JCPSLP Vol 23 Issue 2 2021

Reducing/managing complexities The Toolkit developers are speech-language pathologists and researchers in the field of ABI, and leveraged their expertise during development to facilitate the Toolkit’s clinical relevance and suitability to ABI. Moreover, people with ABI, their communication partners, and clinicians were included from project inception (Andersson, 2018; Titov et al., 2019; Varsi et al., 2019), and lay-language, accessible, captioned videos were created to engage stakeholders with the application of the NASSS-CAT to the Toolkit. In recognition of their expertise through lived experience, we obtained funding to pay people with ABI and their communication partners for this consultation. Although the Toolkit was thus designed considering the needs of people with ABI, clinicians will need to consider the individual complexities of their own ABI caseload in clinical practice. Domain 2. The technology The online platform used for social-ABI-lity and interact- ABI-lity is an off-the-shelf application. Through online accounts attached to a personal email address, developers edit and monitor the interventions, and users view videos, select answers via touchscreen or mouse, and type responses in self-directed learning. By contrast, the technology for convers-ABI-lity was custom-created in a collaborative, iterative process between the clinical research development team and a technology vendor. Users complete self-directed tasks between online video-conferenced treatment sessions with a speech-language pathologist. These include viewing videos, selecting and typing responses, and making and uploading recordings. Complexities The future availability of interact-ABI-lity and social-ABI-lity can be affected by the varying financial status, availability, licence subscriptions, and user terms and agreements of the commercial online platform on which they are hosted. For example, if the host platform company were to dissolve, a backup of the intervention contents would need to be maintained for hosting on alternative platforms. Unexpected outages of the platform may also affect user access. The bespoke nature of convers-ABI-lity raises other complexities, such as interoperability with future browsers and operating systems, requiring ongoing maintenance by the technology vendor. Additionally, convers-ABI-lity was designed for a larger screen, while interact-ABI- lity and social-ABI-lity are device-responsive. Although operational on smaller screens, convers-ABI-lity users may have a suboptimal experience if they can only access the Internet via mobile devices. convers-ABI-lity also requires a web-camera and microphone, either built into a monitor or smart mobile device, or in addition to a desktop. Users also need stable internet access for large file uploads and online telehealth consultations with the speech-language pathologist. Reducing/managing complexities The Toolkit’s user interfaces were co-designed with end-users, and their intentional similarity to everyday technologies such as video calling and online forms and booking systems aim to improve usability. Web applications also update automatically, do not require an installation process, and enable remote monitoring of progress and implementation. The off-the-shelf platform and device- responsiveness of interact-ABI-lity and social-ABI-lity may also facilitate their implementation.

Clinicians will find themselves as the first contact for technical troubleshooting by people with ABI and their communication partners using convers-ABI-lity. They may need to devote time to upskilling families in using the platform, and backup plans for technology failures. Clinicians may benefit from a checklist of technology requirements for clients/patients. The developers will also need to provide broader, ongoing online technical support, including reporting update requirements to the convers- The Toolkit offers a co-designed, evidence-based solution for people with ABI, their communication partners, and clinicians. convers-ABI-lity and interact-ABI-lity provide communication partner training (CPT), which is recommended in international guidelines as best practice management of cognitive communication disorders following ABI (Hebert et al., 2016; Togher et al., 2014). social-ABI-lity is based on current recommendations to train people with TBI in the safe and effective use of social media (Brunner et al., 2021). Despite the value and psychosocial need for both these forms of communication training, population need far outpaces global health care capacities to offer training face-to-face. Worldwide, stroke and TBI directly affect an estimated 86 and 49 million people respectively (Cieza et al., 2020), a number which is projected to grow continuously, and which does not include countless communication partners. In addition to this growth, there are large-scale shortages of speech-language pathologists (e.g., Commonwealth of Australia, 2014) qualified to provide CPT. Limited face-to-face health care capacity to meet the growing global burden of ABI makes the prospect of scalable online delivery models not only compelling, but potentially essential. Online delivery methods for psychosocial interventions have already shown national- scale increases in reaching marginalised groups who do not access traditional health care (Titov et al., 2019). CPT for people with TBI has also shown efficacy when delivered via telehealth (Rietdijk et al., 2020), and convenient online delivery meets an expressed need by carers of people with ABI for support that transcends geographical boundaries (Gan et al., 2010). Complexities To be considered useful, the Toolkit’s value must be apparent to people with ABI, their communication partners, clinicians, services, and funding bodies. Its value must outweigh the inconvenience or cost of offering it within private and public health services, and offer a “return” for funding investment or user fees. This will require concerted effort by the developers to communicate this value in marketing, research dissemination and grant writing, as well as championing and leadership by people with ABI, their communication partners, and clinical and management teams in their own contexts. Reducing/managing complexities The clinical outcomes and experiences of users must be measured to demonstrate the Toolkit’s value. To simplify this process, the developers have sought to incorporate these measures into the Toolkit itself. The team also systematically searched for market competition and consulted business and health economics expertise regarding commercialisation. The team also considered branding, with an internal member of the development team (Miao) ABI-lity technology vendor where necessary. Domain 3. The value proposition

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology