Will You Be Using SLPAs?

1. Please select a category that best describes your role:

Please select a category that best describes your role: Speech Language Pathologist

Speech Language Pathologist Limited

Speech and Hearing Clinic Manager/Owner

For Profit Contracting Agency Manager/Owner

Local Education Agency Supervisor

State Supported Institution Supervisor

Other State Agency Supervisor

2. I need the SLPA for services provided in a:

I need the SLPA for services provided in a: School Setting

Home or Residential Setting

Rehabilitation Setting

Medical Setting

3. I need the SLPA for services provided to:

I need the SLPA for services provided to: Children with a primary speech pathology special education need

Children with a secondary or tertiary speech pathology special education need

Children in a private school setting

Children with medical/cognitive needs

Developmentally Disabled Children

Developmentally Disabled Adults

Adults with medical/cognitive needs

4. I will supervise SLPAs

	Yes	No
1 Full Time SLPA	I will supervise SLPAs 1 Full Time SLPA Yes	No
2 Full Time SLPAs	2 Full Time SLPAs Yes	No
3 Part Time SLPAs	3 Part Time SLPAs Yes	No
A Combination of Full and Part time SLPAs	A Combination of Full and Part time SLPAs Yes	No
I will not be supervising SLPAs	I will not be supervising SLPAs Yes	No

5. I will use the SLPA to perform the following tasks:

	Yes	No
1. Conduct speech and language screenings without interpretation, using screening protocols specified by the supervising speech-language pathologist.	I will use the SLPA to perform the following tasks: 1. Conduct speech and language screenings without interpretation, using screening protocols specified by the supervising speech-language pathologist. Yes	No
2. Provide direct treatment assistance, including feeding for nutritional purposes to patients, clients or students except for patients, clients or students with dysphagia, identified by the supervising speech-language pathologist by following written treatment plans, individualized education programs, individual support plans or protocols developed by the supervising speech-language pathologist.	2. Provide direct treatment assistance, including feeding for nutritional purposes to patients, clients or students except for patients, clients or students with dysphagia, identified by the supervising speech-language pathologist by following written treatment plans, individualized education programs, individual support plans or protocols developed by the supervising speech-language pathologist. Yes	No
3. Document patient, client or student progress toward meeting established objectives as stated in the treatment plan, individual support plan or individualized education program without interpretation of the findings, and report this information to the supervising speech-language pathologist.	3. Document patient, client or student progress toward meeting established objectives as stated in the treatment plan, individual support plan or individualized education program without interpretation of the findings, and report this information to the supervising speech-language pathologist. Yes	No
4. Assist the speech-language pathologist in the collecting and tallying of data for assessment purposes, without interpretation of the data.	4. Assist the speech-language pathologist in the collecting and tallying of data for assessment purposes, without interpretation of the data. Yes	No
5. Act as a second-language interpreter during assessments.	5. Act as a second-language interpreter during assessments. Yes	No
6. Assist with informal documentation during an intervention session by collecting and tallying data as directed by the speech-language pathologist, preparing materials and assisting with other clerical duties as specified by the supervising speech-language pathologist.	6. Assist with informal documentation during an intervention session by collecting and tallying data as directed by the speech-language pathologist, preparing materials and assisting with other clerical duties as specified by the supervising speech-language pathologist. Yes	No
7. Schedule activities and prepare charts, records, graphs or other displays of data.	7. Schedule activities and prepare charts, records, graphs or other displays of data. Yes	No
8. Perform checks and maintenance of equipment.	8. Perform checks and maintenance of equipment. Yes	No
9. Participate with the speech-language pathologist in research projects, in-service training and public relations programs.	9. Participate with the speech-language pathologist in research projects, in-service training and public relations programs. Yes	No
10. Sign and initial treatment notes for review and co-signature by the supervising speech-language pathologist.	10. Sign and initial treatment notes for review and co-signature by the supervising speech-language pathologist. Yes	No

6. Will you allow the SLPA to author daily lesson plans?

Will you allow the SLPA to author daily lesson plans? Yes

Maybe (please describe)

7. Please rate how you anticipate the usefulness will be by having the SLPA provider type:

	Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For assisting with evaluations and assessments	Please rate how you anticipate the usefulness will be by having the SLPA provider type: For assisting with evaluations and assessments Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For data collection	For data collection Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For providing quality treatment services	For providing quality treatment services Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For providing in-class supports	For providing in-class supports Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For expanding my caseload	For expanding my caseload Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A
For addressing the shortage of speech-related service providers in Arizona	For addressing the shortage of speech-related service providers in Arizona Not at all usefull	Minimally usefull	Somewhat usefull	Moderately usefull	Highly usefull	N/A

8. Please describe how you anticipate you will manage the clinical supervision of SLPAs within your organization:

Please describe how you anticipate you will manage the clinical supervision of SLPAs within your organization:

9. Do you have any reservations about using SLPAs in your organization?

Do you have any reservations about using SLPAs in your organization? No

Yes

If Yes, please specify

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