JCPSLP Vol 21 No 3 2019

Professional competence The importance of professional competence is discussed across the Values (Quality Standards and Continuing Competence), Principles (Professional Integrity), and Standards of Practice (Professional Competence and Professional Standards) sections of the Code of Ethics. SLPs are required to continually update and extend their professional knowledge and skills, represent their training and competence accurately, and practice only within the limits of their personal competence (Speech Pathology Australia, 2010). When clinicians practice beyond this scope, it is evident to both clients (see Box 2) and their family members (see Box 3). In Australia, speech pathology students must graduate with competency in multimodal communication (Speech Pathology Australia, 2017) and SLPs do not require specific credentialing to work in the field of AAC (Speech Pathology Australia, 2012). However, the Speech Pathology Australia (2012) Clinical Guideline for AAC states that SLPs must recognise the need for ongoing education and may seek supervision from clinicians who have expertise in AAC. Box 2. Reflections from Sarah*, an adult who has cerebral palsy and uses AAC A lot of speech-language pathologists have no idea. I did have kind of speech-language pathologist I had her fifteen years. Way too long. I was eleven when I got my first communication device DeltaTalker 2 and I don’t think she had worked with AAC before. Of course I had to learn Minspeak 3 . She wanted to teach me I used to go Monday morning. We started to learn APPLE fruit. I was enjoying learning Minspeak that much I used to come home from school every afternoon to learn Minspeak myself I used to play around to work out where everything was. I saw the occupational therapist three times already I was in front of her. I stopped going. However I know if I hadn’t of been determine to learn and left it up to you [the SLP] I may not of gotten used to the communication device and gotten the ability to communicate I would no way be where I am today * Sarah is a pseudonym for the author who chose to remain anonymous. In addition to our ethical obligations, there is mounting research evidence for the importance of developing individual professional competence in the introduction of AAC systems. Baxter, Enderby, Evans, and Judge (2012) and Moorcroft, Scarinci, and Meyer (2018) conducted systematic reviews of the barriers and facilitators to the provision and use of AAC systems and noted that a lack of SLP training was a significant barrier to the successful implementation of these systems. Likewise, early career SLPs interviewed by De Bortoli, Arthur-Kelly, Mathisen, and Balandin (2014) identified that their lack of skills and experience in AAC was an obstacle to intervention and reflected that gaining knowledge and experience would support their work. Similarly, in Box 1, a now experienced SLP has provided a reflection on the limitations in her attempts to introduce AAC when early in her career. The impact of experience on the success of AAC introduction is not surprising, given research has found differences in SLPs’ approach to AAC assessment and intervention as a function of their level of experience (Dietz, Quach,

Lund, & McKelvey, 2012). Dietz et al. (2012) explicitly investigated the impact of experience on AAC clinical decision-making and noted that, whereas AAC clinical specialists approached assessment and intervention in a way that was holistic, individualised, and functional; general practice SLPs introduced AAC through a structured, decontextualised process. SLPs interviewed by Moorcroft, Scarinci, and Meyer (2019) suggested that where complex clients are supported by SLPs who are new to AAC, supervision by more experienced clinicians may assist to improve outcomes. Beneficence and non-maleficence The value of beneficence and non-maleficence, as described in The Code of Ethics, must also be considered when introducing AAC systems. This value is discussed with specific reference to AAC intervention within the Speech Pathology Australia (2012) Clinical Guideline for AAC which states that interventions must be selected and delivered in a manner that demonstrates benefit and minimises harm to the person with complex communication needs and his or her communication partners. There are numerous benefits of AAC including improved participation in society (Thomas-Stonell, Robertson, Oddson, & Rosenbaum, 2016), reduced stress during communication (Angelo, 2000), and improved overall quality of life (Angelo, 2000). AAC systems also support the development of receptive and expressive language (Thomas-Stonell et al., 2016) and can, at times, foster speech production (Millar, Light, & Schlosser, 2006). When an AAC system is successfully introduced, the client may access these benefits; however, a recent study by Moorcroft et al. (2019) suggests that services delivered by inexperienced SLPs can prevent positive outcomes for the client. Moorcroft et al. (2019) noted that the introduction of AAC systems by clinicians inexperienced in AAC intervention can result in negative experiences with AAC for the client or family and the rejection or abandonment of the AAC system. Such was the case for Hannah Gutke who, in Box 3, has described abandoning multiple AAC systems for her daughter, Claire, because Claire’s SLPs lacked the expertise to account for her complex movement patterns when prescribing the systems. Although Claire now successfully uses an AAC system, during the time she spent with earlier and less appropriate systems she did not have access to a means of communication and her family invested emotional and financial resources that might have been better used elsewhere. In addition, Moorcroft et al. (2019) suggest that for some families, negative experiences with AAC may make them reluctant to attempt AAC again in the future, even when introduced by an experienced clinician. Consequently, the person with complex communication needs may be prevented from accessing the benefits of AAC systems in both the short- and long-term. Fairness and autonomy The principles of fairness and autonomy are also relevant to the introduction of AAC systems. The Code of Ethics states that SLPs must provide clients with access to services that are consistent with their need and respect their client’s right to self-determination and autonomy. However, restricting the provision of AAC service delivery to SLPs who have extensive experience working with people who have complex communication needs would likely reduce access to services. As such, the unmet demand for SLP services may increase and clients would no longer be able to exercise their autonomy to select their preferred service

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology