JCPSLP Vol 22 No 1 2020

generally vocationally trained with a Certificate III or IV in allied health assistance. AHAs are required to have supervision provided by an AHP and are encouraged to access continuing vocational development by way of appropriate training and in-services. When working with speech-language pathology, AHAs may be employed in a range of settings and practice areas across the lifespan (O’Brien et al., 2018). They are considered by Speech Pathology Australia (SPA) as a supplementary workforce and not as a replacement for qualified speech-language pathologists (SLPs). SPA has specified the range of tasks which are unsuitable for delegation to AHAs, including (but not limited to) assessment, diagnosis and clinical problem solving (SPA, 2016a). AHAs are not able to become members of SPA, they do not currently have a governing or representative body, and they also do not currently have a unique award category, meaning that information regarding this group is difficult to access (NSW Health, 2012). Lizarondo and colleagues (2010) explored the roles and responsibilities of people in roles whose aim was to assist AHPs, including but not limited to therapy assistants, rehabilitation assistants and Indigenous support workers. They conducted a systematic review of the literature which identified 10 eligible studies, of which the methodologic quality was not examined. In this work, they discuss that assistant roles fall into two key categories: clinical duties requiring client contact, and non-clinical duties requiring no client contact. Lizarondo and colleagues (2010) discuss the diverse ways in which the tasks of assistants and professionals are described; the professionals’ tasks were described as “evaluating, assessing, diagnosing, planning, and implementing” (p. 151), while assistants’ tasks were described as “assisting, supporting, administrating, monitoring, and maintaining” (p. 151). The difference between the description of tasks was discussed as accurately representing the scopes of practice of the professional and vocational groups, and reflecting the tasks which remain the sole responsibility of AHPs (Lizarondo et al., 2010). Allied health assistant training Allied health assistance training is a nationally recognised qualification (specifically Certificate IV) which allows the AHA to work either with their chosen allied health field or as a generalist AHA across two or more allied health areas (including for example, physiotherapy, occupational therapy or podiatry). General electives in the allied health assistance course include modules such as Work with diverse people, Interpret and apply medical terminology appropriately, and Manage legal and ethical compliance (TAFE NSW, 2017). AHAs training to work with speech-language pathology can choose to undertake specific electives, including, for example, Provide support in dysphagia management and Supporting the development of speech and communication skills (TAFE NSW, 2017). Student AHAs are required to pass assessments using case studies and presentations, and are also to undertake clinical placements totalling at least 120 hours under the supervision of a qualified AHP (TAFE NSW, 2017). AHAs’ level of supervision in these placements is dependent on their level of experience and skill, as judged by their supervising AHP. The AHP delegates tasks to the student AHA as guided by their professional association, employing organisation, and their own confidence in delegation (Queensland Health, 2016). Prior to completing these placements, AHA students are required to meet the specific requirements of the health

service including criminal records checks, relevant codes of conduct, and working with children checks. There are people in the workforce undertaking assistant roles who have not undertaken vocational training, and in these instances, some Australian health services are conducting recognition of prior learning in order for them to gain vocational recognition for the skills and experience gained through their employment (NSW Health, 2012; Queensland Health, 2016). There is currently movement in health services to employ AHAs with Certificate IV qualifications; however, variation remains in AHA training given the different available training organisations and courses. Allied health assistant demographics In a 2012 survey of AHAs employed by NSW Health (NSW Health, 2012), it was found that there were 787 AHAs employed across NSW health, including assistants in pharmacy. It was noted, however, that the survey data was reliant on manual entry, so these numbers were considered as an estimate. These data showed that the AHA workforce was largely female (78.9%). Of AHAs workers, 48.9% worked part time, with 38.9% working in metropolitan areas, 38.9% in regional areas, and 21.7% working in rural areas (NSW Health, 2012); 30% of AHAs worked in acute or community settings, 40% in a subacute setting, with the average length of employment being 6.6 years. It was noted that there were inconsistencies in the qualifications gained, with only 33.7% of participants holding a Certificate IV at the time of the survey (NSW Health, 2012). As shown in Table 1, male participation and rural working are very different between AHAs and SLPs.

Table 1. Workforce and demographic characteristics of AHAs and speech-language pathologists

AHAs

SLPs

% males

21.1% (NSW Health, 2012) 48.9% (NSW Health, 2012) 21.7% (NSW Health, 2012)

2.5% (AIHW, 2013)

Part-time work

38.9% (Lambier & Atherton, 2003) 23.7 SLPs/100000 population (AIHW, 2013) Approx. 4.5% (O’Callaghan, McCallister, & Wilson, 2005)

Rural

The role of allied health assistants in speech-language pathology AHAs have been utilised in speech-language pathology in the US, UK, Canada and in some states of Australia. However, working with AHAs remains poorly documented in the speech-language pathology literature (O’Brien et al., 2013). AHAs in speech-language pathology are employed across a range of settings including both paediatric and adult caseloads, disability and brain injury services. They have been utilised across levels of acuity from inpatient to community and telepractice settings. Some professional associations such as the American Speech Hearing Association (ASHA) and the Royal College of Speech and Language Therapists (RCSLT) have reflected the importance of AHAs to the profession by creating a

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology