No RXXX 21 November 2009 HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA REGULATIONS DEFINING THE SCOPE OF THE PROFESSION OF AUDIOLOGY In terms of section 33(1) of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974), the Minister of Health, acting on the recommendation of the Health Professions Council of South Africa, has made the regulations set out in the Schedule hereto. SCHEDULE A. In this Schedule the Act shall mean the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974), and, unless the context otherwise indicates, any expression to which a meaning has been assigned in the Act shall bear such meaning. B. The following acts are hereby specified as acts that shall, for the purpose of the Act, be deemed to be acts pertaining to the profession of Audiology: Definitions evidence-based practice is defined as an approach in which current, high-quality research evidence is integrated with practitioner expertise and the individual client s/patient s preferences and values into the process of clinical decision making (ASHA, 2005). scope of profession: these regulations describe the range of professional services offered within the profession of Audiology. individual s scope of practice /competency: levels of education, experience, skill, and proficiency with respect to the roles and activities identified within this scope of practice document vary among individual providers. An Audiologist typically does not practice in all areas of the field. As the HPCSA Code of Ethics specifies, Audiologists may practice only in areas in which they are competent based on their education, training, and experience (HPCSA, 2008). The purpose of this document is to describe the Scope of Practice in Audiology to: 1. Delineate the areas of professional practice of Audiologists; 2. Provide information to other professionals, government departments, policy makers, medical aids, health care providers, educators, consumers, and members of the public about professional services offered by qualified Audiologists; 3. Provide guidance for the educational preparation and professional development of Audiologists. Purpose of the profession
Audiologists are professionals engaged in autonomous practice to promote healthy hearing, communication competency, and quality of life for persons of all ages through the prevention, identification, assessment, and habilitation/rehabilitation of hearing, auditory function, balance, and other related systems. Qualification for practice Audiologists currently hold a four year undergraduate degree in audiology from a programme accredited by the Health Professions Council of South Africa Professional Board for Speech, Language and Hearing Professions. Exit level outcomes require that the graduate be able to practice safely, competently and independently. Upon graduation, Audiologists register with the HPCSA, complete a year of Community Service and are then eligible for registration in the category independent practice. Demonstration of continued professional development is required for continued registration with the HPCSA. Framework for practice 1. Audiologists in South Africa practice in a multilingual and multicultural context. It is the Audiologists responsibility to be knowledgeable about and to provide culturally and linguistically appropriate services. 2. Clinical practice in Audiology strives to have a firm evidence base. 3. The International Classification of Functioning, Disability and Health (WHO, 2001) guides Audiologists to provide services to improve quality of life by reducing the impact of impairments of body functions and structures related to hearing, auditory function and vestibular and related balance functions, activity limitations, participation restrictions, and barriers created by contextual factors. 4. The HPCSA ethical guidelines, Batho Pele principles, The Patient s Rights Charter, The UN Convention on the Rights of Disabled People and the South African Constitution all underpin Audiologists professional and ethical practice. SCOPE OF THE PROFESSION OF AUDIOLOGY 1. Hearing, auditory and vestibular function Audiologists address hearing, auditory function and vestibular related balance disorders: Assess and diagnose dysfunction in hearing, auditory function and vestibular related balance disorders. Deliver audiologic habilitation/rehabilitation services including: o selecting, fitting, verification and dispensing of hearing aids and other hearing assistive devices; o assessment and follow-up services for persons with cochlear implants and middle ear implantable devices; o providing a comprehensive program of diagnostic, therapeutic services, devices, counselling, and other management strategies. Functional diagnosis of vestibular disorders and management of vestibular rehabilitation; Research pertinent to all of these fields of practice.
The professional functions in Audiology include clinical/educational services (identification, diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research. 2. Clinical services Audiologists provide clinical services that include the following: prevention identification/ screening assessment/evaluation consultation diagnosis management counselling collaboration record keeping and report writing referral Examples of these clinical services include: using data to guide clinical decision making and determine the effectiveness of services; making service delivery decisions (e.g., admission/eligibility, frequency, duration, location, discharge/dismissal) across the lifespan; determining appropriate context(s) for service delivery (e.g., home, school, telepractice, community); documenting provision of services in accordance with accepted procedures appropriate for the practice setting; collaborating with other professionals (e.g., identifying neonates and infants at risk for hearing loss); serving as expert witness. 3. Promotion Audiologists engage in the promotion of healthy hearing, auditory and vestibular function. Examples of promotion include: promoting healthy lifestyle practices that may help prevent hearing and balance problems e.g. reducing exposure to loud sounds; ear care. 4. Prevention Audiologists engage in prevention activities related to hearing, auditory function and balance Activities include
prevention of hearing loss and protection of hearing function by designing, implementing, and coordinating occupational, school, and community hearing conservation and identification programs participation in noise measurements of the acoustic environment to improve accessibility and to promote hearing wellness presenting primary prevention information to at risk groups; providing early identification and early intervention services; 5. Advocacy Audiologists engage in advocacy regarding hearing, auditory and vestibular function. Activities include Advocacy for communication needs of all individuals that may include advocating for the rights/funding of services for those with hearing loss, auditory, or vestibular disorders; Advocacy for issues (i.e., acoustic accessibility) that affect the rights of individuals with normal hearing; Consult with professionals of related services when needed; Participate in development of an individualized education programme for school-age children or an individualized family service plan for children from birth to 36 months old; Consult with educators as members of interdisciplinary teams about communication management, educational implications of hearing loss and other auditory dysfunction, educational programming, classroom acoustics, and large-area amplification systems for children with hearing loss and other auditory dysfunction; Advocate for social inclusion and participation; Consult about accessibility for persons with hearing loss and other auditory and vestibular dysfunction in public and private buildings, programs, and services; Consult with individuals, public and private agencies, and governmental bodies, or as an expert witness regarding legal interpretations of audiology findings, effects of hearing loss and other auditory dysfunction, balance system impairments, and relevant noise-related considerations; Case management and service as a liaison for the consumer, family, and agencies in order to monitor audiologic status and management and to make recommendations about educational and vocational programming; Consultant to industry on the development of products and instrumentation related to the measurement and management of auditory or balance function; Promoting professional services; Recruiting potential audiologists; Active participation in professional organizations to contribute to best practices in the profession. 6. Identification Audiologists engage in identification activities related to hearing, auditory and vestibular function.
Activities include Identifying dysfunction in hearing, and in the auditory and vestibular systems; Supervision, implementation, and follow-up of newborn and school hearing screening programs; Screening for speech, language, cognitive communication disorders, and/or preferred communication modalities that may affect education, health, development or communication and may result in recommendations for rescreening or comprehensive speech-language pathology assessment or in referral for other examinations or services; Identification of populations and individuals with or at risk for hearing loss and other auditory dysfunction, balance impairments, tinnitus, and associated communication impairments as well as of those with normal hearing; In collaboration with speech-language therapists, identification of populations and individuals at risk for developing speech-language impairments. 7. Assessment Audiologists engage in the assessment of hearing, auditory and vestibular systems. Activities include Conducting and interpreting behavioural, electroacoustic, and/or electrophysiologic methods to assess hearing, auditory function, balance, and related systems; Measurement and interpretation of sensory and motor evoked potentials, electromyography, and other electrodiagnostic tests for purposes of neurophysiologic intra-operative monitoring and cranial nerve assessment; Evaluation and management of children and adults with auditory-related processing disorders; Evaluation and non-medical rehabilitation of children and adults with vestibularrelated disorders; Performance of otoscopy for appropriate audiological management or to provide a basis for medical referral; Cerumen management to prevent obstruction of the external ear canal and of amplification devices; Preparation of a report including interpreting data, summarizing findings, generating recommendations and developing an audiologic treatment/ management plan; Referrals to other professions, agencies, and/ or consumer organizations. 8. Habilitation/Rehabilitation Audiologists provide habilitation/rehabilitation of hearing, auditory function, and vestibular related balance systems. Activities include As part of the comprehensive audiologic habilitation/rehabilitation programme, evaluating, selecting, verification, fitting and dispensing hearing assistive technology devices including hearing aids;
Assessment of candidacy of persons with hearing loss for cochlear implants and provision of fitting, mapping, and audiologic rehabilitation to optimize device use; Development of a culturally appropriate, audiologic rehabilitative management plan including, when appropriate: o Recommendations for fitting and dispensing, and educating the consumer and family/caregivers in the use of and adjustment to sensory aids, hearing assistive devices, alerting systems, and captioning devices; o Counselling relating to psycho social aspects of hearing loss, and other auditory dysfunction, and processes to enhance communication competence; o Skills training and consultation concerning environmental modifications to facilitate the development of receptive and expressive communication; o Evaluation and modification of the audiologic management plan. Provision of comprehensive audiologic rehabilitation services, including management procedures for speech and language habilitation and/or rehabilitation including but not exclusive to speech-reading, auditory training, communication strategies, manual communication and counseling for psychosocial adjustment for persons with hearing loss or other auditory dysfunction and their families/caregivers; Consultation and provision of vestibular and balance rehabilitation therapy to persons with vestibular and balance impairments; Assessment and non-medical management of tinnitus using biofeedback, behavioral management, technology, and counselling; Provision of training for professionals of related and/or allied services when needed; Participation in the development of individualized education programmes for schoolage children or individualized family service plan for children from birth to 36 months old; Provision of in-service programs for school personnel, and advising school districts in planning educational programs and accessibility for students with hearing loss and other auditory dysfunction; Measurement of noise levels and provision of recommendations for environmental modifications in order to reduce the noise level; Management of the selection, purchase, installation, and evaluation of large-area amplification systems. Facilitating the process of obtaining funding for equipment and services related to difficulties with hearing, auditory function and balance; Serving as case managers, service delivery coordinators, and members of collaborative teams (e.g., individualized family service plan and individualized education program teams, transition planning teams). 9. Education and training Audiologists also serve as educators and researchers. With reference to hearing, auditory function and balance disorders, Audiologists Educate the public and foster awareness of hearing, auditory function and balance disorders and their treatment Provide in-service training to families, caregivers, and other professionals; Educate, supervise, and mentor current and future audiologists Educate, supervise, and manage Audiology assistants and other support personnel
Measure functional outcomes, consumer satisfaction, efficacy, effectiveness, and efficiency of practices and programs to maintain and improve the quality of audiologic services; Design and conduct basic and applied audiologic research to increase the knowledge base, to develop new methods and programs, and to determine the efficacy, effectiveness, and efficiency of assessment and treatment paradigms; disseminate research findings to other professionals and to the public; Educate assistants. Serve as expert witnesses 10. Administration Administer and manage clinical and academic programs; Participate in the development of policies, operational procedures, and professional and technical standards; Supervision of support personnel. 11. Practice settings: Audiologists provide services in a variety of settings including, but not limited to: early intervention settings, pre-schools, and day-care facilities public and private schools health care settings (public and private hospitals, neonatal intensive care units, urban and rural clinics, rehabilitation facilities, long term care facilities, behavioural and mental health facilities) universities and university clinics private practice physician s office individuals homes and community residences communities industry defence force research facilities city, provincial and national institutions and government departments hearing aid companies 12. Range of clients/patients: Audiologists provide services Across the lifespan to all age groups from neonates to the geriatric population To individuals, families, and groups from diverse linguistic and cultural backgrounds The listing of specific areas within these regulations does not exclude emerging areas of practice in this dynamic and continuously developing profession. References:
American Speech-Language-Hearing Association. (2004). Scope of Practice inaudiology [Scope of Practice]. Available from www.asha.org/policy. HPCSA Regulations document pertaining to Education and Training standards in Audiology The regulations published under government Notice R889 are hereby withdrawn. ------------------------------------