Episode #99: Communication Partner Training for Health Care Professionals with Dr. Jytte Isaksen

Welcome to the Aphasia Access Aphasia Conversations Podcast. I’m Katie Strong and I’m  a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Dr. Jytte Isaksen. We’ll be talking about Making Communication about Healthcare Everyone’s Responsibility: Communication Partner Training for Health Care Professionals Jytte Isaksen is an associate professor at the Department of Language and Communication, University of Southern Denmark in Odense, Denmark. She has a background as speech and language pathologist. Jytte lectures in the speech-language pathology and audiology programs in evidence-based practice, qualitative research methodologies, neurogenic communication disorders including aphasia, and other clinical subjects. Jytte’s research is centred around communication with people with aphasia, for example communication partner training of health professionals, but she is also interested in outcome evaluation of aphasia therapy, involvement of people with aphasia in research, and supporting access and services for people with aphasia in low- and middle-income countries. A current research project of hers is about families living with aphasia and how to make sure that they get support throughout the care pathway. Jytte is a part of the international research group Collaboration of Aphasia Trialists, where she serves in the executive committee and as chair of the working group Societal Impact and Reintegration.     In this episode you will: Learn about the importance of trained healthcare providers who can communicate with people living with aphasia. Be introduced to the KomTil method of training developed in Denmark. Be inspired to consider how you might incorporate communication partner training with healthcare providers in your community. Katie: As we get started, I wondered if you could you tell our listeners exactly what is meant by communication partner training. And why is it so important for health care providers?   Jytte: Thank you so much, first of all, Katie and Aphasia Access for inviting me to talk about this topic that is very close to my heart. I think that conversation communication partner training, CPT, is defined in different ways in literature. But one of the definitions that I usually stick to is that CPT is an umbrella term that covers different types of complex interventions for communication partners of people with aphasia, and possibly the person with aphasia themselves. And why is it important to healthcare professionals? I would say it's important for everyone working with a person with aphasia because you need to be able to communicate with them. No matter if you are a nurse, or a physiotherapist, or anyone in the healthcare system. The secretary on the ward that needs to communicate with people with aphasia. You need to be able to express yourself in a way that people with aphasia better understand you, but also support them in their expression so that they can say what they really want to say, or some of it at least.   Katie: Absolutely. I completely agree. Being able to have conversations about your healthcare is just so important. So important. What role do speech-language pathologists play in the training of healthcare professionals?   Jytte: We play a very important role. I think it's a way of opening up participation in life, including in healthcare, for people with aphasia. Since we are the professionals especially trained in being able not just to treat, but hopefully also to communicate with people with aphasia, I think we as a profession are a good way into that. But I will later in this podcast talk about how other healthcare professionals can also be CPT providers. We have tried to do that in the project I will tell you about later today.   Katie: Yeah, that's so exciting. I'm really excited to talk about your work. I was wondering though if you could tell us how you got interested in the area of CPT.   Jytte: Yeah, that's a good question. Mainly because so many clinicians in Denmark were interested and still are interested in CPT. I think it was back in early 2000, some of my clinical colleagues went to the Aphasia Institute in Toronto, Canada and got trained by Aura Kagan and colleagues in the Supported Conversation for Aphasia, or the SCA program. They got back to Denmark, wrote a little bit about it, told a little bit about it, but it didn't really get that traction in the beginning. Maybe we weren't ready for that. I was more or less newly qualified at that time.   An evaluation of the Danish neurorehabilitation system was written up in 2011 and my now retired colleague, Lise Randrup Jensen from University of Copenhagen, was invited to evaluate and show the evidence around everything related to aphasia. What she enhanced in that evaluation was that there was moderate evidence that healthcare professionals trained to be better communication partners could have a different impact on people with aphasia’s participation. That was picked up mainly at that time by one medical doctor. I should say, this is my interpretation of everything. That medical doctor or consultant in neuro, I think it was acute neurology, she said “I want to have this implemented in this hospital. So, no matter who is working with people with aphasia here should be trained to be better communication partners.” So, I think they are very brave. They employed a clinician that was already trained at the Aphasia Institute, and they employed Lise as a researcher on this part-time. Then they started to train all their staff to do research on it and then it really started to get some traction. They not only wrote at some point a research article, but they were also invited out into different health professional communities. They wrote in the nursing magazine, and the physio magazine, and so forth. All of a sudden, so many people around the country knew about SCA specifically, and went back to their SLP asking, “Can we be trained in this method?” And, somehow, I got interested. It was very natural that I picked it up together with Lise and then we started to do research together.   Katie: It's fantastic, the energy, it’s such an the organic way that it came about. That seems really authentic and people being interested. All of the different disciplines. Showcasing and getting work out in interdisciplinary audiences is so important. Yeah, I love that story. Thanks for sharing. So, I'd like to get into a little more of the details. You've taken a lead role in training healthcare providers in Denmark, and I was hoping you could talk us through a little bit about how the training was developed and the philosophy behind your training.     Jytte: Yeah, as I mentioned previously, it was a lot of SCA going on, and there still is in Denmark. So many of us, Danish clinicians and researchers, have been to Toronto and gotten SCA training. But we got back with a material developed in a Canadian context with English speaking videos, and we had to do some adaption. But it was hard to know what could we change and still call it SCA. So, at some point, I was invited into a project at the local hospital in Espia, where I live on the west coast of Denmark. It was really a nurse at the acute ward there that also had read about SCA, and she went to one of the project people there saying, “I think we should be taught some kind of CPT.” And then it started.   So, our project man, he was very great at getting people together. Very funnily, he knew what SCA and CPT were because his daughter studied to be an SLP and wrote her master thesis about it. Lots of clinicians from that hospital, from the neurorehabilitation unit that the acute hospital usually would send their patients to, and then to the five surrounding municipalities that got the people with aphasia out where they lived afterwards. They got together, some researchers, me as an SLP researcher, and a colleague from public health. It wouldn’t be right to say we were doing something new. So, we were standing on the shoulders of the giants, like Aura Kagan and Nina Simmons-Mackie, and other people that have worked before with CPT. We invited healthcare professionals from all stages throughout the care pathway, but definitely also people with aphasia and significant others. At first, we started with studying, “What is going on here? How do you communicate in this area of Denmark? How does the transfer happen between hospitals and from hospitals out into community care?” We got some ideas on what could be better. But then we again invited people in to do some co-design and co-development with us. So, that was how it all started. But you also asked about the philosophy, Katie.   Katie: That's alright. Well, before we get into that, I know many of them might, but I'm not sure if all of our listeners know what you mean by co-design.   Jytte: Yeah, I'm not sure that I know that either, Katie.   Katie: Well, how are you thinking of it?   Jytte: I claim I use co-design in many of the things I do. By that, I mean we invite all of the relevant stakeholders in. Well not all, but at least some of the relevant stakeholders for whatever we were going to develop. In this case, it was a CPT program, but it was also some support materials, and we developed a few other things I can talk about later. We have done workshops with them [stakeholders] asking them different questions, very open questions in the beginning. Our overarching goal from the beginning was not to create CPT, or communication partner training. It was to create cohesiveness throughout the healthcare system. It would be a good idea, we assumed, that all the way from when you were hospitalized until you finished your treatment out in your own home or in the community, that you would meet staff that knew what aphasia was, that knew how to communicate with aphasia, that used some of the same support materials. So, we asked them very openly, “How could that look? What is needed for that to be a reality?” We were quite sure from the beginning that some training had to take place. So, really, the CPT program called KomTil that we developed was a part of answering that more broad question.   Katie: Yeah, it's really a beautiful way to get something to work. I think that's why it’s been so successful in your country, because you really brought it in from the ground up. People are truly interested, and then getting input from the health providers who are going to be using it, and the stakeholders, people with aphasia, family members. Thank you for sharing. I think that it's certainly something that's easier said than done, and you're showing us that it can be done, so thank you. So, did you want to remark on the philosophy?   Jytte: Yeah. So, I'm sitting here with the sheet in front of me. I think you will all be able to have a look at it and Katie will talk more about that later, where you can find it. But we have what we call our strategies and tools. There is a drawing, and it really looks like a dart board. There is a bullseye in the middle, and that is what is really most important to this training. It's also important for me to tell you that it has been people with aphasia and their family members that have told us what they found was most important. That strategy is called “person-to-person”. With that, we mean that in any kind of healthcare contact, it's important that both the person with aphasia, but also the healthcare professionals, remember that it's two humans really talking together. It's not about if you have aphasia or not, or if you are a nurse or not, it's about two people having to communicate. So, you need to try to work on creating a relationship. Be respectful to each other coming from different systems and with different points of view. The last point is to be honest about what you don't know or what you don't understand. When you don't understand what the person with aphasia is saying, instead of pretending, it's okay to say, “I'm sorry, I don't understand what you’re saying.” So, that's the bullseye of our figure.   The next circle around the bullseye is parted into two, and one is called “your court”, like you are part of the tennis court. Those are the strategies that you can do yourself without making too much effort. So, you could slow down your speech rate. You could have a natural tone of voice, knowing that you are speaking to an adult competent person. Emphasize key words in your oral speech. Have short sentences, yes-no questions, one question at a time. So, that simple communication advice that many of us are using with clients, but also advise other people to use with people with aphasia. Also take your responsibility in the communication because you know, or are being taught, in the CPT program that you really need to not control but be responsible for moving forward the conversation and providing support. Then the other half of that middle circle is “know your co-player”. So, know who is on the other side of the court. Try to think about, “Who is it that you are speaking with? How must it be to have aphasia and not be able to express yourself in the way that you would like to feel that you are competent and intelligent?” It’s as Aura Kagan always says, “the aphasia is masking who you are, and your competencies”. Make sure that there is enough time for the person with aphasia to give their response if you ask a question, or if they want to formulate something. Also, make sure that you understand each other. Try to check if, “What I understood you said was this and that. Is that true?” or “What I tried to say before was this and that, are you with me?”   Then there is the outer ring, divided into four parts and we call them “strategies”. They may be extra. Some of them are quite natural in communication and some of them are not so much. One tool could be “pointing”, so be more intentional about when you point at your body, towards things, and at the person you're communicating with. The next one is also rather natural. Try to use “facial expressions, gestures, body language”, and be intentional about it. Like right now as we are talking Katie, my hands are everywhere but it doesn't mean anything. But I could use my hands to be more precise in underpinning what I'm saying, and the same with my facial expression. Then the last two tools are the ones that are a bit more unnatural. “Write down keywords”. So, have pen and paper ready and write the keywords in whatever you were talking about. We’re talking about tools, Katie, then I would write down tools on this sheet of paper. You could also use keywords if you want people to point at different choices you give them. So, it can work as a support for what you say, but it can also be something you write down based on what the person with aphasia says to make sure, “Have I understood you right?” In the written keywords section, we also have drawings. So, we could draw to show something more visually. The last one is “pictures” or any kind of pictorial support. Especially the last two things, written keywords, drawings, and pictures, need some kind of preparation. You need to have pen and paper with you. You need to be willing to draw. Many people say to me, “But I don’t draw, and people can’t see what I’m drawing.” Also, the pictures. Either you need to prepare the conversation and have pictures with you, or have a tablet or a smartphone, or have physical pictures that you can point at and talk about. So that was a long explanation about the KomTil.   Katie: Beautiful. So, this KomTil graphic will be in the show notes. The reference will be there as well as the articles that Jytte’s talking about, so please check them out. I think brings [these strategies] to an intentional and simplified way. It really makes it make sense, breaking those things up into different areas. Wow, fantastic.   Jytte: Can I add one thing, Katie?   Katie: Of course.   Jytte: The idea with this model was also like, “Could we start in the middle, and actually solve or bridge over some of the communication challenges between us and the person with aphasia by just really being present and trying to build a strong relationship?” Or maybe a little bit more is needed. Maybe I need to slow down and do a little instead of starting in the outer circle with drawing or pictures because maybe it’s not needed. You should use it if it's needed. If not, no need to do it.   Katie: Yeah. That's so important. I was actually earlier this week having a conversation with our local aphasia support group. We were talking about how to talk with your health care providers, and I think they would agree that being treated like a person and having that relationship is really the place to start. Well, you all have not only developed this, but you also are training different healthcare providers, speech pathologists, or other disciplines on how to train other people on communication partner training. So, could you talk to us about what's important about consistency in this program? Also, how does somebody become a trainer?   Jytte: Yes. So as SCA, that also has a train-the-trainer model, we have made the same. Because it's really not good to develop something and then keep all the knowledge within that small group. We wanted KomTil to have its own life, so that people could get trained as trainers and then go out into their workplaces and train their colleagues. That would also mean that you would have KomTil trainers in many places with specific competencies that could underpin implementation, train new staff, do some refresher training. So, that was really the intention from the beginning. For this to be sustainable, we need a train-the-trainer model. This is then a little bit different compared to most other CPT programs. We have chosen together with the co-designers we had in the beginning that it was not only SLPs that could be KomTil trainers. Our very first group of KomTil trainers when we were still a research and development project was a good group of SLPs, but also OTs and PTs. We had a few nurses, we had a nursing assistant. I think that is almost what I'm most proud about, especially when I look at those trainers today. They got trained, I think it was back in 2018 we did that. Here where I live, the local hospital is just down the road. When I speak with that nursing assistant and nurse on the acute neuro ward and listen to them still doing the training, still inspiring their colleagues, I get inspired, and I get very proud as well.   Katie: What a beautiful thing. I mean, that's just oh wow!   Jytte: Yeah. Also, I guess it's different because in the beginning, it was very much assumed you had to know a lot about aphasia to be able to train CPT. But I think we have cut it down to a model. Yes, there is information about training, but what is really needed in order to be a good communication partner is not necessarily a lot of knowledge about aphasia. Many of them know something because they work with people with aphasia, but it's a lot about how best to communicate with people with aphasia, and then training in it. So, really just practice, practice, practice. We have continued using that model. At the moment, I'm training a group together with a colleague in Iceland online. I also train with another colleague, some Danish healthcare professionals, and again, not just SLPs. We have a nursing assistant, nurse, and special education teacher onboard in our current group. So, the model is like that.   You are also asking, “How can you become a KomTil trainer?” At the moment, we have been charging a little bit here in Denmark when we have trained people. The group in Iceland is my second group outside the country. My second online teaching experience and the first teaching experience was a very mixed group. I got contacted together with Suzanne Beeke, who works with CPT for family members, by the World Federation of Neurorehabilitation because some, not necessarily only SLPs, also medical doctors and neuropsychologists, were interested in receiving training. That was right ‘bang’ in the middle of the pandemic, so we met with them sometimes online. Well, they're all over the world, so we had to do that anyway. Then we agreed to make an online KomTil training for them. Now there are KomTil trainers in Egypt, Colombia, Serbia, Austria, and Greece. That was a crazy experience, but very fun. Some of the countries have really started using this and have trained their colleagues.   Katie: Wow, what an impact. What an impact. So, how many hours is the training for the train-the-trainer? What kind of investment of time do they put in?   Jytte: So, when we do the face-to-face package here in in Denmark, it's four full training days. We usually see them once a week for four weeks and would usually prefer a two-week break in the middle because we would like them to go out and use the KomTil strategies and tools themselves as well. When we have been training online, it's not just the training, we're also talking to them about how best to take a tool from one cultural context and not just do a linguistic translation, but also do a cultural adaption. But you can't meet for four full days on Zoom, you would go bananas. So, what I do with the group from Iceland at the moment is meet with them five times spread over five months. We expect them to read more and be a bit more proactive in acquiring this program because we can't be face-to-face so many hours online.   Katie: I love that there’s some adaptability in that. That's great.   Jytte: What they then learn when they become a trainer is to give what we call the basic training. The training package is developed for their colleagues then. It's a two times three hours training. Again with a two-week break in between so you can go out and do some practice from time one to time two. A part of the train-the-trainer program is also adult learning strategies, implementation, implementation science, and I think we change a little bit every time we do this. Because we are not there yet, and we probably will never be. But what we hear from our trainers is, “Oh, it's so hard to get out and implement this, we really need more knowledge than that.” So that's really what we are very much working on at the moment. To be a bit more sharp in how to talk about implementation and how to get some good strategies out to people that need to not just convince their managers to spend time, but also get the trained colleagues to use the strategies that we taught them. And not just for the first month, but for the rest of their working career with people with aphasia.   Katie: Absolutely. Well, this all just sounds fabulous. And it sounds like it's working. But how do we know for sure? Have there been any measures that have been developed for the training?   Jytte: Yeah, we did develop some measures. Not exactly as a part of this project because so many clinicians here in Denmark also use SCA. They still should do that, I think it's a great program as well. Together with Lise from University of Copenhagen, and Iben Christensen and students we developed the Health Professionals and Aphasia Questionnaire, HPAQ, and it has been tested. It's a 16-item, self-report questionnaire. It can be given pre-post training to the participants (i.e., the health care professionals). It's really measuring if they think that they have become better. “Do I know what to do when I don't understand a person with aphasia? Do I know what kind of support I have in the system? Do I know what to do when things go wrong?” But it is measuring it from one side. We still need outcome measures or tools to measure the exact conversation, but that could be an observation tool. Many of you know that Aura Kagan developed that for her SCA training. There's the Measure of Support in Conversation and Measure of Participation in Conversation.   Katie: Yeah, we can put those references and the HPAQ in the show notes too if people are interested in checking that out more.   Jytte: And then we need an outcome measure for people with aphasia. But of course, you can't measure that “you have been speaking with staff that was not trained, and then they went on training, and now they maybe speak with you in a different way” because people with aphasia would be hopefully long gone from that hospital or wherever the training took place. But it would be nice with an outcome measure measuring the communication accessibility and the level of support. The Aphasia Institute has done the different CAMS measures (the Communication Accessibility Measures in Stroke), I think it is.   Katie: I believe so too, yeah.   Jytte: There is a version for frontline staff, there is a manager's version and there’s also a version for people with aphasia, but it's very lengthy. And it has not been developed for this purpose, so I think there's still a gap there to be filled out.   Katie: Yeah, but some great things in the works and the HPAQ currently available. Fantastic. Well, I know in some of our previous conversations that this original project had some grant funding, but I believe that's ended now. But the program is still running today, and as you've been talking about, it sounds like it's growing, which is amazing. Can you share how the project has been sustained?   Jytte: Yeah, I have already said a little bit about the nurse and the nursing assistant down the road. So, we have those KomTil trainers from the first group of trainers. We have the training course we are doing face-to-face at the moment in Denmark, it’s our third one. Hopefully we will be able to offer those training courses in the future as well. I know I'll be giving one with a clinical colleague later this year. Here, I'm connected with University of Southern Denmark, and I teach future SLPs. They have an elective course in our master's program that they can choose. They get the train-the-trainer training if they choose that course. So, hopefully lots of clinicians will come out here. The first 25 came out last year, and I'll repeat it later this year in the fall.     Katie: Fantastic. Well, you talked about that this is really something that started in Denmark, but that has grown into a more global effort. I know you recently had a publication in 2022 in International Journal of Speech-Language Pathology (IJSLP) with some colleagues that aligns with the Sustainable Goal Development 17. Can you tell us a little bit about that? I'm not sure if I know all about that, and I'm not sure if our listeners do, but talk to us about the importance of that.   Jytte: Yeah. So, the Sustainable Developmental Goals 17 is about partnerships, especially partnerships between developed countries and developing countries. That was really the idea when we first got in touch with the World Federation of Neurorehabilitation. I forgot to mention India, actually, when I mentioned all those countries. It was India, Egypt, at that point, also a physician from Kazakhstan. So, different developing countries where the SLP services are not necessarily that good, and that are maybe even more dependent on other healthcare professionals knowing something about aphasia and being able to communicate with people with aphasia. Maybe there are not at all or very few SLPs at hand. So, that was really what the project was about at that point. Then we ended up sort of sticking the Sustainable Developmental Goals to the whole framework of the work we have done because it was a special issue (in IJSLP) on the UN Sustainable Developmental Goals.   Katie: Wow, that's just amazing. As I'm listening to all of the things that we've talked about today, really CPT training takes a community effort, right? It really seems like it takes a lot. I'm sure a lot of our listeners, and myself included, are thinking, “Wow, this is a really big effort. I'd love to see something like this happen in my own community, but it just seems so big.” Do you have any tips that you could share with clinicians or researchers who are listening who might be interested in starting something in their own facility or region?   Jytte: Yeah, I could say many things. First of all, I think I will say “just do it”. I mean, the whole story I have told here is that in Denmark, it has all been very grassroot-led. It was clinicians thinking this was interesting, let's go to Toronto. It was clinicians asking managers or their colleagues, “Why don't we teach you some strategies for you to be able to better communicate with people with aphasia?” And get some training. I know there's online training available, the Aphasia Institute. Get in touch with me maybe to see what we could do together. I think there are several people that could provide some training to you. Then go out, find your people that would advocate for this as well. Try to tell other healthcare professionals the consequences if we are not able to communicate well with our patients/clients with aphasia. There are so many devastating consequences, as many of you would know already. Also, when we just look separately at the healthcare system. Like we know that people with aphasia are communicated with less when they are hospitalized, they are at greater risk of different types of adverse events, they fall more. Maybe they take the wrong medication because they don't understand what we have taught them. They have longer hospital stays, they are at risk to get back into hospital again because of different things when they are discharged home. So many devastating consequences should talk to everyone really, no matter if you are a manager, or if you are the staff on the ground, that you should do this. I'm sure everyone would be a better healthcare professional if they have those strategies and tools in their working toolbox. It's not enough to be a great nurse, you also need to be a great nurse that can communicate with people with aphasia, in order to be a great nurse to that specific group of patients that you’re serving.   Katie: Absolutely. Well, I love this! You're inspiring. And the “Just do it.” I hear your message also in that we need to get out of our offices and really go out and start collaborations with colleagues. Beautiful.   Jytte: And I know many people do that already. Value that, but also spread it more. I know of many people training ambulance drivers and all sorts of staff. I think this could go on at so many different levels of healthcare and community.   Katie: I agree. You've got my wheels turning too. I spoke last month to the Michigan Stroke Program, and they are primarily frontline providers and a lot of EMTs, and so it makes me think a little bit about that continuum of care. I love it. Well, as we wrap up, any final thoughts you'd like to share with our listeners?   Jytte: Oh, that's a good question. I have already said “go out and do it”. I'm sure that so many of you support communication with people with aphasia every day. So many of your colleagues are already watching you when you do it. So, try to be a bit more expressive about that and say, “This is what I usually do, could you maybe try to do this?” It doesn't need to be complicated. That's really what we have tried to build into this model that I have talked to you about today. Don't start with pictures and keywords if you think that is complicated and not natural for your communication style. We can get most people to ask yes-no questions, or sit down, have a quiet conversation, and be respectful and slow down the pace. As we have said many times when doing this training, this is not rocket science at all. Many of us are doing this but teach everyone you meet on your road when working with people with aphasia to try to do some of the same things.   Katie: Absolutely. Well, Jytte, it's been a fabulous conversation. Thanks so much for joining us today.   Jytte: Thank you, Katie. It has been so nice to be able to talk about this.   Katie: Lots of food for thought. So, listeners, check out the show notes. I'll have all the links to the articles and the KomTil visual that you'll really want to make sure you take a minute to download and some other things that we talked about during today's conversation.   On behalf of aphasia access, we thank you for listening to this episode of Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to check out our growing library of materials, go to www.aphasiaaccess.org. And if you have an idea for a future podcast topic, email us at [email protected]. Thanks again for your ongoing support of Aphasia Access.         Contact information for Jytte Isaksen – Email [email protected]  Twitter @jytteisaksen   Resources Aphasia Institute - Supported Conversation Training – https://www.aphasia.ca/communication-tools-communicative-access-sca/ Aphasia Institute – Communication Access for Measures for Stroke (CAMS) https://cams.aphasia.ca/ Aphasia Institute- Measure of Skill in Conversation (MSC) and Measure of Participation in Conversation (MPC) https://www.aphasia.ca/health-care-providers/resources-and-tools/rating-scales/ Bertram, M., Isaksen, J., Toft, L. E., Olsen, A. M., & Breckling, M. (2021). Evaluering af projekt Forløb for borgere med afasi samt afrapportering af implementeringsopfølgningen KomTil – fra udvikling til drift. Unpublished report from University of Southern Denmark. Cruice, M. Johansson, M. C., Isaksen, J., & Horton, S. (2018). Reporting interventions in communication partner training: A critical review and narrative synthesis of the literature. Aphasiology, 32(10), 1135-1166.  https://doi.org/10.1080/02687038.2018.1482406 Isaksen, J., Beeke, S., Pais, A., Efstratiadou, E-A., Pauranik, A., Revkin, S. K., Vandana, V. P., Valencia, F., Vuksanovic, J., & Jagoe, C. (2022). Communication partner training for healthcare workers engaging with people with aphasia: Enacting Sustainable Development Goal 17 in Austria, Egypt, Greece, India, and Serbia. International Journal of Speech-Language Pathology. https://doi.org/10.1080/17549507.2022.2145355 Kagan, A. (1998). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12(9), 816-830. https://doi.org/10.1080/02687039808249575 Kagan, A., Black, S. E., Duchan, J. F., Simmons-Mackie, N., & Square, P. (2001). Training Volunteers as Conversation Partners Using "Supported Conversation for Adults With Aphasia" (SCA): A controlled trial. Journal of Speech-Language-Hearing Research, 44(3), 624-638. https://doi.org/10.1044/1092-4388(2001/051) Kagan, A., Simmons-Mackie, N., & Shumway, E. (2018). Revised rating anchors and scoring procedures for Measure of Skill and Measure of Participation in Conversation between adults with aphasia and their conversation partners. Toronto, ON: Aphasia Institute. Retrieved from https://www.aphasia.ca/wp-content/uploads/2020/05/VF-MSC-MPC.pdf Kagan, A., Simmons-Mackie, N., Victor, C. J., & Chan, M. T. (2017). Communicative Access Measures for Stroke: Development and evaluation of a quality improvement tool. Archives of Physical Medicine and Rehabilitation, 98(11), 2228-2236.e5. https://doi.org/10.1016/j.apmr.2017.04.017 Randrup Jensen, L., Fromsejer Heiberg, R., Isaksen, J., Berg-Beckhoff, G. (2021). 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Archives of Physical Medicine and Rehabilitation, https://doi.org/10.1016/j.apmr.2016.03.023       Acknowledgements – A special thank you to Serena Chase from the Strong Story Lab at Central Michigan University for her assistance in the transcription of this episode.   Please note: Be sure to scroll down to the next page to find the KomTil visual and citation.      Cite as: Bertram, M., Isaksen, J., Toft, L. E., Olsen, A. M., & Breckling, M. (2021). Evaluering af projekt Forløb for borgere med afasi samt afrapportering af implementeringsopfølgningen KomTil – fra udvikling til drift. Unpublished report from University of Southern Denmark.