JCPSLP Vol 19 No 1 March 2017

Ethical conversations

Aspiring to build culturally responsive, collaborative speech- language pathology services Some ethical reflections for SLPs working with Aboriginal and Torres Strait Islander peoples Helen Smith and Felicity Burke

Speech-language pathologists (SLPs) face ethical challenges when providing equitable services to Aboriginal and Torres Strait Islander peoples. We are conscious of the multitude of wise, expert and often silenced Australian Indigenous voices. Voices that should be sought, listened to, and used to inform policies. Indigenous Australians, with expertise and knowledge, working in collaboration with SLPs, can hope to create ethical practices, services and programs which are relevant, equitable and sustainable for Indigenous Australians. I n this edition of Ethical conversations, we hope to raise the awareness of speech-language pathologists (SLPs) about some current ethical challenges facing the profession when aspiring to provide culturally responsive speech-language pathology services for people who identify as Indigenous Australians. Background reflections As authors who culturally identify as European Australians, we fully acknowledge our perceptions and understandings are informed by our own culture and history. We have worked in remote regions of central Australia. This has afforded us an opportunity to gain some small knowledge and insights into the positive effects of health and education services based on equality and inclusiveness as well as true collaboration with local expert Aboriginal people. We have been enriched and grown, both personally and professionally, through opportunities to participate in transcultural relationships with people from Aboriginal cultural backgrounds. We are very aware that our own cultural heritage impacts any learnings, interpretations and insights we have gained through these experiences. We recognise one of the major challenges faced when considering this topic was our difficulty collaborating directly with SLPs who identify as Indigenous Australians. According to the Australian Bureau of Statistics 2011 census, only 0.26% of audiologists and speech-language pathologists identified as being Aboriginal or Torres Strait Islander (Mason, 2013). We are conscious of the multitude of wise, expert and often silenced Australian Indigenous voices, indigenous voices which should be found, and listened to, and used to inform our policies. Indigenous

Australians with expertise and knowledge, working in collaboration with SLPs can hope to create ethical practises, culturally competent services and programs which are relevant and sustainable (Lowell, 2013). Therefore, we welcome comments and responses to this discussion from Aboriginal and Torres Strait Islander people and communities to progress, deepen and further inform our conversation in future issues. Culture is central “Culture is central to Aboriginal and Torres Strait Islander health and well-being” (IAHA, 2015, p. 7). For services to be culturally responsive the values, beliefs and philosophies must be learned and appreciated for each person, group, family, and community (IAHA, 2015). It takes time to build trust, safety, knowledge, and to develop relationships which integrate respect and a collaborative approach to make services culturally responsive to needs. Taking the time required moves us toward services which fundamentally create environments, processes and practices which are explicitly and consciously culturally inclusive (IAHA, 2014). Indigenous Allied Health Australia (IAHA) has developed a cultural responsiveness framework with six key capabilities: respect for centrality of culture; self-awareness; proactivity; inclusive engagement; leadership and responsibility and accountability (IAHA, 2015, p. 13). These capabilities can be used as the basis for beginning to build a culturally responsive workforce. Speech Pathology Australia’s Code of Ethics states “we do not discriminate on the basis of race” (Speech Pathology Australia, 2010, p. 1). As a profession, if we aspire to building culturally responsive collaborative services with Australia’s First People, exploration of the implications of this seemingly simple statement is required. Culturally responsive service provision requires SLPs to recognise, understand and acknowledge the history of Aboriginal and Torres Strait Islander peoples. It requires SLPs to accept this history and the impact on Indigenous Australians for reconciliation and healing to be fostered. It requires deep reflection by SLPs on the ongoing impact of historical and current events, systemic policies and attitudes on the health and well- being of Aboriginal and Torres Strait Islander peoples. Cultural education and cultural interpreters Currently variable cultural education opportunities for practising clinicians, inadequate use of and potential lack of

KEYWORDS ETHICS INDIGENOUS AUSTRALIANS SLP SERVICE PROVISION

Helen Smith (top) and Felicity Burke

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JCPSLP Volume 19, Number 1 2017

Journal of Clinical Practice in Speech-Language Pathology