Person centred management approach

7.9 Goal setting and aphasia management should be person-centred and strength-based and should be considerate of Aboriginal and Torres Strait Islander models of health and wellbeing.

References: Armstrong et al., 2015: Qualitative study; Armstrong et al., 2019: Discussion paper

NHMRC level of Evidence: Qual

Rationale: Different worldviews may influence people’s preferences and their understandings of what makes interventions worthwhile or successful (Penn & Armstrong, 2017). This is important considering that aphasia may impact many aspects of a person’s life including family and community roles, ability to express cultural identity, and participation in education, employment, and social opportunities (see Statement 5.5). Some of these life areas may be especially important for younger people who have experienced stroke and aphasia (Armstrong et al., 2015; Cochrane et al., 2020; Katzenellenbogen et al., 2014). All of these areas should therefore be considered in goal setting and aphasia management in order to facilitate full reintegration into communities, which has been flagged as a key priority by Aboriginal and Torres Strait Islander people (Armstrong et al., 2015).

It should be noted that the notion of individual goals is a primarily Western concept and may not be used in some Aboriginal and Torres Strait Islander cultures (Armstrong et al., 2019). Identifying and yarning about the things people want to work on may be a more appropriate approach (see statement 7.8). The Shared Decision-Making Model (Agency for Clinical Innovation, n.d.) can be used as a starting point for yarning about this topic.

Speech pathologists should also take a strengths-based approach to their work with Aboriginal and Torres Strait Islander clients. In doing so, speech pathologists are encouraged to consider frameworks such as an Aboriginal model of health and wellbeing and social and emotional models of health and wellbeing to guide their work in goal setting and management. A resource that may guide this process is the National Strategic Framework for Aboriginal and Torres Strait Islander People’s Mental Health and Emotional Wellbeing (Commonwealth of Australia, 2017).

Speech pathologists are encouraged to consider:

●       working closely with family (including family members non-Aboriginal and Torres Strait Islander Australians would call ‘extended family’),
●       working jointly with other allied health colleagues (Cochrane et al., 2016),
●       making pre-discharge links with the client’s local Aboriginal Medical Service or preferred medical service if they are associated with one (see statement 7.11),
●       being flexible with therapy context e.g., including or excluding home visits depending on client’s preferences (Penn & Armstrong, 2017),
●       offering opportunities for the client to participate in yarning and social activity,
●       traditional healing and beliefs,
●       being mindful of co-morbidities whose treatment may take precedence (Penn & Armstrong, 2017), and
●       collaborating closely with ALO/AHW colleagues (see statement 7.6).

References: 

1. Armstrong, E., Hersh, D., Hayward, C., & Fraser, J. (2015). Communication disorders after stroke in Aboriginal Australians. Disability and Rehabilitation, 37(16), 1462-1469. DOI: 10.3109/09638288.2014.972581
2. Armstrong, E., Carmody, A., Robins, A. C., Lewis, T. (2019). Assessment and outcome measures for Aboriginal Australians with communication disorders. Journal of Clinical Practice in Speech-Language Pathology, 21(2), 50-57.