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The Ultimate Guide to Clinical Fellowship for Speech Language Pathologists

Written by Gary Adams, M.A. CCC-SLP, Published on February 5, 2018

The Ultimate Guide to Clinical Fellowship for Speech Language Pathologists

Hey there, soon-to-be SLP! We've put together a guide of the need-to-know info for graduating and starting your career as a Speech Language Pathologist. Wherever you are in your journey, it's never too early or late to learn about this process. Clinical Fellowship through ASHA is the only way to earn those sweet, sweet letters "CCC" in addition to "SLP".

Access the pro-version of this post that includes over 20 videos of SLPs sharing their experience and tips for clinical fellowship.

So . . . what is Clinical Fellowship for Speech Language Pathologists?

Clinical Fellowship is an opportunity that ASHA creates for graduates to apply what they’ve learned, become an independent provider, and increase clinical effectiveness with the help of a mentor. We made this guide for students on their way to becoming SLPs: students who are currently enrolled in a master’s program at a school certified by ASHA’s Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA).

Most schools who have Communication Sciences and Disorders Programs are certified. If you're not sure, here's a list of ASHA’s accredited programs. Being a student in one of these programs streamlines your application for Certification in Speech Language Pathology.

Click here to see the application form.

What's the difference between grad school and Clinical Fellowship?

Your first job as an SLP on your way to earning Certification from ASHA is known as Clinical Fellowship. As a CF-SLP, you have more responsibility and autonomy than you had as a graduate student clinician. Three significant changes from grad school are:

  1. You will practice using your own license
  2. You will get paid for the services you provide
  3. You will not have a supervisor watching you for the majority of the time that you work

What’s it really called?

You may have heard CF and CFY used interchangeably to describe clinical fellowship. A number of years ago, ASHA changed the terminology from CFY to CF. This was probably due to that fact that the Y in CFY stood for YEAR. And Clinical Fellowship is not necessarily one year—its length depends on the number of hours you work.

When you hear an SLP mentor say CFY, that could be a red flag, indicating that they are not up to date on the current CF requirements.

When you refer to your Clinical Fellowship, use "CF" not "CFY."

What does it mean to be an SLP who is certified by ASHA?

CCC-SLP are six letters and a hyphen that mean so much. CCC stands for Certificate of Clinical Competence It indicates that you are a competent professional within the setting of a clinic. SLP, as you know, stands for Speech Language Pathologist.

The designation of CCC-SLP is awarded by the American Speech Language and Hearing Association (ASHA) to create a standardized credential for professionals who provide services related to speech and language.

Real Life Example: Imagine that you’re a parent looking for help for your daughter—you know that teaching social language to your child with autism will be very difficult & making a difference requires a rather particular skill set. Without knowing anything else about the person, the letters CCC-SLP tell you a lot about their education, clinical experience, and skills. Additionally, people with professional associations have standards to maintain—this holds them accountable. Imagining you’re the parent, think about how reassuring it is to have someone with CCC-SLP after their name.

It’s the same for employers who hire SLPs—with just the letters after your name, they know that you have completed a set of requirements that prepares your for work as an SLP. What’s the result, you ask? A good job market for CCC-SLPs.

What do you need to begin practicing?

At a minimum, you just need a state license to begin practicing Speech Language Pathology. This is primarily a guide to clinical fellowship, but there’s no way around it: state licensure is absolutely necessary for you to begin practicing after graduate school. So we’re covering the basics of state licensure.

Every state has their own department for professional licenses. Each state has unique requirements so it is of utmost importance that you check your state’s requirements. ASHA has a fantastic tool to begin researching state licensure requirements.

In most states, SLPs immediately out of graduate school apply for a special license, which is sometimes referred to as a temporary, limited, interim or provisional license. Full state licensure is obtained after the requirements for this special license are met.

Requirements for new graduate SLPs

While each State Regulatory Agency is unique, there are commonalities throughout. Most states require your graduate program transcript, a criminal background check, Praxis results, verification of employment, and a fee. While you’re still a student, familiarize yourself with your own state’s regulatory agency and what they require for Speech Language Pathology.

It’ll make your life easier if you list your state regulatory agency as a recipient of your PRAXIS exam scores.

If your state requires employment verification, it can be tricky. Figure out the process for your own state. Typically it’s a single form that a fully licensed SLP will sign and submit to the agency. It shows that they are supervising you—the provisional licensee—on your way to becoming fully licensed in the state you practice.

Gaining an early understanding of this employment verification process will make your application for state licensure much easier.

State licensure for Speech Language Pathologists

State licensure seems like a complicated process that’s expensive and working against you. It’s actually not! State Licensure is one of the biggest advantages that SLPs have.

A government agency that regulates licensure ensures that only the right people can provide Speech and Language services. For licensed SLPs, the result is a smaller, more skilled workforce. That limited supply results in higher wages for services. Even with fees considered, state licensure financially benefits SLPs.

A license in your state is required by law. It’s the minimum requirement for practicing SLP.

Access the pro-version of this post that includes over 20 videos of SLPs sharing their experience and tips for clinical fellowship.

Standards for ASHA Certification for Speech Language Pathologists

If you would like to someday become a CCC-SLP, you must apply for certification through ASHA.

There’s a Council within ASHA that plays a very significant role in certification. Knowledge of this council and the document that they publish will help you make sense of the certification process.
We’re talking about the Council for Clinical Certification in Audiology and Speech Language Pathology, abbreviated CFCC.

One of the responsibilities of the CFCC to define the standards for certification. You may be surprised to hear that the CFCC has already impacted your life. By setting the standards for Certification in Speech Pathology, they’ve shaped the graduate program of study in which you’re currently enrolled.

Reading the requirements for certification directly from the source is empowering. We recommend reading the CFCC’s 2014 Standards and Implementation Procedures for the Certificate of Clinical Competence in its entirety. It’s only a few pages long and is written in clear, plain English. 

When should you apply for certification?

We recommend applying after you receive your graduate degree; that is, at any time during your Clinical Fellowship. For the application to be accepted, you must submit:

  • Official graduate transcripts
  • Praxis examination results
  • Application form
  • ASHA dues of $461 (Yikes! But don't worry, there are discounts . . . )

The NSSLHA to ASHA conversion discount drops the dues from $461 to $286.

What's the purpose of the Clinical Fellowship for Speech Language Pathologists?

Clinical Fellowship is a subject that we’re very passionate about. It’s an experience that allows you, with a mentor, to apply your academic knowledge, identify your personal strengths and weaknesses, and develop clinical skills.

In ASHA’s words, at the completion of the CF experience, the Speech Language Pathologist will have acquired and demonstrated the ability to

  • Integrate and apply theoretical knowledge
  • Evaluate his or her strengths
  • Identify his or her limitations
  • Refine clinical skills within the Scope of Practice in Speech-Language Pathology
  • Apply the ASHA Code of Ethics to independent professional practice

In addition, upon completion of the CF, you must have demonstrated the ability to perform clinical activities accurately, consistently, and independently and to seek guidance as necessary.

We’ve divided the Clinical Fellowship information that we’re presenting into three broad sections. The first is mentorship. The second is time. The third is documentation. First, we’ll dive into mentorship.

Mentorship for Speech Language Pathologists

A CF Mentor is a CCC-SLP who takes on a number of responsibilities in agreeing to provide CF mentorship. Since your Certification of Clinical Competence is dependent on your mentor, it’s important to know their role in this process. To facilitate selection, ASHA provides guidelines for selecting your mentor.

Your CF Mentor’s ASHA certification must be active for the duration of your CF. Before beginning and periodically during, every CF needs to verify their mentor’s certification with ASHA. Verifying is a simple, quick process that should never be overlooked. Here's the link to ASHA’s online verification system.

Why verify? Any period that your mentor’s certification is not active will not count for your CF.

A quick note that may or may not affect you—ASHA states that your mentor cannot be related to you in any manner.

How to Choose a Mentor as a Speech Language Pathologist

It’s best to work with a mentor whose career you admire and who will work closely with you. Physical location is significant because face-to-face meetings cannot be substituted for alternate methods (phone, video etc). To make sure that you’re a good fit with your mentor, a few good phone conversations can reveal a lot.

Here’s our advice: Get to know and talk about ASHA’s Code of Ethics with your potential mentor.

Why talk about the Code of Ethics? Well, you have to know the ASHA’s Code of Ethics anyway. Plus, it’ll help you go beyond the niceties of social discourse and reveal a lot about one another’s thought process.

From conversations like those, you can predict how you and your mentor will communicate during the CF experience.

One more piece of advice, if your mentor has supervised other CFs, talk with those people about their CF experiences.

Before committing to the mentorship process, you & your mentor should set expectations for your experience. Your Mentor will ultimately be responsible for making a recommendation for your certification.

Making the Most of Mentorship as a Speech Language Pathologist

Directly from ASHA’s Information for Mentors, your mentor’s main purpose is to increase your clinical effectiveness. The best thing that you can do as a CF is to align yourself with your mentor. Accordingly, your main purpose during Clinical Fellowship should be to increase your clinical effectiveness.

As a requirement of Clinical Fellowship, you and your mentor will set aside time to meet. You’ll receive performance feedback, identify strengths and weaknesses, and, through discussion, establish goals to increase clinical effectiveness. Mentors try very hard to provide helpful performance feedback, answer questions, and foster experiential learning. They’re not giving you the answers; instead, they are guiding you to your own solutions and helping you transition to independent practice.

A word to the wise: It can be hard receive constructive feedback without getting either defensive or reverting to the supervisor-supervisee relationship that you had in grad school.

Be mindful of your role as a CF, appreciate feedback from your mentor, and always work to improve your clinical effectiveness.

Time Investment in Clinical Fellowship as a Speech Language Pathologist

In practice, Clinical Fellowship usually starts after you’re out of graduate school completely, as you begin your first job as an SLP.

According to ASHA, the requirements for Clinical Fellowship are: Completion of 1260 hours wherein at least 80% of that time is spent in direct clinical contact. Working 7 hour days 5 days a week, that will equal 36 weeks. Accounting for holidays and typical days off, that’s about 9 months working full time. ASHA notes that even if you work more than 35 hours per week, you cannot shorten your CF—it’s still 36 weeks.

Regarding supervision hours, for each of the 3 segments, your supervisor will participate in 6 hours of on-site observations of direct client contact and 6 other mentoring activities. In total that’ll be at least 18 hours of on-site observation and 18 other mentoring activities throughout your CF.

Think about the 1260 hours that you’ll be working. Just around 18 hours of those hours are direct observation by your mentor. That should give you an appreciation for the level of independence that you’ll experience as a CF.

For a full description of hour requirements, refer to the CFCC’s standards for certification that we introduced earlier.

Access the pro-version of this post that includes over 20 videos of SLPs sharing their experience and tips for clinical fellowship.

Documentation of Clinical Fellowship as a Speech Language Pathologist

Clinical Fellowship is divided into three equal time segments. If you’re working full time, that’s about three months per segment. At the conclusion of each segment, your mentor will assign a rating of your clinical skills in accordance with ASHA’s Clinical Fellowship Skills Inventory, abbreviated CFSI.

Let’s talk about the CFSI. It is not submitted to ASHA—it's for reference only. The CFSI consists of 18 skill statements covering four areas:

  1. Evaluation
  2. Treatment
  3. Management
  4. Interaction

Your supervisor rates your skills on a scale from 1-5. ASHA’s approval of clinical fellowship requires a minimum rating of 3 on each of the core skills. On the CFSI, those are marked with an asterisk.

Your supervisor records these ratings on a separate document that IS submitted to ASHA. This document is called SLPCF Report and Rating Form.

The SLPCF Report and Rating Form is important. It’s a two-page form that represents your entire CF.

The form asks for your CF mentor contact info, CF setting, duration, number of hours that you worked per week in direct clinical contact, skills rating, and finally your mentor’s recommendation for CCC-SLP.

Ultimately, Clinical Fellows must demonstrate knowledge and skills consistent with the ability to practice independently.

After you complete your CF, you will submit the SLPCF to ASHA as part of your Application for certification.


Landing Your First Job as a Speech Language Pathologist

This next section is about preparing you for the interactions that you’ll have with potential employers. We’ll cover what they look for when hiring and give you tools to realize more professional opportunities.

There’s a lot that you can do as a grad student; getting started now will make the process easier when you’re looking for your first job as an SLP.

How to Make Your Resume Stand Out as a Speech Language Pathologist

If you feel like there’s nothing relevant for you to put on your resume, remember:

Not having much experience is OK - everyone started there.

Resumes are used to communicate your education, experience, and potential as an employee. Here are a few tips:

  • Edit your resume to remove irrelevant activities, awards, and part-time experience.

When you’re applying to work as a Speech Language Pathologist, your resume should support your credibility and potential to function in that job.

  • Add specific information about your externships.

You’ve probably used a number of assessments and treatment approaches. You must have used some therapy documentation system as well.

List each clinical experience separately and elaborate on the responsibilities that you had there to give employers a clear understanding of your professional experience.

  • Add your title—Speech Language Pathologist or CF-SLP.

Place it after your name or near the top of your resume. Employers see many professions in addition to SLP so that helps them.

Money (let's not avoid the subject!)

Some people find talking about money to be difficult. If that’s you, then try to take this perspective: You’ve invested a lot in your education. Too much to not get compensated fairly for your work. Have the conversation BEFORE you agree to work.

We’ve done some research on the topic of pay to help you set expectations. Clinical Setting and Location affect pay significantly.

A rough estimate of median annual pay for Clinical Fellowship SLPs is 49—thousand. That’s pretty well in line with what we and most of our friends have earned for CF.

Median pay for fully licensed SLPs is somewhere around $58,000 to $78,000 annually. To get these numbers, we looked at the US Government's Bureau of Labor Statistic and PayScale. Checkout those links and do your own research too!

Many job offers use hourly pay so let’s talk about those numbers too. The median for fully licensed SLPs is $34.40.

The hourly rate for CF-SLPs was not as easily available, but from experience, it’s just slightly less than that, around $30 per hour.

Equally as important as the money you make is the money you spend.

Benefits from your employer affect your total compensation. The biggest one is healthcare. If you need to buy healthcare yourself, without going through your employer, it’s usually hundreds of dollars per month. $300 is a reasonable estimate.

Even if your employer provides health insurance, you may be responsible for paying a portion of your health insurance premium, which can be hundreds per month.

Pay and benefits are a significant part of your professional career so we hope that you take initiative and approach the matter with confidence.

Pay will always be in writing, on your contract. In the next section, we’ll talk about reviewing your contracts for employment. 

Contracts 101 for Speech Language Pathologists

Contracts are used in every employment setting! Let's talk about what you need to know.

Never immediately sign what's handed to you—take the time to read it! Even if that means your new employer is waiting for you.

When you read your contract, check if your contracts refer to any other document. Sometimes they leave things out of the main contract and bury it inside of a much longer document. It may be named something like “employee handbook” but it’s used to bind employees into all sorts of terms and conditions.

One term to look out for is “non-compete.” A non-compete clause limits your options while you’re under contract or sometimes limits your options for years after your contract ends. Some clauses prevent you from working with other clients. Some prevent you from working in a geographic area.

Keep your eyes peeled for a non-compete clause in your contract.

Sometimes you & your employer will edit contracts by hand. This is normal. Make sure that the handwriting is legible on your copy and initial all handwritten edits. Always get a copy of your signed contract.

What’s Required to Start Working as a Speech Language Pathologist

We’ll list and explain what many employers require from SLPs before they even start working. The more that you prepare for these things, the quicker & easier it’ll be for you to start your first SLP job.

Here's what you will likely need:

  • CPR and First Aid Certification
  • Professional Insurance
  • TB Test
  • Background Check
  • SLP license issued by the state in which you'll practice

Access the pro-version of this post that includes over 20 videos of SLPs sharing their experience and tips for clinical fellowship.

Let's Dive Deeper into Those Requirements

BLS Certification. Most healthcare jobs in America require it—it’s common to see this in job descriptions as well. BLS Stands for Basic Life Support. It encompasses CPR and first aid. Definitely get your BLS certification before you’re looking for a job. We think that in-person classes are best, and some universities offer it for free. If you need to, it’s also available online from a number of providers, just Google it & classes will be about $15.

Professional Insurance. Professional liability insurance, also called professional indemnity insurance or errors & omissions, is a form of liability insurance that is standard for medical professionals. It protects you from civil lawsuits that may arise from your work as a therapist. Either your employer or you should have this insurance, so ask about it before you start. If you need your own professional insurance, you can get it quickly online. It’s around $90 per year.

TB Test. Many healthcare positions require Tuberculosis test, abbreviated TB Test. It’s a good idea to get this before you graduate, while you’re not in a rush to start a job. Some University health clinics offer this for free. Of course, keep the documentation handy to give to your future employer.

Background Checks. Each employer usually runs their own. Wait until your employer specifies and arranges for the background check.

Documentation of Licenses. State and ASHA license verifications are possible online, but many employers also want the hard copy of your licenses and credentials.

Usernames and passwords are really easy to forget, especially if you’re only using websites once per year to renew your license. As with your physical credentials, take extra care in making them organized, secure and accessible.

Focus on the Future

Where do you want to go after your CF? Decisions that you make and opportunities that you take advantage of as a grad student and CF can get you in a better position, closer to where you want your career to take you in the long run.

Know your Continuing Education requirements and when your maintenance period begins. Continuing Education is an opportunity to pursue your true area of interest. The knowledge you gain and the people you meet while earning continuing education units will help you specialize in your area of interest & advance your career.

Appreciate that your CF does not determine your entire career path and that your options are slightly more open when you earn your CCC.

PRN is a good way to shape your career when you’re a young professional. To work as a PRN means to work as needed. PRN SLPs pick up shifts at a facility like a hospital or skilled nursing facility (SNF, pronounced "Sniff").

Those facilities use a pool or list of PRN SLPs for when their primary SLP is out of the office, when they need additional help, on weekends, and for holiday shifts. PRNs usually work hourly at a premium rate.

P-R-N is Latin for Pro Re Nata, meaning "as needed."

An exciting, emerging trend in SLP is Teletherapy. It can be a great gig to supplement your primary job. Joining ASHA’s SIG for teletherapy is a great first step if you’re interested.

Career Growth for Speech Language Pathologists

The best way to advance your career is simple: it’s the tried and true method of doing your job well. When you do great work, sharing what you do with your community can lead to many other opportunities.

We recommend volunteering for screenings, which may be through your employer or a local organization. It’s good to know about Inservice training—it’s an effort to develop employee skills that many employers offer.

Volunteer to present in-service training and you’ll be in a leadership role.

Keeping in touch with your graduate program is a good idea. As you progress through your Clinical Fellowship and certifications, you’ll pick up a lot of great experience to share with students through NSSLHA or Alumni programs.

Sharing what you do with an online community can be really fun & rewarding. Blogging is a great tool to reflect and think critically about topics in our field. That reflection, critical thinking, then sharing with an online community benefits you & your readers.

Get Involved with ASHA as a Speech Language Pathologist

State and local professional association involvement can be a great experience that advances your career. Most states have an ASHA-recognized association. Find yours and when they hold their annual conference. These can be a great place to present research, network, and learn . . . Think of it as a mini ASHA conference.

Speaking of ASHA, there’s a year-long program for ASHA members that helps you develop your leadership potential. It’s called the Leadership Development program and it's worth taking a look at!

You’ll hear “SIG” at many ASHA events. It stands for Special Interest Group. These groups have a small fee, and can help you learn a lot about areas of the profession that interest you.

Asha has volunteer opportunities that actually make members a part of the organizational structure. We’ve linked the list of these ASHA committees. Take a look & see if any interest you. If you attend the national ASHA convention, that’s a great time to talk with ASHA leadership about those opportunities.

Access the pro-version of this post that includes over 20 videos of SLPs sharing their experience and tips for clinical fellowship.

Topics:LicensingCareersashaccc-slpcertificationclinical fellowshippraxisSLPspeech therapy