Scope of Practice
Ad Hoc Committee On The Scope Of Practice In Audiology
About This Document: This scope of practice document is an official policy of the American Speech‑Language‑Hearing Association (ASHA) defining the breadth of practice within the profession of audiology. The Audiology Scope of Practice document has not been updated since 2004. The aim of this document is to reflect the current and evolving clinical practice in audiology. Such changes include, but are not limited to, telehealth, discussion of hearing technologies beyond traditional hearing devices (e.g., over-the-counter [OTC]), and personal sound amplification products (PSAPs). Additional updates in advancements in hearing device implantation, vestibular assessment and rehabilitation, hearing preservation, educational audiology, and interoperative monitoring practice are included.
This document was developed by the ASHA Ad Hoc Committee on the Scope of Practice in Audiology. Committee members were Julie Honaker (chair), Robert Beiter, Kathleen Cienkowski, Gregory Mannarelli, Maryrose McInerney, Tena McNamara, Jessica Sullivan, Julie Verhoff, Robert Fifer (board liaison), and Pam Mason (ex officio). This document was approved by the ASHA Board of Directors on August 20, 2018.
Table of Contents
The purpose of the Scope of Practice in Audiology is as follows:
By virtue of training and practice, audiology is a unique profession that specializes in and provides comprehensive diagnostic and nonmedical treatment services for hearing and balance disorders, and related impairments. These services are provided to individuals across the entire age span from birth through adulthood; these individuals include persons of different races, genders, religions, national origins, and sexual orientations. This position statement is not intended to be exhaustive; however, the activities described in this document reflect current practice within the profession. Practice activities related to emerging clinical, technological, and scientific developments are not precluded from consideration as part of the scope of practice of an audiologist. If the audiologist can document appropriate training for new and emerging clinical or technological procedures that fall under the heading of auditory, balance and other related disorders, then such innovations and advances may be incorporated into the Audiology Scope of Practice. Audiologists are trained in all areas of clinical service delivery; however, they commonly have one or more specific areas of specialization. ASHA also recognizes that credentialed professionals in related disciplines have knowledge, skills, and experience that could be applied to some areas within the Audiology Scope of Practice. Defining the scope of practice of audiologists is not meant to exclude other appropriately credentialed postgraduate professionals from rendering services in overlapping practice areas. Often, these partially overlapping skill sets can result in excellent opportunities for IPP.
Audiologists must achieve required competencies in ancillary professional areas. These areas are distinct from but contribute to diagnostic and nonmedical treatment activities. They are very important areas in which to maintain high standards of clinical service. Examples include cultural and linguistic competencies, IPP, patient- and family-centered care, supervision, and mentoring and knowledge of federal and state statutes and regulations.
This scope of practice does not supersede existing state licensure laws or affect the interpretation or implementation of such laws. It should serve, however, as a model for the development or modification of licensure laws.
The goals of this updated Scope of Practice in Audiology of the American Speech-Language-Hearing Association (ASHA) are as follows:
Clinical service delivery areas include all aspects of hearing, balance, and other related disorders that impact hearing and balance, including areas of tinnitus, cognition, and auditory processing for individuals across the lifespan. Audiologists play critical roles in health literacy; in the screening, diagnosis, and treatment of hearing, balance, and other related disorders; and in the use of the International Classification of Functioning, Disability and Health (ICF; WHO, 2014) to develop functional goals and collaborative practice. As technology and science advance, the areas of assessment and intervention related to hearing, balance, and other related disorders grow accordingly. Clinicians should stay current with advances in hearing and balance practice by regularly reviewing the research literature; regularly consulting the Practice Management section of the ASHA website, including the Practice Portal; and regularly participating in continuing education to supplement advances in the profession and to provide additional information that can inform the Scope of Practice in Audiology.
Audiologists are responsible for the assessment of hearing, balance, and other related disorders, including tinnitus and auditory processing, across the lifespan that includes the following:
This assessment includes measurement and professional interpretation of sensory and motor evoked potentials, electromyography, and other electrodiagnostic tests for purposes of neurophysiologic intraoperative monitoring and cranial nerve assessment.
Diagnostic measures should be modified based on patient age and on cognitive and physical abilities of the individuals being assessed. Case findings of dementia, memory, vision, and balance (falling risk) should be used when difficulty in communication and or change of behavior is evident (Beck & Clark, 2009; Li et al., 2014; Shen et al., 2016; Sweetow, 2015; Weinstein, 2017; Weinstein, 2018). Assessment extends beyond diagnostic evaluation and includes informational counseling, interpretation of results, and intervention.
Assessment is accomplished using quantitative and qualitative measurements—including standardized testing, observations, and procedures and appropriately calibrated instrumentation—and leads to the diagnosis of abnormal audiologic and/or balance function. Interpretation of test results includes diagnostic statements as to the probable locus of impairment and functional ability within the hearing, balance, and other related systems under assessment.
Audiologists collaborate with other professionals and serve on care teams to help reduce the perceived burden of hearing, balance, and other related disorders and maximize quality of life for individuals.
Audiologists provide comprehensive audiologic (re)habilitation services for individuals and their families across the lifespan who are experiencing hearing, balance, or other related disorders (e.g., tinnitus and auditory processing disorder). Intervention encompasses the following:
In this role, audiologists
As part of the comprehensive audiologic (re)habilitation program, audiologists evaluate, select, fit, verify, validate, and monitor the performance of a variety of technologies interventions for hearing, balance, and other related disorders. Audiologists provide individual counseling and public education about the benefits and/or limitations of various different classes of devices. Treatment utilizing technology interventions include but are not limited to other emerging technologies:
Treatment for children also includes developmental and educational interventions such as the following:
Audiologists provide screening, assessment, and treatment services for infants and young children with hearing-related disorders and their families. Services include the following:
Audiologists in educational settings provide a full spectrum of hearing services to support academic and social achievement for school-age children, adolescents, young adults, and their families with hearing and related difficulties. Services include the following:
The terms hearing conservation and hearing preservation are often used interchangeably. Both terms focus on preventing noise-induced hearing loss, whether from occupational or recreational sources. Hearing conservation programs are most often, although not exclusively, associated with occupational noise exposure and with U.S. Occupational Safety and Health Administration (OSHA) regulations (OSHA, 2002). In addition, hearing conservation programs have additional elements not found in hearing preservation programs: engineering controls for reducing environmental noise levels, administrative controls for monitoring hearing sensitivity levels, mandated use of hearing protection devices when needed, employee training about noise, the potential synergistic effects of chemical exposure combined with hazardous noise, and requirements for communication about hazards (e.g., warning signs, posting of signs in required hearing protection environments).
Hearing preservation programs focus on non-occupational settings and are most often intended to prevent hearing loss from occurring in individuals who enter the program with normal hearing sensitivity. Examples of hearing preservation programs may include (a) monitoring of auditory function for patients receiving chemotherapy or radiation therapy of the head or neck (University Health Network, 2018) or (b) providing education to students and young adults on the effects of recreational noise and methods to prevent hearing loss (see the Save Your Hearing Foundation at www.earpeacefoundation.org). Audiologists are uniquely qualified through education and training to design, establish, implement, and supervise hearing conservation programs for individuals of all ages in schools, in industry, and for the general public (Lipscomb, 1988).
Audiologists who engage in occupational hearing conservation must monitor current OSHA regulations (OSHA, 2002) regarding the impact of noise levels on hearing sensitivity. This extends to the distribution of, and instructions related to the use of, hearing protection devices.
Audiologists test hearing levels, determine functional hearing ability, measure noise levels, and assess the risk of incurring hearing loss from noise exposure from any source, including non-occupational and recreational noise (Franks, Stephenson, & Merry, 1996a, 1996b, 1996c).
Audiologists implement and manage all aspects of hearing conservation activities—including education, testing, and the determination of program effectiveness—and serve as the supervisor for OSHA and other U.S. government–mandated hearing conservation programs (Suter, 2003).
Audiologists educate the public and other professionals on how to recognize hazardous noise, ways of preventing noise-induced hearing loss, and the risks associated with reduced audibility when exposed to high-level sound.
Telehealth, for audiology, is an alternative method of service delivery that encompasses both diagnostics and intervention services. Diagnostic services are provided using either synchronous or asynchronous protocols (i.e., store and forward, whereby data are collected, stored within a computer, and forwarded at a later time). Audiologists provide services using an evidence-based standard of care (American Telemedicine Association, 2017). When practicing via telehealth, audiologists provide care consistent with jurisdictional regulatory, licensing, credentialing and privileging, malpractice and insurance laws, and rules for their profession in both the jurisdiction in which they are practicing as well as the jurisdiction in which the patient is receiving care. The audiologists providing the service shall ensure compliance as required by appropriate regulatory and accrediting agencies (American Telemedicine Association, 2017).
Areas in which telehealth is a viable option include the following:
Audiologists counsel by providing information, education, guidance, and support to individuals and their families. Counseling includes discussion of assessment results and treatment options. Counseling facilitates decision making regarding intervention, management, educational environment, and mode of communication. The role of the audiologist in the counseling process includes interactions related to emotions, thoughts, feelings, and behaviors that result from living with hearing, balance, and other related disorders.
Audiologists engage in the following activities when counseling individuals and their families:
Audiology is a dynamic profession, and the fact that the audiology scope of practice overlaps with those of other professionals is a reality in rapidly changing health care, education, industrial, and other environments. Hence, audiologists in various settings work collaboratively with other academic and/or health care professionals to make appropriate decisions for the benefit of individuals with hearing, balance, and other related disorders. This is known as interprofessional collaborative practice (IPP) and is defined as “members or students of two or more professions associated with health or social care, engaged in learning with, from and about each other” (Craddock, O'Halloran, Borthwick, & McPherson, 2006, p. 237). Similarly, “interprofessional education [often referred to as “IPE”] provides an ability to share skills and knowledge between professions and allows for a better understanding, shared values, and respect for the roles of other healthcare professionals” (Bridges, Davidson, Soule Odegard, Maki, & Tomkowiak, 2011, para. 5). The advantage of using IPP/IPE is that it broadens the care teams' depth of knowledge and understanding of the individual being evaluated and/or treated. This type of collaboration improves outcomes, efficiency, and safety through person-centered care.
Audiologists conduct and participate in basic and applied/translational research related to auditory, balance, and other related disorders. This research is undertaken as a facility-specific effort or is coordinated across multiple settings. Audiologists engage in activities to ensure compliance with Institutional Review Boards, federal regulations, and international laws pertaining to research. Audiologists also collaborate with other researchers and pursue research funding through grants.
Audiologists administer programs in education, higher education, schools, health care, private practice, and other settings. In this capacity, they are responsible for making administrative decisions related to fiscal and personnel management, leadership, program design, program growth and innovation, professional development, compliance with laws and regulations, and cooperation with outside agencies in education and health care. Their administrative roles are not limited to audiology, as they engage in program administration across departments and at different levels within an institution. In addition, audiologists promote effective and manageable workloads in school settings, provide appropriate services under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA, and engage in program design and development.
Audiologists serve as educators, teaching students in academic institutions and teaching professionals through continuing education in professional development formats. This more formal teaching is in addition to the education that audiologists provide to individuals, families, caregivers, decision makers, and policy makers, which is described in other domains. In this role, audiologists
Audiologists focus on upholding person-centered care in our complex health care and educational systems. Audiologists advocate for hearing, balance, and other related disorders needs of the individuals and families whom they serve.
Audiologists advocate for the profession and for individuals through a variety of mechanisms, including community awareness, prevention activities, health literacy, academic literacy, education, political action, and training programs. Advocacy promotes and facilitates access to communication, including the reduction of societal, cultural, and linguistic barriers. Audiologists perform a variety of activities related to advocacy and outreach, including the following:
Audiologists serve diverse populations, and this includes persons of different races, ages, genders, religions, national origins, and sexual orientations. Audiologists' caseloads include individuals from diverse ethnic, cultural, and linguistic backgrounds as well as persons with disabilities. Culturally based family and community dynamics should be included in the development of an appropriate treatment plan that includes consideration of diversity and evidence-based practice guidelines.
Supervision is broadly defined as overseeing and directing the work of others. The terms clinical supervisor and clinical supervision are often used in reference to the training and education of student clinicians, recognizing that supervision is part of the training and education process. However, clinical supervisors do more than oversee the work of the student clinician. They teach specific skills, clarify concepts, assist with critical thinking, conduct performance evaluations, mentor, advise, and model professional behavior (Council on Academic Programs in Communication Sciences and Disorders [CAPCSD], 2013). Supervision is a distinct area of practice; is the responsibility of audiologists; and crosses clinical, administrative, and technical spheres. Audiologists are responsible for supervising clinical externs/trainees, audiology assistants, credentialed technical staff, and other professional and administrative support personnel. Audiologists also supervise colleagues and peers. Audiologists acknowledge that supervision is integral in the delivery of hearing, balance, and other related services and that supervision advances the profession. Supervision involves education, mentorship, encouragement, counseling, and support across all supervisory roles. In this role, audiologists
According to ASHA's definition, interprofessional education (IPE) is an activity that occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve outcomes for individuals and families whom we serve (ASHA, n.d.-b). Similarly, interprofessional collaborative practice(IPP) occurs when multiple service providers from different professional backgrounds jointly provide comprehensive health care or educational services by working with individuals and their families, caregivers, and communities to deliver the highest quality of care across settings. When both IPE and IPP are used, we refer to this combined term as IPE/IPP.
Audiology is a service profession to which principles of business must be applied for success in educational, health care, and industrial settings. For a business entity (profit or nonprofit) to be successful, good business practices are essential. Providing high-quality services that are consistent in type and amount with a person's needs and with professional and ethical standards is good business practice. It is important that revenues collected for services cover and exceed all expenses (e.g., salary, benefits, overhead). Audiologists must understand their individual responsibility for adhering to practice standards that financially support their organization. Each audiologist's daily decisions (clinical and nonclinical) affect the financial viability of his or her organization. Audiologists must remain compliant and current on policy changes related to billing and coding.
Audiologists may be called upon to provide expertise to other professionals, business, industry, courts, attorneys, public and private agencies, and/or individuals in all areas related to the profession of audiology. Consulting services include but are not limited to
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Index terms: scope of practice
Reference this material as: American Speech‑Language‑Hearing Association. (2018). Scope of practice in audiology [Scope of Practice]. Available from www.asha.org/policy/.
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