Vermont Legislature SmartTranscripts:

[Chair Matthew Birong]: Alright. We're live. Alright. Welcome back, everyone. A little after 2PM. Our final order order of business today is, continued work on h five eighty eight, our OPR bill. And, we're being joined today for a proposal of amendment. And we have guests with us in the gallery. Who would like to go first?

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: Should I

[Chair Matthew Birong]: Please, yes. No, no, right in the other chair. Yes, there you go.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: I'm just gonna introduce myself briefly, and then I'll have my colleagues also introduce themselves. My name's Sierra Downs. I am the current president of the Vermont Speech Language and Hearing Association, hello. Also known as VISHA. VISHA is a statewide nonprofit professional association. We represent the needs of our speech language and hearing professionals, which include speech language pathologists, like myself and my colleague, Hayez, speech language pathology assistants, like my colleague Nicole here, audiologists and hearing professionals. I am, like I said, a speech language pathologist myself. I own and operate a private practice in Downtown Burlington. I specialize in voice, upper airway swallowing disorders, and gender affirming voice training. So I'd like to have Mia introduce herself briefly.

[Mia Wilson, Legislative Chair, VISHA]: Thank you. I am Mia Wilson, and I am a speech language pathologist. I'm the legislative chair of VISHA, and also I am also a speech language pathologist. And I work at the Wyndham Central District as the school speech language pathologist. And also I own a private practice called Camellia Speech Pathology in Stratton, Vermont. And now Is

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: it okay if we pull up a few chairs?

[Chair Matthew Birong]: If you guys

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: wanted to Wonderful, thank you. So, my name is Nicole Lord. I am a speech language pathologist assistant. I currently work for the Wyndham Southwest Supervisory Union. So, I actually service across four schools. So I actually have Twin Valley Middle High School, I have Reidsboro, Stanford, and Halifax. In my role, I provide lots of different services, but I have ten years' worth of experience. And I manage a caseload of around 52 students with my SLP, who is a remote SLP. She actually lives in Pennsylvania. And I service kids ranging from pre kindergarten all the way up to eighth grade. And I also have, I'm sorry, I also am certified in New Hampshire. And I am also nationally certified through ASHA for assistance.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: So, let me just roll on.

[Unidentified VISHA representative (gallery)]: There we go.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: Thanks for the rolling chairs. So, we're here today to speak in support of licensure for speech language pathology assistants like Nicole, as well as the writing and process of a potential new Sunrise Report for the SLPAs in our state. The initial Sunrise Report was completed in 2014, and my colleague Mia will discuss this further in a moment. We have posted our testimony today and the previous 2014 Sunrise Report on your website for your review. So, as you may already know, Vermont faces a significant access issue with speech and language services. Shortages are especially severe in schools and in rural areas. Delayed or limited services affect children's communication, their literacy, learning, and even adults' independence and employment. We work across the lifespan, from early intervention to geriatrics as speech language and hearing professionals. So why do SLPAs matter? SLPAs, speech language pathology assistants, are trained professionals who work under the supervision of licensed SLPs. They extend our reach, enabling us to focus on evaluation, more complex cases, and care planning. Many states already safely and effectively use licensed SLPAs as part of their service delivery models. But why is licensure needed in Vermont? Licensure sets clear standards for training, supervision, and ethical practice. It increases accountability and it protects the overall public. It helps recruit and retain qualified SLP's, giving employers and families clarity about who is providing these services. Vishal, as a board, our position is that we strongly support SLPA licensure as a practical evidence based workforce solution. To understand the role of an SLPA and its importance, I'm very proud to have our intrepid colleague Nicole here, who will present her experience and expertise in the profession. Hi, Nicole. Thank you.

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: So, I'm here to share with you what a clear path to licensure for SLPAs would mean for Vermont's students, families, and providers. The duties of an SLPA, which a lot of people do not know what that is, is to work directly with students to provide activities designed by the SLP to support articulation, language comprehension, and social communication. Other responsibilities that we have are vast, but some are maintaining AAC devices, doing documentation, recording Medicaid, Oh, preparing

[Unidentified VISHA representative (gallery)]: sorry.

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: It's an augmentative device that helps kids communicate. We also prepare all the materials that we use, and also do research, and we also do baseline information on children so we can track their progress. By providing consistent, hands on support, while collaborating closely with a supervising SLP, my role ensures that students receive timely, structured services to support them. So, there are gaps within the whole system, and SLPAs can fill those gaps. Because of the increasing caseloads of SLPs, as we make it necessary to enable SLPs to manage their larger caseloads more effectively. School districts struggle to staff SLPs to satisfy their legal obligations to serve all qualified students, and we also fill that gap. SLP shortages can lead to underserved students, delayed identification and intervention, Less frequent or shorter therapy sessions, or we have to switch from an individual service model into a group service model, which isn't always ideal. And then we also have And then high caseloads can lead to SLP burnout, higher turnover, and increased recruitment costs for school districts. I personally see several students who deserve to have services two to three times a week, rather than the one that we currently have no choice but to do. Because of the limitations of our high caseloads prevent us from doing so. I currently have, right now, a first grade student who's experienced school for the very first time, whose articulation difficulties affect his overall intelligibility and access to education. He should be seen two to three times a week individually. Unfortunately, we can only do it one time a week. And that is in a group setting. And that's because of the shortages and the time limitations. And then, so licensure would actually help by preventing under trained and under qualified SLPAs that and create clear standards for SLPAs. It would make it easier for schools and clinics to hire qualified SLPAs with confidence. And it provides families with clarity on the role and qualifications of the person who is working with their child. So, it would also define the scope of practice, ethics, confidentiality, training, continuing education and supervision, which currently in Vermont, we do not have at all. So pretty much anybody can be placed as an SLPA, treating students. So, this would improve their access to maintaining a quality and safety within their treatment. Offering licensure for SLPAs could ensure that every student receives clinical treatment from a highly qualified, specially trained professional. Communication is the foundation of all learning which advances Vermont children's chances of academic, social, and societal success. Our children and their families deserve to have the opportunity for high quality therapy and the peace of mind that their kid is being treated by a quality trained professional. Thank you very much.

[Chair Matthew Birong]: So the goal here is to ask OPR to do a Sunrise report with looking towards licensure of SLPAs rather than just regulation or any other thing that they Yes. Registration.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: And Mia will be going into more review. So,

[Mia Wilson, Legislative Chair, VISHA]: our effort to advance this initiative, my colleague Mia will discuss the regulatory process. Thank you. I am here to present the process and the specific action we are requesting of the committee. So in Vermont, when a new profession is proposed for regulation, the Office of Professional Regulation, OBR, conducts a sunrise review. The goal of the sunrise report is to determine whether regulation is needed, what level is appropriate, and how to protect the public with the least restrictive approach. So OPR did complete a Sunrise Report back in 2014 on SLPAs by the request of us, Bishop. That 2,000 report included analysis of risk of harm, workforce needs, and regulatory options. The previous Congress report said the following, and I quote, Due to the feedback given to OPR in its public hearing and public comment period, it is OPR's recommendation that SLPAs are to be regulated through licensure. Licensure is appropriate to eliminate substandard or unqualified support personnel from executing specific components of speech and language program and specific in treatment plans developed by the SLP, the speech language pathologist. Our desire is to enact licensure of SLPAs now. However, here is the current situation. OPR has indicated that they do not want to move forward solely based on the 2014 report, and they would like to conduct a new Sunrise review before acting on SLPA licensure. If the committee is not inclined to enact on the SLPA licensure now, we would ask that in directing OPR to complete a new Sunrike review for speech language pathology assistance, and you add the following: We would like OPR to take into account the prior 2014 Sunrise Report on SLPAs and any prior stakeholder input. Because this avoids starting from scratch, uses state resources efficiently, and ensures consistencies across reviews. We have provided the specific language in the testimony we submitted to Nick. And lastly, we want to emphasize that this is a modest process focused request that keeps public protection at the senator. Thank you so much for your attention and please support the process of the new songbird report for SLPAs. We now conclude our testimony. Thank you.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: Thank you.

[Chair Matthew Birong]: Have any objections for our guests at the moment.

[Unidentified VISHA representative (gallery)]: Yes, please. So, now, because there is no licensure, a school district could actually hire an assistant that's not licensed, and just be any other off the street

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: to provide an instruction. Correct. Any direction

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: right now. Any of you could be an SLPA. Yes!

[Chair Matthew Birong]: Good to know.

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: And due to shortages, a lot of times they take their paraprofessionals and we'll put them in that role, they're not actually trained for that role, and have the training and the schooling certifications. We do have training for SLPAs through the University of Vermont.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: So, have professional programming in the state, but without licensure, without any kind of oversight or regulatory process, folks are going into this program and then leaving the state. Because like Nicole's experience being in New Hampshire, do you want to talk a little

[Mia Wilson, Legislative Chair, VISHA]: bit about that?

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: Yeah, so I did practice in New Hampshire and they have a certification process. They've actually recently revamped it. I have renewed it because I felt uncomfortable practicing without anything. So, I actually continue to hold my New Hampshire license for that reason. And it helps a lot with people knowing what their kids are doing and knowing that they're going to make progress if they're with somebody who's actually trained, whereas if somebody isn't, it would pretty much just be go to a room and practice the silence. Just

[Unidentified committee member]: curious if you happen to know if the surrounding states all have licensure for this.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: Yeah, so we have 19 states in The US that have definitive licensure processes. 30 plus states in The US have some kind of oversight or regulatory certification regulation, which is still more than what we have. But we would love to just utilize the same process that language pathologists utilize through the OPRs and just extend that to SLPAs. There really hasn't been much that's changed since 2014 with our profession. Our scope is exactly the same. There's really nothing, but we are willing to continue with the new Sunrise report. We want our SLPAs to be licensed and respected And use that when they're

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: bargaining. It gets a little tricky when the surrounding states actually do offer that. So, Hampshire, Massachusetts, Maine, Rhode Island. New York. New York, unfortunately, does not. That's where I was trained, but I could not work there. But yeah, so in New England itself, Connecticut is the only outlier and ourselves who don't have any regulation. They actually believe have regulation, just not certification.

[Rep. VL Coffin IV (Member)]: I'm

[Chair Matthew Birong]: gonna clarify also, you said also New York does not.

[Mia Wilson, Legislative Chair, VISHA]: Yes, with New York, only the speech language pathologists can practice. But this actually may have to do with the fact that a lot, Because of New York City, there's a lot more supplies of speech language pathologists. Is actually probably They don't need SLPAs. SLPAs to actually conduct it per se. It's a supply and demand part of it. But Vermont specifically is in a huge shortage, huge shortage with their speech and language personnel. So it really would be crucial to actually have an SLPA licensing. Go

[Chair Matthew Birong]: ahead, Rekvich, Sorry.

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: Oh, no, no worries.

[Unidentified committee member]: Who hires you now usually, or people that do what you do? Is it always school districts? I don't know if you have

[Rep. VL Coffin IV (Member)]: a sense of the mix of

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: So our profession in terms of SLPs, we hold a master's level training. We hold national certification to work in the state of Vermont. So we have our own licensure process that is pretty robust. But we Sorry, I'm pregnant, there's pregnancy brain.

[Unidentified VISHA representative (gallery)]: What was the question? Are

[Mia Wilson, Legislative Chair, VISHA]: you talking in terms of the SLPAs? With the SLPAs, it is the school district who hires each. So each school district actually hires their own SLPAs. And in terms of the speech language pathologists, since we are allied health professionals, Some of us actually work in the hospital setting, clinic setting, and also we do actually provide service to children and the students in the school district as well. And also we both have our own private practice because of the humongous need with the adult cognitive part of it and also with the students' speech and language disorders.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: We have one of our only multilingual SLP sitting here with us in the room.

[Mia Wilson, Legislative Chair, VISHA]: Yes, I am the only I'm the 75 Japanese English speaking one in the whole entire country, and then I'm here. And I'm the only bilingual Japanese speaking SLP in the whole state of Yeah, well.

[Unidentified VISHA representative (gallery)]: Know. Doctor. Pinsonault, do we know why OPRs do anything with this after the Sunrise report was done in 2015?

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: So there was, none of us were on the board for Vishal at that point in time, but we have connected with our prior board leadership. And I think we were having difficulties with sustaining the association financially, able to afford having a lobbyist like Zats and Renfrew to help us through the process. But it just kind of stalled and then the pandemic happened. So we're here a little over a decade later and asking for this to be revisited because there's a big need. But that's our understanding at this point. There wasn't necessarily any stop that we could identify other than there's only so many SLPs in the state and we are all unpaid volunteer full time working clinicians. So yeah.

[Chair Matthew Birong]: I'm sorry, yes from the gallery, please identify yourself.

[Unidentified VISHA representative (gallery)]: Yes, on behalf of VICHA. We have posted the Sunrise Report from 2014 on your website, and if you have an opportunity to see it, it's really very extensive. And I don't know if there is Sunrise Support Light that my desk is about to be busted above the yard, but they did such a thorough move job in 2014, perhaps, it's little bit more instead of having just to do a whole piece of paper.

[Chair Matthew Birong]: Yeah, that would be something to ask them for sure, because they may have a reason for needing to do a whole new one since it's been twelve years since the other one was done. I would be surprised if they didn't have to do the whole thing all over again, but I don't know the answer to that. So thank you for that suggestion. And thank you for coming in. Are there any other questions from the table? Oh, rep Coffin.

[Rep. VL Coffin IV (Member)]: Just a couple. She do a lot of work in the schools and down the week. How many students are we looking at that need this the speech help? And have we has there been a drastic increase since COVID in children being schooled from home and then not being around? Yes. The masks.

[Mia Wilson, Legislative Chair, VISHA]: I'll have your thoughts. Yes, so when during the pandemic, since there were isolation, there were going to be perhaps, I cannot actually don't quote me on this, terms of the social pragmatic disorders, maybe a little bit of an increase because you're not communicating with anyone. Learning disability, social pragmatic disorders, it actually even could be a pediatric feeding disorders that we actually treat too. Those are always there. And if you are actually having a learning disability, that automatically is in the scope of the speech language pathologist, because we actually treat the, expressive language disorder and the receptive language disorder. So if there are special ed, if there's actually a special ed place, we automatically will go into it. How many people? It all depends on the school district and how many people actually get, because it's all about consistency. If there's actually a lot of service personnel, there's going to be a lot of people who will be taking care of the students. If there's actually less personnel, they're not going to be taken care of, and they might not be able to be discharged either. Because our goal is to increase the communication and also the understanding of each and every children too. I was

[Rep. VL Coffin IV (Member)]: just kidding because with the shortage of professionals, then I just was wondering what the ratio is, like how many students are we talking to the teachers?

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: I would say, so without knowing exact numbers, in my experience, our caseloads have exploded. And it's not always expressive communicate, social things such as that. Is a lot of articulation, a lot of complicated disorders. Cases. I have found that that's why we're like, why SLPs are needed, because there's just too many kids in every school. And as the year goes on, you get more referrals and even more students than you originally have. And then it just goes from there. It's hard to manage that. For an SLP by themselves, I don't believe that's like caseloads of over 100.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: And I'll also piggyback off of that. You mentioned COVID. Since COVID, having masks, right? And having kiddos go back to school with masks on, especially kiddos with articulation and speech differences or disorders, they're not getting those visual cues. They're not getting the feedback. It affects kiddos with hearing differences as well. So, you're not getting those visual cues. Now that we don't have that, I think things are starting to get better, but there was still that explosion that we're still dealing with, with fewer providers than ever before. So that's where SLPAs come in handy. And we love our SLPAs.

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: We don't know who's actually qualified. That's the hard part. And it's like, I even I would like to find colleagues to talk to. I can't There's no way to find them. And even then, I don't know who is actually trained or has the national certification that everyone can get. So, it gets a little tricky.

[Chair Matthew Birong]: Thank you for coming in

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: and thank you the work

[Chair Matthew Birong]: that you're doing. I know it's really, really important, and I know there are very few of you. So we'll discuss this further as a committee and maybe take some more testimony on it, certainly have OPR come in to talk about it as well.

[Mia Wilson, Legislative Chair, VISHA]: Thank you all

[Nicole Lord, Speech-Language Pathology Assistant (SLPA), Windham Southwest Supervisory Union]: so you much. Very much.

[Mia Wilson, Legislative Chair, VISHA]: Thank you.

[Sierra Downs, President, Vermont Speech Language and Hearing Association (VISHA)]: Next, we can go off.

[Chair Matthew Birong]: Please