JCPSLP Vol 18 no 2 July 2016

support as necessary, and be prepared and willing to discuss our requirements with our managers, employers and colleagues, as an ongoing commitment to providing high quality services for our clients. In this scenario, Jude has the responsibility to educate the manager regarding an appropriate timeframe for safe and effective service delivery and can seek support to do this from other more experienced members of her team. Both case studies explore the potential effects of NDIS on the service delivery frameworks expected by employers and organisations. Also, NDIS participants with complex needs are seeking to maximise the effectiveness of the services they purchase. Our role, whether we are early career or more experienced clinicians, includes education for participants, managers, employers and other team members, including planners, regarding appropriate service delivery models for speech pathology services. Response to ethical challenges “For ethical problems to be effectively managed, they need to be identified, understood, and decisions need to be made about how to manage them” (Speech Pathology Australia, 2014, p.27). The complexities of the NDIS, due both to participant complexity and the funding environment, create the need to integrate proactive ethical problem- solving into our clinical practice. The Ethics Education Package (2014) is a resource available to SPA members, as a self-guided professional education tool that works through four different theoretical models. Examining the case studies through an appropriate theoretical approach may assist the speech pathologist who is managing ethical problems to identify the ethical issues and potential courses of action. For example, the Casuistry approach, which is grounded in the professional and clinical experience of the speech pathologist, may assist in case study 1 to identify the most important issues on this situation and how similar ethical challenges have been managed previously. The Ethics of Care approach would assist the new graduate in case study 2 to identify the needs of the clients, her role and responsibilities, the barriers that exist in the current situation and the resources required to provide appropriate management or improve the current situation. Once the ethical issues and challenges within a particular clinical scenario with an NDIS participant have been identified, what happens next? The obligation to act and make proactive ethical decisions need not weigh heavily on the clinician’s shoulders; rather, ethical principles, standards and decision-making frameworks can be useful tools to identify where discourse should occur and what the key topics should be. As suggested by Lindy McAllister, “like most professional skills, ethical and moral reasoning develop with experience, and .... this development can be supported through mentoring, workplace supervision and professional development programs” (McAllister, 2006, p. 79). Reflection and discussion of the ethical issues that arise in professional practice are key components to developing awareness of the ethical issues and potential courses of action. In the above scenarios, the issues could be addressed in a number of ways: • reflection on professional and ethical obligations and responsibilities • discussion with the employer to describe where the issues sit and identify an appropriate course of action, such as identification of and participation in professional development activities to extend clinical knowledge and skills

• consultation and collaboration within local networks – work colleagues, team leaders, managers, professional supervisor, mentor, local interest groups, and the national speech pathology community through SPA online communities • direct contact with the SPA NDIS project consultant and professional advisors • presentation of appropriate information back to the NDIS, including clinical reasoning and evidence base for the recommended intervention. As an organisation, the NDIS has demonstrated a degree of consideration for well-formed arguments and responded to such discussions to inform the frameworks of the scheme. Conclusion Communication is an intrinsic human right, and as professionals working with clients presenting with complex needs within a new and, at times, challenging funding environment, speech pathologists have the responsibility to provide appropriate services for their clients. As professionals supporting communicative participation, we also have additional responsibilities to advocate for communication rights within complex systems which may have limited knowledge and awareness. Working within complex and challenging situations is a worthwhile endeavour. There is a range of ethical challenges associated with human service delivery, and speech pathologists provide meaningful services, making a difference to people’s relationships, their community and civil participation, their future and their quality of life. Our responsibility as ethical practitioners is to utilise methods available to us to identify the ethical issues and challenges within our work, seek advice and support to explore appropriate responses, then work to ensure optimal services are available for our clients. Disclaimer The information in the quotes, vignettes and case studies in this article are an amalgam of many real-life scenarios, and were created for the purposes of this article by the authors. The person/s described in the discussion is/are not a real person/s. Any similarity to real people or organisations is coincidental. References Eadie, T. L., Yorkston, K. M., Klasner, E. R., Dudgeon, B. J., Deitz, J. C., Baylor, C. R. & Amtmann, D. (2006). Measuring communicative participation: a review of self-report instruments in speech–language pathology. American Journal of Speech-Language Pathology , 15 , 307–320. McAllister, L. (2006). Ethics in the workplace: More than just using ethical decision – making protocols. Acquiring Knowledge in Speech, Language and Hearing , 8 (2), 76–80. National Disability Insurance Scheme (NDIS). (2014) Factsheet: Early childhood intervention – transdisciplinary approach to service provision. Information for NDIA staff, service providers participant families. Retrieved from http:// www.ndis.gov.au/sites/default/files/media/transdiciplinary_ approach_to_service_provisionmay2014.pdf National Disability Insurance Scheme (NDIS). (2013). Factsheet: Teamwork in early childhood intervention services: recommended practices. Based on notes from T. Moore, 2013. Retrieved from http://www.ndis.gov.au/ document/factsheet-teamwork-early-childhood-i National Joint Committee for the Communicative Needs of Persons with Severe Disabilities. (1992). Guidelines for

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JCPSLP Volume 18, Number 2 2016

Journal of Clinical Practice in Speech-Language Pathology