JCPSLP Vol 21 No 2 2019 DIGITAL Edition

Table 1: Principles of practice in paediatric settings

Principle 1: Do no harm

SLPs need to consider that they can inadvertently do harm when they use standardised assessment tools with diverse populations. Diagnoses that infer children are less than standard are hurtful to families and can result in disengagement with school (Macqueen et al., 2018). This may include academic research, time spent chatting to adults in the community, time spent sitting in the playground or playing games, while observing and noting patterns of use and linguistic repertoire. It may also include using a guide or local interpreter. For dynamic or criterion referenced tasks, engage a small group of teacher-selected stronger students or older students from the same speech community as the client. Aboriginal peoples have been clear in their preference for PHC programs (NACCHO, 2018) which focus on community engagement and empowerment. Engagement with PHC programs may provide statistics useful in planning speech-language pathology services. PHC practice allows SLPs to address underlying causes of speech and language difficulty, i.e., working with local housing department to address over-crowding, this reduces transmission of bacteria causing ear disease. Referring a child for assessment is a brave step for many Aboriginal families whose own experience with health personnel may not have been positive. Taking this step is usually only done once family and community members have been consulted and many strategies applied. This high level of concern needs to be acknowledged and family perceptions unpacked as this information is clinically significant. Being singled out is rarely viewed as positive by Aboriginal children. It typically makes delivering services individually less effective. Small groups can be selected with the assistance of the Aboriginal liaison officer or teacher. Selection of groups may be on the basis of age, capacity, family groups or may be multi age. Training older students as tutors for younger community members has many benefits, including allowing older students to review and practise early concepts of literacy which they may have missed. Aboriginal families are more familiar with variation in communication styles than many monolingual/mono- cultural families. This means they are more familiar with discussing various aspects of language and of viewing language in a “meta” way. This ability to talk means discussing concepts like phonological repertoire, phonological awareness and differences in use is comfortable, and encourages great family discussion. Aboriginal children with neurotypical robust linguistic development may not have been exposed to the types of discourse and vocabulary used by teachers in conventional classrooms. It is critical that we view this need for exposure as necessary, not because there is a deficit, but because classrooms reflect and support the dominant cultural and linguistic practices that are significant mechanisms for academic success (Jones, 2013).

Principle 2: Become familiar with linguistic patterns of home language

Principle 3: Engage with primary health care (PHC) providers

Principle 4: Acknowledge a family’s concerns around a child’s difficulties Principle 5: Don’t single a child out for assessment or treatment

Principle 6: “Skill up” and “empower”

Principle 7: Talk about language

Principle 8: Talk about “exposure” not “treatment”

grammatical surface features) is essential to being able to work cross-culturally. The discussion here has raised issues that are pertinent to current speech-language pathology practice involving Aboriginal clients and families. While the development of ultimate best practice principles is ongoing, there are urgent points of practice that need to be addressed. These relate to potential harm caused by clinical practices that do not incorporate community expectations, theoretical considerations, worldviews and cultural practices. Ongoing discussion and addressing of such issues in a discipline dealing with language and culture as their central raison d’être is essential. Acknowledgment We would like to acknowledge Carol Ryder, Tutors and Mums (Home Interaction Program for Parents and Youngsters (HIPPY), Midland, WA) for their input to this paper and support of speech pathology. References Adams, Y., Drew, N. M., & Walker, R. (2014). Principles of practice in mental health assessment with Aboriginal Australians. In P. Dudgeon, H. Milroy, & R. Walker (Eds.), Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practices (2nd ed). Australia: Commonwealth of Australia.

participant, in a conversation that was not an interview controlled by the clinician (Ciccone, Armstrong, Hersh, Adams, & McAllister, 2018; Lin et al., 2016). While potential usefulness of adaptations of the AusTOMS have been noted, alternatives include individualised rating scales that could be used to tailor goals and outcomes to be more culturally and personally appropriate to the client and their family. Greater inclusion of family/community members in ratings and goal-setting may improve clinical processes and ultimate outcomes for clients. Further recommended general principles of practice are outlined in table 2. Conclusion The notion of SLPs assessing communication/language(s) other than their own is fraught from many perspectives. Language reflects one’s culture and worldview; hence to “assess” someone’s language unless you know that particular language/dialect is problematic (even through interpreters). When assessing the language of someone who speaks another dialect of the same language as the SLP, the possibility of confusion exists. Both client and SLP may be unsure which dialect is in use, and therefore the dialect against which communication skills are being measured. Knowledge of dialect and acknowledgment of different semantic systems (as well as phonological and

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JCPSLP Volume 21, Number 2 2019

Journal of Clinical Practice in Speech-Language Pathology