JCPSLP Vol 21 No 1 2019

Reflections Given the widening range of roles in the justice system and issues that may arise, SLPs are likely to encounter novel situations and find it more difficult to draw directly on their own experiences than SLPs in more established fields, making it harder to apply the casuistry approach to ethical reasoning to support their thinking. Similarly, while the inclusion of SLP in the justice system is a recent development, the justice system itself tends to be rooted in tradition, with many practices entrenched in a workplace culture of “that’s the way it’s always been done here”. This may be an additional challenge for SLPs trying to extend and maintain new ethical professional and clinical practices, drawing on the SPA Code of Ethics and a principles-based approach to ethical reasoning. However, we hope that our examples have provided food for thought and encouragement to reflect widely, drawing on related fields and considering different approaches to ethical reasoning. It is our intent that this column provides SLPs with strategies and resources to draw on as our profession tries on some new hats and takes our skills into new and complex contexts, with new clients with complex needs. References Anderson, S. A. S., Hawes, D. J., & Snow, P. C. (2016). Language impairments among youth offenders: A systematic review. Children and Youth Services Review , 65 , 195–203. doi:10.1016/j.childyouth.2016.04.004 Bryan, K., Freer, J., & Furlong, C. (2007). Language and communication difficulties in juvenile offenders. International Journal of Language and Communication Disorders , 42 (5), 505–520. doi:10.1080/13682820601053977 Cameron, L., & Murphy, J. (2006). Obtaining consent to participate in research: The issues involved in including people with a range of learning and communication disabilities. British Journal of Learning Disabilities , 35 , 113–120. doi:10.1111/j.1468-3156.2006.00404.x Communication Resource Centre-Scope. (2007). Easy English writing style guide . Victoria: Scope. Retrieved from http://www.daru.org.au/wp/wp-content/uploads/2013/08/ Easy-English-Writing-Style-Guide.pdf Justice Health & Forensic Mental Health Network and Juvenile Justice NSW. (2017). 2015 Young People in Custody Health Survey: Full Report . New South Wales, Australia: Justice Health & Forensic Mental Health Network and Juvenile Justice. Retrieved from http://www. justicehealth.nsw.gov.au/publications/2015YPICHSReportw ebreadyversion.PDF Jayes, M., & Palmer, J. (2014). Initial evaluation of the Consent Support Tool: A structured procedure to facilitate the inclusion and engagement of people with aphasia in the informed consent process. International Journal of Speech-Language Pathology , 16 (2), 159–168. doi: 10.3109/17549507.2013.795999 Jayes, M., Palmer, R., & Enderby, P. (2017). An exploration of mental capacity assessment within acute hospital and intermediate care settings in England: A focus group study. Di sability & Rehabilitation , 39 (21), 2148–2157. doi: 10.1080/09638288.2016.1224275 Leitão, S., Bradd, P., McAllister, L., Russell, A., Block., S. Kenny, B,. Smith, H., … Wilson, C. (2014).

Mats TM to assist the participation of people with intellectual disability in discussions about their healthcare (Macer & Fox, 2010; Murphy, 2006). Tom decides to go to talk with the clinical psychologist, Natalie, who works with the young people in Dale’s unit as he feels her experience in cognitive assessment, and in consent procedures within the detention centre, will be useful. Natalie agrees that Dale’s communication needs may not have been adequately supported when his mental capacity was assessed with regards to his ability to consent to the forthcoming medical treatment. Reflecting on his previous cases and workplace contexts, Tom and Natalie discuss possible ways that Dale’s cognitive, and communication difficulties may be overcome in this situation. Natalie feels she already has a well-established working relationship with the rest of the team, and suggests that she accompanies Tom when speaking with them about strategies that may help Dale participate in decision-making processes. Tom decides to review the resources he has used previously, taking on board the suggestions he has read about in the articles and those generated from his discussion with Natalie. He decides to write a simple, accessible information sheet, using pictures and Easy English (Communication Resource Centre – Scope, 2007), outlining the proposed medical treatment. He develops a set of appropriate pictures to elicit Dale’s views on the medical treatment using the Talking Mats TM approach (Spilman, 2016), and prepares a modified consent form using pictures and Easy English. Tom and Natalie then take these to the rest of the multidisciplinary team and explain how their use may be of benefit in assessing Dale’s mental capacity and supporting his ability to give informed consent. Tom hopes that, by demonstrating to the team the benefits of supporting Dale’s communication needs when engaging in discussions about his medical treatment, modified approaches to assessing mental capacity and obtaining informed consent can be considered in the future for all the young people in the detention centre, according to their cognitive and communication skills. This would thereby ensure more ethical practice and better outcomes for both the individuals and the service in general, and would demonstrate an important aspect in which speech- language pathology can add to the staffing profile in a justice setting. Scenario 3 Jackie has recently returned to the profession following maternity leave, and has taken a new role as a SLP in an adult prison. Several of the men she has been asked to work with have convictions for child sexual assault, and another is detained on a charge of child homicide. Jackie is finding it difficult to put aside her own personal beliefs, values and morals, particularly as a new mother, in order to build the positive therapeutic relationship with the men with whom she will be working. On reading this third scenario, you may feel you could draw on the Principles-Based Decision Making Protocol or the casuistry approach to work through your thinking. You may decide to access the SPA Ethics training package (2014) which also outlines the narrative and ethics of care approaches to ethical reasoning, and provides ethical reasoning templates for all four approaches (principles- based, casuistry, narrative, and ethics of care), on the ethics resources page (available to SPA members).

Ethics education package . Melbourne: Speech Pathology Australia. Retrieved from https://www.

37

JCPSLP Volume 21, Number 1 2019

www.speechpathologyaustralia.org.au