Season three of Knights Do That, UCF’s official podcast, returns with its fourth guest, Debra Knox, director of UCF’s Communication Disorders Clinic and an associate instructor in the College of Health Professions and Sciences. Knox has worked in this field for more than 25 years and has led the clinic at UCF since 2013. UCF’s Communication Disorders Clinic trains future speech language pathology professionals and provides a range of services to the community.
Here Knox shares the growing need for communication disorders professionals, the constantly evolving nature of the field and what it means to help so many Central Floridian families.
Debra Knox: It is so important for them to understand that just graduating with a master’s degree is only going to keep you current for right now. Next year, two years, three years, five years down the road, there’s going to be new changes that you have to adapt to, and you have to be ready to serve the clients and patients in a new way.
James Evans: Hello and welcome back to another episode of Knights Do That. With approximately 5-10% of Americans having a communication disorder, it is vital now more than ever to understand the importance of speech language pathology. On the show today, we have Deborah Knox, director of UCF’s Communication Disorders Clinic to help us understand these issues and how UCF is addressing them.
The clinic directly impacts the Central Florida community by providing cutting edge diagnostic and treatment services to people of all ages with communication and hearing challenges. The clinic has a mission of not only providing high quality service to our community, but training the next generation of speech language pathologists, who will go on to serve and lead in their communities.
James Evans: Deborah, thanks for being here. How are you today?
Debra Knox: I’m doing well. Thank you.
James Evans: Fantastic. We are so happy to have you, and I think we’re just going to jump right into the questions if you’re cool with that?
Debra Knox: Sounds good to me.
James Evans: Awesome. So you’re the director of the Communications Disorders Clinic here at UCF. What sparked your interest in communication disorders as a field of study and work?
Debra Knox: Well, I would say for myself, probably like most speech language pathologists I was drawn to the field with a strong desire to help people.
And for me, I was drawn to the pediatric population, but others might be more interested in working with adults or the rehabilitative side of things, where they’re helping an individual regain skills that they might have lost from an acquired disorder like Aphasia – somebody who’s had a stroke.
James Evans: So you’ve been doing this for how long now?
Debra Knox: Over 25 years I’ve been in the field.
James Evans: And what is your favorite part about it?
Debra Knox: I think my favorite part about it is really finding that connection with the person that you’re working with, whether it’s an adult or a child, and just feeling that sense of success when they are able to do something new that they maybe had trouble doing before or were never able to do before. Could be something like asking for a toy that they really like. Communication is very powerful.
James Evans: It’s so important to be able to pronounce your own name or pronounce somebody else’s name because names are powerful too. But, just in general, being able to communicate at that base level that most people communicate on is super important for feeling connected to society and just being there.
Debra Knox: It helps someone learn the essence of who you are. When you’re able to share your likes or your dislikes or share ideas and connect with somebody. So on a basic level communication is really your attachment to the world around you and to the people around you.
James Evans: Absolutely. So the Bureau of Labor Statistics expects that the field of speech pathology to grow 29% between 2020 and 2030, which is “much faster than the average for all occupations.” Can you speak to the clinic’s goal of empowering and educating the next generation of speech language pathologists?
Debra Knox: I would say UCF is hyper-focused on preparing contemporary speech language pathologists who are culturally competent and can best serve the communities in which they live and work in. It’s a wonderful career with lots of opportunity and diversity across settings, population, and age.
James Evans: I’m going to deep dive a little bit more on that. You do this work and we’re developing the future speech language pathologist, right? And there’s a very big need for that. Is there a focus in getting them in and out the door? Or are we focused on providing quality there over quantity?
Debra Knox: Oh, definitely quality over quantity. We are an accredited program. And through that accreditation, we are required to meet specific standards. So, despite all time factors or size or anything. Quality is the most important piece I would say. Because the students need to be able to engage in the career for the rest of their lives. And so there’s this component of, you know, continuous education.
They’re always going to need to stay abreast of new developments in research and clinical application. And in order to do that, we’re setting the stage for that here. So this is the springboard for where they’ll go in the future.
James Evans: There’s something you said there that I find really interesting there’s always new technologies or new practices that you have to implement or learn even as an accredited professional.
You can’t learn something that’s going to be the new practice 15 years from now right now, because it just doesn’t exist yet. So how are you inspiring and engaging your graduate clinicians to be lifelong learners?
Debra Knox: I have had to go through the process of just making sure that I stay current with my information. And I think being able to share the history of where things started, even in my own career, when I’m working with students into what I’m teaching now versus what I experienced early on. It’s eye opening. It’s like old school versus new school. And I’ve even done a presentation before professionally on old school version of oral rehabilitation versus new school and things that we do now that we never thought we would do before, but that’s because of the advancement in technology.
So being able to show students I’ve been in this field for a while. And even though I might know a lot of things, I certainly don’t know everything. But I have to be resourceful and I have to keep up with the changes of what’s coming out in research and what we are learning. Because research in all fields, but in speech language pathology specifically, is advancing on a daily basis.
And so it is so important for them to understand that just graduating with a master’s degree is only going to keep you current for right now. Next year, two years, three years, five years down the road, there’s going to be new changes that you have to adapt to, and you have to be ready to serve the clients and patients in a new way.
James Evans: That’s a really good answer. Can you give us insight into all the services that you offer to the community?
Debra Knox: Being one of the nation’s largest CSD programs, we have the benefit of having experts in the fields of practice. There are nine areas of practice that are defined by the American Speech Language and Hearing Association.
So those areas of practice are in: Speech Sound Disorders, Expressive-Receptive Language, Fluency, Voice and Resonance, Communication Modalities, Social Aspects of Communication, Cognitive Aspects of Communication, Hearing Disorders, and Feeding and Swallowing Disorders. I actually think I got all nine of those.
James Evans: You fired those off. That was cool. Director right there.
Debra Knox: Yeah, I work a lot with all of those areas in terms of the student experiences because by the time they graduate, they have to have clinical experiences in all of those big nine areas.
James Evans: Got it. OK. And what does that look like when you’ve got so many different areas and so many services offered?
How does that enable the graduate clinicians? How does that empower them? How does that really get them to the next level? Cause it’s important for accreditation, but just in general as a speech language pathologist or upcoming, right? How does that help?
Debra Knox: Well, the breadth of the expertise is vast and having those experts in all of those different areas within our program is really not common in most programs and so having those experts in the field allows for our students to learn from those leading professionals, to set them on a path for success, as they move into the area of chosen practice in the.
James Evans: That makes perfect sense. So what does mentorship look like at the clinic, right? You have so many experts that know so much in their respective fields and that obviously leads into mentorship roles. And then you’re working with a variety of patients now that may eventually want to be speech language pathologists themselves.
Debra Knox: I would say there are definitely students that are in the program who were inspired to become speech language pathologists because of an experience that they had.
James Evans: Mm-Hmm.
Debra Knox: A personal experience, whether it was their own or a close family member. In fact, that’s one of the discussion posts that I have in one of the first semester classes. And I think it’s important for everybody to reflect on what is their connection to the field as they begin this journey in graduate school. And so mentorship looks like a lot of different things.
So sometimes mentorship is really being a partner in a speech language pathology session with a patient. So maybe the clinical educator actually goes into the room to demonstrate something and to show a technique that maybe the student wasn’t aware of, or maybe needed a little tweaking in how they were implementing.
Mentorship can also look like having a conversation about, “Where do you see yourself in five years? What area of the field are you interested in?” Mentorship can also look like, “Hey, you prepared, you know, this activity and it was really good. What would happen if you tweaked it this way?” And maybe giving them some insight as to a small change that might make a big impact on how the client interacts with them. So mentorship takes on many different appearances throughout the program, but I would say it’s a six semester program. So perhaps mentorship looks a little bit more hands-on at the beginning of the program, maybe in semester two or three, whereas by the time the students get to semester four, five or six, we’re looking for a little bit more independence on their part where the model might be considered maybe a little more consultative.
James Evans: So you’ve been doing this to see plenty of patients move on after receiving the therapy that they needed or receiving the consultation they needed and achieve their goal. And then you’ve also been working with graduate clinicians for so long that you’ve seen them walk across the stage and become that next generation that we’re talking about. Can you walk us through that feeling and that experience when you see the patients get better and the students graduate?
Debra Knox: Sure our clinic is unique because it does have that dual mission: to provide speech language and audiology services to the community, while also preparing the next generation of speech language pathologists. I would say that our patients really connect with that educational mission. Seeing the students grow clinically, and knowing that they are helping them be successful as they move on to become speech language pathologists. And I would say that the students really connect with that feeling of reward and satisfaction when they see their clients or patients succeed at something that they weren’t able to do before.
James Evans: Oh, absolutely. So what does the future of the clinic look like and its work within the community?
Debra Knox: The clinic has grown so much since its inception in the 1980s. And I would say our future goals are to expand the clinical opportunities for the students. Especially in the area of working alongside with students in other healthcare professions or other healthcare disciplines, so that they can learn to be part of a healthcare team working together, putting the patients first and providing that level of care.
James Evans: So you mentioned one really important thing there that I want to point out, which is that aspect of teamwork, right? What does that look like within the curriculum? Because you’re working not only with patients, but you have to work with other experts in their own fields, right? With there being nine different fields, you’re probably not going to be an expert in all of them. You’re going to have some experience, but you’re going to have to work with others who have different, you know, areas of expertise to provide that holistic sense of care.
How does that work? Both for the graduates who are just learning. And then also just in general with the clinicians who are actually full-on speech language path. What does that look like teamwork across the board?
Debra Knox: So I would say there’s collaboration on many levels. I would say first as a speech language pathologist, we partner with our patients to define and set goals both with patients and their family members, depending on their age or what their situation is. Defining those goals and walking hand in hand with them working towards their goal is to help them achieve whatever level of success that they’re aiming for. So that’s one level collaboration, like you mentioned with all the different areas of expertise, and I can’t be an expert in everything. I would say. “Yeah, that is extremely important.” So, we model that in the communication disorders clinic.
So when we have a patient that requires some additional support in an area where we have someone who is an expert, we’ll bring them in to a session and consult with the family, with the patient, [and] with the student to offer some guidance and expertise in a particular area. So I can speak to something that’s happened recently in our clinic there was a patient who was working with a student on specific goals for communication and advocacy.
And then the patient also received hearing aids recently. One of our clinical educators Whitney Hayes she was asked to consult and provide some assistance with how that patient would adapt to working with the hearing aids and improving their proficiency in using the hearing aids so that they can better communicate and engage with others in a communication.
James Evans: We’ve always been a technological university. We’ve always been focused on innovation in that way. So how important is technology? What role does it play in the clinic service and also education?
Debra Knox: Technology is a huge part of the medical field, of course. And I would say that it infiltrates all aspects of our profession from clinically where we are using technology to provide documentation of our clinical services using an electronic medical record.
It is technology that is used to measure voice output levels to measure decibel levels of sound that’s going on in a particular setting there’s technology also that’s used specific for communication. So, maybe some of our clients who aren’t able to speak for themselves are using a speech generating device and those access methods might look very different depending on what limitations a client might physically have. So, for example, a client could use a speech generating device by activating, you know, a button using their finger, or it could be a switch that they use their head to activate. And then we have other clients who have much more limitation physically who might be using eye gaze to activate a message that’s on the speech generating device. So, the students have the opportunity to engage with all levels of that type of technology. So that then when they get out into the community they are able to bring that expertise with them. Having had that opportunity, which I could say is unique also to our clinic in terms of the client caseload that we have specific to AAC, or Alternative & Augmentative Communication.
James Evans: Interesting. So research, what kind of research is done at the clinic? If any?
Debra Knox: So there are always opportunities for research within the School Of Communication Sciences and Disorders. And there are clinical application — applied research — that takes place frequently. And it varies depending on semester project and grants and things like that.
James Evans: Another important thing for UCF is access, right? Access to opportunity, access to service, access to resources, et cetera. So how is the clinic accessible and/or affordable to the community?
Debra Knox: So the clinic accepts referrals from outside entities. So, a patient can be referred by a physician by a colleague because of a specialty that we might have in our clinic they can be referred by a family member or a friend all depending on what the circumstances might be. Then, we accept insurance. We accept Medicare, Medicaid and we also have a sliding fee scale for clients that meet financial eligibility.
James Evans: We’ve talked about the employment for speech language pathologists and how there’s going to be a very big increase in the need for them over the next 10 years or so. That’s one trend in the field.
I’m sure there are others. Are there any that you want to point out specifically that are things to focus on or things that the clinic is specifically combating
Debra Knox: Absolutely. I would say if you were to look at statistics from the American Speech Language and Hearing Association somewhere around 50% of speech language pathologists choose to work in an educational setting. So like in schools. Whether that’s public schools or private schools, they’re employed in a school setting.
And I think that has been pretty consistent over time. Some of the challenges when students get out into the field once they graduate that we can’t necessarily prepare them for are changes in healthcare reimbursement. So, changes that occur with insurance coverage and Medicare fee basis and things of that nature.
That creates challenges for healthcare settings, whether it’s skilled nursing facilities or hospitals in various aspects of the field to maintain speech language pathologists and other allied healthcare professionals on staff providing those services. So, I think it’s really important as new clinicians in the field that they’re also staying abreast of what some of those challenges are within our field, so that they can learn to be very good advocates for not only our profession, but that in turn impacts our patients because when they can maintain access to services, because our field is adequately represented in the medical community and by insurance reimbursement, then we are continuously able to serve our patients and help them reach their communication goals.
James Evans: There’s so much going on, especially with healthcare. I took a class at the beginning of actually my first year. I think it might have been my first semester. And it was all about insurance. Well, health public administration. But there was a very large focus because the professor knew that some of us, like me, were a business major who was not going to do anything in the health field, but wanted to learn about administration in that sector. So there’s a very long and lengthy discussion about insurance and how that works and what is the actual system, because it’s so confusing and we’re a whole bunch of college kids, right? It’s always changing. I just deal with the consumer side of it. I’m buying the insurance, but what does that look like from a healthcare perspective, et cetera?
It’s insane. So it’s definitely a very valid thing to be concerned about and focused about is a new clinician about learning that and just learning in general, what are all these different trends that I may not have noticed or been able to work on because I was learning how to do the job.
I had another question with the students. What should they be doing if they want to get involved with the clinic or if they want to go into the graduate program? What does that look like? What does an ideal candidate look like?
Debra Knox: That is a really good question. In the field of communication sciences and disorders, there is a bachelor’s degree UCF. We do have the bachelor’s level degree in communication sciences and disorders, which is the preparation for the graduate program. But UCF’s master’s program is unique in that we will accept students who have a bachelor’s degree that we consider to be out of field or not specifically in communication sciences and disorders.
So there’s two paths. If the student is already in the undergraduate program to get a bachelor’s degree in communication sciences and disorders, I would say you want to engage in your classes, connect with your coursework and strive to learn and get the best grades possible. Because it is a very competitive field to get into graduate school and so you want to have your best foot forward so that can set you apart. So grades are just one aspect, but I would say you want to maybe volunteer within the community. Doesn’t have to be within speech language pathology, but certainly you want to volunteer with individuals that you might encounter within the field of speech language pathology, whether that’s volunteering at a hospital or even at a school something like that where you can really just learn to interact with a variety of different people who might communicate in different ways.
James Evans: Something really interesting that you said that I just clung onto is that it’s really competitive.
Debra Knox: Yes.
James Evans: To get into the graduate program. How does that work? Obviously, we just don’t want to let anybody in like I, an accounting major, obviously do not have the background and should not be applying or should not be accepted, I should say, into the clinic for graduate work.
But with the expected increase in need for speech language pathologists, and what’s already happening for the need for speech language pathologists, is there going to be any change or any expected look at what it takes to get into a graduate program and to get that education? How are we going to combat that? Is there a conversation happening at conferences, et cetera, about how to look at that?
Debra Knox: That is happening.
James Evans: OK.
Debra Knox: At a national level, I would say from our professional association, there’s been conversations about moving towards competency-based education and all different types of factors. So, for example, another discussion that has been taking place over some time but hasn’t really come to fruition yet is that the graduate students have to acquire 400 clinical hours before they graduate.
James Evans: OK.
Debra Knox: Twenty-five of those hours are in clinical observation, guided clinical observation, and then 375 clinical hours are with direct patient contact. And that has to be across those big nine areas that we’ve already talked about. So that gives a specific number to the experiences that they have to have. But, like you asked me earlier about quality versus quantity, that cutoff number doesn’t necessarily speak to the quality of what those hours have been and we’re talking nationally, you know. Across all programs and everything. So how we as a field look at improving those quality markers, those quality indicators, for those clinical experiences. And that’s where the discussion of possibly a competency-based education program would transition to.
And so that would entail a whole transformation, you know, in higher education within our field. Because, you know, our courses are not necessarily all set up strictly on a competency-based curriculum. Now, because we’re in accredited program, there are competencies that we have to ensure that our students are meeting.
So we have this dual assessment methodology within our field currently. And that is, they have to meet, you know, certain grade expectations, but they also have to meet these competencies. We’re not really sure where this is going yet, but I’m excited about the fact that the conversation is taking place and that, you know, who knows in the next 5 to 10 years, what we see in higher education within the field of speech language pathology may look very different than what it looks like today.
James Evans: Fascinating. So last couple questions. What advice would you give to someone who wants to do what you?
Debra Knox: The advice I would give to somebody who wants to become a speech language pathologist is to reflect on where they see themselves working with patients in the future. You know, what interests them? Because, then they would want to do some research. And what does that look like within our field? So that they would have an idea, a goal set for themselves of where they want to be. Because when they’re in graduate school, really the focus is generalized speech language pathology because we have to give them experiences across all these different areas and it’s once you graduate and move onto positions and jobs within the field that you can really begin to specialize.
If you want to become a speech language pathologist, I would say, you know, do some research, figure out what it is within the field that really excites you because you want to find that area so you have something to aim for as you move through an undergraduate, graduate and then into entry level within the field.
James Evans: Final question. What’s one thing you’re still hoping to do?
Debra Knox: Interesting. Something that I would still hope to accomplish or strive to do is to see the clinic — the communication disorders clinic — really become a hub for a multidisciplinary clinic where patients can come and receive services across maybe physical therapy, occupational therapy, speech language pathology, as well as audiology.
I would say that would be an awesome accomplishment that would not only improve access for patients, but improve that healthcare teamwork experience that our students would get.
James Evans: So then follow up to that. What would it take to get there?
Debra Knox: A lot of buy-in from other programs within the College of Health Professions even the Academic Health Sciences Center.
I think it would just probably take some strategic planning of how to make that happen. But I think the outcomes would be very beneficial on all aspects or all fronts.
James Evans: Oh, I can agree. Having something like that, could be very beneficial.
Debra Knox: Absolutely. And when talking about the research that could take place within that multidisciplinary setting that then could also provide the underpinnings and support for the outcomes that might be improved because of those synergies that then could influence the reimbursement veins where insurances might then pay for co-treatment and aspects like that, that we struggle with in the models that are existing right now.
James Evans: I love it. I love not only the fact that it helps the community, it’s such an all around service for so many people in the community.
And then it also develops really great graduate clinicians that move on into their respective fields with a holistic sense, but also it can be industry changing, right? It can help shape how insurance works when you’re talking about treatment. That’s the big idea that I really love to try and find out and dig to that allows us to be on the cutting edge of academia, but also how are we shaping industry, and economic development, and business. And UCF is situated for that, right?
We’re there. We’re capable of doing it. So I’m really interested to see where that idea goes. And I’m hoping in the future, when I am finally an alumni, that I get to read the news one day or get Pegasus, and that’s one of the stories.
Debra Knox: I would love to see that story as well.
James Evans: I love it. Well, thanks so much for doing the interview today and being here, you have been a fantastic guest with so many great answers.
Debra Knox: Well, thank you so much for having me. I welcome the opportunity always to be able to talk about not only the field, but the program that we have here at UCF, because I really feel like it really is something to be proud of.
James Evans: Speech language pathology is a field that impacts millions of lives and needs places like UCF’s Communication Disorders Clinic to provide quality service to communities and training for future professionals. I want to thank Debra for coming on the show and sharing her insight with us all
Next time, we’re talking with Dr. Gulnora Hundley about her incredible work providing support and group therapy to mental health professionals in Ukraine.
As always, if you’re doing something cool, whether that’s at UCF or somewhere you took UCF that we should know about, send us an email at [email protected] and maybe we’ll see you on an episode in the future. Go Knights, Charge On!