JCPSLP Vol 17 No 1 2015_lores

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JCPSLP Volume 17, Number 1 2015 45
Ethical conversations
KEYWORDS
CALD
DIVERSITY
ETHICS
NARRATIVE
APPROACH
Shannon Golding
(top) and Suze
Leitão
Living out diversity in
practice
A clinical educator’s reflections on ethical decision-making
in a university clinical setting for culturally and linguistically
diverse children
Shannon Golding and Suze Leitão
students on placement, along with a number of new
challenges for both supervisors and students. Some of
the ethical and practical issues faced in this setting were
uncommon and not experiences that the first author had
encountered previously. Although she had experience
working with clients from culturally and linguistically
diverse (CALD) backgrounds, she had not experienced
the concentration of CALD clients and ethical issues within
one setting. For some students it was their first and only
paediatric clinical placement in their final year of study. The
World Health Organization’s International Classification
of Function, Disability and Health (ICF) (2007) was an
important model for considering the children’s speech
and language skills, experiences, family environment, and
support available to them.
This article describes a number of stories from the field
that outline examples of the experiences and challenges
that the clinical educator and students running the clinic
encountered on a regular basis. One story will be worked
through using the narrative approach to ethical reasoning
from the Speech Pathology Australia Ethics Education
Package (Leitão et al., 2014). The casuistry approach to
ethical decision-making will also be considered as each
experience added to a collection of cases that could be
reflected on in order to support the students’ learning.
Finally, a reflection on how to manage working in this clinical
setting and supporting students will be discussed in order
to support and encourage other speech pathologists who
may face similar ethical issues in their clinical setting.
Stories from the field
The university students and clinical educator encountered
many interesting stories each and every day. Working with a
CALD group of children and families presented many new
experiences for the university students on placement that
required explicit and detailed discussion due to the
complexity of the ethical issues. The following stories are a
snapshot of some of the interesting ethical dilemmas that
arose during the clinical educator’s time at the clinic.
Identifying information has been removed.
Before any child could be seen by the university clinic,
informed consent was required from the child’s caregivers.
This was often difficult as many parents had very limited
English skills. One mother did not speak English at all and
a translator was unavailable. The child’s teacher explained
the consent form to the year 6 client who was to be seen
for his language difficulties and asked him to explain it to
his mother and have her sign it when he went home. The
student was the one who would have the most contact
Working in a culturally and linguistically
diverse setting raises a number of ethical
issues. This article outlines stories from the
field and reflections of a clinical educator
who worked in a university clinic at a primary
school in a lower socioeconomic area. The
narrative approach to ethical reasoning is
used to discuss one example of an ethical
dilemma that arose while working in this
setting. The use of both the narrative and the
casuistry frameworks are discussed as
methods of ethical reasoning and decision-
making with reference to the experiences of
the supervisor and the university students
that were on placement.
Description of the context
In this issue’s ethical conversation the first author will reflect
on her experiences as a clinical educator at a university
inter-professional practice (IPP) clinic set in a local primary
school. The first author believes that the experience was an
example where she lived out “diversity in practice”. The
university students on placement included speech pathology,
occupational therapy, physiotherapy and nursing students
who themselves came from a diverse range of cultures and
experiences. The clinic’s focus was on the development of
the students’ discipline-specific clinical skills as well as their
collaboration and learning within the IPP team. The
university students worked with children with developmental
delay, cerebral palsy, autism spectrum disorder, other
disorders that were typical of a paediatric setting, and some
unique cases that were specific to the setting.
The school is located in a relatively low socioeconomic
suburb south of Perth and features great cultural and
linguistic diversity among students with more than 45
languages spoken, including a number of Aboriginal
languages. Countries represented in the school community
include the Philippines, New Zealand, Thailand, China,
Malaysia, Tanzania, India, Kenya, Japan, Myanmar
(formerly Burma), and Sudan. Some children come from
homes where English is not spoken and their first and only
exposure to English was in the school setting. The school
community includes refugee families who are new to Perth
and have limited access to support and services.
For these reasons, the clinical placement provided
interesting and rare learning opportunities for the university