ACQ Vol 13 No1 2011

that we express and protect his/her interests (Speech Pathology Australia, 2010). This extends to the provision of an assessment process that adequately profiles the child’s strengths and weaknesses and makes recommendations which support the child’s access to appropriate services and removes barriers to their participation in the classroom curriculum and family and community life (WHO, 2001). The role of the speech pathologist in assessment According to the Speech Pathology Australia Code of Ethics (2010), one of the principles that speech pathologists must recognise and adhere to is the principle of fairness (justice). Specifically, this refers to the need to provide accurate information and provide clients with access to services consistent with their need. In regards to duties to our clients and to the community, we also have an obligation to ensure our services are accessible and ensure there is equity of access to services for our clients (3.1.6 Service Planning and Provision). At the core of these ethical considerations is the need to provide clients with access to services based on their needs. This is our driving motivation and in order to do this, we must advocate the right to services for our clients (3.1.6 Service Planning and Provision). Does this responsibility to advocate for appropriate services, however, challenge our ethical conduct when client access to appropriate services hinges on our assessment and subsequent report? For example, in the assessment and management of an Indigenous child with English as a second language, we know that the administration of a standardised assessment such as the CELF-4 would not be a valid assessment. However, if the purpose of our assessment and subsequent report was to seek additional funding and thus additional services for this child and that required the use of a standardised measure of language skills, what ethical principles should we adhere to? Does our ethical responsibility lie with the client and ensuring they can access additional services, or does our ethical responsibility lie with ensuring that we use valid assessments to identify their areas of language difficulty even if that means we do not use a standardised measure of language ability? Given the high demand for school-based speech pathology services and the limited resources available for students with special needs in communication, the Position Paper on Speech Pathology Services in Schools (Speech Pathology Australia, 2004), currently under review highlights the potential conflict for speech pathologists in relation to client access to services and anti-discrimination legislation. The federal Disability Discrimination Act 1992 provides guidelines for access to services for people with disability (Attorney-General’s Department, 1992). Despite the existence of guidelines for categorising disability for students with communication difficulties, service providers have a professional and legislative obligation to identify and respond to the therapeutic needs of all children despite their diagnosis or categorical label for educational placement purposes. After all, the Disability Discrimination Act definition of disability applies to all clients, regardless of their eligibility for funding or categorisation (Department of Education and Training, 2010). This issue of equity is addressed by McAllister and colleagues (2009) in their “Three Es of ethical resource allocation” (p. 124). Specifically, speech pathologists should

Written assessment reports are traditionally viewed as a permanent record of a child’s communicative functioning, documenting the status of a client at a given time (Hegde & Davis, 2010). However, in the context of providing a diagnosis for funding purposes, reports may be perceived by the speech pathologist to be the core piece of tangible evidence supporting the family’s quest for additional funding and support. As the predominant form of communication between professionals, reports may also represent the sole means of communication between clinicians and service providers (Flynn & Parsons, 1994; Thompson, 1997), placing further pressure on the clinician to describe the child’s communicative ability in a way that will convince relevant authorities of the child’s eligibility for funding. In the provision of written assessment reports, there may be one or more intended recipients of the assessment information and this may also influence the type of report provided by the speech pathologist. In a study examining parent and clinician perceptions of written assessment reports, clinicians identified parents as the intended recipient of reports (Donaldson et al., 2004). However, not all clinician participants identified parents as the primary target group; some clinicians identified other professionals such as school teachers, doctors, guidance officers, and other allied health professionals as the primary target group for the report. In the case of presenting a summary of assessment as written evidence to support eligibility for funding, the speech pathologist may present information differently when compared with writing for a parent recipient. In a previous Ethical Conversations column, Leitão, Scarinci, and Koenig (2009) highlighted ethical issues relating to access of information for parents when reports are written with unfamiliar jargon and terminology obviously targeted at another recipient. In situations described above where assessment reports constitute a request for funding, speech pathologists must consider where their primary responsibility lies. Who is the client? The Code of Ethics includes a standard of practice relating to our duties to our clients and to the community. However, it does not provide guidance for speech pathologists in identifying who the client is across different settings and therefore the question may be answered differently depending on where the speech pathologist works. In a health setting, is the patient the client? In the school setting, is the classroom teacher the client because they are being provided with strategies to assist curriculum change in order to maximise participation of the child? In a paediatric private practice setting, is the child the client or is their parent/guardian the client? Given the complexities of this question, speech pathologists must give due consideration to their ethical responsibilities. McAllister, Pickstone, and Body (2009) highlight the complexities inherent in determining who the client is in their examination of ethical scenarios in paediatric speech and language disorders and conclude that in any one case, there may be more than one “client” and therefore many stakeholders in the assessment of any one client. While we may be responsible to a number of “clients” in any one case, ultimately, the child is the focus of our professional service delivery and we must not lose sight of this. Given that “the child is the one with no say but with all the potential consequences” (Hand, reported in McAllister, Pickstone, & Body, 2009, p. 102), it is critical

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ACQ Volume 13, Number 1 2011

ACQ uiring knowledge in speech, language and hearing