JCPSLP Vol 23 Issue 2 2021

Table 1. Both developer and clinician perspectives of implementation of the Social Brain Toolkit, according to the domains of the NASSS framework

Domain

Developers with people with ABI and their communication partners • Inclusion of people with ABI from project inception • Design for people with ABI and their communication partners • Involvement of people with ABI and their communication partners in considering implementation issues • Co-design of user interfaces with people with ABI • Use of self-updating web applications • Intentional similarity to common technologies such as video calls and online forms • Measurement of the clinical outcomes and experience of people with ABI and their communication partners • Communication of the Toolkit’s value in marketing, research dissemination and grant writing • Qualitative co-design and implementation studies of challenges for people with ABI, communication partners and clinicians • Continual monitoring of implementation challenges through an in-built feedback loop • Examine organisational issues through qualitative implementation studies to inform this and future iterations of the Toolkit • Flexible order of completion of interventions and modules • Optional completion of one, two or all three interventions • Automated monitoring of Toolkit logins, completions, and user satisfaction and experience • Ongoing support and guidance as part of Toolkit dissemination

Clinicians with people with ABI and their communication partners • Consider the individual complexities of their own ABI caseload in clinical practice

1. The condition

2. Technology

• First contact for troubleshooting by people with ABI and their communication partners • Use of a checklist of technology requirements with people with ABI and their communication partners • Devoting time to upskilling families in the platform/technology • Backup plans for technology failure/ unexpected outages • Championing and leadership by people with ABI, their communication partners, and clinical and management teams in their own contexts

3. Value proposition

4. Adopters

• Feedback of implementation through in-built feedback loop

5. Organisation

• Need governance, supervision and training within a service to support Toolkit’s delivery

6. Wider society

• Consider and respond to wider external social, political, technological and economic factors (e.g., COVID-19), or changes to disability insurance and health care benefit schemes

7. Over time

• Consider referral of people with ABI and communication partners to other interventions available • Considerations of modules available in session planning • Local monitoring of uptake • Local adjustments to functioning in response to shortfalls, disruptions, changes or pressures

framework more accessible to stakeholders. The NASSS- CAT interview schedule suggests developers ask clinicians about potential implementation barriers related to the medical condition of their patients/clients (in our case, ABI). Complexities ABI includes stroke and traumatic brain injury (TBI). ABIs often cause cognitive (Rooij et al., 2016) and communication impairments (Cock et al., 2020; Hewetson et al., 2017) with persistent and highly damaging implications for a person’s mental health (Mitchell et al., 2017), employment (Douglas et al., 2016; Langhammer et al., 2018), and social participation and relationships (Finch et al., 2016; Hilari & Northcott, 2017). People with ABI may also be experiencing concurrent challenges of homelessness (Young & Hughes, 2020) or domestic violence (Baxter & Hellewell, 2019). Therefore, the medically complex nature, psychosocial impact and comorbidities of the condition of ABI itself create complexity in the uptake of online treatments by people with ABI and their communication partners.

ABI and familiar communication partners such as family, friends and partners; (b) social-ABI-lity; social media training for people with ABI seeking to communicate online; and (c) interact-ABI-lity; communication partner training for unfamiliar communication partners, such as the public and

(Top to bottom) Rachael Rietdijk, Melissa Brunner, Leanne Togher, and Deborah Debono

paid support workers of people with ABI. Applying the framework

The NASSS framework (Greenhalgh et al., 2017) contains seven domains: the condition, the technology, the value proposition, the adopters, the organisations, the wider system, and the adaptation and embedding of interventions over time. Based on these NASSS domains, we describe the complexities of implementing the Social Brain Toolkit and potential ways to manage these issues from the perspective of both developers and clinicians (see Table 1). Domain 1. The condition The NASSS Complexity Assessment Tool (NASSS-CAT; Greenhalgh et al., 2020) was designed to make the NASSS

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JCPSLP Volume 23, Number 2 2021

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