JCPSLP Vol 17 Supplement 1 2015_lores

to AAC that all practitioners need to be aware of. These are: • the ethical imperative to maintain and expand clinical competence in AAC • a rapidly expanding field • consenting to assessment and intervention • ensuring that the AAC authentically represents the voice of the person • ethical resource allocation in AAC: working within available resources, and seeking to expand resources. • mobile technologies: an expanding range of AAC options • risks to privacy and confidentiality in AAC communications. The ethical imperative to maintain and expand clinical competence in AAC Although speech pathologists will graduate with knowledge and skill in the range of practice of multi-modal communication (Speech Pathology Australia, 2011), there are many clinicians in the field who have had limited clinical experience in the area and who might actively avoid introducing AAC because of their knowledge limitations (Sutherland, Gillon, & Yoder, 2006). Indeed, few speech pathologists feel competent in advising on AAC interventions or developing AAC programs (Sutherland et al., 2006). Communication is a fundamental characteristic of human interaction (Kaiser & Goetz, 1993) and is recognised as a human right (see United Nations, 2006, Articles, 2, 3, 9, 16, 17, 21, and 24). People with communication disorders should not be denied the opportunity to communicate to the best of their ability and in their preferred mode(s). Therefore, clinicians meeting clients who would potentially benefit from AAC – that is, those who cannot rely upon spoken language to communicate – face an ethical imperative to maintain and extend their skills where a demand or need for a service exists. Their actions would include striving to practise the highest standards of professional competence and extending professional knowledge through professional development, consulting the literature, collaborating with more skilled members of the AAC team, and engaging the support of a mentor or supervisor in the field (see the Association’s Clinical Guideline on Augmentative and Alternative Communication). A rapidly expanding field AAC is a dynamic and rapidly expanding field due to advances in technology and active international research endeavours. This situation has given rise to two important ethical issues for clinicians in the field. First, an untested but promising AAC intervention might be promoted directly to consumers through social media and accompanied by anecdotal evidence (e.g., blogs, YouTube videos) resulting in consumer uptake prior to a formal assessment. Once involved in assessing a person’s communication needs, speech pathologists have an ethical responsibility to conduct a full assessment, and consider all available options and the potential risks and benefits of these prior to recommending intervention options. This includes consideration of options already selected by people with complex communication needs and their families prior to the assessment. Second, owing to the rapid expansion of available assistive technologies, it might not be possible or feasible for clinicians to keep abreast of all technological advances of tools for AAC, or for any expansion in

populations who might benefit. In order to reach an ethical decision in a rapidly expanding field, clinicians are reminded to appraise any new strategy on its theoretical foundations and evaluate these in relation to existing research and published evidence on AAC. Clinicians need to be mindful of the value of the full range of communication strategies and techniques that might be necessary in addition to any high technology options, including non-AAC intervention (e.g., training communication partners to interpret behaviours as communicative), unaided AAC (e.g., sign and gesture), and low or light technologies (e.g., communication boards, single message devices). A person’s communication needs are not likely to be met with the provision of one type of communication aid, and often a range of multi-modal communication options need to be According to the Speech Pathology Australia Code of Ethics (2010), clinicians “strive to ensure informed consent has been obtained from clients for the services we offer” (p. 2). Thus, people with complex communication needs must be given the opportunity to provide informed consent to a particular procedure or intervention, either directly or, in situations in which they have been assessed as being incapable of providing consent, through a proxy (primary support person or legal guardian). Some people with intellectual disability are deemed to be not competent in decision-making about services and interventions. As such, speech pathologists seek to gain informed consent from a person responsible, involve the person with disability to the level of his or her capacity, and strive to attain the ability to recognise when the person’s assent is provided. Observing the person’s behaviours and non-verbal communications can assist clinicians in determining the person’s wishes, but these interpretations should be checked with people who know the person with disability well and are familiar with their communicative behaviours (see Goldbart & Marshall, 2011). It can be difficult to determine a person’s consent for a service when the person does not already have a functional method of communication. To address this problem, clinicians may need to establish a functional and effective method of communication with the person with complex communication needs for the process of obtaining consent for future decisions. Obtaining consent would involve providing information about decisions in formats that are accessible to people with communication difficulty – an ethical imperative according to the World Health Organization (2010). Communication supports for the process of ascertaining the person’s willingness, assent, or consent to decisions include accessible information sheets and consent forms, information displays, schedules, appropriate photographs, pictographs, sign or gesture or objects to help the person participate in each decision to the extent that they are able or desire. Reliance upon a yes/no system is common in the early stages of an AAC assessment. However, the person with complex communication needs must have every opportunity to participate with more than a yes/no response wherever possible. Ensuring that the AAC authentically represents the voice of the person The ethical principles of veracity or truthfulness and autonomy also inform the design of AAC systems, which explored (Beukelman & Mirenda, 2005). Consenting to assessment and intervention

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

www.speechpathologyaustralia.org.au