JCPSLP Vol 22 No 2 2020

Learning from our clients

Ethical conversations Listening to our clients in a pandemic Trish Johnson and Nadia Marussinszky

2 020 has been a challenging year for many of us. Given the Australian bushfires at the start of the year and then the COVID-19 pandemic, a large number of factors have been affecting the way we live our lives, both professionally and personally. Speech Pathology Australia (SPA) provides access to advisors and resources to support members in their professional practice. As advisors we have been aware that many members have modified clinical practice during the COVID-19 pandemic in response to infection prevention and control guidance, modified business operations in private practice, and have also moved quickly to deliver services through different modes, such as via telepractice. The Ethics team at the National Office has noted a 183% increase in enquiries from members relating to ethical decision-making during the first three months of 2020, when compared to 2019. Many queries related to the rapid changes in professional practice that were required during the pandemic, including: understanding obligations to client and staff safety while complying with government restrictions; the ethical dilemma of whether provision of modified services during the pandemic was appropriate, or whether services should be paused until they are able to resume in the usual manner. The overarching theme of many of these additional enquiries, particularly during February and March, was “How do I keep providing effective speech pathology services during the COVID-19 pandemic, while ensuring the safety of myself and my loved ones?”. Resources to support practice SPA National Office staff produce a broad range of resources to support members’ ethical and professional practice. Resources range from formal documents such as professional standards, clinical guidelines, position statements and professional development events, to less formal resources which are presented across a variety of formats. The less formal resources include: podcasts, webisodes, FAQs, information sheets, posts and notifications on the SPA member communities on Facebook (e.g., Private Practice, Early Career, Ageing and Aged Care or Disability groups), support to access professional supervision or mentoring with other SPA members, links to external websites for information such as legislation that guides provision of allied health professional services or funding body rules and requirements. SPA staff develop resources in response to identification of themes in enquiries and requests for information from members and the public. The effects of a pandemic on decision-making As the COVID-19 pandemic unfolded in March/April 2020 and the Australian government took steps to reduce the community transmission through a national shutdown, it was quickly apparent to SPA National Office staff that many members required rapid access to information and support to understand the impacts on their professional practice.

The need for accurate and timely resources crossed many practice contexts, and were particularly apparent in private practice, public health, education and disability. The increase in contact to National Office at this time with requests for information and resources to support decision-making was significant. Members identified that their professional and ethical obligations to their clients, their staff and the profession were paramount; however, the nature of experiencing a pandemic and understanding how to modify practice and service delivery accordingly was, at times, overwhelming for some. In response to the increase in enquiries and discussion in member online communities, there was a rapid and significant increase in the information and resources developed and made available to members, to support decision-making in response to the pandemic and the shutdown. The association published a suite of pages on the website dedicated to COIVID-19 that continue to be regularly updated as new resources and evidence is published. Information can be found on these pages regarding specific guidance for provision of clinical services, telepractice, links to government websites with key information, and the management of issues directly affecting speech pathology professional practice such as access to PPE. These resources support members both to make decisions that are sensitive to their individual situation, and guide members to ensure their ethical responsibilities are reflected in each of these decisions. For some members the resources that SPA developed in the first month of the pandemic proved to be both appropriate and responsive to their needs. For example, between March and July 2020 the SPA FAQ on telepractice was accessed over 20,000 times. However, these guidance documents were insufficient for some members who were hoping to find answers to questions specific to their individual context, and who required assistance to process the information and apply it to their context. The effects of stress and the impact on decision- making and comprehension of complex materials are well known (Starcke, Wolf, Markowitsch, & Brand, 2008). Examination of the experience of health practitioners during the COVID-19 pandemic has also found that stress and anxiety impacted on confidence in decision-making and required consideration when providing support to health care professionals (Lai et al., 2020; Shanafelt, Ripp, & Trockel, 2020). It became apparent that, as the shutdown continued, some SPA members required support to use their usual analytical and problem-solving skills to apply the information available to their specific context. Through ongoing contact with members, National Office staff realised that some required more support to apply that information to their professional practice than they had previously. This appeared to be due to the stress they were experiencing, and the amount of information members needed to process and apply in order to make significant decisions in a short timeframe. It became clear that, if

Trish Johnson (top) and Nadia Marussinszky

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JCPSLP Volume 22, Number 2 2020

Journal of Clinical Practice in Speech-Language Pathology