JCPSLP Vol 21 No 3 2019

Ethical conversations

Ethical considerations for AAC novices Alison Moorcroft, Jane Burrett, and Hannah Gutke

W ith the rollout of the National Disability funding, choice, and control for the first time. In fact, as of March 2019, approximately 30% of NDIS participants were people who did not have access to previous state or Commonwealth programs (National Disability Insurance Agency, 2019). This increase in service users has created a climate of unmet demand for specialised disability services, and the National Disability Insurance Agency (2018) anticipates that in order to deal with this demand Australia will require approximately 40,000 additional providers. A portion of these providers will be speech- language pathologists (SLPs). Although the number of NDIS participants who have complex communication needs is unknown, many SLPs have responded to the demand for services by expanding their caseloads and accepting referrals for children, teenagers, and adults who would likely benefit from an AAC system. However, as described by an SLP in Box 1, these clinicians may not have previously supported clients with complex communication needs, and scenarios such as the following may occur: Susie graduated 5 years ago and works in a private SLP practice in Sydney that has traditionally seen young children with mild–moderate speech and language delays. The practice has recently started to see children who are accessing funding under the NDIS and Susie has identified that many of these children may benefit from an AAC system. Susie’s clinical supervisor is not experienced in AAC intervention but has attended a PECS 1 training so recommended that Susie introduces PECS to her clients who are non-verbal. Although hypothetical, this scenario is realistic and raises the question of whether it is appropriate or ethical for SLPs who have limited knowledge or skills in AAC to commence AAC assessment or intervention without first accessing appropriate training and/or establishing AAC specific supervisory structures. This article will explore this question in depth with reference to the Speech Pathology Australia Code of Ethics (Speech Pathology Australia, 2010). Issues related to professional competence, beneficence and non-maleficence, fairness, and autonomy will be broadly discussed, then used to develop an ethical plan of action for Susie. Insurance Scheme (NDIS) in Australia, many people with disabilities were given access to

Box 1. Reflections from Jane Burrett, SLP

In the current climate, due to the NDIS, it has become more common for clinicians who do not necessarily have the experience to accept referrals for children with complex communication needs requiring AAC. With the increased availability of funds through the NDIS, the pressure on service providers to provide intervention has increased significantly, but the support in upskilling clinicians isn’t necessarily there. Now, many children who were traditionally seen by disability specific services such as ADHC [Ageing, Disability, and Home Care] have gone out into the private/NDIS funded sector with many clinicians who are completely inexperienced in AAC and the complex communication population. I don’t feel like we covered AAC and complex communication extensively in university, and it’s required me to actively seek out extra training, research and mentoring from other clinicians to upskill myself. However, you have to have (a) the time and/or (b) the motivation. There is no function in the NDIS to make this upskilling compulsory which leaves families at risk from receiving inappropriate support and potentially leading to AAC abandonment. Some of my own difficulties related to choosing devices and then recommending them to families because they were what I was familiar with. I feel this is really common with many clinicians. For example, I myself am PECS 1 trained and it was my go-to strategy because that was the training I knew, until I learned about other devices and approaches. With extra training, it’s easier to discriminate between systems more, but that really requires the ability and will to upskill. I feel that it may not be ethical to engage in AAC assessment or intervention without specific training, but in Australia we don’t have clear access or paths towards AAC training, competence or supervision. The lack of guidance and clear direction around these aspects may leave clinicians feeling unsure of what to do and what is ethical. I think that we’ve come to a point where we need clear guidance around who is or is not experienced enough to take on clients with complex communication needs as well as a clearer pathway towards developing competence, so that clinicians can understand the gaps in their own knowledge before taking on such clients.

Alison Moorcroft (top), Jane Burrett (centre) and Hannah Gutke

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JCPSLP Volume 21, Number 3 2019

www.speechpathologyaustralia.org.au