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in AAC implementation, or training to develop knowledge in this area. If there are experienced SLPs available who have the appropriate knowledge and skills regarding AAC either in the local area or via telehealth (Dimian, Elmquist, Reichle, & Simacek, 2018), Susie should provide her clients with options for such services and enable them to make an informed decision. She could then seek professional development in AAC and appropriate supervision, and then return to accepting referrals for clients with complex communication needs as her competence continues to develop. If no alternative services are available or the client elects to continue services despite accurate knowledge of Susie’s competence, she must make concerted efforts to access professional development in AAC as per the suggestions in Box 4. Susie must also use outcome measures as described in the Speech Pathology Australia (2012) Clinical Guideline for AAC to ensure that the intervention she is providing is of benefit to her client. Ultimately, Susie is required to take actions in line with The Code of Ethics (Speech Pathology Australia, 2010) that satisfy her duties to her clients, her employer, and the speech pathology profession. Conclusion This paper has provided a discussion of ethical issues related to SLPs who are novices in AAC engaging in AAC assessment and intervention. The SPA Code of Ethics (2010) highlights the need for SLPs to practice within their level of competence and in a manner that increases benefit and reduces harm to the clients and families they support. It is essential that, before accepting referrals for clients with complex communication needs, SLPs evaluate their own level of competence and seek AAC-specific training and supervision as appropriate. To ensure the best outcomes for clients, there may be a need for such training and supervision to be mandated and regulated by Speech Pathology Australia. However, it is unclear how the benefits of these mandates could be balanced with the need to ensure access to services for all clients. Future research is also required to explore strategies for increasing the effectiveness of AAC training and supervision for both student and practising SLPs. Notes 1 PECS is a product of Pyramid Educational Consultants, Vic., Australia, https://pecsaustralia.com/ 2 DeltaTalker is a product of Prentke Romich Company, Ohio, USA, https://www.prentrom.com/ 3 Minspeak is a product of Semantic Compaction Systems Inc., Pittsburgh, PA, USA, https://minspeak.com/ 5 Key Word Sign is the use of manual signs and natural gesture to support communication.. https://www.scopeaust.org.au/ key-word-sign-australia/ 5 PODD is a product of Gayle Porter and The Cerebral Palsy Education Centre, Vic., Australia, https://cpec.org.au/store/podd/ 6 The iPad is a product of Apple Computers Inc., Cupertino, CA, www.apple.com 7 Proloquo2Go is a product of AssistiveWare, Netherlands, Europe https://www.assistiveware.com/products/proloquo2go 8 AGOSCI is an Australian not-for-profit organisation working in support of people with complex communication needs. https:// www.agosci.org.au/ References Baxter, S., Enderby, P., Evans, P., & Judge, S. (2012). Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: A systematic review and qualitative synthesis. International

provider. This risk must be balanced with the need to ensure the services provided to clients have benefit and reduce harm. Ethical decision-making Given the above information, it may be reasonable for Susie to consider that it is not ethical for her to continue services with her new non-verbal clients. While her entry-level competence in multimodal communication has enabled her to identify that the clients may benefit from AAC systems, she has an obligation to practise only within the limits of her competence, which at this stage, does not include the assessment and intervention of complex clients requiring AAC assessment and intervention. From the information available, Susie also does not have access to regular supervision and mentoring from an SLP who is competent the tools we had determined were best suited to Claire’s needs – one willing to learn about technology that was relatively new, and who was able to support our family and Claire’s wider circles of communication partners to continue to move forward. Box 3. Reflections from Hannah Gutke, the parent of a child who uses AAC My daughter Claire is 8 years old and has a diagnosis of Cri Du Chat Syndrome. Despite accessing speech therapy since she was only a few months old, the effectiveness of any supports was quite haphazard until recent times. Key Word Signing 4 and PECS 1 were introduced to Claire in her first year, and when she was one, we were given a 20-cell direct access PODD 5 and were expected to use this with her with limited instruction or support. We soon handed back the PODD, something which in hindsight I regret. By the time she was four, Claire had moved through multiple speech therapists, each with their own preference in AAC system, and so had also been exposed to choice-making iPad 6 apps, Proloquo2Go 7 , and light-tech switches. It wasn’t until Claire began school and she was introduced to a core vocabulary board that modelling was better explained to me. Soon after, I heard from experts in AAC when I attended my first AGOSCI 8 workshop, AGOSCI conference, and the two-day PODD training. With a significant amount of additional information on hand, particularly around consideration of Claire’s complex movement patterns, I encouraged our speech therapist to help us to pursue trials of high-tech eye gaze devices, and I made Claire an alternate access PODD. When the NDIS rolled out, knowledge of AAC was our first criteria for our new therapists, and we finally received a more consistent approach to therapy for Claire. Upon reflection, it was an understanding of what would be a successful method of AAC access for Claire (eye gaze and partner-assisted scanning) that was lacking in her early support teams. Despite working with multidisciplinary teams, the connection between her physical challenges and her complex communication needs was not strongly considered for quite some time. Once it was, it was a game changer. It was not until we had access to the appropriate tools that we realised that just having a speech therapist was not enough; we needed a speech therapist with expertise in AAC and a willingness to learn more about

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