The American Speech-Language-Hearing Association (ASHA) established the Preferred Practice Patterns for the Profession of Audiology  to enhance the quality of professional services and for an educational tool for ASHA-certified audiologists, other professionals, members of the general public, consumers, administrators, regulators, and third-party payers. The Preferred Practice Patterns provide an informational base to promote quality patient care delivery in health care, education, industry, and other settings in which audiologists practice. They are sufficiently flexible to permit both innovation and acceptable practice variation yet sufficiently definitive to guide practitioners in decision making for appropriate clinical outcomes. They provide a focus for professional preparation, continuing education, and research activities. In publishing these statements, ASHA does not intend to exclude members of other professions or related fields from rendering services within their scope of practice for which they are competent by virtue of education and training.
The Preferred Practice Patterns are neither a yardstick to measure acceptable conduct nor a set of aspirational principles. Rather, they reflect the standard of care relevant to a particular set of circumstances. There may be legitimate reasons for departing from the practice patterns. Audiologists should make the ultimate judgment regarding the appropriateness of any given procedure. This should be based on individual patient circumstances and often is a collaborative decision with the patient, family, caregivers, and other professionals. These practice patterns are to be used with sensitivity to and knowledge of cultural and linguistic differences and the individual preferences and needs of patients and their families and/or caregivers. Practitioners also need to be aware of the ASHA (2003) Code of Ethics when considering alternative practices.
These practice patterns are organized by procedure and were developed to be consistent with the World Health Organization's (2001) International Classification of Functioning, Disability and Health, as well as the framework of the Scope of Practice in Audiology (ASHA, 2004f; see Figure 1). For each procedure, the Preferred Practice Patterns for the Profession of Audiology specify the expected outcome(s), clinical indications for the procedure, clinical process, others who may perform the procedure, setting/equipment specifications, safety and health precautions, and documentation. For many clinical procedures, the Preferred Practice Patterns direct practitioners to more detailed guidelines in the ASHA Policy Documents and Related References section at the end of each statement as well as to related practice patterns. Adherence to the Preferred Practice Patterns does not guarantee a desired outcome.
It is useful to regard these practice patterns within the conceptual framework of ASHA policy statements ranging in scope and specificity from broad to narrow and general to detailed in content. The categories are defined as follows:
Scope of Practice Statement: A list of professional activities that define the range of services offered within the profession of audiology.
Preferred Practice Patterns: Statements that define generally applicable characteristics of activities directed toward individual patients and that address structural requisites of the practice, processes to be carried out, and expected outcomes.
Position Statements: Statements that specify ASHA's policy and stance on a matter that is important not only to the membership but also to consumers or to outside agencies or organizations.
Practice Guidelines: A recommended set of procedures for a specific area of practice, based on research findings and current practice. These procedures detail the knowledge, skills, and/or competencies needed to perform the procedures effectively.
In applying these practice patterns, all ASHA-certified audiologists are bound by the ASHA Code of Ethics. All professional activity must be consistent with the Code of Ethics and with individual state licensure regulations. Particularly relevant to clinical practice are those provisions for holding paramount the welfare of persons served and providing only clinical services for which one is competent, considering education, training, and experience. The Code of Ethics also requires one to maintain the confidentiality of patient records. In addition, practitioners who hold paramount the welfare of persons served must follow standard health precautions when they are providing clinical services that would place themselves or their patients at risk for transmission of communicable diseases (ASHA, 1991). The Code of Ethics also stipulates that practitioners can only delegate the provision of audiologic services to those individuals who hold appropriate credentials or to support personnel who have appropriate training and who receive appropriate supervision by the audiologist.
Related to the framework of ASHA policy statements are the standards that have been established for the certification of audiologists and the accreditation of graduate education programs in audiology. Standards are formalized rules or requirements that must be attained or adhered to, to become part of a group that claims to have met specified criteria. Associations set standards in a variety of areas, recognizing that certain members or entities have achieved, or maintained, certain qualities or competencies. Standards are important because they assure the public and others in the profession that a specific person or program strives for excellence in practice or delivery of service. When certain standards are met, the person or program can publicly claim that they are “accredited” or “certified” by a body responsible for verifying that the standards have been met. Standards programs help to promote public confidence in the professions.
ASHA has developed standards in these areas: certification of audiologists and accreditation of graduate-level educational programs. The Council for Clinical Certification (CFCC) sets the standards for the certification of individuals and verifies that individuals have met those standards. The CFCC authorizes the use of the designator CCC-A (Certificate of Clinical Competence in Audiology) after a person's name when it has been determined that the person meets the certification standards. These standards are designed to demonstrate that certified audiologists possess the skills and knowledge levels necessary for entry into the profession of audiology and maintain their expertise though continuing education. The Council on Academic Accreditation (CAA) formulates the standards for the accreditation of graduate educational programs that provide entry-level professional preparation with a major emphasis in audiology and applies those standards in the accreditation of such programs. Accreditation is intended to protect the interests of students, benefit the public, and improve the quality of teaching, learning, research, and professional practice. Through its accreditation standards, the CAA encourages institutional freedom, ongoing improvement of educational institutions and training programs, sound educational experimentation, and constructive innovation.
The original Preferred Practice Patterns (1992) were the product of extensive peer review by ASHA members and contained patterns for the professions of audiology and speech-language pathology. In clinical areas of controversy, working groups of members with expertise were formed to reach consensus on accepted practice patterns. The 1997 revision of the Preferred Practice Patterns updated the original document, developed additional practice patterns for new or emerging areas of clinical practice, and represented the first time audiology documents were separated from speech pathology documents.
The current Preferred Practice Patterns for the Profession of Audiology represent the consensus of the members of the profession after the consideration of available scientific evidence, existing ASHA and related policies, current practice patterns, expert opinions, and the collective judgment and experience of practitioners in the field. Requirements of federal and state governments and accrediting and regulatory agencies also have been considered. They reflect current practice based on available knowledge. Because audiology is a dynamic and continually developing profession, advances are expected to change current practice patterns. Similarly, advances in educational and health care policy and practices influence professional practices. The practice patterns will be updated periodically to reflect new clinical, scientific, and technological developments that occur inside and outside the profession of audiology.
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American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1998). Support personnel in audiology: Position statement and guidelines. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2003). Code of ethics (revised). Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Clinical practice by certificate holders in the profession in which they are not certified. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Confidentiality. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004c). Conflicts of professional interest. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004d). Evidence-based practice in communication disorders: An introduction [Technical report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004e). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004f). Scope of practice in audiology. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). Cultural competence. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b). Evidence-based practice in communication disorders [Position statement]. Available from www.asha.org/policy.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Pub L. No. 104-191
World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.
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Assessment: (1) Procedures to identify and/or monitor a patient's/client's communication and related abilities and to diagnose communication and related disorders; (2) procedures to identify and determine the appropriateness and/or design of communication and related devices and systems.
At risk: Susceptible to disease, disorder, or injury because of biological, environmental, or behavioral factors. Audiologist: Audiologists hold either a master's or doctoral degree, the Certificate of Clinical Competence from the American Speech-Language-Hearing Association, and, where applicable, state licensure. These professionals identify, assess, and provide treatment for hearing, balance, and related disorders in individuals of all ages. They manage and supervise programs and services related to human communication and its disorders. Audiologists counsel individuals with hearing, balance, and related disorders, their families, caregivers, and other service providers about the disability and its management. They provide preventive services and consultation, and make referrals. Facilitating hearing, balance, and related functions is the goal of audiologists.
Communication and related disorders: Disorders of speech, (articulation, voice, resonance, fluency), orofacial, myofunctional patterns, language, swallowing, cognitive-communication, hearing, and balance.
Consumer: Direct or indirect recipient of professional services. The term consumer primarily refers to patients/clients (direct recipients) but can also refer to families, referral sources, third-party payers, or anyone who receives the results of the speech-language pathologist's and audiologist's work (indirect recipients).
Dispense: To provide or sell products to consumers.
Duration of treatment: The total length of time treatment is received (e.g., 6 months, 1 year).
Functional communication: Ability to convey or receive a message, regardless of the mode, to communicate effectively and independently in natural environments.
Interdisciplinary approach: An approach to clinical management that requires representatives of various disciplines (e.g., speech-language pathologists, audiologists, physicians, nurses, physical therapists, occupational therapists, teachers) to work with an integrated plan of treatment.
Intradisciplinary approach: An approach to clinical management that requires representatives of various professions within the same discipline (e.g., speech-language pathologists, audiologists) to work within an integrated plan of treatment.
Multidisciplinary approach: An approach to clinical management whereby representatives of multiple disciplines work with a patient/client without necessarily forming an integrated plan of treatment.
Natural environments: Actual daily environments in which patients/clients function (e.g., home, school, work).
Neonates: Newborn infants up to the age of 28 days.
Parent/caregiver: Parent/caregiver is defined in the Individuals with Disabilities Education Act (IDEA) as (a) a natural or adoptive parent of a child; (b) a guardian but not the State if the child is a ward of the State; (c) a person acting in the place of a parent (such as a grandparent or stepparent with whom the child lives, or a person who is legally responsible for the child's welfare); or (d) a surrogate parent who has been appointed in accordance with §300.515.
Patient/client: Recipients of clinical care in various settings (e.g., hospitals, schools, clinics, industry).
Planned environment: An environment that is controlled according to screening, assessment, or treatment needs. For example, an environment can be controlled for ambient noise, visual distractors, size, and lighting.
Premorbid health status: Health status before disease, disorder, or injury.
Prevention (primary): Elimination or inhibition of the onset and development of a communication or related disorder by altering susceptibility or reducing exposure for susceptible persons.
Prevention (secondary): Early detection and treatment of communication and related disorders. Secondary prevention may lead to the elimination of the disorder or slowing of the disorder's progress, thus preventing further complications.
Prevention (tertiary): Reduction of a disability by attempting to restore effective functioning. The major approach is rehabilitation of the individual who has realized some residual problem as a result of the disorder.
Products: Prosthetic or assistive systems/devices (e.g., hearing aids, assistive listening systems/devices, sensory aids) and related accessories such as batteries, battery testers, cords, tubing, and hooks.
Referral: The act of sending or recommending for screening, assessment, or treatment. Referral sources may include self, teachers, physicians, and families.
Screening: A pass/fail procedure to identify patients/clients who require assessment.
Speech-language pathologist: Speech-language pathologists hold either a master's or doctoral degree, the Certificate of Clinical Competence from the American Speech-Language-Hearing Association, and, where applicable, state licensure. These professionals identify, assess, and provide treatment for communication and swallowing function and their disorders in individuals of all ages. They manage and supervise programs and services related to human communication and swallowing function and their disorders. Speech-language pathologists counsel individuals with disorders of communication and swallowing function, their families, caregivers, and other service providers about the disability and its management. They provide preventive services and consultation, and make referrals. Facilitating the development and maintenance of human communication and swallowing function is the goal of speech-language pathologists.
Standard health precautions: A set of recommendations, issued by the federal Centers for Disease Control and Prevention, to prevent transmission of blood-borne pathogens (e.g., human immunodeficiency virus, hepatitis B).
Support personnel: Persons who, following academic and/or on-the-job training, provide services as prescribed, directed, and supervised by a certified audiologist.
Third-party payer: A public or private organization that pays or insures health or medical expenses on behalf of recipients of care. Third-party payments are distinguished by the separation between the individual receiving the service (the first party), the individual or institution providing it (the second party), and the organization paying for it (the third party).
Treatment: A professional intervention based on an individualized plan of care.
Type of treatment: Broad categories of treatment, including home programs and computer-assisted, face-toface, individual, or group treatment.