JCPSLP Vol 23, Issue 1 2021

while wearing PPE. For example, speech pathologists were supported to identify relevant exemption clauses for the wearing of masks when the mask created a significant barrier to effective communication or intervention, such as when working with clients with a hearing or cognitive impairment. Other modifications that were used when masks created a barrier to communication included physical distancing combined with Perspex barriers, use of the caregiver to model required actions, use of videos or pictures for demonstration or use of voice amplifiers (SPA, 2020b). Evidence-based practice and agility during a pandemic Modifications to the design and delivery of services were necessary as a result of delivering health care during a pandemic. The accelerated timeframe for adopting the use of telepractice and other alternative service delivery methods, including the use of new technologies, is evidence of the agility of speech pathologists. In addition, many speech pathologists took care to consider the benefit that could be delivered through modified methods of service delivery. Ethical issues that were commonly discussed included: if the method of delivering a specific intervention is modified, will it still have the same benefit; if a benefit is still achieved but is less than the usual method of service delivery, is that an appropriate action to take? Speech pathology is an evidence-based profession, a responsibility on which the provision of quality services relies. Many speech pathologists sought access to evidence regarding alternative methods of service delivery, such as telepractice, to inform the choices they were needing to make within very short timeframes. This included identification of those aspects that could be tailored according to a client’s individual characteristics or context. Prior to the pandemic, many areas of speech pathology practice already had an emerging or established evidence base that supported use of telepractice, and this model of service delivery was generally accepted for use in those areas. Speech pathology interventions for stuttering via telepractice is an example of an area that has a strong evidence base in the published literature. Speech pathologists were also guided to use E 3 BP to inform their ethical decision-making (i.e., evidence available from systematic research, evidence collected through experience in clinical practice, and the preferences of a fully informed client). By considering the evidence to inform decision-making, identification of the level of benefit that is provided from a modified intervention and acting to maximise that benefit, through tailoring the modifications to the client’s context (as far as possible), speech pathologists demonstrated their professionalism and agility. Responsive practice during the pandemic Speech pathologists are obliged to consider and respond to the wider context of the client. This serves to support provision of benefit for that client. The SPA Code of Ethics includes many standards relevant to the obligation to provide responsive and person-centred care, including a key ethical practice standard: “We comply with all relevant legislation, standards and procedures in order to avoid physical and psychological injury to ourselves and others” (SPA, 2020a, p. 9). Continuation of service provision that

was responsive to the health and safety of clients, colleagues and the community was demonstrated during the pandemic thorough the practical responses and modifications that speech pathologists made. During 2020, the ethics team at SPA fielded queries from speech pathologists’ clients who were seeking to have confirmation that the modifications in service delivery that had been introduced were necessary. Those discussions frequently focused on the ethical and professional obligations that speech pathologists must comply with — in this case, as directed by health authorities — and also sought to engage the client in a discussion that confirmed that the modifications were indeed a demonstration of responsive practice through consideration of the client’s health and safety. For example, when a speech pathologist sought to move service delivery onto an online platform (i.e., to provide therapy via telepractice), the speech pathologist was acting in a way that demonstrated they were aware of the health and safety of clients and their role in maintaining appropriate service delivery in the context of a pandemic. Through the identification of appropriate changes to service delivery methods, the speech pathologist was meeting the obligation to be responsive to the needs of the client and the community. Members contacted the ethics team at Speech Pathology Australia during the pandemic to seek support in their decision-making. The majority of the queries related to how speech pathologists could have confidence in the decisions they were making, as other resources were available to support the practical implementation of modifications in practice. Members discussed a range of ethical issues, the most common included: • the obligation to provide effective interventions even when service delivery was modified; • obligations to occupational health and safety considerations for themselves, employees and the community; • the effects of stress and anxiety on decision-making and how that impacted on the ability to incorporate available information into their practice; • the need to maintain professional communication while implementing rapid changes to practice, including how to communicate effectively with clients who were also experiencing rapid change; • the potential long-term effects for the profession of changes in service delivery. Conversely, a small number of speech pathologists contacted the ethics team seeking information and support to enable them to have conversations with their employers, about the need to move service delivery onto online platforms or modify interventions that were being provided, as a response to health and safety obligations. Through informed discussions, those speech pathologists sought to increase their employer’s understanding of the ethical obligations to respond to what was happening in the community around them. Agility and responsiveness, the “new normal”? Prior to 2020, the speech pathology profession was already considered to be responsive and agile in their planning and delivery of professional services. The increased agility and responsiveness demonstrated during 2020 cemented that perception and it is timely to consider whether the breadth and pace of change observed during that year will be the

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JCPSLP Volume 23, Number 1 2021

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