SIG 9

Research Article

Listening and Spoken Language Specialist

Auditory–Verbal Certification: Self-Perceived
Benefits and Barriers to Inform Change
Maria Emilia de Melo,a,b Uma Soman,b,c,d Jenna Voss,c,e Maria Fernanda Hinojosa Valencia,b,f
Dorie Noll,c,g Frances Clark,b,h Gayla Hutsell Guignard,e and Ulrika Löfkvistb,i,j
a
Child Health & Development, Toronto Public Health, Ontario, Canada b Global Matters Committee, AG Bell Academy for Listening and
Spoken Language, Alexander Graham Bell Association for the Deaf and Hard of Hearing, Washington, DC c Fontbonne University, St. Louis, MO
d
Listening Together, Urbana, IL e AG Bell Academy for Listening and Spoken Language, Alexander Graham Bell Association for the Deaf and
Hard of Hearing, Washington, DC f Aurea Lab, Mexico City, Mexico g School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada
h
Auditory Verbal UK, London, United Kingdom i Department of Public Health and Caring Sciences, Uppsala University, Sweden j Department of
Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden

ARTICLE INFO ABSTRACT

Article History: Purpose: The aim of this study was to explore the path to Listening and Spo-
Received March 18, 2022 ken Language Specialist (LSLS) certification from the professional’s viewpoint
Revision received June 15, 2022 as well as to address motivation, self-perceived gains, challenges, and barriers
Accepted June 22, 2022 to certification in an international cohort with the purpose of guiding future
change within the existing certification system.
Editor-in-Chief: Dawn Konrad-Martin Method: Members of the AG Bell Academy for Listening and Spoken Language
Editor: Cynthia Richburg (AG Bell Academy) Global Matters Committee created an online survey dissemi-
nated by the AG Bell Academy in English and Spanish for professionals who
https://doi.org/10.1044/2022_PERSP-22-00060 were certified LSLSs, mentees currently pursuing the certification, and profes-
sionals interested in the certification. Participants (N = 295) were from different
parts of the world. Of the respondents, 48% reported English as their first lan-
guage, 19% reported Spanish as their first language, and the remaining 33%
reported one of 26 other languages as their first language. Approximately 40%
of the total respondents were certified LSLSs (n = 117), and 50% of them lived
in the United States.
Results: The findings indicate that certified LSLSs perceived significant growth
in knowledge and skills as a result of the certification process. Personal motiva-
tion drove individuals to pursue certification. A common barrier among all par-
ticipants was limited resources, such as time, funds, and access to a mentor
who speaks the same language.
Conclusions: There is a need for more awareness of the significant gains LSLS
certification can bring to professionals. There is further need to address, mini-
mize, and overcome perceived barriers in the process. Future similar research is
warranted to explore the gains and barriers of obtaining the LSLS certification
outside the English-speaking countries and in a larger, more population-based
sample.

Intervention options aligned with the principles of

Correspondence to Ulrika Löfkvist: ulrika.lofkvist@pubcare.uu.se.
Disclosure: Gayla Hutsell Guignard works at the AGBell Association,
which is responsible for LSL certification. Ulrika Löfkvist is unpaid chair
for the AGBell Academy. All other co-authors, except Dorie Noll, are
part of the Global Matters Committee (unpaid voluntary work), AGBell
Academy (part of the AGBell Association).
Listening and Spoken Language (LSL) practice using
auditory–verbal (AV) philosophy that are provided by
highly qualified professionals can promote the LSL skill
development of children who are deaf or hard of hearing
(DHH) and empower their parents (Brennan-Jones et al.,
2014; Hitchins & Hogan, 2018; Percy-Smith et al., 2018;

1828 Perspectives of the ASHA Special Interest Groups • Vol. 7 • 1828–1852 • December 2022 • Copyright © 2022 The Authors
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Thomas & Zwolan, 2019). However, currently, there are
insufficient numbers of certified Listening and Spoken
Language Specialists (LSLSs) to meet the needs of families
around the globe. As of May 2022, 1,024 professionals in
the world have obtained certification as an LSLS. Of
these, 746 certified LSLSs are in the United States; 93, in
Canada; 86, in Australia; and 27, in England, which,
together, represents 93% of the world’s total LSLS certi-
fied professionals. Many countries, particularly those with
a higher prevalence of childhood hearing loss, do not have
a sufficient number of highly qualified professionals to
support LSL development of children who are DHH.
Engaging in the LSLS certification process is one way to
develop this knowledge and skills among professionals.
There is an urgent need to increase the number of certified
LSLSs, particularly within different sociocultural and lin-
guistic contexts, to meet the needs of all children who are
DHH and their families wishing to pursue an LSL
approach. This study investigated possible barriers for
professionals pursuing LSLS certification and explored the
self-perceived gains after certification with the aim of
guiding change in the existing certification system.
Global Perspective on Hearing Loss and
Deafness
According to the World Health Organization (WHO)
report on deafness and hearing loss, approximately 466 mil-
lion people worldwide have disabling hearing loss, and 34
million of these people are children (WHO, 2021). Disabling
hearing loss refers to hearing loss greater than 40 dB in the
better hearing ear in adults and hearing loss greater than 30
dB in the better hearing ear in children (WHO, 2021). In
children younger than 15 years old, 60% of hearing loss is
attributable to preventable causes. This figure is higher in
low- and middle-income countries (75%) as compared with
high-income countries (49%; WHO, 2021). Unaddressed
hearing loss presents an annual global cost of US$750 bil-
lion (WHO, 2021). Prevention, early hearing detection, and
intervention are not just cost-effective but also critical to
minimizing the impact of hearing loss on a child’s develop-
ment and educational achievements (Yoshinaga-Itano et al.,
2021). Currently, access to early hearing detection and inter-
vention (EHDI) is inequitable globally. There are many
countries lacking a universal newborn hearing screening
(UNHS) system as well as specialized professionals within
the fields of audiology, speech and language development,
and education (WHO, 2021).
Current Best Practice for Auditory
Habilitation
Hearing loss can have a significant, detrimental
impact on a child’s learning as it negatively affects the
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SIG 9 Pediatric Hearing and Hearing Disorders
development of language through which most other learn-
ing occurs. The Joint Committee on Infant Hearing
(JCIH, 2000) recommends screening for hearing loss in all
infants before 1 month of age; complete audiological diag-
nostics and medical evaluations, if indicated, by 3 months
of age; and the provision of early intervention services
(including hearing technology, as applicable) by 6 months
of age, but preferably as soon as possible. The JCIH 2019
Position Statement (JCIH, 2019) recommends that EHDI
programs that meet the 1–3–6 benchmark (screening com-
pleted by 1 month of age, audiologic diagnosis by
3 months of age, and enrollment in early intervention by
6 months of age) should strive to meet a 1–2–3-month
timeline. Considering that approximately 90%–96% of the
children who are DHH are born to typically hearing par-
ents who use spoken language to communicate (Mitchell
& Karchmer, 2004; Moores, 2001), parents often choose
to pursue an LSL approach for their children’s communi-
cation development.
When LSL is the desired communication outcome,
audiological management by a pediatric audiologist and
appropriately fitted hearing technology that provides opti-
mal auditory access to spoken language(s) are the first step.
Hearing technology, fit well and early, allows children to
develop neural pathways for listening, speech, and language
development (Brennan-Jones et al., 2014; Fulcher et al.,
2012; Rosenzweig, 2017; Yoshinaga-Itano, 2014).
Family-Centered Early Intervention and the
Role of the Professional
In addition to early access to sound, an important
variable that affects a child’s ability to develop spoken
language through listening and that has an impact on
their progress is the involvement of parents and other
caregivers. This includes a caregiver’s skills, knowledge,
and emotional state (JCIH, 2019; Moeller et al., 2013).
Research studies show that caregiver involvement is linked
to positive outcomes for children who are DHH (Lund,
2018; Nicastri et al., 2021). Recognizing the value of the
parents’ and other caregivers’ expertise and the impor-
tance of a family-centered approach with early interven-
tion services facilitates a more efficient, effective, and less
invasive intervention in congruence with the family’s cul-
ture (Rosenzweig et al., 2022).
Among other variables that affect the development
of LSL by children who are DHH, there are the skills and
knowledge of the professionals providing the services to
this population (Ganek & Wilson, 2012). Family-centered
intervention is grounded in the principles of adult learning
and refers to practices that build on families’ strengths
and firming capacity to enhance and promote their child’s
development and learning (Moeller et al., 2013). This is a
shift from the traditional model where a professional
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SIG 9 Pediatric Hearing and Hearing Disorders
(teachers of children who are DHH, speech-language
pathologists, and early interventionists) provides direct child
services to a model where the primary focus of effective
early intervention is on professionals coaching caregivers.
AV Practice
AV practice is a family-centered early intervention
option that has proven to be effective in achieving LSL
outcomes for children who are DHH, with or without
additional needs (Eriks-Brophy et al., 2016; Fulcher et al.,
2012; Hitchins & Hogan, 2018; Lim et al., 2018; Percy-
Smith et al., 2018; Thomas & Zwolan, 2019). In AV prac-
tice, it is the parents who are identified as the main agents
of their child’s language development and, therefore, the
primary client in intervention. Audition is recognized as
the primary pathway for the development of spoken lan-
guage. In AV practice, focus lies on a developmental
rather than remedial sequence of skill acquisition and a
coaching rather than teaching model to support the par-
ents who facilitate their child’s spoken language develop-
ment through listening. AV practice is grounded in 10
principles (AG Bell website-II, 2022) and has specific
strategies based on evidence and defined domains of
knowledge to support its practice (Eriks-Brophy et al.,
2016).
The AV practice approach is not static but has
evolved over the years along with updated knowledge
about hearing loss and communication access, especially
related to advances in diagnostics and hearing technologies.
Moreover, AV practice has adapted to the changes that
resulted from the introduction of the UNHS, including
changes in the profile of the population of children who are
DHH. Those who worked to advance AV practice include
Beebe (1953); Fry and Whetnall (1954); Pollack (1964);
Griffiths (1967); Ling (1976); Auditory-Verbal Interna-
tional; Estabrooks et al. (2020); and today’s leader, the AG
Bell Academy for Listening and Spoken Language (for
brevity, also referred to as the AG Bell Academy in this
article; Goldberg et al., 2010). The AV community is con-
tinuously evolving and improving, and LSLS practice using
AV philosophy is considered synonymous with high stan-
dards of family-centered early intervention services to chil-
dren who are DHH.
One goal of AV practice is to help infants and
young children achieve age-appropriate skills, not only in
listening but also in cognition, language, and verbal com-
munication as quickly as possible to facilitate social inte-
gration with typically hearing peers (AG Bell Academy
for Listening and Spoken Language, 2022a). AV practice
specifically requires the parents and other caregivers to be
the client as well as the child’s primary language model
and facilitator of their development in all areas, including
auditory skills, speech, and language (Hlady-MacDonald,
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2012; Levasseur, 2001). One of the AV pillars is using a
family-centered approach, and it is critical that LSLSs
respect the family’s culture within their local context and
resources (Rosenzweig et al., 2022).
Professionals following an AV approach implement
strategies that maximize language development through
listening. Rosenzweig and Smolen (2021) investigated the
use of specific AV strategies among professionals who
were either certified LSLSs or noncertified professionals
working with children who are DHH learning to listen
and develop spoken language. The results of the investiga-
tion indicated significant differences in the use of AV
strategies between certified LSLSs and noncertified profes-
sionals. The authors highlight that certified LSLSs used
those strategies, which require knowledge of speech acous-
tics, auditory brain development, and spoken language
development for children who are DHH, at significantly
higher rates:
It is likely that the years of specialized post-degree
training in listening and language development the
LSLS group had undergone, facilitated a deeper
understanding of strategies that specifically target
the auditory brain. (Rosenzweig & Smolen, 2021,
p. 14)
LSLS Certification
In response to the need for more professionals
trained in implementing LSL intervention aligned with
AV principles, the AG Bell Academy has created a path-
way for professionals globally to increase their knowledge
base through certification. The LSLS certification is
administered by the AG Bell Academy for Listening and
Spoken Language (2022b), a subsidiary of the Alexander
Graham Bell Association for the Deaf and Hard of Hear-
ing (for brevity, hereinafter referred to as the AG Bell
Association). LSLS certification (Listening and Spoken
Language Specialist Certified Auditory-Verbal Therapist
[LSLS Cert. AVT] and Listening and Spoken Language
Specialist Certified Auditory-Verbal Educator [LSLS Cert.
AVEd]) acts as an identifier of professionals who have
highly specialized skills and as a catalyst to engage profes-
sionals in the attainment and maintenance of highly spe-
cialized skills. LSLS certification was developed in
response to the following and continues to evolve to best
meet the needs of children, families, and professionals
globally:
1. Ensuring that children can achieve their potential.
Given appropriate interventions and supports, chil-
dren who are DHH have the same ability as other
children to develop speech and language. Highly
specialized knowledge and skills are needed to

provide specific services over time that result in LSL
skills and outcomes commensurate with each child’s
potential.
2. Foster a community of professionals who have spe-
cialized knowledge and skills to provide appropriate
intervention and supports to help children achieve
their potential. Most professionals are prepared to
be generalists targeting a wide range of communica-
tion disorders or generalists working with children
using a variety of communication approaches. Only
a very small number of university training programs
prepare professionals to provide LSL intervention.
LSLS certification requires further study in several
areas, including audiology, child development, coach-
ing, counseling, deaf education, education, neuro-
science, psychology, and speech-language pathology.
3. Engage in a mentoring process to gain additional
professional attributes, such as flexibility in thinking,
adaptability in behavior, attention to numerous
details, the ability to prioritize and shift intervention
goals and select discrete targets while engaged in
intervention, and communicating with parents and
caregivers.
Since 2008, the AG Bell Academy has created two
routes for certification, namely, LSLS Cert. AVT and
LSLS Cert. AVEd, making these credentials more inclu-
sive to professionals of various academic and clinical
backgrounds. Professionals who are able to complete the
required clock hours providing individual AV therapy
with children and their parent or caregiver usually pursue
the LSLS Cert. AVT designation. Professionals who are
able to complete the required clock hours providing AV
education services in a group environment in which a par-
ent may or may not be present usually pursue the LSLS
Cert. AVEd designation.
The certification process takes 3–5 years of practice
under the mentorship of a certified LSLS in good standing
and has three components as follows:
1. education and work experience
a. degree in deaf education, speech-language
pathology, audiology, or other related fields
as approved by the AG Bell Academy
b. 900 hr of professional experience in LSL inter-
vention over 3–5 years
2. mentoring and continuing education
a. observation and feedback from a certified
LSLS mentor
b. observation of 10 sessions conducted by a cer-
tified LSLS
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SIG 9 Pediatric Hearing and Hearing Disorders
c. 20 supervised intervention or teaching sessions
of 1 hr each either in person or by video, live
or recorded
d. 70 hr of LSL-related continuing education
3. certification examination—a qualifying exam con-
ducted in either English or Spanish that can be taken
through Kryterion testing centers around the world
The certification process costs approximately US
$600, plus any additional expenses related to mentoring,
continuing education, and transcript review and equivalen-
cies. The LSLS certification process is unique in compari-
son with other known AV-related education programs for
professionals around the world (see Appendixes A and B).
Although there has been an intention to make the
LSLS certification available and international from the
beginning, there have been challenges for professionals to
become certified. This study explores current barriers and
facilitators as actionable items. The AG Bell Academy
has begun a number of initiatives with the purpose of pro-
viding better prerequisites for presumptive candidates
worldwide. For example, the AG Bell Academy has
improved access to its official examination as it is now
offered in English and Spanish in more than 1,100 differ-
ent places around the world (AG Bell Academy for
Listening and Spoken Language, 2022b). The commitment
to making the certification accessible to international pro-
fessionals can also be illustrated by the creation of the
AG Bell Global Matters Committee (GMC), which was
established by the AG Bell Academy in 2017.
The main purpose of the GMC is to support profes-
sionals globally who are interested in enhancing their LSL
knowledge and practice through certification as an LSLS
Cert. AVT or an LSLS Cert. AVEd. The committee is dedi-
cated to being responsive and accountable to children and
their families, the (re)habilitation team, and the broader
team of professionals within the LSL community. Through
partnership, collaboration, inclusiveness, and professional
support, the committee aims to help the AG Bell Academy
share the knowledge and expertise of LSL certification with
professionals around the world (AG Bell Academy for
Listening and Spoken Language, 2022c). The AG Bell Acad-
emy strives to increase the number of certified LSLSs so that
children who are DHH and their families will have access to
qualified professionals in their immediate geographic area.
Continued actions to promote and succeed in having more
available certified LSLSs in the world are therefore highly
warranted. To be successful in prioritizing the committee’s
future strategy, new knowledge about the current situation
related to the certification process is needed.
The aim of this global survey study was to explore
the path to becoming a certified LSLS and to address par-
ticipants’ self-perceived gains and experiences related to
1831
SIG 9 Pediatric Hearing and Hearing Disorders
certification in a large cohort of professionals from differ-
ent parts of the world and with a broad range of socio-
cultural backgrounds. To our knowledge, there are no pre-
vious similar studies.
Research questions:
1. What motivates or discourages a professional to
become a certified LSLS?
2. Which barriers do certified LSLSs and those seeking
certification face during the certification process?
3. Which self-perceived gains of becoming certified do
LSLSs report?
One hypothesis was that most participants would
come from English-speaking countries because the major-
ity of current certified LSLSs are based in the United
States, Canada, and Australia. Furthermore, this research
team hypothesized that barriers in pursuing a certification
process could be different for participants from English-
speaking and/or high-income countries than for partici-
pants from non–English-speaking and/or low- and middle-
income countries, especially if a robust hearing care sys-
tem (e.g., UNHS and EHDI programs) has been estab-
lished in the participant’s home country. However, the
research team also hypothesized that limited dedicated
time and financial support could be potential barriers to
professionals regardless of their demographic background,
as certified LSLSs also underserve remote and rural areas
of high-income countries. Another hypothesis was that
reported gains after certification would be more alike for
all participants than the more cultural-specific barriers.
Researchers hypothesized that most certified LSLSs would
express their satisfaction and confidence with their
increased knowledge and skills about family-centered
intervention based on the AV approach as a major gain
after the certification.
Method and Materials
This cross-sectional, descriptive online survey used
convenience sampling to invite professionals working with
children who are DHH and their families. All profes-
sionals, including certified LSLSs, professionals interested
in the process of becoming a certified LSLS, and those
who were not pursuing LSLS certification, were eligible to
participate. Over a 9-month period, professionals were
invited to complete the anonymous questionnaire.
The study had a mixed-methods design with quanti-
tative and qualitative data collection and analysis and was
initiated and conducted by the members of the GMC. The
GMC consists of a small group of certified LSLSs repre-
senting different parts of the world who have been elected
to provide volunteer work at the AG Bell Academy.
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Participants in the Digital Survey Study
The digital survey was available online between April
26, 2019, and January 27, 2020. Professionals were asked
to self-select one of five categories at the beginning of the
survey: certified, pursuing certification, considering certifi-
cation, unfamiliar with certification, and familiar with certi-
fication but not pursuing certification. This study focused
on the responses of professionals who self-identified as cer-
tified, pursuing certification, and considering certification.
The Global Survey Instrument and Data
Collection Procedure
The members of the GMC created a questionnaire that
reflected questions based on shared clinical experiences as
international LSL professionals and joint discussions within
the group. Face validity was evaluated by two other LSL pro-
fessionals within the AG Bell Academy community. The
questionnaire was translated into Spanish by a member of the
GMC who is a native speaker of Spanish. The translation
was thereafter discussed with another Spanish-speaking mem-
ber of the GMC. Some minor adjustments were made before
the final questionnaire was made digital in both English
and Spanish formats through the SurveyMonkey system
and then distributed online via websites and social media.
Respondents only saw the questions that were relevant to
the category they chose. For example, questions related to
mentoring experience were seen by the certified and pursu-
ing professionals, but not by the considering professionals.
The final questionnaire consisted of two sections: (a)
demographics, work-related tasks, and professional infor-
mation and (b) barriers and gains of LSL certification.
The majority of questions had predetermined alternatives
of responses, and some were open-ended questions.
Data Analysis
The survey results were analyzed with a quantitative
approach to investigate overall tendency in the material in
the three groups, with a focus on descriptive analyses.
Thereafter, two researchers experienced in qualitative
analyses conducted an inductive, qualitative text analysis
to investigate the responses to the open-ended questions
(Elo & Kyngäs, 2008). The following procedure was used:
All the written responses to specific questions were ini-
tially read through to give an overall sense of the material.
Codes were developed inductively based on the content of
the responses. The codes were then sorted into categories
and subcategories based on frequency and relevance to the
research objectives. The resulting categories and subcate-
gories were analyzed in order to identify patterns and con-
nections that would help the researchers understand the
results and create relevant themes.
 SIG 9 Pediatric Hearing and Hearing Disorders

Table 1. Profile of survey participants (N = 295).

completing this survey and did not impact the survey takers’
Certified Pursuing Considering
involvement or receipt of services in the AG Bell Academy
in any way. The collected data were saved securely and only
Variable n % n % n %
shared with the research team. The analysis was completed
Participants 117 100 84 100 94 100 by professionals with IRB/Collaborative Institutional Train-
Language of the ing Initiative training and certificates.
survey
English survey 112 95.73 66 78.57 55 58.51
Spanish survey 5 4.27 18 21.43 39 41.49
Certification Results
credential
Auditory–Verbal 85 72.65 63 75.00 n/a n/a
Therapist Quantitative Survey Results
Auditory–Verbal 32 27.35 15 17.86 n/a n/a
Educator
Supervisor route 3 3.57 n/a n/a
A total of 295 professionals responded to this survey
for AVT/AVEd (see Table 1). A majority of the respondents opted to
certification complete the survey in English. Responses from profes-
No response 1 1.19 n/a n/a
Age group of
sionals who identified as certified, pursuing certification,
children served and considering certification were analyzed.
Birth–2 years 110 94.02 70 83.33 60 63.83 Forty percent of the respondents (n = 117) identified
3–5 years 113 96.58 78 92.86 80 85.11
6–10 years 97 82.91 65 77.38 73 77.66
as being certified, with 94% (n = 110) providing early
Older than 78 66.67 47 55.95 57 60.64 intervention services. Twenty-eight percent of the respon-
10 years dents identified as pursuing certification (n = 84), with
Not applicable 4 4.26
83% (n = 70) providing early intervention services. Thirty-
Note. n/a = not applicable; AVT/AVEd = Auditory–Verbal Therapist/ two percent of the respondents (n = 94) identified as con-
Auditory–Verbal Educator. sidering certification, with 63% (n = 60) providing early
intervention services. This variation in the primary age
group of children served might be related to the knowl-
Ethical Considerations edge and skills of the professionals as well as to the state
of early intervention systems within their communities.
The initial motivation behind this survey was to collect Respondents were asked to report their first language
data for program improvement. Thus, this study was not to better understand the demographic profile of the partici-
reviewed by an institutional review board (IRB). However, pating professionals. Twenty-seven unique languages were
two of the authors have extensive experience with IRB appli- reported, with English being the most commonly reported
cations and developed this survey keeping the basic ethical first language among the respondents (see Table 2).
principles of respect for persons, beneficence, and justice The first research question asked about the perception
(National Commission for the Protection of Human of benefit from obtaining certification as an LSLS. Only the
Subjects of Biomedical and Behavioral Research, 1979). respondents who identified themselves as certified were asked
Additionally, an external organization was hired to assist this question and were asked to identify three perceived ben-
with survey design, data collection, and data analysis for efits. The most common self-perceived benefit was significant
the purpose of providing de-identified data that would growth in knowledge and skills related to LSL (see Table 3).
inform the AG Bell Academy for Listening and Spoken Lan- Respondents who identified as pursuing certification
guage in program planning. The participants were informed were asked about their motivation for pursuing LSLS certifica-
that the questionnaire was anonymous, their participation tion and asked to choose all applicable statements. The most
was voluntary, and they could abandon the survey at any commonly chosen motivating factor was the desire to improve
time. There was minimal risk involved for the participants intervention for the children and families served (see Table 4).

Table 2. Top five languages by groups of survey participants.

Certified Pursuing certification Considering certification

Language n % Language n % Language n %

English 92 78.63 English 26 30.95 Spanish 33 35.11

Spanish 4 3.42 Spanish 19 22.62 English 25 26.60
Danish 3 2.56 Korean 11 13.10 Portuguese 14 14.89
Korean 3 2.56 Danish 9 10.71 Korean 3 3.19
Portuguese 3 2.56 Arabic 3 3.57 Marathi 3 3.19

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SIG 9 Pediatric Hearing and Hearing Disorders

Table 3. Self-perceived benefits of obtaining Listening and Spoken Table 5. Top barriers reported by certified respondents (n = 117).
Language Specialist (LSLS) certification by certified LSLSs (n = 117).
Responses
Responses Barrier (n = 117) %
Benefit (n = 117) %
Overall time commitment (3–5 years) 46 53.82
I have experienced significant growth in 81 94.77 Access to sessions of other LSLS 41 47.97
my knowledge and skills of listening certified professionals for the
and spoken language and related required 10 observation sessions
areas. (direct or videotapes/digital
My professional expertise/opinion 66 77.22 recordings)
appears to be more sought after Cost associated with taking the exam 34 39.78
and/or valued. Completing the required paperwork 31 36.27
I have become more confident in my 56 65.52 Employer support (time off, caseload 31 36.27
provision of services to children and allocation, funding, etc.)
families.
I have increased the number of 34 39.78 Note. LSLS = Listening and Spoken Language Specialist.
presentations, lectures, and/or
workshops I provide.
I have observed improved outcomes in 24 28.08
the children I serve. international barriers, facilitators, and suggestions (see
The service delivery models that I use 17 19.89 Figure 1).
have expanded (e.g., telepractice).
I have become involved in other 16 18.72
professional opportunities (not Theme 1: Barriers to Certification
mentioned above) because of being The barriers perceived by the respondents fit into
certified.
My caseload has grown or changed. 12 14.04 two categories: extrinsic factors, which occur outside of
Other 12 14.04 the respondent (i.e., environmental, cultural, or related to
lifestyle), and intrinsic factors, which are inherent to the
respondent (such as beliefs and emotions related to
The second research question was about the chal- certification).
lenges and barriers perceived during the certification pro- Extrinsic variables that hinder the certification pro-
cess or when considering the certification process. Keeping cess. Researchers identified two extrinsic variables that
in mind the varying stages of the certification process, ques- hindered the certification process, namely, procedure and
tions were asked in a different way to those pursuing certi- resources, with three subthemes identified under resources:
fication compared with those who were certified and those economic, time, and mentoring.
considering certification (see Tables 5–7). Overall, the cost, Procedure. Respondents reported a number of proce-
time, and other resources required to complete the certifica- dural barriers related to requirements for obtaining and
tion requirements were the top barriers reported. For more maintaining certification. Reported obstacles related to
insight, refer to the qualitative analyses below. communication, including slow response times and a
tedious continuing education unit (CEU) approval pro-
Qualitative Content Analysis of Open-Ended cess. Professionals reported challenges with accessing
Questions information from a website that was not user-friendly,
specifically citing website directory failures, nonfillable
Four themes and subthemes were identified for the forms, and unclear procedural instructions. Additionally,
qualitative content analyses of open-ended questions: barriers, respondents cited the barrier of what they considered an
excessive amount of required paperwork. As one respon-
Table 4. Motivation factors of respondents who were pursuing cer- dent noted:
tification (n = 84).

Responses Table 6. Top barriers reported by the pursuing respondents

Motivation (n = 84) % (n = 84).

I want to improve the intervention/ 76 90.48 Responses

education I provide to children and Barrier (n = 84) %
families.
Having the certification will improve my 39 46.43 Completing all the requirements (e.g., 63 75.00
standing within the professional mentoring, continuing education,
community. observation, and equivalency)
Having the certification will allow me to 20 23.81 Cost/expenses of mentoring, training, 53 63.10
get a better job or better salary. and test taking
My job requires this certification. 16 19.05 English skills to prepare for and take 33 39.29
Other (please specify) 5 5.95 the test

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 SIG 9 Pediatric Hearing and Hearing Disorders

Table 7. Top barriers reported by the considering respondents

(n = 94).
Responses
Barrier (n = 94)
Proficiency in the English language to 37
study and take the exam
Access to observations of other LSLS 33
certified professionals for observing
10 sessions (direct or videotapes/
digital recordings)
Cost associated with mentoring 32
Being mentored in a language other 27
than your primary language
Cost associated with other expenses, 26
i.e., books, travel, etc.
Note. LSLS = Listening and Spoken Language Specialist.
The certification process is complicated, expensive
and not always transparent.
Procedural barriers relating to the educational and
CEU requirements for certification were also reported.
Respondents reported lack of access to graduate programs
that focus on LSL. Two professionals reported that they
felt it was impossible to meet the requirements for contact
time with children receiving LSL intervention for people
who do not have a full LSL caseload. Three professionals
reported that meeting the CEU requirement was a barrier
to maintaining their certification, particularly in countries
where AG Bell Academy–approved CEUs were difficult to
access and/or afford.
Resources. Barriers to obtaining LSLS certification
may be related to the lack of resources necessary to
achieve it. Researchers identified three basic categories in
this area: economic, time, and mentoring.
Economic barriers were cited by more professionals
% than any other obstacle to the LSL certification process.
Cost was cited as a concern by 17 professionals, certified
39.36
and noncertified alike. Certified professionals felt that cost
35.11 was a barrier to the pursuit and maintenance of their cer-
tification, citing expenses associated with conference regis-
tration and travel, certification renewal, CEUs, and men-
34.04 torship as significant obstacles.
28.72 Eleven noncertified professionals cited the cost of cer-
27.66 tification as a barrier. Four professionals stated that with-
out financial support from their employers, they would be
unable to cover the costs on their own. The imbalance
between low wages typically earned by LSL professionals
and the high cost of certification and renewal was perceived
as a barrier. The significance of the cost barrier is high-
lighted in the following comments from respondents:
The whole process is incredibly costly. I would
imagine that most of the people seeking certification
are Teachers of the Deaf, who do not get paid
enough to comfortably afford the cost of everything
that goes into this process.
I feel the renewal cost every 2 years is extremely
high.
The LSL process should not be cost-prohibitive and
elitist.
Time was another commonly cited obstacle, as
reported by nine professionals. The time it takes to

Figure 1. Themes and subthemes from the qualitative survey data. Hierarchical sunburst chart representing the strength of each theme and
subtheme identified in the qualitative portion of the survey data.

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SIG 9 Pediatric Hearing and Hearing Disorders
achieve the required 900 contact hours was reported as
prohibitive, particularly for professionals who do not have
a full LSL caseload. Two professionals put it this way:
The length of time to obtain certification should be
reconsidered. The SLP ccc [sic] requires less and is
by far more rigorous.
My caseload of children with hearing loss is too small
to allow for enough hours to pursue certification.
Another factor related to time was the number of
hours required for mentoring, resulting in hesitation by
professionals to pursue certification and difficulty finding
high-quality mentors with the ability to commit 3–5 years
to the mentoring process. Several professionals suggested
that the process should take no more than 2 years.
Finally, respondents reported barriers related to the
mentoring process required for certification. The lack of a
formal mentoring process put forth by the AG Bell Acad-
emy has resulted in variability in costs and quality of
mentoring services, as well as procedural inconsistency.
Some respondents offered suggestions for improvement,
including developing training for mentors, establishing
transparent and consistent criteria for mentors, including
the level of experience and expertise expected, and devel-
oping mentoring procedures and agreements for mentees
and mentors. While several respondents reported good
experiences as mentees, one shared an experience in which
she felt her mentor did not have adequate training, lead-
ing to a negative experience:
I think there needs to be more training of mentors
and contracts signed between mentor and mentee.
Intrinsic variables that hinder the certification pro-
cess. Respondents reported several barriers related to their
perceptions of whether or not certification is a valuable
and worthwhile endeavor. Two respondents questioned
whether the effort involved in the pursuit of certification
would result in career benefits. Another respondent
described certification as a “daunting task,” and others
described frustration, disappointment, and overwhelm
throughout the certification process. One respondent
described her colleagues’ experience by sharing:
We also have two who failed the test and were so
demoralized they did not take it again in the time
frame allotted [sic].
Finally, one respondent’s words capture the emo-
tional toll she experienced related to a certification that
she believed was valuable and worth pursuing but, in her
belief, should be more attainable:
1836 Perspectives of the ASHA Special Interest Groups • Vol. 7 • 1828–1852 • December 2022
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I fully believe in Listening and Spoken Language! I
did sit for the test about 4 years ago and failed. I
poured my heart and soul into the process and I
believe in it. I was devastated. I did not sit again
because I felt like I would fail again.
Theme 2: International Barriers to Certification
The high recurrence of barriers perceived by the
respondents in relation to international and intercultural
issues led the researchers to report this as a distinct theme.
A total of 37 participants reported on this matter. Of
these, 13 were certified, 13 were pursuing certification,
and 11 were considering certification. The elements identi-
fied fit into the following categories: linguistic and cultural
accessibility, economic accessibility, and correspondence.
Linguistic and cultural accessibility. Linguistic acces-
sibility was one of the most reported barriers by the inter-
national respondents. The general perception was that
the certification process is too English-centric with a lack
of accessibility due to the nonexistence and/or lack of
information regarding the certification process and study
materials in other languages. One respondent put it this
way:
For many of the people I encounter in my work, it
is impossible for them to complete certification due
to the language barrier.
One Spanish-speaking participant expressed this situ-
ation in the following words:
It is imperative that the study materials, as well as
the information on the certification requirements,
are in Spanish since many professionals do not
access the certification because they do not under-
stand the requirements and, even though the exam is
in Spanish, they cannot study since the books are in
English.
Participants also mentioned that the required forms
and the certification exam itself—key aspects for obtain-
ing this accreditation—were only available in English.
The survey participants also reported difficulty in locat-
ing mentors who are competent in their native language
as being a significant impediment to their certification
process and recommended adding a tab in the profes-
sional directory that would enable prospective mentees to
know the languages in which mentors are offering their
services.
A number of respondents referred to the certification
process as too focused on the U.S. education system,
including the lack of recognition of international degrees
due to the difference in educational standards that exists
among different countries. The burden of the validation

process was reported as an obstacle for international
LSLS candidates in terms of time, cost, and effort. A
European respondent commented on this matter:
I found it odd that the AG Bell Academy didn’t rec-
ognize my Danish MA degree from the University
of Copenhagen, and I needed to pay extra for a law
firm to go through and validate my degree before I
could sit the exam.
One of the respondents highlighted the professional
threat and emotional stress that sending her original pro-
fessional degree to the AG Bell Academy caused. Respon-
dents also commented on the need for the LSLS certifica-
tion to be officially recognized in their countries as well as
the difficulty obtaining and renewing CEUs in their own
countries and/or language.
Economic accessibility. International respondents re-
ported that the additional cost for document translation,
expenses for travel to attend events awarding CEUs, and
the high costs resulting from currency conversion are
important obstacles toward becoming certified.
Correspondence. Although some participants were
appreciative of efficient responses to e-mails, some expressed
the need to communicate with someone at the AG Bell
Academy who speaks their own language. They reported
that communication in a timely manner when the matter is
urgent is important, which becomes difficult due to time
zone differences. A couple of respondents suggested having
AG Bell Academy representatives in their own countries
who can provide efficient answers to queries.
Barriers categorized by certification status. While
time, expense, and international concerns were the most
often reported barriers by all three categories of respon-
dents (certified, considering, and pursuing), there were a
few barriers that were unique to each category. However,
the limited number of responses for each of these barriers
prohibited further analysis or assumption of broader repre-
sentation of the perceptions of any category of professional.
Certified. Certified LSLSs reported administrative
issues as barriers to maintaining certification, such as
paperwork, problems with the website, and the difficulty
of earning CEUs. A few certified professionals mentioned
the impact that the LSLS certification had on their profes-
sional lives. Their comments reflect the perception that
the certification process does promote the development of
professional skills. The comment made by one certified
respondent reflects the perception of a particular sense of
identity related to belonging to a group of excellent pro-
fessionals after having completed the LSLS certification,
stating it this way:
I have been incredibly fortunate to work in an orga-
nization [sic] with many high-quality mentors on
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SIG 9 Pediatric Hearing and Hearing Disorders
staff and a commitment to ongoing LSL education
and support.
In terms of the impact that the LSLS certification
has had on their professional careers, some of the respon-
dents mentioned the lack of information regarding the
LSLS certification by public and private institutions, pro-
fessionals in other fields, and the general public as a
downside.
Other fields/professions/the public do not know
what LSLS cert [sic] is. I do not feel it has
furthered my career or changed the path of my
career because others do not know or value the
certification.
Considering certification. Professionals considering
certification reported the challenge of earning the required
900 contact hours without a full LSL caseload. Not lim-
ited to, but more prevalent among, professionals pursuing
certification were the barriers of uncertainty about the cer-
tification requirements and lack of training materials
translated into languages other than English.
Pursuing certification. There were no reported bar-
riers unique to professionals pursuing certification, only
shared barriers with the other two categories of respon-
dents. In terms of identity, one of the respondents of this
group expressed her eagerness to belong to this group of
professionals:
I want to be part of this team and I want to certify
[sic] LSL.
Theme 3: Facilitators for Certification
Respondents identified facilitators that influenced
the certification process in four categories: social, adminis-
trative, physical, and intrinsic. Among these were a sup-
portive workplace, high-quality mentorship, the availabil-
ity of local resources and efficient administrative pro-
cesses, and the belief that the certification is worth pursu-
ing. Because the open-ended survey question asked for
comments or suggestions, it is possible that respondents
were more likely to report concerns or barriers than
facilitators.
A strong network of support was an important facil-
itator for success in the certification process. Three
respondents described a workplace that afforded them
access to supportive colleagues and financial support for
mentorship and certification as a significant advantage;
two of the respondents reported that certification would
have been impossible without this support. Two respon-
dents perceived the mentoring process as a positive factor
in the certification process, although one reported that if
her workplace had not covered the cost, mentorship would
1837
SIG 9 Pediatric Hearing and Hearing Disorders
not have been financially feasible for her. One respondent
stated:
The mentoring is wonderful, and the 3-year process
ensures that individuals are adequately trained to be
supporting children with HL and their families.
Administrative and physical factors were also per-
ceived as facilitators to certification, including fast and effi-
cient communication with the AG Bell Academy and access
to a local exam center in Latin America. The intrinsic factor
of believing that the certification process is worth the effort
was also reported as a facilitator. The absence of this belief
was reported as a barrier as well, indicating that emotional
investment and a belief in the inherent value of the certi-
fication play a role in the pursuit of LSLS certification.
Theme 4: Suggestions for Improvement
Suggestions related to international and cultural
concerns included ensuring diversity among certified
LSLSs, ensuring cultural competence by considering lin-
guistic and cultural diversity, and enlisting subject matter
experts to translate materials into other languages. The
following comments represent these suggestions:
While pursuing the goal of adapting the LSLS exam
to other languages, we must make sure the adapters
are not only fluent in the language, but also certified
LSLS [sic] who are subject matter experts.
Test questions according to the development mile-
stones of each country (with authorized experts from
each country).
Respondents also offered suggestions for improve-
ment unrelated to specific barriers or facilitators. Three
respondents suggested that a lower level certification be
developed that is accessible to a wider range of profes-
sionals, including those who are unable to meet the train-
ing requirements but are still providing high-quality ser-
vices to families.
Other suggestions included the need for procedural
transparency, particularly with regard to changes imple-
mented by the AG Bell Academy and the steps involved
in the certification process. Two respondents suggested
ongoing performance monitoring for mentors and certified
professionals. AG Bell Academy–endorsed training was
suggested in order to establish a baseline for competency
for mentors and consistency in training content for profes-
sionals. Two professionals suggested that prior experience
be acknowledged and valued for certified and noncertified
professionals alike.
Three respondents suggested that in order for the
certification to become more widely known and respected,
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the AG Bell Academy’s advocacy efforts promoting the
certification should commensurate with the effort involved
in obtaining it. One respondent felt particularly strongly
about this point:
I dream of a day that the AG Bell Academy aggres-
sively seeks to empower those who have made the
sacrifices and chosen the rigorous path to certifica-
tion by better advocating for their LSL Specialists
and increasing the reach and acknowledgment and
recognition within the world of SLP, TOD, and
AUD. While it has been one of the best decisions I
have ever made in my life, it has also been one sur-
rounded by mocking, rejection, ignorance, and pro-
fessional “loneliness,” if you will, as even after all of
these years, the very field we work in daily is still
largely clueless as to the expertise and specialization
we represent. Having heard more times than I care
to admit, entirely by school districts of students
served, “but you’re just a speech path. We have one
of those and they can do all of this.”
Discussion
This study explored the path of becoming a certified
LSLS and specifically investigated the motivation, self-
perceived benefits, and barriers related to certification in
a global cohort of certified LSLSs and professionals who
were either in the process of becoming certified or consid-
ering certification. As initially hypothesized, the majority
of respondents came from English-speaking countries,
and the majority of certified LSLSs (95%) reported that
they had experienced significant growth in their knowl-
edge and skills of LSL and related areas due to the certi-
fication process. Seventy-seven percent of this subgroup
(certified LSLSs) also reported that their professional
expertise appeared to be more sought after and/or valued
after they became certified, and 65% perceived that they
had become more confident in their provision of services
to children and families. These results are encouraging as
there is an urgent need around the globe for well-
educated professionals who specialize in LSL and who
can support children who are DHH and their families
(WHO, 2021).
Motivation to Pursue Certification
The highest motivating factor of professionals pursu-
ing certification (N = 84) was to improve the intervention/
education they provided to children and families. Ninety
percent (n = 76) stated that this was the main motivation
factor for being certified, whereas only 19% (n = 16)
stated that their job actually required them to become

certified. These results show that individual factors
including personal motivation were the driving force for
respondents’ initiative to begin the certification process,
rather than a demand of their employers. This indicates
that employers might be unaware of the influence of
LSL practice and/or benefits of having a certified staff
member.
Barriers in the Certification Process
The quantitative and qualitative data related to self-
reported barriers in pursuing certification were similar
regardless of which country the respondents came from.
The two main barriers were related to resources (econom-
ics and time factors) for the majority of the whole cohort.
Respondents from non-English countries also reported
that language and cultural aspects were significant bar-
riers, both related to study material and to the formal cer-
tification process. The majority of the barriers reported by
respondents were procedural in nature and serve as oppor-
tunities for the AG Bell Academy to develop new initia-
tives and improve current policies and procedures. Many
of these barriers can be addressed directly (extrinsic bar-
riers) through process improvements, and some may be
addressed indirectly (intrinsic barriers) through messaging
and awareness. The majority of respondents came from
middle- or high-income countries where UNHS and
EHDI programs exist. Even so, the quantitative and quali-
tative results indicated that the conditions for profes-
sionals who work within the field of audiology vary signif-
icantly. Knowledge of the LSLS certification seems to be
limited in the health care system, despite research support-
ing AV practice (Auditory Verbal UK, 2016; First Voice,
2022; Hitchins & Hogan, 2018; Percy-Smith, 2018) and
the self-perceived gains as reported by those who are certi-
fied LSLSs in this study. Current results show that there
are also some misconceptions that might influence profes-
sionals’ decision to pursue LSLS certification. One exam-
ple was that some respondents thought that it is manda-
tory to have a master’s degree to become certified, which
is not the case (a bachelor level is sufficient). The barriers
that were mentioned by participants in the survey were
related not only to individual factors and AG Bell Acad-
emy actions but also to the diversity of worldwide hearing
care systems and support of professionals who work in the
field of audiology.
Actions to Improve the Certification Process
The AG Bell Academy is currently addressing some
of the barriers related to the certification process. One
example of how the AG Bell Academy has tried to reduce
the barriers for professionals is that the organization has
adapted the certification exam in Spanish and added
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SIG 9 Pediatric Hearing and Hearing Disorders
information about certification in Spanish to its website.
The AG Bell Academy has further expanded foreign lan-
guage resources, built up the support for mentors irre-
spective of where they live, and encouraged international
collaborations within and outside the organization. The
AG Bell Academy’s efforts to ensure a global strategy
and to facilitate access of worldwide professionals to
LSLS certification are also shown in the increased num-
ber of approved online CEUs, which are awarded for
each instructional hour of professional development that
contains content within the nine domains of knowledge
for LSLS certification. These endeavors can also be illus-
trated by the launch of an LSL Registry in 2021, which is
a digital platform for certification-related activities. It
allows professionals and AG Bell Academy staff to com-
municate about, store, and submit certification-related
documents, which reduces financial and time investments
in the LSLS certification process between the LSLS can-
didate and the AG Bell Academy (AG Bell Academy for
Listening and Spoken Language, 2022b). The AG Bell
Academy’s vision is not only to encourage all interested
professionals from all parts of the world to become a cer-
tified LSLS but also to raise awareness about LSL prac-
tice more generally for all professionals in the field of
audiology and spread information to other organizations,
such as the WHO.
In March 2021, the WHO released their first hearing
report with predicted and urgent need to develop and
implement preventive intervention strategies in all age
groups, primarily in low- to middle-class countries. To
succeed with this, there is a need for more highly qualified
professionals in the world, the inclusion of new models
such as telehealth practice, and closer collaborations
between hearing care specialists and health care profes-
sionals who are not specialized (WHO, 2021). The WHO
promotes person-centered intervention options to meet the
needs of all individuals and their families and emphasizes
the importance of bringing awareness about hearing loss
and preventive actions to the public. Certified LSLSs are
one group of professionals who might contribute to
achieve the goals of the WHO, as they are highly qualified
within the field of hearing care, may contribute to increas-
ing the availability of LSL services through telepractice,
and already work closely in collaboration with other pro-
fessionals who are not specialized. However, 1,000 certi-
fied LSLSs is a limited number and will not currently
meet the needs of all families that require highly qualified
support in the world. More certified LSLSs are needed.
Therefore, it is important that the self-perceived barriers
that were reported by participants in this study continue
to be acknowledged by the AG Bell Academy and that
these data continue to guide the strategic planning of the
AG Bell Association to ensure ongoing attention to the
benefits and potentials of the LSLS certification.
1839
SIG 9 Pediatric Hearing and Hearing Disorders
Limitations and Observations for the Future
of This Study
One major limitation of the study is that it does not
fully cover a global perspective related to LSL practice.
For instance, only 13% of all current certified LSLSs par-
ticipated in the survey.
Additionally, the qualitative data analysis was
based on a single open-ended question asking for com-
ments or suggestions posed to three categories of respon-
dents in the context of an online survey. Therefore, the
responses may not reflect the full experience of the certi-
fication process but, rather, may have elicited primarily
barriers rather than facilitators, as research suggests that
open-ended question prompts may result in negativity
bias (Poncheri et al., 2008). This study could have
obtained richer responses if respondents were asked to
share barriers and facilitators or to share their experience
with the certification process in their own words. Addi-
tionally, the small sample size did not allow data satura-
tion, so this team was unable to determine whether these
responses are indicative of the broader perceptions of
LSLSs worldwide.
Suggestions for future research include incorporat-
ing a larger sample size from a variety of countries (ide-
ally, all countries where LSLS certification is repre-
sented), randomly but equally divided among profes-
sionals who are certified, pursuing certification, and con-
sidering certification. It would be interesting to include
the perspectives of other professionals in the field, includ-
ing audiologists; families receiving services from certified
LSLSs; and mentors for those seeking certification. It
will be valuable to continue to explore the perspectives
of LSLSs and related stakeholders as the AG Bell Acad-
emy continues to address barriers and facilitators to
certification.
Conclusions
Certified LSLSs perceived that the 3- to 5-year cer-
tification process has increased their knowledge and skills
of LSL, and they felt more valued and confident as pro-
fessionals. There is a need for more actions to spread
awareness of the significant gains LSLS certification can
bring to professionals as well as to address, minimize,
and overcome perceived barriers in the process.
Data Availability Statement
All data generated or analyzed during this study are
included in this published article.
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Acknowledgments
No funding was received for this study; however, the
AG Bell Academy for Listening and Spoken Language has
supported the work of this study through use of staff time
and hiring of a contractor to administer the digital survey.
The authors would like to thank the participants for their
valuable contribution. They would also like to thank Tamala
Bradham of 3C Digital Media Network for assistance with
implementation of the survey and the initial analysis, Robin
Bailey at the Alexander Graham Bell Association for the
Deaf and Hard of Hearing for her assistance related to data
management, and Melody Bertrand for proofreading.
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practice. Alexander Graham Bell Association for the Deaf
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Goldberg, D. M., Dickson, C. L., & Flexer, C. (2010). AG Bell
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Appendix A (p. 1 of 3)
Examples of International Voluntary Specialty Certifications for Pediatric Auditory (Re)habilitation Professionals
Organization
AAA – American Academy
of Audiology (http://
www.AAA.org) and
ABA – American Board
of Audiology
ASHA – American
Speech-Language-
Hearing Association
SAC – Speech-Language
& Audiology Canada
ABA – Academia Brasileira
de Audiologia
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SIG 9 Pediatric Hearing and Hearing Disorders
Country Purpose/population
Type of credential of origin target Prerequisites
Certification issued by USA - Audiologist certification in audiology, Vary according to specialty and scope of work;
the ABA pediatric audiology, tinnitus, and requirements may include the following:
cochlear implant - Educational level (graduation, postgraduation,
doctorate)
- Licensure
- Professional experience
- Professional references
- Exam
Certification USA Certificate of Clinical Competence - Doctoral degree (Aud)
in Audiology (CCC-A) and - Master’s or doctoral degree (SLP)
Certificate of Clinical Competence - Clinical hours supervised attesting to the
in Speech-Language Pathology candidate’s experience in various fields
(CCC-SLP) (number of hours vary according to
supervisor/setting/specialty)
- Passing grade on Praxis examination in
audiology/speech-language pathology
Certification Canada - Speech-language pathologists - SAC membership
- Audiologists - Provisional requirement for the 1st year:
20 CEEs
Certification Brazil Audiologists - Be a legally licensed SLP/Aud (fonoaudiologo)
- Graduate in audiology or speech-language
pathology
- Postgraduation in audiology
- Proof of a minimum of 5 years of aurioral
approach
- Obtain 150 points according to curriculum
analysis criteria and clinical case study (video)
- Proof of a minimum of 5 years of professional
experience in the selected field (evaluation,
activation, mapping, follow-up) with users
of CI or other implantable technologies
(CI cert. only)
- To be related to a CI of other implantable
technologies center, either public or private
(CI cert. only)
 Appendix A (p. 2 of 3)
Examples of International Voluntary Specialty Certifications for Pediatric Auditory (Re)habilitation Professionals
Organization
Karolinska University
Hospital
de Melo et al.: The LSLS Auditory–Verbal Certification Process
Type of credential
Accreditation; 1-year diploma
education program in AV
practice
(part-time)
Country Purpose/population
of origin target Prerequisites
Sweden Speech-language pathologist and - Bachelor’s or master’s degree
educational audiologist/teacher (logopedics, educational audiology, special
of the deaf education)
- Swedish-speaking or speakers of Scandinavian
languages (Norwegian, Danish)
- Work with children aged 0–6 years who are
hard of hearing and their families
- Have at least 4 hr of dedicated practical and

theoretical AV coursework per week during

the education period
- Monthly assignments
- Attend 16 whole course days at the campus
during 1 year (mentored sessions, theoretical
presentations, individual coaching, group
activities, etc.)
- Mandatory individual case presentation during
a joint group event and individual written
exam (at the end of the program)

SIG 9 Pediatric Hearing and Hearing Disorders

Note. Aud = audiologist; SLP = speech-language pathologist; CEEs = continuing education equivalents; CI = cochlear implant; AVT = auditory–verbal therapy; AV = auditory–verbal;
N/A = not applicable..
1843

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 1844

SIG 9 Pediatric Hearing and Hearing Disorders

Appendix A (p. 3 of 3)
Examples of International Voluntary Specialty Certifications for Pediatric Auditory (Re)habilitation Professionals
Perspectives of the ASHA Special Interest Groups • Vol. 7 • 1828–1852 • December 2022

Certification Fees/ Rationale to pursue the

Organization maintenance Title scholarship certification

AAA – American Academy - Number of yearly CEEs (vary - American Board of Audiology - Audiology and pediatric ABA credentials are earned by all leading
of Audiology (http:// according to specialty) Certified Audiologist audiology: annual renovation audiologists, respected by other health
www.AAA.org) and - Hours dedicated to specialty - Pediatric Audiology Specialty varying from US$75 to US$200 care providers, and trusted by patients.
ABA – American Board (pediatric Aud) Certification - Tinnitus management: from Professional certification programs are designed
of Audiology - Adherence to ABA Code of - Certificate Holder – Tinnitus US$550 to US$750 every to recognize practitioners who meet established
Ethics Management 5 years knowledge, skills, or competencies in their
- Valid local registration/license - Cochlear Implant Specialty - CI: N/A profession. Certification is granted once a
Certification candidate has passed an assessment of
previously acquired knowledge, skills, and
competencies.
The ABA offers three voluntary certification
programs that showcase an audiologist’s
expertise and experience. Certified
professionals have passed a rigorous
exam testing their knowledge and skills,
hold a master’s and/or a doctoral degree
in audiology, and have several years of
work experience.
ASHA – American 30 hr of continuing education Certificate of Clinical Initial fees vary from US$286 The Certificate of Clinical Competence (CCC)
Speech-Language- every 3 years Competence: to US$511. validates and provides assurance to
Hearing Association - CCC-A (audiology) Annual renewal varies from consumers and clients; other health care
- CCC-SLP (speech- US$199 to US$225. professionals; and employers, state
language pathology) licensure boards, and third-party payers
that through participation in continuous
professional development activities, they
can be confident certificate holders who
are keeping up with rapid changes in the
professions’ scopes of practice.
For professionals, ASHA certification offers
increased opportunities for employment,
mobility, career advancement, professional
credibility, and more, because it is recognized
by nearly every state’s regulatory agency.
SAC – Speech-Language - Maintain membership - Certified SLP C$336 full membership; no - SAC’s certification program takes a modernized
& Audiology Canada - 45 CEEs over a 3-year - Certified Aud specific fee for certification approach to certification and allows members
period to demonstrate to employers and the general
public their commitment to lifelong learning.
As a long-standing professional designation,
SAC certification is recognized and well
respected in Canada and internationally.
SAC certified members may use the
S-LP(C) or Aud(C) credential after their name.
- SAC offers free online opportunities to reach
part of the CEEs.
ABA – Academia Brasileira N/A - Certificate in aurioral approach From R$575 (US$101.70) to
de Audiologia - Certificate in CI and other R$975 (US$172.44)
implantable technologies
Karolinska University N/A 1-year diploma in AVT US$2.326
Hospital (no certification)

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 SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 1 of 8)
Survey About Listening and Spoken Language Specialist Certification

Conducted by the Global Matters Committee of the Alexander Graham Bell Academy for Listening and Spoken Language
This survey conducted by the Global Matters Committee of the Alexander Graham Bell Academy for Listening and Spo-
ken Language (AG Bell Academy) is for professionals working with children who are deaf or hard of hearing and their fami-
lies. The AG Bell Academy would like to learn more about the current situation and challenges faced by professionals inter-
ested in being certified as a Listening and Spoken Language Specialist Certified Auditory-Verbal Therapist (LSLS Cert. AVT)/
Listening and Spoken Language Specialist Certified Auditory-Verbal Educator (LSLS Cert. AVEd).
The AG Bell Academy wants to hear from professionals around the world and understand their thoughts about Listening
and Spoken Language Specialist (LSLS) certification. Please complete this survey if you have already received your certifica-
tion, are in the process of getting your LSLS certification, or are just considering this certification.

Please answer the questions below. You can provide your e-mail at the end of this survey if you would like to participate
in future surveys related to LSLS certification.

The following statement best describes me at this point.

❍ I am a certified LSLS AVT/AVEd.

❍ I have completed some requirements/am in the process of LSLS AVT/AVEd certification.
❍ I am interested in or considering starting the LSLS AVT/AVEd certification process.
❍ I don’t know about LSLS AVT/AVEd certification and would like to receive information.
❍ I know about LSLS AVT/AVEd but I am not interested in pursuing this certification.

Please share why you are not interested in pursuing LSLS AVT/AVEd certification.
I first heard about LSLS certification from. . .

❍ A colleague
❍ In my undergraduate or graduate training
❍ At a professional event (conference, workshop, etc.)
❍ Through a publication
❍ Social media (Facebook, Twitter, etc.)
❍ Via AG Bell announcements or other communications
❍ Via AG Bell or AG Bell Academy website

I passed the LSLS certification exam in (please write the year as “xxxx”).
Year

Which route to certification did you take/are you taking?

❍ AVEd (Auditory-Verbal Educator) route

❍ AVT (Auditory-Verbal Therapist) route
❍ Administrator/Supervisor route (which sunsets on December 31, 2020)

How has being certified changed your work with children and families?

How has being certified changed your work with other professionals?

I am currently providing LSL mentoring.

❍ Yes
❍ No
❍ I have in the past but don’t have any mentees right now.

Please list the languages in which you can provide mentoring.

I provide mentoring. . .

❍ In my workplace
❍ Outside my workplace
❍ Both
❍ Other

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SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 2 of 8)
Survey About Listening and Spoken Language Specialist Certification
I am listed as a mentor on the AG Bell website.

❍ Yes
❍ No
❍ I don’t know.

I am in a professional community with other mentors.

❍ Yes
❍ No
❍ Other

I started the certification process in the following year:

Year

I have taken the certification exam and. . .

❍ I passed the exam.

❍ I did not pass the exam.

I plan to take the Listening and Spoken Language Specialist Certified AVT/AVEd exam in. . .
Year

I want to obtain this certification because (select all that apply). . .

❍ I want to improve the intervention/education I provide to children and families.

❍ My job requires this certification.
❍ Having the certification will allow me to get a better job or better salary.
❍ Having the certification will improve my standing within the professional community.
❍ Other

I have completed the following steps in the certification process (select all that apply):

❍ Bachelor’s/master’s degree
❍ 900 hr of LSL work experience
❍ 20 hr of observation by certified LSLS mentor(s)
❍ 10 hr of observation of a mentor or other certified LSLS AVT/AVEd
❍ 80 hr of AG Bell Academy–approved continuing education credits
❍ Credential requirement (e.g., state- or national-level licensure or Certificate of Clinical Competence)

The Listening and Spoken Language Specialist Certified Auditory-Verbal Therapist/Educator is given to professionals
who complete the following requirements over 3–5 years and pass the certification exam.
Bachelor’s or master’s degree in speech-language pathology, deaf education, or audiology (qualifications equivalency
check might be required)

1. 900 hr of work experience of providing LSL services to children and families

2. 80 hr of AG Bell Academy–approved continuing education credits
3. 20 hr of observation by a certified LSLS mentor
4. 10 hr of observation of a certified mentor or other LSLS AVT/AVEd
5. Completion of application packet

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 SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 3 of 8)
Survey About Listening and Spoken Language Specialist Certification
To learn more about the Listening and Spoken Language Specialist Certification, go to http://www.agbell.org/Teach or
e-mail academy@agbell.org.

Please rate how easy/difficult it could be/is/was/will be to complete the LSL Specialist Certification requirements.

Requirement Very easy Somewhat easy Somewhat difficult Very difficult

Bachelor’s/master’s degree ❍ ❍ ❍ ❍
900 hr of work experience ❍ ❍ ❍ ❍
20 hr of observation by a mentor ❍ ❍ ❍ ❍
10 hr of observation by an LSL Specialist ❍ ❍ ❍ ❍
80 hr of continuing education ❍ ❍ ❍ ❍
Getting state or national license for providing therapy ❍ ❍ ❍ ❍

The top three challenges I have faced/may face/currently face in pursuing Listening and Spoken Language Specialist
Certification are. . .

❍ Access to continuing education requirements

❍ Access to/finding mentors
❍ Access to observations of other certified LSLS AVT/AVEd
❍ Communication with other professionals following the same process
❍ Credential requirements (degree, licensure)
❍ Economic cost
❍ Paperwork for application (including forms and equivalencies)
❍ Process duration/time commitment of 3–5 years
❍ Qualification equivalency
❍ Receiving information and mentoring in a language different than mine
❍ Recommended study materials on the nine domains
❍ Support of my employer/administrator
❍ Studying and taking the test in English
❍ Other

I would like to see the following resources and information on the AG Bell Academy or through AG Bell to support
candidates during the certification process (select all that apply):

❍ Guidance on how to study for the exam

❍ In-person discussion forums (e.g., at conferences)
❍ Ideas and guidance for successful long-distance mentoring
❍ Information or materials that candidates can share and use
❍ Instructional tutorial or short videos on filling out all the required forms
❍ List of free or low-cost resources, workshops, and webinars
❍ Online/virtual discussion forums and study groups
❍ Repository of videos of certified LSL Specialists for the 10-hr observation requirement
❍ Up-to-date list of mentors currently in practice, which countries they mentor in, and in what language
❍ Videos of session observations with follow-up comments as examples
❍ Web courses offering LSL continuing education credits
❍ Other

My two biggest challenges when preparing to take the exam could be/are/were. . .

❍ Being alone in the process of studying for this exam

❍ Finding the time to study for the exam
❍ Having materials from the AG Bell Academy–recommended reading list
❍ Lack of non-English practice exam or question banks
❍ Lack of support or instruction from mentors or other specialists
❍ Learning about speech-language development and milestones of English-speaking children
❍ Studying materials available only in English
❍ Other

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SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 4 of 8)
Survey About Listening and Spoken Language Specialist Certification
Knowing people in my state/province/country who are interested in pursuing certification, I would consider the following
activities to be challenges:

❍ Accessing videos of certified professionals for observing 10 sessions

❍ Being mentored in a language other than my primary language
❍ Completing required paperwork
❍ Cost associated with continuing education units in the LSLS domains of knowledge
❍ Cost associated with mentoring
❍ Cost associated with other expenses, i.e., books, travel, etc.
❍ Cost associated with taking the exam
❍ Obtaining a bachelor’s or master’s degree in audiology, education, or speech-language pathology
❍ Proficiency in the English language to study and take the exam
❍ Providing, at least, 6 hr of LSL intervention to children who are DHH each week (to meet the 900 hr requirement)
❍ Studying for the LSL exam
❍ Working with a mentor who can observe 20 lessons

I would/get my LSL continuing education hours from the following activities (select all that apply):

❍ Attending conferences/workshops in person

❍ Attending online training/workshops
❍ Providing training/workshops to others
❍ Self-study of reading materials
❍ Speaking at conferences
❍ The trainings/workshops I attend are not preapproved by the AG Bell Academy
❍ Other

Based on my experiences, the top three recommendations I would give to professionals interested in LSL Specialist
Certification are. . .

Thank you for answering the questions so far. The next set of questions are about your experience with MENTORS and
MENTORING related to LSLS certification.

I am currently receiving LSL mentoring.

❍ Yes
❍ No

How did you identify your mentor?

❍ Through the AG Bell LSL Registry

❍ Through networking at a professional event
❍ Based on a colleague’s recommendation
❍ I was assigned a mentor by my supervisor.
❍ Other

How many LSLS mentors did you work with?

❍ 1
❍ 2
❍ More than 2
❍ Other

How did you access mentoring?

❍ Face-to-face mentoring with a mentor who practiced at my workplace

❍ Face-to-face mentoring with a mentor from outside my workplace
❍ Online mentoring with a mentor who practiced at my workplace
❍ Online mentoring with a mentor from outside my workplace
❍ Mixture of face-to-face and online mentoring with a mentor from my workplace
❍ Mixture of face-to-face and online mentoring with a mentor who practices outside my workplace

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 SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 5 of 8)
Survey About Listening and Spoken Language Specialist Certification
Does/did your mentor live and practice in your country?

❍ Yes
❍ No

If no, in which country does/did your mentor live and practice?

How does/did it impact your LSL mentoring?

Is/was your mentor fluent in the language in which you prefer to learn?

❍ Yes
❍ No
❍ Other

How does/did it impact your LSL mentoring?

Is/was your mentor fluent in the language that you used in your intervention sessions?

❍ Yes
❍ No
❍ Other

How did your mentor observe your LSL sessions? Select all that apply.

❍ Live – in my therapy room/classroom

❍ Live – sitting in an observation room
❍ Via telecommunication (Skype, Zoom, etc.)
❍ Recorded sessions
❍ Other

In addition to completing the Fl form, how does/did your mentor provide feedback? Select all that apply.

❍ Observation notes
❍ In-person meeting
❍ Tele-meetings (Skype, Zoom, etc.)

Based on my experiences, the top three recommendations I would give to LSL mentors, especially those mentoring
internationally, are. . .

Thank you for answering the questions so far. The next set of questions are about the COSTS related to LSLS certifica-
tion. Your honest answers will help us identify supports and scholarships in this area.

I pay/paid my mentor using my personal funds.

❍ Yes
❍ No
❍ Other

I estimate the fee of my mentor to be _______ per year (US$).

❍ Less than 500

❍ 500–1,000
❍ 1,000–2,000
❍ More than 2,000

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SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 6 of 8)
Survey About Listening and Spoken Language Specialist Certification
In my country, approximately _______ percent of a candidate’s annual salary would represent mentoring costs each
year.

❍ Less than 10
❍ 11–25
❍ 26–50
❍ More than 50
❍ Other

The most expensive investment toward certification (per year) is. . .

❍ Application form and exam fees

❍ Attending workshops/conferences for continuing education hours
❍ Captioning and translation
❍ Mentor’s fee
❍ Transportation to conferences and other related events
❍ Other

As a mentor, do you require any support or guidance from the AG Bell Academy?

Do you have any additional comments or suggestions for the AG Bell Academy in relation to the certification
process?

Thank you for your answers so far!

The next set of questions are related to where you live and how you provide services. Your answers will be helpful in
identifying how the AG Bell Academy can best support your LSL practice.

I provide rehabilitation/therapy/education to children who are DHH living in. . .

Name of the county

My first language is. . .

❍ Arabic
❍ Bengali
❍ Chinese
❍ English
❍ Hindi
❍ Japanese
❍ Portuguese
❍ Punjabi/Lahnda
❍ Russian
❍ Spanish
❍ Other

I currently work as. . .

❍ Audiologist
❍ Auditory-Verbal Therapist/Educator
❍ Early interventionist
❍ Speech-language pathologist
❍ Teacher of DHH children
❍ Teacher – special education
❍ Teacher – general/mainstream education
❍ Other

1850 Perspectives of the ASHA Special Interest Groups • Vol. 7 • 1828–1852 • December 2022

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 SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 7 of 8)
Survey About Listening and Spoken Language Specialist Certification
My highest education level is. . .

❍ Certificate/diploma
❍ Bachelor’s degree
❍ Master’s degree
❍ Doctoral degree
❍ Degree in medicine
❍ Other

I have provided rehabilitation/therapy/education to children who are DHH for. . .

❍ Less than 3 years

❍ 3–6 years
❍ 6–9 years
❍ More than 10 years

I have provided rehabilitation/therapy/education to children who are DHH from the following age groups:

❍ Birth–2 years
❍ 3–5 years
❍ 6–10 years
❍ Older than 10 years

How comfortable would you be/are you/were you with taking the LSL Specialist Certified AVT/AVEd exam in English?

❍ Very comfortable
❍ Somewhat comfortable
❍ Somewhat uncomfortable
❍ Very uncomfortable

If offered in the future, would you be interested in taking the LSL Specialist Certified AVT/AVEd exam in Spanish?

❍ Very interested
❍ Somewhat interested
❍ Not interested

In my city, neonatal hearing screening is. . .

❍ Universal
❍ Done only in hospitals in big cities
❍ Done only in private hospitals
❍ Not done in my city
❍ Other

In my city, deaf or hard-of-hearing children have access to hearing aids.

❍ Yes, but families have to pay for them.

❍ Yes, but families have to partially pay for them.
❍ Yes, they are provided by the public health/social system.
❍ No, hearing aids are not accessible.
❍ Other

In my city, deaf or hard-of-hearing children have access to cochlear implants.

❍ Yes, but families have to pay for them.

❍ Yes, but families have to partially pay for them.
❍ Yes, they are provided by the public health/social system.
❍ No, hearing aids are not accessible.
❍ Other

de Melo et al.: The LSLS Auditory–Verbal Certification Process 1851

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SIG 9 Pediatric Hearing and Hearing Disorders

Appendix B (p. 8 of 8)
Survey About Listening and Spoken Language Specialist Certification
In my city, deaf or hard-of-hearing children have access to early intervention.

❍ Yes, but families have to pay for them.

❍ Yes, but families have to partially pay for them.
❍ Yes, they are provided by the public health/social system.
❍ No, hearing aids are not accessible.
❍ Other

The Alexander Graham Bell Academy for Listening and Spoken Language is committed to supporting professionals pur-
suing LSLS Cert. AVT/AVEd. If you would give permission to the academy to contact you to collect more information about
your experiences, please provide your name and e-mail address. (Note that this is optional. You can submit your form with-
out providing your name.)

Please provide your name (OPTIONAL)

First Name Last Name

Please provide your e-mail address (OPTIONAL)

Confirm e-mail address
example@example.com

Submit
Note. Reprinted with permission of the AGBell Academy.

1852 Perspectives of the ASHA Special Interest Groups • Vol. 7 • 1828–1852 • December 2022

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