Interview with Nancy Swigert, M.S., CCC-SLP, BRS-S

Beck:Hi Nancy. Thanks for taking the time to meet with me today.Swigert::Hi Doug. Thanks for inviting me.Beck:Before we discuss today's topic, would you please tell me a little about your education and your current position?Swigert::Sure thing. I earned my master's degree in 1978 from the University

Beck:Hi Nancy. Thanks for taking the time to meet with me today.

Swigert::Hi Doug. Thanks for inviting me.

Beck:Before we discuss today's topic, would you please tell me a little about your education and your current position?

Swigert::Sure thing. I earned my master's degree in 1978 from the University of Tennessee at Knoxville. As you noted after my name above, I am also a Board RecognizedSpecialistin Swallowing. I am employed at a private practice here in Lexington, Kentucky, which I started in 1980, called Swigert and Assocoates, Incorporated. We offer a full range of SLP services for adults and pediatrics.

Beck:That's fabulous Nancy. I am always encouraged and excited when I learn of more and more speech language private practices. And please tell me, what are your current roles as an ASHA volunteer leader?

Swigert::I am the Coordinator for Special Interest Division 13, which encompasses swallowing and swallowing disorders. The division has over 5400 affiliates, and the Steering Committee has five people. I also chair the Healthcare Economics Committee, and as you may recall, I am the immediate past president of the ASHA Foundation.

Beck:Thanks Nancy. OK, then, with regard to the issue of Cross-Training in Dysphagia for SLPs, I know ASHA recently rescinded its previous position. Therefore, I'd like you to walk me through that please, and I should note that the opinions you express are yours, and they may or may not agree with the official ASHA stance, but the comments that follow are your thoughts on the subject.

Swigert::That's correct. I am happy to tell you my understanding and thoughts, but at this moment, I am not specifically speaking for ASHA on this matter.

Beck:OK...so in March of 2006, the Legislative Council (LC) of ASHA rescinded the position statement...so perhaps the best place to start is with the original position statement? What did it say, and what did it mean?

Swigert::The original position statement was in 2003 and I was on the ASHA committee that wrote the original. The reason we wrote it was we were getting contacts from ASHA members saying their employers were requesting SLPs to train other professionals, such as Occupational Therapists (OTs), to perform the dysphagia services. SLPs were complaining that it didn't seem right for an SLP to train other professionals, in a function that was clearly within our scope of practice.

Beck:And so at that time, we were talking about SLPs training other licensed healthcare professionals, not technicians or assistants?

Swigert::That's right. We were clearly the best trained professionals with regard to dysphagia diagnosis and treatment services, and so to clarify things, we put together two reports.

One was the technical report, which is the background document. That technical report is still in effect and has not been rescinded. The technical report is essentially a background document which was and is approved by the ASHA Executive Board, and it covers the rationale behind the position statement.

The position statement is more the "I believe" statement. That particular position statement said that the SLP has the education and training to provide dysphagia services, and that the SLP should be the provider for these services, and that the SLP should not train other professionals to provide these same services, as patient safety was (and remains) a real and appropriate concern.

Beck:So the position statement went public in November, 2003. What happened since it was released?

Swigert::Well, within the 2003 position statement, there was a line that said SLPs should not train other professionals (as noted above) with respect to dysphagia diagnosis and treatement options, but it also said that SLPs could not train other professionals within the realm of dysphagia, for continuing education (CE) purposes. The Continuing Education Board operationalized this statement in a guidance memo to CE providers.

The Board indicated that "There is a conflict with this position statement if any part of the activity deals with training participants for direct clinical contact, and there are participants in the activity other than speech-language pathologists, clinical fellows, or speech-language pathology graduate students". The CE Board asked providers to sign a statement indicating the course they were offering was not in conflict with the Position Statement.

Beck:And so in effect, the Position Statement limited the types of courses that could be offered to multi-disciplinary audiences?

Swigert::That's it. Yes. That result of the Position Statement was unintentional. The position statement was never meant to stop interdisciplinary training in general, but was intended to stop the SLP from instructing other professionals, without appropriate background and training to offer dysphagia services. Unfortunately, as you can imagine, problems were being created for SLPs when they were attending training and educational sessions, such as grand rounds on dysphagia, if an ASHA SLP was presenting, and if the attendance included OTs, MDs and others, who generally earn CEs for their attendance and time at these events. Some of these events were not approved for ASHA CE.

Beck:So, the SLP CE Providers were placed in a difficult position, secondary to the ASHA position statement. They either had to limit their audiences or not offer ASHA CE.

Swigert::Yes. That's the way it was playing out, and so we needed to rescind the position statement, to address the unintentional consequence of disallowing multidisciplinary training.

Beck: The other CE providers must be delighted!

Swigert: They are. But the unfortunate thing is some employers think the rescinding statement gave SLPs permission to train others, and it doesn't do that at all. All the rescinding statement did was to allow multidisciplinary training for CE purposes on general topics within dysphagia, but we are still not allowing or encouraging SLPs to train other disciplines in dysphagia diagnosis and treatment.

Beck:This is an amazing example of unintended consequences and rectification. I think you and the committee are to be applauded for recognizing the problem and issuing a statement to clarify what's what, what's allowed and recommended and what is prohibited. It's nice to see ASHA and a committee straighten things out when the secondary effects of a position statement go a little wayward.

Swigert::Yes, thanks, I agree.

Beck:I believe ASHA has produced a number of printed and online works to clarify these issues?

Swigert::Exactly right. In fact, ASHA provides on the Internet, www.asha.org/members/slp/clinical/dysphagia/crosstrainingquestions and within that section there are many papers detailing ASHA's views and stands on these issues.

Beck:Yes, at that URL, they'll find four statements, and I'll paraphrase their titles here; SLPs and CrossTraining Other Professionals on Swallowing, Multiskilled Personnel, The Role of the SLP in Swallowing Disorders, and Educating Others about SLP and Audiology.

Swigert::Right, and there's the ASHA Leader from May 23rd, and soon there will be a new coordinating committee on encroachment, which Brian Shulman (ASHA VP for professional Practices) will appoint, and that will also help avoid difficult situations in the future.

Beck:Thanks Nancy. I appreciate your time and energy to clarify the status of this situation.

Swigert::I'm happy to help, Doug.

Recommended Readings (for ASHA members with Internet access)