ACQ Vol 13 No1 2011

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32 ACQ Volume 13, Number 1 2011 ACQuiring knowledge in speech, language and hearing
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).
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
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)
Retrieved from
publications/position-papers
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.