JCPSLP Vol 21 No 3 2019

Training Intervention for a person with CCN typically involves working with a range of communication partners (CPs) – and specific goals need to be created to support CPs. Within the TEAM framework this is encompassed as training. For a person who is an unintentional communicator, training might involve training the CPs to communicate with the person using Key Word Sign (KWS) or using object symbols. For someone who is a symbolic communicator training might involve training the CP to use a high-tech device. Expand A significant part of any intervention is likely to involve taking a skill the person already has and expanding it. Within a functional approach to intervention, the goal may involve expanding the skill to additional communicative functions, communication partners or in different environments (for example, for a person who already uses a low-tech system to request food items, the goal may be to expand that to requesting other items). The person may not acquire new skills but will become proficient in using existing skills in more locations or with more CPs. Augment Augmenting may involve the addition of pictures, symbols or objects to someone who is using potential communicative acts (Sigafoos et al., 2000) or supporting the person to learn to use a new symbol system such as Picture Communication Symbols © (https://goboardmaker. com/pages/picture-communication-symbols) or Minspeak © (https://minspeak.com). Move The goal may not be that the person will move along the intentionality continuum; however, this is often what novice and student clinicians typically focus their goals on. It is essential therefore that this is included in the framework to support SLPs to consider whether or not the goal for this person is movement along the continuum or not. Within the TEAM framework the following definitions are used. Intervention target refers to the overall focus of intervention by which the goals will be achieved. The intervention may target training, expanding, augmenting or moving. Goal domain (in the red boxes) refers to the type of goal that will be developed. This is not written in SMART format and is not specific to the individual, vocabulary or environment. It identifies the broad area in which specific goals can be written. Intervention approach (in grey boxes) refers to the type of intervention that can be used in the goal domain in order to achieve the goal. To use the framework, the clinician first identifies the level of intentionality of the person and then considers intervention targets at each level. By selecting one or two goal domains (in red boxes), they can then identify suitable intervention approaches (in grey boxes) to achieve each goal. The TEAM framework can be used to identify suitable goals for each level (see Figure 1). This will be illustrated in a case

already discuss interventions and the body of evidence to support each one. Table 1 lists the interventions and provides a reference where the reader can find more information about each intervention. Only intervention approaches with evidence to support their effectiveness are included in the TEAM taxonomy. Case study Robert Robert is a 35-year-old man with an intellectual disability. He does not have any speech and doesn’t use any form of AAC. Robert will look at his communication partner and smile, he will turn his head to someone’s voice. He seems to recognise the voices of his favourite staff member Debbie. Robert likes music and lights and he will sit and look at the reflections on the wall of his room when the sun comes through the coloured glass in his window. Robert has limited mobility and uses a wheelchair. He likes to go out into the community with his carers and seems to enjoy the hustle and bustle of the shopping centre near where he lives. Robert will reach for preferred food items if they are placed near him and he will look at Debbie if he has finished eating and wants more food. Robert was the only child of older parents and they have now passed away, so Robert doesn’t have any visitors. He is often sad on the weekends when some of the other residents go home or have visitors. The staff at his group home would like to know whether they can use any AAC with Robert and they would also like advice about how to plan more activities for Robert on the weekends. Following assessment of Robert, the SLP has determined that he is not an intentional communicator but he is social and engaging. The SLP can see that the staff feel at a loss as to how to communicate with him and how to provide him with positive experiences each day. For an inexperienced or student SLP, this might be a tricky case and the clinician might feel that they have nothing to offer to Robert or his carers. Considering this case using the TEAM framework The first task would be to determine goal domains. The clinician can identify that there are barriers to his participation and, using the tri-focus framework, they would need to focus on Robert, his communication partners and the environment. The challenge is to then set specific functional goals and the TEAM framework will support them to do this. Table 2 describes each intervention target, goal domain and the specific goals for Robert. Writing goals using the TEAM framework allows clinicians to focus on participation and functional outcomes and to incorporate all three parts of the tri-focus framework (learner, partner and environment). Final comment To date, TEAM framework has been used to teach over 400 student SLPs in an undergraduate and postgraduate pre-service curriculum and has been positively received both by students who have used it to scaffold their reasoning in assignments and by the clinicians marking those assignments. To date, there are no studies that have measured its impact on student learning. Future research is needed to measure the impact of using this framework on student and clinician reasoning when writing functional goals and selecting appropriate intervention approaches for people with severe intellectual disability.

study at the end of this paper. Intervention approach

Once some goals have been identified the SLP can select one or more intervention approaches to achieve those goals. There are several excellent papers which review intervention approaches in detail. This paper does not review specific interventions but has identified papers which

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology