JCPSLP Vol 23 Issue 2 2021

Table 4. RE-AIM a Domain IMPLEMENTATION: Information and issues to consider when implementing and evaluating It Takes Two to Talk ®b

What information could be collected?

Issues for consideration

Fidelity of implementation

• Consider including an independent, random fidelity check to minimise positive self-appraisal bias. • Ensure that the procedures for evaluating fidelity (e.g., peer observations, peer and/or self-completed checklists) are reliable and feasible.

• Number of SLPs implementing the program who are trained and certified to implement the program. • SLPs implementation of the program according to workshop program protocol, as measured by an evidence-informed performance checklist (Dunst, 2017). • Qualitative comments on any adaptations to the program that could impact fidelity of implementation. • Parent/carer implementation of communication interaction and language strategies (see parent outcome measures) and diary of completion of home practice.

Cost

• When considering the cost of implementation, develop a reporting system to keep track of the range of direct and incidental costs over time (e.g., workbooks, handouts, morning teas, childcare).

• Number of hours spent by SLPs implementing the program including direct, indirect, and travel time. • Cost of consumables used to conduct the program. • Cost to the parent (e.g., time lost from work, childcare costs).

a Glasgow et al., 2019 b Weitzman, 2017

Table 5. RE-AIM a Domain MAINTENANCE: Information and issues to consider when implementing and evaluating It Takes Two to Talk ®b

What information could be collected?

Issues for consideration

Setting

• Regularly audit and review the quality and completeness of data on reach, effectiveness, adoption, and implementation, and ensure new staff are aware of data documentation procedures. • Long term training and certification of SLPs needs to be maintained, which is an ongoing cost to the organisation and requires supervision processes to maintain fidelity to the program.

• The number of iterations of the program completed over 6-months. • Post-program SLP survey addressing likelihood of continuing to implement the program, potential adaptations required to maintain ongoing implementation of the program and/or replacement options if the recommendation is to discontinue the program.

Individual

• The parent/carer post-questionnaire could be set up as an automated email sent 6-months post completion.

• Parent-completed online questionnaire of the child’s communication skills, activity, and participation 6-months post program, and the parents’ rating of maintenance of skills learned during the program.

a Glasgow et al., 2019 b Weitzman, 2017

completion of intervention implementation checklists can be valuable for evaluating and optimising the fidelity of implementation (Dunst, 2017). Consideration of the economic cost of implementation is also important. The maintenance domain At a setting level, maintenance refers to the methods used to embed the intervention as part of the service to ensure sustainable and continued implementation of an intervention (Glasgow et al., 2019). Maintenance also refers to the intervention continuing to have an effect on the child/ family after the intervention has ceased. Sustained routine implementation requires data on policies and practices of the organisation, evidence that the intervention is established in routine care, and long-term follow-up of client outcomes (see Table 5).

interventions work or do not work, and what steps are required to facilitate optimal implementation and intervention success. The implementation domain Implementation needs to be considered at the level of the setting (i.e., the intervention agent) and the individual (i.e., the parent/carer) (see Table 4). It is measured by studying the fidelity or way an intervention is provided relative to the gold standard (Baker & Williams, 2021) and is critical to understanding intervention effectiveness. Without information on fidelity “it is possible to assume the intervention was ineffective when in fact it was simply not implemented” or not implemented in accordance with developers’ intentions (Noell & Gansle, 2014, p. 389). A range of strategies such as peer observation, and

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology