The Time Has Come for Speech-Language Pathology License Portability

State map of USA

Photo by Kevin Hutchinson

Over the past decade, a chronic shortage of speech-language pathologists has left K-12 schools and healthcare settings in many parts of the United States struggling to provide speech therapy services. The problem has taken a financial toll, driving the cost of services up as institutions spend increasing time and funds searching for speech-language pathologists.

Telepractice offers a promising solution by enabling practitioners to conduct live therapy sessions with clients “anytime, anywhere” using real-time videoconferencing. Telepractice allows practitioners to flexibly “go where the work is” without actually having to physically travel or relocate. Speech-language pathologists who no longer engage in full-time practice but still wish to work part-time, can contract with school districts to provide speech therapy services via telepractice. Ultimately, telepractice addresses a labor problem that impacts many health professions.

This cost-effective approach is being successfully employed by school districts across the United States, reducing costs while providing high-quality therapy. Research indicates that speech therapy delivered through telepractice has comparable quality and outcomes as speech therapy services delivered in-person (American Speech-Language-Hearing Association, 2005; Boisvert, Lang, Andrianopoulos, & Boscardin, 2010; Boswell, 2007; Grogan-Johnson, Alvares, Rowan & Creaghead, 2010; Grogan-Johson et al., 2011).

Although technology has removed geographic constraints, one major barrier remains: time consuming and expensive licensing practices due to a lack of state license portability. While the professional requirements for licensing speech-language pathologists are very similar from state to state, each state has its own licensing process. As a result, speech-language pathologists who want to practice in multiple states must complete applications in each state where a license is sought; submit required documentation; pay licensing fees; and, endure processing times that significantly vary by state. This duplicative process might be warranted if important state-to-state variations in professional requirements for licensing were to exist; however, there is a high degree of consistency in licensing requirements across states.

Though the professional requirements are typically similar, license application processing times and fees vary by state. Some states process applications electronically, while others use a paper-based format. Depending on the state, the processing times for applications range from weeks to months. All states charge licensing application fees (typically $150 and higher) for the initial application, with similar charges for annual license renewal. In some states, licensees must provide fingerprints along with their license application. States do not share fingerprint information; applicants must send fingerprints to the state where the license is requested through an approved process.

The importance of licensure portability was recognized fifteen years ago when the United States Congress passed the Telecommunications Act of 1996 which urged the healthcare industry to develop multi-state licensure models. Similarly, the US Federal Communications Commission called on state licensing boards to accommodate multi-state licensure for health care practitioners. In 2000, the National Council of State Boards of Nursing (NCSBN) instituted the Nurse License Compact (NLC). The NLC allows nurses licensed in a compact state (currently 24 states) to practice in other compact states through a mutual license recognition model. Physicians have labor mobility through an expedited license model.

True license portability for speech-language pathologists is long overdue. License portability would facilitate inter-state practice and thus enable speech-language pathologists who live near state lines to practice in adjacent states where personnel shortages may exist. Greater labor mobility is necessary to serve geographically shifting populations in the US.

It is time to remove the barriers to licensure portability! A national initiative that creates a model for licensure portability for the rehabilitation professions is needed. Licensure portability will enable speech-language pathologists to provide services wherever and whenever needed, thereby unleashing the full potential of telepractice to reduce costs and administrative burdens, increase access to services, broaden career opportunities for speech-language pathologists and improve outcomes for K-12 students and clients in diverse practice settings. A mobile, flexible workforce positioned to use telepractice for inter-state practice could alleviate the chronic shortage of speech-language pathologists.

References

1. 1. American Speech-Language-Hearing Association. (2005). Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement [Position Statement]. Retrieved from www.asha.org/policy.
2. 2. Boisvert, M., Lang, R., Andrianopoulos, M., & Boscardin, M. (2010). Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 13, 423-432.
3. 3. Boswell, S. (2007, March 6). Ohio grant addresses personnel shortage: Innovative strategies meet short-and long-term goals. The ASHA Leader.
4. 4. Grogan-Johnson, S., Alvares, R., Rowan, L. E., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech-language intervention provided by telehealth and traditional side-by-side intervention. Journal of Telemedicine and Telecare, 16, 134-139.
5. 5. Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvares, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school–age children. International Journal of Telerehabilitation, 3(1), 31-42.

(This article was originally published in the International Journal of Telerehabilitation Vol. 3, No. 2, Fall 2011, DOI:10.5195/ijt.2011.6079 (http://telerehab.pitt.edu/ojs/index.php/Telerehab/article/view/6079)

 

Melissa Jakubowitz, M.A., CCC-SLP is currently the Vice President of SLP Services at PresenceLearning and  has been a speech-language pathologist for more than 20 years, working in schools and  private practice before joining PresenceLearning in January 2010. She is a former president of the California Speech-Language-Hearing Association and has been an active member of ASHA serving on Legislative Council for 12 years and on the ASHA Board of Ethics. 

Comments

  1. I think the greater question is: with ASHA licensure in place, is state licensure, much less license portability, even necessary at all?

  2. I’m all for license portability! My husband is in the military and within the last year we’ve moved to two different states. I paid all of the licensing/finger printing fees and got a license in the first state. After an unexpected change in my husbands orders I ended up not even getting to use the license. I then had to pay the licensing and finger printing fees all over again to the new state (the process took 3 months). After a careful look at my new license I found that it will already expired on my birth month this May! All of the money I spent for 4 months of licensure? I called the state but all they could tell me was that “it is their policy”. In my experience many states will give you a year in addition to the remaining months until your birth month. So now I must spend MORE money to renew my license again. I can only hope that license portability would help alleviate these issues!

  3. Kathy Boada says:

    Coming from one of the last states without licensure, Colorado, I can tell you that state licensure does matter! (We are currently running a bill…) ASHA Certification is our national standard but it does not have the force of law in individual states. There is no national or federal law requiring someone who practices speech-language pathology to hold the ASHA CCC’s and ASHA does not have legal authority in any state.
    A state licensure provides for:
     Legally defined minimum standards of education & certification
     Scope of practice is legally defined
     Consumer protection & legal recourse
     Title & degree protection

    While I agree that it it time licensure portability, solving it will take an initiative at the state government level. Perhaps something like the Nurses achieved could be initiated… Could someone at ASHA help lead this charge??

  4. I totally agree with this stance! We who live in New England run up against this problem all the time. Our states are very small compared to most of the rest of the United States and it’s common for an SLP to work at two places, one which may just over a border. Or, move to a new location after getting married. Not only are there applications, possible finger-printing, and gathering of documents to prove your credentials, some states require coursework to be certified as a “teacher” in order to practice in the schools – I am going through that now in Maine. They only just got rid of the requirement of going through a year’s supervision – a duplication of what is required by ASHA. I just made it in on that one and not only saved the hassle, but $100 that went along with that “certification”. When are states going to see us as therapeutic practitioners and not classroom teachers?!?

  5. Ellen Cohn says:

    Thanks to Melissa for authoring a terrific blog entry on an important subject!

    Steering committee members of the ASHA SIG #18 on Telepractice are very concerned about and attentive to the current lack of state licensure portability. There is content about licensure in our latest Perspectives issue and information in the SIG library. The ASHA website has some excellent online resources on telepractice that include licensure.

    While it is my understanding (as a SIG Coordinator) that ASHA SIGs are not to independently advocate for state or national change, this issue is discussed often with ASHA’s Janice Brannon, Director, State Special Initiatives Government Relations & Public Policy. She is a highly regarded expert on the topic.

    The following important point came up in a meeting I attended today…
    It can be tempting to assume that gaining a state license to practice in the client’s state is sufficient to begin telepractice.
    However, states may differ as to what is allowable under their scopes of practice. Telepractitioners therefore need to learn what the scopes of practice allow, in both the client’s state, and the clinician’s state.

    If you are not currently a member of SIG #18 on Telepractice, and are interested in the topic -I hope you will consider joining us as an affiliate!

    Best regards,
    Ellen
    (Coordinator, SIG #18 on Telepractice)

    The following point came up in a committee meeting today…
    It can be tempting to assume that gaining a state license to practice in the client’s state is sufficient to begin telepractice.
    However, states may differ as to what is allowable under their scopes of practice. Telepractitioners therefore need to learn what the scopes of practice allow, in both the client’s state, and the clinician’s state.
    Best regards,
    Ellen

  6. Karen Kruse says:

    “Licensure portability will enable speech-language pathologists to provide services wherever and whenever needed, thereby unleashing the full potential of telepractice to reduce costs and administrative burdens, increase access to services, broaden career opportunities for speech-language pathologists and improve outcomes for K-12 students and clients in diverse practice settings.”

    The above statement says it all-licensure portability would provide a win-win situation for SLPs, administration, and the recipients of services provided. As an SLP working in telepractice, I will pay nearly $400 in licensing fees every two years to cover the costs of licenses in three states. As someone who has lived in several states by choice as well as by virtue of being married to a member of the U.S. Army, obtaining a license in a new state only gets more time consuming as license verification now involves obtaining the required form and procedure for six states.

    Thank you, Melissa Jakubowitz, for this excellent and timely piece, one which I believe beckons SLPs to ask that we no longer be constrained unnecessarily; so that we might spend more time providing services and less time applying and then waiting for licensure. With the growth of telepractice, this is such an exciting time to be an SLP; however, there is a real disparity between the endless possibilities afforded to us through technology and the constraints imposed by licensure requirements of each state. It really is time that the licensing component of our profession reflects the digital age in which we live.

Trackbacks

  1. [...] The Time Has Come for Speech-Language Pathology License Portability Melissa Jakubowitz (M.A., CCC-SLP), VP of SLP Services at PresenceLearning , calls for streamlining the process for SLPs to obtain licenses to practice in multiple states.  Such multi-state licensing is necessary for SLPs who are delivering needed services via telepractice to rural and remote areas. Current licensing processes unnecessarily increase the cost of and cause delays in delivering speech-language therapy services to needy populations. [...]