Abstract
This brief report describes a large-group application of the Communication Partner Instruction (CPI) training model as a means of improving the interactive skills of stakeholders who communicate with individuals with severe intellectual disabilities presenting complex communication and physical profiles. Findings support CPI for large stakeholder groups as study participants reported general satisfaction with both the training sequence and their use of skills learned 1 year post training.
Keywords
Speech-language pathologists (SLPs) have long recognized the value of incorporating stakeholders in communication intervention (Tufts & Holliday, 1959). Here, the term “stakeholders” refers to the interactive partners of persons with communication impairments. Stakeholder-inclusive training has historically involved the parents and peers of those with communication challenges (Choi, 2007; DeVeney, Hagaman, & Bjornsen, 2017; DiSalvo & Oswald, 2002; Mowrer & Conley, 1987). Only recently, the circle of potential stakeholders available for training has been expanded to incorporate those who may be less familiar to individuals with communication disorders (Ogletree et al., 2016).
The use of stakeholders in communication treatment has the potential to extend intervention into real-world, everyday contexts and increase the probability of meaningful, socially valid changes in communicative abilities. Although this possibility sounds attractive, questions regarding its implementation remain unanswered. For example, how do SLPs assist stakeholders with becoming effective intervention agents, and how can the impact of stakeholder training be maximized?
For decades, SLPs and others working in the field of Augmentative and Alternative Communication (AAC) have included stakeholders in training (Light, Binger, & Kelford Smith, 1994; Light, Collier, & Parnes, 1985). Studies examining stakeholder training have illustrated benefits to both stakeholders who were trained and individuals who use AAC (Binger, Kent-Walsh, Ewing, & Taylor, 2010; Collier, McGhie-Richmond, & Self, 2010; Kent-Walsh, Binger, & Hasham, 2010).
The Communication Partner Instruction (CPI) model is one popular stakeholder training model that has emerged from the AAC literature (Kent-Walsh & McNaughton, 2005). CPI is based on strategy instruction for adult learners (Ellis, Deshler, Lenz, Schumaker, & Clark, 1991) and includes the following seven training steps: (1) obtaining a commitment to participate in the training sequence, (2) administering a pretest specific to the skills to be trained, (3) providing a verbal description and physical demonstration of target skills, (4) requiring trainees to recount what they heard and observed in Step 3 while posing questions to assure comprehension, (5) offering controlled and closely monitored practice with trained skills, (6) providing advanced and more independent practice, and (7) administering a posttest to assess skills learned. In a review of stakeholder training studies, Douglas (2012) identified seven investigations where at least three CPI training steps were applied. The most frequent CPI training elements included pre- and posttesting, skill/strategy demonstration, verbal recounting of trained behaviors, and supervised skill practice. All seven studies identified by Douglas reported success with stakeholder training.
Recently, Ogletree et al. (2016) used CPI to train four stakeholders (i.e., communication partners of one adult with severe intellectual disabilities) to use three supportive communication strategies (providing AAC device access, communication opportunities, and modeling). Participants used trained skills more frequently after training, and, though not a dependent variable in the study, the adult with severe disabilities used her AAC device more to initiate with stakeholder participants at the study’s end. Given CPI’s effectiveness for this small stakeholder cohort, the authors of the current study questioned its possible use for larger groups of stakeholders. If effective in large groups, CPI would appear to have significant promise as a tool to extend the impact of therapy well beyond traditional therapeutic settings. For example, large numbers of residential, school, and community personnel could be trained at one time to implement communication strategies, paving the way for more successful interactions throughout the day of persons with severe disabilities.
This brief research report describes a large group CPI effort. The following two research questions were posed:
Method
Participants
Sixty-three stakeholders (hereafter referred to as participants) were included in the study. All were employees of a residential facility for persons with severe intellectual disabilities in North Carolina. Although “stakeholders,” as a group descriptor, certainly could include parents and peers of residents, these groups were excluded given that training occurred through the facility’s mandated continuing-education process and was closed to nonemployees.
Participants selected CPI training from several annual continuing-education workshops offered through their employer. Participants included SLPs (six), occupational therapists (four), social workers/pastoral staff (five), direct-care staff (24), educators (21), and facility administrators (three). Participants varied dramatically as to their academic and work histories. Approximately two thirds held undergraduate or advanced graduate degrees (n = 41) while one third reported high-school completion and/or some college preparation (n = 22). Just over two thirds of participants were female (n = 42). Participants reported between 1 and 30+ years of work experience with individuals with intellectual disabilities.
The six SLPs were essentially small-group facilitators. Each received an overview of and readings specific to CPI from the first author before training. Prior to the initiation of the study, the second author met with SLP participants to assess their knowledge of CPI. This group also participated in Day 1 of training described below. Subtracting SLP participants from the total large group, 57 participants were involved as “trainees” during all training phases.
CPI Training
Institutional review board (IRB) approval for the study was received from the residential facility by the second author before any study activities began. CPI training occurred over 3 months. During this period, the first author led four training sessions occurring 3 to 4 weeks apart. The first author is an American Speech-Language-Hearing Association (ASHA) certified SLP with interests both in intellectual disabilities and the CPI training model.
The first training day was an 8-hr presentation by the first author on the CPI training sequence. The session overviewed the CPI model and provided opportunities for participants to practice and learn CPI training steps. Embedded small group illustrations/activities allowed the presenter to “mingle” among participants, checking for information comprehension and application. At the end of the day, participants were asked to form six small groups (eight to nine participants) that included representatives of most if not all of the professional/paraprofessional subspecialties described above. All groups included one SLP who served as facilitator. Small groups committed to meeting once weekly during the 3-month training period. Each group was asked to select two or more goals they could achieve through CPI that would benefit one resident of their facility that they all knew. Goal selection was aided by SLP facilitators and included objectives such as learning how to prompt communication, offer choices, and create communication opportunities. Selected goals addressed facilitating both residents’ nonsymbolic and symbol communicative abilities (receptive and expressive capacity).
During Training Days 2 and 3, the first author met for 45 min with each CPI small group to discuss the CPI sequence and group progress (approximately 6-hr training days). Small groups, led by their SLPs, were allowed to apply the CPI training steps using strategies and skills that best fit their participants. Typically, these included lecture, discussion, modeling, and role-play. Pre- and posttests were administered casually with questions posed by the SLP leader and responded to orally or in writing by trainee participants. By Training Day 3 (approximately 8 weeks into training), groups had completed CPI Training Steps 1 through 5 on all selected goals. (The CPI training sequence is described in the literature review.) By Training Day 4, all goals had been trained through CPI Step 7 (sequence completion). This day, the first author met with each small group to discuss training and conduct an interview with participants about their perceptions of the training sequence. Afterward, all participants reassembled in a large group to present results from their small-group training sequences.
Data Collection and Analysis Procedures
In the first weekly small-group session following Training Day 1, all 57 trainee participants (excluding SLP facilitators) received a notebook to record their impressions of the CPI training sequence. Trainee participants were asked to write their perceptions of training strengths, weaknesses, and needs. Facilitators encouraged trainee participants to write at least one comment per week and reminded participants to do so during weekly small-group sessions.
During Training Day 4, trainee participants (excluding SLP facilitators) met in their small groups for approximately 20 min to share perceptions of CPI training. The first author prompted participants to discuss strengths, weaknesses, and needs of the training sequence. After responses, the first author occasionally sought clarification (e.g., “Explain that for me in a different way”) or requested additional information (e.g., “Can you tell me a little more?”). All responses were digitally audio-recorded with the participants’ knowledge.
Twelve journals were returned at the end of training (21.05% return rate) containing between three and eight comments each (total of 60 comments). All comments were clearly legible. In contrast, 92 distinct comments were recorded during small-group sharing that occurred on the first author’s Training Day 4. All comments (journaled and recorded) were transcribed verbatim by a graduate student in speech-language pathology with extensive transcription experience. Eleven recorded comments (10.2%) were also transcribed by a second graduate student. Point-to-point transcription comparisons revealed 100% agreement.
Two graduate students were asked to read the comments and generate broad themes related to participants’ perceptions of the effectiveness and efficiency of the CPI training sequence. Ten themes were initially identified and then collapsed to six after consultation with the first author. Three themes were generally positive and thought to reflect CPI program strengths. Three themes clearly reflected perceptions of CPI training weaknesses or needs.
One year after implementation of the CPI training sequence, the second author (an administrator in the residential facility) administered a brief survey to original trainee participants that provided the six themes from the original data analysis. Participants were asked to agree or disagree with each theme. An additional question was offered asking if participants had applied what they had learned in CPI training over the year following the training sequence. The follow-up survey was completed and returned by 16 trainee participants (28.07% return rate).
Results
Table 1 provides six themes generated from the analysis of written and oral comments from participants made both throughout training (written) and as training ended (oral). Evidence of all themes appeared in both the written and oral data sets.
CPI Training Themes.
Note. CPI = communication partner instruction.
Trainee participants responded positively to the structure, routine, and consistency of the CPI training sequence as it was presented in both large and small groups. They also identified small-group learning opportunities as a CPI training strength. Furthermore, participants appeared to appreciate the protracted nature of training, preferring it to a more traditional 1- or 2-day continuing-education format. In contrast, participants identified a lack of consistent participation as well as a lack of investment of some trainees as a training limitation and reported the time required for small groups as a program weakness.
After 1 year, trainee participants remembered the CPI training experience positively. For example, 94% of respondents agreed with the positive theme related to structure, routine, and consistency. In total, 100% of respondents reported agreement with enjoying small-group learning opportunities and agreed with the preference for protracted continuing-education training.
In all, 67% of respondents now disagreed with the theme that small-group training took too much time, and 75% disagreed with the idea that inconsistent participation was a problem. Finally, 56% agreed with the statement that some trainees lacked program investment.
Possibly the most noteworthy response in the survey related to whether trainee participants had applied information learned in CPI training over the year following training. About 87% of respondents replied positively to this question.
Discussion
This brief report described a large-group application of the CPI training model as a means of improving the interactive skills of stakeholders who communicate with individuals with severe intellectual disabilities who present complex communication and physical profiles. The rationale behind stakeholder training is obvious—the communicative success of individuals with ID will be advanced as more communicative partners learn about and provide needed supports. Although stakeholder training has been effective in smaller groups, this study sought to explore the effectiveness and efficiency of larger group training efforts.
The first research question asked if CPI could be successfully delivered to a large group of trainees. In this study, 57 trainee participants took part in CPI training that included one large-group training session conducted by the first author, three follow-up sessions conducted by the first author with small groups, and weekly small-group training sessions facilitated by an SLP familiar with CPI. One of the six themes from the study (trainee participants’ preference for this training in comparison to other formats) supported that CPI can be offered successfully to large groups. In this study, the CPI training package is best described as a hybrid of large- and small-group training opportunities. At least in this format, it appears that CPI is a viable option for large-group stakeholder training.
The second research question inquired about the perceived effectiveness and efficiency of CPI training by a large group of trainees. Initially, study themes (identified via the qualitative analysis of participants’ written and oral comments) suggested support for the training’s structure, consistency, and routine; its use of small groups; and its protracted nature. Dissatisfaction was reported with the time required by small-group training, and participants noted inconsistent involvement and investment of some trainees. One year after the training, trainees reported very high levels of agreement with positive themes and relatively high levels of disagreement with negative themes, suggesting negative impressions may have diminished over time. In sum, it appears that CPI was perceived as both effective and efficient. Most importantly, trainees who completed the final survey reported using skills learned during training.
Although this study is limited by the return rates of written journals and postparticipation surveys, it provides support for CPI training for large groups. Future research should explore the effectiveness and efficiency of CPI training with large stakeholder groups (including parents and peers) in other settings, such as schools and community programs, and whether variations of the hybrid small- and large-group training used here are feasible. Future efforts should also encourage more trainee reflections (written comments), include reflections of group facilitators specific to CPI effectiveness, and consider how learned skills impacted individuals for whom the goals were selected.
It is the hope of the authors that others will consider CPI as a large group or hybrid large/small group training to increase stakeholders’ competence as supportive communicative partners. The findings of this study support this idea for stakeholders of individuals with severe disabilities and complex communication and physical profiles.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.