The following scenarios illustrate the responsibilities of regulated speech and hearing professionals and non-regulated Communication Health Assistants (CHAs) when aspects of practice are delegated to CHAs.
Scenario 1: The Registered Audiologist and the Clerk
You’re a newly hired Registered Audiologist (RAUD) and the Clerk in your clinic advises you that they have been performing annual kindergarten hearing screenings for many years and would like to continue with this task. The Clerk expresses confidence in being able to competently conduct the screenings. How should you, as the RAUD with responsibility for the care of clients, proceed?
The RAUD should be familiar with the following:
- RAUDs practicing in BC are CSHBC registrants regulated by the College.
- Office staff who perform clinical duties such as hearing screenings are not CSHBC registrants but are considered CHAs during the performance of the clinical activities.
- Audiologists may delegate allowable aspects of practice, such as hearing screening, to a CHA with the appropriate education, training, and experience, and verification of their competency.
- The audiologist must have access to documentation verifying a CHA’s education, training, and experience, including on the job training. If there is no evidence of previous training, current practice, or ongoing continuing education, a review of current skills and abilities will be needed.
- The CHA needs to understand the role and responsibilities in accepting a delegation, including the parameters of the delegation, required documentation, expected client outcomes, supervision, and what to do when encountering problems or questions.
- A level of supervision is required; delegated activities where the CHA has achieved competency remain under general supervision of the audiologist.
- Audiologists must obtain informed consent from the client before an aspect of practice may be delegated to a CHA. The CHA must agree to receive the delegation, which should also be documented.
- The audiologist is ultimately responsible for the quality of care provided by the CHA and for ensuring sufficient education and training of the CHA.
Scenario 2: The Registered Hearing Instrument Practitioner and the Office Manager
You’re a Registered Hearing Instrument Practitioner (RHIP) and a new Office Manager has joined your team. This individual has extensive experience working in hearing clinics, where she was responsible for many client interactions, involving otoscopy, cleaning and checking hearing aids, and assisting with basic hearing assessments. While the Office Manager requests to continue these clinical activities, you have not yet verified the person’s education, training, and experience, and validated their competencies. How should you, as the RHIP leading the clinic, respond to the Office Manager’s request?
There are a number of elements the RHIP must be fully familiar with:
- RHIPs practicing in BC are CSHBC registrants regulated by the College.
- The Speech and Hearing Health Professionals Regulation outlines the scope of practice of hearing instrument practitioners, and other information including restricted activities and limits or conditions on services and restricted activities.
- Any office staff who perform allowable clinical activities are considered non-regulated CHAs during the delivery and performance of such activities. These activities are delegated aspects of practice that requires appropriate education, training, experience, and evaluation of competencies.
- These tasks may be assigned on an as required individual basis with informed consent by the client. Any client may revoke this consent at any time.
- Documentation of education and training completed by the CHA must be available to the supervising registrant.
- The CHA must understand the responsibility that comes with being delegated by an RHIP and agree to the delegation.
- Delegation is very specific, with boundaries that must be always adhered to with appropriate follow up.
- The RHIP is responsible for maintaining a continued level of general supervision of the CHA.
Scenario 3: The Registered Speech-Language Pathologist and the Behaviour Interventionist/Speech-Language Assistant
You’re a Registered Speech-Language Pathologist (RSLP) who is new to a school district. You have been assigned schools in the district and will be working with staff who have titles ranging from Behavioural Interventionist to Speech-Language Assistant. All of them will provide aspects of speech-language pathology-related services under your supervision. Before beginning to work with these staff members, what process should you follow?
- RSLPs practicing in BC are CSHBC registrants regulated by the College.
- Staff members who provide aspects of speech-language pathology services function as non-regulated CHAs.
- The RSLP must be familiar with what aspects of clinical care can be delegated to CHAs.
- The RSLP must know the skills and abilities of each of the CHAs. It is insufficient to take someone’s word for their qualifications and currency of practice. Documentation of those qualifications must be reviewed.
- If any CHAs need additional training before you can delegate to them, document what that learning plan will consist of and how the learning will be obtained, and provide an adequate level of supervision until the point that you are confident they can provide safe services under general supervision.
- The CHA can refuse a delegation if they do not feel comfortable with providing the services that you are asking for.
- Before you complete an agreed-upon delegation to a CHA, you must obtain informed consent from each student/decision-maker. At any time, this consent can be revoked by the client/decision maker, which would result in discontinuing that delegation. Obtaining or revoking this consent must be documented.
Scenario 4: The dually registered Audiologist and Speech-Language Pathologist and the Office Assistant
You are a dually registered Audiologist and Speech-Language Pathologist and the owner/operator of a private practice. You have a part-time Office Assistant who provides administration for the office. The Office Assistant is also transitioning into occasionally providing services to your clients, as a CHA. These services will include assisting with initial speech, language, and hearing screenings & assessments, and providing some aspects of speech and language therapy, all under your delegation. Before delegating aspects of speech and hearing services to your CHA for any client, what is the process for obtaining consent from the client for delivering those services?
- Ensure your CHA agrees to the assignments and delegations.
- Recognize, as the clinician responsible for the care of your clients, that you are responsible for obtaining consent from your clients regarding collection, use, and release of their personal information and for obtaining valid informed clinical consent from your clients regarding speech and hearing services that they may receive, including any services provided by your assistant.
- Although your CHA may assist in the consenting process, it is you, the registered clinician, who is ultimately responsible for obtaining and documenting consent.
- Ensure your clients are aware that they can revoke consent for any of the speech and hearing services you and/or your CHA may provide, at any time.
For more information
See the following Notices to the Professions:
- Communication Health Assistants (CHAs): Who are they and what registrants need to know about working with them
- Obtaining and documenting consent when working with Communication Health Assistants (CHAs)
- New protocol clarifies delegation process for non-registrant Industrial Audiometric Technicians performing ear impressions
If you have questions about how to adhere to practice standards and related documents on CHAs, consider requesting professional practice information from CSHBC Professional Practice Advisors. To request professional practice information, or to send general questions, contact CSHBC at [email protected].