Supporting evidence-based practice in speech-language pathology: A review of implementation strategies for promoting health professional behavior change

Photobiomodulation on vocal training and rehabilitation: Delphi consensus based on experts

PURPOSE

To develop a consensus among speech-language pathologists who are voice specialists regarding the criteria for recommending and using photobiomodulation in the context of vocal therapy and training.

METHODS

Seven speech-language pathologists, experts in voice, and with experience in using photobiomodulation in vocal therapy and training participated. The Delphi technique was used to achieve consensus from a panel of experts accessed independently in two phases of collection. In Phase 1, the experts were contacted individually and participated in an interview with 12 questions to gather opinions on the use of photobiomodulation in the investigated context. The experts' responses were used to construct a questionnaire with 55 items presented as statements. The experts were asked to analyze each item and indicate their level of agreement on a five-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of agreement among the judges and to select the final items of the consensus.

RESULTS

Consensus was reached among the experts on 34 items investigated in this study, with a CVC ≥ 0.75. It was observed that 31 items achieved an excellent CVC (≥ 0.78), 14 items with a good CVC (0.60 ≥ CVC ≤ 0.77) and 10 items with a poor CVC (≤ 0.59). The total CVC was considered excellent, with a value of 0.78.

CONCLUSION

There was a consensus among experts about the use of photobiomodulation in vocal habilitation and rehabilitation. It has the potential to improve the criteria for prescribing and using this device by speech-language pathologists. The findings may be useful to improve the criteria for prescribing and the use of this device by speech-language pathologists, in addition to subsidizing the development of future research and clinical recommendations in the area.

Quality Assurance of a Hospital-Based Auditory Verbal Intervention for Children with Hearing Loss

Background: Auditory Verbal Therapy (AVT) has spread globally in the past few years due to its proven positive effect as a rehabilitation method for children with hearing loss (HL). In 2023, a three-year hospital-based AV intervention was implemented in Denmark as a government-funded offer to all children with HL. In the present study, we introduce and study a protocol for facilitating this implementation with a specific focus on clinical applicability and quality assurance. Methods: A working group was set up to drive the implementation process and establish a base for clinical collaboration and coproduction. The final protocol included (1) regular workshops and meetings with all AV specialists, (2) the creation of a database to collect data on the effect of the intervention, and (3) mandatory testing of the auditory skills and receptive vocabulary of the children with HL and a screening of their behavioural and emotional status with the Strengths and Difficulties Questionnaire (SDQ). Results: Data from 53 children with a mean age of 6.6 years were analysed in this study. Results from the SDQ showed that the children scored like the Danish norm on both the SDQ total difficulty score and SDQ prosocial score. Conclusions: This study's findings indicate that children with HL, who participated in three years of hospital-based AV intervention, demonstrate the same emotional and behavioural problems and the same social strengths as their hearing peers. We hope that this study can inspire and guide others who want to implement an AV intervention in a hospital setting.

Development and evaluation of an online professional development course to support delivery of tiered school-based rehabilitation services

PURPOSE

The Facilitating Integration of Rehabilitation Services Through Training (FIRST) Course provides online professional development on tiered service delivery models for rehabilitation professionals working in education settings. Created by content and e-learning experts, this study describes our use of the Analysis, Design, Development, Implementation, Evaluation (ADDIE) instructional design model and the Successive Approximation Model (SAM) to develop, implement, and evaluate the FIRST Course, and reports the findings of an initial program evaluation.

METHOD

Rehabilitation professionals who completed the FIRST Course were invited to complete a cross-sectional survey to evaluate its utility.

RESULTS

Between May 1, 2020, and August 11, 2023, 314 occupational therapists, 54 physiotherapists, and 170 speech-language pathologists completed the online course and survey. Respondents perceived the FIRST Course content to be relevant to their practice and to meet their learning needs regarding tiered services in education settings. Most respondents viewed the course positively and would recommend it to colleagues. More experienced respondents suggested a need for training on tiered service delivery models beyond an introductory level.

CONCLUSIONS

The ADDIE and SAM instructional design models were successfully applied to develop, implement, and evaluate online professional development for school-based rehabilitation professionals who wish to learn about tiered service delivery models.

Identifying Implementation Strategies to Increase Augmentative and Alternative Communication Adoption in Early Childhood Classrooms: A Qualitative Study

PURPOSE

The goal of this study was to identify promising implementation strategies that may increase teachers' and speech-language pathologists' (SLPs) adoption of augmentative and alternative communication (AAC) during routine classroom activities.

METHOD

A grounded theory approach was used to collect and code online, semistructured interviews with six special education teachers and 14 SLPs who taught children aged 3-8 years who used AAC in inclusive and self-contained special education classrooms. Interviews were transcribed and coded verbatim using the constant comparative method. During a member checking process, six participants (n = 30%) confirmed their transcripts and commented on emerging themes.

RESULTS

Participants shared a range of implementation strategies to increase AAC use during typical classroom activities, which were organized into seven themes: distribute modern AAC equipment, provide foundational training, share video examples, develop a systematic plan for adoption, deliver practice-based coaching, alter personnel obligations to provide protected time, and connect with professionals. A preliminary thematic map was created to link implementation barriers, strategies, and potential outcomes.

CONCLUSIONS

AAC interventions effective in clinical research can be difficult to translate into routine practice unless investigators directly explore the needs of and demands on educational professionals. Future research should define implementation strategies clearly, solicit feedback from school-personnel, and match implementation strategies to the needs of local schools to support the uptake of AAC interventions in routine classroom settings.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699757.

Implementation Science in School-Based, Universal-Level Intervention Research: A Scoping Review

PURPOSE

The aim of this study was to map the use of implementation science frameworks, models, and theories in intervention research targeting learning needs in the classroom.

METHOD

A scoping review was conducted. Electronic database and manual searches were conducted. Two reviewers independently completed screening, data extraction, and quality appraisal. Qualitative content analysis was undertaken using Nilsen's taxonomy and the domains of the Consolidated Framework for Implementation Research (CFIR). The data were further analyzed using the CFIR valence and strength rating scales.

RESULTS

Included papers (n = 22) used a diverse sample of implementation science frameworks and models. Most studies used determinant frameworks to guide data collection and analysis. Few studies used implementation science theory. Most studies were mixed methods (n = 11), published since 2019 (n = 20), and conducted in North America (n = 15). Over half of the interventions targeted social, emotional, and mental health (n = 13). A complex interplay of inner setting factors was identified as having a strong influence on implementation. Teachers' knowledge and beliefs, adaptability, and complexity of interventions were also identified as important considerations when conducting research in this context.

CONCLUSIONS

Early engagement with stakeholders in education is recommended when designing universal level speech, language, and communication interventions for use in the ordinary classroom. Adaptive, hybrid designs that test both implementation strategies and effectiveness of interventions may be warranted given the influence of inner setting factors on implementation outcomes.

Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation

BACKGROUND

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice.

AIMS

The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice.

METHODS & PROCEDURES

Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis.

OUTCOMES & RESULTS

CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line.

CONCLUSIONS & IMPLICATIONS

Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area.

WHAT THIS PAPER ADDS

What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.

Implementing the language comprehension test C-BiLLT: a qualitative description study using the COM-B model of behaviour change

BACKGROUND

It is challenging to reliably assess the language comprehension of children with severe motor and speech impairments using traditional assessment tools. The Computer Based instrument for Low motor Language Testing (C-BiLLT) aims to reduce barriers to evidence-based assessment for this population by allowing children to access the test using non-traditional methods such as eye gaze so they can independently respond to test items. The purpose of this study is to develop a contextualized understanding of the factors that influenced clinicians' implementation of the C-BILLT in practice in the Netherlands and Norway.

MATERIALS AND METHODS

A qualitative approach including semi-structured individual interviews with 15 clinicians (speech-language pathologists, neuropsychologists, and one teacher, counsellor, and vision specialist) was used. Data analysis was conducted in two rounds. First, a deductive approach including a codebook was used to code data within the COM-B components describing clinicians' capability, opportunity, and motivation for behaviour change. Then, an abductive approach applying thematic analysis was used to identify meaningful patterns within the COM-B components.

RESULTS

Several meaningful barriers and facilitators were identified across the data. Clinicians used the C-BiLLT with two distinct groups of clients: (1) the population it was originally developed for, and (2) clients that could have also been assessed using a traditional language test. Clinicians working with the first group experienced more, and more complex barriers across all COM-B components, to successful C-BiLLT use than the latter.

CONCLUSION

This study provides timely insights into the capability, opportunity, and motivation factors important for creating and sustaining assessment behaviour change in clinicians who used or attempted to use the C-BiLLT. Potential tailored intervention strategies aimed at improving implementation of novel assessment tools are discussed and may be helpful for others working to improve service delivery for children with complex needs.

Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

PURPOSE

Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties.

METHOD

A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers.

RESULTS

Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic).

CONCLUSION

Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17774819.

Implementation Science Research in Communication Sciences and Disorders: A Scoping Review

PURPOSE

The purpose of this study was to complete a scoping review of implementation science (IS) research in communication sciences and disorders (CSD) over time and to determine characteristics of IS research in CSD.

METHOD

A scoping review was conducted of PubMed and Education Resources Information Center for sources published in English that (a) included CSD practitioners, (b) addressed IS research, and (c) identified a specific evidence-based practice. Resulting sources were systematically examined for study aim, patient populations, implementation framework utilized, setting of the study, implementation strategy examined, and implementation outcome measured.

RESULTS

The majority of the 82 studies that underwent a full-text review (80.5%) were published in 2014 or later. One fourth of the studies were concept papers, and another one fourth focused on context assessment (25.6% of studies, each), 11% focused on designing implementation strategies, and 36.6% focused on testing implementation strategies. The patient population most frequently represented aphasia (21.3%), and most studies (34.4%) were conducted in inpatient medical settings. Nearly half (42.6%) of the nonconcept studies lacked an IS framework. Among implementation strategies identified, approximately one third of studies focused on education and/or training plus another strategy and one fourth focused on education and/or training alone. Implementation outcomes measured typically represented early stages of implementation.

CONCLUSIONS

This scoping review of IS research in CSD described the landscape of IS studies in CSD. IS is intersecting with CSD at a rapid rate, especially since 2014. Future IS research in CSD should adopt an implementation framework a priori and consider the broad range of implementation strategies and outcomes to support the uptake of research into typical practice settings.

Addressing implementation considerations when developing universal interventions for speech, language and communication needs in the ordinary classroom: a protocol for a scoping review

Background: Understanding the factors that influence the implementation of health interventions in the context of education is essential to improving outcomes for children and young people with speech, language and communication needs (SLCN). Yet implementation considerations have not been adequately addressed when developing interventions for this context. The aim of this paper is to present a protocol for a scoping review of existing implementation frameworks that might guide SLCN intervention research in schools.  Methods: In accordance with scoping review guidelines, the proposed study will be conducted in  phases: (1) identifying potentially relevant studies, (2)  screening and selection of studies, (3) charting and extracting data from identified frameworks, (4) collating, summarising and reporting the results and (5) consulting with stakeholders. Two reviewers will conduct the screening and the data extraction phases independently. Identified frameworks will be collated, and described, and constructs from the frameworks will be categorised using domains from the Consolidated Framework for Implementation Research. A draft implementation science model will be proposed based on the findings of the scoping review. Conclusions: The findings of this review will provide guidance for researchers to begin to address implementation considerations when developing and facilitating the uptake of universal interventions for SLCN in the ordinary classroom, and ultimately can contribute towards improving outcomes for this vulnerable childhood population.

Exploring attitudes about evidence-based practice among speech-language pathologists: A survey of Japan and Malaysia

Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries.Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP.Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p < .01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP.Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners.

Addressing implementation considerations when developing universal interventions for speech, language and communication needs in the ordinary classroom: a protocol for a scoping review

Background: Understanding the factors that influence the implementation of health interventions in the context of education is essential to improving outcomes for children and young people with speech and language needs (SLCN). Yet implementation considerations have not been adequately addressed when developing interventions for this context. The aim of this paper is to present a protocol for a scoping review of existing implementation frameworks that might guide SLCN intervention research in schools.  Methods: In accordance with scoping review guidelines, the study will be conducted in six phases: (1) identification of the research question, (2) identification of potentially relevant studies of Implementation Science frameworks, (3) study screening and selection, (4) charting and extracting data from identified frameworks, (5) collating, summarising and reporting the results and (6) consultation with stakeholders. Two reviewers will conduct the screening and extraction stages independently. Identified frameworks will be collated, and described, and constructs from the IS frameworks will be categorised using domains from the Consolidated Framework for Implementation Research. A draft implementation science model will be proposed based on the findings of the scoping review. Conclusions: The findings of this review will provide guidance for researchers to begin to address implementation considerations when developing and facilitating the uptake of universal interventions for SLCN in the ordinary classroom, and ultimately can contribute towards improving outcomes for this vulnerable childhood population.

Development of an online implementation intervention for aphasia clinicians to increase the intensity and comprehensiveness of their service

PURPOSE

To describe the process and outcome of a user and theory informed online intervention for speech pathologists targeting the implementation of intensive and comprehensive aphasia services.

METHODS

The design process followed the eight steps outlined by the Behaviour Change Wheel and incorporated the principles of Integrated Knowledge Translation (IKT). Eight speech pathology researchers and clinicians from four countries (Australia, Canada, the United Kingdom and Ireland) contributed to three focus groups via videoconference.

RESULTS

The online platform, Aphasia Nexus: Connecting Evidence to Practice, provides resources, guidance and support for speech pathologists seeking to improve the intensity and comprehensiveness of their aphasia service. A collaborative and iterative design process facilitated the creation of an intervention envisioned by participants.

CONCLUSIONS

The website contains both interactive elements and resource links which have been arranged under the three headings of resources, action and support. The inclusion of multi-national researchers and clinicians benefitted a design process to make implementation more likely.IMPLICATIONS FOR REHABILITATIONTheoretically informed implementation interventions aim to change the everyday clinical practice of health workers.An online platform has been developed to support speech pathologists' implementation of intensive and comprehensive aphasia services.A collaborative design process can be beneficial in creating an intervention that is relevant to research-users and is more likely to be implemented.

Addressing implementation considerations when developing universal interventions for speech, language and communication needs in the ordinary classroom: a protocol for a scoping review

Background: Understanding the factors that influence the implementation of health interventions in the context of education is essential to improving outcomes for children and young people with speech and language needs (SLCN). Yet implementation considerations have not been adequately addressed when developing interventions for this context. The aim of this paper is to present a protocol for a scoping review of existing implementation frameworks that might guide SLCN intervention research in schools.  Methods: In accordance with scoping review guidelines, the study will be conducted in six phases: (1) identification of the research question, (2) identification of potentially relevant studies of Implementation Science frameworks, (3) study screening and selection, (4) charting and extracting data from identified frameworks, (5) collating, summarising and reporting the results and (6) consultation with stakeholders. Two reviewers will conduct the screening and extraction stages independently. Identified frameworks will be collated, and described, and constructs from the IS frameworks will be categorised using domains from the Consolidated Framework for Implementation Research. A draft IS model will be proposed based on the findings of the scoping review. Conclusions: The findings of this review will provide guidance for researchers in addressing implementation considerations when developing universal interventions for SLCN in the ordinary classroom, and ultimately will contribute towards improving outcomes for this vulnerable childhood population.

Clinician Perspectives on the Assessment of Short-Term Memory in Aphasia

BACKGROUND

Verbal short-term memory (STM) and the related ability, working memory (WM), are widely understood to be integral components of language production and comprehension. However, assessment of these abilities in people with aphasia is hampered by a lack of valid, standardized measures that are clinically appropriate. Focusing primarily on verbal STM, we held a series of five focus groups with speech-language pathologists (SLPs) to understand better their current clinical practices and their beliefs and attitudes regarding assessment of verbal STM in aphasia.

AIMS

The purpose of this study was to explore the attitudes, beliefs and preferences of clinical SLPs to determine: (1) current practices related to verbal STM assessment; (2) the extent to which practices reflect current theories of aphasia and the role of verbal STM in language processing; and (3) practical considerations regarding aphasia assessment in clinical practice.

METHODS & PROCEDURES

Five focus groups were conducted using a semi-structured interview protocol with a total of 44 SLPs. Grounded theory methodology was used to collect, code and analyse the data. Codes were reviewed to identify emerging themes. Themes were compared to explore meta-themes, connections and potential theoretical frameworks.

OUTCOMES & RESULTS

Five main themes were identified: (1) The theoretical understanding that clinical SLPs have regarding the role of verbal STM in aphasia is not always consistent with clinical practice; (2) Clinical SLPs highly value functionally relevant assessments; (3) The intense time constraints in clinical practice affect all aspects of assessment; (4) Clinical SLPs feel that there is a lack of appropriate tests for assessment of STM in aphasia; and (5) Clinical SLPs prefer tests that are comprehensive, easy to administer and psychometrically sound.

CONCLUSIONS

Clinical SLPs report a lack of standardized measures to assess STM in individuals with aphasia. Researchers are met with several challenges in the development of these tests including effective communication with clinicians regarding the benefit of verbal STM assessments, especially as it relates to functional skills, and the creation of a test that is comprehensive yet simple, quick and easy to administer.