Practice-Based Research: Another Pathway for Closing the Research-Practice Gap

Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

A scoping review of virtual synchronous intervention studies in preschool rehabilitation

PURPOSE

To summarize the available evidence for the delivery of synchronous virtual rehabilitation intervention services for preschoolers and to identify key factors associated with virtual intervention.

METHODS

Five databases were searched to identify peer-reviewed articles that assessed virtual interventions for preschoolers delivered by rehabilitation health professionals including physical therapists, occupational therapists, speech-language pathologists, audiologists, and their associated assistants. Relevant data regarding demographics, technology, mode of service delivery, timing, engagement, and measurement data were extracted, and charted. Data were then summarized quantitatively using frequency counts, and qualitatively using descriptive summaries.

RESULTS

Sixteen studies were identified. Virtual interventions primarily targeted language difficulties or disorders, therefore most services were delivered by a speech-language pathologist or audiologist. Most interventions were delivered using Skype or Zoom on a weekly basis. Various technological features (e.g., phonology software, 'e-helpers') were included, and multiple activities (e.g., playdough, bubbles) and strategies were used to support engagement.

CONCLUSION

This scoping review provides current knowledge about the delivery of virtual rehabilitation interventions for preschoolers to help guide best practices for clinicians. Future research could assess the validity of existing outcome measures in the virtual environment, and outline optimal session length and frequency for virtual preschool interventions.

Differences in Child Language Assessment Practices Between School-Based and Non-School-Based Speech-Language Pathologists: Results From a Nationwide Survey

PURPOSE

The purpose of this study was to compare child language assessment practices of speech-language pathologists (SLPs) working in school and nonschool settings to determine if their place of employment impacts the diagnostic decision-making process.

METHOD

School-based SLPs (e.g., direct service providers employed in preschool and/or K-12 schools; n = 382) and non-school-based SLPs (e.g., direct service providers employed in private practices, university clinics, and/or medical settings; n = 147) completed a web-based questionnaire. The questionnaire examined the types, frequency, and perceived importance of specific assessment tools and potential workplace factors that may impact their diagnostic decision-making process.

RESULTS

Both school-based and non-school-based SLPs reported using a combination of assessment tools when evaluating children with potential language disorders. School-based SLPs tended to rank the frequency of use and importance of most assessment tools similarly, while non-school-based SLPs ranked interviews as the most frequently used and most important assessment tool. Statistically significant group differences indicated that school-based SLPs ranked the frequency of use and importance of standardized testing higher compared to their non-school-based counterparts. Also, school-based SLPs rated employment-based factors impacting diagnostic decision making higher compared to non-school-based SLPs.

CONCLUSIONS

SLPs practicing in school-based settings seem to handle more employment-based factors that impact independent diagnostic decision making than SLPs working in different employment settings when assessing children for potential language disorders. Clinical recommendations are provided, and implications for implementation-based assessment research in child language are discussed.

Exploring the attitudes and practices among student clinicians in India on multilingual issues in the field of speech-language pathology

PURPOSE

Student clinicians (graduates and undergraduates) in speech-language pathology deal with various multilingual issues while providing clinical services to individuals with language impairments. This study explores the attitudes and practices of undergraduate and graduate speech-language pathology students in India towards multilingualism and handling these issues.

METHODS

One hundred and twenty-eight students (71 graduates and 57 undergraduates) participated in the study. Phase 1 of the study included the development of a questionnaire to explore the attitudes and practices of student clinicians in speech-language pathology. The questionnaire was converted into an online survey in Phase 2. Phase 3 comprised data and statistical analysis to summarize and interpret collected data.

RESULTS

Graduate and undergraduate students significantly differed in their attitudes and perception toward multilingual issues (p<0.05). Most clinicians demanded a change in the current views on assessment/intervention, considering the linguistic background of the patient/caregivers. Other issues surrounding multilingualism included parents' education levels, lack of sufficient assessment tools, unavailability of translators/interpreters, and poor linguistic competency of clinicians.

CONCLUSION

These findings assist academic programs in planning and developing modules to aid students in handling the major multilingual issues encountered during clinical interactions.

What Is Clinical Evidence in Speech-Language Pathology? A Scoping Review

PURPOSE

Two disparate models drive American speech-language pathologists' views of evidence-based practice (EBP): the American Speech-Language-Hearing Association's (2004a, 2004b) and Dollaghan's (2007). These models discuss evidence derived from clinical practice but differ in the terms used, the definitions, and discussions of its role. These concepts, which we unify as clinical evidence, are an important part of EBP but lack consistent terminology and clear definitions in the literature. Our objective was to identify how clinical evidence is described in the field.

METHOD

We conducted a scoping review to identify terms ascribed to clinical evidence and their descriptions. We searched the peer-reviewed, accessible, speech-language pathology intervention literature from 2005 to 2020. We extracted the terms and descriptions, from which three types of clinical evidence arose. We then used an open-coding framework to categorize positive and negative descriptions of clinical expertise and summarize the role of clinical evidence in decision making.

RESULTS

Seventy-eight articles included a description of clinical evidence. Across publications, a single term was used to describe disparate concepts, and the same concept was given different terms, yet the concepts that authors described clustered into three categories: clinical opinion, clinical expertise, and practice-based evidence, with each described as distinct from research evidence, and separate from the process of clinical decision making. Clinical opinion and clinical expertise were intrinsic to the clinician. Clinical opinion was insufficient and biased, whereas clinical expertise was a positive multidimensional construct. Practice-based evidence was extrinsic to the clinician-the local clinical data that clinicians generated. Good clinical decisions integrated multiple sources of evidence.

CONCLUSIONS

These results outline a shared language for SLPs to discuss their clinical evidence with researchers, families, allied professionals, and each other. Clarification of the terminology, associated definitions, and the contributions of clinical evidence to good clinical decision-making informs EBP models in speech-language pathology.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21498546.

A Systematic Review of Interventions for Late Talkers: Intervention Approaches, Elements, and Vocabulary Outcomes

PURPOSE

The aim of this systematic review was to examine the empirical evidence on interventions for late talkers between 18 and 42 months according to type of intervention approach (direct, indirect, and hybrid), reporting of intervention elements, and outcomes for receptive and expressive vocabulary.

METHOD

This review was registered with PROSPERO and followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eleven databases were systematically searched with 34 intervention studies involving 1,207 participants meeting criteria. Studies were categorized as using a direct, indirect, or hybrid intervention approach, then examined according to intervention elements, vocabulary outcomes, as well as reported tools and type of score used to evaluate outcomes.

RESULTS

Across 34 studies, nine used a direct intervention approach, 10 an indirect intervention approach, and 14 a hybrid intervention approach. One study compared direct and hybrid intervention approaches. All indirect and hybrid approaches included parent training; direct approaches did not. The type and degree of reporting of other intervention elements, as well as the tools and type of score used to evaluate outcomes, varied within and across approaches. Overall, improvements in expressive vocabulary were reported by 93% of studies, with variable results for the nine studies reporting receptive vocabulary outcomes.

CONCLUSIONS

The direct, indirect, and hybrid intervention approaches were typified by specific intervention elements; however, there was diversity in how other elements comprising the approaches were arranged. When making decisions about which intervention approach to use, clinicians need to be mindful of the differences among approaches, how they discuss those differences with parents, and which approaches and elements might be best suited to individual children and their families.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21291405.

Effects of adapted Letter-Sound correspondence instruction with older learners with complex communication needs and autism spectrum disorder

Individuals who use augmentative and alternative communication (AAC) are often excluded from learning literacy skills that use phonological approaches due to challenges with verbal production of speech sounds. This study was conducted to evaluate the effectiveness of systematic literacy instruction with materials modified to teach letter-sound correspondences (LSC) to pre-adolescent and adolescents with autism spectrum disorders (ASD) with minimal or no speech who use AAC. A single subject design across three letter-sound sets was used, with three individuals with ASD. A total of 12 LSC were targeted in the intervention. During the intervention, the participants were instructed using model, guided, and independent practice trials using low-tech letter tiles followed by two extension activities: letter sorting and initial letter-sound picture books. A functional relationship was established between the LSC intervention and the percent of correct responses on the LSC assessment probes. Very large and large effects sizes were calculated for all participants across the three LSC sets. The study adds to the very limited research base related to phonics instruction for older learners (ages 9 to 18) with ASD, demonstrating that LSC progress can still be made at an older age with systematic instruction.

Clinicians' Perspectives of Treatment for Lateralization Errors: A Quantitative and Qualitative Study

PURPOSE

This mixed-methods study aimed to obtain information regarding speech-language pathologists' (SLPs) perspectives about treatment of lateralization errors (LEs), challenges to implementing evidence-based LE treatment practice, and the sources SLPs' use to find evidence to treat LEs. This information can assist our understanding of ways to facilitate the uptake of evidence-based practice into the everyday treatment of clients with this disorder.

METHOD

A convergent parallel mixed-methods design was used to collect data from SLPs (N = 214) using 24 questions from an online survey distributed through electronic mailing lists and Speech and Hearing State Associations. Quantitative data were analyzed using frequencies and averages; themes and subthemes of qualitative data were analyzed using a content analysis approach with no a priori codes. Quantitative and qualitative results were compared and integrated.

RESULTS

Participants believed that LEs required individualized treatment before the age of 5 years, were largely caused by structural and neuromuscular factors, and required an understanding of orofacial and dental structure and function. Challenges to implementing LE treatment included a lack of skills and knowledge specific to LEs, competing demands on clinicians' time and resources, and a research-practice gap. Sources of evidence frequently used to obtain information about LE treatment were colleagues, trainings, workshops, and American Speech-Language-Hearing Association journals.

CONCLUSIONS

Clinicians believe that LE treatment is challenging and requires skill training. Future research in LEs will need to consider the real-world decisions clinicians must make when treating this disorder as well as clinicians' everyday constraints and challenges.

Clinical feasibility, utility, and usability of the Profile of Preschool Communication: A pilot test in community settings

AIM

. This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research.

METHODS

. This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2-3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators.

RESULTS

. Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning.

CONCLUSIONS

. The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools.

Intervention Goals for Preschoolers With Language Difficulties and Disorders: A Scoping Review Using the International Classification of Functioning, Disability and Health Framework

PURPOSE

The primary aim of this scoping review was to categorize language therapy goals reported in intervention studies for preschoolers (i.e., children from birth to 5;0 [years;months]) with language difficulties and disorders within the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework. A secondary aim was to determine whether different therapy goals were reported for two language difficulty/disorder subtypes (i.e., comparing language difficulty/disorder associated with a biomedical condition to those without an associated biomedical condition).

METHOD

The scoping review followed Arksey and O'Malley (2005) guidelines. Articles were retrieved from speechBITE, with age (under 5 years), intervention area (language), and study design (all but systematic reviews and clinical practice guidelines) specified as inclusion criteria. Language goals were extracted and categorized into the ICF components, and the distribution of goals across ICF components was compared for studies involving children with the two language difficulty/disorder subtypes.

RESULTS

A total of 287 articles were identified; 140 met inclusion criteria. Of the 293 goals extracted, 48% aligned with the activities component of the ICF framework, followed by participation (26%), environmental factors (20%), body functions and structures (3%), and personal factors (3%). Most participation-focused goals were reported from intervention studies involving preschoolers with a language difficulty/disorder associated with a biomedical condition.

CONCLUSIONS

Few participation-focused goals were reported in intervention studies for preschoolers with language difficulty/disorder without an associated condition. Future work is needed to support integrating the ICF framework in goal setting for both research and practice.

Using the Experience Sampling Method to Examine the Details of Dosage in School-Based Speech Sound Therapy

PURPOSE

The purpose of this project was to collect practice-based evidence regarding dosage in speech sound therapy sessions in school-based settings. Dosage is the number of trials within a therapy session for any one particular child. School-based speech-language pathologists (SLPs) face a variety of obstacles to service delivery, often making the implementation of evidence-based practices difficult. To that end, we were interested in exploring how therapy parameters, such as group size and session frequency were associated with dosage.

METHOD

Using the experience sampling method, we queried school-based SLPs (n = 90) across the United States. SLPs participated via a phone application, which randomly alerted them to participate 3 times per day for 5 days. SLPs also completed a demographic questionnaire that included information regarding caseload size and job satisfaction.

RESULTS

We report results from 670 therapy sessions. Results revealed that the therapy parameter of group size was negatively related to dosage. The SLP parameter of caseload size was positively related to dosage, but this was a small association. The child parameter of comorbidity was negatively related to dosage.

CONCLUSIONS

Our results support that as group size increases, children receive smaller doses of speech sound practice. Similarly, children who have a reported comorbidity received smaller doses compared to children who have an isolated speech sound disorder. We discuss implications for school-based practitioners and researchers.

Quantifying Therapists' Activities during Sensory Integration Treatment for Young Children with Autism

AIMS

There is limited research on the type and quantity of actions (activities) occupational therapy practitioners utilize when providing sensory integration treatment to children with Autism Spectrum Disorders (ASD).

METHODS

A coding scheme identifying specific aspects of sensory integration treatment was developed and used to analyze 34 videos of 9 children with ASD, aged between 18 and 56 months, treated by 8 occupational therapists. Occupational therapists providing sensory integration treatment to children with ASD were behaviorally coded and rated using Observer XT, a software package designed for analysis of behavioral processes.

RESULTS

Verbal communications, including offers, positive commands, and feedback, to facilitate engagement were the most frequent actions enacted by therapists. Proprioceptive activities were the most frequent sensory opportunities presented. Therapists received high ratings for sensitivity qualities.

CONCLUSIONS

The number of sensory opportunities and interactions the therapists provided suggest concordance with sensory integration treatment components in the clinical setting. General impression ratings indicate engagement between child and therapist may be an important aspect of sensory integration treatment for young children with ASD. Quantification of therapists' actions can provide insight into the moment-to-moment decision-making and relationships between therapist and child during daily practice of sensory integration treatment.

Achieving Participation-Focused Intervention Through Shared Decision Making: Proposal of an Age- and Disorder-Generic Framework

Introduction The World Health Organization's International Classification of Functioning, Disability and Health calls on speech-language pathologists (SLPs) to provide care that impacts all aspects of an individual's experience with a communication disorder, including their participation in valued life situations. However, SLPs often report feeling unprepared to implement and document interventions that target life participation. The purpose of this article is to propose a framework to guide participation-focused intervention practices. This age- and disorder-generic framework is designed to be applicable with clients across the variety of settings in which SLPs work. Method In this clinical focus article, we draw on past research and clinical experience to propose a restructuring of World Health Organization's International Classification of Functioning, Disability and Health components such that participation is the primary focus and outcomes indicator for intervention. In this framework, a specific communicative participation situation is identified and assessed quantitatively, and a corresponding participation-focused goal is established through shared decision making. Following that, assessments are conducted and goals are established in the areas of communication skills, physical and social environments, and personal perspectives. Results The proposed framework provides a concrete organizational structure as well as assessment, goal-writing, and intervention examples to assist SLPs in translating theoretical biopsychosocial frameworks into clinical practices. Conclusions SLPs can and do provide holistic communication services to clients to help them achieve their life participation goals. This article provides an example as to how we can document the need for, as well as the value and impact of our important work, meeting the diverse life participation needs of clients. Supplemental Material https://doi.org/10.23641/asha.12360758.

Music Therapist Experiences of a Randomized Controlled Trial as Clinician Researchers

Music therapy clinicians bring an important perspective to the design and conduct of clinically meaningful studies. Unfortunately, there continue to be roadblocks that hinder clinician involvement in research and the development of successful partnerships between academic researchers and practicing clinicians. To help grow clinician involvement, it is important that research teams share their experiences. As such, the purpose of this qualitative study was to share music therapists' perspectives about their experience of working as a research clinician on a large multisite randomized controlled trial. 10 board-certified music therapists provided written responses to 6 data-generating questions about: (a) reasons for participating, (b) perceived challenges and benefits, (c) experiences of quality assurance monitoring, (d) professional growth, (e) value of research, and (f) advice for clinicians considering research involvement. Using thematic content analysis, we identified primary themes and subthemes for each question (20 themes; 30 subthemes). Qualitative analysis revealed not only common challenges, such as reconciling clinical and research responsibilities, but also benefits, including continued professional growth, greater understanding of research processes, and research participation as a way to advocate and advance the profession. Finally, for clinicians interested in becoming involved in research, therapists noted the importance of having workplace support from a mentor, supervisor, and/or administrator; seeking out available resources; and knowing roles and responsibilities before initiating research involvement. Findings offer important insight and recommendations to support the involvement of clinicians in research and support further exploration of clinician involvement in dissemination efforts to improve translation and uptake of research into practice.

Lessons learned in practice-based research: Studying language interventions for young children in the real world

BACKGROUND AND AIMS

Practice-based research holds potential as a promising solution to closing the research-practice gap, because it addresses research questions based on problems that arise in clinical practice and tests whether systems and interventions are effective and sustainable in a clinical setting. One type of practice-based research involves capturing practice by collecting evidence within clinical settings to evaluate the effectiveness of current practices. Here, we describe our collaboration between researchers and clinicians that sought to answer clinician-driven questions about community-based language interventions for young children (Are our interventions effective? What predicts response to our interventions?) and to address questions about the characteristics, strengths, and challenges of engaging in practice-based research.

METHODS

We performed a retrospective chart review of 59 young children who had participated in three group language interventions at one publicly funded community clinic between 2012 and 2017. Change on the Focus on the Outcomes of Communication Under Six (FOCUS), a government mandated communicative participation measure, was extracted as the main outcome measure. Potential predictors of growth during intervention were also extracted from the charts, including type of intervention received, attendance, age at the start of intervention, functional communication ability pre-intervention, and time between pre- and post-intervention FOCUS scores.

RESULTS

Overall, 49% of children demonstrated meaningful clinical change on the FOCUS after their participation in the language groups. Only 3% of participants showed possibly meaningful clinical change, while the remaining 46% of participants demonstrated not likely meaningful clinical change. There were no significant predictors of communicative participation growth during intervention.

CONCLUSIONS

Using a practice-based research approach aimed at capturing current practice, we were able to answer questions about the effectiveness of interventions delivered in real-world settings and learn about factors that do not appear to influence growth during these interventions. We also learned about benefits associated with engaging in practice-based research, including high clinical motivation, high external validity, and minimal time/cost investment. Challenges identified were helpful in informing our future efforts to examine other possible predictors through development of a new, clinically feasible checklist, and to pursue methods for improving collection of outcome data in the clinical setting.Implications: Clinicians and researchers can successfully collaborate to answer clinically informed research questions while considering realistic clinical practice and using research-informed methods and principles. Practice-based research partnerships between researchers and clinicians are both valuable and feasible.

Psychotherapy trainees' epistemological assumptions influencing research-practice integration

Over the last few decades a growing number of psychotherapy scholars as well as psychotherapy researchers have joined a paradigm shift, moving from a reductionist to a complexity-oriented epistemology. Many authors recognize that when human subjectivity is the object of intervention and study, it is appropriate to resist simplification and to assume a more complex approach. While this paradigm shift is taking place not only in psychology but also in other disciplines, many psychotherapists still share the assumption that psychotherapy practice and psychotherapy research have opposite values; hence, they are worlds that cannot be reconciled. Considering this as one of the main reasons preventing a useful integration of evidence-based practice and clinical training in psychotherapy, we conducted an online survey of 126 Italian trainees from three differently-oriented psychotherapy institutes (cognitive-behavioral, relational-psychoanalytic and relational-systemic) to explore the epistemology underling the clinical and research practices. After presenting a clinical vignette, we asked questions about diagnostic considerations, case formulations, and treatment plans; we also asked questions about participants' involvement in research projects or in research methodology courses and about willingness to be involved in future research studies in their clinical practice. We found some significant differences among trainees with different orientations, but in general most of the responses reflected a positivistic epistemology underlying both clinical and research activities. These findings suggest that a deeper awareness of one's own epistemological assumptions could help trainees foster a more theory-coherent and research-informed clinical practice.

Establishing consensus among community clinicians on how to categorize and define preschoolers' speech and language impairments at assessment

PURPOSE

To achieve consensus amongst speech-language pathologists (SLPs) on the categories and definitions of preschoolers' communication impairments.

METHODS

In Phase 1, impairments were identified, categorized, and defined based on an evidence review. In Phase 2, a four-round Modified Delphi study was completed with SLPs (N = 38). SLPs reviewed three documents that categorized and defined preschoolers': (1) broadly focused impairments, (2) language disorder sub-categories, and (3) speech sound disorder sub-categories; rated whether categories captured all preschoolers with communication impairments and definitions were clear (consensus = 90% agreement across all documents); and made suggestions for improvement. Documents were revised between rounds based on SLPs' responses, literature review, and consultation with experts.

RESULTS

In Round 1, 90% agreement was reached only for the language disorder sub-categories document. In Round 2, no consensus was reached for the Speech Sound Disorder sub-categories document. In Round 3, consensus was reached for all three documents, but a fourth round was run to incorporate newly updated terminology. In Round 4, consensus was reached for updated terminology presented in the language disorders document.

CONCLUSIONS

Clinical and research expertise are integrated throughout the final documents, resulting in consensus terminology for preschoolers' communication impairments. Findings can support consistent terminology for preschoolers with communication impairments amongst SLPs. In research, documents will be used in a developing data collection tool that will undergo reliability testing prior to use in large scale studies related to children's communication. This study demonstrates the value of engaging in practice-based research.

Barriers to implementing evidence-based assessment procedures: Perspectives from the front lines in pediatric speech-language pathology

PURPOSE

This practice-based research study was a collaborative effort between researchers and speech-language pathologists (SLPs). The purpose of the study was to assess SLPs' perceptions of barriers for two new evidence-based assessment procedures to be implemented in practice. Procedures were for (1) program-level outcome monitoring and (2) individual vulnerability testing for children who are deaf or hard of hearing. These procedures were summarized for clinicians in an online learning module.

METHOD

After finishing the online learning module, SLPs completed electronic surveys to identify perceived barriers to implementation. Fifty-four SLPs completed an online survey specific to the program-level outcome monitoring procedures. Twenty-five also completed an online survey specific to individual vulnerability testing. Surveys were structured using the Ottawa Model of Research Use, which assesses barriers within three components: (1) the practice environment; (2) clinicians' knowledge, skills, and beliefs; and (3) the evidence-based innovation (development and content of the online learning module).

RESULTS

Most items specific to program-level outcome monitoring were rated positively. Some barriers were identified within the practice environment and evidence-based innovation, but clinicians' skills, knowledge, and beliefs were not barriers to implementation. For individual vulnerability testing, barriers were noted across all components of the Ottawa Model of Research Use.

CONCLUSIONS

This work demonstrates the value of including front-line clinicians in the development of evidence-based assessment procedures. Through practice-based research, we identified SLPs' perceived barriers to implementation, allowing for modifications to be made to the online learning module prior to wider-scale implementation. The barriers identified and methods used in our work may be useful to other researchers and programs involved in developing materials and methods for the implementation of evidence-based assessment procedures.

Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review

INTRODUCTION

Rural children are likely to benefit from the telehealth delivery of multidisciplinary allied healthcare. This study aimed to (a) identify the scope of literature describing the telehealth delivery of allied health services to children living in rural areas and (b) understand the extent to which implementation - that is, specific activities designed to put telehealth into practice - has been investigated in such literature.

METHODS

Systematic scoping review methodology was used to locate studies in which telehealth delivered allied health services to children aged 0-12 who lived rurally (January 1998-January 2018). Two reviewers screened the studies, extracted data and appraised quality with Critical Skills Appraisal Programme checklists. Databases searched were PubMed, MEDLINE, CINAHL, PsycINFO, ERIC and Cochrane Library.

RESULTS

Data were extracted from 23 papers (two randomised controlled trials, one pseudorandomised controlled trial, one non-randomised experimental trial, two interrupted time series without parallel control groups, 10 case series and seven studies of diagnostic yield). Most were level III (n = 4) or IV (n = 17) when classified according to National Health and Medical Research Council guidelines. One study met all Critical Skills Appraisal Programme quality criteria. Allied healthcare interventions were aimed at improving functioning in communication (n = 10), behaviour and socio-emotional domains (n = 8) and identifying hearing concerns (n = 5). Many studies (n = 12) identified implementation facilitators, largely training and equipment. Only one study referred to an explicit framework for telehealth implementation (user-centred design).

DISCUSSION

Future research should target occupational therapy, physiotherapy, dietetics and social work, and determine the implementation factors and models likely to create successful telehealth services for this population.

Diagnostic Decisions in Child Language Assessment: Findings From a Case Review Assessment Task

Purpose The current study used a case review diagnostic assessment task to examine the diagnostic decisions speech-language pathologists (SLPs) working in the United States made after reviewing child language cases. Method Fourteen SLPs were given 5 case studies that presented either congruent or incongruent results between standardized testing and informal measures. After reviewing the assessment data, SLPs were asked to make a diagnostic decision. Results Unanimous consensus regarding diagnostic decisions was found when the assessment data were congruent. When the data were incongruent, unanimous consensus was not achieved. Standardized testing seemed to guide the diagnostic decision. This pattern of reliance on standardized testing was evident even when 80% of SLPs reviewed informal language data. In 97% of cases, a standardized test was used to guide clinical decision making. Conclusion Three patterns of clinical decision making in child language assessment emerged: (a) use of both standardized testing and informal measures, (b) a reported concern tool as a 1st step in the process, and (c) standardized testing as the most influential data for guiding diagnostic decisions. Although this study provides initial evidence regarding the process of diagnostic decision making, future studies should examine decision making in real time to further validate the implicit rules used during decision making. Supplemental Material https://doi.org/10.23641/asha.7991174.

Research–Practice Partnership: Application to Implementation of Multitiered System of Supports in Early Childhood Education

Purpose

Research–practice partnerships (RPPs) offer a tool for identifying, generating, and implementing evidence-based strategies that improve practice, policies, and client outcomes. We offer a description of RPPs and elements that facilitate successful utilization. The origin of RPPs, various approaches, and anticipated barriers are discussed. We illustrate some of the challenges and rewards of establishing an RPP using an example of a project that sought to implement a multitiered system of supports among a variety of early childhood education classrooms in a large urban school district.

Method

A planning/leadership team established objectives and used surveys, focus groups, classroom observations, professional development records, and student outcome data to inform decision making.

Results

The district's progress in implementing multitiered system of supports in early childhood and ways in which implementation plans were modified as a result of data-based decision making are described. A number of unexpected obstacles interfered with original plans, requiring significant revisions in our theory of change and new strategies to overcome challenges.

Conclusion

This illustration helps elucidate critical elements of RPPs and highlights their applicability to researchers and practitioners in communication sciences and disorders.

School-Based Speech-Language Pathologists' Perspectives on Diagnostic Decision Making

PURPOSE

This study used a structured open interview approach to elicit information from school-based speech-language pathologists (SLPs) regarding their assessment practices for children with suspected language impairment.

METHOD

Phone interviews were conducted with 39 school-based SLPs who were employed across the United States. The interviews explored assessment topics related to assessment tool selection and rationale and the integration of assessment data to determine treatment eligibility.

RESULTS

The results of this study suggest that SLPs use both standardized testing and informal testing for their diagnostic procedures. Standardized testing appears to be the tool that drives diagnostic decisions regarding eligibility and severity. Informal measures, such as parent/teacher interviews and language sampling, were used by school-based SLPs to gather information regarding naturalistic language use; however, they seem less important in the diagnostic decision-making process. Also, SLPs reported completing language sample transcription and analysis in real time while interacting with a child.

CONCLUSIONS

School-based SLPs appear to rely on the results from standardized testing when determining treatment eligibility for children with language impairment. The reliance on standardized testing appears to be driven by institutional policies. We discuss the potential impact of federal/state/district guidelines on diagnostic decisions and consider the research-to-practice gap.

Social Thinking®, Pseudoscientific, Not Empirically Supported, and Non-Evidence Based: a Reply to Crooke and Winner

J. B. Leaf et al. (Behavior Analysis in Practice, 9, 152-157, 2016) wrote a commentary on social thinking (ST), an intervention commonly implemented for individuals diagnosed with autism spectrum disorder (ASD). The authors described what constitutes scientific, pseudoscientific, and antiscientific evidence and contended that ST aligns with the definition of pseudoscience and, to date, is not empirically supported or evidence based. Crooke and Winner (Behavior Analysis in Practice, 9, 403-408, 2016) responded, arguing that ST meets their definition of an evidence-based practice and identifying purported misconceptions and inaccuracies described by J. B. Leaf et al. In the current article, the authors clarify the original arguments, critically evaluate Crooke and Winner's definition of what constitutes evidence-based practice, further evaluate the research on ST, discuss issues regarding how ST is conceptualized, and express concerns about the endorsement and use of an eclectic approach to treating ASD. As this response was written by behavior analysts, it specifically addresses the conceptual consistency of this approach from a behavior-analytic worldview.

Bringing the Simple View of Reading to the clinic: Relationships between oral and written language skills in a clinical sample

PURPOSE

The Simple View of Reading (SVR) predicts subtypes of reading disorder based on weaknesses in word recognition, listening comprehension, or both. This practice-based research study explores predictions of the SVR within a clinical practice setting.

METHOD

The study is a retrospective analysis of 112 assessment records from school-aged children (aged 6.0-16.7) referred for speech-language evaluation. Available scores within four areas (listening comprehension, word recognition, reading comprehension, and oral expression) were extracted and then converted to composites. Composite scores were used to categorize children into SVR subtypes. We examined the distribution of children across subtypes and the relationships among the four constructs.

RESULTS

Children were distributed across all SVR subtypes, but few had impairments only in word recognition. Children with impairments in listening comprehension or word recognition showed poorer reading comprehension than those that did not, but there was imperfect prediction of reading comprehension impairment at an individual level. There were more significant correlations among constructs for younger children. Oral expression and listening comprehension were closely related across analyses.

CONCLUSIONS

The SVR is a clinically useful model for capturing variation and explaining relationships among oral and written language in school-age children.

Bridging the Gap Between Research and Practice: Implementation Science

PURPOSE

This article introduces implementation science, which focuses on research methods that promote the systematic application of research findings to practice.

METHOD

The narrative defines implementation science and highlights the importance of moving research along the pipeline from basic science to practice as one way to facilitate evidence-based service delivery. This review identifies challenges in developing and testing interventions in order to achieve widespread adoption in practice settings. A framework for conceptualizing implementation research is provided, including an example to illustrate the application of principles in speech-language pathology. Last, the authors reflect on the status of implementation research in the discipline of communication sciences and disorders.

CONCLUSIONS

The extant literature highlights the value of implementation science for reducing the gap between research and practice in our discipline. While having unique principles guiding implementation research, many of the challenges and questions are similar to those facing any investigators who are attempting to design valid and reliable studies. This article is intended to invigorate interest in the uniqueness of implementation science among those pursuing both basic and applied research. In this way, it should help ensure the discipline's knowledge base is realized in practice and policy that affects the lives of individuals with communication disorders.