Interview with Susan Bartlett, M.A.

Beck:Hi Susan. Thanks for taking the time to speak with me today. Bartlett:Hi Doug. You're welcome. I'm glad we were able to get together.Beck:Susan, would you tell me a little about your professional education?Bartlett:Sure. My bachelor's is in Speech and Hearing from Elmira College in New York, ,

Beck:Hi Susan. Thanks for taking the time to speak with me today.

Bartlett:Hi Doug. You're welcome. I'm glad we were able to get together.

Beck:Susan, would you tell me a little about your professional education?

Bartlett:Sure. My bachelor's is in Speech and Hearing from Elmira College in New York, , and my master's degree is from the University of Connecticut back in 1974.

Beck:And then you joined the University of Connecticut very early on in your career?

Bartlett:Yes. That's right. I was hired initially to provide clinical services and to provide a model of service delivery to student clinicians. Over time I became involved with providing clinical supervision and increasing my responsibilities as a clinical educator. In 1997 I was named interim Director of the Speech & Hearing Clinic at the University of Connecticut and 1999 I was appointed to the position permanently. I am also a member of the Steering Committee for ASHA's Special Interest Division 11.

Beck:Very good. Would you please tell me about ASHA's Division 11?

Bartlett:Division 11 is involved with both administration and supervision in speech-language pathology and audiology. Part of our mission is to promote best practices in administration and supervision through educational activities, networking and research.
Beck:And I believe you gave a presentation at the ASHA 2005 convention on these same topics?

Bartlett:Yes. Division 11 sponsored a short course at the convention on the topic of Quality Indicators. I was a member of the team along with, Jaynee Handelsman, John Tonkovich, Marilyn Dunham-Wark, and Dianne Meyer. Kelly Appler from the ASHA National Office of ASHA worked with us in an ex officio capacity. In 2004 we formed the working group that created the document "Quality Indicators for Professional Programs in Audiology and Speech Language Pathology" which is accessible online at: convention.asha.org/2005/handouts/293_Bartlett_Susan_073571_100705010610.pdf

Beck:And that document is essentially a blueprint for programs to help measure the quality of their service delivery?

Bartlett:Yes. We designed it for multiple practice environments across speech-language pathology and audiology. We wanted it to be useful and appropriate for all agencies, not just university clinics or hospitals, but also for school-based, early-intervention centers and more. We focused on quality indicators that would help assess and reveal strengths and weaknesses and that could serve as a tool for devising program goals, addressing deficiencies, and recognizing excellence . We also saw it as a tool that might be used to guide the development of new programs.

Beck:What are the primary quality indicators that you presented in this work?

Bartlett:The quality indicators cover five areas. The first is "Purpose and Scope of Services, after that we have "Service Delivery," and then "Program Operations" then "Program Evaluation and Performance Improvement" and lastly, "Ethics."

Beck:Each of those could be an entire chapter, or perhaps a book but given our limited space, can you please address them one-by-one here in brief, and then we'll refer the reader to the ASHA document (above) for the full detail?

Bartlett:Sure. Purpose and Scope of Services essentially indicates that each program should have its own written purpose. The ASHA documents on Scope of Practice, Ethics and Preferred Practice Patterns can be reviewed by the director of a program to help create a written statement. We've provided a comprehensive list of references, which will prove to be very useful, too, while creating and writing these mission statements or purposes for the program.

Beck:OK, very good. And what can you tell me about Service Delivery?

Bartlett:This section looks at making sure the program and the delivery model is appropriate for the needs of the people served. "Persons served" covers a wide range of stakeholders from the clients or patients, to their families, and to the service providers and administrators themselves. This section references the knowledge and skills necessary for the service providers and encourages the use of evidence-based skills and practices. Again, there are many ASHA resources to help develop and establish these protocols.

Beck:And please correct me if I'm wrong, but "Evidence Based" doesn't necessarily mean a classical study using a control and experimental treatment, but can also be a well thought through single subject design, with good, solid scientific appreciation for the treatment and the result?

Bartlett:Right. That's true. "Evidence-Based" has a variety of factors, protocols and meanings, and it reflects more of a quality decision-making approach to assessment and treatment, rooted in scientific principles, rather than a specific procedure. It can be very simple, basic and straightforward, or it can be extremely elaborate. As long as there is a scientific foundation for assessment or treatment, with appropriate interpretation and understanding, a simple protocol for supporting quality service delivery can be fine.

Beck:Please tell me about Program Operations?

Bartlett:Program Operations is a large umbrella divided into a number of sub-topics, such as Administration, Human Resources, Financial Resources and Management, and Physical Facilities and Program Environment.

Beck:So those are the nuts and bolts, the day-to-day operations and issues involved with running a business, or a practice. And then you had Program Evaluation and Performance Improvement. I like that because the title implies that regardless of the status quo, there is room for improvement.

Bartlett:Yes, I agree. The programs and the people who are involved within the program need to be evaluated regularly and of course, improvement is always a goal of this process. This quality indicator is specifies that professionals and administrators are appropriately educated, qualified, licensed, certified etc. to perform the duties and roles of their positions. In other words, we wouldn't want an SLP without appropriate dysphagia training to evaluate or treat patients with feeding and/or swallowing problems. Likewise, an audiologist without cochlear implant training and knowledge shouldn't be assigned to re-map a patient with a cochlear implant, just because the professional is a certified and licensed audiologist.

Beck:OK, that makes perfect sense. And lastly, what can you tell me about Ethics, as they relate to Quality Indicators?

Bartlett:Ethics impacts everything in practice and education. Besides creating an prototype for principled behavior for practitioners and administrators alike, the Code of Ethics sets limitations and expectations for ensuring that clients and other stakeholders are treated fairly in an environment that is safe and non-discriminatory. In addition to being aware and recognizing what we should and should not do, we need to assure compliance with our profession's code and any other code of behavior that is specific to the program or its overarching agency.

Beck:How would a practice monitor its own compliance of ethical standards and guidelines? In other words, I presume most, or perhaps all programs and professionals are aware of ASHA and their state credentialing board's statements on ethics, and so I wonder, how would they know if they were not in compliance?

Bartlett:That's a really good question. It can be difficult, particularly if there are subtle aspects of non-compliance. Nonetheless, if there are written or verbal complaints, those would serve as the basis or the rationale behind the examination of a person's or program's ethical protocols. Additionally, we want to be sure our services are offered and executed by someone appropriately credentialed for that purpose, sort of as we spoke a few moments ago. So ethical concerns and practice patterns are vast, and they must be integrated into the professional and practice protocols to protect the persons we serve and to assure them of the highest quality of service available.

Beck:Susan, this has been a delightful discussion, and I am so appreciative of your time. Thanks for highlighting these points with me.

Bartlett:My pleasure, Doug. Thanks for your interest and time, too.

Beck: I'd like to encourage the readers to review the ASHA document your group authored (noted above) and the related documents on Scopes of Practice, Preferred Practice Guidelines and Ethics, too.

Bartlett:Thanks, Doug