Level 2 / 11-19 Bank Place Melbourne Victoria 3000 T 61 3 9642 4899 F 61 3 9642 4922 office@speechpathologyaustralia.org.au www.speechpathologyaustralia.org.au Principles of Practice November 2001 The Speech Pathology Association of Australia Limited ABN 17 008 393 440 Speech Pathology Australia Acknowledgements In the writing of this document, Speech Pathology Australia wishes to acknowledge the valuable contribution made by the following members: Professional Practice, Standards and Workplace Portfolio, Victorian Branch 1996: Lidia Basile, Melissa Bevan, Sue Gillies, Kym Torresi With assistance from: Angela Kirsner Professional Practice, Standards and Workplace Portfolio 1999 and 2000: Sue Gillies, Kath Sennitt, Leone Carroll, Stacey Baldac, Robyn Cross, Cynthia Harvey With assistance from: PPS&W Victorian Branch (facilitated by Andrew Day) and contributions from: Kylie Lee, Charmaine Grey Project Officer – Jackie Clark Professional Practice, Standards and Workplace Coordinator– Alison Smith Professional Standards Portfolio Standards of Practice Task Group 2001: Leone Carroll, Kath Sennitt, Robyn Cross, Cynthia Harvey Project Officer – Jackie Clark PS Coordinator - Wendy Webster Contributions – Lindy McAllister; Michelle Lincoln, Rina Harber, Vickie Dawson, Libby Clark, Suze Leitão, Gail Baildon, Noni Bourke, Evelyn Terry, Trish Robustellini, Jude Eastaway, Lee McGovern, Stacey Baldac Principles of Practice ISBN 1 876705 04 3 © Speech Pathology Association of Australia Limited 2001 Disclaimer To the best of The Speech Pathology Association of Australia Limited's ("the Association") knowledge, this information is valid at the time of publication. The Association makes no warranty or representation in relation to the content or accuracy of the material in this publication. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of the information provided. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this publication. Principles of Practice Contents Section Heading A. A.1 A.2 About the Principles of Practice Background Purpose 1 1 1 B. B.1 Principles Ethics Public Confidence in the Profession Knowledge of Acceptable, Professional Behaviour Client Services Non-Individual Client Attributable Processes Service Delivery Issues Prioritising Teamwork Individual Client Attributable Processes Referral Consent Assessment Treatment/Goal Setting Discharge/Resolution Planning Counselling Client/Family Education Documentation Service Management Human Resource Management Recruitment and Selection of Speech Pathologists Advertising for Applicants Position Descriptions Interviewing Selection Qualifications Registration Contracts Orientation and Induction Leadership and Supervision Professional Development Performance Management of Staff Employee Relations and Industrial Issues 3 3 3 3 3 3 3 4 4 4 4 5 5 5 6 6 6 6 7 7 7 7 7 7 8 8 8 8 8 9 9 10 10 B.2 B.2.1 B.2.2 B.3 B.3.1 B.3.2 Principles of Practice Page Business Planning 10 Funding 11 Workload Parameters 11 Speech Pathology Australia Section Heading B.3.3 Physical Resources and Facilities B.3.4 B.3.5 B.4 Page 11 Work Environment 12 Information Technology 12 Facility Development and Relocation Planning 13 Physical Environment 13 Waiting Area 14 Reception Area 14 Treatment/Intervention Areas 15 Observation Room 15 Administrative Areas 16 Student Placement 16 Storage of Professional Resources 16 Storage of Files and Medical Records 16 Equipment 17 Itinerant Services 17 17 Marketing and Public Relations Advertising 18 Promotion of Services 18 Contact with the Media 18 Public Statements 18 Promotion of Speech Pathology Australia 18 Publications and Promotional Materials 19 Professional Networks Between Organisations 19 Quality Improvement 19 Measurement Methods 19 Reporting Requirements and Advocacy 20 Education of Others 20 B.4.1 Clinical Education 20 B.4.2 Staff and Community Education 21 B.5 Research 21 B.5.1 Methodologies 22 B.5.2 Funding 22 B.5.3 Dissemination of Results 22 Principles of Practice Section Heading Page C. Definitions 23 D. References 24 E. Further Information 25 E.1 Council Structure 25 E.2 Speech Pathology Australia Position Papers 26 E.3 Other Speech Pathology Australia Resources 26 E.4 Topic References 26 Principles of Practice A. About the Principles of Practice A.1 Background Association documents such as the Standards of Practice (AASH, 1994) and Recommended Minimum Facilities (AASH, 1979) have been widely used for many years by speech pathologists to assist with clinical practice and service management. In 1996, the Victorian Branch of the Professional Practice, Standards and Workplace Portfolio also developed the Guidelines for Good Practice in response to the significant changes occurring in workplaces, employment models and organisational structures. At a national level, a decision was made by Council to merge and extend the Standards of Practice, Guidelines for Good Practice (AASH, 1996) and Recommended Minimum Facilities into a single, user-friendly document. Therefore, a project was launched aiming to provide current information regarding standards of service and service management for speech pathologists working in a range of contexts, including rural and remote locations. A.2 Purpose This document provides a guide for the achievement of high standards of service and service management, beyond the professional competency described in the Competency Based Occupational Standards (CBOS) (Speech Pathology Australia, 2001). Emphasis is placed on describing the broad range of processes to be used within an organisation in the provision of quality speech pathology services to clients. Speech pathologists and services are encouraged to use the principle structure as a checklist upon which to evaluate current practice and to highlight areas for development. Individual speech pathologists may utilise the information to raise their own awareness of issues related to principles and workplace applications, enabling them to contribute to and lobby for high standards of practice. The Principles of Practice may be used as a framework in the establishment or organisation of a speech pathology service. It can assist employers and services to support and work collaboratively with speech pathologists through awareness of accepted principles within the profession. In outlining the principles, it is recognised that no single approach is appropriate to all settings and that diversity is valuable in the provision of speech pathology services. Discretion must be used in setting achievable standards for smaller departments and in assigning levels of responsibility to individual speech pathologists. The document highlights key areas of work practice at an organisational level, with the understanding that speech pathologists will be flexible in their interpretation and continuously strive for the best practice at all times. For issues related to professional competency, reference is made to CBOS (Speech Pathology Australia, 2001). This document provides general information and, where possible, will direct the reader to other documents providing more specific guidelines on a topic. Figure 1.1 highlights the relationship of the Principles of Practice to other Speech Pathology Australia documents and departmental policies and procedures. Best practice principles apply with consideration to: • Quality services and care for our clients; • Review and continual improvement of systems; and • Demonstration of positive outcomes. Principles of Practice 1 Speech Pathology Australia Figure 1.1 Code of Ethics (2000) Association Policy Manual Principles of Practice (2001) • principles • workplace applications • statements CBOS (2001) Position Papers In structuring the document, best practice statements are provided for the component parts of each principle, representing core areas of clinical practice and service management. Where possible, organisation of information is consistent with the Health Activity Hierarchy (National Allied Health Casemix Committee, 2001), however, adaptations have been necessary to ensure relevance to non-health specific contexts, such as private practice and educational settings. 2 Principles of Practice B. Principles B.1 Ethics Best Practice Statement: Speech pathologists have a professional responsibility to observe the highest standards of integrity and ethical principles, as outlined in Speech Pathology Australia’s Code of Ethics (2000). Public Confidence in the Profession The speech pathology service is required to employ speech pathologists eligible for practising membership of Speech Pathology Australia. Consultants or practitioners under contract to the service are also expected to meet the same requirements as salaried personnel. In Australia, only individuals who are eligible for practising membership of Speech Pathology Australia are able to practise as speech pathologists. Knowledge of Acceptable, Professional Behaviour The speech pathology service is expected to demonstrate reference to Speech Pathology Australia’s Code of Ethics (2000) in their employee and client information. Members of Speech Pathology Australia are required to know, understand and observe the Code of Ethics (2000). Non-members are advised to be aware of their professional responsibilities to observe the highest standards of integrity and ethical principles. The speech pathology service is expected to have access to the various position papers provided by Speech Pathology Australia and CBOS (Speech Pathology Australia, 2001). Speech pathologists are expected to familiarise themselves and their employers with the contents of relevant position papers and CBOS (Speech Pathology Australia, 2001). B.2 Client Services Best Practice Statement : B.2.1 Speech pathologists are required to work collaboratively with clients and other team members (i.e., carers and/or families, teachers, administrators and other health care professionals) to facilitate effective service delivery processes and to meet desired outcomes. Non-Individual Client Attributable Processes Service Delivery Issues Effective service delivery models are expected to be utilised for client service, with consideration given to issues such as: Principles of Practice • the individual needs of clients in specific contexts; • the aims of the service within the broader organisation; • access to the service, including geographical constraints; • the needs of culturally and linguistically diverse groups; • available resources and staffing issues; • context/location/timing of intervention; • the continuum of care available within a community for specific populations; • workplace, health and safety. 3 Speech Pathology Australia A range of direct and/or indirect models may be considered for services to clients. Options may include: • direct models of service (assessment and observation, individual and group intervention); • indirect models (training facilitators, resource provision, consultation, curriculum development, advocacy, referral to other services, health promotion, community development, telehealth). The provision of services across various locations in a community (e.g. home, educational sites, institutions, hospitals, community clinics, worksites) is recommended to meet the needs of specific populations. Prioritising It is expected that the designated community will be serviced in an effective, safe and timely manner through the allocation of human and physical resources by the organisation. To manage diverse demands and for effective service provision within existing resources, the speech pathology service may need to consider a system of prioritising both incoming referrals and the current caseload. The service is required to document their prioritisation process using clearly defined parameters such as health and safety, communicative urgency, social and employment outcomes or learning needs. Prioritisation systems will vary with consideration given to current community needs data, service delivery issues, organisational ‘charter’, evidence regarding ‘best practice’ for the setting, available resources and location. By documenting the prioritisation process in policies and procedures, the service is able to provide clients and referrers with a rationale for caseload decisions. Teamwork It is expected that speech pathologists will work closely with clients, their carers and other team members to provide comprehensive and holistic management. Other team members may include allied health professionals, medical staff, care staff, residential care staff, welfare support staff and educational advisers/teachers/teacher aides. Teamwork may be offered using a multidisciplinary, interdisciplinary or transdisciplinary approach. B.2.2 Individual Client Attributable Processes Referral The referral process to a speech pathology service is expected to be clearly defined and documented. This information may be available to the broader community and potential referrers. It is recommended that the service shall refer a client to other services if it is unable to offer specialised areas of management at any point in time from initial contact to follow-up. 4 Principles of Practice Consent It is a legal requirement to obtain permission and/or informed consent, either from the client, guardian or person holding power of attorney, prior to initiation of speech pathology services. The organisation is advised to obtain some legal advice as to the process to be followed by the speech pathology service, with consideration given to issues such as: • the definition of permission; • emergency situations; • the client’s capacity to provide valid ‘informed’ consent and power of attorney; • the age of the client and responsibilities of parents/guardians. Assessment The speech pathologist is required to undertake assessment as outlined in CBOS (Speech Pathology Australia, 2001) using both informal and formal assessment tools, in a timely manner, in order to plan management. It is recommended that the speech pathologist has access to sufficient and current assessment tools, resources and technologies in order to meet standards of practice as outlined in CBOS (Speech Pathology Australia, 2001). Treatment/Goal Setting In negotiation with the client and other team members, it is recommended that a management plan be established and documented, with consideration given to issues such as: • service delivery models and prioritisation processes; • identified needs and expected outcomes of service; • specific issues impacting on management and discharge planning. It is recommended that the plan specifies the process of intervention, outlining its relevance to impairment, activity and/or participation level breakdown, as per ICIDH-2 (World Health Organization, 1997), depending on specific needs. Strategies, responsibilities, timelines and outcome measures may be documented. The service is expected to support the speech pathologist’s access to current information regarding evidence based practice, upon which to base clinical decisions whenever possible. Examples may include: • direct electronic access to databases and journals via the world wide web; • library search facilities. It is expected that the speech pathologist has access to sufficient and current intervention/management tools (including a policy on the use of interpreters if necessary), resources and technologies in order to meet standards of practice as outlined in the Code of Ethics (Speech Pathology Australia, 2000) and CBOS (Speech Pathology Australia, 2001). Organisations need to be aware that for intervention programs delivered by other personnel or team members, some form of monitoring by a speech pathologist is required, as per the Code of Ethics (Speech Pathology Australia, 2000) sections 5.1.6, 5.1.7, 5.1.8, 5.1.9 and 5.3.4. The nature of the program is to be clearly defined to clients as per section 5.1.1. Principles of Practice 5 Speech Pathology Australia Discharge/Resolution Planning The service may provide guidelines to speech pathologists for the development of discharge/resolution plans from the current caseload. These plans may be initiated in conjunction with the client/carer and team when negotiating a service plan, during therapy or as an outcome of the prioritisation process. The plan may address issues such as timing of service, reporting responsibilities, outcomes expected at resolution, discharge destination, ongoing referral agencies or services required, review procedures or the need for a facilitated program. Due to a number of factors, it is acknowledged that some clients continue to experience ongoing communication or swallowing difficulties at the time of resolution/discharge from a service. It is recommended that a reason for discharge from the current caseload and a record of ability at resolution be documented. Follow-up may be necessary in some contexts to review if a client has maintained their optimal level of functioning, as determined at the time of resolution or prioritisation of the caseload. Counselling Speech pathologists may offer informative and affective counselling services within their field of expertise as part of any assessment and intervention. For any issues outside their professional knowledge and skills, it is recommended that speech pathologists refer clients to other professionals or counselling services. Client/Family Education The speech pathology service and speech pathologist have joint responsibility to provide education to clients and caregivers to ensure understanding of issues such as the speech pathology diagnosis, prognosis, treatment and risk management. This may be conducted on a one-to-one basis or in a group setting. Various training methods may be used, such as observation, modelling, feedback or workshops. Documentation It is recommended that minimum standards for clinical documentation are outlined by the service in terms of: • frequency of recording; • required content and formatting (e.g. date, discipline, goals, recommendations, discharge plan, follow-up and signature). Client documentation remains confidential at all times in line with the Code of Ethics (Speech Pathology Australia, 2000) and CBOS (Speech Pathology Australia, 2001). It is expected that the service establishes procedures for the preparation and storage of written reports, reflecting the method and results of assessment, service delivery models, goals of intervention and outcomes. It is recommended that these procedures also include reference to: 6 • the length of time records are required to be stored after the client is discharged from the service i.e. 7 years for adults; to age 25 for children (18 + 7 years); • Freedom of Information Act (1982) and Privacy Act (1998) (see Section E.4 for website). Principles of Practice B.3 Service Management Best Practice Statement: B.3.1 Organisations and speech pathologists have a responsibility to ensure that effective management practices are utilised with reference to the development and/or productivity of the service and quality of work life for staff. Human Resource Management It is expected that management will operate with due consideration to the award or contract entitlements of all staff and the documented human resource policies and legislative requirements of the organisation. In addition, the service is advised by Speech Pathology Australia of a number of minimum expectations for all practising clinicians working in Australia. Recruitment and Selection of Speech Pathologists With all aspects of recruitment and selection, the service is required to adhere to the relevant state and commonwealth legislation and policies and procedures of the organisation. Advertising for Applicants Advertisements for available speech pathology positions are required to include: • stipulation of qualifications required; • eligibility for practising membership of Speech Pathology Australia and registration where required. There may also be specific advertising guidelines for the organisation, in terms of the format and amount of information to be provided. For allied health assistants and other staff, reference should be made to preferred qualifications. Position Descriptions Each position in a speech pathology service is encouraged to have a corresponding position description that may be compiled by a senior speech pathologist or, in the case of a sole position, by the speech pathologist occupying that position in cooperation with the service administrator/s or another allied health professional. Where a new speech pathology service is being created, the organisation is expected to seek the advice of a suitably experienced speech pathologist. Speech Pathology Australia may also be of assistance at this time. The position description may include Selection Criteria and Performance Indicators, and cover areas such as the following: • clinical duties; • administrative duties; • managerial duties; • education/continuing education; • student supervision. Interviewing Interviews are to be conducted with adherence to organisational procedures to ensure fairness, impartiality and selection based on merit. This may involve using a panel of suitably qualified personnel, familiar with selection procedures and the requirements of the position. Principles of Practice 7 Speech Pathology Australia The panel is expected to include at least one speech pathologist with the necessary skills to ensure appointment of a suitably qualified and experienced individual for the position. The interview may be conducted face-to-face or by using distance communication systems, such as by teleconferencing or videoconferencing. Selection It is expected that merit-based selection processes be used to identify the successful applicant. Documentation is required. The selection process of a new staff member will be based on the criteria within the position description, performance at the interview and, when required, after references have been obtained from relevant sources provided by the candidate. Qualifications It is required that new graduates are not employed as speech pathologists until documentation is available from the university confirming their results, thus ensuring eligibility for practising membership of Speech Pathology Australia. Overseas applicants must be accepted by Speech Pathology Australia as eligible for practising membership prior to confirmation of offer of employment. Qualified speech pathologists who have worked for less than 1000 hours over five years are not eligible for practising membership and need to participate in Speech Pathology Australia’s Re-Entry program prior to employment. Registration In Queensland, practising speech pathologists are required by law to have current registration with the Board of Speech Pathologists. Contracts Employers are legally required to provide a written contract of employment for all new employees specifying terms and conditions. Familiarity with the relevant award and basic entitlements is recommended. Advice from a union, prior to signing documentation, may be beneficial. In some states or organisations, speech pathologists may be employed under an Individual Contract (as opposed to an Award or Enterprise Bargaining Agreement). Some contractors and others, such as speech pathologists operating in private practice, are advised to seek legal advice regarding recommended levels of professional indemnity and public liability insurance cover. Orientation and Induction The speech pathology service is required to ensure new staff have an orientation to the service and its principles and practices and, where possible, access to a general organisational induction. To assist new staff to better understand the needs of the community and clients during induction, demographic data may be provided about factors such as: • 8 socioeconomic and sociocultural issues i.e. languages spoken other than English in the community; Principles of Practice • common medical and speech pathology diagnoses; • disability categories and recommended levels of support. Leadership and Supervision Distinction is made between the availability of professional leadership, supervision and line management within an organisation. This involves clearly defining the roles of professional leaders and those of other general managers within the organisation. Access to professional leadership and supervision is a minimum expectation for practising speech pathologists. This may take the form of: • a hierarchical supervisory relationship with a suitably qualified senior clinician within the organisation; • access to a suitably qualified supervisor external to the organisation, such as a mentor; • peer and group processes. The organisation is expected to cover the cost of professional supervision, whether this is accessed from within or outside the organisation. It is recommended that the organisation makes provision for a suitably qualified professional leader of the speech pathology team, responsible for clinical supervision and strategic management, in line with both professional and organisational needs. It is recommended that professional supervision be recognised as a responsibility for which extra remuneration may be warranted. It is recommended that the professional leader of the speech pathology team have a background in speech pathology, especially in larger facilities/departments. Line management functions (i.e. responsibility for overseeing the general administration duties required by the organisation) may be provided using a range of models. In some cases, the professional leader may also perform line management duties. However, some organisations may have clear distinctions between the roles of professional leaders and those of other general managers within the organisation responsible for line management duties. Professional Development Speech pathologists are required to participate in ongoing professional development, as outlined in the Code of Ethics (Speech Pathology Australia, 2000). Speech pathologists are encouraged to participate in the Professional Self Regulation (PSR) program of Speech Pathology Australia. The speech pathologist and the service have joint responsibility to identify the training and development needs of the individual, including negotiation of access to relevant activities. This may or may not be associated with performance measurement strategies. Speech pathologists are encouraged to engage in self-education activities as part of their commitment to ongoing professional development. Self education, training and development may include: Principles of Practice • accessing library services and resources; • attending conferences, inservices, workshops, courses; • using online information services, teleconferences and telemeetings; • attending peer network meetings; 9 Speech Pathology Australia • involvement in special interest groups. There is an expectation for the service to support speech pathologists in networking with other speech pathologists and allied health personnel as an ongoing educational activity to enhance teamwork and maintain the provision of a current, high-quality service(s). There is an expectation for the service to encourage speech pathologists to participate in formal and informal mentoring practices as an ongoing educational activity, either internal or external to the service (see Section E.3 Speech Pathology Australia Mentor Program). Performance Management of Staff The speech pathology service is encouraged to conduct formal clinical performance appraisal and review of speech pathology staff at 6 or 12 month intervals based on position descriptions, annual job plans, or performance indicators that have been predetermined. It is expected that only relevant personnel conduct clinical appraisals. For example: • an established mentor; • immediate professional leader; • peers within the facility or external to it. Instances of inappropriate performance (e.g., disciplinary matters) are to be dealt with jointly by professional leaders/supervisors and line managers, in accordance with the organisation’s policies and procedures. It is recommended that steps be put in place to reduce the risk of recurrence. In instances where the speech pathologist is a member of Speech Pathology Australia, action may also be taken via report to the Ethics Board. In the instance of a complaint being made against the speech pathologist, it is expected that the individual will seek assistance from their professional leader/supervisor, mentor or from a senior speech pathologist. The organisation is expected to cover the cost of professional supervision if this is unavailable from within the service. Employee Relations and Industrial Issues While Speech Pathology Australia will respond to issues that have the potential to affect the standards of the profession, industrial issues may be more effectively addressed by a union. Union membership is voluntary. Legislation addressing award rates and the role of unions has altered significantly in the past few years. It is to the benefit of the speech pathologist to be aware of these changes and their implications for the workplace. For issues regarding pay-rates and grading levels, the speech pathologist is expected to seek assistance from supervisors and/or line managers in negotiations with the organisation. If necessary, contact with relevant unions may be of assistance. B.3.2 Business Planning Speech pathologists and professional leaders are encouraged to contribute to the formulation of a strategic plan for the service each year, documenting the projects and actions planned for the period. These are to be aligned with the core business of the organisation and will require ongoing review and evaluation in terms of funding, organisation of the service and workload parameters. 10 Principles of Practice Funding The organisation is required to provide an adequate and equitable budget to support the speech pathology service in terms of productivity, standards of practice and quality of work life. For example, provision may be made for: • salary and wages: professional and administrative support staffing (including factors such as ‘on-costs’ of productivity benefit, superannuation, leave loading, leave accrual, travel and accommodation, rural and remote services allowance etc); • operating expenditure (including items such as administrative resources and equipment, clinical resources and equipment, information technology systems, maintenance and repairs, professional resources, professional development costs, depreciation of equipment); • extraordinary expenditure (including items such as capital works, equipment replacement, upgrades, special project funding). Workload Parameters On behalf of the organisation, the speech pathology team may use information collected from clients, staff and research to define workload parameters (maximum, minimum or optimal workload ratios) reflecting the employment context, goals of the service and service delivery model. Workload ratios will vary within and across employment contexts. Some examples of workload parameters are: • a statement about the context; • a brief outline of the core business of the service; • a description of the service delivery models used; • client and non-client attributable time; • percentage of the working week recommended for clinical service management, teaching and training, research; • supervision ratios. Some examples of factors influencing the definition of workload parameters include: B.3.3 • responsible use of client and public money; • client outcomes and evidence based practice data; • client satisfaction with the service; • client health and well-being; • staff performance with regards to the ability to satisfy minimum standards of practice and/or complete the range of clinical and operational task demanded of them; • staff satisfaction, health and well-being; • staff supervision levels (considering experience and geographical factors); • access to professional development; • time for planning and preparation; • human resource maintenance (absenteeism and turnover); • length of the working day. Physical Resources and Facilities It is expected that speech pathologists have access to facilities that meet local government, state, territory and commonwealth legislative Principles of Practice 11 Speech Pathology Australia requirements, including Occupational Health and Safety policies, and ensure efficient and effective delivery within the model of service. The service and speech pathologists are referred to the Code of Ethics (Speech Pathology Australia, 2000) sections 5.1.7; 5.1.8; 5.1.11 for further information. The service is required to maintain physical resources and facilities necessary for provision of professional services to clients, considering the following: • • • Occupational, Health and Safety factors; productivity (effectiveness and efficiency); human resource maintenance. Work Environment Organisations have a legal obligation to provide a healthy and safe workplace. The service is required to establish and implement a plan in line with organisational policies and procedures for dealing with emergencies such as bomb threats, fire, weather, loss of electrical power and other events that may effect the safety of staff and clients. Back-care training is also recommended. The setting, clinical equipment and materials are required to be maintained in a sanitary condition and undergo any scheduled maintenance as specified by manufacturers. Infection control procedures are expected to be adhered to by all staff. An Occupational Health and Safety audit is conducted of the physical work environment on an annual basis, with management notified of any issues. Examples may include: • • • • training of new staff in Occupational Health and Safety issues and emergency procedures pertinent to their work environment; raising the awareness of staff that Occupational Health and Safety is a shared responsibility of both management and employees; adherence to workplace Occupational Health and Safety Standards (if available); participation in workplace Occupational Health and Safety Committees (if available). Information Technology Access to information technology can assist the speech pathology service in the delivery of client related services and service management. Examples of such technologies are: • • • • 12 email and Internet for research and communication; software for data collection and reports; software programs and hardware for intervention; software and hardware for efficient production of therapy resources. Principles of Practice It is expected that provision be made for adequate training, service maintenance, data protection (privacy) and back-up procedures to support any information technology system. Facility Development and Relocation Planning In relocating or developing the work environment, issues to be considered may include: • the speech pathology service delivery model (i.e., individual sessions, group programs, etc); • the nature of clinical work undertaken and associated special requirements; • administrative work undertaken and associated special requirements (i.e., phone systems, computers, photocopying, fax machines); • clinical and administrative resource storage and ease of access; • storage of files and records; • confidentiality/privacy issues for clients; • Occupational Health and Safety requirements – including infection control and fire/evacuation procedures; • clinical issues; • expansion of the service; • observation room and room for students. It is recommended that the professional leader or members of a speech pathology service be consulted and involved in negotiations around such relocations or developments, from the initial planning phases. Documentation of meetings may allow the tracking of decisions and agreements. During facility development and relocation planning, the service may consider the following, if applicable: • physical environment; • waiting areas; • reception areas; • treatment/intervention areas; • observation rooms; • administration areas; • student placement; • storage of professional resources; • storage of files and medical records. Information regarding standards is available on state government websites (see Section E.4). Physical Environment Compliance with commonwealth, state and local building, fire safety and accessibility codes is a legislative requirement. Principles of Practice 13 Speech Pathology Australia Relocation and development planning should consider the following examples: • lighting placement and levels; • indoor air quality and air temperature (including in photocopying area if applicable); • regulations regarding access for disabled staff and/or clients; • noise levels i.e. for conversation, clinical assessment and intervention, audiometry screening, privacy and confidentiality. Clinical areas especially may require sound treatment, and consideration of where they are located in relation to foot traffic, lift wells and other office and clinical rooms. Sources of information regarding the legislative requirements associated with these issues are provided in Section E.4. Waiting Area (if applicable) Consideration may be given to the following examples, if applicable: • ensure the location of the waiting area does not block a thoroughfare, with ample room for seating/wheelchairs; • access to reception area (if applicable); • access to public toilets; • adequate space to allow for a small children’s play area, if appropriate; • furniture appropriate for the needs of the clinic; • pamphlet rack or stand/noticeboard. Reception Area (if applicable) Consideration may be given to the following examples, if applicable: 14 • allows view of waiting area; • co-located to speech pathology staff offices; • allows interaction with either standing or seated clients without impediment; • ensures equipment or material that may contain client information may not be directly viewed from the waiting room area; • allows easy access to filing/storage areas; • reception desk/bench; • computer/printer and communication equipment (e.g., telephone, facsimilie access) to support work; • adjustable work desk (adequate for computer and writing area) and chair; • shelving for personal resources; • photocopy area with adequate ventilation and linked workspace to allow layout and material preparation; • separate lockable file area; • access to staff ‘mail boxes’ and easy view of service ‘location board’ (if applicable) from work desk; • information brochures; • wheelchair access. Principles of Practice Treatment/Intervention Areas Consideration may be given to the following examples: • accessible to waiting area - does not require clients to move through areas that may hold confidential client information (e.g., office area); • hand washbasin within treatment rooms, or immediately accessible to the speech pathologist; • flooring suitable to intervention type (e.g., carpet to assist sound treatment and/or linoleum for wet areas, carpet for a play area); • ‘wet’ areas for treatment areas as clinically indicated (e.g., paediatric feeding); • adequate storage for clinical resources used within treatment room; • adequate floor and workspace area, with space for a small group as required (e.g., carers/family members, interpreters, advocates, other clients etc); • wheelchair accessible treatment table; • power points at table height for easy access, as required (e.g., tape recorders etc); • wall/ceiling examination lights mounted if clinically indicated (e.g., head and neck caseload); • wall mounted mirror, or access to portable mirror if clinically indicated (e.g., rehabilitation settings); • food preparation area/equipment if clinically required; • facilities and means of infection control; • wheelchair access. Observation Room If an observation room is to be considered as part of the treatment area for specific training or assessment purposes, then the following fittings are expected to be considered: Principles of Practice • one way mirror; • screening capability internal to therapy room; • mounted wall cameras and audio/video capabilities. 15 Speech Pathology Australia Administrative Areas The office area of the speech pathology service is required to reflect the work patterns of the staff, whether located in a contained office, openplan office or co-located with a treatment space. For example, consideration may be given to the following: • adequate floor and workspace area to allow for accommodation of an ergonomic, adjustable desk (adequate for computer, telephone and writing area), filing cabinet/s, shelving for professional resources and visitor’s chair; • if open plan office area, rooms to be available to allow private discussion and individual supervision; • if not co-located, administrative area must be within close distance of the treatment areas; • adjustable work chair; • lockable filing cabinet; • shelving for professional resources; • access to telephone and computer to allow clinical and administrative requirements to be met (depending on work ‘flow’ within area, therapists may require individual access to ensure they can utilise the equipment when not engaged in direct clinical work); • space for project officers and research assistants. Sources of information regarding the legislative requirements associated with these issues are provided in Section E.4. Student Placement Accommodation for clinical students should be considered in any planning. This may include providing additional desk space, telephone and computer access and/or identifying work areas that may be ‘booked out’ by students. This may be multidisciplinary accommodation. Storage of Professional Resources A separate area may be necessary for the storage of professional resources. Consideration may be given to the following: • storage of professional resources should be readily accessible from the administrative and treatment/intervention areas; • storage areas should be lockable; • shelving should be adjustable to allow for variances in storage requirements (adequate shelving should be provided for items that require greater depth than standard items); • heavier items that are for use in a variety of locations should be mounted on a trolley or other suitable device to allow easy transport. Storage of Files and Medical Records Client records are confidential. Files must be adequately secured, ensuring confidential items are stored in a locked filing cabinet, compactus or other fitting, with this being within a locked office or record storage room. Adequate space and fittings must be provided for all current files, discharged files and archived records. 16 Principles of Practice Equipment The service is required to ensure that all equipment used is in proper working order and is appropriately calibrated and maintained as per manufacturer’s advice and as stated in the Code of Ethics (Speech Pathology Australia, 2000), section 5.1.11. Itinerant Services It is recommended that the organisation provide information to the recipient of the service, explaining the accommodation and any other requirements for the speech pathologist, prior to commencement of the itinerant service. Risk management assessment is recommended prior to commencement of itinerant services at new sites, to ensure the personal safety of itinerant officers, particularly if visiting private homes. If issues are identified, resolution is required prior to commencement of the service. The speech pathologist may negotiate individual arrangements with a contact person at each site for a workspace and support services, meeting all occupational, health and safety requirements. Examples may include: • quiet work space of appropriate size for client and caregiver contact; • access to phones and administration support for taking of messages; • access to a photocopier; • access to toilets and basic kitchen facilities; • specific work site health and safety requirements (i.e., procedures for fire drills); • specific work site procedures for client contact (i.e., child protection training, cardiac arrest procedures, wheelchair transfers). Where arrangements are found to be inadequate (i.e. placing clients or staff at risk), Occupation, Health and Safety processes may require services to be temporarily withdrawn until alternative arrangements can be organised by management. The weight carried by itinerant speech pathologists in transporting resources between work sites needs to be monitored as per state Health and Safety Guidelines and may involve individual risk assessment (see Section E.4). Back-care training is to be provided by the service to itinerant speech pathologists. The service is required to provide appropriate base facilities for accommodating itinerant speech pathologists. B.3.4 Marketing and Public Relations Speech pathologists have a responsibility to contribute to the positive public image of speech pathology and its services to the community through marketing, promotions and/or public relations, in accordance with CBOS (Speech Pathology Australia, 2001), while abiding by the Code of Ethics (Speech Pathology Australia, 2000) with particular reference to sections: 5.1.1 (Accurate information), 5.1.2 (Professional competence), 5.1.10 (Advertisements), 5.1.12 (Private benefits), 5.2.1 (Professional conduct), 5.3.1 (Professional standards), 5.3.5 (Public Statements), 5.3.7 (Conflict of interest). Principles of Practice 17 Speech Pathology Australia Advertising It is expected that all advertising be conducted within the Trade Practices Act, Code of Ethics (Speech Pathology Australia, 2000) and in a professional manner. It is expected that speech pathology services are promoted through channels and professional forums, such as the following examples: • listings in the telephone directory; • private practitioner’s associations; • letters to general practitioners/specialists and organisations; • conferences and trade displays; • journals and professional publications. Promotion of Services Speech pathologists are encouraged to share knowledge freely about research and clinical practice with colleagues and the community in conjunction with marketing their services. Speech pathologists and services have joint responsibility to educate and inform the community responsibly about policies, issues and trends that are associated with communication disabilities. Contact with the Media It is expected that speech pathologists seek guidance from supervisors, mentors and/or managers and access Speech Pathology Australia resources (see Sections E.1 and E.3) when planning media releases. The service is expected to document the procedure to be followed when contacted by the media about issues or cases. Speech pathologists are required to follow the guidelines of their organisation to protect patient confidentiality. Speech pathologists are not permitted to speak on behalf of Speech Pathology Australia unless authorised. Public Statements It is expected that speech pathologists exercise caution when making public statements to ensure information is accurate and suitable for the forum. Speech pathologists need to state clearly whom they represent when speaking to the media and public. It is recommended speech pathologists liaise with colleagues, supervisors and managers to ensure a consistent and timely approach for advocacy or promotion. Speech pathologists are required to represent employer’s views fairly and in accordance with the Code of Ethics (Speech Pathology Australia, 2000). Promotion of Speech Pathology Australia When representing Speech Pathology Australia members must seek permission from a member of Council or ensure their material is part of an agreed Association strategy for their Branch. When using Speech Pathology Australia logos/materials prior written approval must be obtained from the Association. 18 Principles of Practice Publications and Promotional Materials At all times in the development of publications and materials, speech pathologists are required to acknowledge the contributions of colleagues and sources of original material (seeking permission to use the material, according to copyright requirements). Refer to the Code of Ethics (Speech Pathology Australia, 2000). Care should to be taken to ensure materials published (in hard copy or electronic form on websites) are of a high quality and are accurate and professional. Professional Networks Between Organisations Speech pathologists are encouraged to represent client and Speech Pathology Australia members’ interests in appropriate forums concerning issues with health funds, public sector bodies, unions, employers, insurers, consumer groups, private practitioners’ groups, members of parliament and the general public. Speech pathologists are expected to identify and establish links with other associations and groups and explore the options and benefits of concerted action. B.3.5 Quality Improvement The organisation has ultimate responsibility for ensuring the quality, efficiency and effectiveness of the speech pathology service. On behalf of the service, it is recommended that speech pathologists manage the establishment of procedures to ensure ongoing quality improvement within quality improvement policies of the organisation and meeting Speech Pathology Australia standards, detailed in CBOS (Speech Pathology Australia, 2001) and the Code of Ethics (Speech Pathology Australia, 2000). It is recommended speech pathologists seek technical advice as to how to best collect and organise data, using information technologies, to facilitate queries and reports on various workload parameters, quality assurance measures, research activities and financial management. Measurement Methods The service and speech pathologists are encouraged to proactively explore, trial and provide information to their organisation about suitable measurement practices. Examples of data collected are: • objective, formal test/retest data; • observational or functional data through the use of outcome measures; • measures of unmet needs and waiting time; • client and staff perceptions of the service. Examples of methods of collecting this information are: Principles of Practice • file audits; • client satisfaction surveys; • focus groups and formal discussion forums; • case meetings; • clinical assessment (pre/post); • staff needs analysis surveys; • staff job satisfaction surveys; • time management audits; 19 Speech Pathology Australia • formal staff appraisal Management). Reporting Requirements and Advocacy (see Section B.3.1 Human Resource The service and speech pathologists have joint responsibility to ensure the organisation is informed about the effectiveness of the service. For example, information may be provided about: • staffing; • budgets; • resources and equipment; • facilities; • information systems; • procedures and processes. This is to be conducted in a manner consistent with the reporting procedures of the organisation. If these factors are shown to effect client outcomes or quality of work-life for staff (as this relates to absenteeism and/or turnover), there is an expectation that employing bodies explore ways to act on this information. B.4 Education of Others Best Practice Statement There is an expectation that the organisation will support the speech pathologist in conducting formal and informal teaching and/or training activities that relate to the imparting of knowledge, skills and clinical competency to others, as part of a structured program or through team collaboration (National Allied Health Casemix Committee (NAHCC), 2000). In addition to client and family members (see Section B.2), recipients of this education may include: B.4.1 • undergraduate students; • postgraduate students; • practitioners in speech pathology; • other professionals and assistants; • community groups. Clinical Education All practising speech pathologists are encouraged to contribute to the provision of clinical education and clinical placement for undergraduate and postgraduate level speech pathology students, work experience students and students of other health disciplines. There is a requirement that the clinical education of students and service delivery to clients adhere to the principles and duties described in the Code of Ethics (Speech Pathology Australia, 2000). When undertaken, there is a requirement that clinical educators provide support for students to conduct assessments and treatments and to engage in other forms of service delivery commensurate with students’ levels of experience, knowledge, competence and confidence to undertake the task at hand. The level of supervision, surveillance or online teaching can be direct or indirect as required, to enable student learning without jeopardising client care. Final year students should be encouraged to be self-directing and self-evaluating of their learning. 20 Principles of Practice The service is expected to have a supportive policy regarding clinical education that facilitates student placements and guides clinicians in relation to health, safety, and insurance procedures and provisions, and the rights of clients, staff and students. There is an expectation that the educational facility will provide clinical educators with preparation and support for placement, and with detailed documentation regarding the nature, objectives and assessment for any placement. New graduates are encouraged to participate in the clinical education of beginning and intermediate level students at the site through providing opportunities for observation and discussion. They are not expected to be the sole or main clinical educator for any speech pathology student’s placement. Responsibility for the clinical education and assessment of advanced students is ideally expected to be undertaken by more experienced clinicians (i.e., with a minimum of 12 - 24 months of experience). B.4.2 Staff and Community Education The speech pathology service and individual speech pathologists have joint responsibility to provide education to other professionals, therapy assistants, staff and community groups. Education is required to ensure others have an awareness of the needs of clients and an understanding of issues such as the speech pathology diagnosis, prognosis, intervention goals, useful strategies and risk management. Education may be conducted on a one-to-one basis or in a group setting. Various training methods may be used, such as observation, modelling, feedback, development and use of audio-visual resources or workshops. If a formal intervention program is to be delivered by other personnel or team members, organisations need to be aware that initial education and ongoing monitoring by a speech pathologist is required, as per the Code of Ethics (Speech Pathology Australia, 2000) sections 5.1.6, 5.1.7, 5.1.8, 5.1.9 and 5.3.4. B.5 Research Best Practice Statement: Organisations are encouraged to support individual speech pathologists and teams to undertake research. The speech pathology service and speech pathologists are encouraged to audit the service continually, identifying major issues pertinent to the relevant population and stakeholders as priorities for research, designed to advance the knowledge of the profession. Assistance in conducting the research may be sought as required from associated academic/professorial research units and/or universities and Speech Pathology Australia. Principles of Practice 21 Speech Pathology Australia B.5.1 Methodologies Research is required to be consistent with the particular organisation’s ethical procedures and/or guidelines, use suitable methods and be adequately resourced. This may include seeking formal ethical approval from the organisation. Use of suitable methodologies for the research question and the population (e.g., single-study designs, group studies, controlled experimental, qualitative approaches) is expected. Speech pathologists are advised to clarify issues regarding the intellectual property rights from research or any resource development they undertake. B.5.2 Funding Funding may be sought internally and/or externally to support the research. Examples of funding sources include workplaces, grants, scholarships, philanthropic associations and charitable organisations. Guidelines are generally obtained when an application is being made. B.5.3 Dissemination of Results Reporting of research efforts and results is encouraged, both within and outside the profession in accordance with the Code of Ethics (Speech Pathology Australia, 2000). This may include formal conference presentation, informal inservicing, media contact, and/or publication in professional journals. 22 Principles of Practice C. Definitions The terminology used in the Principles of Practice is defined as follows: • Contract: refers to a document specifying the status, time periods, remuneration, and conditions by which the member of the service is employed. • Line management: refers to the general administration of mandatory organisational procedures and daily operations, funding for resources, maintenance of facilities, access to organisational information and staff training, amongst other functions, to ensure high standards of service. • Minimum staffing levels: refers to the minimum number of staff (full-time equivalent) required to provide adequate service to a given population. Ratios of staff to clients will vary depending on a range of variables, such as type of caseload, travel times, other duties expected (refer to National Allied Health Casemix Committee documentation). • Physical resources: refers to the physical environment of the workplace, including building/s and equipment that are utilised by speech pathologists. • Planning: refers to the forward planning and scheduling of activities, services and projects. • Professional leadership: refers to management of the speech pathology team and individual speech pathologists, fulfilling the need for professional representation at an organisational level in terms of advocacy, policy development, team building, service development, monitoring and coordination, among other functions, to ensure high standards of practice. • Qualifications: refers to the minimum academic standards that must be met before an employee can be employed by the service. This relates to eligibility for membership of Speech Pathology Australia for speech pathologists. • Registration: refers to the situation in some states (Queensland only at the time of printing) in which a speech pathologist must meet the requirements of a Speech Pathology Registration Board and pay a registration fee, prior to being employed as a speech pathologist. • Service: refers to speech pathology workplaces in contexts ranging from health, community services, education and private practice groups. • Supervision: refers to the provision of profession-specific support and guidance to speech pathologists in relation to their clinical and administrative workloads, their work practices, and their professional goals as determined in performance appraisal. • Time management skills: refers to the professional’s ability to prioritise work, to work efficiently and to delegate appropriately (Davidson & Griffin, 2000, p.19). • Work environments: Work environments may encompass: shared intervention areas; shared office areas; individual intervention/office areas; the grounds and building a speech pathologist works within. Speech pathologists may work in one of the above work environments as well as delivering service in areas that are not under the jurisdiction of their employer, such as a client’s home, workplace or school setting. Principles of Practice 23 Speech Pathology Australia D. References American Speech and Hearing Association (1982). Proposed Standards of Practice. Australian Association of Speech and Hearing (1979). Recommended Minimum Facilities. Melbourne, Victoria. Australian Association of Speech and Hearing (1994). Standards of Practice. Melbourne, Victoria. Australian Association of Speech and Hearing (1995). Memorandum and Articles of Association. Melbourne, Victoria. Australian Association of Speech and Hearing (1996). Speech Pathology Assistants. Melbourne, Victoria. Australian Community Health Association (1993). Manual of Standards for Community and other Primary Care Services. Community Health Accreditation Standards Program (CRMP) (3rd ed.). Bondi Junction , NSW. Davidson, P. & Griffin, R. (1999). Management Australia in a Global Context. John Wiley & Sons Australia: Milton Guidelines for the Planning of Health Centres, Health Commission of N.S.W. and Government Architect Joint Working party pp. 25, 37, 38, March, 1977. National Allied Health Casemix Committee (NAHCC) (2001). Health Activity Hierarchy (Version 1.1). National Allied Health Casemix Committee (NAHCC) (2000). Draft Discussion Sheet. National Allied Health References Standards, Speech pathology Diagnosis/Indication for Intervention Speech Pathology Association of Australia (2001). Competency-Based Occupational Standards (CBOS) for Speech Pathologists. Melbourne, Victoria. Speech Pathology Association of Australia (2000). Code of Ethics. Melbourne, Victoria. Speech Pathology Association of Australia, Victorian Branch (1996). Guidelines for Good Practice. Melbourne, Victoria. Standards Australia (1994). Catalogue of Australian Standards and Other Products. Homebush, NSW. Standards of Australian Association of Speech and Hearing, July 1973, Child Health Centres – Standard Plans, Bureau of Maternal and Child Health, File No. 1292, Health Commission of N.S.W. – ref. Meetings of 26.2.69 and 14.12.72. The Australian Council of Hospital Standards N.S.W. (1993) World Health Organization (WHO) (1997). ICIDH-2 International Classification of Impairments, Activities, and Participation. Available: www.who.int/msa/mnh/ems/icidh/icidh.htm 24 Principles of Practice E. Further Information E.1 Council Structure Council Role Current information re: President • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Vice President Operations Vice President Communications Continuing Professional Development Member Networks Practice, Workplace and Government Professional Standards Public Affairs Scientific Affairs Principles of Practice International issues Inter-association liaison University relations Finances Budget Promotional materials Sponsorship activities Policy and Procedure Manual Councillor’s Handbook Member communications Website Speak Out Support for volunteers Awards Ethics procedures Professional Development Mentor Programs Reference Groups Special Interest Groups Government relations National Allied Health Casemix Committee Health Professions Council of Australia Medico-legal issues Industrial liaison CBOS University course accreditation Overseas qualifications Professional Re-Entry Professional Self Regulation (PSR) Principles of Practice Position papers Media liaison Promotional activities Consumer Task Group National Conference ACQ Research Task Group Data collection Advances in Speech-Language Pathology 25 Speech Pathology Australia E.2 Speech Pathology Australia Position Papers Under review. E.3 Other Speech Pathology Australia Resources Code of Ethics (2000) CBOS (2001) Speech Pathology Australia website at www.speechpathologyaustralia.org.au Speech Pathology Australia Mentor contact person in each Branch Professional Self Regulation booklet Re-Entry information Workplace Relations Reference Group in Practice, Workplace and Government Portfolio E.4 Topic References Topic: Available from: Equal Opportunity Legislation • Australian Human Rights and Equal Opportunity Commission (www.humanrights.gov.au) • Australian Privacy Commissioner (www.privacy.gov.au) • National Occupational (www.nohsc.gov.au) • Standards Australia and Quality Assurance Services Phone: 02 8206 6060 • Commonwealth Government Bookshops • State Government Workplace Health and Safety websites i.e. www.whs.qld.gov.au • Comcare Australia (www.comcare.gov.au/fs-ohs.htm) Occupational Health and Safety Standards and Work Environment Health and Safety Commission Clinical Education Contacts for Universities (available from National Office) Unions Practice, Workplace and Government Leaders of each Branch 26 Principles of Practice