JCPSLP Vol 20 No 3 November 2018

Ethical conversations

Ethical decision- making: Should I use this therapy approach? Suze Leitão (in consultation with SPA Ethics Board members and SPA National office staff)

T he Senior Advisor Ethics and Professional Practice and the Ethics Board of Speech Pathology Australia (SPA) are often contacted to provide guidance regarding the use of a range of therapy approaches. These contacts are made by speech-language pathologists (SLPs), and also by members of the public and other professions about the practice of some SLPs. The framework outlined below has been devised to support clinical, ethical, and professional decision-making by members of the speech-language pathology profession regarding evidence-informed practice. This document is provided as a resource to assist clinicians when choosing therapy approaches to implement with clients. It supports ethical and professional decision- making in light of theory and best available evidence. The questions that follow encourage clinicians to consider what they already know and what further information is needed to support robust and effective decision-making. Applicability • Why am I considering this approach? • What does this therapy approach aim to do? • Does it have stated objectives or goals? • Does this therapy approach apply to my client/client group? • Has the therapy approach been used with similar clients? We start by reflecting on “why” we are considering adopting this approach? For example: Is our choice being driven, or limited, by funding? Is the approach being recommended by a third party, a family, and/or a funding body? And if so, why? This first set of questions then asks us to reflect on the aims of the therapy approach we are considering, if these aims are explicitly stated, and if there seems to be a match between the approach and the profile of the client we are considering. Evidence • Has this therapy approach been evaluated? • Where can I direct my clients/families if they want more information? • Who carried out the evaluation? Who funded the evaluation? • Have the results been published? • Is the information/data on websites or promotional materials associated with the program? • Is the information/data in a journal article? And if so, is it peer reviewed? • How strong is the research design?

• How confident can I be in the research study? • How strong is the level of evidence (at this stage)? These questions ask us to consider if there is any existing research that has investigated whether the approach is effective. They encourage us to identify how independent this research is – for example, if it has been carried out by the developers of the approach and not yet been independently evaluated. This is not necessarily a problem, but directs us to consider what (if any) marketing strategies are being used to sell the product, and whether any testimonials are genuine and accurate (at times, a simple web search will confirm this). In addition, the questions ask us to consider how strong the research design has been and therefore how confident we can be in the findings at this stage. For any approach (whoever has evaluated it), we should always consider the level of evidence, as evidence is rarely all-or-nothing. A website may contain promotional materials/testimonials but may also cite published work (if so, we need to evaluate who published it and if we can be confident in the findings). Clinicians who want to understand more about how evidence can inform their choice of therapy approaches, and evidence-based practice (EBP) in general, can access resources to evaluate group designs and to understand single subject designs through SPEECHBITE and the EBP page on the SPA website (see reference list for weblinks). Validity • Is the therapy approach consistent with usual speech pathology practice? • Are other SLPs using this approach? • Is there a theoretical rationale underlying the approach? • Does this support an explanation as to why it should work? Many therapy approaches do not yet have strong levels of evidence, especially if they are new. Clinicians should consider whether a therapy approach “makes sense” in the context of speech pathology interventions. In other words, what theoretical rationale underpins an approach that might help us understand why it should work? Is this approach one that would generally be considered within the realm of “speech-language pathology”? If other clinicians are using the approach, can you speak to them? Ethical practice • Do I need to be trained to use this approach? • Who by? • Is any cost reasonable and justifiable? • Are there any risks to my client if I implement it?

Suze Leitão

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JCPSLP Volume 20, Number 3 2018

Journal of Clinical Practice in Speech-Language Pathology