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legislation and regulations to facilitate this transition (e.g., Australian Government Department of Health, 2020). When implementing the Toolkit, developers and clinicians need to consider and respond to the wider external social, political, technological and economic factors like the pandemic, or changes to disability insurance and health care benefit schemes. Domain 7. Adaption and embedding over time Both the Toolkit, and the organisations using it, must be flexible to ensure its continued use. Complexities Organisational capacity for ongoing innovation and change is crucial to successful implementation (Titov et al., 2019). The Toolkit itself must also be flexible to be sustainable. Reducing/managing complexities To ensure the Toolkit could be adapted to user needs, developers made the order and completion of some modules of the interventions flexible. It is also possible to complete one, two, or all three interventions from the Toolkit. Clinicians may consider this in their referrals and session planning. Processes to monitor and evaluate the Toolkit’s use and outcomes over time are also key to ensuring sustainability. The Toolkit developers have sought to ensure automated collection of these measures are in-built into the Toolkit itself. These include online analytics of logins, completion of tasks and modules, and survey data of user satisfaction and experience. Services and clinicians likewise need to monitor the uptake of the Toolkit in their own context, and make local adjustments to functioning to address any shortfalls, disruptions, changes or ongoing pressures to Toolkit implementation. The Toolkit developers may need to provide clinicians with support and guidance to do so as part of the Toolkit’s dissemination. Conclusion Speech-language pathologists seeking to embed evidence- based eHealth interventions like the Social Brain Toolkit into routine clinical practice will need to be aware of many and varied potential implementation challenges. Although COVID-19 has accelerated the reduction of complexities in the wider implementation context of the Social Brain Toolkit (Domain 6), clinicians seeking to implement the Toolkit will always face the complexities of ABI itself (Domain 1). Their own experience as intervention adopters (Domain 4) will include potential changes to clinical and administrative workflow when delivering the treatment, as well as frontline technological troubleshooting (Domain 2) and engagement of people with ABI and communication partners (Domain 4). Clinicians will also vary in the implementation context of their organisations (Domain 5), including their organisation’s ability to adapt and embed the Toolkit into services over time in different circumstances (Domain 7). At times, clinicians or their management may need to advocate for the value of the Toolkit (Domain 3) to ensure its continued use, and this may involve the collection of patient-reported outcome and experience measures to garner support. The use of implementation frameworks such as the NASSS, as described above, can assist both clinicians and intervention developers to consider implementation challenges from design through to clinical implementation. In the case of the Social Brain Toolkit, such a framework enables awareness of these complexities to both (a) guide intervention

development, and (b) better equip speech-language pathologists who are implementing the Social Brain Toolkit as an eHealth management platform for cognitive-communication disorders following ABI, while also highlighting potentially similar implementation challenges and complexity for other evidence-based eHealth interventions. References Andersson, G. (2018). Internet interventions: Past, present and future. Internet Interventions , 12 , 181–188. https://doi. org/10.1016/j.invent.2018.03.008 Australian Government Department of Health. (2020). The new COVID-19 Telehealth MBS items can now be claimed (updated to include for new services by GPs, other medical practitioners, specialists and allied health) . Australian Government Department of Health. http:// www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/ Content/news-2020-03-29-latest-news-March Baxter, K., & Hellewell, S. C. (2019). Traumatic brain injury within domestic relationships: complications, consequences and contributing Factors. Journal of Aggression, Maltreatment & Trauma . http://www.tandfonline.com/doi/ab s/10.1080/10926771.2019.1602089 Brunner, M., Hemsley, B., Togher, L., Dann, S., & Palmer, S. (2021). Social media and people with traumatic brain injury: A metasynthesis of research informing a framework for rehabilitation clinical practice, policy, and training. American Journal of Speech-Language Pathology , 30 (1), 19–33. https://doi.org/10.1044/2020_AJSLP-20-00211 Christie, H. L., Bartels, S. L., Boots, L. M. M., Tange, H. J., Verhey, F. R. J., & de Vugt, M. E. (2018). A systematic review on the implementation of eHealth interventions for informal caregivers of people with dementia. Internet Interventions , 13 , 51–59. https://doi.org/10.1016/j. invent.2018.07.002 Christie, H. L., Martin, J. L., Connor, J., Tange, H. J., Verhey, F. R. J., de Vugt, M. E., & Orrell, M. (2019). EHealth interventions to support caregivers of people with dementia may be proven effective, but are they implementation- ready? Internet Interventions , 18 , 100260. https://doi. org/10.1016/j.invent.2019.100260 Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet , 396 (10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0 Cock, E. D., Batens, K., Hemelsoet, D., Boon, P., Oostra, K., & Herdt, V. D. (2020). Dysphagia, dysarthria and aphasia following a first acute ischemic stroke: Incidence and associated factors. European Journal of Neurology , 27 (10), 2014–2021. https://doi.org/10.1111/ene.14385 Commonwealth of Australia. (2014). Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia . https://www. aph.gov.au/Parliamentary_Business/Committees/Senate/ Community_Affairs/Speech_Pathology/Report Douglas, J. M., Bracy, C. A., & Snow, P. C. (2016). Return to work and social communication ability following severe traumatic brain injury. Journal of Speech, Language, and Hearing Research , 59 (3), 511–520. https://doi. org/10.1044/2015_JSLHR-L-15-0025 Finch, E., French, A., Ou, R. J., & Fleming, J. (2016). Participation in communication activities following traumatic brain injury: A time use diary study. Brain Injury , 30 (7), 883–890. https://doi.org/10.3109/02699052.2016.1146959

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology