JCPSLP Vol 19 No 1 March 2017

developed skills in communicating effectively with Indigenous colleagues and/or clients during their placement. Importantly, students reflected not only on Indigenous cultures but also the impact of their own culture and societal positioning. “I realised how privileged I was to be able to study and have opportunities to pursue my dreams because of what my parents or my own society have given me” (SLP Student group 2). Client-centred practice Clinical educators described assisting the students to focus on the client as the centre of all their activities, rather than evaluation of their own professional skills. They did this by giving students more autonomy and constantly redirecting them to consider how their planned therapy sessions would impact on the children. “They switched from being a student to focusing on the client and managing their workload. It wasn’t like ‘you’re being assessed’; it’s about what’s going to be best for our kids” (OT CE 1). Student comments reflected this emphasis on client- centred care, including the importance of informal assessment processes. For instance, one student noted: “I learnt a lot about how cultural differences should be considered carefully in the planning and execution of therapy. I considered this ‘discomfort’ with testing and conducted all therapy or individual sessions informally” (SLP student, group 2). In contrast, in context 2, some students had difficulty with this style of service provision because they were focused on accruing placement hours and this affected the appropriateness of their service provision. [A couple of the students] were concerned their hours would not count as they needed assessment hours in particular. They were focused on testing during the group sessions rather than supporting the development of the children. (CE SLP 2) Students were also expected to develop integrated goals and reports on the children’s progress. Students reported the benefits of working in this way. Working in a strengths based approach with my occupational therapy student made therapy so much more holistic and motivating…and how much their (OT) therapy plays a role in the goals I am trying to achieve. (SLP student, group 2) Clinical educators described their expectation that the students move beyond their discipline-specific roles to support the child’s needs. They also modelled being comfortable to seek information from the other discipline and work collaboratively to support their intervention goals in therapy sessions. When we see a child who has more OT needs than speech pathology needs, we’ve gone “It’s the child who’s the important part, so now you need to learn more about OT, so you can assist”. (SLP CE 1) When students embraced role expansion in this way, the clinical educators reinforced their efforts and celebrated the value of this expansion. “And we always give them such positive feedback for that. When we have the speechie there and they’re giving prompts for pencil grasp, for posture, we’ve done our job” (OT CE 1). Interprofessional leadership The cultivation of this interprofessional client-centred approach required leadership from the clinical educators to model teamwork practices and create a teamwork culture.

In context 1, these practices had been developed over several years and were well established. Clinical educators consciously modelled teamwork and trust in each other to the students throughout the clinic. We have complete trust in the other’s professional judgement, teaching and learning judgement, understanding of what the children need, understanding of what the students need…and that’s what [the students] say to us, isn’t it? “We watch you, we see how you discuss things, the respect you have for each other” (OT CE 1). This trust extended to splitting responsibility for observing students’ clinical sessions, so that both clinical educators did not always need to be present. They further split responsibility for reviewing the therapy plans generated by student teams, so that each clinical educator provided feedback on half of the interprofessional plans, thereby reducing their workloads. We are not [both] always present, there might be a week go by when I haven’t seen a session with one child, because I have been looking at sessions with someone else. There is no sense from the students’ perspective that they are worried about that. (OT CE 1) This was reflected in student responses, with 94% of students in context 1 reporting they received appropriate feedback and supervision. In context 2, 73% of students reported they received adequate feedback. These CEs reflected that, because they were new to working with each other, they quickly learned throughout the placement to include each other more when collaborating with students. There was inconsistency in our feedback initially given that we were new to working with each other. Our feedback on session plans worked much better when we discussed it before sending it to students. This improved throughout the program as our relationship grew (OT CE 2). Overall, 93% of students indicated that they were satisfied with the placement and it provided an environment conducive to their learning. One student comment exemplifies the variety of factors described above in creating an overall positive learning experience. I feel I learned more in this placement than I have in any other. The knowledge shared by staff members surrounding cultural sensitivity was informative and their passion inspiring. I learned a lot about Indigenous culture and also a lot about how to ensure activities are culturally relevant. (OT student, group 3) Discussion This study sought to determine the practices and processes which support the development of clinics in Indigenous contexts. Data obtained from student surveys revealed that overall, 94% of students in context 1 and 78.5% of students in context 2 felt they were more skilled in working with Aboriginal and Torres Strait Islander clients as a result of their practical experience. This difference appeared to be due to the newer nature of context 2 and the need to establish opportunities for more integrated interprofessional practices. Students’ negative responses were connected with university requirements, their stage of learning (i.e., earlier year levels) and their concerns about not learning specific clinical skills in this style of service provision. In contrast, context 1 included final or near-final year students and greater freedom to “take the pressure

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JCPSLP Volume 19, Number 1 2017

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