by Penny Tonn, MS, CCC-SLP (Speech-Language Pathologist); NWACS Contributor

There is a history of tension for interprofessional practices, most commonly recognized in the treatment of communication deficits related to Autism Spectrum Disorder within the fields of speech language pathology (SLP) and applied behavior analysis (ABA). The two fields have overlapping scopes of practice in the treatment of communication deficits but different theoretical backgrounds and training. This dichotomy between ABA and SLP approaches has yielded some debate. As an SLP working in an ABA clinic, it has warranted some deep introspection of my own understanding of collaboration and scope of practice. As a result, I have experienced growth from positive collaborations as well as conflicts in collaboration. It has also facilitated action: the need to take action to improve collaborative approaches to better serve my clients.

Interprofessional Practices & Education

Interprofessional education (IPE) and interprofessional practices (IPP) are evidence based approaches to treatment of neurodevelopmental disorders and associated deficits. The World Health Organization (WHO) states that IPE “occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (World Health Organization, 2010). This type of education supports practitioners’ understanding of related and complementary fields. Furthermore, implementation of collaborative practices requires not only understanding, but a systematic strategy for implementing collaborative practices to truly effect change in practices and support patient outcomes. Essentially, working together not only improves patient outcomes, but it supports our own professional development and ability to work effectively within interdisciplinary teams.

Conflicts in Collaboration

Several major areas of conflict arise when considering collaborations between SLP and ABA providers: differences in training and theoretical backgrounds, disparities in funding, unclear scope of practice, and poor clarity and training on how to engage in IPP effectively.

• Training and Backgrounds

SLPs have unique training with linguistic, behavioral, developmental, cognitive, and social theoretical backgrounds. This knowledge base is integral in treating a wide variety of communication disorders, including supporting individuals using AAC. ABA professionals have robust training in behavioral theories and skillfully manipulate environmental variables to reduce or increase socially significant behaviors, including the very important behavior of communicating. Although the fields converge, our unique training can support different aspects of developing communication. In my experience, having a better understanding of behavioral principles has undoubtedly improved my skills as an SLP. I feel confident that my colleagues in the field of ABA would say the same of my knowledge and expertise.

• Funding

It is no secret that reimbursement for SLP services is significantly less than what is provided for ABA services, specifically in regards to the treatment of ASD. There is certainly room for SLPs and members of ASHA to advocate at a legislative level for improved funding for SLP services; however, this also yields to the vital nature of collaborating with service providers who can spend more time with clients and families. To a certain extent this may be understandable, as a behavioral analyst is likely addressing adaptive skills, behavior, communication, social/emotional, and cognitive/academic areas. An SLP’s specific knowledge in communication can support the communication programs developed and implemented by ABA team members and with the limited time that may be available, connecting and sharing effective strategies allows us to work smarter together.

• Scope of Practice

Clearly defining each professional’s scope of practice is one of the most crucial steps that professionals from both fields must take. SLPs have clear guidelines from the American Speech-Language-Hearing Association (ASHA) on what areas of treatment are within our expertise, whereas behavioral analysts may treat a larger range of life skills. Within the context of communication, clearer guidelines must be written and accepted widely by SLPs and behavior analysts to better delineate when consultation and referrals are needed. Treating individuals with minimal verbal communicative skills requires adept approaches to address vocabulary, morphosyntax, and social communication areas, to name a few. They also require use of behavioral approaches to motivate and support the desire to communicate. Many organizations are working to address issues related to scope of practice. I encourage professionals from all scopes to seek out organizations doing this work and get involved.

• Collaborating in Practice

Many providers have limited training in how to engage in collaborative practices. Many graduate training programs are beginning to include collaboration training within their coursework but for those of us that are long since out of graduate life, getting involved feet-first is the best option. A few helpful guidelines from my research and experience have shown me that collaboration requires effective listening, support from your administrative team, clear guidelines in frequency and duration for collaborative meetings, and an explicit goal for client progress. 

Each collaboration opportunity can be seen as an opportunity to ask: What can I offer my team member to better support this client? What can my team member offer me to better support this client? Collaboration does not have to be rooted in disagreement. We can make a commitment to change our mindsets to improve our clinical practices and support the understanding of what we do for others and the importance of each of our roles. Although this is not a comprehensive view of the complex nature of collaboration, it provides a starting point for making changes and taking action.

What are some ways you are working to engage in collaborative practices? Share your experiences in the comments below or on the NWACS Facebook page!

Helpful links:

Interprofessional Education Collaborative

Scope of Practice in Speech-Language Pathology

AUCD Network Centers

References:

Cardon, T. (2017). Speech-language pathologists and behavior analysts: Perspectives regarding theories and treatment of autism spectrum disorder. Perspectives of the ASHA Special Interest Groups SIG 1, 2(1), 27-46.

Donaldson, A. & Stahmer, A. (2014). Team collaboration: The use of behavior principles for serving students with ASD. Language, Speech, and Hearing Services in Schools, 45, 261-276.

Gerdts, J., Mancini, J., Fox, E., Rhoads, C., Ward, T., Easley, E., & Bernier, R. (2018). Interdisciplinary team evaluation: An effective method for the diagnostic assessment of autism spectrum disorder. Journal of Developmental & Behavioral Pediatrics, 39(4), 271-281.

Kelly, A., & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 48(1), 120-131.

Marks, A. (2018). Interprofessionalism on the augmentative and alternative communication team: Mending the divide. American Speech Language Hearing Association SIG 12, 3(12), 70-19.

Manlapaz, N. (2018). Speech-language pathologists and behavior analysis: How is collaboration viewed among their professions. California State University, ProQuest Dissertations Publishing. 10784372.

Musaji, I., Self, T., Marble-Flint, K., & Kanade, A. (2018). Moving from interprofessional education toward interprofessional practice: Bridging the translation gap. Perspective of the ASHA Special Interest Groups, 4(5), 971-976.

Pfeiffer, D., Pavelko, S., Hahs-Vaughn, D., & Dudding, C. (2019). A national survey of speech-language pathologists’ engagement in interprofessional collaborative practice in schools: Identifying predictive factors and barriers to implementation. Language, Speech, and Hearing Services in Schools, 50, 639-655.

Tallia, A., Lanham, H., McDaniel, R., & Crabtree, B. (2006). 7 characteristics of successful work relationships. Family Practice Management, 13, 47-50.