JCPSLP Vol 19 No 1 2017

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JCPSLP Volume 19, Number 1 2017 47
adults (Lowell et al., 2011; Amanda O’Keefe, personal
communication). The lack of appropriate assessment tools
and frameworks may in turn lead to misdiagnosis with both
over and under diagnosis of disorder being problematic.
The Contemporary Uses of Aboriginal Languages
research project (Lowell, Gurimangu, Nyomba & Yingi,
1996), written collaboratively, explores the extensive
language teaching and learning strategies employed by
Yolngu (people from north-east Arnhem Land) to support
communication development in children. The report
highlights sources of cross-cultural miscommunication that
may arise through lack of recognition of the sociolinguistic
difference between non-Aboriginal and Yolngu children.
Cross-cultural miscommunication in turn is often viewed
from a deficit model by the non-Aboriginal culture rather
than celebrating the inherent strength and cultural
appropriateness of the Yolngu way.
The Australian Psychological Society (APS) recently
recognised the damaging perception of deficit versus
difference. In September 2016 the APS issued a
public, formal apology to Aboriginal and Torres Strait
Islander peoples apologising for, among other areas,
“The inappropriate use of assessment techniques and
procedures that have conveyed misleading and inaccurate
messages about the abilities and capacities of Aboriginal
and Torres Strait Islander people” (APS, 2016).
Physical environment
Amanda O’Keefe, an experienced clinician working in
Darwin, highlighted how the built environment can
unintentionally prevent people from receiving the care they
need. Her example was the multi-storey, highly air-
conditioned hospital in Darwin. Many people from remote
communities make their way outside to be in a warmer,
more familiar natural space. This makes it harder for staff to
find patients when they are required for investigations and
treatments. In turn, this may lead to unintended delays in
care. The old Darwin Hospital with verandas and windows
for fresh air fostered a more accessible healing environment
and an easier way to ensure people could be found and
provided with the care they required. When building new
services, the impact of the built environment needs to be
part of the conversation. All health professionals have a
responsibility to ensure that their workplace is inclusive,
welcoming and acknowledging of Aboriginal and Torres
Strait Islander peoples.
Access to community-based services
The Speech Pathology Australia Code of Ethics states we
are an evidence-based profession and we value
accountability and responsibility. Some successful culturally
responsive models of speech-language pathology service
delivery have occurred across Australia in the past.
Unfortunately, these tend to be isolated and stopped when
project funding or government service policies change. For
example, in the mid-1990s in east Arnhem Land,
community-based hearing programs were established
which employed local co-workers in collaboration with
remotely based SLPs. With changes in models, first the
co-worker funding was lost, followed by the remotely based
SLP services. Now there is a single “remote” SLP for the
whole of the Top End of the Northern Territory based in an
allied health team working with a key case worker, using a
fly-in fly-out model. This means that people discharged
from hospital after an acute event may wait 6–8 weeks
before they receive follow up in their local community (Anne
access to health literate linguistic and cultural interpreters
and co-workers (IAHA, 2014; Lowell, Schmitt, Ah Chin, &
Connors), and lack of cultural competence educators and
culturally appropriate resources (Lowell, Lotfali, Kruske, &
Malin, 2011) all contribute to inaccessibility of speech-
language pathology services for Indigenous Australians. A
narrative approach to ethical reflection may help us to
create and provide future services which are beneficent and
prevent harm (Speech Pathology Australia, 2010). This
would involve firstly recognising past injustice, then
identifying current barriers and finally envisaging how truly
linguistically and culturally accessible services, through a
culturally responsive and collaborative approach, may look
(Lowell, 2013).
Models of collaboration
Michelle Lincoln (personal communication, 2016), shared
some exciting research projects currently being conducted
in partnership with Indigenous Australians. For example,
Aboriginal and Torres Strait Islander peoples carers and
stakeholders are being asked “What does a culturally
appropriate service look like?” (Aboriginal Health & the
National Health and Medical Research Council of NSW,
2016). Another example shared is current research through
collaboration with the Ngaanyatjarra Pitjantjatjara
Yankunytjatjara (NPY) Women’s Council (an Indigenous
human services and advocacy organisation in Central
Australia) asking “What makes a good life for people with
disability?” from an Indigenous Australian’s perspective in
remote central Australian communities. In the Northern
Territory, Anne Lowell shared an example of collaborative
research between Charles Darwin University and Yalu
Marŋgithinyaraw, Galiwin’ku, the “Growing up children in
two worlds: Building Yolngu skills, knowledge and priorities
into early childhood assessment and support” project. This
project uses collaborative research to build recognition of
Indigenous Australian early childhood strengths, priorities
and knowledge in communities in north-east Arnhem Land.
The intent of the research projects is to ensure the creation
of culturally responsive and collaborative services.
Accessible services
We would contend that inclusive engagement means
encouraging, fostering and enabling Aboriginal and Torres
Strait Islander people to say what makes a good service for
them. We need to listen and learn what safe and culturally
accessible services might look like for many diverse groups
and individuals. The Speech Pathology Australia Code of
Ethics upholds autonomy. Inclusive engagement means we
can maximise autonomy. There appears to be an uneasy
marriage between the Speech Pathology Australia Code of
Ethics aspiration for justice, “We strive to provide clients
with services consistent with their need” (Speech Pathology
Australia, 2010, p. 1) and the reality of SLP services,
particularly for many Indigenous Australians. Diverse
culture, languages, geographic locations and financial
considerations all contribute to inequities of access to
speech-language pathology services for Indigenous
Australians (Wylie, McAllister, Davidson, & Marshall, 2013).
This is even more apparent for Indigenous Australians from
rural or remote settings (IAHA, 2015; Lowell, 2013).
Language
We need to listen and learn what communication and
language needs might look like for many diverse Indigenous
groups and individuals. Many SLPs have commented on
the lack of valid standardised tests for both children and