JCPSLP Vol 23 No 3

Ethical conversations

Eyes wide open Key ethical issues for speech pathology students and their supervisors in a private practice setting. David Kinnane, Helen Smith, and Donna Dancer

T he private sector for speech pathology services continues to expand, fueled by the rollout of the National Disability Insurance Scheme (NDIS), increasing prevalence of people with complex communication needs, the ageing population, privatisation of public services, our expanding scope of practice, and increasing demand for speech pathology services across Australia. Speech pathology students now have more opportunities to work with speech pathologists in private practice prior to graduation, including on clinical placements and as allied health assistants (AHAs). Many clients and families value the flexibility and value for money associated with working with speech pathology students under the supervision of qualified speech pathologists in private practice. Increasingly, private practices recognise client, commercial, and recruitment benefits from working with students. Both Speech Pathology Australia (SPA) and the National Disability Insurance Agency (NDIA) support speech pathology students working within private practices to provide services to clients—but with some important caveats and qualifications. In this article, we outline some of the key ethical and practical questions and considerations students and speech pathologists should consider when thinking about how best to work together in private practice to support clients (including NDIS participants). We also provide references for further reading and guidance, including from Speech Pathology Australia. Are these experiences considered to be a “vocational placement”? Vocational placements, as defined in the Fair Work Act 2009, are lawfully unpaid. Most university-arranged clinical or student placements with private practices are vocational placements: they are a required component of the student’s speech pathology degree, and there is no entitlement for pay for the work the student undertakes. Many universities have contracts with private practices that meet the Fair Work requirements (for more information, see the Fair Work Ombudsman’s Fact Sheet on Vocational Placements, 2017b). Vocational placements in private practice are becoming more common and are a great way for students to apply their knowledge in real-world settings while also learning about business. Potential benefits for clients include increased treatment dosage (e.g., for therapies based on principles of motor learning [Maas et al., 2008]), increased access to services, and reduced wait times. Potential benefits for private practitioners and businesses include increased opportunities: • to access research, professional development, and new ideas through relationships with universities; • for employed speech pathologists to supervise others and to get management experience; and

• to work on systems and resources to improve the quality of their client services. For the profession, vocational placements in private practice can help to meet the future demands of clients and employers for speech pathologists in the growing private sector (Sokkar, McAllister, Raymond, & Penman, 2019). In vocational placements, a speech pathologist in the relevant private practice will be responsible for supervising students’ clinical work. Students on vocational placements can provide services to NDIS participants provided they are supervised by a speech pathologist when delivering the services, and the participant (client) has agreed that the student may deliver specific aspects of the support (usually documented in the service agreement between the provider and the participant) (NDIS, 2020). Speech Pathology Australia considers that a student who has been engaged to work as an AHA is not undertaking a vocational placement, as this work is undertaken outside of arrangements with universities (i.e., not for the purpose of a clinical placement within a speech pathology degree course). Outside of vocational placements, should students be asked to work for free? Students should be wary of unpaid work experience “opportunities”, “trials” and “internships”. Other than for vocational placements, students should be paid for productive work, for work that assists with the ordinary operation of a private practice, and for work that would normally be performed by employees. Limited exceptions to the general rule may exist (e.g., if the role is short term, primarily observational, and the main benefit of the work is for the student [rather than a client or private practice]). But, in general, students should be paid for their work—especially for revenue-earning work that is ultimately paid for by a client or third-party payer. More information on these factors can be found in SPA’s Position Statement on Volunteering in Speech Pathology (2015), and the Fair Work Ombudsman’s Fact Sheet on Unpaid Work (2021a). Speech Pathology Australia members, including student members, can access support and advice on these matters by contacting the Association. Student speech pathologists employed as AHAs should be paid appropriately and have the appropriate working with children checks when working with a paediatric population Pay and other conditions in private practice should meet the relevant minimum requirements specified in the Health

David Kinnane (top), Helen Smith (centre) and Donna Dancer

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology