JCPSLP Vol 23, Issue 1 2021

Speech pathology: An agile and responsive profession

Ethical conversations Speech pathology: An agile and responsive profession Patricia Bradd and Trish Johnson

W hile many new terms and phrases were coined during the last twelve months, one used ad nauseum when describing the changes to daily life due to the COVID-19 pandemic was “unprecedented”. Other aphorisms spring to mind when considering the changes made within the professional practice of speech pathology during the pandemic in Australia, including those chosen as the topic for this edition of JCPSLP: “agility” and “responsiveness”. In reflecting on 2020, it is valuable to identify and learn from the flexibility and innovation demonstrated within the profession of speech pathology, and to consider the changes made to service delivery within an ethical framework, such as the Speech Pathology Australia (SPA) Code of Ethics (Speech Pathology Australia, 2020a). Reflection in this way promotes learning and can assist to identify future support needs that benefit clients and the community, and to sustain modified service delivery models. Modifications to provision of clinical service: Reflection through an ethical lens Over the course of the COVID-19 pandemic in 2020, significant restrictions were imposed across many aspects of daily personal and professional life in order to control the spread of COVID-19 in Australia. Those changes were frequently made at short notice and required adaptations to be made within a very short timeframe, often impacting activities at the core of delivery of many speech pathology services. When the first mandatory lockdown occurred as a national response to the pandemic, actions such as working “in person” or “face-to-face” with clients were significantly restricted. For those working in clinical contexts where in-person service delivery was still possible and required, the introduction of mandatory personal protective equipment (PPE), including the wearing of face masks and other PPE items, resulted, for many, in significant barriers to effective communication. Many speech pathologists moved rapidly to provide services via telepractice, using the values described in the SPA Code of Ethics to guide their decisions regarding the practical aspects involved in that method of interacting with clients. At all times, speech pathologists demonstrate the values of respect and responsiveness in their practice through a focus on person- and relationship-centred care. In adjusting models of service delivery, many gave careful consideration to the need for robust and ethical processes that still retained core elements of effective professional practice, including efficacy of interventions and whether progress toward goals could be achieved, along with issues such as consent and privacy.

Speech pathologists switching to telepractice for the first time with a client considered a range of factors that could potentially impact on the effectiveness of therapy and ongoing progress toward achievement of client goals. These factors are described in the Speech Pathology Australia position statement Telepractice in Speech Pathology (SPA, 2014). When considering a switch to delivery of services via telepractice, the ethical and professional obligations of a speech pathologist include ensuring that the intervention is “at least equivalent to standard clinical care” (SPA, 2014, p. 5). Speech pathologists made rapid but responsive decisions to support access to effective interventions, including consideration of sensory and physical characteristics such as vision, hearing, motor dexterity, physical endurance and positioning, and communication characteristics such as auditory comprehension, sign language use, speech intelligibility, skill and need for written language, use of AAC. Discussions were held with clients and families regarding consent for participation in telepractice sessions and how it would be achieved within that client’s specific context. Those discussions were integral to successful use of the telepractice model of service delivery. For example, clinicians working with paediatric clients with autism spectrum disorder (ASD) were mindful of each client’s individual ability to engage with them on a screen within therapeutic activities. For some clients that would not be a viable option and other methods to provide ongoing support and benefit, such as parent training sessions instead of direct client interventions, were provided. For others, it meant structuring sessions to have sufficient rest breaks and timing activities to account for distractions that may interrupt a session. Other client characteristics or circumstances meant that telepractice was not an option at all, such as for those clients who did not have reliable internet or the appropriate equipment to access videoconferencing platforms. In those contexts, speech pathologists also demonstrated professionalism by advocating and supporting those clients to have equitable access to the resources needed to continue to receive services. In other contexts, speech pathologists continued to deliver professional services “in person”, with modifications to the interventions that were provided in order to maintain appropriate infection prevention and control practices. Modifications such as cessation of instrumental assessment of voice or consideration of actions undertaken during a bedside swallowing assessment are examples of ways in which speech pathologists demonstrated their commitment to maintenance of their own health and well-being and that of their colleagues and clients. Speech pathologists considered how to be responsive to individual client characteristics when delivering in-person services

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology