Meaningful goal setting for communication disorders in acute hospital care: expanding the FOURC model

Abstract

Background The FOURC model was developed to guide collaborative goal setting between speech-language pathologists and their adult clients (Haley et al. 2019). It was first implemented in outpatient clinics for clients recovering with poststroke aphasia. Here, we present an extension of the model to acute hospital care, which means consideration of rapidly changing communication profiles, brief treatment periods, high information needs, and communication barriers that restrict patients’ control of their own medical and discharge needs.Methods & Procedures The extension was developed over a 2-year period by translating FOURC principles to practical circumstances and responding to feedback from practicing clinicians. The extension is structured around four foundational communication and participation goals to be used with all patients, a graded documentation rubric for these goals, and three of the four original FOURC intervention prongs. We illustrate application through four patient case examples that represent diverse diagnoses and levels of severity.Conclusions This acute care version of the FOURC model provides a structured approach to outcomes-focused, person-centered, and synchronized communication treatment during the first few days after hospital admission. Conceptually, the model supports patient engagement, effective communication with health care teams and families, and continuity of care. It was designed to support immediate intervention with measurable results by the time of discharge to home or the next level of care. Research is needed to determine whether our team’s informal observations of positive results are replicable and stable.