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Volume 17, Number 1 2015


had significant experience with this population and

benefited from the support and advice of their peers. They

also found they were reading more research in order to up

skill for this new client group. The clinical educator was

aware that she was responsible for the students and so

supervised closely to ensure that they acted within their

competence. She kept more complex cases for later on in

the students’ placements when they had developed their

confidence and clinical skills with CALD clients. These

meetings meant that our practice was always being

evaluated and improved, and we were able to deliver a

high-quality, ethical and efficient service to the school

population. These debrief sessions and case discussions

allowed the university students to broaden the focus on the

clinical aspects of the cases and discuss numerous ethical

dilemmas which prepared them for other ethical dilemmas

that they faced over the course of their placement. The

casuistry approach to ethical decision-making (Leitão et al.,

2014) supports decisions and reasoning to be based on

previous cases that a team has either experienced, read

about or discussed.

As the clinical educator I needed to use my past

knowledge and experience in the placement to guide

and assist the students to follow the narrative approach

to ethical decision-making and to refer them back to

previous cases using the casuistry approach. Not only did

the university students develop their clinical knowledge

and skills in this setting but they also had the experience

of working through numerous ethical issues that were

unique to the cultural and linguistically diverse clients in that

setting. Both the students and my own ethical decision-

making skills and problem-solving abilities were greatly

challenged. The placement allowed all of us the opportunity

to develop two different methods of ethical reasoning, the

narrative approach and the casuistry approach, that could

be used to resolve ethical issues in the future.


Leitão, S., Bradd, P., McAllister, L., Russell, A., Block., S.

Kenny, B.,… Wilson, C. (2014).

Ethics education package


Melbourne: Speech Pathology Australia.

The Speech Pathology Association of Australia.


Code of ethics.

Retrieved from http://www.


World Health Organization (WHO). (2007).


Classification of Function, Disability and Health (ICF)


Retrieved from

enough to proceed. Reflecting on the situation in hindsight

makes one think about the questions one would ask or

the response that would be given if a client made a similar

comment in the future. It may be important to find out

further information but it would be critical to do so without

leading the child on or asking a loaded question.

It was important to ask ourselves the following questions

which structure the narrative approach. What was the

child’s background story? What might have led the child to

make such comments? Was the child able to clearly and

correctly articulate what was occurring at home? What

was the child’s current story? What was known about the

child and their current home life? How could we find out

more information about the client’s situation? What was the

child’s future story? What would be the potential outcome

if we did report? What would be the outcome if we didn’t

report the child’s comments?

There could have been potential consequences for

reporting something that wasn’t an issue and rather was

a miscommunication by the child and misinterpretation by

the student clinician and clinical educator. There could have

been serious consequences for not reporting if indeed the

child was being physically abused at home. In line with

the SPA Code of Ethics (2010), we saw the importance

of telling the truth and preventing further harm for the

child. We were aware that it was important to share this

information with the teacher and principal for both legal and

compelling moral reasons. The school staff members were

aware of the child and her history and would able to deal

with this information accordingly.

As health professionals who were new to the setting

and new to working with the child, we did not know the

answers to many of these questions. The child, her teacher,

and the school principal were all important characters in

the narrative as they could all provide details and different

perspectives to the story and ethical dilemma. The narrative

approach highlights the importance of obtaining the full

story. The teacher and principal were well aware of the

background story for this child and were able to provide us

with some insight into the important factors in the child’s

history. As we were unsure how to interpret the child’s

comments, it was important to gain further information from

the school staff members to support our decision-making.

Due to privacy and confidentiality they were unable to share

specific information; however, their comments made us

confident in reporting the child’s comments as unfortunately

the child’s comments seemed to “fit” with the child’s

previous experiences and family history. (Further action was

taken by the school staff after we made our report.)

This was not an isolated event – there were other

occasions where children disclosed experiences of abuse

to the university students on clinical placement. These

experiences were quite upsetting for the university students

and, as a clinical educator, it was important to ensure that

both the university students’ well-being and the well-

being of the children were protected. The first experience

of disclosure provided the team with a precedent that

allowed for more efficient and ethical management of future

examples as per the casuistry approach which supports

case-based learning (Leitão et al., 2014).

Reflections on working in this setting

We had daily debrief team meetings where we could

discuss issues and events of the day. This was frequently

focused on the challenges and possible solutions of

working with CALD clients. The university students had not

Shannon Golding

is a speech pathologist with an interest in

research and culturally and linguistically diverse children. Her PhD

focused on the speech and language development of children

adopted from overseas. She also has experience supervising

health science students on inter-professional placements both in

school settings in Perth and in hospital settings in Cambodia.



is chair of the Ethics Board and interested in applying the

various theoretical approaches described within the 2014 Speech

Pathology Australia Ethics Training Package to a range of

workplace contexts.

Correspondence to:

Suze Leitão

School of Psychology and Speech Pathology

Curtin University, Perth WA