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June 4, 2013

Professional Issues Class Post: The Big Nine

As we explore state licensure, we're going to talk about the difference between being able to practice (ASHA certification) and being allowed to practice (state teacher certification or state licensure).  ASHA wants to make sure that you understand that just because you have the CCC, that doesn't mean you should practice in every area of the field.  As of 8/31/13 (or 12/31/2013 for some), WKU is going to tell the world that you have speech-language-hearing competencies in nine areas.  

Given that just because you're recognized as being competent doesn't mean that you are, what are your thoughts? Do you feel competent to assess and treat each of the big nine across the lifespan? So feel free to replace 'competent' with 'confident'.  We all have strengths and weaknesses; ASHA wants to make sure that you know yours. 

Wow, what a though-provoking question! This question was asked of us students a while ago and I found that I needed some time to reflect on each of the "big nine" competencies and my ability to approach them, as it relates to being a future SLP and clinician. I think I am finally ready to summarize my competence in the areas that relate to the "big nine."

As graduate students, our mission in the world of academics is to synthesize, integrate, and familiarize ourselves with coursework, bookwork, and clinical work to become 'confident' in treating, as best we can as new clinicians (usually with direct supervision), clients who present with disorders or challenges with the any of big nine.

To begin, what are the "big nine?"  The nine areas that communication disorder clinicians should be fairly familiar with are the following, in no particular order:

Language: receptive and expressive
Dysphagia (swallowing)
Cognitive aspects of communication
Communication modalities (AAC)
Source: ASHA

So, now that we've listed what the nine competency areas are, let's delve into my personal feelings and attitudes about each of the 'big nine.'  First, I'd like to recognize an aspect of the reflection/question, mainly the portion of knowing that recognition of confidence doesn't always mean competency.

Let's get started.

I feel pretty solid about my skills as a clinician working on articulation needs.  My early beginnings as an SLP-A in a school setting really facilitated my understanding of how to evaluate and target speech sound disorders in multiple ways. Articulation is a topic that I feel pretty confident about and it is one of the major reasons why I decided to pursue this profession in the first place.  I feel confident and competent in this topic area.

Oh boy.  This is a subject that I am fascinated with, and have dabbled with very lightly in terms of evaluating and treatment, but it is an area that I want to become a stronger clinician in! Unfortunately, my career as a student clinician was very lacking in exposure to clients who stutter, which is understandably something that was uncontrollable by me or anyone else; I feel my desire and excitement to continue learning about stuttering makes up for my lack of experience in this subject matter, since this is definitely an area I want to excel in.

As with fluency, voice disorders were something I had little exposure to, but a topic that I am really interested in furthering my education and experiences in.  I had a great opportunity to shadow an SLP who worked in an ENT's office, performing modified barium swallow studies, FEES evaluations, and treated various voice disorders as needed.  This opportunity to shadow her was very beneficial to my learning; however,

Language: Receptive and Expressive
Ahhh, finally we hit an area that I feel both competent and confident in: language disorders. I take great satisfaction in assessing, evaluating, and treating language breakdowns and creatively coming up with ways in which I can draw and inspire improvement from the client in multiple forms.  As with articulation, my clinical foundation was established while I was an SLP-A within an elementary school, so naturally articulation and language disorders were our 'meat and potatoes' of therapy targets, and I feel that my early experience in this 'big nine' subject matter was truly shaped by some very skilled coworkers and supervisors.  What is the old saying...? Something like:  "I learned from the best."

This is an area I feel pretty neutral terms of my learning and experience. What I mean is that I feel like I have the basics down: I know the general anatomy and knowledge about hearing disorders and conditions, I can easily and quickly screen hearing using an audiometer, I know general information about most hearing aid models, and I know what it feels like to be hearing impaired firsthand (more on that for another post).  That being said, there are other areas and aspects of the hearing category that I don't quite feel competent or knowledgable about, such as auditory processing disorders, cochlear implants, and other aspects of hearing.

Dysphagia (Swallowing)
I feel good about my understanding of dysphagia.  I've had the pleasure of having a very skilled clinical supervisor who taught me many great techniques for treating dysphagia.  I also gleaned great knowledge from watching her use NMES devices (neuromuscular electrical stimulation), namely the VitalStim system.  I also had very positive experiences in learning different compensation techniques and caregiver/community awareness collaboration.  I know that there's a lot more for me to learn in this subject matter, but I feel confident that I've established a solid foundation from which to grow my experiences and knowledge.

Cognitive Aspects of Communication
Much like with language disorders, this area (also known as Cog-Ling... cognitive-linguistic aspects) is one area that I've had the fortunate experience of establishing a strong foundation with.  While I was externing with my sub-acute rehab center (the same one I was with that enhanced my knowledge of dysphagia, mentioned above), I was privvy to work with a multitude of clients who exhibited various needs in cog-ling therapy and evaluation.  I feel confident that further clinical applications in this area will bolster my competence (isn't that usually how it goes, though, with the two being so intertwined!).

Communication Modalities
I feel... less than confident in this area.  At most, I've dabbled with iPads as AAC devices, played with apps like Proloquo2Go and the like, and brushed up on some very basic ASL/SEE signs... but really, this is one category I need a lot of aid and support in!  Sometimes I think that our experiences as new clinicians are truly shaped by what we are exposed to... and in many cases, it just depends on how the stars align for what we get to become familiar with, so for me, AAC/Comm Modalities were definitely not in the stars.  This is one 'big nine' that I do not feel confident or competent with, but I do hope that my future work as a clinician will garner me some experience-- after all, we have to start from somewhere, right?

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