JCPSLP Vol 21 No 3 2019

Multimodal communication

TEAM A taxonomy of clinical decision-making for communication intervention in people with severe intellectual disability including AAC Andy Smidt

Planning intervention for a person with severe intellectual disabilities is complex and involves integration of assessment findings within a number of frameworks to create functionally relevant and client-focused goals. Novice clinicians frequently find this process daunting and may be tempted by published packages which may be lacking in evidence of their effectiveness. The heterogeneity of the population means that not all intervention packages will be suitable for all. This paper proposes a taxonomy to support student and novice SLPs working with those with intellectual disabilities to develop holistic, ecologically valid goals and identify suitable intervention approaches. S peech-language pathologists (SLPs) working with people with a disability need to be able to assess and plan intervention considering a range of factors including person-centred practice, the participation model (Beukelman & Mirenda, 2013), the tri-focus framework (Siegel-Causey & Bashinski, 1997), the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) or ICF-CY (for children and youth), and evidence-based practice (King, Batorowicz, & Shepherd, 2008). However, a novice SLP may be overwhelmed (Lum, 2005) by the availability of intervention packages claiming to be suitable for people with complex communication needs (such as http://www.icdl.com/), Hanen More Than Words (http://www.hanen.org/Programs/ For-Parents/More-Than-Words.aspx), Social Thinking (https://www.socialthinking.com), Talkabout (alexkelly.biz/ product-category/talkabout-books)) as well as a large range of apps for iPads and tablet computers. The option to utilise a ready-made package is tempting for many (Lof, 2011) but not all packages will be suitable for all clients and the heterogeneity of people with a disability requires provision of intervention based on the specific needs of each individual. Given the plethora of tools available to support the communication of people with a disability, it is unsurprising that students and novice clinicians feel overwhelmed with options (Lum, 2005) and may be tempted by interventions that are widely promoted rather

than those with highest evidence (Lof, 2011; McCurtin & Healy, 2017). In order for clinicians to make evidence-based decisions, they need to develop reasoning about a range of factors. It is therefore essential that students and novice clinicians are supported to develop that reasoning. Indeed, Kamhi (2011) argues that the most important thing that educators can do is to improve the clinical decision-making of future clinicians. He further argues that finding a research paper to support an intervention does not, in and of itself, demand critical thinking. A range of skills are needed to incorporate evidence into clinical decision-making for people with a disability (King et al., 2008) including listening, building partnerships with communication partners, counselling, collaboration, decision-making and goal-setting. There is a significant body of literature that describes working with communication partners including families and paid staff (Kent-Walsh, Murza, Malani, & Binger, 2015; van der Meer et al., 2017) which King et al. (2008) argue requires SLPs to keep family needs at the forefront of their thinking and planning. This is a complex process involving both sensitivity to client and family concerns, but also meta- cognitive skills that allow clinicians to incorporate a range of issues including impairment, functioning and quality of life (King et al., 2008). Intervention for people with severe intellectual disabilities The scope of intervention for people with a disability has broadened from a focus on specific communication outcomes to include a focus on functional outcomes and quality of life (Buntinx & Schalock, 2010). The implementation of the participation model (Beukelman & Mirenda, 2013) and the ICF (World Health Organization, 2001) has encouraged a focus on participation in community environments and on the impact of societal attitudes and resources on the quality of life of a person with a disability. People with a disability present with a broad range of complex communication needs (CCN) along a continuum of intentionality (Butterfield & Arthur, 1995) ranging from those who are not yet intentional communicators, to those who clearly communicate using symbols. Consideration of these many issues requires SLPs to have a clear understanding of these factors and how they intersect. Alternative and augmentative communication (AAC) can be beneficial for individuals who have communication needs

KEYWORDS AUGMENTATIVE

AND ALTERNATIVE COMMUNICATION CLINICAL DECISION-MAKING GOAL-SETTING NOVICE CLINICIANS SEVERE INTELLECTUAL DISABILITY THIS ARTICLE HAS BEEN PEER- REVIEWED

Andy Smidt

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JCPSLP Volume 21, Number 3 2019

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