Scope of Practice for Audiologists and SLPs

Scope of Practice

• Audiologists can treat hearing disorders but cannot diagnose speech and language disorders.
• Speech-Language Pathologists (SLPs) can treat speech, language, and literacy disorders but cannot diagnose hearing loss.
• Both Audiologists and SLPs can complete assessments, but assistants can only assist, not perform assessments independently.
• Both Audiologists and SLPs can write treatment plans, but assistants must follow their supervisor's plan.

Documentation and Licensing

• SOAP notes document client progress or information for each therapy session. Important for audits and insurance.
• CCC stands for Certificate of Clinical Competence.
• SLP licensing requirements: Requires a master's degree, completion of supervised clinical hours, passing the PRAXIS exam, and having a CCC (CCC-SLP).
• Audiologist licensing requirements: Requires a clinical doctorate (CCC-A).
• ASHA - American Speech and Hearing Associate - provides resources, lobbying, and ethical guidelines for SLPs.
• SLPs must complete 400 observation hours prior to direct client contact (25 clinical observations, 375 direct client contact).
• Audiologists must complete 1,820 observation hours.

Ethics and Compensation

• Personal Ethics: Formed from upbringing, acculturation, personal choices, and education. Not everyone with similar ethics tenets applies them in the same way.
• Professional Ethics: Establish right and wrong actions in serving clients in the workplace. Provide a common set of core values when confronted with ethical dilemmas.
• SLPs are most often paid by billable units.
  • Therapy Unit = 15 minutes
  • Evaluation Unit = 30 minutes
• ASHA Board of Ethics provides the Code of Ethics for SLPs.
• American Academy of Audiology (AAA) Ethical Practice Board provides the Code of Ethics for Audiologists.

Hearing and Listening

• SLPs need to know how to perform hearing screenings and interpret audiometric data to help patients with hearing impairments.
• Auditory skills hierarchy:
  • Detection: Is sound present or not?
  • Discrimination: Ability to tell the difference between sounds.
  • Identification: Labeling or choosing items.
  • Comprehension: Responding in a logical way.
• Listening Age: Length of time someone has had consistent access to sound, using hearing technology all day.
  • Ex: 24-month-old who received hearing aids at 10 months old = listening age of 14 months old.
• Chronological Age: Age from birth.

Additional Information

• Continuing Education: Required for SLPs and Audiologists after gaining CCCs. New methods of treating are introduced, and it helps learn about new populations or disorders.
• Diagnosis: Conclusion of the assessment and evaluation; what is going on with the client.
• Prognosis: How the client is expected to do in therapy given the diagnosis.
• Screening: Determines if an evaluation or referral is needed.
  • Pass or Fail - Cannot diagnose or describe details of a disorder.
• Hearing Screenings: Done at birth and can be done at any time.
• Formal/Standardized Tests: Based on a normative score, and scores that funding sources are looking for.
  • Normal Range: 7-13.
• Informal/Criterion-Referenced Tests: Checklist of skills, percent of correctness.
• HIPAA: Health Insurance Portability and Accountability Act - protects privacy.
• Conflict of Interest: SLPs or Audiologists receiving personal or financial gain from clients or manufactures that compromises professional judgment.

Language Assessment

• Language Assessment includes: Case history, parent interview, test results, observations.
• Hearing Screening includes:
  • Otoscopy: Examines structures of the ear.
  • Tympanometry: Shows how well the middle ear is working.
  • Oto Acoustic Emissions (OAE): Shows how well the inner ear is working.
• Transcription for speech samples is in IPA (International Phonetic Alphabet).
• Transcription for language samples is in orthography (normal writing).

Articulation Treatment

• Articulation treatment techniques: Target selections, stimulus words selections, treatment techniques, feedback phrases.
  • Ex: Use a mirror, gestures, amplification, tactile feedback, metaphors.
• Articulation treatment approaches:
  • Van Riper (Traditional) Approach: Focuses on correcting individual phonemes.
  • Paired-Stimuli Approach: Operant conditioning, using a keyword.
  • Multiple Phoneme Approach: Targets all troubled sounds at the same time.
  • Core Vocabulary Approach: Focuses on whole-word production.
  • Non-Speech Oral-Motor Therapy: Used prior to teaching speech sounds.
• SMART Goals: Specific, Measurable, Achievable, Relevant, Timely.

Articulation and Phonological Disorders

• Articulation Disorder: Speech sound errors.
• Phonological Disorder: Difficulties with the language rules that underlie speech.
• Syllable Structure Patterns:
  • Weak syllable deletions
  • Final consonant deletion
  • Initial consonant deletion
  • Reduplication
  • Consonant cluster reduction/deletion
  • Epenthesis
• Assimilation Simplification Patterns:
  • Labial, alveolar, velar, nasal assimilation.
  • Prevocalic voicing and postvocalic devoicing.
• Phonological Processing Components: Phonological awareness, working memory, and retrieval.

Phonological Treatment Approaches

• Maximal Oppositions: Uses a pair of words to contrast (ex: "meat" and "seat").
• Multiple Oppositions: Targets several sounds during one session.
• Cycles Approach: Trains in patterns.
• Metaphon Therapy: Helps acquire the rules of the phonological system.

Developmental Age and Caregiver Coaching

• Developmental Age: The age a child is functioning at. Treatment should be based on developmental age.
• Caregiver Coaching Recommendations:
  • Create a positive environment.
  • Recognize individual family needs.
  • Ensure caregivers have a feeling of potential success.
  • Develop active listening skills.
  • Educate on all communication and intervention options.
  • Provide peer support.
  • Ensure caregivers play an active role in the plan.
  • Focus on outcomes and progress.

Early Intervention and Augmentative and Alternative Communication (AAC)

• Early Intervention (EI) for language skills: Best addressed when identified early.
  • Family involvement key.
  • Activities developmentally appropriate and motivating.
  • Play skills usually targeted.
  • Child may not have a large vocabulary.
• Modes of Language: Reading, writing, gesturing, listening, speaking.
• Types of AAC:
  • No-Tech: No external support (sign language).
  • Low-Tech: External support, but no batteries (printed photos, paper and pencil).
  • Mid-Tech: Batteries, but no computer component (talking photo album).
  • High-Tech: Computer component (iPad).
• Who might need AAC: Individuals with limited speech or speech that is not functional.
• Skills needed for AAC:
  • Linguistic Competence: Knowledge of the language code/features of AAC.
  • Social Competence: Knowledge of language/AAC for interaction (pragmatics).
  • Operational Competence: Knowledge of accessing and operating an AAC device.
  • Strategic Competence: Knowledge of maximizing communication success despite limitations of AAC.
• AAC Treatment Ideas: Modeling, individualizing content, teaching communication partners.
• Communication Partner Training Strategies: Include them in therapy sessions.
• PBS - Positive Behavioral Support: Discover the underlying cause of challenging behaviors.
• ABA - Applied Behavioral Analysis - A scientific approach to improving socially acceptable behaviors.

Behavior Management

• Antecedent: Something in the environment that causes or prevents behavior.
• Behavior: A response to the environment.
• Consequence: A reaction to the behavior that increases or decreases the probability of it happening again.
• Techniques for teaching new behaviors:
  • Task analysis: breaking down a task and teaching individual parts.
  • Chaining: teaching individual steps of a task and then sequencing them (forward and backward).
  • Prompting: using helpful cues that help with task initiation.
  • Shaping: different levels of reinforcement.
• Senses are important in behavior management because some children may exhibit challenging behavior to seek sensory stimulation or to avoid sensory input.
• Hypersensitive: Over-responsive to sensory information.
• Hyposensitive: Under-responsive to sensory information.
• Recommendations for responding to challenging behaviors: Positive and negative reinforcement, and extinction.
• Positive Reinforcement: Something positive given to increase the frequency of a behavior.
• Negative Reinforcement: Removing something negative to increase the frequency of a behavior.