According to ASHA (the American Speech-Language-Hearing Association), prevention of communication disorders is one of the speech-language pathologist’s primary responsibilities. In terms of improving the health and lifestyles of the patient population, and for sustaining human happiness in general, it’s clear that preventing issues from coming up in the first place is preferable to treating them after the fact.
Despite holding this position, the reality is that most SLPs, and most SLP positions, focus largely on treatment rather than prevention. SLPs are not taught how to approach speech-language problems from the public health perspective. Patients, and disorders, are primarily viewed and treated as individual issues rather than systemic problems that might be dealt with through public policy or health education.
But that perspective is beginning to shift within the SLP community. At one point, the primary public health consideration for SLPs was in training public health professionals to conduct rudimentary screening of populations for speech or language issues which could then be referred to a specialist SLP for treatment. Now, however, some SLPs are arguing that speech-language pathologists may have a public health role themselves.
Expanding The Horizon of Speech-Language Pathology Practices
Although there are major efforts to investigate and find cures or ways to prevent autism, stroke, and other conditions that commonly lead to communications difficulties, these efforts are well outside the scope of practice for SLPs. Similarly, reducing traumatic injury, another major cause of speech and language afflictions, is the target of various public health campaigns, but these are not of immediate concern to SLPs.
Instead, SLPs in public health more often serve in conventional roles that allow them to connect with larger communities through the schools, workplace and community health and outreach programs.
In The Schools
In at least one major respect, many SLPs do already work in a capacity that allows them to address public health concerns related to speech and hearing from both a treatment and prevention standpoint. According to ASHA, almost half of all currently employed SLPs in the United States work in educational settings. Although this work can involve a lot of hands-on treatment with individual patients, much of it also involves screening for early-childhood speech and language disorders. Notably, the U.S. Early Hearing Detection and Intervention (EHDI) program, implemented in all fifty states, often relies on SLPs to conduct otoacoustic screening and other hearing tests to identify hearing issues in the general population of schoolchildren.
Community and Workplace
This type of work is at least a preview of the type of broader public health role that SLPs might eventually serve. There are a number of policy and prevention issues where SLPs can contribute expertise and education:
- Hearing conservation
- Environmental noise reduction
- Sociological considerations, such as aging and disease
- Improving access to SLP care
- Infection control of diseases with audiological effects
- Vocal health and hygiene
SLPs certainly have the experience and education necessary to serve in a public health role that focuses on the big-picture perspective surrounding these issues. For example, an SLP can offer information on best practices for maintaining the health of the voice and vocal tract, or on foods and feeding methods to prevent swallowing difficulties.
This expertise can be offered in public information campaigns, or as seminars or presentations made to other medical or social work professionals. They may focus on educating workers in professions who have a chronic risk of developing certain speech or swallowing problems. For example, recent projects in Tennessee and Minnesota have focused on prevention efforts among cheerleaders and seminary students… both of whom rely heavily on projecting their voices as a part of their regular duties.
SLPs can also provide the public with common warning signs or symptoms of speech-language disorders that might indicate a reason to seek professional consultations. They can assist other public health professionals in detailing the detrimental effects of certain lifestyle choices, such as smoking or chewing tobacco, on the vocal and swallowing tracts.
In addition to SLPs working in schools, who provide vital public health services by handling EHDI screening, there are other positions that have a larger public health focus than most clinical positions.
Public health approaches to speech-language pathology also involve delivering services to populations that may not commonly have access to such specialist assistance. The United States Public Health Service, for example, employs a number of SLPs who may be sent to provide services in:
- Chronically underserved populations or regions of the country.
- Areas of natural disaster or disease outbreak.
- Areas where public health education or counseling are needed.
Finding Public Health Positions as a Speech Language Pathologist
ASHA has a special interest group that is dedicated to public health issues related to audiology, SIG 8, Audiology and Public Health. The SIG’s mission is to address public health issues relating to all aspects of audiology. Their goals are:
- Creating a higher visibility for public health perspectives within ASHA and allied fields.
- Raise awareness and promote prevention to reduce the impact of hearing and balance disorders.
- Serve as liaison to other professional organizations engaged in public health outreach.
- Serve as a resource within ASHA for public health information and expertise.
- Disseminate information about current research in public health topics.
As an SLP, joining this SIG will put you in touch with other like-minded audiologists and SLPs and offer access to resources related to public health approaches to audiology. The SIG sponsors live online chats, which feature experts on topics related to public health and prevention. It also sponsors short courses with the same focus and offers a seminar at the annual ASHA convention.
Positions with school districts often have a public health component and it’s possible to take a job as an SLP in education that has a large focus on public health and preventative issues.
Although there are few specialty positions focused on public health and prevention for SLPs today, the increasing awareness of the effectiveness of public health approaches in managing disorders of all types is bound to change that. One of the best ways to pursue a career specializing in public health and prevention as an SLP may be simply to become one of the advocates for that approach to the profession.