JCPSLP Vol 17 Supplement 1 2015_lores

Conclusion The two scenarios outlined above demonstrate that AAC practice is highly complex, with many factors influencing the outcomes from the preschool classroom to the courtroom. Further, although people who apply to the Aids and Equipment Programs for communication aids across the country usually do receive a device, funding differs markedly between states. In Victoria, for example, 700 communication aids are allocated per year, where statistics indicate there are 10,220 people with complex communication needs (ABS, 2006). Our concerns are not only with those who never receive the AAC intervention they require, but also with those who do receive an AAC device without the appropriate support. When technology fails repeatedly, the desire to communicate decreases (Williams, Krezman, & McNaughton, 2008). Our journey towards ethical practice and AAC has just begun – a long road lies ahead. References Australian Bureau of Statistics (ABS). (2006). http://www. abs.gov.au Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting adults and children with complex communication needs . Baltimore, MD: Brookes Publishing. Williams, M.B., Krezman, C., & McNaughton, D. (2008). Reach for the stars: Five principles for the next 25 years of AAC. Augmentative and Alternative Communication , 24 (3), 194–206. 1. Also known as CAUS – Communication Aid Users Society http://www.caus.com.au/ 2. Communication support worker (CSW): CSWs are specifically trained to understand a range of communication methods and devices, and support and/relay communication from a person with little or no speech to another person (Communication Rights Australia) Barbara Solarsh works at the Communication Resource Centre, Scope, and for the Bendigo Health Regional Communication Service. She has worked extensively in the field of disability in community-based settings, both in rural South Africa and in regional Australia, and has been involved in multi-professional student training. She has a strong interest in the ethics of sustainable interventions in underresourced areas. Meredith Allan is a person who uses Augmentative and Alternative Communication (AAC). Meredith is one of the very few AAC users in Australia in the full-time open employment workforce. She was a member of the Speech Pathology Australia Ethics Board from 2002 to 2008.

support workers (CSW), none of whom are available at that time. If Rachel could find someone to take that role, CRA would offer the required training. It is very important that the communication support worker understands the CRA Code of Ethics (http://www.caus.com.au/Products/tabid/57/ Default.aspx) which must be complied with in carrying out this role, to ensure that the message conveyed is what the communication aid user intended and is not influenced by the CSW. In addition to training the communication support worker, CRA would also need to train members of the legal team about hearing evidence from a person who uses a communication aid and the role of the CSW. Ethical dilemmas Beneficence and non-maleficence: The issue of the court case was brought up at the last funded speech pathology session. Susie is in the best position to prepare Rachel for the court case, but time for an application to TAC for additional speech pathology hours is short. As Susie knows Rachel’s parents would not be able to afford the fees, should she provide a few additional sessions to Rachel in the hope that money will be forthcoming? Preparing the word-based communication board would certainly take 2–3 sessions to ensure that the correct vocabulary and information was included. Having someone who is not adequately skilled design the communication board, or not having the communication board at the hearing could compromise the strength of Rachel’s evidence. Truth: Susie prognosticated early on in therapy that Rachel’s dysarthria was severe and that she would need AAC to meet her communication needs in the future. However, Rachel has only reluctantly agreed to get a Lightwriter™, which she finds frustrating due to the slow pace of communication. Susie has continued to do basic speech therapy while encouraging practice of the Lightwriter™. She has wrestled with where to put the emphasis of therapy, however, and now feels that Rachel needs more therapy to support her to use the Lightwriter™. TAC has indicated that Rachel should now have a break in therapy. Susie knows Rachel needs a number of different ways of communicating, but she feels she has not been able to achieve this. Justice: TAC has funded a significant number of speech pathology hours as well as providing attendant care dollars. Even if additional therapy hours are allocated after the 6-month break, it will not help Rachel with the court hearing. Rachel obtained her Lightwriter™ from the Aids and Equipment Program (http://www.dhs.vic.gov.au/ disability/supports_for_people/living_in_my_home/aids_ and_equipment_program), but Susie feels there are other communication devices that Rachel could try when she is ready. Autonomy: Susie feels that Rachel’s dysarthria is unlikely to improve further and that Rachel would be advised to use her Lightwriter™ or word communication board in court. However, Rachel wants to use speech and only revert to AAC if necessary. This is her choice, although it is Susie’s view that it may not be in her best interest. Professional integrity: If Susie was to act as the CSW, she would need to be trained by CRA even though she is a qualified speech pathologist. She would need to be aware of and understand the CSW Code of Ethics. Susie would also have to accept that she would not be paid speech pathology fees, but at the rate of a CSW.

Correspondence to: Marie Atherton Senior Advisor Professional Issues

Speech Pathology Australia Level 2, 11–19 Bank Place, Melbourne VIC 3000 email: matherton@speechpathologyaustralia.org.au

This article was originally published as: Solarsh, B., & Allan, M. (2010). Ethical issues in augmentative and alternative communication. ACQuiring Knowledge in Speech, Language, and Hearing , 12 (2), 93–95.

53

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

www.speechpathologyaustralia.org.au