SLPA Supervision

This page highlights guidelines for supervision from the ASHA Scope of Practice for the Speech-Language Pathology Assistant (SLPA) and includes information on the following topics:

Supervisor Qualifications
Supervisor Training and Preparation
Expectations for the Supervising SLP
Amount of Supervision Required
Medically Fragile Students, Patients, and Clients
SLP-to SLPA rati o
Ethics
Telesupervision
Billing and Reimbursement for Services
Resources

Supervisor Qualifications

Supervisors and SLPAs should consider these requirements and regulations:

State regulations, which may include licensure or registration
ASHA guidelines in addition to the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) requirements, which are recommendations for practice
CFCC requirements for SLPA certification

The ASHA Scope of Practice for the SLPA recommends that the supervising speech-language pathologist (SLP):

Holds the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) from ASHA and/or possesses the necessary state credentials
Has completed a minimum of 9 months of experience after being awarded ASHA certification (i.e., completion of the 9-month Clinical Fellowship followed by 9 months of experience)
Has completed a minimum of 2 hours of professional development in clinical instruction/supervision
Adheres to state guidelines for supervision of the SLPA

It is also recommended that the professional development course taken in clinical instruction or supervision include content related to the supervision of SLPAs.

Supervisor Training and Preparation

First time supervisors, or those who want to enhance their supervision skill set, will benefit from these tools and resources.

Knowledge and Skills Needed by Speech-Language Pathologists Providing Clinical Supervision
Self-Assessment in Supervision: The Use of the Rubric as a Means of Self-Assessment (Perspectives on Administration and Supervision)
Tips for First Time Supervisors
Report of the ASHA Ad Hoc Committee on Supervision (Knowledge, Skills and Training Considerations for Individuals Serving as Supervisors) [PDF]
Phased-in Training for Clinical Supervision (ASHA Journals Academy)
Resources for Developing CE Courses in Supervision

Expectations for the Supervising SLP

In addition to the minimum qualifications listed above, the following additional roles and behavior are expected of the supervising SLP:

Adhere to the principles and rules of the ASHA Code of Ethics
Adhere to applicable licensure laws and rules regulating the practice of speech-language pathology
Conduct ongoing competency evaluations of the SLPAs
Provide and encourage ongoing education and training opportunities for the SLPA that are consistent with the competencies and skills required to meet the needs of the students, patients, and clients served
Develop, review, and modify treatment plans for students, patients, and clients that the SLPA implements under the SLP’s supervision
Make all case management decisions
Adhere to the supervisory responsibilities for SLPs
Retain legal and ethical responsibility for all students, patients, and clients served
Maintain an active interest in collaborating with SLPAs
Accurately document and regularly record all supervisory activities, both direct and indirect.

Amount of Supervision Required

The amount and type of supervision required must be consistent with the

SLPA’s skills and experience;
needs of the students, patients, and clients;
service setting;
tasks assigned; and
laws and regulations that govern SLPAs.

To ensure adequate and appropriate supervision, the supervising SLP should outline their expectations in collaboration with the SLPA. As the relationship continues to develop over time, the SLP/SLPA team can decide how and to what extent supervision is needed.

First Contact

Before the SLPA begins to provide support independently, the supervising SLP must have first contact with all individuals on the caseload. “First contact” includes establishing rapport, gathering baseline data, and securing other necessary documentation to begin (or continue) the plan of care for the student, patient, or client. As the SLP/SLPA team dynamic continues to develop beyond the initial onboarding, minimum ongoing supervision must always include documentation of direct supervision provided by the SLP for each student, patient, or client at least every 30–60 days (depending on the frequency of visits and sessions and depending on the setting).

The SLP may adjust the amount of supervision if they determine that the SLPA has met appropriate competencies and skill levels. The supervisor should review, in regular intervals, data on every student, patient, and client served by the SLPA ; this can be considered “indirect supervision.” Supervisors should arrange designated days and times of day (morning or afternoon) in such a way that all students, patients, and clients receive direct contact with the supervising SLP.

Medically Fragile Students, Patients, and Clients

According to the ASHA Scope of Practice for the SLPA, “medically fragile” is a term used to describe an individual who is acutely ill and in an unstable health condition. If an SLPA treats such an individual, that treatment requires 100% direct supervision by an SLP. States, health care providers, payers, and facilities may also define the term “medically fragile” based on medical diagnosis and needed support.

ASHA maintains two separate policy documents that set forth the fundamentals of ethical conduct in the professions. Both documents address considerations for supervision.

The ASHA Code of Ethics (2016a) applies to every individual who is (a) an ASHA member, whether certified or not; (b) a nonmember holding the ASHA Certificate of Clinical Competence; (c) an applicant for membership or certification; or (d) a Clinical Fellow seeking to fulfill standards for certification.
The ASHA Assistants Code of Conduct (2020b) applies to all ASHA-certified audiology and speech-language pathology assistants as well as applicants for assistant certification.

Issues in Ethics: Speech-Language Pathology Assistants also provides guidance for speech-language pathology assistants and their supervisors. This statement reflects ASHA’s policy on the use of SLPAs and does not supersede state credentialing and licensure laws.

SLP-to-SLPA Ratio

The supervising SLP should determine the appropriate number of assistants whose practice can be supervised within that supervisor’s workload. Although more than one SLP may supervise an SLPA, it is recommended that the SLP not supervise or be listed as a supervisor for more than three full-time equivalent (FTE) SLPAs in any setting. The SLP is responsible for determining how many SLPAs they can supervise while still maintaining the highest level of quality for services provided.

Ethics

ASHA maintains two policy documents that describe the fundamentals of ethical conduct in the professions. Both address considerations for supervision.

The ASHA Code of Ethics (2016a) applies to every individual who is (a) an ASHA member, whether certified or not, (b) a nonmember holding the ASHA Certificate of Clinical Competence, (c) an applicant for membership or certification, or (d) a Clinical Fellow seeking to fulfill standards for certification.
The ASHA Assistants Code of Conduct (2020b) applies to all ASHA-certified audiology and speech-language pathology assistants, as well as applicants for assistant certification.

Issues in Ethics: Speech-Language Pathology Assistants is designed to provide guidance for speech-language pathology assistants and their supervisors and reflects ASHA’s policy for the use of SLPAs and does not supersede state licensure laws.

Telesupervision

Telesupervision occurs when a qualified professional observes, from a distance, the delivery of services and provides feedback or assistance as needed. With telesupervision, the SLP can view and communicate with the patient and SLPA in real time via telecommunication software (e.g., virtual platforms), webcam, telephone, and similar devices and services to supervise the SLPA. This enables the SLP to give immediate feedback. Telesupervision does not include reviewing a recorded session later. See ASHA’s Practice Portal on Telepractice for information on licensure and teacher certification, international considerations, and reimbursement and other topics. The page also includes a comprehensive list of resources—including checklists and videos to inform practice.

Laws and Regulations

The use of telesupervision as an alternative to in-person supervision may depend on the policies, regulations, and/or laws of various stakeholders such as universities, clinical settings, ASHA, state licensure boards, and state and federal laws and regulations.

Increasingly, state licensure laws may or may not include guidance or regulation regarding telesupervision. States may vary in terms of whether they specifically address the issue of supervising students from a distance. See practice policy for your state. In some cases, providers and clients, patients, students may not reside in the same state or country. Serving Students in Other States and Countries Through Telepractice provides information and guidance when this occurs.

Ethical Responsibilities

The supervisor has an ethical responsibility to determine if telesupervision is appropriate in view of the type of setting, client population, and level of competence of the individual delivering the service.

When implementing telesupervision practice and policies, consider the security of the telesupervision transmission, keeping in mind relevant state and federal laws such as Health Insurance Portability and Accountability Act (HIPAA) and Family Education Rights and Privacy Act (FERPA). Policies about safety, liability, and whether a certified and/or licensed professional needs to be on site are important considerations. Considerations for Group Speech-Language Pathology Treatment in Telepractice addresses service delivery, documentation, privacy and confidentiality of telepractice across settings.

Knowledge and Skills

Delivering supervision services from a distance requires knowledge and skills for managing technology, complying with licensure and security requirements, providing feedback, and so forth. Training may be necessary to ensure that the quality and effectiveness of the telesupervision is equivalent to in-person supervision.

Tips And Considerations for Telesupervision

Conduct a trial prior to the scheduled observation to identify and resolve technical and logistical issues (e.g., connectivity location of the microphone and camera).
Always have an alternate means for the telesupervisor and clinician to communicate in case there is a problem with connectivity or equipment.
The telesupervisor should share their web camera when being introduced to the client, student, or patient at the beginning of the session but may stop sharing the web camera after introductions in order to minimize distractions.
Providing the background case information as well as an outline for the test plan or lesson plan in advance helps to plan camera and microphone placement so that the telesupervisor can have an optimal view of the client, student, or patient and their materials.
If the supervisor is providing online feedback or instructions during the session, the telesupervisee can receive communications via an earpiece to avoid distracting the client, student, or patient.

Billing and Reimbursment for Services

States and third-party payers (e.g., insurance, Medicaid) vary in their policies regarding recognition of SLPAs as approved service providers, rate of reimbursement for assistant-level services, and other policies.

The supervising SLP and SLPA are jointly responsible for knowing and understanding federal and state regulations and individual payer policies, billing for services at the appropriate level, and providing the amount and type of supervision required by the payer when billing for SLPA services.

Services of speech-language pathology assistants are not recognized for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services.

American Speech-Language-Hearing Association

SLPA Supervision

Supervisor Qualifications

Supervisor Training and Preparation

Expectations for the Supervising SLP