We work on the Comprehensive Stroke Unit at Trillium Health Partners. The Stroke program at THP is a regional program serving a large area in the west Greater Toronto Area. Stroke patients transition from the emergency department, ICU or neuro step-down unit to acute care on the Stroke Unit. If appropriate, stroke patients remain on the unit, with their same team of therapists for rehabilitation. 

Lisa is one of two full-time SLPs on the Stroke Unit. Jenn is a full time CDA providing communication therapy to up to 20 patients in the rehab beds on the unit.

SLPs are responsible for all screening and assessment activities, all dysphagia assessment and management, attending team rounds, communicating with physicians, family meetings and documentation. Given the busy nature of the stroke unit, Jenn's primary focus is providing communication intervention. This includes educating patients and families with respect to communication strategies. The primary overlap between CDA and SLP is provision of communication intervention (SLP will provide when time permits) and patient and family education.

Good communication, no pun intended. It's very important to ensure that goals and activities are clearly communicated by the SLP to the CDA and for the CDA to promptly report concerns to the SLP.

Fortunately, on the Stroke Unit we have a full range of therapy assistants (CDA, OTA, PTA) that are fully integrated into the team. This model has been in place since the inception of the Stroke Unit and has allowed them to play an integral role in the stroke rehab process. For a newer CDA or a newly created role on a team, it would be important for the SLP to educate the team in terms of scope of the SLP versus CDA and highlight the benefits of having a CDA on the team.

"It's very important to ensure that goals and activities are clearly communicated by the SLP to the CDA and for the CDA to promptly report concerns to the SLP."

Having assistants who can focus most of their day on direct patient care allows more patients to be seen in a day and more therapy time for patients. Having a skilled CDA allows the SLP to assign tasks even before a full communication assessment is completed and adjust goals based on feedback from the CDA.

Perhaps misconceptions by patients, families, and among the newer members of the team about our roles. We need to ensure any questions or concerns about patient care from these groups are addressed by the right professional.

No changes, perhaps just the method of collaboration. In areas with fewer resources, supervision and collaboration between the SLP and CDA could be done virtually, with the right team. This way, their services could be expanded across a larger geographic area, or more frequent visits, without travel being a barrier.

It is important for the SLP to outline expectations of the CDA and ensure understanding of boundaries within their role as CDA. As the relationship evolves, the SLP may feel more comfortable allowing more independent practice by the CDA or may need to address issues with the CDA if they are not meeting the expectations. 

This may be a bit challenging for a newer SLP working with a more experienced CDA. However, as the SLP, you are the regulated professional and hold accountability for the care provided so it may be necessary to have uncomfortable conversations.

Thank you Jenn and Lisa for sharing your insights! As an SLP working in the acute care setting, I certainly hope to see more opportunities between SLPs and CDAs, including roles in less conventional settings.