Background: The following comments pertain to the use of unlicensed SLP assistants at Central Virginia Training Center, a residential facility of the Commonwealth of Virginia Department of Behavioral Health and Developmental Services.  Individuals served have a diagnosis of intellectual disability and also may have other medical diagnoses.  The facility has two levels of care: Intermediate care facility for individuals with intellectual disability which has a major regulatory emphasis on active treatment and integration back into the community.  There is also a licensed nursing facility on site with both skilled and long term beds. The facility has utilized SLP assistants since 2006.

Current assignments of unlicensed assistants: Currently 4 SLP assistants serve the facility.  There are 6 licensed speech-language pathologists (SLP's) who supervise them.  Supervisory duties of SLP’s are divided into clinical and administrative.  Each SLP is responsible for clinical supervision of the assistant(s) assigned to their caseload.  One SLP has administrative supervision duties for 3 assistants and another SLP has administrative supervision duties for 1 assistant.

Duties of unlicensed assistants:

• Assists SLP with observations and gathering information to assist SLP with assessments.
• Develops a “communication dictionary” describing the individual’s communication.
• Conducts routine interaction programs for individuals as assigned by the SLP.
• Conducts reinforcement activities for individuals as assigned by the SLP.
• Produces communication materials as requested by SLP.
• Assists SLP during therapy sessions, as assigned (SLP is conducting the therapy).
• Provides hearing screenings as assigned and discusses results with SLP.
• Arranges audiological evaluations and accompanies individual to audiology appointments.
• Performs hearing aid checks and arranges for repairs.
• Trains direct support staff in hearing aid care.
• Models communication strategies for functional settings and trains direct support staff to provide communication supports.
• Monitors AAC for availability and working order.
• Represents speech-language pathology discipline at team meetings when therapist has schedule conflicts.
• Checks off/approves new direct support staff’s competence at mealtime and supports adherence to facility mealtime protocols and individuals’ eating precaution plans.
• Supports SLP department with development and maintenance of databases that are used in shared department computer files.

Qualifications:  The SLP assistant is classified as a Therapist I.  A bachelor’s degree is preferred but not required since there are no current regulatory requirements.  Of the 4 assistants currently in positions, 2 have a bachelor’s degree (only one has a degree in communication disorders).  Two have other certifications-one is a certified nursing assistant (CNA) and one is an emergency medical technician (EMT). Both have current certifications in those fields.  All of them have been trained by licensed speech-language pathologists to perform the tasks that they have been assigned and have demonstrated competency in performing those tasks.

Comments: The use of SLP assistants has been of enormous value to us in this setting.  They provide quality services to the individuals that we serve, and are in close communication with the SLP who provides clinical supervision.  If a requirement of a bachelor’s degree becomes the standard, I would like to see a clause for grandfathering in assistants who do not have the degree so that our assistants can continue in their current position.  Not being able to continue in their current position may pose a financial hardship on these staff, the individuals they serve, and to the facility.