Background: Goal setting is an essential step in the clinical reasoning process
of speech and language therapists (SLTs) who provide care for children, adolescents
and adults with communication disorders. In the light of person-centred
care, shared or collaborative goal setting between the SLT and client is advised
in (inter)national guidelines. SLTs face challenges in implementing (shared) goal
setting as theoretical frameworks and practical interventions are scarce and less
applicable to use with a wide range of communication vulnerable populations.
Aims: A first step in developing theory and practical interventions is to explore
first-hand experiences of SLTs and clients about day-to-day goal-setting practice.
This study was guided by the following research question:What are the perspectives
and needs of SLTs and persons with communication disorders regarding
(shared) goal setting in routine SLT services?
Methods & Procedures: The qualitative study was carried out in the setting
of routine speech–language therapy services in community practices, primary
education and neurological rehabilitation in the Netherlands. Data collection
followed the principles of video-reflexive ethnography, using video footage of
goal-setting conversations to facilitate semi-structured, reflexive interviews.Data
analysis was based on reflexive thematic analysis. A total of 12 interviews were
conducted with client–SLT dyads, covering perspectives from children, parents
and adults with a range of communication difficulties and their SLTs.
Outcomes & Results: Data analysis resulted in four themes, of which two contain
subthemes. Each theme represents a central organizing concept found in
SLT and client interviews. The themes were identified as: (1) goal setting is a
complex process; (2) goal talk needs to be communication accessible; (3) communicative
participation goals are hard to grasp; and (4) the importance of
relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under
these themes.
Conclusions & Implications: SLTs are encouraged to view shared goal setting
as a process that needs to be explicitly planned and communicated with
clients regardless of their age or communication vulnerability. SLTs have expert
knowledge and skills when it comes to supporting communication and applying
these skills during goal talks might strengthen shared goal setting and foster a
therapeutic relationship. There is a need to concretely conceptualize and embed
shared goal setting in policy and clinical guidelines. The themes reported have
tentative clinical implications for developing such policy, and shared goal-setting
interventions for SLT practice, under the condition that SLTs and people with
communication disorders are continuously involved.
