JCPSLP Vol 21 No 3 2019

In a recent study, Klang et al. (2016) investigated the content of individual educational program (IEP) goals for students with CCN. They related the goals to the different levels within the ICF-CY (World Health Organization, 2007) and found that few goals were directed at the level of body structures or functions, and most were at the level of activities and participation. However, they noted that the majority of goals did not focus on broader outcomes such as interaction, participation and leisure activities and recommended that professionals need support to develop participation-focused goals. Ogletree and Pierce (2010) proposed that we redefine success in AAC for people with SID to move away from treatment outcomes such as pointing to a symbol or imitating a gesture to a broader definition of success that includes socially valid and functionally relevant outcomes. They echo the definitions of Carpenter, Bloom, and Boat (1999) and state four ideal outcomes as result in (a) increased self-esteem, (b) increased control over their life, (c) increased achievement and independence, and (d) joyful participation. Intervention goals need to include the outcomes identified by Carpenter et al. (1999) as well as being specific and measurable (Wade, 2009). There is research describing the difficulty clinicians have in writing goals and suggesting mnemonic devices and other strategies to support goal writing (Carlin et al., 2016). The SMART acronym is preferred by many although there are several variations of the acronym and there is no evidence that indicates that use of the SMART acronym improves goals. For clinicians working with people with a disability, there are other key aspects to goals that the SMART acronym does not cover such as functionality, generality and ease of integration (Notari-Syverson & As a lecturer in disability and AAC, the author developed the TEAM framework over a number of years as a way to support the conceptual understanding of students about how interventions link to each other and to the ICF. The framework was built on two documents. The first is the work of BILD in their Communication for Involvement toolkit (now out of print) which divided interventions into sections such as ‘profiling and information gathering approaches’ and “sensory and creative approaches”. The author found that this document assisted students to think about the type of approach they wanted to use but not the reason why they might choose this intervention. The second document that influenced the development of the TEAM framework was from Goldbart and Caton (2010). These authors reviewed the evidence for a range of interventions and divided them into groups including ‘ways of capturing and sharing information’, formal and informal approaches, training and participation. The TEAM approach has evolved with many revisions based on student feedback. It has been presented at two conferences (Smidt & Huzmeli, 2018) which allowed further development based on the questions and feedback from conference delegates. Taxonomy The aim of devising the TEAM framework was to provide a taxonomy of intervention options to allow student or novice SLPs working with people with a disability to focus their intervention and goals. The taxonomy uses the letters of the word TEAM (T) training, (E) expanding, (A) augmenting and (M) moving. Each letter is linked to a word that represents a category of intervention targets. Shuster, 1995; Smidt, 2010). TEAM framework

resulting from both developmental or acquired conditions and can be beneficial to support expressive communication for those who are symbolic communicators, and also for receptive language even for those who are unintentional. Beukelman and Mirenda (2013) state that there is no “typical” AAC user. However, graduating SLP students may have limited knowledge of AAC (Costigan & Light, 2010) which leaves them ill-prepared to recommend appropriate AAC interventions for their clients (Carlin et al., 2016). This is compounded by a lack of consistency in the way in which interventions are described in research (Snell et al., 2010). Snell et al. recommend the use of a taxonomy of treatment components to assist in genuine comparison of research evidence. Taking this a step further, a taxonomy can help clinicians to navigate the range of intervention options and identify which types of intervention might be beneficial for each individual. What is the goal of intervention? Current best practice (Brady et al., 2016) includes an expectation that all people, irrespective of their age, disability or current skills, are considered to have behaviours that have potential to be communicative (Ogletree & Pierce, 2010). This might imply that intervention will result in people moving along the continuum so that current unintentional communicators will become intentional or symbolic if the intervention is successful (Butterfield & Arthur, 1995). However, this is not always a realistic goal. Rather, a realistic goal might be to improve the overall success of interactions by achieving changes in the communication partners’ behaviours or in the environment (Ogletree & Pierce, 2010). For many people with severe intellectual disability (SID), the goal of intervention may not be that the person will develop new communicative behaviours but rather that there is a focus on improving participation and quality of life. It can be challenging for novice clinicians to devise appropriate goals that are realistic and achievable and to acknowledge that the goal might not result in the person to moving along the continuum of intentionality (Carlin et al., 2016). New graduates and those without prior experience in working with someone who is not an intentional communicator oftentimes seek to recommend intervention that will move them towards symbolic communication and this may result in communication partners having unrealistic expectations. Hustad, Keppner, Schanz, and Berg (2008) found that clinicians who were not experts in AAC tended to devise goals to improve oral-motor skills, language and speech, with fewer goals based on functional communication outcomes. In contrast, in a study of AAC experts by Lund, Quach, Weissling, McKelvey, and Dietz (2017), self-identified expert clinicians had more of a focus on participation, multimodal communication and on expanding a person’s repertoire of communicative intents. Dietz, Quach, Lund, and McKelvey (2012) found that many qualified practitioners who were experienced but did not regard themselves as specialising in AAC did not feel confident assessing clients for AAC, and the authors recommended that practice guidelines were needed to support those not experienced in AAC to align their intervention with the participation model. Carlin, Boarman, and Brady (2016) reported that student SLPs struggled with writing clinical goals particularly for those who rely on AAC and found it difficult to configure these goals to address different levels of communicative competence (Light & McNaughton, 2014).

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology