JCPSLP Vol 19 No 1 March 2017

access to health literate linguistic and cultural interpreters and co-workers (IAHA, 2014; Lowell, Schmitt, Ah Chin, & Connors), and lack of cultural competence educators and culturally appropriate resources (Lowell, Lotfali, Kruske, & Malin, 2011) all contribute to inaccessibility of speech- language pathology services for Indigenous Australians. A narrative approach to ethical reflection may help us to create and provide future services which are beneficent and prevent harm (Speech Pathology Australia, 2010). This would involve firstly recognising past injustice, then identifying current barriers and finally envisaging how truly linguistically and culturally accessible services, through a culturally responsive and collaborative approach, may look (Lowell, 2013). Models of collaboration Michelle Lincoln (personal communication, 2016), shared some exciting research projects currently being conducted in partnership with Indigenous Australians. For example, Aboriginal and Torres Strait Islander peoples carers and stakeholders are being asked “What does a culturally appropriate service look like?” (Aboriginal Health & the National Health and Medical Research Council of NSW, 2016). Another example shared is current research through collaboration with the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council (an Indigenous human services and advocacy organisation in Central Australia) asking “What makes a good life for people with disability?” from an Indigenous Australian’s perspective in remote central Australian communities. In the Northern Territory, Anne Lowell shared an example of collaborative research between Charles Darwin University and Yalu Mar ŋ githinyaraw, Galiwin’ku, the “Growing up children in two worlds: Building Yolngu skills, knowledge and priorities into early childhood assessment and support” project. This project uses collaborative research to build recognition of Indigenous Australian early childhood strengths, priorities and knowledge in communities in north-east Arnhem Land. The intent of the research projects is to ensure the creation of culturally responsive and collaborative services. Accessible services We would contend that inclusive engagement means encouraging, fostering and enabling Aboriginal and Torres Strait Islander people to say what makes a good service for them. We need to listen and learn what safe and culturally accessible services might look like for many diverse groups and individuals. The Speech Pathology Australia Code of Ethics upholds autonomy. Inclusive engagement means we can maximise autonomy. There appears to be an uneasy marriage between the Speech Pathology Australia Code of Ethics aspiration for justice, “We strive to provide clients with services consistent with their need” (Speech Pathology Australia, 2010, p. 1) and the reality of SLP services, particularly for many Indigenous Australians. Diverse culture, languages, geographic locations and financial considerations all contribute to inequities of access to speech-language pathology services for Indigenous Australians (Wylie, McAllister, Davidson, & Marshall, 2013). This is even more apparent for Indigenous Australians from rural or remote settings (IAHA, 2015; Lowell, 2013). Language We need to listen and learn what communication and language needs might look like for many diverse Indigenous groups and individuals. Many SLPs have commented on the lack of valid standardised tests for both children and

adults (Lowell et al., 2011; Amanda O’Keefe, personal communication). The lack of appropriate assessment tools and frameworks may in turn lead to misdiagnosis with both over and under diagnosis of disorder being problematic. The Contemporary Uses of Aboriginal Languages research project (Lowell, Gurimangu, Nyomba & Yingi, 1996), written collaboratively, explores the extensive language teaching and learning strategies employed by Yolngu (people from north-east Arnhem Land) to support communication development in children. The report highlights sources of cross-cultural miscommunication that may arise through lack of recognition of the sociolinguistic difference between non-Aboriginal and Yolngu children. Cross-cultural miscommunication in turn is often viewed from a deficit model by the non-Aboriginal culture rather than celebrating the inherent strength and cultural appropriateness of the Yolngu way. The Australian Psychological Society (APS) recently recognised the damaging perception of deficit versus difference. In September 2016 the APS issued a public, formal apology to Aboriginal and Torres Strait Islander peoples apologising for, among other areas, “The inappropriate use of assessment techniques and procedures that have conveyed misleading and inaccurate messages about the abilities and capacities of Aboriginal and Torres Strait Islander people” (APS, 2016). Physical environment Amanda O’Keefe, an experienced clinician working in Darwin, highlighted how the built environment can unintentionally prevent people from receiving the care they need. Her example was the multi-storey, highly air- conditioned hospital in Darwin. Many people from remote communities make their way outside to be in a warmer, more familiar natural space. This makes it harder for staff to find patients when they are required for investigations and treatments. In turn, this may lead to unintended delays in care. The old Darwin Hospital with verandas and windows for fresh air fostered a more accessible healing environment and an easier way to ensure people could be found and provided with the care they required. When building new services, the impact of the built environment needs to be part of the conversation. All health professionals have a responsibility to ensure that their workplace is inclusive, welcoming and acknowledging of Aboriginal and Torres Strait Islander peoples. Access to community-based services The Speech Pathology Australia Code of Ethics states we are an evidence-based profession and we value accountability and responsibility. Some successful culturally responsive models of speech-language pathology service delivery have occurred across Australia in the past. Unfortunately, these tend to be isolated and stopped when project funding or government service policies change. For example, in the mid-1990s in east Arnhem Land, community-based hearing programs were established which employed local co-workers in collaboration with remotely based SLPs. With changes in models, first the co-worker funding was lost, followed by the remotely based SLP services. Now there is a single “remote” SLP for the whole of the Top End of the Northern Territory based in an allied health team working with a key case worker, using a fly-in fly-out model. This means that people discharged from hospital after an acute event may wait 6–8 weeks before they receive follow up in their local community (Anne

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JCPSLP Volume 19, Number 1 2017

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