Interprofessional Caregiver Education, Training, and Wellness in the Context of a Cohort Model for Aphasia Rehabilitation

Abstract

Patient-centered care is extending the sphere of health care beyond the patient, focusing attention upon the family caregiver(s). In this context, patient–family relationships are at the center of consistent, well-developed interprofessional interventions that encompass caregiver education, training, and wellness. Cohort models of intervention include groups of patients who start and stop a program or intervention simultaneously. One such cohort-based service delivery model is an intensive comprehensive aphasia program (ICAP), which provides an ideal context in which to address holistic care for the person with aphasia and his or her family caregivers. The interprofessional family caregiver intervention program of the ICAP at the University of Montana is twofold: (1) speech–language pathologists and graduate student clinicians in speech–language pathology provide family caregiver education and resources, communication training, and psychosocial support and (2) a licensed professional counselor and counselor-in-training provide group counseling for family caregivers focusing on personal wellness, caregiving strategies, emotional health, and adaptation to significant life changes. The fusion of equitable interprofessional collaboration, along with the cohort model of the ICAP, allows for acquisition of knowledge, communication strategies, and coping skills along with the development of close, meaningful relationships with other caregivers and persons with aphasia.

Intensive Comprehensive Aphasia Programmes: a systematic scoping review and analysis using the TIDieR checklist for reporting interventions

“…In other words, rationales for comprehensive therapy and the need for or importance of each ICAP element (e.g., the cohort) were less clear. Two articles highlighted the need to address multiple levels of the ICF in the LIFT1&2 and Big Sky Montana ICAPs [104,111]. Another included a focus on multiple linguistic levels (e.g., from word to sentence) as a goal of the Boston ICAP [100].…”

“…A minority of articles provided specific rationales for caregiver intervention (LIFT1&2, Big Sky Montana) [104,111]. Only one article hypothesized about the rationale for involving a cohort, suggesting a cohort was necessary for shared learning, shared psychosocial experiences, quick bonding, and a shared focus (Big Sky Montana) [111].…”

“…A minority of articles provided specific rationales for caregiver intervention (LIFT1&2, Big Sky Montana) [104,111]. Only one article hypothesized about the rationale for involving a cohort, suggesting a cohort was necessary for shared learning, shared psychosocial experiences, quick bonding, and a shared focus (Big Sky Montana) [111]. Some articles in this review focused on a specific aspect of an ICAP and their rationale naturally linked to that aspect, for example, focus on intensive versus distributed treatment provision in LIFT3 [103], use of an experience sampling method in Louisiana [113], the importance of personalized goal-setting in Aphasia House [98], or the rationale for specific evidence-based therapies in PIRATE [112].…”

“…This level of detail does not allow for replicability of the intervention. The articles did not transparently or explicitly list resources used, however, Boston and Big Sky Montana ICAPs [100,111] provided links to clinician resources available online, and some listed specific software and hardware requirements. During data extraction, it was evident that materials used by clinicians would have been linked to the therapies provided, even if those materials were not described.…”

“…An article by Escher et al centred on Occupational Therapy work on the Boston ICAP including a focus "on IADLs [instrumental activities of daily living], leisure, social participation, and work or volunteering" [102,p.3]. Other ICAPs provided basic details on the involvement of other professionals as follows: counsellors provided counselling both for carers and people with aphasia and an informally recruited carer liaison helped to facilitate some of the caregiving sessions in Big Sky Montana [111]; researchers of unknown clinical background were described as running goal-setting sessions in LIFT1&2 [104]; a research psychologist developed cognitive retraining materials and tasks in Oklahoma [135]; a volunteer assisted with group sessions in Milton Keynes [116]; psychology students provided support to carers and a kinesiologist delivered tai chi sessions in Louisiana [113]; a clinical neuropsychologist delivered the intervention in Oklahoma [135]. As will be highlighted under TIDieR item 5, some ICAPs reported on different therapy approaches but did not provide detail on either procedures or providers.…”