JCPSLP Vol 23 Issue 2 2021

The reach domain When implementing a new intervention, SLPs need to consider the reach of the intervention—the number, proportion, and representativeness of the children/families suitable for and willing to receive the intervention (Glasgow et al., 2019). Data needs to be collected about who is eligible and who receives the intervention, in addition to barriers and facilitators for children/families to receive the intervention (see Table 1). Information about intervention reach is important for (a) determining if the children and families accessing the service are representative of the target population in the local area, (b) comparing if children/ families receiving the intervention are similar/different to the children/families participating in published evidence, and (c) and understanding who the intervention works for and who it does not. The success of methods used to reach the target population can also be considered. The effectiveness domain Effectiveness (see Table 2) refers to the impact of an intervention on desired outcomes plus unintended consequences (including negative effects) (Glasgow et al., 2019). Outcomes measured can be clinically specific targets (e.g., size of a child’s expressive vocabulary) in addition to more distal measures beyond targets such as a child’s activity and participation, and quality of life (Sandbank et al., 2021). As Thomas-Stonell et al. (2013) point out, if outcome measures only capture the intervention target, opportunities are missed to identify subsequent social functional changes. The FOCUS-34 © (Thomas-Stonell et al., 2015) is one such patient (parent) reported outcome measure with robust psychometrics designed to capture the impact of intervention on young children’s activity and participation. When working with young children the outcome for others working with children (e.g., parents/carers, educators) also need to be considered. Finally, organisations need to consider the economic outcomes or costs relative to client outcomes when making decisions about resource allocation and exploring cost minimisation and relative cost–benefits. In a helpful tutorial paper for SLPs on health economics, Burns et al. (2020) provide SLPs with guidance on various types of health economic evaluations, costs, and outcome data to consider when engaging in implementation research. In an application of the RE-AIM framework, Bittar et al. (2018)

children grow up they continue to have difficulties with speech, language, and literacy relative to peers who talk on time (Hawa & Spanoudis, 2014; Neam et al., 2020), and that the “wait and see” approach needs to be reconsidered (Capone Singleton, 2018). Astrid is involved in a local evidence-based practice clinical group with an interest in late talkers. The group recently completed an appraisal of research evidence on interventions targeting parent responsiveness (e.g., Heidlage et al., 2020). In light of Astrid’s summary of what was learned from the appraisal of the research, the team have decided to implement It Takes Two To Talk®—the Hanen Program® for parents of children with language delays (Weitzman, 2017). However, the team is unsure if the program would be suitable and just as effective for the families in their local area for two reasons. First, the wider evidence-base in early language intervention has a proclivity towards efficacy studies, with few studies involving practice-based research (Crook & Olswang, 2017). Second, the homogeneity of the research participants limits the generalisability of the evidence to all the late talkers and their families (e.g., culturally and linguistically diverse [CALD] communities and families of low socioeconomic status [SES]) on their caseloads. The team decide to use the RE-AIM framework (Glasgow et al., 1999) to guide their implementation plans and evaluation. What is the RE-AIM framework? The RE-AIM framework was developed by Glasgow et al. (1999) to assist clinicians, researchers, and decision- makers with the task of translating research into practice. The acronym RE-AIM refers to five domains considered important when translating and implementing research into practice: reach , effectiveness , adoption , implementation and maintenance . Together these five domains help inform the planning and evaluation of intervention implementation. RE-AIM has been used by clinicians and researchers across the globe to evaluate intervention implementation across various fields in health care (Glasgow et al., 2019). What follows is an overview of each RE-AIM domain and how each domain could be applied to our hypothetical scenario to plan and evaluate the implementation of It Takes Two To Talk® (Weitzman, 2017) in paediatric SLP practice. • Demographic characteristics of children and parents/carers. For example child’s age, parental education level, SES, CALD background and language(s) spoken in the home, history of prior therapy, need for interpreters, involvement in early childhood education, home literacy environment, child’s screen time, transport used to access the service. • Attendance and non-attendance of children and parents/carers per session. • Reason for non-attendance. • Proportion of late talkers accessing the service who did vs did not receive the program and why (e.g., parent declined service delivery, reason for a child not being suitable). • If parents/carers were given any choice regarding when and where they received the program. What information could be collected?

Table 1. RE-AIM a Domain REACH: Information and issues to consider when implementing and evaluating It Takes Two to Talk ®b

Issues for consideration

• Review standard case history form used in the service. Ensure necessary child and parent demographic data are gathered. This could aid further evaluations of models of service. Consider using secure online questionnaire/ data collection software to facilitate efficient data entry (by parent/carer), data extraction, and analysis. • Use established electronic notes/data systems rather than paper, to minimise double handling of clinical data. • To minimise inconsistencies in documentation between clinicians, implement a documentation protocol and training, and conduct routine clinical audits to ensure documentation is consistent.

a Glasgow et al., 2019 b Weitzman, 2017

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology