JCPSLP Vol 19 No 2 2017

Ethical conversations

Ethics in clinical practice An interview with Dr Brenda Carey, clinician researcher Susan Block

I n an attempt to demonstrate how clinicians can integrate ethical practice, clinical research and clinical practice in a private practice setting, Dr Brenda Carey has graciously agreed to describe her experiences. Dr Carey has many facets to her work. She completed her PhD while managing an RCT comparing face-to-face and telehealth delivered treatment for adults who stutter. She has an honorary affiliation with the Australian Stuttering Research Centre at Sydney University, is a clinical supervisor at La Trobe University, a member of the Lidcombe Program and Camper­ down Program Trainers Consortia, and runs a successful private practice in Melbourne. Brenda was interviewed by Dr Susan Block, Senior Member, SPA Ethics Board. How have you managed to blend private practice and research? I managed to link in with university research programs and have been employed by, or collaborated with several universities. That has great benefits – it enabled me to choose what projects to be involved with. The combination of workplaces is really interesting. To have the opportunity to research your “most real” participants (your clients) means sampling from an ecologically valid group. On the other hand, I think not working in academia also brings a cost because I believe that really interesting research comes from really interesting ideas, and working with people directly involved in research as their primary focus in academia may be more likely to generate interesting ideas. So does that mean that you get added intellectual stimulation from your university contact? Yes, as a clinician in private practice I see the practical application of research; but the negative is not being a part of a think tank that is integral to the best academic environments. The other negative is that I do not have ready access to funding from within my workplace or the support mechanisms to do research. Another negative of not working within a research team at a university is less experience in designing research projects, writing and publishing. I consider it far better to have access to a team with experience in all these processes. Why have you continued in private practice and not academia, which is more set up for research? This is an issue that I continually grapple with as I enjoy both, and both have very strong positives. However,

ultimately what I really value is my independence and this combination affords me greatest control over my professional experience. I do not end up doing the parts of an academic role about which I may not be passionate (e.g., some aspects of teaching, administration!). However, a negative of private practice is that the role of a private practice – to provide quality therapy to those who request and who would benefit from it –can sometimes be in conflict with that of a research clinician. For example, if interested in a project on preschool stuttering, the project criteria might stipulate that the children have stuttered for a certain amount of time, but my clinical experience might suggest that some of these children would benefit from earlier commencement of treatment. Thus, at times there is potential for conflict. Another key tension in private practice is that a private practice needs to be sustainable financially, whereas sometimes conducting research ethically means it is not possible to charge for a treatment, thus there is no income generated from that client contact. How do you determine your projects? Often in collaboration with a team at another university; sometimes from a clinical question that has come up from my clinical experience, or a query from the literature. For example, the Lidcombe Program treatment literature shows that parents can find it a stressful experience to administer the Lidcombe Program and I have found this in my practice. As a result, I am evaluating the impact of a support group for parents whose children are doing the Lidcombe Program. To whom do you apply for ethics approval? This is a key reason for needing to collaborate with a university or relevant body. Research with human participants requires ethics approval (https://www.nhmrc.gov.au/health-ethics/ human-research-ethics-committees-hrecs) and journals require evidence of this to publish outcomes. The process can be quite complicated so it is good to work with someone who has experience of the paperwork and the process. It also ensures we do the right thing by our clients/participants. Have you met any conflicts of interest or ethical problems in your research and clinical practice? One potential conflict is retaining client participants for the entirety of the clinical trial in private practice, when the

Susan Block

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JCPSLP Volume 19, Number 2 2017

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