CSHA advocates for the community

(From Summer 2021 Convey magazine)

By Jennifer Snelling

THESE DAYS, we have become more comfortable with telehealth, teletherapy and Zoom. But more than a year ago when we were all asked to shelter in place, many practitioners were concerned about how to best continue serving their clients and patients.

This included recent graduates earning their Required Professional Experience (RPE) credits and SLP assistants. Could they be supervised by live video?

“Their work impacts tens of thousands of children and adults who require speech-language pathology and audiology services,” says Linda Pippert, MA, CCC-SLP, MBA, CSHA’s immediate past board chair and chair of the CSHA Foundation.

In order for practitioners to continue supporting their clients, the governor would need to approve waiver requests from the state licensing boards to allow supervision to happen remotely. CSHA legislative advocate Laura Preston had invested the previous year – her first with CSHA – in building relationships with government agencies. Her efforts put CSHA in position to seek those waivers in last year’s emergency situation. Preston arranged a meeting for Pippert, then CSHA’s board chair, with representatives of the Department of Education and the governor’s office. Within a few days of the meeting, the administration approved the waivers.

“CSHA saved the jobs of SLPAs and RPEs and in turn provided access to services to children in schools, early intervention, clinics and medical centers throughout California,” Pippert says.

While advocacy has always been a part of CSHA, the organization made a big leap two years ago when Preston joined the team. It was during that time that the CSHA board adopted the association’s first-ever advocacy platform. A standard resource in nonprofits, the platform provides an overarching strategy and priorities to the association’s advocacy efforts, making CSHA an increasingly effective voice for the community.

The board-approved platform allows the organization to be agile and intentional when approaching the Legislature and governmental agencies about licensure, clinical practice reimbursement rates and a host of other issues.

As a leading voice advocating for the profession and those it serves, CSHA collaborates with the state and licensing board to solve problems, as in the issues around telepractice early in the pandemic. In addition, CSHA’s advocacy work represents the field by advancing policy, supporting research and grant funding on issues that affect clients and practitioners, and increases the visibility of the services provided by the profession.

“If you are working today through the pandemic, that is CSHA’s work. We’ve let the licensing board and the Legislature know what our needs are. That’s all happened through advocacy,” says Michele Linares, MS, CCC-SLP, chair-elect of CSHA, and chair of the CSHA Advocacy Committee. “The board-approved platform provides a broad policy framework for pursuing the association’s mission by identifying and prioritizing those areas of legislative, policy and regulatory issues in which the association will engage. This direction has allowed us to emerge as the thought leaders in California advocacy.”

The shift in CSHA’s advocacy started a couple of years ago when, coincidentally, a study commissioned by the Legislature was released that explored reimbursement rates for services based on cost of living, travel time and other factors. Buried in the study was a section that called for a 0% rate increase for early intervention therapeutic services.

These services were already not adequately funded, and many providers were counting on a rate increase in order to continue providing services. Preston jumped feet-first into this issue on CSHA’s behalf and, after a great deal of work, the state amended the study, and the administration approved a rate increase for providers.

Preston supported the effort to adopt the advocacy platform and began working with the newly reconstituted advocacy committee in 2019, which includes six members. The members of the committee are listed on the CSHA website under “about us.”

The professional practice and the workforce issues addressed by the committee include pursuing changes in current law around Fiberoptic Endoscopic Evaluation of Swallowing (FEES). On that issue, Preston has worked to cue up a CSHA-sponsored bill, and garnered support for that legislation, when the pandemic hit and the bill was tabled.

For CSHA members working in schools, the organization advocates for updating language in the California Education Code to ensure it reflects current best practices, increased funding for speech-language pathology and audiology services, and collaborating with interpreters and translators. A bill on these issues is currently in the works.

For CSHA members in the health care field, the organization advocates for the inclusion of their services in alternative payment models, equitable reimbursements of services across age span and settings, and coverage of habilitation and rehabilitation as essential health benefits.

As SLPs and audiologists, CSHA members are all about helping patients and clients communicate. To further that goal, CSHA advocates for early intervention, appropriate assessments, services and funding to ensure that people with communication disorders have access to the care they need.

The board revisits the platform every two years to identify opportunities for updates and clarifications.

“The platform shapes the advocacy work we do throughout the year because the board has identified the things we have to prioritize,” Linares says. “It’s online for everyone to see. The platform has been a results-focused road map, and Laura is a highly skilled advocate who produces results.”

“Joining the CSHA team has been an honor, because these are issues I happen to care deeply about,” Preston says, “I’m so glad Brian (CSHA CEO Brian Lewis) reached out to me when he had the opportunity. He’s not only a strategic thinker, but as a former lobbyist himself, he understands how things work and is able to fully support me in doing my work on CSHA’s behalf.”

Since coming on board, Preston has helped CSHA advocate for approving California State Universities (CSUs) to offer AuD programs and increased funding to California state graduate programs in communicative disorders to address the SLP shortage in California. Both measures passed, and there are now four new AuD programs to meet the audiology needs of Californians and more graduate student spots at CSUs.

Collaborations

Partnering with other California organizations to work for a common cause is an important aspect of the advocacy program. Some of the organizations that share CSHA’s goals are Californians for Quality Early Learning, the California Academy of Audiology and the California Physical Therapy Association. Perhaps most important is CSHA’s partnership with the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board (SLPAHADB) at the Department of Consumer Affairs.

The licensing board’s goal is to advocate for consumers and regulate practitioners. As such, one might expect that relationship to be potentially adversarial. Instead, the partnership is collaborative and keeps the consumer first and foremost in consideration.

“There are some very shared common goals that we have,” says Paul Sanchez, SLAPAHADB executive officer. “CSHA would want to benefit the profession and make sure the standards remain high in California. That’s a goal we have because our goal is consumer protection. The partnership is important to the board and me because it can help us achieve those goals.”

In addition to working together in times of emergency, CSHA helps the board rapidly get information out to its membership through its CSHA QuickNotes emails. When there is an update at the licensing board, the update is sent out to CSHA members, often on the same day as the update is posted to the licensing board website.

The relationship works both ways, says Holly Kaiser, MA, CCC-SLP, CSHA board director at large and a member of SLPAHADB.

For example, when the licensing board is looking at scope of practice questions, such as the difference between an SLPA and an SLP, or the encroachment of other professions, the board has subject matter experts available to consult on CSHA’s Professional Practices Advisory Committee.

“CSHA has become a valuable resource for the board,” says Kaiser. “For example, we need help analyzing applications for license from practitioners trained in foreign countries. CSHA has a number of people who could take on that role, such as members who are working in universities. It’s such a wealth of expertise that they can find directly through CSHA.”

Advocating for the community

CSHA’s mission is to “serve our profession, our members, our clients and our communities through evidenced-based leadership in professional practice strategic advocacy, thought leadership and inter-professional collaboration.”

To that end, the association’s advocacy work translates professional expertise and insights into the legislative and policy arenas – areas with their own processes, timelines and institutional practices.

“As professionals, we are very aware of the barriers that impact our work and our ability to serve our client, but we may not have the language or the advocacy expertise to elicit change,” says Raquel Narain, MA, CCC-SLP, BCBA, chair of CSHA board. “Our knowledge, combined with Brian and Laura’s in the advocacy field, has helped us build our impact.”

As it does each year, the Advocacy Committee takes positions on key pieces of legislation. One of those bills this year is AB 435, regarding digital hearing aids with specific proprietary software. CSHA has a support position on the bill that would require hearing aid dispensers and dispensing audiologists to notify consumers if the hearing aid they are purchasing uses proprietary software and can only be adjusted or repaired at specific facilities or locations.

The bill would provide that the purchaser of the hearing device must be aware of the product they are purchasing and if there will be limitations on where it may be adjusted or repaired. Currently, many purchasers have found themselves unable to have a devise repaired that includes proprietary software.

“We have to consider the unintended consequences, so we are asking the Legislature to require that the dispensers notify the consumer so that they understand the proprietary nature of the software before they purchase,” Linares says.

Another current bill that CSHA supports is AB 1468, which requires health care service contracts to continue coverage for a number of services, including speech-language therapy and auditory services, without preauthorization to get clients through the door more quickly.

“Advocacy isn’t just reactive,” says Linares. “We can be proactive and not just be a good therapist, but also be a good advocate for consumers and the community at large. Having a platform and a strategy keeps us on track and moving forward. “

The power of more voices

There are some 30,000 SLPs and audiologists in California, but CSHA’s membership is only around 3,000. Many professionals join American Speech-Language-Hearing Association (ASHA) and consider that sufficient. By not joining CSHA, professionals miss the opportunity to be a part of the organization that is impacting decisions made in California that affect the profession here and those it serves.

“The California Legislature listens more closely to California-based organizations than those outside the state and always has,” Preston says. “And that goes for all professions, not just ours. I’m representing all speech-language-hearing professionals in the state in the work I do for CSHA. Everyone benefits from our work. We need everyone to join CSHA because we’re already working for you and you can really help elevate our collective voice.”

Adds Narain, “The more members CSHA has, the bigger and more influential our voice will be throughout California.”

CSHA will soon be launching a virtual advocacy network, a new member benefit to provide additional advocacy information and to help them contact their state representatives on important issues. Imagine if all CSHA members engaged in the advocacy network and contacted the Legislature to advocate for their practice and those they serve.

“CSHA’s work in advocacy gives our industry a voice,” Narain says. “We are a profession that believes communication is a fundamental human right and we work tirelessly to empower our clients and stakeholders to use their voice to advocate for themselves and their loved ones. But unfortunately, we don’t always do the same for ourselves. Through our advocacy platform, we are creating pathways for our members to be heard, and joining our state association is the first step in that process.”

Jennifer Snelling is a freelancer who writes for a variety of publications and institutions, including the University of Oregon. She’s a frequent classroom volunteer and is active in schools in Eugene, Oregon.