Interview with Nancy Creaghead Ph.D., President of the American Speech Language Hearing Association (ASHA)
AO/Beck: Good morning Dr Creaghead. Thanks for taking the time out of your busy schedule to meet with me this morning.
Creaghead: Good Morning Dr. Beck. Happy to be here.
AO/Beck: Why don't we start with a little biographical information for the reader who may not be familiar with you?
Creaghead: Sure. I am a speech-language pathologist (SLP) and live and work in Ohio. I teach at the University of Cincinnati, primarily in child language and school related issues. I have been at UC, in the department of Communication Sciences and Disorders for 30 years, and I have served as department head for just over ten years.
AO/Beck: How big is the department?
Creaghead: We have 18 faculty members and we have approximately 75 master's students in the SLP and audiology programs, of which about 18 are in the audiology program. Additionally, we have just developed the proposal for our Au.D. program. We sent the proposal to the UC Board of Trustees in June, and it will go to the state Board of Regents in September. We hope to start taking Au.D. students in 2003. Additionally we have about 20 Ph.D. students in the SLP and the Audiology programs.
AO/Beck: Regarding programs and numbers, one area that is a major concern for many audiologists is the number of Au.D. programs. In essence the argument is that there were simply too many schools previously and because there were so many, there were lots of schools with 3 or 4 or 5 students, and the issue is that with so many tiny, ill-funded and poorly staffed programs it simply is not possible to provide a comprehensive and state-of-the-art clinical or professional program. So the question is, how many audiology programs would you like to see available, perhaps 3 years from now?
Creaghead: I cannot tell you an exact number, but in essence - I must agree. Having fewer programs with better funding and more comprehensive clinical and professional training programs, with more resources available, is a good thing for the students and the profession. I see this happening at this time and I think that closure of some of the smaller and underfunded programs is sad, but ultimately beneficial. In Ohio, at one time we had 8 master's programs, and that was too many. Right now we have three Au.D. programs in process, and there may be a 4th, and you can certainly make the case that that is enough. So basically, in Ohio, we've cut the number of programs in half. However, I don't think the discussion should focus solely on the number of programs, rather the discussion might be on developing strong, well funded programs. Just because there are fewer programs in the country does not mean that those programs will be well funded, or of high quality. To use Ohio as an example, we have half the number of programs, but the funding for the half that were cut did not migrate to the new Au.D. programs in the state. That is the flaw in the logic if one only considers the number of programs and assumes that small numbers will translate into stronger programs. That is something that people need to understand. Even if we cut the number of programs in Ohio to one, the quality of that program would be determined by the resources that program has.
AO/Beck: What is the downside of closing the smaller MA/MS programs?
Creaghead: Well the obvious answer is the loss of jobs for some. But frankly, there is a tremendous shortage of PhD researchers and faculty in audiology, so if the individual is willing and able to move, I think they will certainly find employment, and I think there will be many opportunities for these people. Another issue is having less access to programs for students living in remote states and geographical areas. Some states may wind up without an audiology program, and that is unfortunate because of the possible shortage of audiology service providers. But if we're careful we can make sure that there is reasonable access and have it well situated across the country. Again program quality is the issue. A small number of weak programs would be the worst of all worlds for the profession of audiology.
AO/Beck: What about accreditation of Au.D programs? How should that be managed in an ideal world?
Creaghead: Thanks for that question, I know this topic comes up a lot and it is important. I believe the entry level programs are best served by the current accreditation model. That is, ASHA already accredits all entry level program, and it is efficient and thorough and is up and running through the ASHA Council on Academic Accreditation (CAA). I firmly believe that the CAA best serves the needs of entry level audiology programs. The programs for practicing audiologists are not entry level programs. As post-masters programs, they are in a different situation, and the current model of accreditation for entry level programs does not apply. The students who obtain the part time or distance education based Au.D. doctoral degree have already been through an accredited program when they got their MA/MS degrees and they are already licensed to practice. So the bottom line is that programs out there accepting entry level Au.D. students are already accredited by ASHA through the CAA, and perhaps the issue is really just the transitional, post-masters Au.D. programs. I am not sure which way that will go, but I believe that some of the concerns that have been expressed about certain post masters Au.D. programs indicate that accreditation would be valuable. The CAA is looking at this issue, and I believe they will have recommendations, including consideration of an accreditation of all professional doctoral programs, in the near future.
AO/Beck: What does CAA accreditation do for the program and the students?
Creaghead: CAA accreditation is important. In essence, it provides quality control. It allows all the programs to be compared to the same measures and standards, and it states that the programs are indeed providing appropriate education and training for the students. Additionally, CAA accreditation allows federal funding for the programs, students and research efforts. Importantly, CAA accreditation also helps the students know they are seeking and enrolling in an approved, high quality program. Specialty accreditation for audiology programs is consistent with specialty accreditation of most professional education programs.
AO/Beck: Do you think certification via the CCC-A is in the best interest of the profession, or do you think that recognition via state license is the better long term solution
Creaghead: Both state licensure and the CCC-A are important. I believe that maintaining the CCC-A is best in the long term. One important issue is that the CCC-A represents the presence of a long established national standard for the profession. The standard is set, it works, and it allows the states to defer to the professional standard, without each of them having to create their own standards if they choose to do so. In addition, as standards change, the CCC-A is the vehicle to enable the changes to be made in a timely manner. Without such a national standard, transitioning states to an AuD entry level would take at least a decade or perhaps two. Importantly, another issue is the portability of the CCC-A. You can move from one state to another, and then by proving you have earned your CCC-A previously, in many cases, the new state will accept that as an appropriate background for licensure. Without the CCC-A, there is a potential that every state would have its own unique licensure requirements, and although some of them might be quite strong, others might be very weak. This has occurred in some professions, and some are trying at present to move toward more uniform standards. Also, there are a few states that do not have licensure, and without certification there is no mechanism for third party payers to determine who is qualified to provide services. So bottom line, ASHA is totally dedicated to maintaining the CCC-A. ASHA is not at all opposed to licensure, in fact ASHA has been pushing forward licensure for many decades and continues to be a primary force in the support of state licensure. But we believe the national standard should be the CCC-A, and that the two combined designators, the CCC-A and the state license, are in the best interest of the states, the professionals and the patients we serve.
AO/Beck: What about the suggestion that perhaps in 5 to 10 years, once the Au.D. degree
has been out there for a while, and after all of the programs are accredited, couldn't the degree itself serve as the quality control designator we're all seeking? It works pretty well for physicians to simply write M.D.' after their names, indicating that they have graduated from medical school?
Creaghead: You are right that the M.D. degree shows that physicians have a certain kind of training, whereas the MA, MS or PhD does not indicate the type of education, only the level. The AuD degree will indicate the kind of education that audiologists have. And it is also true that an accreditation process can provide a level of assurance that the education professionals receive is appropriate. On the other hand, physicians are licensed to practice and certified for their specialty areas. The current status is that the CCC-A, which is a certification for individuals to practice, defines the standards for practice, and the CAA, which is an accrediting body for academic programs, assures that graduate educational programs (e.g. Au.D. programs) provide the opportunity for students to achieve those professional practice standards. The additional assurance to the public is the process of assuring through individual certification and licensure that each person who practices meets those standards - and importantly continues to meet them. Achieving the degree does not suggest continuing clinical competence, but most licensure laws and the CCC-A promote continuing competence through continuing education requirements.
AO/Beck: So am I correct, that from your perspective, accreditation, licensure and certification are separate and unique issues and you see them all as separate and necessary at this time?
Creaghead: The license, the degree and the certification all have certain niches they fill, and they are each valuable and necessary.
AO/Beck: Nancy, can you please revisit the issue of America's Hearing Healthcare Team Initiative (AHHTI) and the recent ASHA pull-out of that program?
Creaghead: Sure, as you know, when ASHA joined the AHHTI, we did so because we thought it was in the best interest of clients and the profession. We were pleased that we were able to come to agreement with AAO-HNS on a definition of audiologist that included independent and autonomous. However, other definitions remained problematic, and we discontinued our participation because we did not see that we were moving effectively toward developing a public awareness campaign. We believed that ASHA's resources could be used more effectively for audiology in other ways. We simply could not spend another year working on definitions! We are, of course open to collaborating with AAA, AAO-HNS, ADA and the IHS too. We believe we can gain more by working together on a fair and even playing field, and we're ready and willing to do that. However, we cannot work together for the benefit of individuals with hearing loss if skills, degrees and knowledge are not accurately and fairly represented. When we announced that ASHA was pulling away from the AHHTI, I got lots of email from audiologists, as well as from the presidents of the ADA and the AAA supporting that decision, and I was indeed grateful for their kind words and support. Many of the letters included thanks to ASHA for their efforts in collaboration on this public awareness campaign and regret that the effort could not go forward.
AO/Beck: Nancy, I know time is running out. I thank you for your time and your willingness to speak with me. I can tell you that the vast majority of audiologists I speak with support collaborative relationships between the major national professional groups, and I'd like to urge you to keep pushing forward on collaboration and establishing mutually beneficial goals and actions.
Creaghead: I agree Doug. We all benefit when we work together, and that is indeed my goal too. Thanks for your time too.
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For more information on AHHTI CLICK HERE.
ASHA Withdraws From The America's Hearing Healthcare Team Initiative
5/20/02
