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Audiology Assistants

Overview

An audiology assistant is a person who, after appropriate training and demonstration of competency, performs delegated tasks that are prescribed, directed, and supervised by a certified and/or licensed audiologist. When hearing aid dealers are serving in the role of assistant, their duties will always be clarified by the supervising audiologist.

Audiology assistants may or may not be regulated by state laws and regulations, and the supervising audiologist is responsible for determining the applicable requirements in his or her state and work setting. See ASHA’s State-by-State page for a summary of state requirements for audiology assistants.

Audiology assistants improve access to patient care by increasing the availability of audiology services, increase productivity by reducing wait times and enhancing patient satisfaction, and reduce costs by performing tasks that do not require the professional skills of a certified and/or licensed audiologist (Dunlop et al., 2006; Kasewurm, 2006; Saccone & Steiger, 2008).

Support personnel may assist audiologists in the delivery of services, where appropriate, provided these guidelines are followed.

Note: Teleaudiology Clinical Technicians (TCTs) provide patient/equipment interface support under the supervision of a licensed audiologist who is delivering audiology services from a site located at a distance from the actual patient testing site. TCTs are currently only being used in the Veterans Administration and are not specifically included in the scope of this document

Affiliation with ASHA

ASHA has established an Associates Affiliation program for support personnel in speech-language pathology and audiology, open to individuals who

Applicants are required to obtain the signature of their ASHA-certified supervisor(s) in order to become ASHA Associates.

Key Issues

Minimum Qualifications for Audiology Assistants

Minimum qualifications for audiology assistants include the following:

Roles and Responsibilities of the Audiology Assistant

Audiology assistants engage in only those tasks that are planned, delegated, and supervised by the audiologist and permitted by state law. The duties and responsibilities assigned are based on the training, available supervision, and specific work setting. The scope of practice of the supervising audiologist also dictates the duties and responsibilities assigned to the audiology assistant. The list below provides examples and is not meant to be all inclusive.

The types of services that audiology assistants perform—if permitted by state law and when the assistant has demonstrated competence—include the following:

Audiology assistants who are fluent in a language or languages in addition to spoken English and who have the necessary training and skills may serve as translators, interpreters, and/or cultural brokers, when needed.

Audiology assistants will not perform any task without the express knowledge and approval of the supervising audiologist or any task that may be prohibited by state or federal law. The list below provides examples and is not meant to be all inclusive.

Actions that audiology assistants are not to perform include the following:

Audiology assistants with specialized training from the Council for Accreditation in Occupational Hearing Conservation (CAOHC) perform the following services under the supervision of a certified and/or licensed audiologist or physician:

Tasks that CAOHC-certified occupational hearing conservationists shall not do include

Ethical Obligations of Audiology Assistants

Although the ASHA Code of Ethics does not apply directly to any individual who is working in a support role (e.g., technician, aide, or assistant) under the supervision of an audiologist, those individuals in a support role must be knowledgeable about the provisions of the Code. Individual state licensing boards may have ethical requirements for audiology assistants. See ASHA’s State Overviews for specific information.

Because the ethical responsibility for patient care or for subjects in research studies cannot be delegated, the audiologist or hearing scientist takes overall responsibility for the actions of the assistants when they are performing assigned duties. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the Code. It is imperative that the supervising professional and the assistant behave in a manner that is consistent with the principles and rules outlined in the Code. See ASHA’s Issues in Ethics: Audiology Assistants.

Education and Training for Audiology Assistants

Consider the following in developing training programs for audiology assistants:

The supervising audiologist is responsible for maintaining written documentation of completed training activity. Most audiology assistants receive their education and training on-site by the supervising audiologist/employer. Currently, ASHA is aware of only one formal audiology assistant training program in the country, at Nova Southeastern University.

Supervision

Qualifications of a Supervising Audiologist

In order to serve as a supervisor, ASHA requires that an audiologist hold a full, current, and unrestricted license to practice audiology from a state, territory, commonwealth, or the District of Columbia (where applicable) and recommends that the audiologist have a Certificate of Clinical Competence in Audiology granted by ASHA. In the case of an individual exempted from state licensure based on practice in a specific institution or setting, ASHA recommends the individual meet one of the following conditions:

Roles and Resonsibilities of the Supervising Audiologist

The supervising audiologist has the ultimate clinical, ethical, and legal responsibility for the care provided to the patient. Responsibilities of the supervising audiologist include

Amount and Frequency of Supervision

The supervising audiologist is responsible for determining the level of supervision that is required based on the activities that are delegated to the assistant, the skills of the assistant, and the clinical setting. On some occasions, multiple levels of supervision are utilized. Permissible levels of supervision for audiology assistants include the following direct and indirect services.

Direct: The supervising audiologist is present in the same room while the audiology assistant is engaged in direct health care activities.

Indirect: The supervising audiologist is in the same physical area and is immediately accessible to the audiology assistant. The supervising audiologist meets and interacts with patients/clients as needed. The audiology assistant and supervising audiologist discuss, plan, or review evaluation and treatment. Area supervision is available only when the audiology assistant has been formally assigned a graduated level of responsibility commensurate with this type of supervision. This level is synonymous with direct supervision.

General: Services are furnished by the audiology assistant under the supervising audiologist's guidance. The supervising audiologist's presence is not required during services, but the supervising audiologist must be immediately available by phone or pager and able to be physically present as needed.

The amount and type of supervision required are based on the skills and experience of the audiology assistant, the needs of patients/clients served, the service delivery setting, the tasks assigned, and other factors.

See Teleaudiology Clinical Technicians for specific information on TCT supervision.

Ethical Requirements for Supervising Audiologists

ASHA strives to ensure that its members and certificate holders preserve the highest standards of integrity and ethical practice. The ASHA Code of Ethics (ASHA, 2010) sets forth the fundamental principles and rules considered essential to this purpose. The Code of Ethics applies to all individuals who are members of ASHA, regardless of whether they are certified members, nonmembers holding the Certificate of Clinical Competence from the Association, or applicants for membership or certification.

The following principles and rules of the ASHA Code of Ethics specifically address issues that are pertinent when an audiologist supervises support personnel in the provision of services or when conducting research:

Principle of Ethics I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activity, and they shall treat animals involved in research in a humane manner.

Guidance: The supervising audiologist remains responsible for the care and well-being of the client or research subject. If the supervisor fails to intervene when the assistant's behavior puts the client or subject at risk or when services or procedures are implemented inappropriately, the supervisor could be in violation of the Code of Ethics.

Principle of Ethics I, Rule A: Individuals shall provide all services competently.

Guidance: The supervising audiologist must ensure that all services, including those provided directly by the assistant, meet practice standards and are administered competently. If the supervisor fails to intervene or correct the actions of the assistant as needed, this could be a violation of the Code of Ethics.

Principle of Ethics I, Rule C: Individuals shall not discriminate in the delivery of professional services or the conduct of research and scholarly activities on the basis of race or ethnicity, gender, gender identity/gender expression, age, religion, national origin, sexual orientation, or disability.

Guidance: The supervising audiologist is responsible for ensuring that there is no discrimination in service delivery, as indicated above. Discrimination exhibited by the audiology assistant could be a violation of the Code of Ethics.

Principle of Ethics I, Rule D: Individuals shall not misrepresent the credentials of assistants, technicians, support personnel, students, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name and professional credentials of persons providing services.

Guidance: The supervising audiologist must ensure that clients and subjects are informed of the title and qualifications of the assistant. This is not a passive responsibility; that is, the supervisor must make this information easily available and understandable to the clients or subjects and not rely on the individual to inquire about or ask directly for this information. Any misrepresentation of the assistant's qualifications or role could result in a violation of the Code of Ethics by the supervisor.

Principle of Ethics I, Rule E: Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills, knowledge, and judgment that are within the scope of their profession to assistants, technicians, support personnel, or any nonprofessionals over whom they have supervisory responsibility.

Guidance: The supervising audiologist is responsible for monitoring and limiting the role of the assistant as described in these guidelines and in accordance with applicable licensure laws.

Principle of Ethics I, Rule F: Individuals who hold the Certificate of Clinical Competence may delegate tasks related to provision of clinical services to assistants, technicians, support personnel, or any other persons only if those services are appropriately supervised, realizing that the responsibility for client welfare remains with the certified individual.

Guidance: The supervising audiologist is responsible for providing appropriate and adequate direct and indirect supervision to ensure that the services provided are appropriate and meet practice standards. The audiologist should document supervisory activities and adjust the amount and type of supervision to ensure that the Code of Ethics is not violated.

Principle of Ethics II, Rule B: Individuals shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their level of education, training, and experience.

Guidance: The supervising audiologist is responsible for ensuring that he or she has the skills and competencies needed to provide appropriate supervision. This may include seeking continuing education in the area of supervision practice.

Principle of Ethics II, Rule D: Individuals shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's competence, level of education, training, and experience.

Guidance : The supervising audiologist must ensure that the assistant only performs those activities and duties that are defined as appropriate for the level of training and experience and in accordance with applicable licensure laws. If the assistant exceeds the practice role that has been defined for him or her, and the supervising audiologist fails to correct this, the supervisor could be found in violation of the Code of Ethics.

Principle of Ethics IV, Rule B: Individuals shall prohibit anyone under their supervision from engaging in any practice that violates the Code of Ethics.

Guidance: Because the assistant provides services as “an extension” of those provided by the professional, the audiologist is responsible for informing the assistant about the Code of Ethics and monitoring the performance of the assistant. Failure to do so could result in the audiologist’s being found in violation of the Code.

For the most current information pertaining to ethics and support personnel, see ASHA’s Issues in Ethics: Audiology Assistants.

State/Federal Laws and Regulations

Laws and regulations for audiology support personnel in educational and other practice settings vary from state-to-state. Differences may be reflected in a number of requirements including the following: education, supervision, continuing education, titles used for support personnel, and regulation or laws or lack thereof. See ASHA’s State-by-State page for a summary of state requirements for audiology assistants. For the most current information, always check with your state licensure board and/or department of education for the requirements for specific practice settings.

Reimbursement

The use of assistants can improve access to and reduce costs of quality audiology services. State policies regarding Medicaid reimbursement of services provided by an audiology assistant are limited. Nationally, audiology assistant services are not covered by Medicare. For private health plans, check with the payer in question to determine their provider qualifications. In general, Medicaid, Medicare, and private health plan reimbursements are limited for audiology services provided by assistants or audiologists using teleaudiology to deliver services.

Resources

ASHA Resources

ASHA's Model Bill for State Licensure of Audiologists, Speech-Language Pathologists, and Audiology and Speech-Language Pathology Assistants [PDF]

Issues in Ethics: Audiology Assistants

ASHA State Overviews

State Support Personnel Trends [PDF]

ASHA's Associate Program

Summary of State Regulation and Requirements Trends

Experience, Attitudes and Competencies of Audiologic Support Personnel in a Rehabilitation Hospital

References

American Academy of Audiology. (2010a). American Academy of Audiology position statement: Audiology assistants. Retrieved from www.audiology.org/resources/documentlibrary/
Documents/2010_AudiologyAssistant_Pos_Stat.pdf
.

American Academy of Audiology. (2010b). Audiology assistant task force report. Audiology Today, 22(3), 68–73. Retrieved from www.audiology.org/resources/audiologytoday/
Documents/2010_05-06/AT%2022.3%20-%20LOW.pdf

American Speech-Language-Hearing Association. (2010). Code of ethics. Retrieved from www.asha.org/policy/ET2010-00309/.

Dunlop, R., Beck, L., Dennis, K., Gonzenbach, S., Abrams, H., Berardino, J., & Hall, S. (2006). Support personnel in VA audiology. Audiology Today, 18(1), 24–25. Retrieved from www.audiology.org/resources/
audiologytoday/archives/Pages/default.aspx
.

Kasewurm, G. (2006). The positive impact of using audiologist's assistants. Audiology Today, 18(1), 26–27. Retrieved from www.audiology.org/resources/audiologytoday/
Documents/AudiologyToday/2006ATJanFeb.pdf
.

National Hearing Conservation Association. (1990). Code of ethics. Retrieved from www.hearingconservation.org/displaycommon.cfm?an=1.

Saccone, P., & Steiger, J. (2008). Hearing aid care protocol for audiology assistants. Audiology Today, 20(1), 34–37. Retrieved from www.audiology.org/resources/audiologytoday/
archives/Pages/default.aspx
.