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Journal of Fluency Disorders27 (2002) 4363

Academic and clinical education inuency disorders: an update

J. Scott Yaruss a, , Robert W. Quesal ba Department of Communication Science and Disorders, University of Pittsburgh,

4033 Forbes Tower, Pittsburgh, PA 15260, USAb Western Illinois University, Macomb, IL, USA

Received 7 July 2001; received in revised form 28 November 2001; accepted 4 December 2001

Abstract

This paper presents a survey of the academic and clinical education in uency disor-ders provided by American SpeechLanguageHearing Association (ASHA)-accreditedtraining programs. Respondents were 159 programs (out of 256, return rate = 67.4%)that completed a questionnaire seeking information about the courses and clinical expe-riences they require, the expertise of their faculty and supervisors, changes following the1993 modication of training requirements for the ASHA certicate of clinical compe-tence (CCC), and preliminary plans for changes in preparation for the 2005 standards.Results, which supplement ndings from an earlier survey distributed in 1997 (Yaruss,1999), indicated that nearly one-quarter of programs allow students to graduate withoutcoursework in uency disorders, and nearly two-thirds allow students to graduate with-out clinical practicum experiences. Findings suggest a trend toward fewer required classestaught by less experienced faculty, fewer clinical hours guided by less experienced super-visors, and a greater likelihood that students will graduate without any academic or clini-cal education in uency disorders. Given the repeated nding that many speechlanguagepathologists are uncomfortable working with people who stutter, as well as ASHAs appar-ent de-emphasis of uency disorders within the increasing scope of practice in the eld of speechlanguage pathology, these results are a cause for concern about the future of uencydisorders.

Educational objectives: The reader will learn about (1) the coursework and clinicalpracticum experiences that are currently required for students in ASHA-accredited training

Corresponding author. Tel.: + 1-412-383-6538; fax: + 1-412-383-6555. E-mail address: [email protected] (J.S. Yaruss).

0094-730X/02/$ see front matter 2002 Elsevier Science Inc. All rights reserved.PII: S 0094-7 30X(01 )00112 -7


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44 J.S. Yaruss, R.W. Quesal / Journal of Fluency Disorders 27 (2002) 4363

programs; (2) trends indicating a reduction in training requirements for uency disorders;and (3) ways of improving these requirements. 2002 Elsevier Science Inc. All rightsreserved.

Keywords: Stuttering; Training; ASHA; Speech therapy

1. Introduction

In recent years, many clinicians and researchers in the eld have been engagedin an ongoing discussion about the academic and clinical education in uencydisorders that is provided to graduate students in training programs in the United

States that areaccredited by the American SpeechLanguageHearing Association(ASHA). Evidence of the interest in academic and clinical training can be seen innumerous publications (e.g., Brisk, Healey, & Hux, 1997; Leith, 1971; Mallard,Gardner, & Downey, 1988; St.Louis & Lass,1980; Yaruss,1999) andpresentationsat the annual ASHA conventions (e.g., Campbell, Hill, Yaruss, & Gregory, 1996;Chapman & Keintz, 1996, 1998; Kuster et al., 2000), as well as in the topic of the 2001 leadership conference of ASHA special interest division for uency anduency disorders (SID-4), which focused specically on improving academic andclinical education in uency disorders.

There are a number of potential explanations for this apparently growing inter-est in graduate education in uency disorders. One is the repeated nding that bothstudent clinicians and experienced speechlanguage pathologists are less comfort-able working with stuttering than other communication disorders (e.g., Brisk et al.,1997; Kelly et al., 1997; Mallard et al., 1988; St. Louis & Durrenberger, 1993).Many students and clinicians also appear to hold common misconceptions aboutstuttering or harbor negative attitudes about people who stutter (e.g., Cooper &Cooper, 1985, 1996; Lass, Ruscello, Pannbacker, Schmitt, & Everly-Myers, 1989).Previously existing concerns about clinicians comfort with stuttering have been

compounded by concerns about the elimination of specic training requirementsin uency disorders for graduate students pursuing the ASHA certicate of clinicalcompetence in speechlanguage pathology (CCC-SLP).

Prior to the implementation of the current standards (ASHA, 1993), studentswere required to obtain at least 25 hours of clinical practicum with people whostutter. Although this amount of training can be considered minimal, it was thesame as the amount of experience required in other disorder areas, and it gavestudents some exposure to diagnosis and treatment in uency disorders. Currently,however, training programs are not required to provide specic experience with

the traditional disorder areas of voice, uency, articulation, and language. Instead,programs must focus training on speech disorders (which includes stutteringamong other areas) or language disorders for pediatric and adult populations.This change provided needed exibility for programs that had been having dif-culty meeting the 25 hours requirement, particularly given the expanding scope of


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J.S. Yaruss, R.W. Quesal / Journal of Fluency Disorders 27 (2002) 4363 45

practice within the eld. Still, the change focused renewed attention on the trainingstudents receive, and how this training may be related to students comfort withdisorder areas such as stuttering.

In an attempt to gather information about student training in the area of uencydisorders, Yaruss (1999) presented a survey of coursework and clinical experiencesrequired by ASHA-accredited graduate programs. This survey, distributed in 1997,examined factors such as

(a) the size of the program (both in terms of the number of students andthe number of academic and clinical faculty), (b) the amount of requiredand elective coursework in uency disorders available to students, (c)the degree to which this coursework focuses on theoretical backgroundor clinical application, (d) whether the coursework involved practical orlab sessions, (e) whether assessment of students performance involvedcompetency-based testing, (f) the number of hours of clinical practicumtraining obtained by most students, (g) the level of clinical and researchexpertise of the academic faculty teaching the courses in uency, (h) thelevel of clinical experience of the clinical faculty providing supervisionin uency, and (i) the nature of any changes in program requirementsfollowing the1993 change in ASHAs regulations. (Yaruss,1999, p. 173).

The survey was sent to 239 ASHA-accredited graduate training programs, and

a total of 134 programs responded (overall response rate from initial and follow-upmailings = 56%).Results from the 1997 survey indicated that 75% of responding programs had

at least one required course devoted to uency disorders, with 29% offering atleast one elective course. Overall, 18% of responding programs indicated thatit was possible for a student to graduate without taking any classes specicallydevoted to uency disorders. Clinical experience was required by fewer programs,with more than 50% of programs reporting that no clinical practicum hours inuency disorders were required. No relationships were found between the amount

of academicandclinical education in uency disordersandprogram size, measuredeither in terms of the number of students or the number of faculty, suggestingthat educational requirements in uency disorders are not simply related to theavailability of resources. Finally, one-half of responding programs indicated thatthey reduced or eliminated their academic and clinical requirements followingASHAs elimination of specic standards in uency disorders in 1993.

By themselves, these ndings are a cause for some concern, given prior negativereports about clinicians comfort and competence with uency disorders. Com-pounding these concerns were post-hoc analyses suggesting that the respondents

to the 1997 survey tended to be those with a particular interest in the area of u-ency disorders (as indicated by membership in ASHAs SID-4 or the InternationalFluency Association), suggesting that the 105 programs that did not respond tothe survey may have training requirements in uency disorders that were even lessrigorous.


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Although the 1997 survey yielded important information about the amount of training that is provided in graduate programs across the country, there are a num-ber of difculties with the survey that hamper further interpretation of the ndings.

First, although an attempt was made to elicit responses from all ASHA-accreditedtraining programs, only slightly more than half of the programs responded to thesurvey. As a result, it is not entirely clear how representative the ndings are, andas noted above, there is some indication that there may have been a responder biastoward greater representation by programs with faculty members who had a vestedinterest in maintaining training requirements in uency disorders. Second, becausethe specialty recognition program was still in development at the time of the 1997survey, it was difcult to assess this possible responder bias based on whetheror not the faculty were Board Recognized Specialists in Fluency Disorders. Now

that the inaugural cadre of specialists has been certied, it would be helpful torepeat the survey to assess more directly the degree of interest in uency disordersamong the individuals who responded to the survey, and whether interest in u-ency disorders had any relationship to the academic or clinical requirements in theprogram. Third, the results from the 1997 survey presented only a snapshot of thetraining requirements across the eld. The ndings cannot tell us if the trainingrequirements at graduate programs are relatively stable over time, or if there is atrend toward increased or decreased requirements as the scope of practice withinthe eld continues to broaden, or as the specialties represented within a programs

faculty change. Understanding any trends is critical to formulating an appropriateresponse for ensuring appropriate training in uency disorders for graduate studentclinicians. Fourth, some of thequestions from the initial survey sought only generalinformation about factors affecting training in uency disorders. If we are to morefully document the current status of academic and clinical education to supportfurther research as requirements change, then more detailed information is neces-sary. Fifth, the survey asked only general questions about whether programs madechanges in their academic or clinical education based on ASHAs 1993 changein the training standards. Specic information about the nature of those changes

was gleaned from comments made by the respondents, so it is clear that the initialinformation that was obtained cannot be representative of the overall pattern of changes that were implemented. Thus, further information about the nature of pastchanges will be necessary.

Finally, since the 1997 survey was completed, ASHA has released a new setof academic and clinical education requirements for the CCC, to take effect 1January 2005 (ASHA, 2000).Thenew CCCguidelines do not specify requirementsabout the courses or clinical experiences students must complete, but instead,focus on the competencies students are expected to achieve. Examples of these

competencies include: the ability to demonstrate specic knowledge about thenature, assessment, and treatment of a variety of disorder areas (including uencydisorders), as well as knowledge about research, ethics, and professional issues.This focus on theoutcome rather than theprocess of preparing competentcliniciansmay be seen as a positive step for improving students training; however, it still


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raises questions about how graduate students will receive the training they need if programs do not require coursework or clinical experiences in uency disorders.In order to assess the future impact of the new standards on training programs

educational requirements, therefore, it will be necessary to have a more thoroughunderstanding of the requirements that are currently in place. Furthermore, if weare to understand the rationale behind any changes that are enacted, it will be usefulto gather information from training programs as they are planning and preparingto implement changes to their curricula and training programs.

In sum, as the eld prepares to implement the new training standards for theASHA CCC, it will be useful to haveconsiderably more detailed information aboutthe education in uency disorders that is currently provided by ASHA-accreditedgraduate programs, as well as more specic information about how programs have

changed their requirements over the past several years. The 1997 survey gath-ered some of this information; however, more information is needed. Accordingly,the purposes of this follow-up study were: (a) to collect additional informationabout the academic and clinical education in uency disorders that is providedin ASHA-accredited graduate training programs and (b) to compare the ndingsto the 1997 results in an attempt to identify any trends in as programs prepare toimplement the 2005 standards.

2. Methods

2.1. Questionnaire

This study involved a two-page questionnaire (shown in Appendix A) that wassent to all 256 training programs that were accredited by ASHA in October 2000.The present survey was similar to the original 1997 survey, in that data werecollected in the following categories: (a) demographic information (e.g., num-ber of students and faculty), (b) academic coursework (e.g., number and nature

of classes), (c) individual(s) teaching the academic coursework (e.g., research andclinical experience with uency disorders), (d) clinical practicumexperiences (e.g.,number of students obtaining practicum), (e) individual(s) supervising the clini-cal practicum experiences (e.g., experience with uency disorders), (f) changesin training in response to the revisions to the CCC standards. The present surveydiffered from the initial survey, however, in that it collected more specic infor-mation in each of these categories, such as the number of credit hours assignedto each course in uency disorders, whether the faculty members are membersof ASHAs SID-4 or hold specialty recognition, the average number of hours of

clinical practicum students obtain, and more detailed information about changesassociated with the 1993 and 2005 revisions to the CCC standards. As a result,the current survey was sufciently similar to the 1997 survey in order to allowcomparisons to be made across the two samples, while still collecting informa-tion that was lacking in the original questionnaire. (Note that direct comparison


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between the 1997 dataset and the present data is not possible since programs werenot required to identify themselves in either the initial or follow-up surveys.)

2.2. Respondents

Contact names and addresses for accredited programs were obtained from theASHA website, and recipients were sent a packet containing a cover letter, thequestionnaire, and a return envelope. The purpose of the cover letter was to explainthe background and rationale for the study and to assure respondents that individualprograms would not be identied in the results. In fact, as with the 1997 survey,respondents were not required to disclose the name of their institution. This wasdone to minimize the chance that programs might refuse to respond to the survey

due to concerns that their training requirements would be singled out in resultingpublications.Following the initial mailing of this follow-up survey, in November 2000, 121

responses were received (response rate = 47.3%). This initial response rate isvery similar to that for the original survey conducted in 1997, in which 122 out of 239 questionnaires were returned (initial response rate = 51.0%). In an attempt toincrease the overall responserate (oneof the goals of this follow-up study), a secondmailing was sent out to 167 programs in February 2001. (The second mailingexcluded programs that had voluntarily indicated the name of their institution in

their response.) An additional 38 programs returned the survey, yielding a totalnumber of programs responding equal to 159, and a total overall return rate equalto 67.4% an increase of 20% compared to the 56.1% return rate for the 1997survey.

As is common with survey research of this kind, some respondents did notprovide answers to all of the questions on the survey. Thus, the total number of responses for some questions was less than 159. To facilitate interpretation in theresults presented below, the total number of programs responding to each item ispresented along with the analyses.

3. Results

3.1. Program size and duration

A total of 135 programs provided information about the number of undergrad-uate students enrolled in the major, with the average size of the undergraduateprogram equaling 101.5 students (S .D. = 62.8, range = 6350). For the 154

programs that provided information about the number of students in the graduateprogram, the average size of the graduate program was 54.6 students (S .D. = 36.3,range = 6400).

A total of 100 programs provided information about the number of part-timefaculty, with an average number of part-time faculty members of 4.0 (S .D. = 3.6,


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range = 020). The 131 programs that provided information about full-time fac-ulty indicated an average number of full-time faculty of 9.6 (S .D. = 6.3, range =360).

The vast majority of programs (134 out of 149 responding, or 89.9%) indicatedthat their program is on a semester system, with an average program length forthe Masters degree of 5.2 semesters (S .D. = 1.0; range = 310). The remainingprograms (15 out of 149 responding, or 10.1%) reported using a quarter system,with an averageprogram length for the Masters degreeof 7.3 quarters (S .D. = 1.0;range = 48).

3.2. Academic education

3.2.1. Required and elective coursework All 159 responding programs provided information about required and electivecoursework in uency disorders. A total of 123 programs (77.4%) indicated thatthey have a required graduate course exclusively devoted to uency disorders, andthat the required courses are worth, on average, three credits (S .D. = 0.4, range =25). Also, 53 programs (33.3%) reported that they have an elective graduatecourse exclusively devoted to uency disorders, and that the elective courses areworth, on average, 2.8 credits (S .D. = 0.6; range = 15). Respondents indicatedthat approximately 50% of students take these elective courses (S .D. = 31.8%;

range = 5100%).A total of 23 programs (14.5%) reported both a required and an elective course,and 55 programs(35.7%) reported that stuttering is covered aspart of other courses.Still, this coverage was often provided in courses on neurogenic disorders or clin-ical methods, and the percent of class time spent on uency disorders ranged from0 to 50%. Only 6 programs (3.8%) reported neither a required nor an elective classin uency disorders. Overall, these gures are quite similar to those reported in the1997 survey, in which 75% of programs reported a required course, 29% reportedan elective course, and 5% reported neither an elective nor a required course. In

this survey, a total of 36 programs (22.6%) indicated that it is possible for a studentto graduate without taking any courses exclusively devoted to uency disorders, agure that is slightly higher than the 17.8% reported in the 1997 survey.

3.2.2. Nature of academic coursework When asked about the nature of the academic education in the required and

elective courses on uency disorders, respondents indicated that theoretical is-sues, such as the etiology of stuttering, occupied an average of 40.2% of classtime (S .D. = 17.6%; range = 0100%), clinical issues; such as diagnosis and

treatment, occupied an average of 58.6% of class time (S .D.=

17.3%; range=

0100%), and other issues; such as professional relations and specialty recogni-tion, occupied an average of 1.2% of class time (S .D. = 4.4%; range = 025%).Viewed differently, 42 programs (27%) reported a roughly equal balance betweentheoretical issuesandclinical application,24 programs (15%)reported an emphasis


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on theoretical issues, and 91 programs (58%) reported an emphasis on clinical ap-plication. These gures indicate a slight shift toward a greater emphasis on clinicalapplication when compared to the 1997 survey, when 59% of programs reported

an equal split between theory and clinic, 11% reported an emphasis on theoreticalissues, and 30% reported an emphasis on clinical applications.A total of 114 respondents (71.7%) indicated that courses include some sort

of laboratory or practical sessions, a gure that is higher than the 58.5% reportedin the 1997 survey. Only 46 programs (28.9%) indicated that courses require anykind of competency-based testing to evaluate students performance, a gure thatis similar to the 30.5% reported in the 1997 survey.

3.2.3. Individuals teaching courses

When asked about the individuals teaching the courses in uency disorders, 121programs (out of 152 responding, 79.6%) indicated that courses were taught bytenure-track faculty, and 21 (13.2%) indicated that courses were taught by adjunctor part-time faculty. These ndings indicate a reduction in the number of full-timefaculty teaching uency disorders compared to the 1997 data, when full-time fac-ulty taught 89% of the classes and adjunct or part-time faculty taught only 6% of classes.

Consistent with thendings from the1997 survey, nearly all programs indicatedthat the person teaching the uency courses holds the ASHA CCC (138 out of 140

responding, or 98.6%). Most also reported membership in ASHAs SID-4 (99out of 149 responding, or 66.4%). Only 55 (out of 149 responding, or 36.9%)reported they have received the Certicate of Specialty Recognition in FluencyDisorders, though 90 (out of 155 responding, or 58.1%) reported that uency wastheir primary area of academic or clinical expertise (a gure somewhat lower thanthe 65% found in the 1997 data). In addition, 75% of programs rated their facultymembers previous clinical experience with stuttering to be extensive (rating 4or 5 on a 5-point scale) and 58% rated their current clinical experience to beextensive. Only 32%of responding programs rated their faculty members research

experience with stuttering to be extensive, a gure slightly lower than the 37%found in the 1997 data.

3.3. Clinical education

3.3.1. Clinical practicum experiencesOutof 150programsthat provided information about required practicumexperi-

ences, 55 (36.7%) reported that clinical experience is required in the assessment of uency disorders, and 54 (36.0%) reported that experience is required in the treat-

ment of uency disorders. These gures represent a decrease from the ndings of the 1997 survey, when 44% of programs required experience with assessment and49%requiredexperiencewith treatment. Overall, 97 programs (out of 149 respond-ing, or 65.1%) reported that it is possible for students to graduate without any clini-cal experience in stuttering, an apparent increase from the 59% in the 1997 survey.


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The 120 programs that provided information about the clinical practicum theyoffer in the assessment of uency disorders reported an average of 7.8 hours of assessment experience (S .D. = 6.7%, range = 035%), with 58.2% of this time

spent with children and 41.8% spent with adults. Of the 136 programs that providedinformation about where students obtain the majority of their clinical practicumhours in assessment, 81 (59.6%) reported that the majority of the practicum is ob-tained in a university clinic, 47 (34.6%) reported that the majority of the practicumis obtained in an externship outside the university clinic, and 8 (5.9%) indicated arelatively even split between in-clinic and out-of-clinic experiences.

The 117 programs that provided information about the clinical practicum theyoffer in the treatment of uency disorders reported an average of 16.7 hours of treatment experience (S .D. = 9.2, range = 050), with 58.8% of the time spent

with children and 41.2% spent with adults. Of the 134 programs that providedinformation about where students obtain the majority of their clinical practicumhours in assessment, 74 (55.2%) reported that the majority of the practicum is ob-tained in a university clinic, 54 (40.3%) reported that the majority of the practicumis obtained in an externship outside the university clinic, and 6 (4.5%) indicated arelatively even split between in-clinic and out-of-clinic experiences.

3.3.2. Individuals supervising clinical practicum experiencesFifty programs (31.6%) indicated that the person who typically supervises the

clinical practicum is the same as the person who teaches the academic course-work. Of the remaining programs, 96 provided information about the individualssupervising the students clinical practicum experiences, with 48 programs (50%)indicating that thesupervisor views uency disordersas a primary area of expertise,a gure considerably lower than the 73% found in the 1997 survey.

Only 36 out of 96 programs (37.5%) reported that the supervisor is a member of ASHAs SID-4, and 19 out of 91 programs (20.9%) indicated that the supervisorhas received the Certicate of Specialty Recognition in Fluency Disorders. Atotal of 14 programs (8.8% of the entire sample) indicated that both the academic

and clinical faculty members held specialty recognition. Finally, 53% of programsindicated that their supervisors previous clinical experience in uency disorders isextensive (rating 4 or 5 on a 5-point scale), and 49% indicated that their supervisorscurrent clinical experience is extensive, gureswhich are lower than the68%foundin the 1997 survey.

3.4. Relationship between education and program size

To evaluate whether the academic and clinical education requirements of the

training programs was related to the size of the program, programs were dividedinto small, medium, and large sizes based on (a) the number of graduate studentsenrolled in the program, and (b) the total number of faculty in the program (in-cluding part-time and full-time faculty). Small programs were dened as those ator below the 33rd percentile and larger programs were dened as those at or above


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the 67th percentile. A Chi-square analysis revealed no signicant relationshipsbetween the number of graduate students and the likelihood that a student couldgraduate without any academic coursework ( 2 = 1.42, df = 2, P = 0.49) or

clinical practicum ( 2

= 0.32, df = 2, P = 0.85). Similar negative ndingswere found between the number of faculty in the program and the likelihood thata student could graduate without any academic coursework ( 2 = 1.13, df = 2,P = 0.57) or clinical practicum ( 2 = 1.46, df = 2, P = 0.28). These ndingsare consistent with the results of the 1997 survey, which also found no relationshipsbetween program size and training requirements.

3.5. Changes in program requirements

3.5.1. Following 1993 changes to CCC standardsOverall, 90 programs (57.0%) reported changes in their academic and clinicaleducation requirements following ASHAs 1993 modications to the standards forthe CCC, a gure slightly higher than the 50.4% that reported changes in the 1997survey. Of the 90 programs that reported changes, 23 (25.6%) indicated that theyreduced course requirements (e.g., by eliminating the stuttering course or makingit an elective, or by reducing the number of credit hours assigned to the classfrom 3 to 2 credits). Three programs (3.3%) indicated that they increased courserequirements (e.g., by making an elective course a requirement or increasing the

number of credits assigned to a course).Changes in the clinical practicum were more common: of the 90 programsthat reported changes, 86 (95.6%) reported reductions in the clinical practicumrequirements, and none reported increases in the clinical practicum. Both of thesegures represent notable increases from the results of the 1997 survey, in which9% of programs reported a change to the academic coursework and 63% of pro-grams reported changes to the clinical practicum. This nding suggests eitherthat the initial survey underestimated the magnitude of the reductions in train-ing that followed the implementation of the 1993 standards or that reductions in

training requirements may have continued to occur since the time of the 1997survey.

3.5.2. In preparation for 2005 changes to CCC standardsSeveral programs indicated that their faculty is still reviewing the new standards

and many respondents simply indicated that they did not yet know whether changeswould occur. Still, at this early stage of planning, 35 programs (22.3%) indicatedthat they anticipate changes in the academic or clinical training in uency disordersin preparation for ASHAs new 2005 standards for the CCC. Of those, 22 (62.9%)

expect further reductions in academic requirements (e.g., reducing the credit hoursfor the uency class), and 18 (51.4%) expect further reductions in clinical re-quirements. A few respondents commented that they do not anticipate any furtherreductions in their academic and clinical educational requirements in uency dis-orders since they have already eliminated all requirements. A few other programs


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indicated that they anticipated increases in academic (5 programs, or 14.3%) orclinical training (6 programs, or 17.1%), though no specic details were provided.Finally, several respondents noted concern about the future of uency disorders

within the eld as a whole and others indicated that the future of academic andclinical education within their department would depend upon whether they wereable to replace a retiring faculty member with another individual with expertise instuttering.

4. Discussion

The purpose of this study was to provide information about the academic and

clinical education in uency disorders that is provided to students in ASHA-accredited graduate training programs. Results indicate that the majority of train-ing programs do offer both required and elective courses in uency disorders,and that many students take elective courses when they are available. Only 6programs indicated that they offer no courses in uency disorders at all, thoughseveral others indicated that their information about uency disorders is pro-vided in a class that addresses multiple topics. Nearly one-quarter of the pro-grams that responded to this survey allow their students to graduate without tak-ing courses in uency disorders. Similarly, although clinical practicum may be

available to students in many programs, the average number of hours of expe-rience they receive is small, and nearly two-thirds of the responding programsallow students to graduate without any clinical practicum hours in uency dis-orders. The amount of academic or clinical education provided by the trainingprograms was not related to the size of the programs, measured either in terms of the number of students or the number of faculty, a nding which suggests that theamount of training is not simply associated with the amount of resources that areavailable.

Overall, ndings from the present study are consistent with the results of a

similar survey conducted in 1997 (Yaruss, 1999), which also indicated that manygraduate students in speechlanguage pathology do not receive very much trainingin the area of uency disorders. In fact, a comparison of the two surveys revealsa number of trends. As shown Fig. 1, present ndings suggest: (a) an increasein the number of programs that allow students to graduate without academic orclinical training in uency disorders; (b) a reduction in the amount of assessmentand treatment experience students are required to obtain; (c) a decrease in thenumber of full-time faculty members, and corresponding increase in the numberof part-time or adjunct faculty members teaching courses in uency disorders; and

(d) a decrease in the number of faculty with extensive clinical and research ex-perience in uency disorders. These last two ndings may reect the number of faculty with expertise in uency disorders who have retired, but who have notbeen replaced by new faculty with similar expertise. On the other hand, a compar-ison with the 1997 survey also indicates an increase in the number of programs


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offering practical or laboratory sessions associated with academic coursework, atrend which may help to improve education within the classroom setting even if the number of clinical experiences is reduced. In addition, there appears to have

been an increase in the number of programs that emphasize clinical application intheir graduate courses, as opposed to focusing primarily on theoretical issues andbackground. If conrmed, this trend would parallel a suggestion made by Quesal(2001) in a presentation at the SID-4 leadership conference aimed at improvingacademic and clinical education in uency disorders.

Of course, it is not possible to determine from these results whether this ap-parent trend represents a true change in the training provided to graduate studentsin our eld, or whether the differences between the 1997 survey and the presentsurvey are due to sampling differences or, perhaps, regression to the mean. As

noted above, respondents were not required to identify their programs on thesurvey, in an attempt to reduce the likelihood that some individuals would notrespond because of concerns that their program would be singled out or identiedin the results. Thus, direct evaluation of changes within individual training pro-grams is not possible, and it would be useful, in further studies of this kind, tobe able to track changes in the requirements of specic training programs (e.g.,through coding of response forms or other means of identifying responses). Still,given that the current analysis includes data from more than two-thirds of allASHA-accredited training programs, combined with the fact that present results

are largely replicate ndings from the 1997 survey, it seems safe to conclude thatthe future of academic and clinical education in uency disorders is in a precariousposition.

It is important to recognize that this investigation, like the original 1997 study,is affected by response bias. Although this survey had a notably higher overallresponse rate (67.4%) than the 1997 survey (56.1%), it is still likely that the indi-viduals who took the time to complete the survey were those who were interested inuency disorders and, in particular, the fate of academic and clinical education inuency disorders in graduate training programs. Such a response bias is probably

unavoidable forany study that depends upon participants to provide information bycompleting and returning a survey, and self-selection most certainly has an impacton the ndings for this research. With the 1997 survey, the potential self-selectionbias was demonstrated through a post-hoc analysis that examined the percentageof programs that had a faculty member belonging to ASHAs SID-4 (61% in the1997 survey) compared to the total number of programs that were represented inSID-4 (40% in the 1998 roster). A similar situation exists with the present dataset.According to the SID-4 roster dated 16 July 2001, which indicates a total of 699division members, approximately 92 of the 259 programs that received this survey

(36.5%) have at least one faculty member belonging to the special interest divi-sion. In contrast, 66.4% of programs that responded to the survey indicated thatthey have a faculty member belonging to the division, a gure that is 87% higherthan the total percentage of programs represented in the division roster. Thus, thepresent results do appear to be affected by a response bias in which programs that


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do have a faculty member belonging to the division were more likely to respondthan programs that do not. Of course, membership in a special interest divisiondoes not by itself suggest that a particular faculty member has expertise in uency

disorders; however, it does indicate a certain degree of interest and is therefore arelevant measure.The present study attempted to take the analysis of a potential response bias one

step further by also considering whether the ndings may have been affected by anover-representation of programs with a faculty member who holds the Certicateof Specialty Recognition in Fluency Disorders. This could not havebeen done withthe1997 data,because thespecialty recognition program was still in theearlystagesof implementation at that time. At this point, however, it is possible to determinewhether the responding programs were more likely to have a uency specialist

on the faculty. Although it is not entirely clear what impact a uency specialistwill have on a curriculum, is seems reasonable to assume that a Board RecognizedSpecialist in Fluency Disorders may serve as an advocate for retaining academiccoursework or clinical practicum experiences in uency disorders, even in theface of changing ASHA requirements. Indeed, a Chi-square test examining therelationshipbetween thelikelihood that a program wouldallowstudents to graduatewithout a class in uency disorders and the presence of a uency specialist onthe faculty revealed that programs with a uency specialist were signicantly lesslikely to allow students to graduate without a class in uency disorders ( 2 = 5.04,

df = 2, P = 0.025). Therefore, additional post-hoc analyses were undertaken todetermine whether the responding programs were more likely to be those with auency specialist.

A review of the list of Board Recognized Specialists in Fluency Disorders(avail-able at: http://www.ausp.memphis.edu/sbfd ), dated 1 May 2001 (the most currentlist as of this writing) reveals that roughly 87 out of the 259 ASHA-accreditedtraining programs that received this survey (33.6%) have at least one uency spe-cialist on the faculty. (The total number of uency specialists at that time was296.) Of the programs that responded to this survey, however, 60 programs re-

porting either an academic or a clinical faculty member with specialty recognition(40.2%, a gure that is 20% greater than the overall percentage of programs thathave a uency specialist on faculty). In other words, programs with a uencyspecialist were somewhat more likely to respond to this survey than programswithout a uency specialist. Consideration of the raw numbers makes the se-lection bias in these data even more apparent, for 69% of the programs with auency specialist (60 out of 87) responded to the survey, whereas only 51% of those programs without a uency specialist responded (88 out of a total of 173ASHA-accredited programs without a specialist). Thus, it appears that the data

in this survey are affected by self-selection bias resulting in over-representationof programs with faculty members with expertise in uency disorders and, per-haps, more rigorous training standards in uency disorders. Of course, it is im-possible to determine, with certainty, the training requirements of those pro-grams that did not respond to the survey; however, it seems likely that many
http://www.ausp.memphis.edu/sbfdhttp://www.ausp.memphis.edu/sbfd


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of those programs, like many of the programs without a uency specialist thatdid respond to this survey, may have fewer requirements in the area of uencydisorders.

Finally, the present survey attempted to extend the ndings from the original1997 survey by gathering additional details about changes in academic and clinicaltraining requirements following ASHAs 1993 revisions to the CCC standards, aswell as some preliminary information about preparations for the new 2005 stan-dards. More than half of the programs reported that they did make changes intheir academic or clinical training requirements in 1993. Many of these programsindicated that they had eliminated coursework requirements or changed requiredcourses to electives. In addition, several programs indicated that they reduced thenumber of credit hours assigned to the class, for example, by turning a 3-credit

class into a 2-credit class. Although individuals interested in preserving academictraining in uency disorders would no doubt nd this to be preferable to havinga program eliminate a class outright, it is still worth noting that 2-credit gradu-ate courses do not presently meet the requirements established by the specialtyrecognition board for uency disorders. Thus, students who complete their train-ing at programs that offer only a 2-credit graduate course will be ineligible forspecialty recognition unless they earn an additional graduate credit in uencydisorders.

Unfortunately, the question regarding changes in program requirements fol-

lowing the implementation of the 1993 standards was mistakenly formatted onthe present survey sheet. The question used a checkbox to indicate whether therewere changes in training requirements, as opposed to a Yes/No/No answer for-mat. Because of this formatting error, it is not possible to determine whether anempty checkbox meant no changes or simply no answer, so the results for thisquestion may actually underestimate the true number of programs that institutedchanges in 1993. (Indeed, this seems likely, given the fact that nearly two-thirdsof programs now allow students to graduate without clinical practicum in u-ency disorders, something that would not have been allowed under the pre-1993

guidelines.) The same problem exists for the question about changes in prepara-tion for the 2005 guidelines. Not surprisingly, however, many respondents statedthat their programs are still working on the changes in curriculum and clinicaltraining that will be needed in order to address the new ASHA training standards.Although the 2005 standards do not specify the amount of clinical or academictraining students should receive in the area of uency disorders, it is possiblethat the new guidelines might lead to alternative models of training due to therequirement that student clinicians be able to demonstrate competency in the areaof uency disorders. At present, however, given the fact that only one-third of

the responding programs indicated that they use any sort of competency-basedtesting in their courses on uency disorders, it appears that many programs havea considerable amount of work before them as they prepare for the 2005 stan-dards. Because the training standards have yet to take effect, this situation is onethat is still developing and unfolding. In order to fully evaluate the impact of


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experience, not less, is needed to prepare clinicians to help people who stutter.Present results suggest that the eld does not appear to be headed in this di-rection, at least as far as the training that is provided in graduate programs is

concerned.Given that it is highly unlikely that ASHA will reinstate educational or clinicalrequirements in uency disorders or other specic disorder areas, training pro-grams, and indeed, the profession as a whole, must work to identify alternateways of preparing student clinicians to appropriately and effectively evaluateand treat uency disorders. Examples include an increase in the availability of post-graduate continuing education courses or in-service presentations on uencydisorders (cf. Sommers & Caruso, 1995), increased partnership with organizationssuch as the Stuttering Foundation of America (SFA) and National Stuttering Asso-

ciation (NSA) for providing ongoing education of speechlanguage pathologistswho may be less comfortable with their skills for helping people who stutter, an in-creased number of activities sponsored by SID-4 (such as the newly created uencyboot camps), and, ultimately, increased participation in the specialty recognitionprogram by clinicians with an interest in uency disorders. If such efforts are notundertaken, and if the apparent trends identied in this study continue, then it islikely that the number of clinicians who are qualied to help people who stutterwill decrease even further. It is hoped that the results from this survey, and, inparticular, the trends that are seen in the comparison with the 1997 ndings, will

contribute needed support to the growing effort to identify meaningful and appro-priate ways to train graduate students as well as practicing clinicians aboutuency disorders and to improve the quality of clinical services that is providedfor people who stutter.

Acknowledgments

The authors are grateful to the faculty who completed the questionnaire andalso to our colleagues in ASHAs Special Interest Division 4 who have taken upthe challenge of improving academic and clinical training in uency disorders.The authors also appreciate the assistance of Dana Knight and Patsy McMelleonin distributing the questionnaires and entering the data. Portions of this paperwere presented at the 2001 ASHA convention in New Orleans, LA. This re-search was supported, in part, by an NIH Grant (R01 03810) to the University of Pittsburgh.


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Appendix A

continued on next page


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Appendix A (continued )

References

American SpeechLanguageHearing Association (1993). Membership and certication handbook of the American SpeechLanguageHearing Association for speechlanguage pathology . Rockville,MD: American SpeechLanguageHearing Association.

American SpeechLanguageHearing Association (2000). Standards and implementation for thecerticate of clinical competence in speechlanguage pathology . Rockville, MD: AmericanSpeechLanguageHearing Association.

Brisk, D. J., Healey, E. C., & Hux, K. A. (1997). Clinicians training and condence associated withtreating school-age children whostutter: a national survey. Language,Speech, and Hearing Servicesin Schools , 28 , 164176.


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Campbell, J. H., Hill, D. G., Yaruss, J. S., & Gregory, H. H. (1996). Integrating academic and clinicaleducation in uency disorders . Invited seminar presented at the annual convention of the AmericanSpeechLanguageHearing Association, Seattle, WA.

Chapman, L., & Keintz, C. (1996). Student clinical experience: is it adequate in all disorder areas ?

Presentation at the Annual Convention of the American SpeechLanguageHearing Association,Seattle, WA.

Chapman, L., & Keintz, C. (1998). Perceptions of newly certied SLPs concerning graduate clinical preparation . Presentation at the Annual Convention of the American SpeechLanguageHearingAssociation, San Antonio, TX.

Cooper, E., & Cooper, C. S. (1985). Clinician attitudes towards stuttering: a decade of change(19731983). Journal of Fluency Disorders , 10 , 1933.

Cooper, E., & Cooper, C. S. (1996). Clinician attitudes towards stuttering: two decades of change. Journal of Fluency Disorders , 21 , 119136.

Kelly, E. M., Martin, J. S., Baker, K. E., Rivera, N. I., Bishop, J. E., Krizizke, C. B., Stettler, D. S., &Stealy, J. M. (1997). Academic and clinical preparation and practices of school speechlanguage

pathologists with people who stutter. Language, Speech and Hearing Services in Schools , 28 ,195212.

Kuster, J. K., Cordes, A. K., Guitar, B., Hood, S. B., Quesal, R. W., Bernstein Ratner, N., & Yaruss, J.S. (2000). Educators forum: academic training in stuttering and other uency disorders . Seminarpresented at the Annual Convention of the American SpeechLanguageHearing Association,Washington, DC.

Lass, N. J., Ruscello, D. M., Pannbacker, M. D., Schmitt, J. F., & Everly-Myers, D. S. (1989).Speechlanguage pathologists perceptions of child and adult female and male stutterers. Journalof Fluency Disorders , 14 , 127134.

Leith, W. R. (1971). Clinical training in stuttering therapy: a survey. Journal of the American Speechand Hearing Association , 13 , 68.

Mallard, A. R., Gardner, L. S., & Downey, C. S. (1988). Clinical training in stuttering for schoolclinicians. Journal of Fluency Disorders , 13 , 253259.

Quesal, R. W. (2001). How do students learn if clients arent there ? Presentation to the SeventhAnnual American SpeechLanguageHearing Association Special Interest Division 4 LeadershipConference, Toronto, Ontario.

St. Louis, K. O., & Durrenberger, C. H. (1993). What communication disorders do experiencedclinicians prefer to manage? ASHA, 35 , 2331.

St. Louis, K. O., & Lass, N. J. (1980). A survey of university training in stuttering. Journal of the National Student Speech Language Hearing Association , 10 , 8897.

Sommers, R. K., & Caruso, A. J. (1995). In-service training in speechlanguage pathology: are wemeeting the needs for uency training? American Journal of SpeechLanguage Pathology , 4(3),

2228.Yaruss, J. S. (1999). Current status of academic and clinical education in uency disorders atASHA-accredited training programs. Journal of Fluency Disorders , 24 , 169184.

CONTINUING EDUCATION

QUESTIONS

1. The purpose(s) of the present study was/were to:a. evaluate the current academicand clinical education requirements in the area

of uency disorders at ASHA-accredited graduate institutionsb. examine changes in training requirements at graduate programs that haveoccurred since ASHA changed the standard for the ASHA CCC in 1993

c. obtain preliminary information about changes that programs have plann-ed for their training requirements as the new standards take effect in 2005


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d. collect additional information about academic and clinical training to sup-plement data collected in a prior survey distributed in 1997

e. all of the above

2. The methods of this study involved:a. a questionnaire sent to all undergraduate programs that have a major incommunication science and disorders

b. a questionnaire sent to all graduate programs that were accredited by ASHAas of October 2000

c. a questionnaire sent to all undergraduate and graduateprogramsin the UnitedStates that have a major in communication science and disorders

d. a survey of syllabi of uency courses at randomly selected training programse. none of the above

3. The present survey differed from the original (1997) survey in that it:a. collected more detailed information about programs training standards in avariety of categories

b. sought more detailed information about whether academic or clinical facultyspecialized in uency disorders

c. involved both interview and questionnaire-based data collection proceduresd. (a) and (b) onlye. (a), (b), and (c)

4. Results of this survey indicate:

a. the majority of programs do provide coursework in uency disordersb. the majority of programs allow students to graduate without any clinicalexperience in uency disorders

c. the majority of programs do not provide coursework in uency dis-orders

d. (a) and (b)e. (b) and (c)

5. Combined with the results of the 1997 survey (Yaruss, 1999), present ndingsindicate trends suggesting that:

a. fewer programs are requiring courses in uency disorders and fewer pro-grams are requiring clinical experience in uency disordersb. individuals teaching classes and supervising clinical practicum report less

expertise in uency disordersc. more programs maintaining the old 25 hour requirement for clinical experi-

ence in uency disordersd. (a) and (b)e. (a), (b), and (c)

articulo disfluencia

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