The Certificate of Clinical Competence (CCC) has long been held as the gold standard credential in the field of speech-language pathology. Sold by the American Speech-Language-Hearing Association (ASHA), the CCC is marketed as a mark of quality and professionalism, signaling that a speech-language pathologist (SLP) has met rigorous standards for clinical competence. However, growing concerns from clinicians, researchers, and advocates suggest that the CCC is not the necessity ASHA often portrays it to be. In fact, it may function more as a barrier than a benefit for many SLPs and the clients they serve. Let's unpack why the CCC is increasingly viewed as an outdated requirement and why it is not essential for providing high-quality care.
The History of the CCC
The CCC was established in the mid-20th century when the field of speech-language pathology was still developing consistent educational and clinical standards. Before the establishment of state licensure boards, the CCC played a critical role in defining a national standard for clinical competence and ensuring a baseline level of quality across the profession. It provided a unifying credential that employers, clients, and other stakeholders could rely on to verify the qualifications of SLPs. At that time, anyone could hang a shingle and claim to be an SLP. Consumers could guarantee quality by hiring an SLP with the CCC to provide clinical care.
However, the profession's landscape has changed dramatically since the CCC's inception. Today, every state in the U.S. has a licensing board that oversees the education, clinical training, and ongoing professional development of SLPs. These state boards have stringent requirements that ensure clinicians are competent and up-to-date. With the establishment of these final state licensing boards, the CCC's role as a necessary gatekeeper has become redundant. What was once a vital credential has now become an unnecessary financial and administrative burden for many SLPs.
The High Cost of the CCC
One of the most glaring issues with the CCC is its cost, which has little to no ROI. Obtaining and maintaining this credential comes with a hefty price tag for an SLP compared to salary and other required expenses. SLPs who are unable or afraid (yes, afraid) to opt out of the CCC must pay for the certification annually, which ASHA bundles with their membership and costs $250. Additionally, SLPs pay for a state license and potentially a certificate or licensure from their state board of education or department of health. They must accrue professional development hours to retain the state licensure and certifications required to practice in each state where they render services. These fees add up and reduce the clinician's overall net income. A lower net income is especially problematic when reimbursement for SLP services rendered is lower than ever and the cost of living has skyrocketed. For many SLPs, the financial burden of maintaining the CCC far outweighs its perceived benefits.
The costs don't just stop at the individual level. Historically, employers required the CCC for consumer protection and to ensure they were hiring someone with standardized training. Although the state license now ensures both concerns, employers continue to include the CCC as part of the job requirement. Why? "Because this is how we have always done it." Did I mention that most employers do not reimburse for the cost of the CCC, even though state licensing boards do not require it for licensure and insurance companies do not require it for billing insurance in most states? An employer's refusal to remove the CCC requirement from job descriptions artificially narrows the hiring. It forces some clinicians to shoulder unnecessary expenses to remain competitive in the job market.
Clinical Competence: Defined by Practice, Not Credentials
ASHA often touts the CCC as a guarantee of clinical competence, but this claim warrants scrutiny. Clinical competence is ultimately determined by boots on the ground with hands-on experience, good mentorship, evidence-based practice, and ongoing professional development—not by holding a specific credential that offers no benefits to the clinician or the consumer that the state license doesn't already require. Many states already have robust licensure processes that require SLPs to meet strict educational and clinical training standards. In fact, some state's requirements are more stringent than the ones needed to purchase the CCC. Once licensed, SLPs are subject to state-mandated continuing education requirements (except in Hawaii) to ensure they remain up to date in their practice.
In essence, state licensure already fulfills the role of ensuring competency, making the CCC redundant. By framing the CCC as an essential credential, ASHA creates a gatekeeping mechanism that benefits only the organization financially while doing little to enhance the quality of care provided to clients.
Barriers to Access
The CCC requirement disproportionately affects clinicians from diverse or underserved backgrounds. For SLPs who are already struggling with student loan debt, working in lower-income areas, or balancing caregiving responsibilities, the cost and time associated with the CCC can be prohibitive. This creates an inequitable system where only those with the resources to maintain the credential can access specific jobs or opportunities, further perpetuating disparities in the field.
Moreover, the CCC requirement limits access to care for clients in underserved areas. If qualified clinicians are excluded from jobs simply because they lack the CCC, clients in these regions may face longer wait times or a lack of services altogether. Removing the CCC requirement could help address workforce shortages and improve access to care for vulnerable populations without compromising the clinician's quality or competency.
The Case for Removing the CCC Requirement
A growing number of professionals and organizations are calling for the CCC to be reconsidered as a mandatory credential. Fix SLP, a grassroots movement focused on improving the field of SLP, has made significant strides in this area. Through advocacy efforts, we have influenced companies like Tobii Dynavox and PRC Saltillo to remove the CCC requirement for certain processes and instead rely on state licensure as the primary qualification.
Similarly, we partnered with teams of clinicians to advocate by working with Medicaid programs in states like Michigan, Arkansas, and North Carolina to eliminate the CCC as a prerequisite for provider enrollment and reimbursement, recognizing that state licensure alone is sufficient. These changes reduce barriers for clinicians and expand access to essential services for clients.
Modernizing the Future of SLP
The field of SLP is at a crossroads. The CCC, once seen as a mark of excellence, has become a point of contention for many clinicians who feel it no longer serves their professional needs or the needs of their clients. By removing unnecessary requirements like the CCC, the field can shift its focus toward what truly matters: evidence-based practice, equitable access to care, and the professional autonomy of clinicians. Instead of focusing on the "value of the CCC," ASHA could focus on the value of the advocacy and support services they offer clinicians, resulting in increased reimbursement rates and more respect within the places we serve.
It's time to question whether the CCC is a badge of honor or a barrier to progress. As more clinicians, employers, and policymakers recognize its limitations, we can move toward a more inclusive and effective model for defining clinical competence. After all, the ability to provide high-quality care doesn't come from paying for a credential; it comes from dedication, experience, and a commitment to lifelong learning—qualities that no certificate can define.