Many speech pathologists have ventured outside these established traditions into areas involving non-clinical behavior, such as public speaking, voice training, and foreign accent. These new ventures can generate confusion among professionals.

A speech-language pathologist (SLP) providing instruction in accent modification exclusively (in the absence of any clinical condition requiring a formal medical or special education referral) is not providing a clinical or healthcare service. When a clinician or SLP provides this services in the U.S., it is considered an elective service by the American Speech-Language & Hearing Association (ASHA), the regulating body for licensed speech clinicians.

The recipient of accent modification instruction is not a patient. Consider them your students, participants, or ideally, your clients.

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This isn’t therapy.

“Accent therapy” is simply an inappropriate term. Accented speakers are not producing disordered speech. The presence of an accent does not constitute a delay or disorder in the speech production process. An accent is the result of speaking English after learning the phonology of another language, or of English as it is spoken outside of the United States. ASHA acknowledges this with very similar wording in promotional material targeting members of the public who are seeking the assistance of a speech pathologist for accent-related concerns (http://www.asha.org/public/speech/development/Accent-Modification).

When a speech professional addresses foreign accents, he or she is engaging in a very specialized form of ESL teaching, and may be using concepts and principles that are already familiar to speech pathologists. Since clinical knowledge and concepts may be applied during the instructional sessions, the ILP believes a speech-language pathologist is among the most qualified individuals to do the job. Because speech professionals tend to think in “clinical” terms, they may sometimes slip into thinking of their clients as patients and the training as therapy. This does not make it so, and it is important to keep this distinction in mind.

The true role of the accent modification instructor outside of clinical settings is a consultant.

You may happen to be a consultant who also holds a license to practice speech-language pathology, but when addressing a client’s concerns regarding pronunciation in the absence of any disorder or limiting condition, there isn’t a pathology to address. Teaching a consenting adult to begin using new habits is behavior management at best. Tennis instructors, martial arts teachers, and cooking show hosts use variations of the same approach.

When the professional who conducts training for pronunciation and accent modification does so in a clinical setting, or under the administration of a clinical organization (in other words, as an employee or representative of a clinical service provider), all of the expected and required ethical and confidentiality concerns associated with clinical service delivery must be addressed. If your client receives your services within the context of a clinical service delivery model, then you are, indeed, presenting yourself as a speech pathologist.

The practicing SLP can opt to create a simple agreement statement which acknowledges the non-clinical nature of the services being provided. This agreement should acknowledge the absence of a medical diagnosis, medical treatment, or medical referral, and can be included in your payment/service agreement or contract. Examples of this will be provided later in the course. This type of agreement would not be appropriate for a practicing clinician who provides accent and pronunciation instruction to individuals who were referred through a clinical setting. Licensed SLPs who provide accent modification instruction as an elective service in a clinical setting are expected to adhere to ethical standards and practices as set forth by ASHA and/or the local and relevant regulatory and licensing boards.

Let’s define clinical setting.

The term  clinical setting does not simply imply a physical location.

Think of the clinical setting as an environment, or a set of circumstances.

A clinical setting is determined by the environment and circumstances in which referral, assessment and treatment services are provided. An individual may be referred to a speech-language pathologist by a physician for a variety of reasons. A clinician can decide to provide treatment to an individual to address an identified disorder.

An accent, whether regional or foreign, is neither a medical diagnosis nor a disorder. There is no such thing as “treatment” for an accent.

If the referred individual seeks the services of a speech pathologist based on a doctor’s referral, the patient is receiving the referral and any potential services in a “clinical environment.” That individual is treated as a patient, and all interactions and data collection are subject to health information privacy rules and HIPPA (Health Insurance Portability and Accountability Act) security rules, as well as the ethical standards of clinical service delivery as set forth by ASHA, even if the CCC-holding instructor operates as a sole proprietor or independent business entity.

Take the medical referral and the identified condition out of the equation, and you have a non-disordered, neuro-typical consenting adult client – not a patient, and no treatment.

If you hold a Certificate of Clinical Competence (CCC) awarded by ASHA (the American Speech-Language-Hearing Association), you have an ethical responsibility to refer any individual whom you suspect may have an underlying condition related to a communication disorder. If, after informally consulting with a potential client, you detect no suggestion or suspicion of such an underlying condition, you may proceed to consult, tutor, instruct and teach non-clinical skills for a fee. The intake process for the PESL method, as you will learn in an upcoming unit, will help rule out these suspicions.

Any instructor with no clinical affiliations whatsoever does not need to make these distinctions, as there are no regulatory bodies governing or dictating the practice of accent modification instruction. Any one can “hang up a shingle” and offer accent modification instruction, and call the service by whatever name they choose. The practice and delivery of accent modification services is not overseen or controlled by any regulatory board. That’s because in providing such a service there aren’t any disorders or conditions being diagnosed or treated. An accent is simply the result of speaking more than one language, or speaking a language in more than one geographical-linguistic region.

ASHA acknowledges and promotes this perspective on their public information page regarding Accent Modification. ASHA categorizes accent modification instruction as an elective service which speech-language pathologists may chose to provide. Remember… anyone can provide this service.

If you are a licensed SLP, your experience may support your credibility when presenting to potential clients, as long as they understand the instructor and client roles:

• the instructor will not provide any clinical or diagnostic services;
• the instructor will not provide services based on any medical condition;
• the client will voluntarily participate in speech production exercises that are deemed safe for any healthy individual and do not create a threat to their health or welfare in any way.

It is acceptable to display clinical credentials. You may print your credentials on business cards and web sites, much like celebrity doctors show their credentials on book covers. Showing your credentials in this manner does not imply the delivery of clinical services. It does not make you the client’s healthcare provider. If that were so, Dr. Mehmet Oz and Dr. Deepak Chopra would have an awful lot of paperwork to file for each of the millions of people who read their books and subscribe to their digital newsletters. It should be noted that these items are required to include disclaimer statements to rule out confusion or misleading representation.

You must never, ever misrepresent the field of speech pathology, or your title.

If you are providing accent modification instruction in a clinical setting, all of this information supports your work as long as you follow standard intake and treatment procedures. If you happen to be a licensed SLP who wishes to provide this service independent of a clinical employer and clinical environment, follow the simple steps to rule out the need for a referral, and you may ethically and safely provide this service to paying clients.

The perspectives, approaches, standards and regulatory mandates mentioned in this unit may not apply in locations outside of the United States.

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Required Viewing: Watch the Video for Unit 1.1 for more insight and details about the role of the instructor.

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Now that we’re all starting from the same point of understanding regarding who can offer accent modification instruction, let’s dig in to the good stuff…

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