Caseload Characteristics For additional information, please contact Jeanette Janota, Surveys & Analysis Team American Speech-Language-Hearing Association Rockville, MD 20850 800-498-2071, ext. 8738 [email protected] ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Contents Executive Summary....................................................................................................................1 Activities ......................................................................................................................................2 Facility ............................................................................................................................................. 2 Populations Served ....................................................................................................................3 Facility ............................................................................................................................................ 3 Population Density........................................................................................................................... 3 Years of Experience......................................................................................................................... 3 Adult Services .............................................................................................................................4 Facility ............................................................................................................................................. 4 Population Density........................................................................................................................... 5 Years of Experience......................................................................................................................... 5 Pediatric Services .......................................................................................................................6 Facility ............................................................................................................................................. 6 Population Density........................................................................................................................... 7 Autism..........................................................................................................................................7 Facility ............................................................................................................................................. 7 Population Density........................................................................................................................... 7 Swallowing ..................................................................................................................................8 Population Density........................................................................................................................... 8 Survey Notes and Methodology ................................................................................................ 8 Response Rate.................................................................................................................................. 8 Other Reports ................................................................................................................................... 8 Suggested Citation .....................................................................................................................9 Supplemental Sources ...............................................................................................................9 Additional Information................................................................................................................9 Thank You....................................................................................................................................9 Appendix: State Listings and Data Tables ............................................................................. 10 Regions of the Country .................................................................................................................. 11 Table 1: Populations Served by Type of Facility ..................................................................... 12 Table 2: Adult Patients, Areas of Intervention ......................................................................... 13 Table 3: Pediatric Patients, Areas of Intervention .................................................................... 15 Table 4: Swallowing Services by Type of Facility................................................................... 17 Figures Figure 1: Figure 2: Figure 3: Activities ...................................................................................................................... 2 Populations Served ....................................................................................................... 3 Adult Areas of Intervention.......................................................................................... 4 i ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Figure 4: Pediatric Areas of Intervention..................................................................................... 6 Table 1: Pediatric Areas of Intervention by Population Density ................................................ 7 Table ii ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Executive Summary The American Speech-Language-Hearing Association (ASHA) conducted a survey of speech-language pathologists (SLPs) in the spring of 2013. The survey was designed to provide information about health care–based service delivery and to update and expand information gathered during previous SLP Health Care Surveys. The results are presented in a series of reports. This report addresses only questions on the survey pertaining to caseload. Data are drawn from all six types of health care facilities: general medical and long-term acute care (LTAC) hospitals, rehabilitation (rehab) hospitals, pediatric hospitals, skilled nursing facilities (SNFs), home health agencies and clients’ homes, and outpatient clinics and offices. Highlights: 73% of SLPs’ time was spent in individual treatment. 60% of services were to adults. In adult settings, 41% of services were in the area of swallowing. Time spent on swallowing was highest in general medical and LTAC hospitals (59%). Times spent on aphasia (23%) and traumatic brain injury (TBI; 19%) in adults were highest in rehabilitation hospitals. In pediatric settings, 38% of services were in the area of language. SLPs who provided pediatric services in outpatient clinics spent more time on articulation and phonology (28%) and fluency (5%) than did SLPs in other types of facilities. 22% of the average (mean) pediatric caseload was children with autism. 12% of respondents said professionals other than SLPs provided primary swallowing services in their facilities. 1 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Activities SLPs in health care facilities spent the overwhelming majority of their time providing direct treatment: 73% to individuals and 1% in group settings. They also spent 20% of their time providing clinical documentation. Figure 1. Activities Documentation 20% Other 6% Group treatment 1% Individual treatment 73% n = 1,663 Facility The activities performed by SLPs who were clinical service providers varied by the type of facility in which they worked: x Individual treatment ranged from 67% in pediatric hospitals to 77% in SNFs (p = .000). x Group treatment ranged from less than 1% in SNFs and home health agencies or clients’ homes to 3% in rehabilitation hospitals (p = .000). x Clinical documentation accounted for 17% of the time of SLPs in SNFs but 23% in general medical and LTAC and pediatric hospitals (p = .000). 2 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Populations Served The clinical service providers in the survey provided, on average (mean), 60% of their services to adults (see Figure 2). Remaining services were fairly evenly distributed among infants and toddlers, preschoolers, and school-age children. Figure 2. Populations Served Infants/ toddlers 15% Preschoolers 13% Adults 60% School-age children 11% n = 1,686 Facility The range of clients’ ages varied widely by type of facility (p = .000; see Appendix, Table 1): x Not surprisingly, a large majority of services in SNFs (99%), rehabilitation hospitals (89%), and general medical and LTAC hospitals (89%) were provided to adults. x In pediatric hospitals, services were distributed between infants and toddlers (42%), preschoolers (32%), and school-age children (25%). x In home health agencies and clients’ homes, most services were provided to infants and toddlers (43%) and adults (33%), with the remainder to preschoolers (16%) and school-age children (8%). x Outpatient clinics and offices had the most even distribution by age: 30% to preschoolers, 29% to school-age children, 26% to adults, and 15% to infants and toddlers. Population Density Only services to school-age children varied significantly by population density. Clinical service providers identified the type of area where they worked (rural, suburban, metropolitan/urban) and the time spent serving school-age children. Those in rural areas spent 7% of their time with school-age children; those in metropolitan/urban areas, 11%; those in suburban areas, 12% (p = .004). Years of Experience Two age groups varied by years of experience: x Time spent with infants and toddlers ranged from 10% for clinicians with 22 to 24 years or 31 or more years of experience to 22% for those with 13 to 15 years of experience (p = .011). x Time with preschoolers varied between 10% (clinicians with 22 to 24 years of experience) and 19% (those with 13 to 15 years; p = .031). 3 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Adult Services More adult service time was in the area of swallowing (42%) than in any other area of intervention (see Figure 3). This was true overall and for each type of facility (see Appendix, Table 2). Figure 3. Adult Areas of Intervention Voice/ resonance 6% Other 2% AAC 3% Accent modification 1% Aphasia 16% Dementia 15% Swallowing 42% TBI 8% Motor speech 7% Other cognitive 2% n = 1,148 AAC = augmentative and alternative communication TBI = traumatic brain injury Facility All 10 areas of intervention were affected by the type of facility where the SLPs worked (see Appendix, Table 2): x SLPs in clinics spent more time on augmentative and alternative communication (7%), other cognitive communication disorders (5%), voice/resonance (15%), and other services (8%) than did SLPs in other types of facilities (p = .000). x More time was spent addressing motor speech disorders in home health and clients’ homes than in other environments (10%; p = .000). x Time spent on dementia services was highest in SNFs (27%; p = .000). x Time spent on aphasia (23%) and traumatic brain injury (TBI; 19%) was highest in rehabilitation hospitals (p = .000). x No more than 1% of time in any type of facility was spent on accent modification/communication effectiveness (p = .023). x Time spent on swallowing was highest in general medical and LTAC hospitals (59%; p = .000). 4 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Population Density Only four adult services varied by population density (not shown in any table): x SLPs in rural areas spent more time on dementia services (21%) than did SLPs in suburban (15%) or SLPs in metropolitan (12%) areas (p = .000). x Approximately 6% of SLPs’ time in rural areas was spent on TBI compared with 7% of SLPs’ time in suburban and 9% of SLPs’ time in metropolitan areas (p = .032). x Time spent on voice/resonance depended on locale and accounted for 4% of SLPs’ time in rural areas, 5% of SLPs’ time in suburban areas, and 7% of SLPs’ time in metropolitan/urban areas (p = .026). x A small amount of time was spent by SLPs on other communication disorders, with a range from less than 1% for SLPs in rural areas to 2% for those in suburban areas and 3% for those in metropolitan/urban areas (p = .031). Years of Experience Half of the areas of adult services (i.e., aphasia, motor speech, swallowing, voice/resonance, and other services) were affected by years of experience, but not in a linear fashion. That is, the percentage of time that clinicians spent with individuals with a specific disorder did not increase or decrease in a straight line as the number of years of experience increased. 5 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Pediatric Services SLPs who worked with pediatric patients spent a greater percentage of their time on language (38%) than on any other area of intervention. Additionally, nearly one quarter of their time was spent on articulation and phonology (see Figure 4). Facility The type of facility in which SLPs worked had an effect on 7 of the 10 areas of intervention included in the survey: x SLPs in home health agencies and clients’ homes (47%) spent more time on language than did SLPs in other types of facilities (p = .000). x SLPs in general medical and LTAC hospitals (36%) spent more time on swallowing and feeding than did SLPs in other facility types (p = .000). x SLPs in pediatric hospitals spent more time on resonance (3%) than did SLPs elsewhere (p = .011), and those in outpatient clinics and offices spent more time on voice (4%) than did SLPs in other types of facilities (p = .002). x SLPs in outpatient clinics spent more time on articulation and phonology (28%) and on fluency (5%) than did other SLPs (p = .000). x SLPs in rehabilitation hospitals spent considerably more time on cognitive communication (28%) than did other SLPs (p = .000; see Appendix, Table 3). Figure 4. Pediatric Areas of Intervention Voice Swallowing 2% 15% Resonance 1% Other 2% Articulation/ phonology 24% Prevention/ wellness 1% Language 38% AAC 5% Cognitive communication 8% Fluency 3% n = 818 6 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Population Density Half of the areas of intervention differed by population density (p < .05). The largest was a 9% difference between the amount of time spent by urban and rural SLPs in the area of articulation and phonology (see Table 1). Table 1. Pediatric Areas of Intervention by Population Density Area of Intervention Urban Suburban Rural p (n = 345) (n = 338) (n = 121) Articulation–phonology Augmentative and alternative communication (AAC) Cognitive communication Fluency 20.1 26.0 28.9 .000 5.0 5.2 8.0 .038 8.6 7.8 7.1 .605 3.3 2.9 2.8 .805 Language 35.7 41.4 37.1 .008 0.8 0.8 1.9 .033 19.5 11.9 11.2 .000 Voice 2.7 1.3 2.0 .142 Resonance 2.0 0.8 0.7 .081 Other 2.4 2.0 0.4 .157 Prevention/wellness Swallowing and feeding Autism Children with autism accounted for an average (mean) of 22% of the caseload of SLPs in health care facilities. The median was 15%. Facility Both medians and means varied by type of facility. Medians were 0% in general medical and LTAC hospitals, 1% in rehabilitation hospitals, 10% in pediatric hospitals, 15% in home health agencies or clients’ homes, and 25% in outpatient clinics or offices. Means were 11% in general medical and LTAC hospitals, 17% in rehabilitation hospitals, 20% in home health agencies or clients’ homes, 21% in pediatric hospitals, and 28% in outpatient clinics or offices (p = .000; not shown in any table). Population Density Population density had an impact on the proportion of children with autism in SLPs’ caseloads: 20% of the caseload of clinicians in metropolitan/urban and rural areas and 24% of the caseload of SLPs in suburban areas (p = .047; not shown in any table). 7 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Swallowing In response to a question asking whether professionals other than SLPs provided primary swallowing services in their facilities, an average of 12% said yes. This varied from 2% in SNFs to 47% in pediatric hospitals (see Appendix, Table 4). There was no effect based on years of experience (p = .537). Population Density Population density had an impact on the proportion of SLPs who reported that other professionals provided primary swallowing services (p = .000; not shown in any table). This response was made by: x 5% of SLPs in rural areas x 10% of SLPs in suburban areas x 15% of SLPs in metropolitan or urban areas. Survey Notes and The SLP Health Care Survey has been fielded in odd-numbered years since 2005 to gather information of interest to the profession. Members, volunteer leaders, and staff rely on data from the survey to better understand the priorities and needs of SLPs. Methodology Response Rate The survey was mailed in February 2013 to a random sample of 4,000 ASHA-certified SLPs who were employed in health care settings in the United States. An e-mail reminder was sent a week later. Second (March) and third (April) mailings followed, at approximately 3- or 4-week intervals, to individuals who had not responded to earlier mailings. The sample was a random sample, stratified by type of facility and by private practice. Small groups, such as pediatric hospitals, were oversampled. Therefore, weighting was used when presenting data to reflect the actual distribution of SLPs in each type of facility within ASHA. Of the original 4,000 SLPs in the sample, 1 was deceased, 10 were retired, 4 had bad addresses, 133 were employed in other types of facilities, 20 were not employed in the field, and 5 were ineligible for other reasons, leaving 3,827 possible respondents. The actual number of respondents was 2,048, resulting in a 53.5% response rate. The results presented in this report are based on responses from those 2,048 individuals. Other Reports Results from the 2013 SLP Health Care Survey are presented in a series of reports at www.asha.org: x Survey Summary Report x Caseload Characteristics x Workforce and Practice Issues x Annual Salary Report x Hourly and Per Visit Wage Report x Private Practice Owners x Survey Methodology, Respondent Demographics, and Glossary 8 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Suggested Citation American Speech-Language-Hearing Association. (2013). ASHA SLP Health Care Survey 2013: Caseload characteristics. Available from www.asha.org. Supplemental Resources Practice Portal. www.asha.org/practice-portal. Information for Speech-Language Pathologists. www.asha.org/slp/. Multicultural Affairs and Resources. www.asha.org/practice/multicultural/. Additional Information For additional information regarding the 2013 SLP Health Care Survey, please contact Gennith Johnson, associate director of Health Care Services, at 800-4982071, ext. 5681, or [email protected]; Monica Sampson, associate director of Health Care Services, at ext. 5686, or [email protected]; or Janet Brown, director of Health Care Services, at ext. 5679, or [email protected]. To learn more about resources for ASHA members working in health care, visit ASHA’s website at www.asha.org/slp/healthcare. Thank You ASHA would like to thank the SLPs who completed the 2013 Health Care Survey. Reports like this one are only possible because people like you participate. Is this information valuable to you? If so, please accept invitations to participate in other ASHA-sponsored surveys and focus groups. You are the experts, and we rely on you to provide data to share with your fellow members. ASHA surveys benefit you. 9 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Appendix: State Listings and Data Tables 10 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Regions of the Country Northeast i Middle Atlantic o New Jersey o New York o Pennsylvania i New England o Connecticut o Maine o Massachusetts o New Hampshire o Rhode Island o Vermont South i East South Central o Alabama o Kentucky o Mississippi o Tennessee i South Atlantic o Delaware o District of Columbia o Florida o Georgia o Maryland o North Carolina o South Carolina o Virginia o West Virginia i West South Central o Arkansas o Louisiana o Oklahoma o Texas Midwest i East North Central o Illinois o Indiana o Michigan o Ohio o Wisconsin i West North Central o Iowa o Kansas o Minnesota o Missouri o Nebraska o North Dakota o South Dakota West i Mountain o Arizona o Colorado o Idaho o Montana o Nevada o New Mexico o Utah o Wyoming i Pacific o Alaska o California o Hawaii o Oregon o Washington 11 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 1: Populations Served by Type of Facility 18. Of the time that you spend providing clinical services, approximately what percentage is spent with the following age groups? Total must equal 100%. (Percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Clinical service provider Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Outpatient Age Groups Total SNF Client’s LTAC Hospital Hospital Clinic/ Office Home Hospital (n = 1,686) (n = 280) (n = 135) (n = 68) (n = 413) (n = 351) (n = 413) Infant-toddlers Mean 15.4 Statistical significance 4.1 2.7 F = 176.3, df = 5, 1653, p = .000 42.2 0.2 42.6 15.2 31.8 0.3 16.4 30.2 24.5 0.6 8.4 28.9 1.4 98.9 32.7 25.8 Preschool Mean 13.3 Statistical significance 4.1 3.8 F = 146.3, df = 5, 1653, p = .000 School age Mean 11.0 Statistical significance 3.3 4.1 F = 159.1, df = 5, 1653, p = .000 Adults Mean 60.2 Statistical significance 88.5 89.4 F = 405.8, df = 5, 1653, p = .000 12 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 2: Adult Patients, Areas of Intervention 21. Of the time that you spend providing ADULT services, approximately what percentage is spent in the following areas? Total must equal 100%. (Mean percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Clinical service provider Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Outpatient Adult Services Total SNF Client’s LTAC Hospital Hospital Clinic/ Office Home Hospital (n = 1,148) (n = 263) (n = 119) (n = 7) (n = 396) (n = 145) (n = 199) AAC Mean 3.1 Statistical significance 1.1 2.8 F = 20.0, df = 5, 1122, p = .000 (n < 25) 1.4 5.8 6.6 (n < 25) 0.1 1.3 1.4 (n < 25) 12.5 19.3 17.3 27.3 14.0 5.1 3.1 5.4 12.4 Accent modification/communication effectiveness Mean 0.5 Statistical significance 0.1 0.2 F = 2.6, df = 5, 1122, p = .023 Aphasia Mean 15.6 Statistical significance 13.9 23.3 F = 14.6, df = 5, 1122, p = .000 Cognitive communication: Dementia Mean 14.7 Statistical significance 5.5 8.7 F = 113.1, df = 5, 1122, p = .000 (n < 25) Cognitive communication: TBI Mean 7.6 Statistical significance 6.7 19.2 F = 43.9, df = 5, 1122, p = .000 (n < 25) (Table 2 continues on next page.) 13 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 2 (Continued): Adult Patients, Areas of Intervention 21. Of the time that you spend providing ADULT services, approximately what percentage is spent in the following areas? Total must equal 100%. (Mean percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Clinical service provider Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Outpatient Adult Services Total SNF Client’s LTAC Hospital Hospital Clinic/ Office Home Hospital (n = 1,148) (n = 263) (n = 119) (n = 7) (n = 396) (n = 145) (n = 199) Cognitive communication: Other Mean 2.4 Statistical significance 1.5 3.3 F = 5.4, df = 5, 1122, p = .000 (n < 25) 1.5 2.2 5.2 (n < 25) 4.8 9.5 9.1 (n < 25) 46.4 35.1 20.2 (n < 25) 2.6 5.2 14.9 (n < 25) 0.3 2.2 7.9 Motor speech Mean 6.8 Statistical significance 6.3 8.3 F = 9.2, df = 5, 1122, p = .000 Swallowing Mean 41.5 Statistical significance 59.2 29.7 F = 97.4, df = 5, 1122, p = .000 Voice/resonance Mean 5.8 Statistical significance 5.2 4.1 F = 26.1, df = 5, 1122, p = .000 Other Mean 2.0 Statistical significance 0.5 0.4 F = 14.2, df = 5, 1122, p = .000 14 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 3: Pediatric Patients, Areas of Intervention 19. Of the time that you spend providing PEDIATRIC services, approximately what percentage is spent in the following areas? Total must equal 100%. (Percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Clinical service provider Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Outpatient Pediatric Services Total SNF Client’s LTAC Hospital Hospital Clinic/ Office Home Hospital (n = 818) (n = 87) (n = 31) (n = 67) (n = 18) (n = 254) (n = 353) Articulation-phonology Mean 24.0 Statistical significance 18.9 13.4 F = 10.6, df = 5, 802, p = .000 15.0 (n < 25) 22.6 28.1 9.1 (n < 25) 5.5 5.3 7.4 (n < 25) 7.8 6.8 2.2 (n < 25) 1.1 4.5 30.1 (n < 25) 46.8 39.1 Augmentative and alternative communication (AAC) Mean 5.5 Statistical significance 3.7 5.5 F = 1.9, df = 5, 802, p = .085 Cognitive communication Mean 7.9 Statistical significance 7.1 28.2 F = 12.3, df = 5, 802, p = .000 Fluency Mean 3.0 Statistical significance 2.6 1.1 F = 5.6, df = 5, 802, p = .000 Language Mean 38.4 Statistical significance 24.0 23.9 F = 17.8, df = 5, 802, p = .000 (Table 3 continues on next page.) 15 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 3 (Continued): Pediatric Patients, Areas of Intervention 19. Of the time that you spend providing PEDIATRIC services, approximately what percentage is spent in the following areas? Total must equal 100%. (Percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Clinical service provider Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Outpatient Pediatric Services Total SNF Client’s LTAC Hospital Hospital Clinic/ Office Home Hospital (n = 818) (n = 87) (n = 31) (n = 67) (n = 18) (n = 254) (n = 353) Prevention/wellness Mean 1.0 Statistical significance 0.1 0.5 F = 0.9, df = 5, 802, p = .457 0.8 (n < 25) 1.0 1.1 29.6 (n < 25) 12.7 8.4 0.8 (n < 25) 0.3 3.6 3.4 (n < 25) 0.3 1.4 1.6 (n < 25) 1.8 1.8 Swallowing and feeding Mean 15.0 Statistical significance 36.3 22.9 F = 28.3, df = 5, 802, p = .000 Voice Mean 2.0 Statistical significance 1.4 3.2 F = 3.8, df = 5, 802, p = .002 Resonance Mean 1.3 Statistical significance 2.5 0.4 F = 3.0, df = 5, 802, p = .011 Other Mean 1.9 Statistical significance 3.6 0.9 F = 0.7, df = 5, 802, p = .655 16 ASHA SLP Health Care Survey 2013: Caseload Characteristics Report Table 4: Swallowing Services by Type of Facility 25. In your facility, do any professionals other than SLPs provide primary swallowing services (e.g., assessment, treatment, instrumental studies)? (Percentages) Analyses limited to respondents who met the following criteria: CCC-SLP Employed full-time or part-time General Home Health/ Medical/ Rehab Pediatric Responses Total SNF Client’s Clinic/ Office LTAC Hospital Hospital Home Hospital (n = 1,896) (n = 298) (n = 150) (n = 79) (n = 493) (n = 362) (n = 483) Yes 11.6 11.1 5.3 46.8 1.6 17.1 14.1 No 88.4 88.9 94.7 53.2 98.4 82.9 85.9 Statistical significance Ȥ2(5) = 163.2, p = .000, Cramer’s V = .296 7/29/13 17
© Copyright 2026 Paperzz