Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) Position Paper on Support Personnel in Speech-Language Pathology and Audiology

Endorsed by the CASLPA membership July, 1995

Prepared by the Ad Hoc Committee on the Role and Use of Support Personnel.

Catriona M. Steele, MHSc
St. Joseph's Health Care Centre, Toronto, Ontario

Debbie Barton, MA
Chedoke-McMaster Hospitals, Hamilton, Ontario

Barbara Meissner Fishbein, MA, DSP
North York General hopsital and NRC, Feldman, & Associates, North York, Ontario

Ann Meltzer, LCST
The Rehabilitation Centre, Ottawa, Ontario

Terry Pennock, MSc
Surrey Place Centre, Toronto, Ontario

Mary Soucie, DSPA
York Regional Roman Catholic Separate School Board, Aurora, Ontario

Susan Wagner, MSc
University of Toronto, Toronto, Ontario

The Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) endorses the supervised use of support personnel in both speech-language pathology and audiology as a means of enhancing the services provided by fully qualified professionals. The assistance of support personnel can be sought with the intention of increasing the frequency, efficiency and/or availability of services.

The ultimate responsibility for ensuring the well-being of the client, and for designing assessment and intervention programs, lies with the supervising clinician. Consumers must be informed by a qualified clinician whenever their speech-language or audiology services will be provided by support personnel. Certain clinical tasks may be delegated to support personnel, but the supervising clinician retains the legal and ethical responsibility for all services provided or omitted.

The following activities should be performed only by a fully qualified professional and should not be delegated to support personnel:

1. Interpretation of a referral, assessment, diagnosis, prognosis, or client/student performance.
2. Selection, modification, or termination of assessment tools/methods, treatment procedures, or treatment goals.
3. Initial contact with the client/student.
4. Consultation or communication with referral sources (e.g., teachers, physicians).
5. Administration of any assessment or treatment activities which may pose a risk to the client/student or which require continuous clinical judgment and monitoring during their use.
6. Discharge planning and reporting.

It is the responsibility of the supervising speech-language pathologist or audiologist to identify client/student care activities or department/program support activities which are appropriate to delegate to support personnel. The scope and nature of activities delegated to support personnel will vary based on the employment setting, model of service delivery and needs of the caseload. In situations where a speech-language pathologist or audiologist is contracted in a consultative role (e.g., school boards), support personnel may be used to enhance the delivery of intervention programs established collaboratively by the classroom teacher/consultee and the consulting clinician. The clinician supports the consultee (e.g., classroom teacher) who retains ultimate responsibility for the client/student. The consultee (e.g., classroom teacher) may delegate tasks to the support person, and may provide direct supervision to the support worker in conjunction with the consulting clinician.

On-the-job training is essential for all support personnel. The supervising clinician is responsible for determining the design, content, and amount of training required within their particular work setting.

Speech-language pathologists and audiologists should not undertake to supervise support personnel without adequate preparation. The required level of preparation should be determined in accordance with the guidelines established by provincial regulatory bodies, and should include a minimum of two years of clinical experience. Additional preparation in the form of formal course work, workshop attendance or independent study is highly recommended.

A registered/licensed/certified speech-language pathologist or audiologist should be available to direct, support, and consult with support personnel at all times. On-site supervision is preferable, and must be provided on a regular basis. Employers should ensure that an alternate means of supervision by another qualified clinician is established as a contingency for situations when the primary supervisor is unavailable; supervision by a professional from a related health-care discipline is not acceptable under these circumstances. In cases where supervision is not available, the support person should be re-assigned and no longer classified as a speech-language pathology or audiology assistant.

The use of support personnel without the provision of adequate supervision as outlined above is not condoned. Therefore, the efficacy of services provided by support personnel cannot be considered independently or in isolation from those provided by the supervising clinician.

Any existing provincial guidelines and regulations which govern the use of support personnel should be adhered to at all times.

A position paper represents the direction CASLPA has taken on a particular topic or provides guidelines for particular areas of practice. These positions are time-bound, representing the thinking at a particular point in time.