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Tuesday, October 8, 2013

Article: Family Friendly (Self-Anchored Rating Scale)

In the September 1 ASHA Leader, Lynn Fox describes the Self-Anchored Rating Scale, an approach to treatment that (read the entire article, HERE):
  • Helps clients and their families see how their beliefs and strengths are critical elements for successful treatment.
  • Avoids dissuading family members from their feelings and beliefs or persuading them that other strategies would be best.
  • Helps identify reasonable treatment goals.
  • Minimizes the family's frustration, uses their strengths and focuses on identifying solutions embedded in their story.
  • Reveals positive change as it occurs and promotes further change.
  • Uses evidence-based principles.
Introducing AAC may feel like a failure or an admission of defeat to families of nonverbal or minimally verbal communicators. Using the SARS as a starting place might be very helpful to temper the over-zealous SLP with big plans for the individual when introducing AAC to families who are not themselves pulling for it. I'll admit that it appears more aligned with the medical model (rather than a school setting), but the principals are solid!
Excerpt from Fox's article about working with a family after Mom's aphasia (50 years old):
"SARS links the clinician, the patient and the patient's family in a collaborative partnership focused on reaching the family's goals. It involves seven components.
  • Invite the family to join in a partnership...participate in each I could align my intervention with their resources and strengths. My role would be to plan intervention with [the patient's] family, not for them. At our first meeting, I began by asking family members to describe their understanding of the situation. I acknowledged differences among the family members and focused on where we found common ground.
  • Introduce the SARS.
    At the first session, the family and I began creating a SARS scale. I drew a vertical line on an open manilla file folder with 10 at the apex, 0 at the base, and the numbers 1–9 spaced evenly in between. Using the family's language, we anchored the scale with a description of their status shortly after the onset of aphasia and recorded that information adjacent to a number they assigned. Sometimes a family assigns a 0 to the description, but often they use 1 or 2, indicating that communication was possible but very difficult. I guided [the patient's] family to include a description of how she communicated, the challenges family members experienced and how they managed those challenges.
  • Identify the family's long and short-term goals.
    I began this step with a discussion of long-term goals by posing a question: "What will communication look like when Donna no longer needs treatment?" After the family described an ideal future outcome, we again wrote their descriptions on the SARS adjacent to numbers they selected. Each family member's assigned number became a visual shorthand for his or her expectations in relation to the other members of the family. For example, Donna's husband assigned a number slightly higher than Donna and their daughters, suggesting that he expected a more favorable outcome. I noted this difference in a neutral tone and encouraged the family to discuss their expectations openly. Such discussions help family members calibrate their hopes and accept that more than one outcome is possible.
  • Discover solutions that link clinician and family expertise. (link to descriptions in the full article, HERE)
  • Create change through small steps.
  • Give assignments that build upon the family's successes.
  • Recognize that change takes time.
Lynn Fox, PhD, CCC-SLP, is professor emerita in the Department of Speech and Hearing Sciences at Portland State University. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech Disorders; and 12, Augmentative and Alternative Communication. 

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