JCPSLP Vol 23 No 3

Practice contexts Evidence from practice contexts acknowledges the policies, systems, and environments relating to speech pathology service provision and practice, and the demands, constraints, and resource limitations of workplace settings. Speech pathology practice contexts are diverse and one way to conceptualise them is to consider international, national, and local level contexts (SPA, 2021). International level The speech pathology practice context is influenced by overarching frameworks, conventions, and declarations at an international level that guide the advocacy and provision of support for people with communication needs, and impact and inform service provision with individuals and communities (McLeod, 2018). For instance, Article 21 of the Convention of the Rights of Persons with Disabilities (CRPD; United Nations, 2008) begins: States Parties shall take all appropriate measures to ensure that persons with disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek, receive and impart information and ideas on an equal basis with others and through all forms of communication of their choice… In 2014, the International Communication Project published the Universal Declaration of Communication Rights pledging that: “the ability to communicate is a basic human right. We recognise that everyone has the potential to communicate…We believe that people with communication disabilities should have access to the support they need to realise their full potential”. Additionally, speech pathology practice is informed by the International Classification of Functioning, Disability and Health (ICF; World Health Organization [WHO], 2001). The International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY; WHO, 2007), a derived classification containing additional information relevant to children and youth, has now been merged back into the ICF by the WHO. The ICF framework reflects the shift from a medical model of practice to the more holistic, biopsychosocial model underpinning contemporary practice where the health and well-being of individuals is considered within their broader environments. The global COVID-19 pandemic has also significantly changed our ways of life and practice as speech pathologists, with impacts felt across all levels of the practice context. National level At a national level, the Australian practice context is influenced by schemes such as the National Disability Insurance Scheme (NDIS), Medicare, and private health insurance which provide funding for individuals with disabilities to access support. Not all individuals meet the eligibility criteria for these government-funded schemes, or can afford private health insurance, leading to disparities. For those who are eligible, the funding received is not always enough to meet their needs. These schemes also have requirements for speech pathologists and other service providers to adhere to in practice. Local level Local level practice contexts vary from clinic-based environments to homes, early childhood education settings, and schools, hospitals and health care services, justice centres, aged-care facilities, and research and university settings to name a few. It is important to consider the

communities in which you are interacting with individuals, and the families and significant others in individuals’ lives. There is also a need to consider the cultural context, languages spoken, and diverse perspectives and goals of community members (SPA, n.d.). Other local level factors include resources (e.g., staffing and funding), policies and procedures in workplaces, and state-based and organisational models of service delivery. Evidence and data can be gathered during everyday practice in workplaces to inform decision-making and build practice-based evidence (Dobinson & Wren, 2019). Interrelationship of practice contexts The three levels of practice context are interrelated. Constraints at the local level sometimes reflect decisions made at an international or national level, or other local level factors. For instance, individuals’ access to speech pathology services may depend on their eligibility for government-funded schemes, the type or amount of funding received, and the availability of appropriate and culturally responsive services in their local area. Individuals’ eligibility and waiting times for services, and the amount and type of services speech pathologists can provide, may reflect prioritisation policies, care pathways, and whether organisations are adequately resourced and funded to meet demand (e.g., McGill et al., 2021). Restrictions on inter- and intrastate travel, lockdowns, and COVID-safe guidelines implemented in workplaces during the COVID-19 pandemic also impacted practice contexts, leading to the rapid uptake of telepractice instead of, or in addition to, in-person service provision and practice; creative clinical/practice education, including use of simulation and virtual formats; or, in some cases, ceasing service provision entirely. Considerations for implementing evidence-based practice Resource constraints and workplace policies can limit the ability to best meet the needs of individuals and families. There can be a conflict between “evidence-based practice and reality” (McGill et al., 2021, in press). Inclusion of evidence from the practice context in the definition of EBP legitimises challenges faced in real-world practice contexts and, rather than fuelling a continued sense of inadequacy or conflict between EBP and reality, it is recognised as a key part of contemporary EBP. However, there is a risk of becoming overly service-focused in our decision-making and losing sight of the needs of the individuals and communities we serve (McGill et al., 2021, in press). We must remember that the practice context is just one of four sources of evidence to consider in decision-making. Constraints within the practice context should be balanced with the needs, values, and preferences of individuals, families, and communities, internal evidence from clinical expertise, and external evidence from systematic research (Hoffmann et al., 2017). Also, we should not simply accept all the constraints within our practice contexts as our permanent reality. Advocacy can lead to changes in funding, systems, and policies to better meet the needs of individuals and communities and support the speech pathology workforce to flourish. We can all play a role in continuing to advocate for changes at national and international levels, questioning the status quo, reimagining service provision, working to address constraints within our workplaces, and enhancing our cultural responsiveness, to ultimately improve quality of care and meet the needs of individuals and communities (McGill, 2020; McGill &

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology