Audiology Scope of Practice Expands as Profession Grows Change—we’re all familiar with it. The quotes at right, from a spiritual leader and corporate chief, reflect the value of anticipating change rather than trying to cope with its aftermath. These insights also reflect the rationale considered by the audiologists involved with modifying ASHA’s Scope of Practice in Audiology. Much ... Features
Free
Features  |   April 01, 2003
Audiology Scope of Practice Expands as Profession Grows
Author Notes
  • Michael Bergen, is a faculty member in the department of speech communication arts and sciences at Brooklyn College, Brooklyn, NY. He spent seven years as a clinical audiologist at Manhattan Eye, Ear, & Throat Hospital in New York City. Contact him by e-mail at mbergen@brooklyn.cuny.edu.
    Michael Bergen, is a faculty member in the department of speech communication arts and sciences at Brooklyn College, Brooklyn, NY. He spent seven years as a clinical audiologist at Manhattan Eye, Ear, & Throat Hospital in New York City. Contact him by e-mail at mbergen@brooklyn.cuny.edu.×
Article Information
Hearing Disorders / Practice Management / Professional Issues & Training / Features
Features   |   April 01, 2003
Audiology Scope of Practice Expands as Profession Grows
The ASHA Leader, April 2003, Vol. 8, 1-25. doi:10.1044/leader.FTR2.08062003.1
The ASHA Leader, April 2003, Vol. 8, 1-25. doi:10.1044/leader.FTR2.08062003.1
Change—we’re all familiar with it. The quotes at right, from a spiritual leader and corporate chief, reflect the value of anticipating change rather than trying to cope with its aftermath. These insights also reflect the rationale considered by the audiologists involved with modifying ASHA’s Scope of Practice in Audiology.
Much has changed since 1996, when the scope of practice was last revised. It is not only changes in the audiology profession that should result in modifications to the Scope, but changes in related professions and in the larger health care arena.
When enough change occurs, the audiology profession is obligated to modify its professional scope of practice. As ASHA president Glenda Ochsner noted in a recent interview, “As technology and newly emphasized needs change and develop, I expect to see our scopes of practice continuing to expand.”
What has occurred since our last Scope document was introduced in 1996? Those who have worked in the field undoubtedly have noticed technological advancements, and have observed the increasingly varied caseloads across practice settings.
Below are some of the key changes audiologists have faced in the last few years:
  • Regulations governing patient privacy. Health care providers must follow new regulations to protect patient confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) affects how patient data is handled, from storage to electronic submission for third-party payers. HIPAA also places new restrictions on the type of contact we may have with our consumers.

  • Cerumen management. Some audiologists now include cerumen management as a service.

  • Increasing specialization. Examples include cochlear implant programming and rehabilitation.

  • New terminology. New terms have become part of the vocabulary of audiology—BAHA, auditory neuropathy/dys-synchrony, posturography and VNG, for example.

  • Universal newborn hearing screening. This emerging area of practice, also known as Early Hearing Detection and Intervention (EHDI), is now almost truly “universal” in the United States.

  • Credentials. In the future, a doctoral degree will be the entry-level requirement for ASHA certification; many educational programs are now modifying their curricula to conform to the impending changes.

  • Mandatory continuing education. ASHA now requires continuing education as a requirement for certification renewal.

Revisions in the Scope: The ICF
What is the mechanism behind revision of the Scope of Practice? Susan Brannen, vice president for professional practices in audiology, invited me to sit on the Professional Practices in Audiology Coordinating Committee for the purposes of revising the audiology scope of practice. Others serving on this committee include: Donna Fisher Smiley, Jean Pierre Gagné, and Tina Mullins. The committee was selected so as to be representative of a diverse cross-section of professional practice and experience. We corresponded by telephone conference, face-to-face meetings, and e-mail, and reviewed numerous documents and considered current practice. We are in the final stages of preparing our revised draft proposal that will then be professionally edited, made available for widespread peer review by the ASHA membership, and submitted to the ASHA Legislative Council.
One of the primary adjustments to our scope will be to include the concepts proposed by the World Health Organization (WHO) health classification system, known as the International Classification of Functioning, Disability and Health (ICF; WHO, 2001). The basic ideas introduced in that document express a standard language for the description of health. The Speech-Language Pathology Scope, revised in 2001, incorporates those concepts, and our committee felt strongly that the audiology scope also should include them.
Specifically, the ICF is organized into two parts: “Functioning and Disability” and “Contextual Factors,” each of which has two parts. “Functioning and Disability” refers to body functions and structures and describes “impairments” of such in a more sensitive language than had been used in the past (gone are words with negative connotations like “handicap” and “problem”). It also describes “activity and participation,” as well as the “limitations” and “restrictions” of each. “Contextual Factors” is divided into environmental issues and personal factors.
How do we apply the concepts of the ICF to our current practice? Consider someone who is assessed with a hearing loss. We would describe this as an impairment of hearing. As professionals, we would not make any assumptions about the difficulty this person may perceive, but our experience and education would enable us to formulate some likely possibilities. While considering a habilitative/rehabilitative plan, we would want to assess the amount of perceived difficulty from the person and from significant others (perhaps using self-assessment or interview). This would help us to more easily assess the person’s activity limitations/participation restrictions.
The contextual factors consider environmental (physical, social, and attitudinal) issues and personal factors (including, but not limited to, age, gender, and socioeconomic background) when a treatment plan is pending. These concepts potentially allow us to more accurately consider how the impairment affects the individual and those around him/hers’ and to engage a treatment plan that will factor in individual differences, such as cultural issues. Perhaps most importantly, it may allow us to help the person to participate, and not to “treat the disorder.”
The concept of the ICF may also help us to describe more accurately the difficulties and limitations that may or may not occur, not only to the patient, but also to others in the environment. It is important to realize that activity limitations/participation restrictions are not necessarily dependent upon hearing impairment (i.e., it is possible to have hearing loss without having associated difficulty) and that they can occur without presence of obvious impairment (a person with documented normal hearing may experience difficulty similar to those with hearing loss).
Despite the breadth of these changes, wholesale revisions were not made to the audiology scope of practice. Indeed, in some areas it would be preferable to keep the scope broad so as to allow audiologists to engage in emerging activities that are legitimately within the scope. Language that is too specific may restrict our practice. Each modification has been considered thoroughly so as to include those that reflect a true change.
Just as we have had many ASHA members work hard to elevate our practice, to create autonomy, and to enhance the stature of the audiology profession, our committee has worked hard to ensure that the revised scope appropriately reflects current audiology practice. However, the committee realizes that no matter how much work we put in, our revised “Scope of Practice for Audiology, 2003,” will be obsolete before long. Change will always happen—but when it does, a committee of audiologists will labor again to keep the document relevant and updated.
History of ASHA Scope of Practice
1989
Legislative Council adopts the document entitled “Scope of Practice for Speech-Language Pathology and Audiology.” The completed document (1990) is less than 650 words in length.
1995
Separate practice statements are approved for speech-language pathology and audiology. LC approves the “Scope of Practice in Audiology” position statement as ASHA policy.
1996
“Scope of Practice in Audiology” approved. The document, now more than 1,700 words, describes in great detail the varied duties and practice settings of audiologists.
2003
The Professional Practices in Audiology Coordinating Committee will submit a revised “Scope of Practice in Audiology” document totaling over 2,200 words for editing and peer review. The document introduces the concepts of the WHO’s ICF.
Developing Practice Policy Documents
(This process is summarized from the ASHA Committee Toolkit.)
1. ASHA develops a variety of practice policy documents, such as the “Scope of Practice.”
2. Based upon input from members and others, a decision is made to revise a document, either by a committee appointed by the Executive Board or by an ASHA Special Interest Division.
3. An ASHA staff contact person is assigned to provide support.
4. Groups conduct work through meetings, conference calls, or in other ways. They are expected to thoroughly identify and read related resources.
5. The group drafts a document/proposal.
6. The draft is professionally edited.
7. Peer review by a select, targeted group with specific expertise and by widespread membership.
8. The group revises the proposed document after considering every comment and incorporating it into the document or providing justification for its absence.
9. The final scope document is submitted to the ASHA Legislative Council.
10. ASHA membership is informed.
11. Once approved, the new policy is disseminated.
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
April 2003
Volume 8, Issue 6