JCPSLP Vol 14 No 2 2012

Topics of choice could vary from direct patient care, administration, professional relationships, and referrals, research in professional publications or work–life balance issues and even career changes. The consultee may identify the type of problem, briefly describe the background information, pose their concerns, give pertinent history of the problem, disclose pertinent personal experiences with the problem, and relate attempts made to address the problem, then open up the floor for group discussion. Following Friere’s (1983) cyclical approach to learning (noted earlier), consultants would, after listening and reflecting, have a dialogue with the consultee to seek clarification and to actively respond as part of a group collaboration to consider possibilities, techniques, resources and strategies to address the consultee’s issue. Based on Hart’s (2010) model, examples of peer-group consultation scenarios involving speech pathologists are provided in Table 7. It is beneficial, we believe, for each consultee and consultant, as a PGC collaboration, to commit to discussing their progress at subsequent meetings. It is wise, if agreed, that each PGC should begin by reflecting on the success or otherwise of the previous session’s consultation (Hart, 2010).

Table 6. Summary of consultee preparation, presentation, and perpetuation 1. Preparation • develop awareness of yourself • choose your clinical case study/ topic/issue • put your material in context • consider evidence based research/ practice • formulate questions 2. Presentation • structure the meeting • deliver the formal presentation • prepare for self-disclosure • interact with peer group consultants • recognize societal/cultural influences 3. Perpetuation (of the consultation process) • take some time for review • evaluate whether your needs were met • consider long-term implications of individual presentation • plan future PGCs Source: Gavrin, 1985

Table 7. Examples of possible peer-group consultation scenarios

1. Consultation request: Clinical case Consultee’s question

“I have an ethical dilemma regarding another professional. I have a primary school student I recently assessed who has a language learning difficulty and behavioural issues. The family have tried many approaches in the past to address their child’s needs. A professional involved (from another discipline) has recommended the family pursue expensive naturopathic treatment, but the literature indicates there is no evidence base for this treatment. I’d value the group’s opinion. What would you do?” Group consultants’ clarification and responses The consultants asked the consultee for more details regarding the background history of the student, the consultee’s involvement so far and the additional management options trialled previously. Each consultant discussed treatment approaches used with their clients who had similar issues, focusing on those approaches that had been successful and had some research evidence of positive gain. In a subsequent PGC meeting, research articles that highlighted the lack of evidence for the particular naturopathic treatment were discussed. Discussion also occurred about the consultee’s relationship with the professional involved. The pros and cons of approaching the other professional were discussed as was the duty of care to the student and the family. Discussion The consultee found the group was able to frame all the issues regarding this client in a way that the consultee was able to weigh up the issues and possible responses. The group considered that the consultee could approach the professional’s training board for guidance as to best practice guidelines and present alternatives to the family that were evidence based and suitable for the student and school environment. The consultee thanked the group for their support and suggestions and committed to discussing progress at the next PGC. “A member of our speech pathology staff has resigned and has not been replaced. The manager of allied health services reported that, due to government budget cuts, it was unlikely the member would be replaced and that the service delivery would have to change to cater for this change in staffing. As a speech pathology departmental manager I am unsure how to address the issue with management and with my speech pathology staff, who are now expected to have an increased case-load over and above their already excessive workload. I have tried ‘all the strategies in the book’ to have a replacement appointed but to no avail. I’d value the group’s opinion. What would you do?” Group consultants’ clarification and responses The consultants clarified details with the consultee about the workplace structure including staffing ratios and current levels of need. Consultants discussed service delivery issues such as core responsibilities versus non-core tasks and prioritisation of responsibilities of staff, expertise among staff, employment of an allied health assistant plus other strategies. Strategies for approaching management regarding the necessity for increased staffing were also discussed. Consultants reported on their own success or otherwise of negotiating with management. Engaging a third party to assist with negotiations was also discussed, with members sharing their experiences and offering to collaborate. The consultee made notes of discussion points, welcomed the collaboration and planned to look into the literature for other solutions. Discussion The consultee was quite frustrated and agitated initially. Once consultants shared their personal experiences and possible solutions, the consultee became visibly more relaxed. After thanking consultants for their input, the consultee promised to discuss progress at the next PGC. 2. Consultation request: Organisational issue Consultee’s question

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JCPSLP Volume 14, Number 2 2012

Journal of Clinical Practice in Speech-Language Pathology