Overview of size, composition and role
Overview of group
|Description of profession||Speech pathology, (previously called speech therapy), is the assessment, diagnosis, management and treatment of individuals who are have disorders of communication (speech, language, voice, fluency, social skills and behaviours, literacy and numeracy, problem solving and general learning) and/or swallowing and who are unable to communicate effectively or manage their nutritional status. Speech pathologists treat communication and swallowing impairments throughout a person’s life span. Speech pathology is a health service that is delivered across many jurisdictions including disability, education, aged care and the private sector.|
Speech pathology is not a registered profession in any State except Queensland which makes it difficult to collect reasonable and accurate demographic data on the profession. It is estimated that there are approximately 6,500 practising speech pathologists in Australia. The 2006 census recorded 3,865 practising speech pathologists.
Speech Pathology Australia (SPA) has 4,000 fully-qualified practising members.
|Gender mix||97% female, 3% male|
EXHIBIT 66 - Distribution by Age and State
EXHIBIT 67 - Overview of practice attributes
Education, registration and accreditation
- To become a member of Speech Pathology Australia (SPA), completion of a SPA-accredited university course is required. The training course can be undertaken as a four year undergraduate Bachelor’s degree or a two year postgraduate Masters degree.
- In order to be eligible to register with Medicare, Speech Pathologists practising in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other states, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of SPA.
Funding and referral system
- Eligible Speech Pathologists can access Medicare on referral from a GP (and in some instances, a psychiatrist or a paediatrician) through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); and the Helping Children with Autism or any other Pervasive Developmental Disorder items (MBS items 82000-82025).
- A range of bodies conduct specific programs which may pay for speech pathology services where eligibility is met and an appropriate referral from a medical practitioner has been provided to the speech pathologist. These include the Department of Veterans Affairs, WorkCover, vocational rehabilitation and motor accident authorities.
- Speech Pathology services can be rebated under certain ancillary tables of private health funds.
Peak National Body
|Speech Pathology Australia|
|Address||Level 2 / 11-19 Bank Place|
|Contact||+61 3 9642 4899
+61 3 9642 4922
Speech pathologists and eHealth
Examples of relevant eHealth applicationsSome example of uses of eHealth that speech pathology clients could benefit from include:
- Computer-based speech training and therapy programs (always need supervision – either by therapist or parent/carer trained by therapist)
- Assessment, diagnosis and some treatment using telehealth (particularly in rural and remote areas)
- Online education and Continuing Professional Development (CPD) for professional self-regulation and contribution towards Certified Practising Speech Pathologist status
- Speech generating devices for people with complex communication needs
- Digital referrals and electronic health records
Current eHealth 'Position'In the health sector, speech pathology adoption of technology is variable due largely to insufficient infrastructure investment to purchase hardware in the first instance, and secondly appropriate software programs. The profession uses a great deal of technology in different settings, such as the assessment of swallowing which uses computerised diagnostic imaging equipment. There is little use of electronic health records except where an individual agency has implemented a partial electronic health record. Speech Pathology Australia has always expressed commitment to and support in developing the PCEHR as part of the effort to improve overall health outcomes including allied health outcomes for clients. There is a general concern that many projects have been initiated but there is little tangible evidence at a practical level of success with an integrated electronic health record (other than individual arrangements in facilities) and often allied health is not part of project scope.
Most speech pathologists undertake some of their training at public hospitals where access to necessary infrastructure for eHealth applications can be limited. Where this is the case, it can limit the opportunity to develop skills.
Speech pathology services are largely provided by face-to-face contact. In the health sector, agencies are paid for ambulatory allied health services. Community health centres generally have low levels of staffing to manage a diverse range of clients and often have to rely on attracting funding for specific programs. Availability of technology in public and community health settings is restricted. In the private sector about 30% of practices use electronic practice management and this has largely been driven by the use of electronic billing through HICAPS and Medicare.
Some electronically enabled therapy programs are coming into use but they do require supervision by someone who has been trained to deliver, monitor and evaluate the program with the client. A greater evidence-base is needed to support some of these therapies. In some areas of practice eg. fluency treatment, there has been extensive use of the evidence base to inform the development of online fluency programs.
Telehealth techniques are also increasingly being used by speech pathologists in rural and regional Australia. Assessment, diagnosis and some interventions can be provided using telehealth programs. Limitations include lack of familiarity/acceptance by Indigenous people, and the lack of funding through Medicare for telehealth and case management for allied health practitioners.
Much of speech pathology work is undertaken as part of a multidisciplinary team, and electronic records and referrals can make it easier to manage patient care across the multiple health professionals involved in their care and across multiple settings when patients are transferred. At present this occurs in settings like rehabilitation where a multidisciplinary approach to patient care is the standard.
Key barriers to eHealth adoption are the lack of appropriate funding structures under Medicare for allied health services, and poor access to services. Software vendors are not motivated by the allied health market which is too small and too fragmented, and the products available are much too medical-centric and lack relevance for allied health practitioners. There is also the issue that the professions which do not yet have national registration but are self-regulated are likely to need to undertake more steps to be able to access the health identifier system.
Drivers for uptake of eHealth will include education and the availability of products that make jobs easier and introduce efficiencies into practice. A standard toolkit for practice which includes a standardised eReferral system for speech pathology would be a great help according to Speech Pathology Australia.
Key insights from eHealth readiness survey
- 47% of respondents saw fewer than 6 patients per day. 45% worked at more than one practice location. 33% worked at least occasionally in a rural or remote region.
- Education was the leading application of computers for speech pathologists (56% access clinical reference materials online, 48% complete CPD online). However, for many applications, speech pathologists show significant interest in making greater use of computers although current adoption is low. Collaboration (20% send or receive referrals online, while a further 66% would like to, 20% share health records with other practitioners online, while a further 63% would like to), note-taking (31% use a computer to enter patient notes after a consultation, a further 55% would like to) and patient education (20% use a computer to show patients health-related information, a further 55% would like to) are the leading examples.
- 18% of respondents indicated they used telehealth applications, with 28% indicating they were likely to within the next 3 years. Interest in telehealth amongst speech pathologists is split between training (11% very interested), monitoring patients remotely (11%) and consultations with other practitioners (11%).
- 32% of respondents used only paper records, and just 1% only used computerised records. Of the 68% using some form of computerised records, 27% use an EHR. Expectations of computer use amongst speech pathologists are high (82% believe the majority of their colleagues use computers), although access to a shared patient summary was not universally desired (45% strongly agreed they would like access).
- Affordability was the dominant barrier to further eHealth adoption suggested by speech pathologists (51% strongly agree), followed by the availability of adequate IT support (31%) and concerns about patient privacy (25%). Other technology concerns registered strongly (e.g., maintaining compatibility internally 25% and externally 24%) as did the effect on productivity (24%).
- Two dominant adoption drivers emerged for speech pathologists – the advice of their professional body (50% strongly agreed) and financial incentives (48% strongly agreed).