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1、The Future of the Speech-Language Pathology in Health CareASHA ConventionNovember 21, 2008Where are we now and where are we going?Ones destination is never a place but rather a new way of looking at things. -Henry MillerDistribution of ASHA-Distribution of ASHA-Certified SLPs Certified SLPs Schools
2、55%Health Care 35%College/University 4%Other 6%Source: ASHA 2006 dues notice; n=89,062 certified SLPsSLPs in Health Care SLPs in Health Care (2007 Health Care Survey)(2007 Health Care Survey)Speech & Hearing Center/Outpatient Clinic25%Hospitals22%Skilled Nursing Facilities21%Home Health14%Rehabilita
3、tion Hospital12%Pediatric Hospital 4%Other 2%http:/asha.org/about/membership-certification/member-data/HealthcareSurvey07.htm Attrition Data (1996-2003)Attrition Data (1996-2003)Years ExperienceChange from health care to schoolsChange from schools to health care515%8%5-914%5%10-1613%3%17 +7%3%Attrit
4、ion DataAttrition DataApproximately 70% stayed in health care, regardless of years of experiencePPS occurred during this time period2% of member with 17+ years experience retired within the 7-year periodPercentage of members not employed and not seeking work decreased with years of experienceuLess t
5、han 5 years 4%u5-9 3%u10-16 2%u17 + 1%www.asha.org search “attrition survey”Supply and DemandAdvice is the only commodity on the market where the supply always exceeds the demand. -Author Unknown Supply and Demand for Supply and Demand for SLPsSLPsGraduate Programsu244 programs surveyed in 2000-2001
6、uMasters degrees awarded in 1999-00: (5,692) In 1989-2000: 3,528 (61% increase)u4% decrease in enrollments between 1998-99 and 2000-01uUpdated survey data on grad programs due soon (Higher Education System)What We Dont Know About What We Dont Know About SupplySupplyWhy are people choosing other fiel
7、ds?Factors affecting attrition rates?uMaternity leaveuReduce to part timeuChange professionsuOther?DemandDemandBureau of Labor Statistics State Occupational Projectionsu11% growth anticipated from 2006 2016u12,000 new jobs anticipated by 2016uConsidered “about average” growthhttp:/www.bls.gov/oco/oc
8、os099.htm Vacancies in Health CareVacancies in Health CareDo you currently have funded, unfilled positions for SLPs at your facility?20052007uPediatric hospitals50%54%u Rehab hospitals41%43%uHome health 47%38%u Clinic40%34%u Hospitals37%42%uSNF37%34%Average 40%38%(2007 ASHA Health Care Survey)Curren
9、t Trends in Health CareHappiness is nothing more than good health and a bad memory. -Albert Schweitzer Caseload TrendsCaseload Trends Caseload TrendsCaseload TrendsPopulation Served 2005 2007uInfants and Toddlers 14% 16%uPreschoolers 15% 13%uSchool-Age Children 12% 12%uAdults 59% 60%n = 1,923 (2005)
10、; n = 2,229 (2007)http:/asha.org/NR/rdonlyres/F8BD8799-3D59-4D86-BD9F-40EBE64E1E22/0/HC07CCTrends.pdfCaseload TrendsCaseload TrendsAdult Intervention 2005 2007uAccent modificationn/a 1%uAphasia 17% 17%uCognitive-comm.21% 21%uMotor speech 8% 8%uPrevention n/a 1%uSwallowing 45% 46%uVoice/resonance 7%
11、5%uOther 3% 2%Caseload TrendsCaseload TrendsChild Intervention 2005 2007uArtic./phonology 25% 24%uCognitive-comm. 14% 14%uFluency 3% 3%uLanguage 36% 35%uPrevention/wellness n/a 1%uSwallowing/feeding 16% 17%uVoice/resonance 3% 3%uOther 3% 3%Caseload TrendsCaseload TrendsProductivityuMedian hours of d
12、irect patient care = 6uMedian hours worked per day = 8uAverage productivity = 75%Professionals other than SLPs providing swallowing services slight drop from 13% (2005) to 12% (2007) responding “yes”SLPs working in early intervention from health care = 26% Median percentage of patients from racial o
13、r ethnic minority = 20%Median percentage of patients needing bilingual services or interpreter = 5%Scope of Practice TrendsScope of Practice Trends Scope of Practice TrendsScope of Practice TrendsEmerging areas of practiceuElectrical stimulation for facial weakness from Bells palsythe otolaryngologi
14、st implants the device and the SLP programs it uElectrical stimulation with implantable electrodes (SLPs programming the devices) uEsophageal dysphagia (assessment) uHigh-speed imaging of the larynx uOtoacoustic emissions screening by SLPs uProviding communication support for the acquisition of Engl
15、ish to international adopteesuTransnasal esophagoscopy and pharyngeal/esophageal manometry uSpeech-language pathology services for homeless children uVerb network strengthening treatment (VNeST) (enhances word meaning for verbs) http:/asha.org/members/phd-faculty-research/reports/EmergingAreasClinic
16、alPractice.htm Scope of Practice TrendsScope of Practice TrendsExpanding areas of practiceuCervical auscultation for swallowing uComputer-assisted language intervention uForensic speech-language pathology services uLow incidence disorders uNeeds of bilingual/multilingual children as an area where SL
17、Ps need continuing education to address needs of this population being served uNeurotoxicants (Expanding role of SLP in prevention) uRole release (transdisciplinary, primary service provider models) in early intervention uSLPs working with persons with cochlear implants uTelepractice in the schools
18、uTraining bilingual personnel Scope of Practice TrendsScope of Practice TrendsExpanding areas of practiceuWorking with individuals with autism uWorking with individuals in high poverty areas uUse of Internet treatment uWork with multilingual populations uWork with a more diverse population uVoice an
19、d variations by race and ethnicity uDialect use and code switching by professionals and students in communication sciences and disorders (CSD) programs uAssessing oral competency of college students, professionals, consumers uWorking in the Neonatal Intensive Care Unit (NICU) u3:1 service delivery m
20、odel Other TrendsOther Trends Other TrendsOther TrendsPrivate practiceu19% of SLPs in health care are owners or co-owners of a private practice (2007 survey)uOf those, over half work full-time in private practiceMedicare billinguMIPPA July 1, 2009uhttp:/asha.org/members/issues/reimbursement/medicare
21、/SLPprivatepractice.htm Other TrendsOther TrendsTelepracticeOutcomes data uNOMS accepted by NQFEvidence-based practiceOther TrendsOther TrendsImpact of shortagesuEncroachmentuHiring less qualified professionalsuEmployer demandsuEthical dilemmasEncroachmentEncroachmentIn all settings: schools, health
22、 care, early interventionAll age groupsNICU to EI to geriatricsAll disordersswallowing, language, speech, cognition, AACHiring Less Qualified Hiring Less Qualified ProfessionalsProfessionalsRole of SLP AssistantsuReimbursementuSupervisionOther non-SLPsEmployer DemandsEmployer DemandsExpectations of
23、non-SLP managers:uGroups, timed vs. untimed codes Caseloads; productivityWeekend coverageBroad range of competenciesEthical ChallengesEthical ChallengesInappropriate patients or inappropriate frequency and duration of servicesDocumentation that misrepresents need for treatmentPracticing outside pers
24、onal scope of practicePatient well-being vs. insurance requirements (e.g., feeding)Charting Our Own CourseThe future aint what it used to be.-Yogi Berra Increased Awareness of the Increased Awareness of the ProfessionProfessionMedia coverage Share Your Stories, language development experts in key ma
25、rketsPodcasts (www.asha.org home page)Publications in other trade journalsuHome care, long term care, stroke, pediatricsReward Yourself With a Career in Health Care BrochureRecruitment and Retention Recruitment and Retention StrategiesStrategiesFlexible work schedulesConnect with local graduate prog
26、ramsMarketing/community in-servicesGood orientation for new hiresRecognition and appreciationuNot necessarily monetaryCareer laddersOngoing traininghttp:/asha.org/members/slp/healthcare/recruitment/Rec_Ret_SLPs_HC.htm Professional AdvocacyProfessional AdvocacySee http:/asha.org/about/Legislation-Adv
27、ocacy/ for information about federal and state effortsTake Action site uhttp:/asha.org/about/legislation-advocacy/grassroots/uEasy ways to connect with your legislatorsContact informationContact informationAmy Hasselkus, M.A., CCC-SLPahasselkusasha.orghealthservicesasha.org 301-296-5686800-498-2071 ext. 5686
