Neuropsychologists operate within increasingly complex organisational contexts where advocating for client rights intersects with organisational priorities, budget constraints, and competing stakeholder interests. This presentation examines the neuropsychologist's role as a rights-based advocate within organisations and for our clients. Dr. Marot will discuss practical approaches to systemic change, including how to articulate neurodiversity and neurocognitive difference as organisational assets rather than deficits, how to challenge ableist bias, and advocate for equitable access to neuropsychological services and support. The session will explore tension points between individual advocacy and organisational requirements, with strategies for navigating these effectively and ethically. Case examples from Australian organisational contexts will illustrate how structured neuropsychological input can influence better individual outcomes alongside potential policy and practice improvement.

Background: Across jurisdictions, guardianship-related capacity assessments are increasingly expected to reflect rights-based practice: supporting the person to participate in decisions, eliciting their will and preferences, and documenting why less restrictive options are insufficient before substitute decision-making is considered (Browning et al., 2024; Kohn & Blumenthal, 2014; McSwiggan et al., 2016). However, there is limited practice-based evidence on how consistently these principles are documented in real-world health settings, or how services can monitor implementation over time. Tasmanian reforms commencing 1 September 2024 (Guardianship and Administration Amendment Act 2023 (Tas)) provided a timely opportunity to examine these issues in practice.

Aims: To audit documentation of (1) supported decision-making (SDM), (2) will and preferences, and (3) least-restrictive alternatives in guardianship-related capacity assessments, and to examine associations between these domains and cohort differences over time.

Methods: Retrospective audit of de-identified cases from two periods (Jun–Aug 2024 vs Jun–Aug 2025) in a Tasmanian public health setting; cases aged <65 were excluded. SDM documentation was graded 0–4 (0=no evidence; 4=multiple strategies plus the person’s response/why insufficient). Will and preferences were scored 0–2 (0=not stated; 2=elicited with values/rationale/consistency). Least-restrictive alternatives were scored 0–3 (0=none; 3=trialled with outcomes/why insufficient). Nonparametric analyses examined cohort differences and associations.

Results: N=19 cases met inclusion (2024 n=8, mean age=82.2 years; 2025 n=11, mean age=84.6 years). SDM was operationalised (SDM≥2) in 52.6% and best-practice SDM (SDM=4) in 15.8%. Will and preferences were meaningfully elicited in 15.8%. Least-restrictive options were trialled with documented outcomes in 52.6%, while 36.8% had none documented. Documentation domains were strongly associated: SDM correlated with will/preferences (p=0.0015) and least-restrictive documentation (p=0.0028), and will/preferences correlated with least-restrictive documentation (p=0.0050). Pre/post comparisons showed no significant change in threshold indicators (all p>0.05), including SDM≥2 and least-restrictive trialled/planned. Assessor-note SDM documentation increased from 12.5% to 36.4%, although the trend was not statistically significant (p=0.338).

Conclusion: Findings highlight a translational gap between rights-based principles and routine documentation of capacity practice. Although post-reform differences were not statistically significant, higher-quality SDM documentation aligned with better documentation of will/preferences and least-restrictive alternatives, suggesting these domains function as an interconnected practice set rather than standalone requirements. For clinicians and services beyond Tasmania, this audit offers a practical framework for examining whether contemporary legal and ethical expectations are visible in everyday assessment records, and supports the use of targeted prompts, training, and repeat audit to strengthen implementation.

Formal clinical neuropsychology training equips practitioners with structured frameworks and ethical guidelines reflecting ideal, best practice. However, the realities of working with clients from diverse, underrepresented backgrounds can challenge our sense of competence and ethical clarity as a clinician. The aim of this session is to facilitate self-reflection and collaborative learning by sharing my own experience of working with highly diverse clients as a culturally diverse clinician. I hope to share some of the insights and ethical dilemmas encountered while working with client groups that many colleagues rarely have the opportunity to serve. This includes First Nations clients from regional and remote areas; people who are profoundly deaf and people from refugee backgrounds.

Rather than providing prescriptive solutions, this session aims to highlight the lived realities and ethical tensions that arise in this work. Through case examples and personal reflection, I will explore issues like: How do we navigate the tension between professional guidelines and cultural safety? What does it mean to practice self-reflection when our own cultural frameworks are fundamentally different from those of our clients? How do we reconcile the desire to “do no harm” with the recognition that standard assessment tools and interventions may not be culturally appropriate or meaningful?

This talk will encourage clinicians to critically examine their own assumptions, biases, and practices when working with diverse client groups. Participants will be invited to engage in self-reflective practice, consider the complexities of ethical decision-making in cross-cultural contexts, and leave with questions—rather than answers—to guide their ongoing professional development. This session is designed for psychologists committed to deepening their understanding of ethical practice in the face of real-world complexity and diversity.