Working with Communication Health Assistants in Your Practice

A Communication Health Assistant (CHA) is a therapy assistant who is not registered with the College of Health and Care Professionals of BC, but who is employed by a Registered Speech-Language Pathologist (RSLP) or an RSLP’s employer to support the RSLP’s area of clinical practice (i.e. Speech-Language Pathology). Titles that fall under the category of CHAs may include Speech-Language Pathology Assistants (SLPAs), Speech and Hearing Assistants, Speech and/or Language Assistants, and Communication Disorders Assistants (CDAs). Other occupational titles such as Education Assistants, Behaviour Interventionists, and Rehabilitation Assistants are considered CHA’s whenever they are providing services delegated by the SLP.  CHA’s are not regulated. Please see POL-QA-10-Communication-Health-Assistants-Titles-and-Credentials from CHCPBC regarding  the use of titles and credentials by CHAs.

A RSLP may delegate certain aspects of practice to CHAs who have adequate education, training, supervision, and who have been determined to be competent in the required skills. Appendix A of SOP-PRAC-04-Communication-Health-Assistants-Delegation-Assignment from CHCPBC has a comprehensive list of which aspects of practice can be delegated to CHAs and which cannot.

RSLPs are required to obtain informed consent from the client for all services delivered to a client; this consent should be documented (see SOP-PRAC-06-Client-Consent document from CHCPBC). In addition, consent must be obtained for the delegation of services to a CHA (see PRAC-04-Communication-Health-Assistants-Delegation-and-Assignment document from CHCPBC). Please note that, according to the SOP-PRAC-06-Client-Consent document from CHCPBC, CHAs may assist in the consent process but the RSLP is responsible for the consent process and the CHA cannot be the signatory on the consent document.

At the very least, all CHAs require ‘general supervision’. The specific amount of supervision required is based on the CHA’s individual level of relevant education and experience in their role. For example, supervision may be constant for a new or training CHA or for a new skill area, close for a CHA whose skills are emerging, or general for a CHA who is competent in the delegated skills. There is no specified minimum number of hours or frequency so long as the CHA is adequately supervised for delegated tasks as per your clinical judgement. See SOP-PRAC-07-Supervision and  SOP-PRAC-05-Communication-Health-Assistants-Education-Training-and-Competence from CHCPBC for more information on determining competency and level of supervision required.

As above, this is dependent on the CHA’s level of competency. However, the RSLP must document all delegations and the CHAs acceptance of the delegation. See SOP-PRAC-03-Virtual-Care for more information.

There is no specific educational program that must be completed by CHAs in BC; however, there are minimum competencies that they must possess. It is the supervising SLP’s responsibility (i.e. even if they are not the employer) to ensure these minimum competencies are in place. This CPG-09-CHAs-Verifying-Education-Training-Competence training checklist should be completed prior to delegating tasks to a CHA. If you are an employee of a company, the competency of any CHAs to which you delegate tasks remains your responsibility; please discuss necessary competency training for your CHAs with your employer.

RSLPs are responsible for verifying a CHA’s formal training and/or clinical competencies before delegating services and should advise CHAs to maintain copies of their training and continuing education records. According to the CPG-09-CHAs-Verifying-Education-Training-Competence  document from CHCPBC formal education is considered current if it was attained within the last 7 years and/or if the CHA has been practising their skills within the previous 3 years. A review of current skills and abilities is warranted if there is no evidence of previous training, current practice, or ongoing continuing education or if there are any competency concerns by either the supervising RSLP or the CHA. If a CHA’s clinical competencies are found to be lacking, RSLPs must create a learning plan that outlines specific continuing education or training requirements (including expected date of completion) in order to address any gaps in clinical competencies for the CHA. It is also the RSLP’s responsibility to create a supervision plan (see SOP-PRAC-07-Supervision) in order to ensure the CHA is appropriately supervised during delegated activities that involve any competency concern areas. Please see the Clinical Practice Guideline called  CHAs: Verifying Education, Training, & Competence (Appendix B of CPG-09) for sample learning and supervision plans.

See Speech-Language & Audiology Canada (SAC)’s document CHA_Guidelines_SLP-Assistant for additional guidelines and suggestions.