Issues in Ethics: Audiology Assistants
About This Document
Published 2017. This Issues in Ethics statement, originally published in 2014, is a revision of Support Personnel (2004), which revised ASHA Policy Regarding Support Personnel (1979). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
This Issues in Ethics statement is intended to provide guidance for audiology assistants and their supervisors. 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 certified and/or licensed audiologist. Individuals who serve in this capacity go by a variety of job titles, including "technician," "aide," and "assistant." Audiology assistants may or may not be regulated by state laws and regulations, and the supervising audiologist is responsible for determining the applicable requirements in their state and work setting. Audiology assistants improve access to patient care by increasing the availability and variety of audiology services in numerous work settings. They may assist audiologists in the delivery of services or the conduct of research, where appropriate, provided that these guidelines are followed.
- The roles and tasks of audiology assistants are assigned only by supervising audiologists.
- Supervising audiologists provide appropriate training that is competency based and specific to job performance. (The supervising audiologist is responsible for maintaining written documentation of completed training activity.)
- Supervision is comprehensive, periodic, and documented.
- The supervising audiologist maintains the legal and ethical responsibilities for all assigned audiology activities provided by support personnel.
- Services delegated to the audiology assistant are those that are permitted by state law, and the audiology assistant is appropriately registered/licensed if the state so requires.
- The audiology assistant meets minimum qualifications for audiology assistants per ASHA guidelines. (See State Support Personnel Trends [PDF].)
- The needs of the consumer of audiology services and protection of the consumer are always paramount.
Standards, licensure, and practice issues vary from state to state; this Issues in Ethics statement describes only ASHA’s policy for the use of audiology assistants. It 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 Code provides members and certificate holders with guidance regarding the ethical issues that may arise regarding ethical considerations related to audiology assistant practice parameters.
Likewise, while audiologists utilize assistants for direct patient interaction and clinical treatment, hearing scientists utilize assistants in human subject research, data collection and scholarly activities. The Code's Preamble states, in pertinent part, “[t]he preservation of the highest standards of integrity and ethical principles is vital to the responsible discharge of obligations by audiologists, speech-language pathologists, and speech, language, and hearing scientists who serve as clinicians, educators, mentors, researchers, supervisors, and administrators” (para. 3). Generally, hearing scientists are not required to be licensed by a state or certified by ASHA, but because the state-by-state requirements may change over time, hearing scientists have an ethical obligation to stay abreast of applicable and changing credentialing requirements.
Discussion
Preparation of audiology assistants may vary considerably across states and across work settings. For an audiologist to serve as a supervisor, ASHA requires that they hold a full, current, and unrestricted license to practice audiology from a state, territory, commonwealth, or the District of Columbia (where applicable) and recommends that the audiologist have a Certificate of Clinical Competence in Audiology, granted by ASHA. In the case of an individual exempted from state licensure, there may be specific institutional or setting requirements for supervisors of audiology assistants.
Audiology assistants engage in only those tasks that are planned, delegated, and supervised by the audiologist and permitted by state law. The duties and responsibilities assigned are based on the training, available supervision, and specific work setting. The scope of practice of the supervising audiologist also dictates the duties and responsibilities assigned to the audiology assistant.
Because 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 assigned duties. If the assistant engages in activities that violate the Code, the supervising professional may be found in violation 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. Likewise, simultaneous compliance with applicable state codes of conduct/ethics is required.
The Board refers individuals to the following sections of the Code for discussion of issues related to the use of audiology assistants. Guidance relating to these sections of the Code is also provided in the Audiology Assistants Practice Portal.
The principles and rules of the Code (described below) specifically address issues that are pertinent to an audiologist’s supervision of support personnel when services are provided or research is conducted:
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 activity, and they shall treat animals involved in research in a humane manner.
Guidance: The supervising audiologist or hearing scientist 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.
Principle of Ethics I, Rule A: Individuals shall provide all clinical services and scientific activities competently.
Guidance: The supervising audiologist or hearing scientist must ensure that all services and scientific activities, 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 failure could be a violation of the Code.
Principle of Ethics I, Rule C: Individuals shall not discriminate in the delivery of professional services or in the conduct of research and scholarly activities on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialect.
Guidance: The supervising audiologist or hearing scientist is responsible for ensuring that there is no discrimination in service delivery or scientific activities, as indicated above. Discrimination exhibited by the audiology assistant could be a violation of the Code.
Principle of Ethics I, Rule D: Individuals shall not misrepresent the credentials of aides, assistants, technicians, support personnel, students, research interns, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name, role, and professional credentials of persons providing services.
Guidance: The supervising audiologist or hearing scientist must ensure that clients and subjects are informed of the title, role, 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 client or subject 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 by the supervisor.
Principle of Ethics I, Rule E: Individuals who hold the Certificate of Clinical Competence may delegate tasks related to the provision of clinical services to aides, assistants, technicians, support personnel, or any other persons only if those persons are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served 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 is not violated.
Principle of Ethics I, Rule F: Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills, knowledge, judgment, or credentials that are within the scope of their profession to aides, 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.
Principle of Ethics II, Rule E: Individuals in administrative or supervisory roles shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's certification status, education, training, and experience.
Guidance: The supervising audiologist or hearing scientist must ensure that the assistant performs only 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 or hearing scientist fails to correct this, the supervisor could be found in violation of the Code.
Principle of Ethics IV, Rule I: Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics.
Guidance: Because the assistant provides services as “an extension” of those provided by the professional, the audiologist or hearing scientist is responsible for informing the assistant about the Code and monitoring the performance of the assistant. Failure to do so could result in the audiologist or hearing scientist being found in violation of the Code.
Principle of Ethics IV, Rule R: Individuals shall comply with local, state, and federal laws and regulations applicable to professional practice, research ethics, and the responsible conduct of research.
Guidance: This rule emphasizes the importance of the supervising audiologist or hearing scientist ensuring that the assistant complies with all laws and regulations applicable to their setting/facility and practice, not only state codes of ethics and state licensure laws.
Failure to adhere to these principles and rules constitutes a violation of the Code. Although some audiology assistants may choose to affiliate with ASHA as Associates, the Code does not directly apply to Associates. However, any individual who is working in a support role under the supervision of an audiologist or hearing scientist must be knowledgeable about the provisions of the Code. It is imperative that the supervising professional and assistant behave in a manner that is consistent with the principles and rules outlined in the Code. Because the ethical responsibility for patient care or for care of subjects in research studies cannot be delegated, the audiologist or hearing scientist takes overall responsibility for the actions of assistants when they are performing assigned duties. If an assistant engages in activities that violate the Code, the supervising professional may be found in violation of the code if adequate oversight has not been provided. This is likewise true with respect to assistant actions that violate state licensure laws or regulations.
Further, it is the responsibility of ASHA members and certificate holders to ensure that support personnel under their supervision behave in an ethical manner, which includes not engaging in activities outside their education, level of training, experience, and competence. This responsibility may begin with development of the job description and tasks to be assigned; will extend to supervision of all work performed and all monitoring of daily activities; and, typically, will include evaluation of support personnel job performance. Education and guidance of employers and consumers may be necessary, particularly in order to ensure that credentials of support personnel are not misrepresented to the public, including persons served and their families, as well as funding sources and regulatory agencies.
The amount of supervision for any one assistant is determined by the training and experience of both the audiology assistant and the audiologist or hearing scientist as well as by the specific job tasks and any laws or regulations pertaining to such activity. Similarly, the number of assistants supervised by a professional must allow supervision that is appropriate in both quantity and quality. Members who exercise only nominal supervision over an individual, because they have responsibility for too many assistants, may be found to violate Code requirements in failing to hold paramount the welfare of persons served (Principle of Ethics I).
Guidance
Resources are available to help audiologists and hearing scientists maintain and enhance the use of audiology assistants within the profession. Individuals are encouraged to consult current ASHA position statements, the Audiology Assistants Practice Portal, and guidelines and practice policy documents pertaining to the training, use, and supervision of audiology assistants.
