Speak Out August 2018

Ethics of care approach worksheet

What are the needs of the individual and family affected by this dilemma? How would this client define "quality care"? The parents are seeking speech pathology services to determine the most appropriate approach or AAC AT device to establish reliable communication for their daughter. They are unaware that a student speech pathologist may not have the necessary skills or knowledge to provide appropriate advice and are willing to try anything that may be useful. The parents are also keen to utilise the NDIS funding to access the maximum possible services for their daughter, as they consider more sessions will equal more success. What key relationships does this client have with e.g., family, friends, community, and others from social, educational, spiritual, and employment organisations? The daughter lives at home with her parents and attends an SDS during weekdays. She does not have many other opportunities for social contact other than visitors to her house. A friend of her parents has a daughter who is a speech pathology student, who has offered to help with trialling AAC AT. How will care provided help the client to maintain important relationships? Communication with her parents and at the SDS is limited. Identification of an appropriate AAC method or device will have a significant impact on her relationships with her family and participation in educational and social relationships inside and outside the home. What are the roles and responsibilities of the health care team in providing care? What are the speech pathologists’ responsibilities for care? Phill has a responsibility to ensure speech pathology intervention is providing benefit for this client. By trialling an AAC AT that is not appropriate at this time there may be an opportunity cost for the client, i.e. working with the iPad may use time and funds that could be used to work with AAC AT that will be successful. Phill also has a responsibility to provide information for the parents to understand what is evidence based care in this situation and what are appropriate roles for the different people involved in speech pathology intervention. He understands it will be important to identify a way to discuss what is an appropriate role for the speech pathology student to contribute to the client’s progress without damaging the relationship he has started to build with the family. Phill decides to focus on the positive aspects of communication that he has been able to identify the client already has, such as eye contact, vocalisation, to gently introduce his professional opinion that an iPad may be useful in future but is not the best AAC method to use at this time. Phill identifies the evidence that will support this discussion, other AAC AT that may be appropriate to introduce now, and apps/features on the iPad that have not yet been trialled which may be more appropriate for the client, to ensure the parents understand that he will work towards developing an AAC system that will be beneficial for their daughter. How can the team collaborate to facilitate care outcomes? Phill has experience working with AHA’s to support speech pathology intervention so he understands that the speech pathology student can play an important role as an AHA in achieving this client’s goals. He will need to discuss with the student what are appropriate actions for her to undertake as an AHA, and that she must work under his direction in a delegated role, not independently from him, to ensure benefit is provided to the client. Phill decides to talk with the parents first to explain what delegated work is in speech pathology, and to reassure them that he is supportive of the student working as an AHA with the client. He will focus on the therapeutic benefit that can be achieved if the AHA is acting in an appropriate delegated role, by acknowledging the financial benefit of being able to purchase more ‘practice time’ with an appropriate AAC method than could be achieved within his sessions alone. He will then ask for a meeting where the parents and the AHA are all present to reiterate the appropriate role for an AHA in working with this client and encourage discussion to ensure everyone is working together.

Are there any barriers to effective care? How effective is communication between the client, carers, and health professionals?

Until now, there has not been any communication from the parents about the speech pathology student, or any communication between Phill and the student. This has resulted in inappropriate actions by the student, which can hopefully be influenced positively through open communication between all parties and support from Phill. (continued on next page)

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August 2018 www.speechpathologyaustralia.org.au

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