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The process of becoming a certified speech-language pathologist in the Czech Republic and the United States of America

Gabriela Smeckova

Abstract: The article describes the certification process in speech-language pathology in the Czech Republic and in the USA. There are some similarities and differences in this process, some of which will be discussed later. The article explains the certification process specifically for speech-language pathologists who will be working in medical settings in the Czech Republic and in the USA.

Keywords: Speech-language pathologist, certified speech-language pathologist, supervisor, certification process in the Czech Republic and USA.

Introduction

According to the American Speech-Language-Hearing Association (ASHA), speech and language pathologists are experts in communication. “Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults” (Speech-Language Pathologists).

The process of becoming a certified speech-language pathologist is very different in the Czech Republic (CR) and in the USA. The purpose of this article is to describe the process of becoming a certified speech-language pathologist in the CR and in the USA for those who work in a medical setting. The author of this article used to teach speech-language pathology at Palacky University in Olomouc, the Czech Republic, and worked as a SLP in a private clinic. Now she is teaching speech-language pathology at Valdosta State University, USA. Being a certified SLP and having teaching experience in both the Czech Republic and the United States gives her a unique opportunity to describe the certification process from both perspectives.

The certification process in speech-language pathology in the Czech Republic

“The Association of Speech-Language Pathologists of the Czech Republic (Asociace klinických logopedů, AKL ČR) brings together clinical speech therapists and speech therapists working in health care, included in the pre-clinical preparation in the field of clinical speech therapy. The aim of AKL CR is to protect the professional interests of clinical speech therapists, to develop the field of clinical speech therapy both theoretically and practically, to guarantee the professional level of clinical speech therapists in order to provide clients with services in line with current patient care standards” (Asociace klinických logopedů ČR).

The standards for certification in speech-language pathology are established by the Ministry of Health and The Institute of Postgraduate Education in Healthcare.

The first prerequisites to become a certified SLP are to earn a master’s degree in Speech-language Pathology or Special Education from Pedagogical faculty and to pass state exams in speech-language pathology and deaf studies. The students who graduate in the academic year 2018/2019 and later must complete a course called Speech-language pathologist in the health care system. This course can be taken when students are juniors or seniors at the graduate level or after they have already graduated. The course lasts for two semesters and includes 80 hours of classroom education, 40 hours of internship, and 180 hours of practical experience in a speech-language clinic (Zákon č. 96/2004 Sb. v aktuálním znění). Zákon č. 96/2004 Sb. v aktuálním znění is a legal document - Law No. 96/2004). Once all the conditions mentioned above are met, the graduate student can start his/her certification process in speech-language pathology. First, he/she has to start an introductory practice when working in a medical setting. This practice lasts from three to twelve months when working full time (40 hours/week). The speech-language pathologist working in a medical setting must work under the supervision of a certified speech-language pathologist. There has to be a contract between the speech-language pathologist and his/her supervisor (certified speech-language pathologist) in which the roles and responsibilities of both parties are defined. The supervisor monitors if the speech-language pathologist follows The Program of certification in speech-language pathology (Nařízení vlády č. 31/2010 Sb.). Nařízení vlády č. 31/2010 Sb is another important legal document that was created by the Czech government.

The certification process lasts at least 36 months if working full time (40 hours/week). This process is divided into two parts: the basic (fundamental) branch and the specialized branch. Each branch lasts 18 months. The purpose of the certification process is to gain knowledge and experience in prevention, evaluation, and therapy in speech-language pathology. When the speech-language pathologist finishes the certification process, he/she becomes a certified speech-language pathologist who can work independently (without supervision). The Program of certification in speech-language pathology states three conditions:

• Education during the certification process is realized during day-to-day job duties (Zákon č. 96/2004 Sb., o nelékařských zdravotnických povoláních, ve znění pozdějích právních předpisů a Zákoníku práce (Labor Law) ve znění pozdějích právních předpisů). Law No. 96/2004 and Labor Law are both legal documents created by Czech government.
• The minimum length of the certification process is 36 months when working full time (40 hours/week) under supervision. The speech-language pathologist must spend at least 6 weeks at an accredited workplace.
• The practice at an accredited workplace can be done at any time during the certification process.

The fundamental branch lasts 18 months when working full time under the supervision of a certified speech-language pathologist. The speech-language pathologist has to take a number of courses (in the field of speech-language pathology, law in the healthcare system, first aid, etc.) and spend at least three weeks in a different certified workplace during this period of time. Two weeks have to be spent in a hospital setting or an inpatient clinic and one week at a private clinic or an outpatient clinic. The speech-language pathologist has to collect credits for workshops, complete the practical experience in a different certified workplace, and pass an exam that concludes this fundamental branch.

The specialized branch lasts 18 months as well. During this period of time the speech-language pathologist attends workshops, collects credits for it, and has to spend at least three weeks in a different workplace that is certified (hospital, outpatient clinic, inpatient clinic, private clinic). During the entire certification process the SLP must collect at least 60 credits which allow him/her to approach (apply) to the attestation exam.

During the first eighteen months, the SLP has to gain knowledge and experience in evaluation and treatment in the following areas:

• Voice disorders.
• Anatomy and physiology of speech and language and the role of the central neural system in speech and language.
• Phonetics.
• Speech and language development.
• Language delay and specific language impairment.
• Speech sound disorders.
• Cleft and lip palate, resonance disorders.
• Aphasia.
• Fluency disorders.
• Motor speech disorders.
• Anatomy and physiology of hearing, auditory nervous system.
• Hearing disorders.
• Knowledge from other disciplines (audiology, linguistics, neurology, clinical psychology, special education, etc.).

The SLP has to be knowledgeable about ethics and law in health care, documentation, technologies used for evaluation, and therapy. The “Logbook” is another important part of the entire certification process. The “Logbook” states the list and the number of evaluations that must be done during the 36 months period. By the end of the fundamental branch, the SLP should be done with half of the evaluation list. Vzdělávací program specializačního vzdělávání v oboru klinická logopedie (The Plan of Education in Speech-Language Pathology) is a legal document that specifies the evaluations and the number of them. There are evaluations of gross and fine motoric skills, evaluation of production and expression of speech, aphasia’s evaluation, etc.

At the end of the specified branch, the speech-language pathologist must have a deep knowledge of the following:

• Voice disorders (prevention and therapy).
• Literacy disorders.
• Autism spectrum disorders and developmental disabilities.
• Cognitive-linguistic disorders.
• Hearing disorders.
• Knowledge from other disciplines (psychiatry, genetics, endocrinology, etc.).

The SLP should be experienced by the end of this branch with evaluation and therapy of voice disorders and speech and hearing disorders. The “Logbook” has to be completed at the end of this time as well.

The evaluation of speech-language pathologist by the supervisor

In addition to an evaluation at the end of the entire certification process, the supervisor frequently evaluates the SLP. The reports are written in the Logbook and Speech-pathologist certification's card.

The speech-language pathologist must meet the following criteria before applying to the attestation exam:

• Completion of six weeks of practical experience in a certified workplace and its evaluation.
• Completion of all required workshops.
• Completion of all required evaluations in the Logbook.
• Submission of three case studies.
• Passing a written exam (passing score is 80%).
• Completion of at least 60 credits for workshops during the entire certification process.

(Nařízení vlády č. 31/2010 Sb. – Government Ordinance No. 31/2010).

§ 6 and § 7 Vyhlášky č. 189/2009 Sb. defines the attestation exam. Vyhláška č. 189/2009 Sb.

(Law No. 189/2009) is a legal document. The exam has two parts:

• interaction with a patient (the speech-language pathologist has to demonstrate a therapeutic approach to a client with a specific diagnosis).
• theoretical part (three questions that the speech-language pathologist has to answer.)
• Evaluation and treatment of a child or teenager with communication disorders.
• Evaluation and treatment of an adult with communication disorders.
• Anatomy and physiology of speech and language.

The speech-language pathologist picks one question that actually includes three areas that are mentioned above. The speech-language pathologist cannot see the questions when picking it. There is a list of all the questions for the attestation exam that is available at the beginning of the certification procces (Atestační otázky klinická logopedie – Questions for Attestation Exam is a document that was created by the Associations of Speech-Language Pathologists of the Czech Republic).

After completing the requirements and passing the attestation exam, the speech-language pathologist becomes a certified speech-language pathologist who can work independently.

The certification process in speech-language pathology in the USA

The standards for audiology and speech-language pathology certification are established by members of ASHA’s Council for Clinical Certification in Audiology and Speech-language Pathology (CFCC).

The first prerequisites are to earn a master’s degree from a CAA-accredited program (The Council of Academic Accreditation in Audiology and Speech-Language Pathology).

Requirements for applying to a master’s program in speech-language pathology vary from institution to institution and this topic is outside the scope of this article.

The pathway to certification in speech-language pathology can be described in eight steps.

• The first step is to earn a master’s degree from a CAA-accredited program.
• The second step is to take and pass the Praxis Examination in Speech-Language Pathology at any time before, during or after applying.
• The third step is to submit the application for the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) to ASHA.
• The fourth step is to choose ASHA membership that brings some benefits.
• The fifth step is to select the mentor(s) and verify that they hold current ASHA certification. Also, the student will need to successfully complete his/her Clinical Fellowship (CF) experience of at least 36 weeks and 1,260 hours.
• The sixth step is to complete the Clinical Fellowship Report and Ratings Forms (SLPCF) with mentor(s) and submit it to ASHA.
• The seventh step is revision of the student's application by ASHA. This can take up to six weeks from the date when your document was received.
• The eighth and final step means that the student has been awarded the CCC-SL.

(Speech-Language Pathology Pathway to Certification).

All the steps will be discussed more in depth.

The 2020 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology is a document that discusses all the standards for certification in this field. This document describes the degree, education program, program of study, knowledge outcomes, skills outcomes, assessment, speech-language fellowship, and maintenance of certification in depth (2020 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology).

The first step of certification was already described above. The Praxis Examination in Speech-Language Pathology – the second step - is an important component of ASHA certification standards. The Exam is taken online and the passing score is 162 (on a 100-200 scale). The Praxis exam is used as a requirement for one or more of the following:

• ASHA Certificate of Clinical Competence in Speech-Language Pathology.
• State Professional Licensure.
• State Teacher Credential.

“Students are eligible to apply for certification once they have completed all graduate-level academic course work and clinical practicum and been judged by the graduate program as having acquired all of the knowledge and skills mandated by the current standards” (About the Speech-Language Pathology Praxis Exam). Once the applicant sends his/her application, he/she has two years to complete the certification process, that includes passing the Praxis Exam. It is recommended that the applicant registers and takes the Praxis exam no earlier that the completion of his/her graduate coursework and graduate clinical practicum or during the first year of clinical practice following graduation. The applicant should consider that each state has different requirements for state licensing and it can be related to completion of Praxis exam. Each state determines its passing score for professional licensure and teacher credentialing. The specifics of each state’s licensure and teaching requirements are not the intent of this article. Most states adopt the same passing score as required for ASHA certification. “The Praxis exam is comprehensive and, as a result, the test-takers will need to synthetize information they have learned from many sources and understand the subject as a whole” (About the Speech-Language Pathology Praxis Exam). There are two important sources that can be used by the applicant: Speech-Language Pathology Study Companion and General Information and Study Tips. ASHA provides the Speech-Language Pathology Exam content (Praxis exam). The content has three parts: Foundations and Professional Practice (44 questions), Screening, Assessment, Evaluation, and Diagnosis (44 questions), Planning, Implementation, and Evaluation of Treatment (44 questions). There is a list of topics that are covered in The Praxis exam (Speech-Language Pathology Exam 5331 Content).

The third step in a pathway to certification is applying for certification in Speech-Language Pathology. An applicant applies under the current standards for certification in Speech-Language Pathology. The 2020 Standards for Certification in Speech-Language Pathology are now in effect. If the student graduated from a program accredited by the CAA or from a program with CAA-candidacy status, the student can submit the online application any time after completing the necessary coursework and graduate clinical practicum, and after receiving confirmation from the student’s program director that the requirements in Standards 1-5 have been met (Apply for Certification in Speech-Language Pathology).

The applicant will next choose ASHA membership. There are a few categories (certified member, membership without certification, graduate student membership, etc.). Each category has its own benefits.

The fifth step in the certification process is The Clinical Fellowship. A Guide to the ASHA Clinical Fellowship Experience explains all the most important parts of this process. “The SLP CF is a mentored professional experience that begins after the completion of academic course work and clinical practicum. The goal of the CF is to allow the Clinical Fellow to transition between being a student enrolled in a communication sciences and disorders (CSD) program and being an independent provider of speech-language pathology clinical services” (A Guide to the ASHA Clinical Fellowship Experience). The Clinical Fellowship (CF) experience is a minimum of 1,260 hours and a minimum of 36 weeks of full-time experience or its part-time equivalent. The applicant can complete the experience in one or more locations with one or more mentors. The CF experience is divided into three equal segments and each segment represents one third of the total experience. One segment contains approximately 420 hours. Full-time CF experience is considered 35 hours per week for 36 weeks, for total of 1,260 hours. “Eighty percent of the Clinical Fellow’s work week must be spent in direct clinical contact related to the management of communication disorders that fit within the ASHA Scope of Practice in Speech-Language Pathology. Twenty percent of the work week may be spent doing other activities such as attending in-service or providing trainings and presentations” (A Guide to the ASHA Clinical Fellowship Experience). The Clinical Fellow is required to complete his/her CF experience within 4 years or less from the date his/her CF started. The CF experience can be started only after all the requirements are met, which means that all academic coursework and supervised clinical practicum have been completed and verified by the graduate program director. The Clinical Fellow must ensure before the beginning and during the CF, that his/her mentor(s) meet the required qualifications. Currently, for those who apply after January 2020, their mentoring SLP(s) must hold a current CCC-SLP, have a minimum of 9 months of full-time clinical experience after earning CCC-SLP and have completed a minimum of 2 hours of professional development in the area of supervision after earning CCC-SLP (in ibid). A guide to the ASHA Clinical Fellowship experience states the fellow’s responsibilities in detail. One of the responsibilities is to submit a written request to the Council of Clinical Certification in Audiology and Speech-Language Pathology (CFCC) if the fellow and his/her mentor are considering alternative methods of supervision/telesupervision -and have the request approved – before the CF experience starts. Besides the fellow’s responsibilities the Guide defines the mentor's qualifications and responsibilities as well. Each mentor must complete a minimum of 6 hours of on-site and in-person direct and 6 hours indirect observation during each segment. It means 18 hours of direct and 18 hours of indirect supervision during the full CF experience. The indirect observation can include reviewing diagnostic reports, treatment reports, etc. The CF mentor must provide feedback about the fellow’s performance at least once during each segment of the CF in the 2020 Clinical Fellowship Skills Inventory form. This inventory consists of 21 skill statements covering these areas: assessment, treatment, professional practice, interpersonal. There is a 3-point rating scale for each skill. Approval of the CF experience requires a minimum of “2” on each of the 21 skills during the last segment (2020 Clinical Fellowship Skills Inventory). A complete CF experience must include the following:

• A minimum of 1,260 hours of clinical experience working under the mentorship of a CCC-SLP who meets the mentor requirements stated in 2020 Standards.
• A minimum of 36 weeks of clinical experience working under mentorship of a CCC-SLP (or its part-time equivalent).
• A minimum of 6 hours of direct supervision and 6 hours of indirect supervision completed each segment by each mentor.
• A minimum rating of 2 under the 2020 CF experience in the final segment of the CF.
• All hours/segments recommended by each CF mentor in order to count toward the CF experience.

A Clinical fellow can apply for the CCC-SLOP at any time, it is not necessary to wait until the conclusion of the fellow’s CF experience. The Clinical fellows can use a visual guide about clinical fellowship experience (Completing the Clinical Fellowship Experience).

Once the fellow sends the application (the sixth step), it can take up to 6 weeks to review it. If all the requirements are met, the fellow becomes a certified speech-language pathologist and may use CCC-SLP.

Conclusion

There are definitely some similarities in the process of becoming a certified speech-language pathologist in the Czech Republic and the United States of America. One of them is the requirement of earning a master’s degree in Speech-Language Pathology. Another similarity is the requirement of a certification by itself. In addition, working under supervision is another similarity. However, there are more differences in the certification process. For example, the length of the certification process differs. In the Czech Republic, it is at least 36 months after completion of the introductory practice that can last up to from 3 to 12 months. In the USA, on the other hand, the clinical fellowship lasts at least 36 weeks and 1,260 hours. Another difference is the Praxis Examination in the USA. This exam is a requirement that all students have to take before, during or after applying for CCC-SLP to ASHA. In the Czech Republic there is no exam that students have to pass before applying for the certificate in Speech-Language Pathology. Also, the graduate students in the USA do not need to complete a course called Speech-language pathologist in the healthcare system after graduating while graduate students in the Czech Republic must complete said course. In the author’s opinion, ASHA offers more sources for applicants of CCC-SLP including the Praxis Study Companion and General Information and Study Tips. The main similarities and differences in the certification process in both countries can be found in Table 1 Similarities and Differences in the Certification Process.

Reference

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Informace o autorovi

Mgr. et Mgr. Gabriela Smeckova, Ph.D.

Department of Communication Sciences & Disorders, Valdosta State University

1500 North Patterson Street

31698-0050 Valdosta, Georgia

The United States

gsmeckova@valdosta.edu