Comprehensive Study Notes on Goal Setting in Multimodal Communication

Goal setting for multimodal communication (MMC) intervention is identified as an area that university students frequently find challenging.
A primary issue in current goal setting practices is the tendency to create goals that are far too broad in terms of the concepts being targeted.
In language development, particularly for emergent communicators, asking an individual to use all communication functions at once is unrealistic. This lack of refinement makes data collection nearly impossible.
There is often a lack of specificity regarding the representational level of communication. Goals fail to define exactly how an individual will demonstrate their intent during an exchange.
While functional and meaningful communication must remain the priority, the "how" of communication is critical for the MMC population.
Contrast with verbal communicators: For those who use speech, the method of communication (speaking) is known; the focus is simply on broadening vocabulary or functions. For MMC users, the specific mode or support used to communicate must be established and specified.

Clinicians must avoid placing an inherently higher value on symbolic modes of communication (e.g., words, pictures) over non-symbolic modes (e.g., gestures, facial expressions).
If an individual uses a gesture that is effective and efficient, there may be no clinical need to force them to select a symbolic mode to communicate the same message.
Example: If a person shakes their head "no" in response to a yes/no question, they have functioned as an effective non-symbolic communicator. Requiring them to then select "no" on a high-tech device is unnecessary and can be perceived as the communication partner being oblivious or unkind.
Increased specificity in communication modes should only be encouraged when there is a lack of clarity that causes confusion for the partner.

The traditional speech pathology metric of $80\%$ accuracy is often inappropriate for communication goals.
Communication accuracy is difficult to define and measure. For instance, if a partner starts a topic and the individual changes it, it is unclear if that constitutes an "inaccurate" response if the message was understood.
Focusing strictly on accuracy can lead to missing signs of meaningful progress. Communication should be viewed as an observable, functional, and meaningful interaction rather than a skill to be mastered with a percentage-based score.

Engagement Duration: Measuring how long a client stays near their MMC device while a partner models its use and provides instruction.
Joint Attention and Participation: Tracking how long a child remains engaged in an activity while a partner provides aided language stimulation (modeling), even if the child does not use the device themselves.
Initiation frequency: Counting how many times a child seeks out a partner specifically to use or engage with MMC.
Motoric Interactions: Measuring the frequency of reaching for or tapping an MMC tool.
Independence in Mobility: Tracking how often an individual independently moves to a new location while carrying their aided communication tools.
Mode Neutrality: Goals should value the individual's preferred mode of communication. Whether they use sign or an electronic device, the priority is that the communication is efficient and effective.

Non-Intentional to Intentional: For non-symbolic intentional communicators, the goal is to become more proficient at that stage while introducing more symbolic modes as a secondary focus.
Expanding Functions: Broadening the types of communication used, such as requesting a desired activity a specific number of times per session or requesting that an activity cease.
Expanding Contexts: Moving a skill from a specific activity (e.g., requesting to stop playing with cars) to diverse settings (e.g., dinner time, school vs. home) and different partners (e.g., mom, dad, teacher).

Context Specificity: Define exactly where the goal occurs (e.g., during a child-led literacy read-aloud or mealtime at home).
Representation Level: Specify the communication supports available, such as a Speech Generating Device (SGD) or a specific overlay (e.g., a $50$ -cell overlay).
Meaningful Criteria and Independence: Define the level of prompting provided by the communication partner, explicitly detailing minimum, moderate, or maximum prompting and the type of modeling used.
Method of Demonstration: For advanced users, this might involve sequencing multiple cells or words. For early-stage users, it may simply involve noticing or reaching for the MMC tool.

Sample Goal 1 (Self-Advocacy): When given unrestricted access to MMC supports and aided language input, the client will self-advocate by using symbolic language to protest during a non-preferred activity using expressive vocabulary (e.g., "no" or "I don't like that") following partner modeling during instances where pre-symbolic communication is observed (e.g., pushing behavior), occurring on $3 \text{ out of } 4$ consecutive data days.
Sample Goal 2 (Choice Making): By a specified date, when asked "What do you want to do?" during choice opportunities, the client will use a preferred method of symbolic language given no more than one direct verbal activity choice in more than $80\%$ of opportunities presented across $3$ consecutive sessions in naturally occurring contexts.

Interventions for Brianna should be functionally focused on activity participation, communication, and swallowing.
Long-term goals (spanning $2 \text{ to } 3$ years) can be broader, while short-term goals must be highly specific and meet SMART criteria.
Social and Emotional Communication: Short-term goals can target the top three most frequent emotions Brianna is currently unable to express. Providing specific vocabulary for these emotions (via signs or a communication board) can reduce frustration and the tendency to "lash out."
Functional Vocabulary (The Concept of "Stop"): Using the concept of "stop" or "cease" can replace lashing out behaviors. This is measured by the symbolic replacement of negative behaviors rather than simple accuracy percentages.
Assessing Success: Success for Brianna can be measured using a Likert scale (e.g., a happy face scale) to track her own satisfaction with school friendships, rather than just counting the number of friends she has.
Swallowing Intervention: Initial goals should focus on trialing different International Dysphagia Diet Standardisation Initiative (IDDSI) levels and implementing environmental modifications before setting specific dietary intake goals.