ACQ Vol 13 No1 2011

profession, and these are referred to in the Association’s Credentialling Position Statement (SPA, 2009a). The Credentialing Position suggests that the following levels of practice currently operate within the profession: “entry- level”, “advanced practice”, “specialisation” and “extended skills”. The Credentialing Position Statement provides possible interpretations for which clinical activities might be categorised under these levels of professional practice. However, the statement does not categorically identify the various activities and roles of current speech pathology practice. To this end, the statement does not provide specific guidelines for training to enable individuals to achieve these various levels of professional practice. A number of the existing SPA position papers also refer to levels of professional practice beyond entry-level practice (SPA, 2004a; 2005a; 2007b). The SPA position papers aim to present a summary of evidence and approaches to clinical practice relevant to that area. In some instances these papers also provide examples of how the various levels of professional practice might be verified. However, the papers do not define measurable competency standards, nor specific content or methods for training. With only nine current position papers, there are many other areas of speech pathology competency and practice outlined within the profession’s Scope of Practice (SPA, 2003) that are without clearly defined standards regarding practice and training (Table 1). Table 1. Speech Pathology Australia position papers Dysphagia: General (2004b) Dysphagia: Modified barium swallow (2005b) Fibreoptic endoscopic evaluation of swallowing (FEES): An advanced practice for speech pathologists (2007b) Tracheostomy management (2005a) Speech pathology in child and adolescent mental health (2001c) Speech pathology services in schools (2004a) Working in a culturally and linguistically diverse society (2009b) Augmentative and alternative communication (2004c) Evidence-based speech pathology practice for individuals with autism spectrum disorders (2009c) Failure to clearly and specifically define the competencies required to perform the activities and roles undertaken across the breadth of contemporary speech pathology practice affects the consistency and quality of services provided. When SPs do not possess appropriate skills and knowledge, and/or fail to perform within an agreed scope of practice, the likelihood of causing harm to patients increases significantly. Given that the profession’s title is not protected through registration or existing legislative instruments (except in Queensland), the public is currently unable to be guaranteed of the quality and safety of services provided by individuals claiming to be SPs. Other than the entry-level competency standards defined in C-BOS (SPA, 2001a), it is not clear what competencies and training are required to undertake these various levels of professional activities that are performed as part of contemporary speech pathology practice. Retrieved from http://www.speechpathologyaustralia.org.au/ publications/position-papers

which as outlined in the objectives of the Association’s Constitution (SPA, 2008), are primarily aimed at protecting and advocating for the profession (Carlton, 2008). Unfortunately, the Australian Health Workforce Ministerial Council, which comprises the health ministers from the Commonwealth government and all state and territory governments, decided that SPs, dental technicians, optical dispensers and occupational therapists would not be included in the National Scheme. (The health ministers subsequently reviewed their decision, and agreed to include occupational therapists in the scheme.) For speech pathology, it is understood that this decision was made primarily on the basis that the evidence presented in the submission did not support a finding of increased adverse effects to the public in jurisdictions where the profession is not regulated (i.e., states and territories other than Queensland). Appeals for this decision to be reviewed were unsuccessful. The unsuccessful submission for inclusion in the scheme detailed a number of legitimate risks to public safety posed by speech pathology practice, particularly where individuals practise without the competencies to do so. The profession has a duty of care to address and mitigate these risks to public safety. This paper explores approaches adopted by other health professions, both in Australia and internationally, that aim to ensure that health professionals have the competencies to work within their individual scopes of practice, in order to deliver quality health care that minimises harm to the public. This paper proposes that a career and professional development framework for the speech pathology profession in Australia may provide a quality assurance mechanism to assure the public of the competency of the speech pathology workforce, while also offering benefits to the profession. Competency and scope of practice The scope of practice of a health profession serves to guide qualified individuals of that health profession about the types of clinical activities that they can undertake, given the appropriate training and competency. A scope of practice also informs other parties, such as the public, other professionals, consumers, insurers and lawyers, about the services that they can expect a specific health profession to provide. The Australian speech pathology Scope of Practice document published by SPA (2003) is intended to be read in conjunction with other core Association documents including Code of Ethics (SPA, 2010), Parameters of Practice (SPA, 2007a), Competency-Based Occupational Standards (C-BOS) – Entry level (SPA, 2001a), Principles of Practice (SPA, 2001b) and other Association position papers and statements. Together, this suite of documents aims to define the competencies and professional conduct expected to enable individuals to operate within their scope of practice. Speech pathology is likely to continue to enhance and expand its scope of practice to enable suitably qualified individuals to be involved in a range of activities that are physically invasive, utilise technology in the assessment and treatment of patients, and further develop roles as primary health practitioners with specific patient groups whose clinical status indicates that regular management by a medical practitioner or other health professionals is no longer required (SPA & Speech Pathologists Board of Queensland, 2008). SPA has acknowledged that levels of professional practice beyond entry-level practice exist within the

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing