Speak Out December 2018

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CONFIDENT DECISION-MAKING

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This is the fourth and final 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 Narrative 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. Case study Tarri has been a sole practitioner for nine years and during that time she has built up a small caseload working with just a few children and adolescents at a time, who have speech and language disorders. Tarri has decided to increase the size of her practice and has started to work with clients funded through NDIS. This has resulted in clients seeking her services for difficulties she is not as familiar with, such as severe ASD, complex communication needs and intellectual disability. Tarri is keen to expand her knowledge and experience so that she can work with clients presenting with a broader range of communication difficulties and has started to attend meetings of her local speech pathology network. She has joined the SPA Disability online member community and is impressed with the discussions and support provided by colleagues around Australia. Tarri has also started an online course through the speechBITE website, to learn how to read research articles more effectively and increase her knowledge about the evidence of interventions. Nia is a six-year-old girl, the daughter of parents who emigrated to Australia when Nia was four. Nia has been exposed to a bilingual home environment, however is displaying limited communication in both languages. Nia is brought to see Tarri by her mother, who tells Tarri that she has just separated from Nia’s father. Nia’s mother states that the father never wanted to hear that Nia was having difficulties and she does not want him to know that she has brought Nia for a speech pathology assessment. Tarri agrees to this and commences her assessment. It soon becomes apparent that Nia is demonstrating a severe delay in speech and language development. Tarri is concerned that Nia appears to display signs indicative of autism, as well as aggressive behaviour when Tarri presents language-based activities, Nia actually bit Tarri on the arm during her second session. Tarri knows that Nia needs assessment by other professionals to fully diagnose her difficulties and wants Nia to

be seen by a Paediatrician. Tarri discusses her concerns with the mother and suggests that she look into seeking funding for services through NDIS. The mother refuses all of Tarri’s suggestions for further assessment and states that she wouldn’t trust anyone other than Tarri. The mother asks that Tarri just provide the therapy Nia needs to ‘get better at talking’. However, the mother does want Tarri to talk to Nia’s teacher, as her limited communication is impacting on Nia’s participation at school. Tarri calls the teacher and talks with her about her concerns. The next day, a gentleman calls Tarri, claiming to be Nia’s father. He is very angry as he heard from the teacher that Nia is receiving speech therapy from Tarri and is demanding to be told when the next appointment is booked so he can come along to have a look. Tarri considers that she has enough clinical knowledge to begin to work with Nia, and has developed professional networks which will support her to expand her knowledge, however, she is starting to feel that this situation is becoming more complex than she expected and there are so many questions running through her mind she doesn’t know where to start! Is she the right person to be working with Nia? How can she develop her knowledge and skills to work with a bilingual child with autism? What are her obligations to let the father attend the session and how does she manage the tension between the father and the mother?

Worksheet available on the SPA website

Level1 /114WilliamStreet T 61 396424899

MelbourneVictoria3000

F 61 396424922

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

Narrative Approach Who are the important characters in thisdilemma?

Whoneeds to tell their story (e.g.,client, carer,health careprofessional,andemployer)? Whatare the different perspectives that each charactermaybring to this dilemma? [Type your answer here]

Whatstrategieswill facilitate important stakeholders to havea ‘voice’ in thisdilemma? Are thereanysociocultural, communication, or physicalbarriers thatmust be addressed? Is the setting appropriate for hearingand sharingstories?How can ‘open’ communication be maintained? What verbaland non-verbalmessagesmust be attended to during interactions?How can I check that Ihave ‘heard’ each character’s story? [Type your answer here]

What is thebackground story? Whatdo the charactersperceiveas important factors in their history? Apart frommedical history,what other past factorsmay influence aclient’s current values and choices? [Type your answer here]

EthicalReasoningFrameworks:NarrativeApproach SpeechPathologyAustralia©Copyright2016

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December 2018 www.speechpathologyaustralia.org.au

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