Report on Emerging Areas of Clinical Practice

May 2008

A. Background and Purpose

An ASHA National Office team was formed to address one of the strategies within ASHA's 2005-2007 Strategic Plan pertaining to the identification of emerging areas of clinical practice in audiology and speech-language pathology.

  • Issue D -Rapid increase in the knowledge and skill sets needed to provide quality professional services in a culturally competent manner across various practice settings will lead to specialization areas of clinical practice related to communication sciences and disorders.
  • Outcome 3 -Identification of the specialization areas in communication sciences and disorders
  • Strategy 2 -By December 31, 2007, the Academic Affairs team in collaboration with the Professional Practices units and the Special Interest Division and International Liaison (SIDIL) programs will have reviewed extant data from ASHA sources (e.g., Higher Education Data System [HES], practice analysis) and will report on emerging areas of clinical practice.

Team Members

  • Loretta Nunez, Academic Affairs (team leader)
  • Susanna Aulbach, Academic Affairs
  • Sharon Beamer, Audiology Professional Practices
  • Leigh Deussing, SIDIL
  • Diane Paul, Speech-Language Pathology Practices: Clinical Issues

This report presents information on the methodology and data sources used to identify emerging areas of clinical practice in the professions and summarizes the findings of the review.

B. Methodology

Clinical Questions

The team formulated the following questions for the purpose of evaluating the data sources and identifying possible emerging areas of clinical practice:

  1. Is the practice in the current Scope of Practice in Audiology and/or Speech-Language Pathology? If yes, is the practice applied as described in the scope(s) of practice? If no, are clinicians being asked to perform a new procedure?
  2. Are new populations being served by clinicians? Or are existing treatment approaches being applied to new populations?
  3. Is there research to support including the practice as an emerging area of practice?
  4. Are speech-language pathologists (SLPs) and/or audiologists being excluded from areas of clinical practice that are within their respective scopes of practice?
  5. Is there a new service delivery model being used?

A flowchart [PDF] was established to facilitate the process of determining possible areas of emerging clinical practice.

Data Sources Included in the Review

The team selected several timely and relevant data sources for inclusion in the review. Data sources and their time periods are identified below. Data collection results were recorded on a tracker [PDF].

Team members coordinated the review of specific data sources. Team members, other staff, and Division Steering Committee members, selected on the basis of area of interest, expertise, and/or professional discipline, conducted the reviews. Data sources were the following:

  • Technical assistance reports (January 2006 to September 2007)
    • Audiology Practices unit
    • Office of Multicultural Affairs
    • Speech-Language Pathology Practices unit
  • Publications (January 2005 to August 2007)
    • ASHA journals
      • American Journal of Audiology (AJA)
      • American Journal of Speech-Language Pathology (AJSLP)
      • Contemporary Issues in Communication Science and Disorders (CICSD; published by the National Student Speech Language Hearing Association [NSSLHA])
      • Journal of Speech, Language, and Hearing Research (JSLHR)
      • Language, Speech, and Hearing Services in Schools (LSHSS)
    • Other journals (January 2005 to August 2007)
      • Genetics in Medicine
      • Journal of the Acoustical Society of America (JASA)
      • International Association of Logopedics and Phoniatrics (IALP) journal
      • International Journal of Audiology
      • Journal of the American Academy of Audiology (JAAA)
      • New England Journal of Medicine (NEJM)
  • Trade magazines
    The team considered reviewing the following trade magazines as potential sources: Advance for Audiologists, Advance for Speech-Language Pathologists, Hearing Journal, Hearing Instruments, and Audiology Today. However, the team decided against their use because they are not peer-reviewed publications.
  • Grants (January 2005 to August 2007)
    • ASHFoundation
    • Department of Education
    • National Institute on Deafness and Other Communication Disorders (NIDCD)
  • ASHA surveys
    • Audiology (2007)
    • Critical Issues-Legislative Council (2007)
    • Healthcare (2007)
    • Schools (2007)
  • Special Interest Divisions
    • Conference calls
    • E-mail lists
    • Minutes
    • Newsletters (July 2006 and August 2007)
    • Steering committees
  • E-mail lists and Web forums (January 2007 to August 2007)
    • ASHA Audiology e-mail list
    • ASHA Audiology Web forum
    • ASHA Speech Web forum
    • ASHA Web forum-education topics
    • Divisions' Web forums
    • American Academy of Audiology (AAA) e-mail list
    • Council of Academic Programs in Communication Sciences and Disorders (CAPCSD) e-mail list
  • ASHA continuing education and professional development programs
  • ASHA Convention programs (2006 and 2007)
  • Other conference programs (2007)
    • ASHA Healthcare Conference
    • ASHA Schools Conference
    • Audiology Now! Convention (AAA)
    • British Columbia Academic Health Council's Practice Makes Perfect conference
    • CAPCSD Conference
    • Early Hearing Detection and Intervention (EHDI) conference
    • Educational Audiology Association (EAA) conference
  • Related Professional Organizations (2007)
    • American Association on Intellectual and Developmental Disabilities (AAIDD)
    • Association of Federal Audiologists and Speech Language Pathologists (AFASLP)
    • Council for Accreditation in Occupational Hearing Conservation (CAOHC)
    • Council for Exceptional Children (CEC)
    • International Association for Logopedics and Phoniatrics (IALP)
    • Military Audiology Association (MAA)
    • National Black Association for Speech-Language and Hearing (NBASLH)
    • National Hearing Conservation Association (NHCA)
    • Veterans Affairs Audiology Association (VAAA)
  • Licensing laws
  • ASHA policy documents (2002 to 2007)
    • Scopes of Practice
    • Certification Standards
  • Other
    • Media sources

C. Data Collection

For details concerning the data collection process, see the tracker [PDF]. The purpose of the data collection and literature review process was to find evidence of emerging areas of practice; the intent was not to evaluate the quantity nor quality of associated research.

Determining Areas of Emerging Clinical Practice

The team applied questions noted in section B to determine whether the topic met criteria for consideration as an emerging area of practice. The team reached consensus on areas of practice categorized as "emerging," "expanding," and "nonemerging" and documented these areas on the tracker [PDF]. The team defined these categories as:

  • Emerging -new areas of practice for which clinicians are being asked to perform a new procedure, work with a new population, apply an existing treatment approach to a new population, or use a new service delivery model. The new area may or may not be in the current scope(s) of practice.
  • Expanding -although not new areas of practice, expanding areas represent practice trends that involve an increasing number of professionals.
  • Nonemerging -not new areas of practice. These areas were proposed to the team as emerging but the team determined them to be existing areas of practice (neither emerging nor expanding). Additionally, nonemerging areas included novel assessment or treatment approaches that had no known research and very limited use (e.g., mentioned once in one convention program).

D. Results

Emerging and expanding areas of practice are listed below. Nonemerging areas are listed separately. The attached tracker [PDF] provides the details of each clinical practice area, including the data source and rationale for selecting a practice as emerging or expanding or excluding it from these categories.

Emerging Areas of Clinical Practice

The following areas were considered to be new areas of clinical practice based on review of data sources and the established criteria. Preservice education and/or professional development will likely be needed in these areas.


  • Audiologists to screen for mild traumatic brain injury (TBI)
  • Broadband reflectance
  • Caloric stimulation as treatment
  • Ear camera
  • Genetic screening for hearing loss (HL)
  • Hybrid cochlear implantation with new populations of persons with HL (i.e., mild/moderate HL or high frequency HL)
  • Neuromonics (tinnitus treatment protocol)
  • Otoacoustic emissions for predicting sudden infant death syndrome
  • Targeted stimulation after acoustic trauma limiting noise induced hearing loss (animal model)

Dual Interest

  • Emergency preparedness-audiologists and SLPs in a new role

Speech-Language Pathology

  • Electrical stimulation for facial weakness from Bell's palsy-the otolaryngologist implants the device and the SLP programs it
  • Electrical stimulation with implantable electrodes (SLPs programming the devices)
  • Esophageal dysphagia (assessment)
  • High-speed imaging of the larynx
  • Otoacoustic emissions screening by SLPs
  • Providing communication support for the acquisition of English to international adoptees (who do not have language disorders in their native language)
  • Transnasal esophagoscopy and pharyngeal/esophageal manometry
  • Speech-language pathology services for homeless children
  • Verb network strengthening treatment (VNeST) (enhances word meaning for verbs)

Expanding Areas of Clinical Practices

The following areas were not considered as new areas of clinical practice based on the criteria but were considered to represent an expanding area because they represent major practice trends in response to current technological, societal, legislative, economic, environmental, and/or political influences. With an increasing recognition of their importance, a greater number of professionals are engaged in these areas of practice. Preservice education and/or professional development may be needed in these areas.


  • Automated test of word recognition-Phase II studies
  • Evaluation of American Sign Language proficiency
  • Infant hearing aids
  • Transposition hearing aids
  • TBI screening

Dual Interest

  • Application of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) framework for viewing disability
  • Audiologists and SLPs and their role in communicating information for consumers in accordance with health literacy goals
  • Evidence-based clinical practice in schools and other settings
  • Responsiveness to intervention-preschool intervention for at-risk children
  • Use of augmentative and alternative communication (AAC) devices and sign language with new populations

Speech-Language Pathology

  • Cervical auscultation for swallowing
  • Computer-assisted language intervention
  • Forensic speech-language pathology services
  • Low incidence disorders
  • Needs of bilingual/multilingual children as an area where SLPs need continuing education to address needs of this population being served
  • Neurotoxicants (Expanding role of SLP in prevention)
  • Role release (transdisciplinary, primary service provider models) in early intervention
  • SLPs working with persons with cochlear implants
  • Telepractice in the schools
  • Training bilingual personnel
  • Working with individuals with autism
  • Working with individuals in high poverty areas
  • Use of Internet treatment
  • Work with multilingual populations
  • Work with a more diverse population
  • Voice and variations by race and ethnicity
  • Dialect use and code switching by professionals and students in communication sciences and disorders (CSD) programs
  • Assessing oral competency of college students, professionals, consumers
  • Working in the Neonatal Intensive Care Unit (NICU)
  • 3:1 service delivery model

E. Conclusions and Recommendations

This strategy related to:

  • Issue D -Rapid increase in the knowledge and skill sets needed to provide quality professional services in a culturally competent manner across various practice settings will lead to specialization areas of clinical practice related to communication sciences and disorders.
  • Outcome 3 -Identification of the specialization areas in communication sciences and disorders

Under the ASHA Specialty Recognition Program, the standards used to recognize specialty areas of practice include the following:

  • The specialty area is neither parallel to nor subsumed within the scope of practice of another area of specialization.
  • The specialty area affects a definable population of consumers whose needs require a distinct body of knowledge, skills, and experience.
  • The specialty area represents a distinct and definable body of knowledge and skills, grounded in basic and applied research, as well as in principles derived from professional practice.
  • The specialty area is one in which individual practitioners currently practice and/or are required for the delivery of services to consumers.
  • The specialty area has mechanisms for acquisition of the required knowledge, skills, and experience.

Although we have identified emerging areas of clinical practice, we do not consider any of these emerging areas as possible areas of specialization in CSD at this time. In fact, it would be highly unlikely that any "emerging" area of practice would become an area of specialization. Areas of specialization need to have a clear evidence base, should be tracked over time, and/or be a prominent area of practice. Typically, areas of specialization are broader areas of practice that are long established rather than specific assessment or treatment techniques or new areas of practice.

It is recommended that the team disseminate the results of this report to ASHA members and the academic community in 2008. It is also recommended that the process and tools the team created for this initiative (e.g., flowchart, identified data sources, data tracker) be adopted and implemented routinely by the Professional Practices Units in order to track emerging areas of practice on a systematic basis.

F. Resources

ASHA Corporate Partners