The Educational Audiology Association (EAA) recently developed and approved a scope of practice (SOP) for audiologists who work in educational settings. The SOP describes essential practice areas that are unique to the practice of educational audiology (EAA, 2019).
Educational audiology was first described in the Joint Committee Report “Audiology and Education of the Deaf” (Ventry, 1965). This report helped to define audiology services in the 1975 Education for all Handicapped Children Act, PL 94-142, now known as the Individuals with Disabilities Education Act (IDEA) (2004). In the 54 years since the first reference to educational audiology, the school-based audiologist's role has evolved significantly as the field of audiology has changed.
Early identification of hearing loss, support for students with varying hearing levels in the general education setting, and technological advances such as cochlear implants and remote-microphone hearing-assistance technology are all factors resulting in the need for audiologists who specialize in school-based services.
Nearly every child with reduced hearing between the ages of five and 18 participates in some type of school setting. Clinical audiologists who see children to monitor hearing status and perform updates to personal hearing instruments generally do not see children in school settings. In ideal situations, children have both a clinical audiologist for the management of personal hearing instruments and an educational audiologist for hearing-assistance technology and habilitation support (e.g., listening skill development, social communication, self-advocacy, counseling) in the school setting.
Educational audiologists are specifically qualified to make recommendations regarding the support that students need to gain access to information, both auditory and visual, to succeed in the classroom. For students using personal hearing instruments (e.g., hearing aids, cochlear implants, bone-conduction devices), educational audiologists support school-based teams so they understand how to perform daily listening checks to ensure the hearing instruments are working properly.
Educational audiologists also evaluate, fit, and manage personal and classroom remote-microphone hearing assistance and other technologies. Lastly, educational audiologists are in a unique position of having access to school-based teams to provide training and support for the technologies the students use to access information.
The school-based team, including speech-language pathologists and school psychologists, is also important when assessing and determining whether students have central-auditory-processing deficits. In addition to collaborating on assessment, educational audiologists observe and work with students in their classroom and help guide team members when making decisions about support and services.
School settings provide unique challenges to audiologists working in clinical and/or hospital settings. For example, audiologists may recommend a personal-frequency-modulation or digital-modulation (FM/DM) system for a student. However, what happens next varies even within the same general locale, making it difficult for clinical audiologists to keep track of how each school district handles these recommendations.
Some districts employ audiologists, some contract with educational agencies or co-ops, and some employ independent contractors. Other districts may not provide any services from audiologists.
This variability makes it difficult to ensure children are well-managed in their everyday school environment without the support of an educational audiologist.
Using the Scope of Practice
Consider this common scenario of a student with hearing levels in the moderate-loss range who wears bilateral hearing aids.
The district does not have an educational audiologist, but recognizes the need for the student to have hearing-assistance technology to help him access instruction. Well-meaning, yet ill-informed, school administrators ask available staff such as teachers of the deaf/hard of hearing, speech-language pathologists, or even school nurses, to select and fit this technology.
As a result, a classroom audio-distribution system (CADS) is selected. There is no speech-in-noise testing to determine the student’s signal-to-noise ratio (SNR) needs, no measurements to assess classroom noise and reverberation, and no assessment to validate whether the CADS addresses the student’s listening needs.
In contrast, an educational audiologist following the scope of practice individually evaluates the student’s auditory access needs in the context of the student’s classroom settings to determine the appropriate personal or classroom hearing-assistance technology option. The educational audiologist also performs the necessary fitting, verification, and validation procedures that ensure the device is providing the intended benefit for the student. In addition, training for the student and relevant staff is conducted so that the technology is used appropriately and accurate expectations are determined.
Hearing-assistance technology, when applied appropriately, is an essential tool to help ensure students who are deaf or hard of hearing can access instruction and communication as effectively as their hearing peers.
Although clinical and educational audiologists share much of the same background and training, it is important to recognize the specialization areas of the two practices.
EAA developed this SOP document to help guide clinicians in understanding the unique role of educational audiologists with students in the educational environment. Clinical and educational audiologists can and should work collaboratively to aid students with varying hearing levels to reach developmental, language, and educational milestones at the same time as their peers.