JCPSLP Vol 23 Issue 2 2021

Figure 1. The rationale for the branding of the Social Brain Toolkit and its three constituent interventions, convers-ABI-lity, social-ABI- lity, and interact-ABI-lity. Logo design © Melissa Miao 2020 for the Social Brain Toolkit.

Complexities The complexities of organisations in which clinicians practice will directly affect their implementation experiences. Organisational culture concerning the introduction of innovations, and the distribution of power and human resources to do so, critically affect implementation success (Greenhalgh et al., 2017). Additionally, the vision and mission of organisations may not always align with an online service delivery model for people with ABI and their communication partners. For example, some organisations may define their mission as directly supporting people with ABI, rather than offering interventions for communication partners. Reducing/managing complexities The most successful delivery of online psychosocial interventions occurs in clinics with the best governance, supervision and training in place (Titov et al., 2019). Services may benefit from explicitly creating such structures and procedures to support delivery of online interventions like the Toolkit. The Toolkit’s developers will also examine organisational issues through qualitative implementation studies to inform this and future iterations of the interventions. Domain 6. The wider context The Toolkit is a form of eHealth conceptualised just prior to and developed during the COVID-19 pandemic. It enters an increasingly digital society with growing global health care burdens. Complexities Successful implementation of the Toolkit does not depend solely on individual clinician or organisational effort. The political and regulatory context of an eHealth intervention critically affect implementation success (Titov et al., 2019). Regulations regarding health care payment schemes and health data privacy vary with time, technology, digital

designing a logo to communicate the Toolkit’s purpose (see Figure 1 for rationales and processes informing the Toolkit’s brand design, including stakeholder engagement). Domain 4. The adopters The eventual adopters of the Toolkit will include people with ABI and their communication partners, paid support workers, and clinicians. Complexities It is essential to understand the changes the Toolkit will make to workflow and clinical processes for clinicians (Granja et al., 2018; Titov et al., 2019), as well as equivalent practical challenges for people with ABI and communication partners accessing the Toolkit in the community. It is also important to understand role or identity changes introduced by online service delivery, such as clinician expectations of their ability to develop therapeutic alliances and see clinically significant gains online, or potential fears of job loss due to automatisation (Titov et al., 2019). Reducing/managing complexities A large cohort study recently revealed that people with ABI already frequently access cognitive and communication interventions online, irrespective of age, and especially in areas with limited clinical access (Munsell et al., 2020). Online treatments are acceptable to speech-language pathologists (Pitt et al., 2018) and caregivers have expressed their need for accessible support (Gan et al., 2010), all of which has arguably become more pronounced in the COVID-19 context. The specific challenges facing the Toolkit’s adopters are being identified through qualitative co-design and implementation studies and will continue to be monitored, empowering adopters with meaningful feedback loops to communicate their needs over time. Domain 5. The organisation The Toolkit has been developed in order to address the needs of clinicians working across a variety of organisational contexts, including public health, private practice, and contracted service providers, from metropolitan to rural geographies.

access, geography and political leadership. Reducing/managing complexities

The COVID-19 pandemic precipitated an accelerated global shift to online models of health care under new policies,

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JCPSLP Volume 23, Number 2 2021

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