Question
How can we write collaborative goals with patients with aphasia?
Answer
A great model for collaborative goal setting is the FOURC model developed by Haley, Cunningham, Barry, & de Riesthal in 2019. This is a great collaborative process that makes goal setting a more active process with our clients rather than a passive process. Instead of focusing on a person's problems, the FOURC model suggests that clinicians and clients think about how to build on strengths.
Dr. Haley has a really great website (https://www.med.unc.edu/ahs/sphs/card/resources/aphasia-goals/fourc-model/) describing the model. Some specific things to think about when we're planning to discuss goals with our clients is that we're not talking about the list of things that are wrong. Instead, we are asking, "Who are your communication partners?" Or, "What's important to you?" "How do you want to grow?" Or "What resources do you have that you can pull from?"
The four steps of the FOURC model are: choose a communication goal, create client solutions, collaborate on a plan, and complete and continue. It's an evolving process that we're doing over and over again. In each of those four steps, the FOURC suggests focusing on the following four areas:
- Skills and ability - which is related to the language modality
- Intentional strategies - such as self-cueing or metacognition. Meaning, what can the client do to help them think about things in each of those steps along the way?
- Environmental supports - such as trained communication partners and what the community knows about aphasia or how accessible print is in those environments?
- Motivation and confidence - What does the client know about aphasia, what's their aphasia knowledge? Can they do some self-reflection on their goals? And also thinking about choice and initiative.
Refer to the SpeechPathology.com course, Supporting Clients and Families Living with Moderate to Severe Aphasia, for more information on strategies and resources for delivering evidence-based services for people living with moderate to severe aphasia.
