Audiology Support Personnel: Preparation, Supervision, and Ethical Considerations
This official policy document of the American Speech-Language-Hearing Association (ASHA) is the product of a working group charged with revising and updating the document Support Personnel in Audiology: Position Statement and Guidelines (ASHA, 1998). Members of the working group were Kyle Dennis, Diane Eger, Cindy Johnson, Mary Jo Schill, Vickie Tuten, and Jaynee Handelsman (chair). Pam Mason served as ex officio for the group. This document supercedes the 1998 document and applies to (a) all members of ASHA, regardless of whether they are certified; (b) all nonmembers holding the Certificate of Clinical Competence from the Association; and (c) applicants for membership or certification.
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Federal and state health care and education reform initiatives, changing U.S. demographics, and the broadening scope of practice of audiologists (American Academy of Audiology [AAA], 2004; ASHA, 2004; Council on Academic Accreditation in Audiology and Speech-Language Pathology and Council For Clinical Certification in Audiology and Speech-Language Pathology, 2008), emerging new technology, and changes in audiology practice patterns have affected the delivery of audiology services. Audiologists are using support personnel in audiology service delivery systems to ensure both the accessibility and the highest quality of audiology care while addressing productivity and cost-benefit concerns. Twelve states license support personnel in the professions of audiology and/or speech-language pathology, 21 states register support personnel, and five states certify support personnel (ASHA, 2009). About 20 states mention audiology assistants, 12 states register assistants, and one state certifies audiology assistants (AAA, n.d.).
This position statement and guidelines document does not supersede federal legislation and regulation requirements or any existing state licensure laws, nor does it affect the interpretation or implementation of such laws. The document may serve, however, as a guide for the development of new laws or, at the appropriate time, for revising existing licensure laws.
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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 licensed audiologist (Dunlop et al., 2006; Kasewurm, 2006; Saccone & Steiger, 2008).
Audiologists spend most of their direct patient care time administering tests. It is the position of ASHA that hearing health care delivered in this manner is inefficient and inconsistent with practice models of other independent practitioners, such as physicians, dentists, and optometrists. In these practice models, routine and technical services are performed by support personnel under the supervision of a licensed health care professional. Using this practice model, audiology assistants would perform technical services that do not require the professional judgment of a licensed audiologist, such as otoscopy and cerumen removal; acoustic immittance tests; pure tone hearing testing; ear impressions; device ordering; electroacoustic analysis; checking, repairing, or modifying hearing aids; hearing aid orientations; and administrative duties.
Audiology assistants are critical to a new delivery model. In a time of limited resources, audiologists need support in performing routine tasks to allow them more time for management and treatment of individuals with hearing loss, balance disorders, tinnitus, and other auditory disorders.
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It is the position of ASHA that support personnel may assist audiologists in the delivery of services where appropriate. The roles and tasks of audiology support personnel, herein referred to as audiology assistants, will be assigned only by supervising audiologists. Supervising audiologists will provide appropriate training that is competency-based and specific to job performance. Supervision will be comprehensive, periodic, and documented. The supervising audiologist maintains the legal and ethical responsibilities for all assigned audiology activities provided by support personnel. The needs of the consumer of audiology services and protection of that consumer will always be paramount (AAA, 2010a, 2010b; ASHA, 2010; National Hearing Conservation Association, 1990). Audiologists are uniquely educated and specialize in the diagnosis and rehabilitation of hearing and related disorders. As such, audiologists are the appropriate, qualified professionals to hire, supervise, and train audiology assistants.
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SUPPORT PERSONNEL: 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 licensed audiologist. When hearing aid dealers are serving in a role as an assistant, their duties will always be clarified by the supervising audiologist.
SUPERVISING AUDIOLOGIST: An audiologist who holds a full, current, and unrestricted license to practice audiology from a state, territory, commonwealth, or the District of Columbia (where applicable), and who has been practicing for at least 1 year after meeting these requirements. In the case of an individual who furnishes audiology services in a state that does not license audiologists, or an individual exempted from state licensure based on practice in a specific institution or setting, the individual must meet one of the following conditions:
Have a Certificate of Clinical Competence in Audiology granted by ASHA.
Have successfully completed a minimum of 350 hours of supervised clinical practicum (or be in the process of accumulating that supervised experience under the supervision of a qualified master's or doctoral level audiologist); or performed at least 9 months of full-time audiology services under the supervision of a qualified master's or doctoral level audiologist after obtaining a master's or doctoral degree in audiology or a related field; or performed a minimum of 12 months' full-time equivalent of supervised clinical practicum; or after January 1, 2011, completed a program of study that includes a minimum of 1,820 hours of supervised clinical practicum; and completed a national examination in audiology.
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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; nonmembers holding the Certificate of Clinical Competence from the Association; and applicants for membership or certification.
Although the 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 or hearing scientist, those individuals in a support role must be knowledgeable about the provisions 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. Since 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 duties assigned. If the assistant engages in activities that violate the Code of Ethics, the supervising professional may be found in violation of the Code.
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 activities, 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 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 professions 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: Since 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 being found in violation of the Code.
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Have a high school degree or equivalent.
Have communication and interpersonal skills necessary for the tasks assigned.
Have a basic understanding of the needs of the population being served.
Have met training requirements and have competency-based skills necessary for the performance of specific assigned tasks.
Have any additional qualifications established by the supervising audiologist to meet the specific needs of the audiology program and the population being served.
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Training for audiology assistants should be well-defined and specific to the assigned task(s). Supervising audiologists will 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 information on roles and functions. Continuing training opportunities should be provided to ensure that practices are current and that skills are maintained. The supervising audiologist will maintain written documentation of completed training activities.
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Audiology assistants may engage in only those tasks that are planned, delegated, and supervised by the audiologist. The duties and responsibilities assigned to audiology assistants shall be based on the training, available supervision, and the specific work setting. The scope of practice of the supervising audiologist shall also dictate the duties and responsibilities assigned to the audiology assistant.
The types of services that audiology assistants may perform include the following:
Greet and escort patients.
Schedule patients.
Package and mail earmold orders, device repairs, and factory returns.
Perform inventories of equipment and supplies.
Enter clinic supply orders.
Perform checks on hearing aids and other amplification devices.
Perform troubleshooting and minor repairs to hearing aids, earmolds, and other amplification devices.
Clean hearing aids and other amplification devices.
Perform electroacoustic analysis of hearing aids and other amplification devices.
Instruct patients in proper use and care of hearing aids and other amplification devices.
Demonstrate alerting and assistive listening devices.
Instruct patients in proper ear hygiene.
Assist audiologists in treatment programs.
Assist audiologists with setup and technical tasks.
Prepare materials for ear impressions.
Maintain and restock test and treatment rooms.
Perform equipment maintenance and biological checks.
Conduct hearing and tympanometric screening on older children and adults (without interpretation).
Conduct otoacoustic emission screening.
Perform nondiagnostic otoscopy.
Perform cerumen management under the supervision of an audiologist or physician.
Take ear impressions under the supervision of an audiologist.
Perform audiologic and vestibular tests (without interpretation).
Assist audiologists in hearing testing of pediatric patients.
Perform pure-tone hearing screening.
Perform universal newborn hearing screening tests.
Perform infection control duties within the clinic/service
Assist patients in completing case history or other relevant forms.
(Note: This list provides examples and is not intended to be all-inclusive.)
Audiology assistants will not perform any task without the express knowledge and approval of the supervising audiologist. Actions that audiology assistants shall not be allowed to perform include the following:
Determine case selection.
Determine evaluation protocols.
Interpret observations or data into diagnostic statements of clinical management strategies or procedures.
Participate in team or case conferences, or any interdisciplinary team, without the presence of the supervising audiologist or an audiologist designated by the supervising audiologist.
Write, develop, or modify a patient's individualized treatment plan.
Assist with patients without following the treatment plan prepared by the audiologist or without proper supervision.
Compose or sign 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.
Transmit clinical information, either orally or in writing, to anyone, including the patient, without the approval of the supervising audiologist.
Select patients for treatment services or discharge patients from treatment services.
Disclose clinical or confidential information, either orally or in writing, to anyone other than the supervising audiologist.
Counsel or consult with the patient, family, or others regarding the patient status or service, or make referrals for additional services.
Refer to themselves either orally or in writing with a title other than one determined by the supervising audiologist.
(Note: This list provides examples and is not intended to be all-inclusive.)
Audiology assistants with specialized training from the Council for Accreditation in Occupational Hearing Conservation (CAOHC) may perform the following services under the supervision of a licensed audiologist or physician:
Perform checks and calibration of audiometric instrumentation.
Perform otoscopic screening and pure-tone threshold testing for the purpose of hearing conservation.
Provide basic counseling of employees concerning test results and criteria for employee referral.
Fit and train employees on personal hearing protection devices.
Perform fit testing of hearing protection devices.
Assist CAOHC course directors in conducting training courses.
Provide employee hearing conservation education, training, and motivation.
Perform record keeping.
Generate periodic hearing conservation statistical reports.
Tasks that CAOHC-certified occupational hearing conservationists shall not do include the following:
Assume the role of a professional supervisor of the audiometric monitoring portion of a hearing conservation program.
Assume the role of an instructor of other occupational hearing conservationists.
Interpret audiograms.
Conduct any type of audiometric testing other than air conduction, such as bone-conduction testing or speech audiometry.
Diagnose hearing disorders.
Independently evaluate hearing conservation program effectiveness.
Conduct noise surveys and analyses or be responsible for noise-control solutions.
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Supervising audiologists will provide supervision for only those clinical activities for which they are qualified and have been approved to perform by their employing health care organization. The supervising audiologist has the ultimate clinical and legal responsibility for the care provided to the patient.
Supervising audiologists will have the primary role in all administrative actions related to audiology assistants, such as hiring, training, determining competency, and conducting performance evaluations. In addition, the supervising audiologist maintains final approval of all directives given by administrators and other professionals regarding audiology tasks. Supervising audiologists will assign specific tasks to the support person. Such tasks must not require the exercise of professional judgment or entail interpretation of results or the development or modification of treatment plans. An assessment of the audiology assistant's proficiency in performing assigned tasks will be accomplished by the supervising audiologist on a predetermined, periodic basis. This assessment will be used to provide feedback to the audiology assistant to promote continuous performance improvement.
Supervising audiologists have the responsibility to delegate and supervise specific tasks to audiology assistants. Such tasks must not exceed the knowledge and skills of audiology assistants or exceed their scope of practice, specifically the exercise of professional judgment, the interpretation of results, or the development or modification of treatment plans. The number of audiology assistants supervised by an audiologist must be consistent with the delivery of appropriate, quality service. 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.
Levels of supervision:
In general, audiology assistants with less education or training require more intense and more immediate supervision than do those with more advanced education and training or more experience. The amount and type of supervision required should be 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. For example, more intense supervision will be required during orientation of a new audiology assistant; initiation of a new program, task, or equipment; or a change in patient/client status.
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 will encourage and permit trainees to assume increasing levels of responsibility commensurate with their individual progress, experience, skill, knowledge, and judgment.
Permissible levels of supervision are listed below. 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 will be utilized.
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 formally been 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.
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It is the intent of this document to give guidance for the use of audiology assistants in audiology settings, thereby increasing access to timely and efficient audiologic services. It is the responsibility of the supervising audiologists to stay abreast of current guidelines and to ensure the quality of services rendered.
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American Academy of Audiology. (2004). Scope of practice. Retrieved from www.audiology.org/resources/documentlibrary/Pages/ScopeofPractice.aspx.
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 Academy of Audiology. (n.d.). Audiology assistants. Retrieved from www.audiology.org/advocacy/state/Documents/AudiologyAssistants.pdf
American Speech-Language-Hearing Association. (1998). Support personnel in audiology: Position statement and guidelines [Guidelines, position statement]. Retrieved from www.asha.org/docs/html/GLPS1998-00038.html.
American Speech-Language-Hearing Association. (2004). Scope of practice in audiology. Retrieved from www.asha.org/docs/html/SP2004-00192.html.
American Speech-Language-Hearing Association. (2009). State licensure trends and quarterly updates: Support personnel. Retrieved from www.asha.org/uploadedFiles/SupportPersonnelTrends.pdf.
American Speech-Language-Hearing Association. (2010). Code of ethics. Retrieved from www.asha.org/docs/html/ET2010-00309.html.
Council on Academic Accreditation in Audiology and Speech-Language Pathology and Council For Clinical Certification in Audiology and Speech-Language Pathology. (2008). A practice and curriculum analysis for the profession of audiology. Rockville, MD: American Speech-Language-Hearing Association.
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.
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American Academy of Audiology. (2006). Position statement on audiologist's assistants. Audiology Today, 18 (2), 27-28. Retrieved from www.audiology.org.
American Academy of Audiology. (2009). Code of ethics. Retrieved from www.audiology.org/resources/documentlibrary/Pages/codeofethics.
American Speech-Language-Hearing Association. (2004). Support personnel [Issues in ethics]. Retrieved from www.asha.org/policy.
American Speech-Language-Hearing Association. (2006). Preferred practice patterns for the profession of audiology. Retrieved from www.asha.org/docs/html/PP2006-00274.html.
American Speech-Language-Hearing Association. (2011). 2011 standards and implementation procedures for the Certificate of Clinical Competence in Audiology. Retrieved from www.asha.org/Certification/Aud2011Standards/.
Canadian Association of Speech-Language Pathologists and Audiologists. (2010). Supportive personnel guidelines: Working with audiologists. Retrieved from www.caslpa.ca/PDF/Audiologists%20Supportive%20Personnel.pdf.
Council for Accreditation in Occupational Hearing Conservation. (2004). CAOHC certified occupational hearing conservationist scope of practice and limitation. Retrieved from www.caohc.org/ohc/scopeofpractice.php.
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