From Policy to Practice: A Speech-Language Pathologist's Guide to Advancing Communication Access Through Accommodations

Purpose: In health care settings, people with communication disabilities (CDs) are more likely to experience ineffective communication and worse outcomes. A substantial contributor is the absence of routine accommodations: modifications to practices and procedures, and aids and services provided by the health care team to enable equitable access to care. Federal law, including the Americans with Disabilities Act, requires health care teams to provide accommodations. In practice, however, successful provision requires a collaborative effort in which patients and their supporters make requests, and health care team members respond. Both groups are often underprepared for these roles. Speech-language pathologists (SLPs) have unique knowledge to prepare both patients and health care team members. This clinical focus article highlights ways SLPs can do so, ultimately advancing the practice of accommodations. Method: This guide draws on the literature and the authors' clinical, health system, and research experience to offer two potential paths for SLPs. Both paths are oriented around the Capability, Opportunity, Motivation–Behaviour (COM-B) model, a behavior change model widely used in implementation science. The first path offers ways SLPs can empower patients with the capability, opportunity, and motivation to request accommodations. The second pathoffers ways SLPs can support health care teams in building the capability, opportunity, and motivation to provide accommodations. Conclusions: Routine accommodations remain an unrealized, yet actionable step toward equitable communication access for people with CDs. We offer this guide as a resource for SLPs ready to advance this effort, whether within their therapy rooms or across their organizations.