PROFESSIONAL ISSUES

Audiology Assistants

Overview

Key Issues

Minimum Qualifications for Audiology Assistants

Minimum qualifications for audiology assistants include the following:

  • minimum educational standards required by the state [PDF]
  • communication and interpersonal skills necessary for the tasks assigned
  • a basic understanding of the needs of the population being served
  • successful completion of the training requirements and competency-based skills necessary for the performance of specific, assigned tasks
  • additional qualifications established by the supervising audiologist to meet the specific needs of the audiology program and the population being served
  • additional requirements established by the facility of employment

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:

  • greeting and escorting patients
  • scheduling patients
  • packaging and mailing earmold orders, device repairs, and manufacturer/lab returns
  • maintaining inventories of supplies and checking function of equipment
  • performing checks on hearing aids and other amplification devices
  • performing troubleshooting and minor repairs to hearing aids, earmolds, and other amplification devices
  • cleaning hearing aids and other amplification devices
  • performing electroacoustic analysis of hearing aids and other amplification devices
  • instructing patients in proper use and care of hearing aids and other amplification devices
  • demonstrating alerting and assistive listening devices
  • instructing patients in proper ear hygiene
  • assisting audiologists in treatment programs
  • assisting audiologists with setup and technical tasks
  • preparing materials for ear impressions
  • maintaining and restocking test and treatment rooms
  • performing equipment maintenance and biological checks
  • conducting hearing and tympanometric screening on older children and adults (without interpretation)
  • conducting otoacoustic emission screening
  • performing nondiagnostic otoscopy
  • performing pure-tone audiologic reassessment on established patients
  • preparing the patient for VNG/ENG or evoked testing
  • assisting audiologists in hearing testing of pediatric patients
  • performing pure-tone hearing screening and universal newborn hearing screening tests
  • performing infection control duties within the clinic/service
  • assisting patients in completing case history or other relevant forms
  • interacting with hearing instrument manufacturers/suppliers regarding status of orders/repairs

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:

  • determining case selection or evaluation protocols
  • interpreting observations or data into diagnostic statements of clinical management strategies or procedures
  • participating in team or case conferences or on any interdisciplinary team, without the presence of the supervising audiologist or an audiologist designated by the supervising audiologist
  • writing, developing, or modifying a patient's individualized treatment plan
  • assisting with patients without following the treatment plan prepared by the audiologist or without proper supervision
  • composing or signing any formal documents (e.g., treatment plans, reimbursement forms, or reports)—progress notes written by audiology assistants may be reviewed and cosigned by the supervising audiologist, subject to local facility policy
  • transmitting or disclosing clinical information, either orally or in writing, to anyone, including the patient, without the approval of the supervising audiologist
  • selecting patients for treatment services or discharging patients from treatment services
  • counseling or consulting with the patient, family, or others regarding the patient status or service or making referrals for additional services
  • referring to themselves either orally or in writing with a title other than one determined by the supervising audiologist

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:

  • checks and calibration of audiometric instrumentation
  • otoscopic screening and pure-tone threshold testing for the purpose of hearing conservation
  • basic counseling of employees concerning test results and criteria for employee referral
  • fit and training of employees on personal hearing protection devices
  • fit testing of hearing protection devices
  • assistance to CAOHC course directors in conducting training courses
  • employee hearing conservation education, training, and motivation
  • recordkeeping
  • generation of periodic hearing conservation statistical reports

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

  • assuming the role of a professional supervisor of the audiometric monitoring portion of a hearing conservation program,
  • assuming the role of an instructor of other occupational hearing conservationists,
  • interpreting audiograms,
  • conducting any type of audiometric testing other than air conduction, such as bone-conduction testing or speech audiometry,
  • diagnosing hearing disorders,
  • independently evaluating hearing conservation program effectiveness,
  • conducting noise surveys and analyses or being responsible for noise-control solutions.

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:

  • Training for audiology assistants should be well defined and specific to the assigned task(s).
  • Supervising audiologists ensure that the scope and intensity of training encompass all of the activities assigned to audiology assistants.
  • Training should be competency based and provided through a variety of formal and informal instructional methods with written policies and procedures.
  • Audiologists should provide audiology assistants with written information on roles and functions. Ongoing training opportunities should be provided to ensure that practices are current and that skills are maintained.
  • Training includes, but is not limited to, the identification of and appropriate response to cultural and linguistic factors affecting service delivery.

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:

  • have a Certificate of Clinical Competence in Audiology granted by ASHA
  • have met the requirements for certification from ASHA
  • passed a national examination in audiology

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

  • administrative actions related to audiology assistants, such as hiring, training, determining competency, and conducting performance evaluations;
  • final approval of all directives given by administrators and other professionals regarding audiology tasks;
  • delegation and supervision of specific tasks to the support person (such tasks must not exceed the knowledge and skills of audiology assistants or exceed their scope of practice—specifically the exercise of professional judgment, interpretation of results, or development or modification of treatment plans);
  • assessment of the audiology assistant's proficiency in performing assigned tasks on a predetermined, periodic basis;
  • providing feedback to the audiology assistant to promote continuous performance improvement.

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.

  • More intense supervision will be required during the orientation of a new audiology assistant; at the initiation of a new program, task, or equipment; or when there is a change in patient/client status. In general, audiology assistants with less education, training, or experience require more intense and more immediate supervision than do those with more advanced education and training or experience
  • The level of supervision is determined by the experience and demonstrated competence of the audiology assistant and the complexity of the patient/client's health care needs. The supervising audiologist directs the care of the patient and provides supervision based on the nature of the patient/client's condition, the likelihood of major changes in the management plan, the complexity of care, and the experience and judgment of the audiology assistant being supervised.
  • Audiology practices encourage and permit trainees to assume increasing levels of responsibility commensurate with their individual progress, experience, skills, knowledge, and judgment, provided those responsibilities remain within the scope appropriate for an assistant.
  • The number of audiology assistants supervised by an audiologist must be consistent with the delivery of appropriate, quality service, and any applicable state law. It is the responsibility of the individual supervisor to protect the interests of patients/clients in a manner consistent with state licensure requirements, where applicable, and the ASHA Code of Ethics.

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

References

Content Disclaimer: The Practice Resource Project, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.