JCPSLP Vol 17 No 1 2015_lores

Ethical conversations

Living out diversity in practice A clinical educator’s reflections on ethical decision-making in a university clinical setting for culturally and linguistically diverse children Shannon Golding and Suze Leitão

Working in a culturally and linguistically diverse setting raises a number of ethical issues. This article outlines stories from the field and reflections of a clinical educator who worked in a university clinic at a primary school in a lower socioeconomic area. The narrative approach to ethical reasoning is used to discuss one example of an ethical dilemma that arose while working in this setting. The use of both the narrative and the casuistry frameworks are discussed as methods of ethical reasoning and decision- making with reference to the experiences of the supervisor and the university students that were on placement. Description of the context In this issue’s ethical conversation the first author will reflect on her experiences as a clinical educator at a university inter-professional practice (IPP) clinic set in a local primary school. The first author believes that the experience was an example where she lived out “diversity in practice”. The university students on placement included speech pathology, occupational therapy, physiotherapy and nursing students who themselves came from a diverse range of cultures and experiences. The clinic’s focus was on the development of the students’ discipline-specific clinical skills as well as their collaboration and learning within the IPP team. The university students worked with children with developmental delay, cerebral palsy, autism spectrum disorder, other disorders that were typical of a paediatric setting, and some unique cases that were specific to the setting. The school is located in a relatively low socioeconomic suburb south of Perth and features great cultural and linguistic diversity among students with more than 45 languages spoken, including a number of Aboriginal languages. Countries represented in the school community include the Philippines, New Zealand, Thailand, China, Malaysia, Tanzania, India, Kenya, Japan, Myanmar (formerly Burma), and Sudan. Some children come from homes where English is not spoken and their first and only exposure to English was in the school setting. The school community includes refugee families who are new to Perth and have limited access to support and services. For these reasons, the clinical placement provided interesting and rare learning opportunities for the university

students on placement, along with a number of new challenges for both supervisors and students. Some of the ethical and practical issues faced in this setting were uncommon and not experiences that the first author had encountered previously. Although she had experience working with clients from culturally and linguistically diverse (CALD) backgrounds, she had not experienced the concentration of CALD clients and ethical issues within one setting. For some students it was their first and only paediatric clinical placement in their final year of study. The World Health Organization’s International Classification of Function, Disability and Health (ICF) (2007) was an important model for considering the children’s speech and language skills, experiences, family environment, and support available to them. This article describes a number of stories from the field that outline examples of the experiences and challenges that the clinical educator and students running the clinic encountered on a regular basis. One story will be worked through using the narrative approach to ethical reasoning from the Speech Pathology Australia Ethics Education Package (Leitão et al., 2014). The casuistry approach to ethical decision-making will also be considered as each experience added to a collection of cases that could be reflected on in order to support the students’ learning. Finally, a reflection on how to manage working in this clinical setting and supporting students will be discussed in order to support and encourage other speech pathologists who may face similar ethical issues in their clinical setting. Stories from the field The university students and clinical educator encountered many interesting stories each and every day. Working with a CALD group of children and families presented many new experiences for the university students on placement that required explicit and detailed discussion due to the complexity of the ethical issues. The following stories are a snapshot of some of the interesting ethical dilemmas that arose during the clinical educator’s time at the clinic. Identifying information has been removed. Before any child could be seen by the university clinic, informed consent was required from the child’s caregivers. This was often difficult as many parents had very limited English skills. One mother did not speak English at all and a translator was unavailable. The child’s teacher explained the consent form to the year 6 client who was to be seen for his language difficulties and asked him to explain it to his mother and have her sign it when he went home. The student was the one who would have the most contact

KEYWORDS CALD DIVERSITY ETHICS NARRATIVE APPROACH

Shannon Golding (top) and Suze Leitão

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JCPSLP Volume 17, Number 1 2015

www.speechpathologyaustralia.org.au