JCPSLP Vol 17 Supplement 1 2015_lores

Pathology (Reilly, Douglas & Oates, 2004), the new SpeechBITE™ initiative from Speech Pathology Australia and the University of Sydney (http://www.speechbite.com/) It is important to balance clinical expertise with the necessity for evidence from systematic clinical trials of interventions. For example, a randomised control trial recently published by Gillam et al. (2008) draws some important conclusions about different treatment conditions (e.g., computer-assisted language intervention and individualized language intervention) and the variety of activities that can facilitate development. In a recent ASHA forum, Hoffman (2008), a practising speech pathologist and researcher, reflected on her experience of participating in this large clinical trial: For every child who ate a particular type of treatment up with a proverbial spoon, there was one for whom that treatment was as appealing as dry toast. It was then that I truly understood the necessity of large scale trials … I could see that clinical expertise is built on individual results, it very clearly shows the trees, but across a large scale that particular compass can’t guide one out of the forest very well. With the best available evidence on intervention outcomes, a conversation between Geraldine and the speech pathologist can begin to consider: • the available evidence for each intervention type; • what improvements Julie might be expected to make; • what commitments, both time and financial, the family will need to make; • what language and educational support Julie can expect to get within her school; • any other information Geraldine would like to help her with her decisions. This might include, for example, research on long-term outcome for children with language impairments. This conversation must also lay plain the potential conflict of interest for the speech pathologist – if a choice between

interventions is made, will the speech pathologist lose a client? I began by saying real-life is complex and can be messy and in the end, the evidence may or may not be clear about the effectiveness of all our interventions. However, it IS our ethical responsibility to know what the available evidence tells us . Every individual client is different and will respond to interventions differently. The best evidence needs to be integrated with clinical reasoning in order to make ethical decisions around service delivery for each of our clients. References Atherton, M. (2007). The workforce of the future: Key trends, ethical considerations . Presentation given at the 2007 Speech Pathology Australia National Conference, Sydney, Australia. Gillam, R., Frome Loeb, D., Hoffman, L., Bohman, T., Champlin, C., Thibodeau, L., Widen, J., Brandel, J., & Friel-Patti, S. (2008). The efficacy of fast forword language intervention in school-age children with language impairment: A randomised control trial. Journal of Speech, Language, & Hearing Research , 51 , 97–119. Hoffman, L. (2008). ASHA Special Interest Division 1 – Discussion forum. Retrieved 19 June 2008 from http://www.asha.org/Forums/shwmessage. aspx?ForumID=9227& MessageID=263 McAllister, L. (2006). Ethics in the workplace. ACQ , 8 (2), 77–80. Reilly, S., Douglas, J., & Oates, J. (Eds). (2004). Evidence based practice in speech pathology . London: Whurr Publishers. Speech Pathology Australia. (2000). Code of ethics . Mel­ bourne: Speech Pathology Association of Australia Limited. This article was originally published as: Eadie, P., & Atherton, M. (2008). Ethical conversations. ACQuiring Knowledge in Speech, Language, and Hearing , 10 (3), 92–94.

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

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