Missouri's Speech Implementer Model

Missouri is the only state in the country which uses the Speech Implementer Model in their schools. This means that in addition to SLPs (Speech-Language Pathologists) and SLP-As (Speech-Language Pathologist Assistants), Speech Implementers can perform speech therapy with students in MO schools. We think this is not best practice and needs to slowly be phased out. In a 2014 presentation, DESE (MO's Dept of Education) stated "going forward. . .eventual phasing out of the SI Model as capacity is built for SLP-As." Speech Implementers are not being phased out nor is there any incentive for schools to phase them out and this is concerning.

Some in our coalition have worked with MoDE to figure out the best way to deal with concerns related to the Speech Implementer Model. We have had conversations with DESE and a couple legislators regarding our concerns related to the Speech Implementer Model, specifically the data DESE gave us of the number of SLPs, SLP-As, and Speech Implementers in MO schools. Rep. David Wood has worked with us regarding some of our concerns. During the 2018-2019 school year, an audit was conducted of schools to make sure DESE has correct information of who was providing students their speech and language services. We are going to continue to work on this issue, as we think it is important that students, regardless of where they live in Missouri, receive therapies from licensed providers.

What is the difference between an SLP, an SLP-A, and a Speech Implementer?

All three are able to perform speech and language services in Missouri schools, but they are different. 
 

SLP (Speech-Language Pathologist)
Education requirement: Masters degree in a Speech-Language Pathology; completion of a clinical fellowship

     year to obtain Certificate of Clinical Competence (CCCs)
Licensure: Must be licensed through the State Board of Healing Arts


SLP-A (Speech-Language Pathologist Assistant)

Education requirement: Bachelor’s Degree in Communication Sciences and Disorders from program ASHA

           approved to grant Master’s SLP degrees OR Bachelor’s Degree in other area with a total of 21 hours in

           five speech/language areas; 25 hours of SLP observation; 25 hours of SLP clinical assisting or

           practicum

Licensure: Must be licensed through the State Board of Healing Arts

Speech Implementer
Education requirement: Bachelors in Elementary or Secondary Education and a valid MO teaching 

           certificate
Licensure: None

School districts must attempt to hire an SLP or SLP-A before hiring a Speech Implementer. The Speech Implementer Model was created to offer a short-term solution to schools. In many rural areas, the Speech Implementer Model has become the preferred method, with Speech Implementers filling the role of the therapist for years. Some therapy clinics have tried to contract out SLPs or SLP-As into rural schools to perform speech and language services. While DESE policy does require schools to try to hire SLPs or SLP-As before hiring an implementer, the policy does not require school district contract an SLP or SLP-A before hiring a speech implementer.

What services can SLP-As and Speech Implementers perform?

While SLP-As and Speech Implementers perform speech and language services, the scope of what they can do is limited. They are able to provide the daily or weekly therapy sessions. They implement IEPs and document progress. They cannot perform evaluations, interpret data, or develop and write IEP goals. An SLP must do these activities. An SLP must also supervise the work of SLP-As and Speech Implementers.

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How much supervision is required for SLP-As and Speech Implementers?

An SLP must supervise SLP-As and Speech Implementers. In rural areas, SLPs will often travel many miles between schools supervising multiple SLP-As and Speech Implementers. Interestingly, more supervision is required for an SLP-A than a Speech Implementer, even though an SLP-A has significantly more training in speech and language development. 
 

SLP-A
Ratio: An SLP can supervise 3 SLP-As at one time.
Level of Supervision: 1 hour per week -or- 1 of every 3 student sessions (used for parttime SLP-As)


Speech Implementer

Ratio: There is no limit to how many Speech Implementers an SLP can supervise.
Level of Supervision: The SLP maintains regular contact and supervision with Speech Implementers. The frequency

      is determined by the supervising SLP.

The above is a brief summary of SLPs, SLP-As, and Speech Implementers in MO.

Learn more about DESE's requirements for SLP-As and Speech Implementers.

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