JCPSLP Vol 22 No 1 2020

to facilitate more time for the SLP to focus on tasks of a higher clinical complexity as well as being a financially viable use of human resources (O’Brien et al., 2018). SLPs are well versed in the large number of administrative tasks that accompany a clinical caseload, and there is the potential for task-sharing some of this load with an AHA, again increasing the possible time able to be spent providing direct clinical intervention (O’Brien et al., 2018). Another valuable aspect that AHAs may bring to the speech-language pathology profession is their demographic proximity to the local community, bringing much needed diversity into the profession (Byrne, 2015). The provision of appropriate care to all consumers requiring speech- language pathology services is a priority for the profession, as well as providing services in a way which is consumer focused as well as culturally and demographically appropriate (O’Brien et al., 2018). The speech-language pathology profession lacks diversity (Byrne, 2015) and it is important to look at how the profession plans to provide culturally competent services given the current demographic makeup of the profession. Gwynne and Lincoln (2017) discussed the importance of culturally competent healthcare services to support and increase the likelihood of Aboriginal people accessing such services. It is suggested that working with AHAs may improve the diversity of speech-language pathology, and in doing so, may improve the profession’s access to communities who have been traditionally more difficult to access. Importantly, recruiting and offering vocational development of AHAs from Aboriginal backgrounds would be a positive step in meeting the health needs of Aboriginal people. While it is important to consider what AHAs can bring to speech-language pathology, it is equally important to consider what they cannot do. SPA states that AHAs are never to be considered as a replacement to qualified SLPs and specifies roles which are the sole responsibility of the SLP and are not to be delegated. This information is also supported by the documentation of the RCSLT and is relevant to the development of local policies and procedures regarding training, employment, supervision, delegation and maintenance of quality service provision (RCSLT, 2008). Tasks which must remain the responsibility of the SLP include client selection or discharge from services, conducting assessment procedures, altering treatment plans or goals, and independently writing reports (SPA, 2016a). Perceptions of speech-language pathologists to working with allied health assistants Despite potential benefits of working with AHAs, ongoing resistance to working with them continues to be documented. O’Brien and colleagues (2018) found SLPs had paradoxical perceptions in relation to the introduction of AHAs across the spheres of role, tasks and relationships. They explored the perceptions of SLPs to working with AHAs and found a paradoxical relationship between positive and negative perceptions. Positive perceptions included sharing workload and decreasing administrative tasks however working with AHAs was also viewed as having the potential to decrease the focus on consumers; a potential threat to a strongly held value for SLPs. It was argued that for SLPs to positively perceive working with AHAs, the workforce redesign needed to be clearly related to factors which drive successful participation in clinical

membership category or affiliation for AHAs within the professional associations (Ostergren & Aguilar, 2015). Similarly, the RCSLT has recognised that working as a speech-language pathology AHA is a viable career pathway into the speech-language pathology profession, and are currently supporting the development of a “degree apprenticeship” in order to enable such career progression (RCSLT, 2017). Speech Pathology Australia has identified numerous titles for staff in support roles in the guidelines for delegation, collaboration and teamwork in speech pathology practice (SPA, 2016a), and recognises the value of these roles within the management of a clinical caseload (SPA, 2016b). Utilising AHAs through effective delegation allows SLPs to dedicate a greater proportion of their time to tasks requiring a higher level of clinical skill and knowledge (O’Brien et al., 2018). Delegation of tasks to an AHA occurs when an AHP supervises and allows an AHA to provide treatment, in the presence of a treatment plan which has been devised by the AHP (Queensland Health, 2016). Key principles for utilising AHAs, as discussed by SPA (2016a), include: (a) the importance of SLPs maintaining responsibility and accountability for care provided by an AHA under their supervision; (b) availability of guidelines and protocols developed by SLPs to guide the practice of AHAs; and (c) SLPs establishing competency of AHAs prior to tasks being delegated. SPA recommends that SLPs should have experience and knowledge in delegation and supervision, and that new graduate SLPs should receive support from more experienced SLPs if they are responsible for supervising AHAs (SPA, 2014). It is also discussed that SLPs are responsible for judging AHA level of competence, as well as ensuring appropriate tools and training to complete the delegated task (SPA, 2016a). Importantly, it remains unclear what level of supervisory training AHPs are afforded in their undergraduate training (Schmidt, 2013). Currently there is a clear plan for activities AHAs can perform within other allied health professions such as physiotherapy and occupational therapy, and some Australian states have speech-language pathology specific AHA job descriptions. Appropriate task lists for AHAs cover a range of clinical settings including adult rehabilitation, community paediatrics and acute settings. SPA’s guidelines for delegation, collaboration and teamwork in speech- language pathology practice outline the appropriate delegation of tasks, taking into consideration the career stage of the AHA. For example, an established AHA with discipline-specific training may conduct specific screening tasks, and record information with no interpretation; however, it is not recommended that a newly appointed AHA complete such tasks (SPA, 2016a). Arguably, the most important aim of working with AHAs is to extend the breadth of speech-language pathology services – that is, increasing the intensity, frequency and availability of services. Therapy intensity is required to achieve clinical outcomes in clinical areas such as speech sound disorders, aphasia and brain injury (Godecke et al., 2014; Meinzer, Streiftau, & Rockstroh, 2007) and there is evidence to suggest intervention can be equally effective when delivered by SLPs or AHAs (e.g. Boyle, McCartney, O’Hare & Forbes, 2009). Similarly, working with AHAs has the potential to improve access to speech-language pathology services, for example, through efficient use of telehealth; having AHAs living locally and being available in rural locations while accessing supervision and being delegated to by SLPs in larger centres. They may be able

31

JCPSLP Volume 22, Number 1 2020

www.speechpathologyaustralia.org.au