44 / 60
42
ACQ
Volume 13, Number 1 2011
ACQ
uiring knowledge in speech, language and hearing
that we express and protect his/her interests (Speech
Pathology Australia, 2010). This extends to the provision of
an assessment process that adequately profiles the child’s
strengths and weaknesses and makes recommendations
which support the child’s access to appropriate services
and removes barriers to their participation in the classroom
curriculum and family and community life (WHO, 2001).
The role of the speech pathologist
in assessment
According to the Speech Pathology Australia Code of Ethics
(2010), one of the principles that speech pathologists must
recognise and adhere to is the principle of fairness (justice).
Specifically, this refers to the need to provide accurate
information and provide clients with access to services
consistent with their need. In regards to duties to our clients
and to the community, we also have an obligation to ensure
our services are accessible and ensure there is equity of
access to services for our clients (3.1.6 Service Planning and
Provision). At the core of these ethical considerations is the
need to provide clients with access to services based on
their needs. This is our driving motivation and in order to do
this, we must advocate the right to services for our clients
(3.1.6 Service Planning and Provision). Does this
responsibility to advocate for appropriate services, however,
challenge our ethical conduct when client access to
appropriate services hinges on our assessment and
subsequent report? For example, in the assessment and
management of an Indigenous child with English as a
second language, we know that the administration of a
standardised assessment such as the CELF-4 would not be
a valid assessment. However, if the purpose of our
assessment and subsequent report was to seek additional
funding and thus additional services for this child and that
required the use of a standardised measure of language
skills, what ethical principles should we adhere to? Does our
ethical responsibility lie with the client and ensuring they can
access additional services, or does our ethical responsibility
lie with ensuring that we use valid assessments to identify
their areas of language difficulty even if that means we do
not use a standardised measure of language ability?
Given the high demand for school-based speech
pathology services and the limited resources available
for students with special needs in communication, the
Position Paper on Speech Pathology Services in Schools
(Speech Pathology Australia, 2004), currently under review
highlights the potential conflict for speech pathologists in
relation to client access to services and anti-discrimination
legislation. The federal
Disability Discrimination Act
1992
provides guidelines for access to services for people with
disability (Attorney-General’s Department, 1992). Despite
the existence of guidelines for categorising disability for
students with communication difficulties, service providers
have a professional and legislative obligation to identify and
respond to the therapeutic needs of all children despite their
diagnosis or categorical label for educational placement
purposes. After all, the Disability Discrimination Act definition
of disability applies to all clients, regardless of their eligibility
for funding or categorisation (Department of Education and
Training, 2010).
This issue of equity is addressed by McAllister and
colleagues (2009) in their “Three Es of ethical resource
allocation” (p. 124). Specifically, speech pathologists should
Written assessment reports are traditionally viewed as a
permanent record of a child’s communicative functioning,
documenting the status of a client at a given time (Hegde &
Davis, 2010). However, in the context of providing a
diagnosis for funding purposes, reports may be perceived by
the speech pathologist to be the core piece of tangible
evidence supporting the family’s quest for additional funding
and support. As the predominant form of communication
between professionals, reports may also represent the sole
means of communication between clinicians and service
providers (Flynn & Parsons, 1994; Thompson, 1997), placing
further pressure on the clinician to describe the child’s
communicative ability in a way that will convince relevant
authorities of the child’s eligibility for funding.
In the provision of written assessment reports, there
may be one or more intended recipients of the assessment
information and this may also influence the type of report
provided by the speech pathologist. In a study examining
parent and clinician perceptions of written assessment
reports, clinicians identified parents as the intended recipient
of reports (Donaldson et al., 2004). However, not all clinician
participants identified parents as the primary target group;
some clinicians identified other professionals such as
school teachers, doctors, guidance officers, and other allied
health professionals as the primary target group for the
report. In the case of presenting a summary of assessment
as written evidence to support eligibility for funding, the
speech pathologist may present information differently
when compared with writing for a parent recipient. In a
previous Ethical Conversations column, Leitão, Scarinci,
and Koenig (2009) highlighted ethical issues relating to
access of information for parents when reports are written
with unfamiliar jargon and terminology obviously targeted at
another recipient.
In situations described above where assessment reports
constitute a request for funding, speech pathologists must
consider where their primary responsibility lies. Who is the
client? The Code of Ethics includes a standard of practice
relating to our duties to our clients and to the community.
However, it does not provide guidance for speech
pathologists in identifying who the client is across different
settings and therefore the question may be answered
differently depending on where the speech pathologist
works. In a health setting, is the patient the client? In the
school setting, is the classroom teacher the client because
they are being provided with strategies to assist curriculum
change in order to maximise participation of the child? In a
paediatric private practice setting, is the child the client or
is their parent/guardian the client? Given the complexities
of this question, speech pathologists must give due
consideration to their ethical responsibilities. McAllister,
Pickstone, and Body (2009) highlight the complexities
inherent in determining who the client is in their examination
of ethical scenarios in paediatric speech and language
disorders and conclude that in any one case, there may be
more than one “client” and therefore many stakeholders in
the assessment of any one client.
While we may be responsible to a number of “clients”
in any one case, ultimately, the child is the focus of our
professional service delivery and we must not lose sight
of this. Given that “the child is the one with no say but
with all the potential consequences” (Hand, reported in
McAllister, Pickstone, & Body, 2009, p. 102), it is critical