Change of SLP Scope of Practice

To Audiologists Across America:

Once again our profession is being challenged. Everyone wants a piece of our territory. As Dr. Noel Crosby said in her 1999 President's speech at the Florida annual meeting, ''I'm angry! We must own the hearing test'' I would add, ''and other special tests''.

With that as introduction, it has come to my attention that ASHA has a revised draft of the Scope of Practice in Speech-Language Pathology, prepared by the Ad Hoc Committee on Scope of Practice in Speech-Language Pathology. The document is available for peer review. This can be accessed in several ways, such as; www.asha.org/peer_review/slp_scope.htm, by email at actioncenter@asha.org, through Fax-on-Demand at 877-541-5035 (documents 7017 and 7018) and by the action center at 800 498-2071.

Once again, someone is trying to get a piece of our territory by adding audiology test procedures into their scope-of-practice. It bothers me even more when that someone happens to be the speech-language pathologists who represent some 90 percent of ASHA.

The specific area of concern cab be found on page 9, lines 150 - 161 (items 2, 3, and 4). I'll address the three items in order (below).

Item 2: ''Developing and establishing augmentative and alternative communication techniques and strategies including selecting, prescribing, and dispensing of systems and devices.''

The language used does not state what kinds of ''devices'' they are talking about. Does it mean alternative devices to hearing aids or devices specific to speech involvement and communication? If it means alternative devices for communication for hearing impaired people, with or without hearing aids, I must protest. The way this is written, FM systems and hearing aids could fall into this poorly defined category referred to as ''devices''. If these devices are not selected and adjusted by an audiologist, the potential for harm exists. I believe we need to add clear verbage which eliminates auditory devices (such as ALDs and hearing aids) from item 2.

Item 3: ''Providing services to individuals with hearing loss and their families (e.g., communication counseling, auditory training, speech reading, speech and language intervention secondary to sensory aid placement, manual inspection of amplification devices including verification of appropriate battery voltage.)''

The audiologist should be doing the communication counseling. The audiologist is the expert with respect to auditory communication and related resources, needs, strategies, etc. for the hearing impaired. I strongly suggest ASHA eliminate the phrase ''communication counseling'' from item 3.

This next item is where the main controversy lies. The document states:

Item 4: ''Screening hearing across the life span through the use of conventional age-appropriate pure-tone screening methods, as well as screening for auditory system dysfunction through the use of dedicated physiologic and acoustic screening technologies (e.g., ABR, OAE, aural acoustic immittance) for the purpose of initial detection and referral of individuals with possible hearing loss.

I say, ABSOLUTELY NOT! SLPs have no business performing ABRs and OAEs, nor should they be performing acoustic immitance. The acceptance or promotion of Item 4 is clearly not in the patient's best interest. This is not where their area of expertise lies. Allowing (and indeed encouraging) SLPs to take on these responsibilities, and indeed sanctioning their participation in audiology-specific diagnostic tests (even if they're called ''screening technologies here'') is foolhardy, irresponsible and insulting.

Do audiologists offer accent reduction therapy? Do we perform phonological screenings? Pragmatic screenings? Cognitive deficit testing? Language screenings for educational placement? Of course not. When I suspect the need for SLP screenings, I make the referral to the recognized expert in these areas, my SLP colleagues.

I do so because it is in the best interest of the patient, and because it helps support my colleagues in SLP. I believe a mutual respect and a mutually beneficial relationship is in order here, particularly because it is in the best interest of the patient.

I cannot believe I need to write a letter to ASHA which identifies and defends the areas of expertise and scope of practice of audiology. What will they think of next? We have enough problems between the two professions without fostering more dissent. I cannot believe ASHA would publish, or even consider this stance.

Therefore, I ask that every audiologist IMMEDIATELY contact ASHA and let them know your thoughts on this matter. We must protect the consumer from ill-prepared individuals conducting tests they are not trained to perform.

Thank you all in advance for participating. We have only until October 10th to comment on this matter. Please hurry.

Cindy Simon, Au.D.
President, FLAA