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JCPSLP Volume 17, Number 1 2015 47
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.
References
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.
(2010). Code of ethics. Retrieved from http://www.
speechpathologyaustralia.org.au/library/Ethics/
CodeofEthics.pdf
World Health Organization (WHO). (2007). International
Classification of Function, Disability and Health (ICF).
Retrieved from http://www.who.int/classifications/icf/en/
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. Suze
Leitão 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
email: