National information
Archives: 1999-2000
Finland
Specialization studies in speech therapy
After many years of stand still, the legal grounds of starting the specialization studies in speech therapy have finally come to the point that serious planning of the specialization education program is to start this spring. With the support of the Ministry of Education, a post has been opened in the University of Helsinki for a person who will make the first version of the plan during the forthcoming summer.
The specialization education program is part of post graduate studies* for those speech therapists who already have their master's degree and want to advance their professional skills also to the direction of scientific study. The specialization education is planned to take 2-3 years and consist of 50 credits, including a theses based on scientific study on a professional topic.
After a planning period of around one years, the program will start to recruit first students and focus on neurogenic speech-language disorders.
*Note that in Finland the students in logopedics graduate with MA degree. The second degree is so called Licenciate in Philosophy (not obligatory), and the third one is the PhD. degree. The specialization studies will lead to the Licentiate degree.
Incomes policy agreement signed
A new comprehensive incomes policy agreement for Finland was signed on Friday 15 December 2000. The two-year wage agreement will mean an increase in labour costs of 3.1% in 2001 and 2.3% in 2002. The agreement covers about two million wage-earners, comprising some 90% of Finnish employees.
The new agreement was signed by all of the central employer and employee confederations except the Confederation of Unions for Academic Professionals (AKAVA). Despite the failure of their parent organisation to sign, however, unions representing a large proportion of the AKAVA membership base have also negotiated collective agreements that are in line with the general agreement.
Of AKAVA members, nursery school teachers, librarians, psychologists, speech therapists, social workers and doctors declined to sign the new agreement. These unions, representing the low-paid sectors working most typically in the municipalities, also demonstrated - in a recognized way - their unsatisfaction toward the present situation and demanded a special act to be taken to improve the median level of their wages.
Commentary
An odd feature of this round was AKAVA's decision to remain outside the agreement as a central organisation. However, almost all its member unions joined the agreement. Some of the unions that remained outside will most likely take some sort of industrial action. The problems are focused on the low-paid sectors like kindergarten teachers, who work in the municipalities. The Prime Minister, Mr Paavo Lipponen, has already promised to support the idea that also the municipalities should start a wage structure study.
(Modified version of the AKAVA information letter from 18 December 2000)
France
May 2001
For the last three years, French Speech and Language Therapists have been working with government agencies on redefining their professional responsibilities in three areas:
Redefining competence with a stress on greater autonomy in prescribing therapeutic interventions, a clearer definition of areas of competence, a broader definition of those therapeutic acts for which therapists are considered competent, a recognition of their competence in health education, prevention, training within and outside the profession, research and participation in the struggle against illiteracy;
Revision of the text of the professional act nomenclature covered by the national health insurance program: Professional acts will most likely be reformulated and the content of SLT assessments will be clarified;
The creation of "regional and national Offices" for paramedical professions, which will delineate ethical, jurisdictional and administrative powers for five professions: physiotherapists, nurses, Speech and Language Therapists, Orthoptists and Podiatrists.
Germany
Legal guidelines for prescription of logopedic intervention
In October 2000 the Dbl has started a press campagne against the new guidelindes for prescription of logopedic intervention saying that these guidelines will reduce the number of prescription in a way that children with speech and language disorders will no longer have the possibilty to get logopedic intervention.
The health care system in Germany is dominated by physicians and the health insurance funds which means that these two groups determine the guidelines for prescription. They form the commission of physicians and health insurance ("Bundesausschuß Ärzte Krankenkassen"), a constitutional instituition. The only legal way for logopedists (or other paramedical groups) to influence these guidelines is to declare a statement. Concerning the actual guidelines the Dbl has criticized the following points:
1) Obligatory medical diagnosis restricted to the following physicians: Phoniatrics, ORL, (Neurologist only in case of aphasia)
Most of the prescriptions in private practice in Germany come from the paediatrics (about 55%) because they ensure the medical prevention check-up in children from 0 - 6 years. About 20% of the prescriptions come from the GP (General Physic-ian) prescribing logopedic intervention after rehabilitation. The restriction to specific physicians does not correspond with the german prescription practice.
The second aspect was that the kind of diagnosis should cover also the logopedic diagnosis. Physic-ians should therefore be responsible for the realization of diagnosis in speech, language and voice disorders while now the logopedists in Germany can realize this diagnosis independently.
2) Medical orientated nomenclature
The structure of the guidelines represents a medical orientated nomenclature following the WHO- ICD 10 of 1980. The Dbl has tried to describe another structure following the actual nomenclature of the ICIDH-Beta Draft 2 of 1999 corresponding better to our fioeld of work.
3) Fixing of the number of intervention for each kind of disorder
The guidelines prescribe the number of interventions for each of the disorders without having realized any research to determine the minimum or maximum of interventions.
The Dbl has convinced the Ministry of Health to change the guidelines in terms of the first argument but not for point 2 and 3.
The Dbl is convinced that the low status of our profession in Germany is the raison why German logopedists have actually no chance to gain acceptance by the political authorities.
Consequences for the Dbl
- Undergraduate education in Germany has to have the same level as all over in Europe.
- German logopedists need to establish research in speech and language pathology.
- The profession has to be independent of medical prescription.
There are different ways to reach these aims, the Dbl has already started some activities to change the status of the profession.
Actions to raise the level of undergraduate education
The Dbl has formed a working group in which the different professional groups working in the field of speech and language pathology in Germany take part. The following academic professions are integrated in this group:
- Clinical linguists
- Rehabilitation pedagogues (Sprachheilpädagogen)
- Speech trainers/researchers (Sprechwissenschaftler)
The working group has worked out a professional profile and minimum standards for undergraduate education in Germany following the CPLOL-standards. These papers have been presented to the politics in Germany without any effect until now.
The next steps will be to present the quality of logopedic assessment and intervention methods in public; at the G.A. of the Dbl in June there will be a vote on the „Quality Guidelines of speech and language pathology".
Italy
May 2001
In Italy, in the first months of the year, an university reform has been approved, which turned to be
very important for speech therapy. Our Ministry of University and Scientific Research has conformed the studies in our country to the European model, reorganizing all the university courses in: "diploma of bachelor" (3 years), "diploma of specialist bachelor" (other 2 years in the same field of formation), "master" ( 1 or 2 years on a specific subject), "doctorate" in the field of the research.
This reform will allow us to have, in a few years, a very complete and articulated formation in speech therapy. FLI, together with other professional associations, has a lot fought for having a role in this reform and for transforming current diplomas, according to the new norms, already from next academic year.
It does not seem easy to obtain at once a specialist bachelor (that will be common at 60% to other rehabilitation professionals); it will be attempted to begin with master and doctorate: this will be the objective of our work in a reasonable time of 3-5 years.
In the hospitals and in the centres of speech therapy a great effort continues in order to activate the manager role, that is always opposed by doctors and psychologists. Anyway, the law 251/00 previews this level for the speech therapist and the process, even if it will be slow, will be completed.
FLI will have its next Congress in Naples on 25-26-27 October 2001, having postponed the one of 2000. The central topic will be swallowing in all its physiological and pathological aspects, in the children and in the adults, from the speech therapy point of view and in relationship to ENT, orthodontics, facial surgery, neurology.
It has been observed that the treatment of dysphagia and swallowing disorders represents, in this moment, the most recent and massive kind of intervention in our field of competence.
The congress will include a conference about "Minimal standards in the initial training of ST in Europe and free circulation of professionals", with the participation of representatives of Health Ministries from several European countries.
Luxembourg
Acknowledgement of diplomas by Ministry
In May 2000, representatives from A.L.O. met with the Ministry of Health and Welfare to discuss their concern regarding acknowledgement of diplomas.
A.L.O; insists on a conditional right to practice for those speech and language therapists who do no speak the three official languages spoken in this country, which would allow them to practice in their mother tongue. The legal specialist from the Ministry of Health claims that the European legislation does not permit this type of restrictive right. The president of A.L.O. has therefore taken the necessary steps to have her diploma recognized in the various countries of the European Community. Results from these proceedings will be communicated to the Ministry in the near future.
Training in dysphasia-dyslexia
A.L.O. organized two training courses on dysphasia and dyslexia in December 2000 and March 2001.
Taking a stand
During the month of March, A.L.O. publicly criticized various radio and TV programs on dyslexia. Information given on the treatment of dyslexic children was incomplete since no mention was made of the role of the speech and language therapist in therapy. We also requested a meeting with the Ministry of Education to discuss our concerns, but our letter remained unanswered.
Negotiations with the Union of Health Insurance Companies
New negotiations took place regarding reimbursement by the Union of Health Insurance Companies of aphasia-related expenses and post cochlear implant remediation. Reimbursement for written language disorders was again rejected.
Introducing statistics for UCM (Union of Health Insurance Companies)
The "private practice" task force has constructed a questionnaire which will permit the statistical evaluation of speech and language therapy in the private sector. These statistics will usefully support our forthcoming negotiations with the Union of Health Insurance Companies.
Ethics
The Ministry of Health has asked the Higher Board of Health Professions to draw up a common code of ethics for all professions represented on this Board. Since some of these disciplines had already drawn up their own code of ethics, they disagreed with this plan. After discussion, it was decided that a common code would be written for all professions, complemented by a specific code for each profession concerned. The final document will be submitted to the Ministry of Health in the months to come.
Insurance for dependent persons
In September 2000, A.L.O. introduced in the Insurance for Dependent Persons a list of all speech and language activities, taken from the July 2d, 1999 WHO memorandum.
Portugal
We are happy to inform that our basic 3 year Bachelor's Degree course is now completed with another year which gives a Licentiate Degree to our new students!
There has been a big adherence from all the "older" therapists (those who have already completed the bachelors degree course and who now wish to continue their studies) which is a good sign of the necessity of this change.
As you know there are only 2 recognized schools in Portugal, so we are happy once more to inform that a new Institute has been legislated and a speech therapy course will initiate in the year 2001/2002.
The 2nd National Congress of Speech Therapists is taking place on the 16th and 17th of November 2001. there will be 3 main themes:
- Education of Speech Therapists and one of our invited speakers as representative of CPLOL is Linda Schrey-Dern.
- Language disorders and literacy skills
- Clinical phonology
Sweden