American speech language and hearing Association
Scope of Practice in Speech-Language Pathology
Ad Hoc Committee on the Scope of Practice in Speech-Language Pathology
About This Document
This scope of practice document is an official policy of the American Speech-Language-Hearing Association (ASHA) defining the
breadth of practice within the profession of speech-language pathology. This document was developed by the ASHA Ad Hoc
Committee on the Scope of Practice in Speech-Language Pathology. Committee members were Kenn Apel (chair), Theresa E.
Bartolotta, Adam A. Brickell, Lynne E. Hewitt, Ann W. Kummer, Luis F. Riquelme, Jennifer B. Watson, Carole Zangari, Brian B.
Shulman (vice president for professional practices in speech-language pathology), Lemmietta McNeilly (ex officio), and Diane
Paul (consultant). This document was approved by the ASHA Legislative Council on September 4, 2007 (LC 09-07)
Introduction
The Scope of Practice in Speech-Language Pathology includes a statement of purpose, a framework for research and clinical practice,
qualifications of the speech-language pathologist, professional roles and activities, and practice settings. The speech-language
pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the
areas of communication and swallowing across the life span from infancy through geriatrics. Given the diversity of the client
population, ASHA policy requires that these activities are conducted in a manner that takes into consideration the impact of culture
and linguistic exposure/acquisition and uses the best available evidence for practice to ensure optimal outcomes for persons with
communication and/or swallowing disorders or differences.
As part of the review process for updating the Scope of Practice in Speech-Language Pathology, the committee made changes to the
previous scope of practice document that reflected recent advances in knowledge, understanding, and research in the discipline. These
changes included acknowledging roles and responsibilities that were not mentioned in previous iterations of the Scope of Practice
(e.g., funding issues, marketing of services, focus on emergency responsiveness, communication wellness). The revised document also
was framed squarely on two guiding principles: evidence-based practice and cultural and linguistic diversity.
Statement of Purpose
The purpose of this document is to define the Scope of Practice in Speech-Language Pathology to
1. delineate areas of professional practice for speech-language pathologists;
2. inform others (e.g., health care providers, educators, other professionals, consumers, payers, regulators, members of the
general public) about professional services offered by speech-language pathologists as qualified providers;
3. support speech-language pathologists in the provision of high-quality, evidence-based services to individuals with
concerns about communication or swallowing;
4. support speech-language pathologists in the conduct of research;
5. provide guidance for educational preparation and professional development of speech-language pathologists.
This document describes the breadth of professional practice offered within the profession of speech-language pathology. Levels of
education, experience, skill, and proficiency with respect to the roles and activities identified within this scope of practice document
vary among individual providers. A speech-language pathologist typically does not practice in all areas of the field. As the ASHA
Code of Ethics specifies, individuals may practice only in areas in which they are competent (i.e., individuals' scope of competency),
based on their education, training, and experience.
In addition to this scope of practice document, other ASHA documents provide more specific guidance for practice areas.
illustrates the relationship between the ASHA Code of Ethics, the Scope of Practice, and specific practice documents. As shown, the
ASHA Code of Ethics sets forth the fundamental principles and rules considered essential to the preservation of the highest standards
of integrity and ethical conduct in the practice of speech-language pathology.
Speech-language pathology is a dynamic and continuously developing profession. As such, listing specific areas within this Scope of
Practice does not exclude emerging areas of practice. Further, speech-language pathologists may provide additional professional
services (e.g., interdisciplinary work in a health care setting, collaborative service delivery in schools, transdisciplinary practice in early intervention settings) that are necessary for the well-being of the individual(s) they are serving but are not addressed in this
Scope of Practice. In such instances, it is both ethically and legally incumbent upon professionals to determine whether they have the
knowledge and skills necessary to perform such services.
This scope of practice document does not supersede existing state licensure laws or affect the interpretation or implementation of such
laws. It may serve, however, as a model for the development or modification of licensure laws.
Framework for Research and Clinical Practice
The overall objective of speech-language pathology services is to optimize individuals' ability to communicate and swallow, thereby
improving quality of life. As the population profile of the United States continues to become increasingly diverse (U.S. Census
Bureau, 2005), speech-language pathologists have a responsibility to be knowledgeable about the impact of these changes on clinical
services and research needs. Speech-language pathologists are committed to the provision of culturally and linguistically appropriate
services and to the consideration of diversity in scientific investigations of human communication and swallowing. For example, one
aspect of providing culturally and linguistically appropriate services is to determine whether communication difficulties experienced
by English language learners are the result of a communication disorder in the native language or a consequence of learning a new
language.
Additionally, an important characteristic of the practice of speech-language pathology is that, to the extent possible, clinical decisions
are based on best available evidence.
ASHA has defined evidence-based practice in speech-language pathology as an approach in
which current, high-quality research evidence is integrated with practitioner expertise and the individual's preferences and values into
the process of clinical decision making (ASHA, 2005). A high-quality basic, applied, and efficacy research base in communication
sciences and disorders and related fields of study is essential to providing evidence-based clinical practice and quality clinical
services. The research base can be enhanced by increased interaction and communication with researchers across the United States
and from other countries. As our global society is becoming more connected, integrated, and interdependent, speech-language
pathologists have access to an abundant array of resources, information technology, and diverse perspectives and influence (e.g.,
Lombardo, 1997). Increased national and international interchange of professional knowledge, information, and education in
communication sciences and disorders can be a means to strengthen research collaboration and improve clinical services.
The World Health Organization (WHO) has developed a multipurpose health classification system known as the International
Classification of Functioning, Disability and Health (ICF; WHO, 2001). The purpose of this classification system is to provide a
standard language and framework for the description of functioning and health. The ICF framework is useful in describing the breadth
of the role of the speech-language pathologist in the prevention, assessment, and habilitation/ rehabilitation, enhancement, and
scientific investigation of communication and swallowing. It consists of two components:
• Health Conditions
º Body Functions and Structures: These involve the anatomy and physiology of the human body. Relevant examples in
speech-language pathology include craniofacial anomaly, vocal fold paralysis, cerebral palsy, stuttering, and language
impairment.
º Activity and Participation: Activity refers to the execution of a task or action. Participation is the involvement in a life
situation. Relevant examples in speech-language pathology include difficulties with swallowing safely for independent
feeding, participating actively in class, understanding a medical prescription, and accessing the general education curriculum.
• Contextual Factors
º Environmental Factors: These make up the physical, social, and attitudinal environments in which people live and conduct
their lives. Relevant examples in speech-language pathology include the role of the communication partner in augmentative
and alternative communication, the influence of classroom acoustics on communication, and the impact of institutional
dining environments on individuals' ability to safely maintain nutrition and hydration.
º Personal Factors: These are the internal influences on an individual's functioning and disability and are not part of the health
condition. These factors may include, but are not limited to, age, gender, ethnicity, educational level, social background, and
profession. Relevant examples in speech-language pathology might include a person's background or culture that influences
his or her reaction to a communication or swallowing disorder.
The framework in speech-language pathology encompasses these health conditions and contextual factors. The health condition
component of the ICF can be expressed on a continuum of functioning. On one end of the continuum is intact functioning. At the
opposite end of the continuum is completely compromised functioning. The contextual factors interact with each other and with the
health conditions and may serve as facilitators or barriers to functioning. Speech-language pathologists may influence contextual
factors through education and advocacy efforts at local, state, and national levels. Relevant examples in speech-language pathology
include a user of an augmentative communication device needing classroom support services for academic success, or the effects of
premorbid literacy level on rehabilitation in an adult post brain injury. Speech-language pathologists work to improve quality of life
by reducing impairments of body functions and structures, activity limitations, participation restrictions, and barriers created by
contextual factors.
Qualifications
Speech-language pathologists, as defined by ASHA, hold the ASHA Certificate of Clinical Competence in Speech-Language
Pathology (CCC-SLP), which requires a master's, doctoral, or other recognized post-baccalaureate degree. ASHA-certified speechlanguage pathologists complete a supervised postgraduate professional experience and pass a national examination as described in the
ASHA certification standards. Demonstration of continued professional development is mandated for the maintenance of the CCCSLP. Where applicable, speech-language pathologists hold other required credentials (e.g., state licensure, teaching certification).
This document defines the scope of practice for the field of speech-language pathology. Each practitioner must evaluate his or her own
experiences with preservice education, clinical practice, mentorship and supervision, and continuing professional development.
As a
whole, these experiences define the scope of competence for each individual. Speech-language pathologists may engage in only those
aspects of the profession that are within their scope of competence.
As primary care providers for communication and swallowing disorders, speech-language pathologists are autonomous professionals;
that is, their services are not prescribed or supervised by another professional. However, individuals frequently benefit from services
that include speech-language pathologist collaborations with other professionals.
Professional Roles and Activities
Speech-language pathologists serve individuals, families, and groups from diverse linguistic and cultural backgrounds. Services are
provided based on applying the best available research evidence, using expert clinical judgments, and considering clients' individual
preferences and values. Speech-language pathologists address typical and atypical communication and swallowing in the following
areas:
• speech sound production
º articulation
º apraxia of speech
º dysarthria
º ataxia
º dyskinesia
• resonance
º hypernasality
º hyponasality
º cul-de-sac resonance
º mixed resonance
• voice
º phonation quality
º pitch
º loudness
º respiration
• fluency
º stuttering
º cluttering
• language (comprehension and expression)
º phonology
º morphology
º syntax
º semantics
º pragmatics (language use, social aspects of communication)
º literacy (reading, writing, spelling)
º prelinguistic communication (e.g., joint attention, intentionality,
communicative signaling)
º paralinguistic communication
• cognition
º attention
º memory
º sequencing
º problem solving
º executive functioning
feeding and swallowing
º oral, pharyngeal, laryngeal, esophageal
º orofacial myology (including tongue thrust)
º oral-motor functions
Potential etiologies of communication and swallowing disorders include
• neonatal problems (e.g., prematurity, low birth weight, substance exposure);
• developmental disabilities (e.g., specific language impairment, autism
spectrum disorder, dyslexia, learning disabilities, attention deficit disorder);
• auditory problems (e.g., hearing loss or deafness);
• oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-motor dysfunction);
• respiratory compromise (e.g., bronchopulmonary dysplasia, chronic obstructive pulmonary disease);
• pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal insufficiency/incompetence);
• laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis, tracheostomy);
• neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebral vascular accident, dementia,
Parkinson's disease, amyotrophic lateral sclerosis);
• psychiatric disorder (e.g., psychosis, schizophrenia);
• genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome, velocardiofacial syndrome).
The professional roles and activities in speech-language pathology include clinical/ educational services (diagnosis, assessment,
planning, and treatment), prevention and advocacy, and education, administration, and research.
Clinical Services
Speech-language pathologists provide clinical services that include the following:
• prevention and pre-referral
• screening
• assessment/evaluation
• consultation
• diagnosis
• treatment, intervention, management
• counseling
• collaboration
• documentation
• referral
Examples of these clinical services include
1. using data to guide clinical decision making and determine the effectiveness of services;
2. making service delivery decisions (e.g., admission/eligibility, frequency, duration, location, discharge/dismissal) across the
lifespan;
3. determining appropriate context(s) for service delivery (e.g., home, school, telepractice, community);
4. documenting provision of services in accordance with accepted procedures appropriate for the practice setting;
5. collaborating with other professionals (e.g., identifying neonates and infants at risk for hearing loss, participating in
palliative care teams, planning lessons with educators, serving on student assistance teams);
6. screening individuals for hearing loss or middle ear pathology using conventional pure-tone air conduction methods
(including otoscopic inspection), otoacoustic emissions screening, and/or screening tympanometry;
7. providing intervention and support services for children and adults diagnosed with speech and language disorders;
8. providing intervention and support services for children and adults diagnosed with auditory processing disorders;
9. using instrumentation (e.g., videofluoroscopy, electromyography, nasendoscopy, stroboscopy, endoscopy, nasometry,
computer technology) to observe, collect data, and measure parameters of communication and swallowing or other upper
aerodigestive functions;
10. counseling individuals, families, coworkers, educators, and other persons in the community regarding acceptance,
adaptation, and decision making about communication and swallowing;
11. facilitating the process of obtaining funding for equipment and services related to difficulties with communication and
swallowing;
12. serving as case managers, service delivery coordinators, and members of collaborative teams (e.g., individualized family
service plan and individualized education program teams, transition planning teams);
13. providing referrals and information to other professionals, agencies, and/or consumer organizations;
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