64B20-4.003. On-the-Job Training, Role and Observation of Speech-Language Pathology and Audiology Assistants

(1) A licensee who employs a speech-language pathology assistant or an audiology assistant shall provide such assistant with on-the-job training, and shall maintain responsibility for all services performed or omitted by such assistant. The licensee shall not permit the assistant to perform any service on a client unless:

(a) The licensee provides the assistant with on-the-job training for each service for which there is no available documentation of a previously acquired competency; and,

(b) The assistant is clearly identified as an assistant by means of a nametag or similar identification.

(2) At a minimum, on-the-job training shall include step by step instruction and demonstration of each and every service the assistant is to perform and continuous visual observation by the licensee of the assistant’s performance of such service until the licensee establishes the assistant’s competency. The licensee shall maintain a record of each service indicating the activity, date, time, and location of the foregoing demonstration and observations concerning competency. The record shall be signed by both the licensee and the assistant and a copy thereof shall be provided to the assistant and shall be maintained by the supervising licensee for the duration of employment and shall be maintained by the assistant as long as the assistant is certified by the Board. A new supervising licensee shall obtain and maintain for the duration of employment, records demonstrating competency for all services performed by the assistant. Upon request of the Department or Board, the supervising licensee and the assistant shall produce the documentation of competency records required herein.

(3) The speech-language pathology or audiology licensee shall notify the Department within thirty (30) days of any changes in the roster of assistants registered under his or her name by submitting Form DH-MQA 1269 (4/13), entitled “Board of Speech-Language Pathology and Audiology Assistant Activity and Supervisory Plan,” hereby adopted and incorporated by reference, and can be obtained from the following website at http://www.flrules.org/Gateway/reference.asp?No=Ref-03085, or http://www.doh.state.fl.us/mqa/speech/index.html.

(4) Following the completion of on-the-job training, the speech-language pathology assistant shall engage only in those services that are planned, designed and supervised by the speech-language pathology licensee. The scope of services which a speech-language pathology assistant may provide includes:

(a) Record case history information.

(b) Screen speech, language or hearing by the use of procedures that are included in published material containing directions for administration and scoring.

(c) Implement, without diagnostic interpretation, evaluative procedures that are:

1. Planned and designed by the licensee; and,

2. Included in published materials which have directions for administration and scoring.

(d) Implement treatment programs that:

1. Are planned and designed by the licensee to meet pre-established goals; and,

2. Contain pre-established criteria for mastery.

(e) Record, chart, graph or otherwise display data relative to client performance.

(f) Perform clerical functions necessary to maintain clinical records.

(g) Report changes in client performance to the licensee having responsibility for that client.

(h) Prepare clinical materials.

(i) Test equipment to determine if the equipment is performing according to published specifications.

(j) Participate with the licensee in research projects, in-service training, public relations programs, or similar activities as planned, designed and directed by the licensee.

(k) Serve as an interpreter (translator) for the speech-language pathology licensee during clinical procedures.

(l) Assist in the evaluation or treatment of difficult-to-test clients.

(5) The speech-language pathology licensee shall not delegate to the speech-language pathology assistant any tasks which call for a diagnostic interpretation or put the client at physical risk. The following tasks shall not be delegated to a speech-language pathology assistant:

(a) Conducting the initial interview with the client.

(b) Performing initial testing or evaluation.

(c) Determining or discussing specific diagnoses with the client or making statements regarding prognosis or levels of proficiency.

(d) Relating or discussing with clients or consumers of services the reports from other professionals or related services unless those findings have previously been interpreted and reported by the supervising licensee.

(e) Providing any interpretation or elaboration of information that is contained in reports written by the licensee, although he or she may, upon assignment from the licensee, present information regarding clients at staffings or conferences; however, the assistant may discuss with the client or consumer specifically observed behaviors that have occurred during a treatment when they are supported by objective data.

(f) Performing any procedure where there is a risk of physical injury as a result of the procedure; specifically, the insertion of tracheoesophageal prostheses or catheter into the esophageal puncture; endoscopy; administration of barium or other substances for the assessment of swallowing; fitting or insertion of tracheal valves or instrumentation for generation of voice; and initial measurements and fitting of oral prostheses.

(g) Devising or planning treatment based upon assessment or diagnostic findings.

(h) Providing counseling to the client or to his or her family.

(i) Making referrals for additional services.

(j) Signing any document without the co-signature of the licensee.

(k) Using any title other than the Speech-Language Pathology Assistant.

(l) Determining patient or client dismissal criteria have been met.

(6) Following the completion of on-the-job training by the supervising audiology licensee, the audiology assistant may engage only in those services that are planned, designed, and supervised by the licensee.

(7) The audiology licensee may permit the audiology assistant to perform the following services under the direct supervision of the supervising licensee or when acting pursuant to Board of Speech Language Pathology and Audiology approved protocols as established in Rule 64B20-4.0046, F.A.C., in order for the licensee to be available for consultation and direction:

(a) Conduct basic hearing testing without diagnostic interpretation, including air and bone conduction thresholds and speech audiometry.

(b) Conduct impedance audiometric testing.

(c) Assist in the evaluation of difficult-to-test patients.

(d) Record case history information.

(e) Assist in conducting real ear measurements.

(f) Assist in ABR, ENG, and otoacoustic emissions testing.

(g) Report changes in client performance to the audiology licensee having responsibility for that client.

(h) Participate with the audiology licensee in research projects, in-service training, in public relations programs, or similar activities as planned, designed and directed by the audiology licensee.

(i) Assistant in implementing a plan or program for management and/or treatment developed by the supervising audiology licensee.

(8) The following activities of a certified audiology assistant are permitted under the responsible supervision of the supervising audiologist without the requirement of the physical presence of a supervising audiologist:

(a) Demonstrate assistive listening devices.

(b) Test prescription hearing aids to determine if they meet appropriate specification and/or mechanical performance. A prescription hearing aid is defined in Rule 64B20-8.0011, F.A.C.

(c) Demonstrate care and use of the prescription hearing aid controls, battery insertion and insertion of the hearing aid or ear mold into the ear.

(d) Perform clerical functions necessary to maintain clinical records.

(e) Prepare clinical materials and where appropriate, in accordance with universal precautions.

(f) Test equipment to determine if the equipment is performing according to published specifications.

(g) Screen hearing using established criteria on a pass/fail basis, including but not limited to newborn hearing screening.

(9) The audiology licensee shall not delegate to the audiology assistant any tasks which call for a diagnostic interpretation or put the client at physical risk. The following tasks shall not be delegated to an audiology assistant:

(a) Providing diagnostic services to children below the age of five years or to other clients whose hearing impairment, medical condition, behavior or other disabling condition would preclude the use of services from anyone other than the licensed audiologist.

(b) Performing any procedure where there is a risk of physical injury as a result of the procedure; specifically, where injury to the physical structures of hearing is likely to occur.

(c) Developing a plan of care or treatment for auditory or vestibular disorders.

(10) The speech-language pathologist shall directly observe the speech-language pathology assistant’s service as follows:

(a) During the first 12 months of continuous employment on at least one occasion, and if treatment is provided, a minimum of one session every 30 days per client or more frequently depending upon the individual client’s needs.

(b) Following the first 12 months of continuous employment on at least one occasion and, if treatment is provided, a minimum of one session every 60 days or more frequently depending upon the individual client’s needs.

(11) A speech-language pathology assistant who has greater than 12 months continuous employment at one site and changes employment settings shall, for the first 30 calendar days of employment within a new facility, be provided the same level of supervision/observation as required for new assistants. After the initial 30 days, with licensee certification of competency, then the assistant will be provided supervision as required for the assistant who has greater than 12 months experience.

Rulemaking Authority 468.1125(3), 468.1135(4) FS. Law Implemented 468.1125(3), (4), 468.1215 FS. History–New 3-14-91, Formerly 21LL-4.003, 61F14-4.003, Amended 9-8-94, 8-17-95, Formerly 59BB-4.003, Amended 2-2-04, 2-21-05, 9-9-13, 3-18-20, 3-15-21, 5-3-23.