JCPSLP Vol 18 no 2 July 2016

but the bottom line is that Katie feels pressured to provide an intervention that she isn’t confident will benefit some children and their family, and, as well, she feels unable to provide adequate time to provide a high-quality and effective intervention for some of her clients. Case study 2 Jude graduated last year and was delighted to get a newly established position providing services to adults with disabilities for a residential accommodation provider. She hadn’t had a student placement in an adult disability setting, but she had loved the presentation by a guest lecturer about some of the emerging areas of practice with people with disabilities who use informal means of communication. The first priority of her employer was to assess all of the residents and provide them with mealtime guidelines. Jude was feeling daunted – she didn’t have any experience with assessment and management of dysphagia in people with complex life-long disabilities. Furthermore, the manager of client programs had told her that she was expected to assess all five residents in each house, write up their guidelines and then train one of the support workers how to follow them, so that they could then train the rest of the staff – all in five hours. When Jude hesitantly suggested that she would need more time, the manager informed her that the organisation had negotiated with the NDIS how much funding was available to provide speech pathology, and she just had to manage it within the funding envelope. Jude was just about ready to quit, but she had always enjoyed a challenge, and decided that this was the challenge that she had to have! Using the Code of Ethics to work through the challenges The ethical responsibilities of a speech pathologist in case study 1 include provision of accurate and timely information to educate parents or carers, to ensure they understand the evidence base behind an intervention and their decision- making is fully informed. Although it can be difficult to find the time to access the research, the speech pathologist’s responsibility includes provision of information regarding the evidence base for different types of service provision, including the more “traditional” scenarios that the family are comfortable and familiar with. Provision of this information is undertaken while also respecting their autonomy to make decisions regarding the types of intervention that are offered, timing, location, etc. We have an obligation to “evaluate the services we provide on an ongoing basis to ensure that they are as effective as possible. We provide services only if our clients can reasonably expect to benefit from them” (SPA, 2010, Clause 3.1.6). By enacting these ethical responsibilities we can discuss with families the potential effectiveness of intervention and efficiency of use of funded time. This can include the benefits of all aspects of work involved in providing therapy, to ensure the family are aware of the behind the scenes work and its value to the overall program and contribution to progression towards achievement of goals. Case study 2 highlights the obligation we have to maintain quality and safe care of our clients. While we strive to continually update and extend our professional knowledge and skills, we must also be aware of the boundaries of our professional competence, and practise professionally within the scope of our level of education, training and expertise. This means we need to seek

Members were asked to identify whether the introduction of the NDIS is leading to an increase in the ethical challenges for practitioners, and if so, to identify the areas where those challenges lie. Seventy-seven responses were collected, and, in brief, 53% of respondents provide services in an NDIS trial site; and 86% of respondents anticipated or have experienced ethically challenging issues in speech pathology service delivery as a result of the introduction of the NDIS. The survey asked respondents to identify where the ethical challenges lie, according to the professional principles and standards contained within the Code of Ethics (2010). All respondents identified ethical issues relating to provision of services for NDIS participants in at least two or three Standards of Practice. Table 1 sets out the issues most frequently mentioned by the respondents.

Table 1. Ethical issues identified and their relationship to the SPA Standards of Practice

Duties to our clients and the community

Duties to our profession and ourselves

Service planning and provision

Professional standards

Professional competence

Supervision

Accurate and timely information

Development of your profession

Duties to our employers

Duties to our colleagues

Professional competence

Professional standards

Two case studies and working through challenges Case study 1 Katie is an experienced speech pathologist who has been working in a not-for- profit disability provider organisation for more than ten years. There is a lot about the NDIS that she thinks is really great. The individualised funding model has empowered parents to make choices about how funds are used, and is allowing parents to prioritise and get greater access to speech pathology services. The flip side of the coin is that Katie now finds herself having to negotiate with families for the provision of evidence-based treatment approaches. The discussions have gone in all sorts of directions. For some parents, the only model that they know of for “therapy” is weekly sessions of one to one with the therapist sitting opposite the child at a table in a small room at a clinic. Of course, for some children that model is a perfect fit, but for lots of the children who Katie is being asked to see, it is not. Families are really wanting to do the best for their child and get value for the money that they are now able to access; they can’t see the value of all the “behind the scenes” teamwork that goes into ensuring coordinated, collaborative, cohesive, consistent supports. For some families, Katie has been trying to advocate for the provision of AAC interventions alongside coaching for parents to support them to provide early speech and language facilitation strategies, but they have wanted her to focus solely on direct speech interventions. The daily targets for NDIS funded face-to-face hours of service provision are also posing a challenge, as is the pressure from her manager to do all of her documentation and device programming while she is with the client. There seems to be a slightly different permutation for each family,

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JCPSLP Volume 18, Number 2 2016

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