Do you assign or delegate to a Communication Health Assistant (CHA) to provide health services for your clients? If you do, or you’re unsure if you do because you’re unfamiliar with the term CHAs, consider the following excerpts from scenarios:
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?
Scenario 2: The Registered Hearing Instrument Practitioner and the Office Manager
You are a Registered Hearing Instrument Practitioner (RHIP) and a new Office Manager has joined your team. This individual has extensive experience working in hearing clinics, including responsibility 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?
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 speech-language pathology-related services under your supervision. Before beginning to work with these staff members, what process should you follow?
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?
For information about how the registrants in these scenarios should proceed, read the Notice to the Professions containing the full scenarios, and also read below.
Who are CHAs and what you need to know about working with them
All of the above scenarios have something in common: the registered speech and hearing health professionals in the scenarios work with non-registrant staff who meet the definition of CHAs.
CHAs are non-registrants employed by a registrant or a registrant’s employer to support the registrant’s clinical practice of audiology, hearing instrument dispensing, or speech-language pathology.
Communication health assistant, or CHA, is not typically a job title. Individuals who provide CHA services can have occupational titles ranging from “Behaviour Interventionist” to “Office Assistant”. “CHA is a conceptual, overarching title,” explains Cathy Silversides, CSHBC’s Director, Quality Assurance & Professional Practice.
The following word cloud shows examples of titles that CHAs can have:
Non-registrants may have more than one role. They may perform CHA activities at times and non-clinical activities at other times. “As a non-registrant being supervised by a registrant, you are only a CHA when you are being assigned and/or delegated tasks or clinical activities by that registrant,” says Ms. Silversides.
Assignment and delegation are at the heart of interactions between registrants and CHAs. Assignment is a process where a registrant directs a CHA to perform health service tasks that have low or negligible risk and do not involve any clinical decision-making, subject to meeting CSHBC requirements.
Delegation is a process where a registrant directs a qualified CHA to perform an allowable aspect of speech and hearing health services to specific clients, also subject to meeting CSHBC requirements. Delegated services may be higher risk for clients and involve clinical decision-making.
“Verifying the education and training, experience, and competence of a CHA, and understanding the specific needs of a client, are key to safe and effective delegation of health services,” says Ms. Silversides. Registrants must also ensure that CHAs they supervise use titles commensurate with their education, training, experience, and verified competencies.
Registrants must never delegate their scope of practice in its entirety to a CHA. Only certain, allowable aspects of practice may be delegated or assigned to CHAs, under general supervision of the registrant, as outlined in the Communication Health Assistants (Delegation & Assignment) (PDF) clinical Standard of Practice. This key document includes a detailed list of profession-specific activities eligible for assignment and delegation, along with a list of profession-specific activities that registrants must not delegate. As well, the document has a delegation and assignment decision tree. All registrants working with CHAs should review this document.
CSHBC Bylaws, Standards of Practice, and related documents clearly outline specific requirements for registrants working with CHAs. Registrants are expected to be familiar with these requirements. See the Key CSHBC resources section below for a list of important documents. Note that other resources not listed below are listed in the key documents and should also be reviewed by registrants.
Among the requirements for registrants is obtaining and documenting consent from clients, and agreement from CHAs themselves, to provide aspects of speech and hearing health services. See the Notice to the Professions on consent when working with CHAs for more information.
CSHBC Practice Reviews conducted with registrants may include screening and assessment of registrants’ adherence to CHA requirements. Non-adherence to CHA requirements may lead to required remediation, and failure to remediate can be referred to the CSHBC Inquiry Committee.
While assignment and delegation of health services to CHAs can contribute substantially to quality of care, registrants must be mindful of their ultimate responsibility. “Ultimately, it is the responsibility of the registrant supervising the CHA to ensure that safe, appropriate care is being provided,” says Ms. Silversides.
Key CSHBC resources
Clinical Standards of Practice
- Communication Health Assistants (Delegation & Assignment) (PDF)
- Communication Health Assistants (Education, Training, & Competence) (PDF)
Clinical Practice Protocol for RAUDs
For more information
See the following Notices to the Professions:
- Obtaining and documenting consent when working with Communication Health Assistants (CHAs)
- Communication Health Assistant scenarios
- 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].