, we're going to discuss the question that we always get next, which is can I just stop paying for the CCC? So if that's the question that you're trying to grapple with right now, tune in to episode number two. And we'll see you guys next time. Thank you.
