JCPSLP Vol 18 no 2 2016

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JCPSLP Volume 18, Number 2 2016 77
but the bottom line is that Katie feels pressured to provide
an intervention that she isn’t confident will benefit some
children and their family, and, as well, she feels unable to
provide adequate time to provide a high-quality and
effective intervention for some of her clients.
Case study 2
Jude graduated last year and was delighted to get a newly
established position providing services to adults with
disabilities for a residential accommodation provider. She
hadn’t had a student placement in an adult disability
setting, but she had loved the presentation by a guest
lecturer about some of the emerging areas of practice with
people with disabilities who use informal means of
communication. The first priority of her employer was to
assess all of the residents and provide them with mealtime
guidelines. Jude was feeling daunted – she didn’t have any
experience with assessment and management of
dysphagia in people with complex life-long disabilities.
Furthermore, the manager of client programs had told her
that she was expected to assess all five residents in each
house, write up their guidelines and then train one of the
support workers how to follow them, so that they could
then train the rest of the staff – all in five hours. When Jude
hesitantly suggested that she would need more time, the
manager informed her that the organisation had negotiated
with the NDIS how much funding was available to provide
speech pathology, and she just had to manage it within the
funding envelope. Jude was just about ready to quit, but
she had always enjoyed a challenge, and decided that this
was the challenge that she had to have!
Using the Code of Ethics to work through
the challenges
The ethical responsibilities of a speech pathologist in case
study 1 include provision of accurate and timely information
to educate parents or carers, to ensure they understand the
evidence base behind an intervention and their decision-
making is fully informed. Although it can be difficult to find
the time to access the research, the speech pathologist’s
responsibility includes provision of information regarding the
evidence base for different types of service provision,
including the more “traditional” scenarios that the family are
comfortable and familiar with. Provision of this information is
undertaken while also respecting their autonomy to make
decisions regarding the types of intervention that are
offered, timing, location, etc.
We have an obligation to “evaluate the services we
provide on an ongoing basis to ensure that they are as
effective as possible. We provide services only if our clients
can reasonably expect to benefit from them” (SPA, 2010,
Clause 3.1.6). By enacting these ethical responsibilities
we can discuss with families the potential effectiveness
of intervention and efficiency of use of funded time. This
can include the benefits of all aspects of work involved in
providing therapy, to ensure the family are aware of the
behind the scenes work and its value to the overall program
and contribution to progression towards achievement of
goals.
Case study 2 highlights the obligation we have to
maintain quality and safe care of our clients. While we
strive to continually update and extend our professional
knowledge and skills, we must also be aware of the
boundaries of our professional competence, and practise
professionally within the scope of our level of education,
training and expertise. This means we need to seek
Members were asked to identify whether the introduction
of the NDIS is leading to an increase in the ethical
challenges for practitioners, and if so, to identify the areas
where those challenges lie. Seventy-seven responses
were collected, and, in brief, 53% of respondents provide
services in an NDIS trial site; and 86% of respondents
anticipated or have experienced ethically challenging issues
in speech pathology service delivery as a result of the
introduction of the NDIS.
The survey asked respondents to identify where the
ethical challenges lie, according to the professional
principles and standards contained within the Code of
Ethics (2010). All respondents identified ethical issues
relating to provision of services for NDIS participants in at
least two or three Standards of Practice. Table 1 sets out
the issues most frequently mentioned by the respondents.
Table 1. Ethical issues identified and their
relationship to the SPA Standards of Practice
Duties to our clients and the
community
Duties to our profession and
ourselves
Service planning and provision Professional standards
Professional competence Supervision
Accurate and timely information Development of your profession
Duties to our employers Duties to our colleagues
Professional competence Professional standards
Two case studies and working
through challenges
Case study 1
Katie is an experienced speech pathologist who has been
working in a not-for- profit disability provider organisation
for more than ten years. There is a lot about the NDIS that
she thinks is really great. The individualised funding model
has empowered parents to make choices about how funds
are used, and is allowing parents to prioritise and get
greater access to speech pathology services. The flip side
of the coin is that Katie now finds herself having to
negotiate with families for the provision of evidence-based
treatment approaches. The discussions have gone in all
sorts of directions. For some parents, the only model that
they know of for “therapy” is weekly sessions of one to one
with the therapist sitting opposite the child at a table in a
small room at a clinic. Of course, for some children that
model is a perfect fit, but for lots of the children who Katie
is being asked to see, it is not. Families are really wanting to
do the best for their child and get value for the money that
they are now able to access; they can’t see the value of all
the “behind the scenes” teamwork that goes into ensuring
coordinated, collaborative, cohesive, consistent supports.
For some families, Katie has been trying to advocate for the
provision of AAC interventions alongside coaching for
parents to support them to provide early speech and
language facilitation strategies, but they have wanted her to
focus solely on direct speech interventions. The daily
targets for NDIS funded face-to-face hours of service
provision are also posing a challenge, as is the pressure
from her manager to do all of her documentation and
device programming while she is with the client. There
seems to be a slightly different permutation for each family,