Scope of practice

Speech pathology scope of practice in Australia (Scope of practice) is a core Speech Pathology Australia (SPA) document. This core document supersedes and replaces the Scope of practice in speech pathology (SPA, 2015).

The Speech pathology scope of practice document aligns with other SPA core documents: the Professional standards for speech pathologists in Australia (SPA, 2020a) (Professional standards), the Code of ethics (SPA, 2020b) and Evidence-based practice for speech pathology in Australia (SPA, 2021). The Speech pathology scope of practice in Australia serves as a resource for speech pathologists, consumers, educators, employers, other professionals, regulating bodies, government agencies, funding bodies and the general public. This document provides a definition of ‘practice’ and describes scope of speech pathology practice in relation to the roles, networks and contemporary practice settings in Australia. The practice definition in this document is consistent with and used across multiple SPA functions including the Certification program guide for certified practising speech pathologists (SPA, 2022).

Introduction

The Professional standards for speech pathologists in Australia (SPA, 2020a) describes scope of practice as ‘the full spectrum of roles, functions, responsibilities, activities and decision-making capacity that speech pathology professionals are educated, competent and authorised to perform’ (New South Wales Health, 2011, as cited in SPA, 2020a, p. 7).

For the purpose of this document, the term ‘role’ encompasses ‘roles, functions, responsibilities, activities and decision-making capacity’. Speech pathology practice is evidence-based, informed by scientific and technological developments together with contextual and cultural factors. Innovation, consumer feedback and research in speech pathology inform practice and ongoing review of the scope of practice.

Speech pathology is a dynamic profession, and a description of contemporary scope of practice requires recognition that the roles of speech pathologists are diversifying into new areas of practice in changing work environments, and that the roles of speech pathologists in Australia rarely occur in isolation. Therefore, speech pathology scope of practice in Australia also considers a speech pathologist’s contemporary practice context and practice networks. Speech pathology practice may extend in scope and competency requirements beyond those expected at entry to the profession. Advanced and extended practice are commonly used terms that describe the growth of professional capacity occurring on a continuum from novice to expert practitioner (SPA, 2019; Ward, 2019).

Advanced practice is considered within scope when ongoing professional development, additional training, and professional experience occur following entry to the profession. In contrast, extended practice requires the professional to take on discrete knowledge and/or a new skill set additional to the recognised scope of practice of a profession (New South Wales Health, 2011). Determining and monitoring credentialing for extended practice is the responsibility of workplaces (SPA, 2019). It is of note that an individual speech pathologist’s scope of practice may be more circumscribed than the profession’s scope of practice and will be directly influenced by the needs of the service and service users (SPA, 2020a; Ward, 2019). Therefore, an individual speech pathologist’s scope of practice will be determined by their work context, personal competencies and ongoing professional development.

Speech pathologists are required to engage in relevant, evidence-based education and quality supervision when advancing, extending, or changing their scope of practice. Certified practising speech pathologists undertake continuing professional education and complete specified hours of practice to ensure their practice is informed by current knowledge and evidence and to maintain a contemporary scope of practice. As stated in the Code of ethics (SPA, 2020b), speech pathologists recognise their competence (scope of education, training, and experience) and do not practice beyond these limits. In this document, scope of practice is described in relation to the practice roles of speech pathologists in the Australian context, their practice networks and contemporary practice settings. 

What is practice

The SPA Board of Directors defines ‘practice’ as encompassing roles in which a speech pathologist uses their knowledge, skills, professional attributes and ethical judgement to contribute to culturally responsive, lawful, safe and effective delivery of evidence-based speech pathology services. Practice in speech pathology is not restricted to direct services to individuals and is inclusive of all activities related to the provision of services to individuals, communities and populations with communication and swallowing needs.

Speech pathology practice may be remunerated or part of a formal volunteer arrangement. Speech pathologists may work in various roles such as practitioner, regulator, consultant, advocate, manager, academic, student educator, researcher, and in policy development and prevention and promotion and other roles that result in evidence-based speech pathology service provision. The definition of practice is used across SPA functions for membership and certification and is consistent with the NASRHP’s description of ‘practice’ as use of relevant professional knowledge and skills in the course of an individual’s work to contribute to safe and effective delivery of services within one’s profession (NASRHP, 2016).

Speech pathologists work in service delivery for children and infants, young people, and adults with communication and swallowing needs, management, administration, education, research, policy development, prevention and promotion. Central to speech pathology practice is a focus on communication and swallowing needs of children, young people, and adults throughout the lifespan and roles that build knowledge, skills and professional services that respond to identified communication and swallowing needs of individuals, families and communities. As described in the Professional standards (SPA, 2020a): Speech pathologists have comprehensive knowledge and understanding of communication and swallowing, and communication and swallowing needs, throughout an individual’s lifespan. Speech pathologists support every individual’s right to optimal communication and swallowing (p. 6). Identification of need considers the unique context of the person, family, and community.

The speech pathologist works in partnership to identify areas of need and to design services to achieve equitable outcomes for individuals, families, and communities. A range of factors may cause or result in an individual or community having communication and swallowing needs. These may include but not be limited to:

• delay, disorder, disability, diversity, impairment, or loss
• inadequacy or incongruence of communication and swallowing for social, personal, community and vocational needs.

Speech Pathology Scope of Practice in Australia 4 Speech pathologists work towards optimising:

• communication for interacting and exchanging information, for a range of purposes and across different contexts, including understanding and expression using verbal (speech), written, signed, natural nonverbal, and augmentative and alternative communication
• swallowing and mealtime participation to support health, wellbeing, and participation.

This includes orally eating, drinking, and taking medication, saliva control, sucking, chewing and engagement in mealtimes, as well as protecting the lungs from food, drink and saliva. For the purpose of describing the Scope of practice and to aid readers understanding of the breadth and scope of speech pathology practice, communication can also be described as encompassing areas of language (for example, verbal, nonverbal, written), speech, hearing, voice, fluency and cognition.

As noted in the Code of ethics (SPA 2020b), speech pathologists consider the diverse context of individuals and/or communities, as identified in the World Health Organization’s International classification of function, disability and health (ICF) (WHO, 2001).

Practice networks

Speech pathologists work in collaboration with individuals, families, carers, Elders, communities, and populations in responding to the communication and swallowing needs of people across the lifespan. Speech pathology practice networks may include, but not be limited to:

• children and adults with communication and swallowing needs
• parents/families, carers, communication partners, friends and workplace and recreation contacts – colleagues, managers of people with communication and swallowing needs
• Elders/communities, cultural advisers and cultural support workers
• interpreters and translators
• other speech pathologists and speech pathology students
• childcare workers
• education professionals and students (including early childhood educators, kindergarten, preschool, primary and secondary school teachers)
• other health professionals and students (including doctors, nurses, allied health professionals)
• disability and aged-care workers
• allied health assistants, therapy assistants, disability support workers and volunteers
• members of the legal services
• communities and community organisations
• government and non-government organisations
• tertiary education institutions providing professional degrees in speech pathology.

Glossary

Advanced practice is described in terms of a professional’s experience, beyond-entry competency, or additional training. The term ‘advanced’ is relevant for both generalist and focused clinical settings and to specific client groups and geographical settings (Ward, 2019).

Advocacy is speaking and acting to promote and support the human rights of others and protect their welfare and justice. It is supporting individuals and communities to advocate for and represent their own needs. It involves advancing the profession of speech pathology in the areas of public health and policy, to benefit individuals and communities with communication and swallowing needs (American Speech-Language Hearing Association, n.d.; Disability Advocacy Network Australia, 2021).

An autonomous professional is equipped to make decisions about service delivery based on the professional’s own knowledge and expertise in accordance with the knowledge base of the profession, legislation, regulation, and relevant code of ethics (Skar, 2010; World Confederation for Physical Therapy, 2017).

Credentialing is the process of validating an individual’s qualifications, skills, experience, training and/or competency to perform certain procedures or service activities against a set of recognised standards (Speech Pathology Australia, 2019).

Cultural responsiveness or culturally responsive practice ‘is the means by which cultural safety is achieved, maintained and governed. Culturally responsive practice recognises the centrality of culture to people’s identity and working with people to determine what is culturally safe care for them as individuals’ (Indigenous Allied Health Australia, 2019, p. 3).

Cultural safety is experienced by Aboriginal and Torres Strait Islander Peoples when individual cultural ways of being, preferences and strengths are identified and included in policies and processes, and the planning, delivery, monitoring and evaluation of care. It describes a state where people are enabled and feel they can access care that suits their needs, challenge personal and institutional racism (when they experience it), establish trust in services, and expect effective, quality care. The individual determines whether the service they receive is culturally safe, or not (Indigenous Allied Health Australia, 2019, p. 2).

Elders are men and women in Aboriginal and Torres Strait Islander communities who are respected for their wisdom and knowledge of their culture, particularly the lore. Male and female Elders, who have higher levels of knowledge, maintain social order according to the lore. The word ‘Elder/s’ is capitalised as a mark of respect (University of New South Wales, 2019).

Extended scope of practice refers to taking on ‘a discrete knowledge or skills base additional to the recognised scope of practice of a profession and/or regulatory context of a particular jurisdiction’ (Allied Health Profession’s office of Queensland, 2014, p. 11).

Evidence-based practice refers to the integration of evidence gleaned from the best available external research evidence, the perspectives and values of clients, clinical expertise and the practice context (Speech Pathology Australia, 2021).

Prevention and promotion strategies and initiatives can be primary, secondary or tertiary in nature. Primary prevention focuses on eliminating or inhibiting onset and development of a communication, swallowing or mealtime participation need. Secondary prevention involves early detection and treatment of communication, swallowing and mealtime needs that may eliminate the need to slow its progress, thereby preventing secondary complications. Tertiary prevention involves reducing need by attempting to restore effective functioning. The major approach is rehabilitation when some level of residual need results from an existing difficulty (American Speech-Language Hearing Association, 1988).

The Certification Program is the regulatory framework within which the recency of practice and continuing professional development obligations of certified practising speech pathologists are monitored and enforced (Speech Pathology Australia, 2022).

The term support worker includes paid or voluntary workers who are delegated tasks by a speech pathologist to facilitate the delivery of speech pathology services. Other terms for support workers may include support staff, allied health workers, allied health assistants, therapy aides, integration aides, language/literacy aides or school services officers. It is acknowledged that support workers may be part of a multidisciplinary team and may also be supervised and delegated tasks by school principals, teachers and other health professionals (Speech Pathology Australia, 2014).

Volunteering in speech pathology occurs when speech pathology related services are provided without financial gain to the speech pathologist, of the individual’s own free will and without coercion (Speech Pathology Australia, 2015).

Speech pathology in Australia

SPA recognises, values and respects Aboriginal and Torres Strait Islander Peoples and their cultures, knowledges and languages. Speech pathologists provide culturally responsive and culturally safe services that acknowledge and respond to cultural and linguistic diversity in the communities and individuals they serve (SPA, 2020b). In Australia, speech pathology is a self-regulating profession and SPA is a member of the National Alliance of Self-Regulating Health Professions (NASRHP). Speech pathologists are autonomous professionals who work and advocate for the optimisation of communication and swallowing across the lifespan.

Speech pathologists work and collaborate with individuals, families and communities, leaders and Elders and other professionals to plan, develop, implement and monitor speech pathology services and practice. In this document, community refers to a group of people living in one area or people who are considered as a unit because of their interests, social group or nationality (Australian Institute of Family Studies, 2019). A community may be large or small, and any person may be a member of any number of communities. A person’s community includes communication and mealtime partners within their families, social networks in educational, vocational, recreational and employment contexts, services and other supports. Speech pathologists practice in accordance with the SPA Code of ethics (SPA, 2020b) and uphold the Professional standards (SPA, 2020a). Speech pathologists have a commitment to evidence-based practice and to lifelong learning and ongoing professional development. Speech pathology practice can occur across a range of settings, contexts and service delivery models.

Speech pathology roles

Speech pathology scope of practice in Australia may include:

Delivery of speech pathology services to individuals throughout the lifespan and their families and communities including:

• screening/assessment of communication and swallowing needs o interpretation, diagnosis and reporting of communication and swallowing functions o planning of speech pathology intervention or service response
• implementation and evaluation of intervention or service response to optimise and facilitate communication and swallowing

Prevention, promotion and advocacy for individuals, families, communities, services and other supports and networks, including:

• prevention of communication and swallowing difficulties o promotion of optimal communication and swallowing
• advocacy regarding communication and swallowing needs

Education in relation to speech pathology practice including:

• tertiary education of speech pathology students
• practice education o continuing professional development for speech pathologists and other professionals o education of the public regarding speech pathology services and communication and swallowing needs of individuals, families and communities

Research in communication, swallowing and related fields

Administration and/or management of speech pathology services, for example:

• coordination of a speech pathology service o supervision of speech pathology staff
• maintenance of quality of practice and services in speech pathology

Consultation with government, justice systems, industry and communities regarding people with communication and swallowing needs 

Community development to enhance and support communication access and optimal communication and swallowing across the lifespan

Policy development and advice in relation to speech pathology services for individuals, families and communities with communication and swallowing needs

Regulation of professional practice and standards of practice in speech pathology

Volunteering including engagement in philanthropic activities as a speech pathologist in formally recognised volunteer programs

Other roles that accompany the provision of evidence-based speech pathology services.

Practice settings

Speech pathologists practice in a variety of settings, including but not limited to:

• Aboriginal and/or Torres Strait Islander Health
• community health including home services
• disability service providers 
• early intervention
• early childhood education and care
• education settings – preschools, schools and colleges
• government and local councils
• health service settings – hospitals (public and private), rehabilitation centres and community clinics
• justice settings – youth justice centres, adult correctional settings and community justice services 
• mental health and forensic mental health services 
• private practice 
• professional associations (for example, Speech Pathology Australia)
• research institutes
• residential aged care and community aged care services
• trauma services – developmental trauma, child protection and out-of-home-care services
• universities and university clinics.

Service delivery

Speech pathology services are delivered using a range of evidence-based approaches that consider "the best available external evidence, the perspectives, and values of service users, professional expertise, and the external context" (SPA, 2021, p. 5). Service delivery models may include:

•  clinic, community, and home-based services
• individual, family, and group services
• in-person and telepractice services (SPA, in prep.)
• multidisciplinary, interdisciplinary1, and transdisciplinary team approaches (SPA, 2016).

References

Allied Health Profession’s Office of Queensland. (2014, June). Ministerial taskforce on health practitioner expanded scope of practice: Final report. Queensland Government. https://www.health.qld.gov.au/__data/assets/pdf_file/0031/161977/ministerial-taskforcereport.pdf

American Speech-Language Hearing Association (ASHA). (1988). Prevention of communication disorders. Position Statement. https://www.asha.org/policy/ps1988-00228/

American Speech-Language-Hearing Association (ASHA). (n.d.). ASHA member advocacy: An overview. https://www.asha.org/Advocacy/Advocacy-Overview/

Australian Institute of Family Studies. (2019). What is community development? Australian Government. https://aifs.gov.au/cfca/publications/what-community-development

Disability Advocacy Network Australia (DANA). (2021). What is advocacy? https://www.dana.org.au/how-to-advocate/

Indigenous Allied Health Australia (IAHA). (2019). Cultural safety through responsive health practice. http://iaha.com.au/wp-content/uploads/2019/08/Cultural-Safety-Through-Responsive-HealthPractice-Position-Statement.pdf

National Alliance of Self Regulating Health Professions (NASRHP). (2016). Self Regulating Health Profession Peak Bodies Membership Standards. http://nasrhp.org.au/wpcontent/uploads/2018/01/SR_Standards_Full_Dec_2.pdf

New South Wales (NSW) Health. (2011). Health Professionals Workforce Plan Taskforce: Discussion paper to inform and support the NSW Government’s Health Professionals Workforce Plan. NSW Government. https://www.health.nsw.gov.au/workforce/hpwp/Publications/hpwpdiscussion.pdf

Skar, R. (2010). The meaning of autonomy in nursing practice. Journal of Clinical Nursing, 19, 2226– 2234. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.02804.x

Speech Pathology Australia. (2014). Working with support workers. Position statement. Author.  

Speech Pathology Australia. (2015). Volunteering in speech pathology. Position statement. Author. 

Speech Pathology Australia. (2016). Parameters of practice: Guidelines for delegation, collaboration and teamwork in speech pathology practice. Author. 

Speech Pathology Australia. (2019). Credentialing. Position statement. Author. 

Speech Pathology Australia. (2020a). Professional standards for speech pathologists in Australia. Author. 

Speech Pathology Australia. (2020b). Code of ethics. Author.

Speech Pathology Australia. (2021). Evidence-based practice for speech pathology in Australia. Author. 

Speech Pathology Australia. (2022). Certification program guide for Certified Practising speech pathologists. Author.

Speech Pathology Australia. (In prep.). Telepractice in speech pathology. Position Statement. Author.

University of New South Wales. (2019). Indigenous terminology. https://teaching.unsw.edu.au/indigenous-terminology

Ward, E. C. (2019). Elizabeth Usher memorial lecture: Expanding scope of practice: Inspiring practice change and raising new considerations. International Journal of Speech-Language Pathology, 21(3), 228–239. https://doi.org/10.1080/17549507.2019.1572224

World Confederation for Physical Therapy. (2017). Professional autonomy. https://www.wcpt.org/node/47964

World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). https://www.who.int/standards/classifications/international-classification-of-functioningdisability-and-health

World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. https://www.who.int/publications/i/item/framework-for-action-oninterprofessional-education-collaborative-practice

Speech pathologists are autonomous professionals who work and advocate for the optimisation of communication and swallowing across the lifespan. Contemporary speech pathology practice in Australia is dynamic, evidence based and collaborative, and continues to diversify into new areas of practice in changing work environments and contexts. The scope of practice of speech pathologists will be shaped by their work context, personal competencies and ongoing professional development, in accordance with the SPA Professional standards (SPA, 2020a) and Code of ethics (SPA, 2020b).