JCPSLP Vol 22 No 1 2020

specific research and literature. From this concern regarding role delineation also follows concerns regarding efficacy and supervision, as well as the potential for litigation (O’Brien et al., 2013). These are certainly issues which are addressed in the literature for other disciplines and have a strong bearing on the way that speech-language pathology may perceive an AHA program in NSW. Recommendations We suggest that SPA, as the national peak body representing SLPs, has a role to play in incorporating AHAs in the profession nationally, for example, in an affiliation or associate membership capacity. This would have benefits for both SLPs and AHAs. The numbers of AHAs are relatively low, and currently there is no national representative body for this group of workers. Associate membership of the professional association would offer opportunity for AHAs to become part of a wider clinical network, acquire greater knowledge of speech-language pathology, and potentially allow ongoing access to training, improving vocational development. We suggest that future research focus on further defining the AHA role in relation to speech-language pathology is critical, as is increasing the specificity of policies guiding their implementation. Similarly, having AHAs as associate or affiliate members of the association would allow them to be aware of, educated in and bound by the SPA code of ethics. We also suggest, as per the Royal College of Speech and Language Therapists, that working as SLP AHAs may be a viable pathway into the profession (RCSLT, 2017). This would be beneficial for SLPs who will have greater access and understanding of what AHAs can do, and how they may value-add through their skills and demographic proximity to the local community. Given the different demographics of AHAs and SLPs, this could positively contribute to professional diversity by improving male, culturally and linguistically diverse, and Aboriginal participation rates. The purpose and consequences of the workforce redesign of utilising AHAs remains the subject of debate between individuals, professions and organisations (Lizarondo et al., 2010). Understanding how SLPs perceive working with AHAs and the impact on their current role in the context of this workforce redesign may impact overall perceptions of working with AHAs, allowing more effective utilisation and resulting in greater benefit to consumers. Establishing clearly defined professional boundaries for both SLP and AHA roles is essential in increasing the profession’s preparedness for practising in such a workforce model. Similarly, an understanding of the speech- language pathology values and identity will be a critical point of clarification for SLPs and will allow the profession to strategically respond to workforce changes. It is suggested that a thorough understanding of what an AHA can and cannot be delegated can be of assistance in preparing clinicians and individual services to work with AHAs. AHAs have the potential to make a valuable contribution to the profession and to the communities we serve. It will be increasingly important for SLPs to be prepared to work with AHAs, and to be competent and confident in their roles and responsibilities in relation to delegation and supervision. Acknowledgments The authors acknowledge receipt of scholarship funding from the Centre for Institutional and Organisation Studies (CIOS) at the University of Newcastle. The authors also gratefully acknowledge the participants who volunteered

services by consumers (O’Brien et al., 2018). However, there is evidence to suggest that AHAs are able to develop good relationships with clients given their demographic similarity to the general population, use of accessible language, and ability to spend more time with clients than AHPs (O’Brien et al., 2018). Research by O’Brien and colleagues (2013) suggested that professionals with previous exposure to working with AHAs had generally more positive perceptions than those without prior experience (O’Brien et al., 2013). From the findings of both studies, the role of the client needs to be a central consideration in the move towards SLPs working more extensively with AHAs. The preparedness of speech- language pathologists for working with allied health assistants Consideration is needed about how prepared (both in perceptions and formal training) SLPs are to work with AHAs. SLPs need to be educated in what AHAs can do and what value they can add to practice, in order for the profession to get the most value out of working with AHAs. The assistant workforce has been adopted by other professions including but not limited to occupational therapy, physiotherapy and dietetics, but is slow to be utilised by speech-language pathology, particularly in NSW. There have been limited studies conducted with specific reference to assistants in speech-language pathology, and the literature is largely based in other allied health disciplines. While there are parallels in terms of work environments and roles, discipline-specific research is required due to the clinical tasks conducted by SLPs, as well as characteristics specific to the discipline such as demographic and workforce issues (O’Brien, 2018).Clinical outcomes and consumer focus are priority considerations for SLPs, but there remains a perception that the workforce redesign of introducing AHAs is being driven by economics and service issues rather than specific evidence or consumer need (O’Brien et al., 2018). This indicates that further information regarding AHAs, and what they can contribute to the profession and to client care needs to be more widely available to SLPs. Introduction of supervision and delegation topics in SLP undergraduate training may go some way to preparing entry-level practitioners for working in such a model. Further research is required to develop a strategy for education of clinicians regarding their role in delegating to and supervising AHAs. SLPs need exposure to AHAs within their undergraduate clinical placements, as they are graduating with little or no experience in delegating, or effectively using the skills of an AHA (Goldberg, Williams, & Paul-Brown, 2002). Providing practising and student SLPs with exposure to working with AHAs may provide opportunities for shaping positive perceptions of such a workforce redesign (O’Brien et al., 2013). However, this presents a workforce challenge, as AHAs employed to work in speech-language pathology remain relatively rare in some states of Australia (O’Brien et al., 2013). Without such exposure, existing departments may perceive employing an AHA to be a risk. The ongoing paucity of AHAs in speech-language pathology has the potential to continue the ambivalence to a new generation of graduates. This will have an impact on the training and educational preparation of SLP students in the future. The role of the SLP and AHAs are not adequately defined and delineated, which stems from a lack of discipline-

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology