Author: Brett McCardel, MS, CCC-SLP
Crafting patient-centered goals in aphasia treatment can be difficult. Factors include lack of time for SLP’s to plan/productivity demands, clients not feeling comfortable yet navigating the neurorehabiltation landscape, and the difficulty in articulating goals given the aphasia itself. Though both clinicians and people with aphasia report wanting to create more collaborative goals, the process to doing so can be tricky. Thankfully, Katarina Haley and colleagues have developed the FOURC Model (Haley, de Riesthal, Barry, and Cunningham, 2019).
Per Haley and colleagues: “The FOURC Model outlines a collaborative process for working with clients to identify and pursue self-identified goals, coordinate interventions, and achieve real life outcomes.”
In order to draft patient-centered goals, the model relies on Four Steps and Four Prongs. In this post, we’ll go over both parts of the model:
The Four Steps
Choose Communication Goal: To begin the process of goal setting, the client can describe their current life circumstance, their communication environment (i.e., who they regularly communicate with, their daily routines, etc), and their interests and current motivations. By utilizing active listening and Supported Conversation strategies, the clinician can help the client identify a goal area that is meaningful and relevant to their everyday life (such as reading a book to their grandchildren, or writing an email to a friend). If needed, an activity-based assessment such as the Assessment for Living with Aphasia (Kagan et al., 2011) or structured interview with LIV Cards (Haley et al., 2010) can be used as starting places for discussing what goals matter the most to the client.
Create Client Solutions: Once a goal is created, turn the client’s attention to the Four Prongs of the model (Skills and Abilities, Intentional Strategies, Environmental Supports, Confidence and Motivation) and explain that this goal can be addressed from multiple angles. Explain what the Four Prongs are, and encourage the client to brainstorm for themself what possible supports might look like for each prong. Doing this allows the client to take ownership of their goal and treatment plan, and allows the clinician to know of any special circumstances that need to be considered during treatment.
Collaborate on a Plan: Now the clinician can individually address each prong and add their input to the supports identified by the client. Considerations from other members of the treatment team (such as family members) can also be discussed at this stage.
Complete and Continue: Now that a plan has been put into place, it is time to enact the plan! It’s important to stress that this plan can always be updated and edited to best meet the client’s needs at any time.
Four Prongs
Skills and Abilities: This prong is focused on the language modalities themselves, and the client’s relative strengths and vulnerabilities in each. Since a functional goal has been determined (e.g., speaking at a wedding, texting a friend), the clinician can choose impairment-based assessments that more deeply assess the specific language skills in question and recommend treatment approaches that will best target these skills. For example, if your client is interested in texting, you may consider giving a spelling assessment such as the Arizona Battery for Reading and Spelling, and then utilize a treatment technique such as Copy and Recall Treatment on a set of core functional words deemed important by the client.
Intentional Strategies: These are strategies that the client employs themself to help support their communication skills (examples include self-cueing, metacognitive strategies, and AAC use). These strategies should be trained and practiced in a variety of contexts so that the client feels comfortable using them in any situation in where a communication breakdown may occur.
Environmental Supports: These are factors in the environment that are outside of the client’s control. Environmental supports come in many different forms, and can include physical supports (such as aphasia-friendly print material), reducing environmental distractions (such as having conversations in quiet areas), and supportive communication partners and communities (especially people trained in Supportive Conversation techniques).
Motivation and Confidence: This prong is concerned with the psychological needs of the client, and addresses adjusting to aphasia. Areas of emphasis may include education about aphasia, finding local and online support groups, connecting socially with others, and celebrating moments of success.
Taken together, the Four Steps and Four Prongs of the FOURC Model can be a powerful framework to help support developing meaningful goals. Crafting patient-centered goals can be challenging if you’ve not had much experience doing so, but the benefits are undeniable. While the clinician is the expert on speech and language, the client is the expert on themselves. When both perspectives are taken together, this collaborative process can lead to treatment outcomes that make an immediate and positive impact on your client’s everyday life.
Living in the Seattle, WA area and looking for client-centered aphasia treatment? Click here to learn more about the services we provide, or contact us at (206) 395-4259 / Brett@archwaysrehab.com
References:
Haley KL, de Riesthal M, Barry J, & Cunningham K. (2019). Setting goals for communicative life participation in aphasia. American Journal of Speech-Language Pathology, 28 (1), 1-13.