Educators' Perceptions of Barriers and Facilitators to the Implementation of Screeners for Developmental Language Disorder and Dyslexia

A Generic Implementation Framework for School-Based Research and Practice

PURPOSE

One of our biggest challenges is integrating evidence-based research into practice to serve students with communication disorders. To encourage the systematic application of research findings into practice, implementation science offers frameworks and tools, many of which have a narrow scope. It is important to have comprehensive frameworks that encompass all essential implementation concepts to support implementation in schools.

METHOD

Guided by the generic implementation framework (GIF; Moullin et al., 2015), we reviewed implementation science literature to identify and tailor frameworks and tools covering all core concepts of implementation: (a) the process of implementation, (b) the domains and determinants of practice, (c) implementation strategies, and (d) evaluations.

RESULTS

We created a version of the GIF for school settings, called the GIF-School, to bring together frameworks and tools that sufficiently cover core concepts of implementation. The GIF-School is accompanied by an open access toolkit, which lists selected frameworks, tools, and useful resources.

CONCLUSION

Researchers and practitioners, in speech-language pathology and education more broadly, who seek to apply implementation science frameworks and tools to improve school services for students with communication disorders may turn to the GIF-School as a resource.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23605269.

Factors Impacting Implementation of Universal Screening of Developmental Language Disorder in Public Schools

PURPOSE

Developmental language disorder (DLD) is an underidentified neurodevelopmental disorder that affects, on average, one out of 11 kindergarten-age children (ages 4-6 years). Children with DLD can face academic, behavioral, psychiatric, emotional, and social challenges. Universal screening is seen as an effective way for public school districts to increase DLD identification rates. However, little is known about factors impacting implementation of school-based universal screenings for DLD. We partnered with a large suburban school district in the Intermountain West region of the United States to gather detailed perspectives from school personnel regarding the barriers and facilitators to the implementation of universal screening in their district.

METHOD

Using a two-phase mixed-methods design, we first conducted focus groups to identify potential barriers and facilitators to universal screening. We then used the qualitative data from the first phase to develop a 20-item survey to assess agreement with the focus group results among a wider group of district speech-language pathologists and kindergarten teachers from the school district.

RESULTS

Our survey showed moderate levels of agreement with our focus group results. In particular, school personnel showed high levels of support for universal screening for DLD, with interesting interplay across various factors: (a) the negative impact of unmanageable workload on personnel under both referral- and universal-based identification formats, (b) the preference for paraprofessionals to administer screenings, (c) the role that Response to Intervention programs may play in offsetting workloads associated with universal screenings, and (d) the need for increased awareness and education about child language development and impairment among general education teachers and the public.

CONCLUSION

Recommendations for incorporating these factors into more useful and applicable collaborative research-based efforts are presented.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23661876.

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.

Barriers and facilitators to implementation of developmental screening and early intervention in Canadian organizations following completion of a training and coaching model: a thematic analysis

Introduction

Developmental delay affects approximately 1 in 4 children under 6 years old. Developmental delay can be detected using validated developmental screening tools, such as the Ages and Stages Questionnaires. Following developmental screening, early intervention can occur to address and support any developmental areas of concern. Frontline practitioners and supervisors must be trained and coached to organizationally implement developmental screening tools and early intervention practice. No prior work has qualitatively investigated the barriers and facilitators to implementing developmental screening and early intervention in Canadian organizations from the perspectives of practitioners and supervisors who have completed a specialized training and coaching model.

Methods and Results

Following semi-structured interviews with frontline practitioners and supervisors, thematic analysis identified four themes: cohesive networks support implementation efforts, implementation success is dependent on shared perspectives, established organizational policies increase implementation opportunities, and COVID-19 guidelines create organizational challenges. Each theme encompasses sub-themes that describe implementation facilitators: strong implementation context, multi-level multi-sectoral collaborative partnerships, adequate and collective awareness, knowledge, and confidence, consistent and critical conversations, clear protocols and procedures, and accessibility to information, tools, and best practice guidelines.

Discussion

The outlined barriers and facilitators fill a gap in implementation literature by informing a framework for organization-level implementation of developmental screening and early intervention following training and coaching.

Exploring the acceptability, feasibility, and appropriateness of a communication-friendly classroom tool for use in Irish schools: A qualitative inquiry

BACKGROUND

Ten percent of the school-aged population have speech, language, and communication needs (SLCN) that impact access to the curriculum. Successful implementation of classroom-based SLCN interventions can reduce barriers to learning, thereby improving educational outcomes for this vulnerable population. The challenges of implementing innovations in educational settings are well-documented, yet limited studies have addressed such considerations when developing, and piloting universal level SLCN interventions for use in Irish schools.

METHODS

A qualitative exploratory study was undertaken to establish the acceptability, feasibility, and appropriateness of a universal level SLCN intervention. An advisory panel of teachers (n = 8) and children with SLCN (n = 2) were engaged as co-researchers in the study. The Communication Supporting Classrooms Observation Tool, developed as part of the Better Communication Project in the UK, was trialled across a diverse sample of school settings (n = 5). Semi-structured interviews were conducted with school practitioners and school leaders, and a deductive content analysis was undertaken using the domains of the Consolidation Framework for Implementation Research.

DISCUSSION

The observation tool was viewed as acceptable with suggested additions. Integrating use of the tool within existing data-informed, school self-evaluation processes aimed at supporting school improvement was noted as a potential means of supporting implementation. A knowledge gap in relation to school-based models of support for SLCN was identified which may negatively impact implementation. An implementation strategy targeting coherence, cognitive engagement and contextual integration is indicated if the tool is to be normalised into routine practice in Irish classrooms. Implementation needs appeared to vary at the school level.

CONCLUSIONS

The importance of early-stage exploration to guide implementation planning with regards to developing and testing universal level interventions for SLCN in schools is highlighted. Engaging an advisory panel provides important insights to guide implementation decisions. Findings suggest an adaptive design is required when planning implementation studies targeting classroom setting.

Positive Predictive Values Associated With Adapting the Redmond Sentence Recall Measure Into a Kindergarten Screener for Developmental Language Disorder

PURPOSE

Researchers estimate the prevalence of developmental language disorder (DLD) in 5-year-olds to be between 7% and 12%. Current identification systems in public schools typically favor referral identification formats over targeted or universal screenings. Public schools face unique challenges when assessing the value of screening measures for DLD that include real-world considerations such as administration, time, and resource constraints. This study used the positive predictive value (PPV) of the Redmond Sentence Recall (RSR) to assess its fidelity when administered by special education paraprofessionals. Our obtained PPV was compared across three areas: (a) previous studies that have utilized the RSR, (b) rates extrapolated from the participating school district's preexisting referral system from a previous study, and (c) expectations based on DLD prevalence.

METHOD

Language screenings were conducted in two elementary schools using the RSR administered by school-based paraprofessionals trained on the screener protocol. One hundred sixty-four kindergarten students (age range: 5-6 years) were screened. Confirmatory testing was completed on all students who failed the screener.

RESULTS

Of the 164 students screened, 19 failed the RSR (11.5%), and 14 met criteria (8.5%) for DLD (PPV = .74). Our PPV was similar to previously published studies that utilized the RSR using research assistants and was higher than the PPV associated with teacher-based referrals from the participating school district.

CONCLUSION

The RSR represents a potentially useful screener for identifying children at risk for previously unidentified language disorders in public schools.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22044479.

Building Sustainable Models of Research-Practice Partnerships Within Educational Systems

PURPOSE

To describe the 9-year journey of a group of language and literacy researchers in establishing and cultivating Research-Practice Partnerships (RPPs). Those interested in incorporating implementation science frameworks in their research may benefit from reading our exploration into this type of work and our lessons learned.

METHOD

We showcase how a group of researchers, who are committed to collaboration with school practitioners, navigated building and scaling RPPs within educational systems necessary for our long-term implementation work. We provide details and illustrative examples for three, distinct, mutually beneficial, and sustainable partnerships.

RESULTS

Three different practice organizations are represented: (1) a single metropolitan school, (2) a small metropolitan school district, and (3) a large metropolitan school district, highlighting specific priorities and needs depending on the type of practice organization. Each partnership has distinct research and practice goals related to improving language and literacy outcomes in children. We describe how the researchers assisted with meeting the partner practice organizations' goals and engaged in capacity building while producing rigorous scientific knowledge to inform clinical and educational practice. Additionally, we discuss how research priorities and strategies were pivoted in the past year due to the COVID-19 pandemic, illustrating our commitment to the partnerships and how to respond to challenges to guarantee long-term sustainability.

CONCLUSION

By discussing three distinctive partnerships, we demonstrate the various ways researchers can approach RPPs and grow them into mutually beneficial collaborations and support implementation goals.