Speak Out August 2018

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This is the third article in the current series using worksheets available to members on the Ethics Education page of the SPA website to assist in clinical decision making. This case study uses the Ethics of Care approach to ethical reasoning. Disclaimer The information presented in this case study is fictional and any similarity to real people and organisations is coincidental. The information is an amalgam of many real-life scenarios, therefore the person/s described in the discussion is/are not a real person. This case study was created for the purpose of this article. Phill is a speech pathologist working in a multi-disciplinary practice, providing speech pathology services to participants in the NDIS. Phill has begun to work with a new client whose parents are self-managing the allocated NDIS funds. The client is a 14-year-old girl with severe ASD, non-verbal with very limited communication, level 3 under the DSM V. She has had patchy speech pathology services in the past due to her family moving around the state regularly for her father’s work. The parents tell Phill they do not have any recent speech pathology reports to show him as they only moved into town six months ago and have been waiting for her NDIS plan to be approved. The parents are happy to talk about the therapy she has had previously, mostly regarding the introduction of a PODD system which has not had much success to date. Her NDIS Plan includes funding for weekly speech pathology sessions and one of her goals is to identify an appropriate AAC method/device, to support her communication with her family. Phill has worked with the client for the first four sessions to establish her current communication skills and scheduled the fifth session at her special developmental school (SDS) to observe her interactions with other students and staff. Phill arrives at the SDS and is surprised to see the client with an iPad in her hand. On further observation he sees her teacher trying to assist the client to use it to make a choice for a snack, with limited success. The parents had never mentioned that their daughter used an iPad at school. Phill calls them to ask how long she has been trying it and to find out whether it has been successful at all. He was even more surprised to hear the background story: Not long after the family moved to town the parents were approached by a friend’s daughter who was a final year speech pathology student. The student proposed that she could do Case study Phill’s story

some voluntary “work” with their daughter, to see if the daughter could use an iPad to communicate, as the student had just had a placement where clients had used them. The student also explained that it would help her with her studies and she could put the experience on her resume when she graduated, to help her get a real job. The parents were happy to let the student try the iPad with their daughter. When the NDIS plan was approved, they offered to pay her as an Allied Heatlh Assistant, which the planner had suggested as a cheaper option than spending all the money allocated for speech pathology on sessions with a qualified speech pathologist. The parents had not wanted to tell Phill as they thought he might not like them spending the money that way and would want it all to be available for his work. They think their daughter is really benefitting from the iPad as watching videos on it calms her when she becomes upset. Phill is in a dilemma. How does he tell the parents that the iPad may not be the most appropriate AAC for their daughter at present, and that the speech pathology student is not yet qualified to make decisions and advise on devices to trial without coming across as controlling or limiting progress for their daughter? Also, how does he talk with the speech pathology student about what is an appropriate role for her in this situation without it sounding like he just wants access to the full funds allocated to speech pathology?

Worksheet available on the SPA website

Level1 /114WilliamStreet T 61 396424899

MelbourneVictoria3000

F 61 396424922

office@speechpathologyaustralia.org.au www.speechpathologyaustralia.org.au

Ethics of Care Approach Whataretheneedsoftheindividualandfamilyaffectedbythisdilemma? Howwouldthisclientdefine‘qualitycare’? Whatkeyrelationshipsdoes thisclienthavewithe.g., family,friends,community, andothers fromsocial, educational, spiritual,andemploymentorganisations? Howwillcareprovidedhelptheclienttomaintainimportant relationships? [Type your answer here]

Whataretherolesand responsibilitiesofthehealthcareteam inproviding care? Whatarethespeech pathologists’ responsibilities forcare? Howcan theteamcollaboratetofacilitatecareoutcomes? [Type your answer here]

Arethereanybarrierstoeffectivecare ? Howeffectiveiscommunication betweentheclient,carers,andhealthprofessionals? Arethereanyfactors,including policies,structureofhealthservices,attitudes,and values of healthprofessionals,whichmaydisempowerthisclient? [Type your answer here]

Whatresourcesarerequiredtoprovidecompetent healthcare? Do I/we requiremore knowledgeortrainingtomanagethisclient?Aretheavailableresources appropriate? [Type your answer here]

EthicalReasoningFrameworks:Ethics ofCareApproach SpeechPathologyAustralia©Copyright2016

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August 2018 www.speechpathologyaustralia.org.au

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