JCPSLP Vol 23 Issue 2 2021

Implementation science

Top 10 in dissemination and implementation science For SLP and audiology practitioners Amanda Owen Van Horne

3 Implementation science is about your clients

1 Implementation science is about you Implementation science is about helping the average clinician adopt evidence-based practices (EBP). The primary question of implentation science is how to take information developed in the research lab and get it in the hands of practitioners (Eccles & Mittman, 2016). EBP—that have known benefits when implemented under laboratory conditions—are usually the first step in an implementation science research program. Many ideas trialled in a research lab aren’t suitable for broad uptake. But those that are are frequently not taken up because they aren’t designed with the end user in mind or don’t get shared effectively with the end user (Moir, 2018). The focus of implentation science is getting the best practices out of the lab and into the clinician’s hands. 2 Implementation science is about your practices and what is feasible in your practice Implementation science draws on EBP and aims to distill the key elements—the active ingredients, if you will—so that the rest of the process can be as flexible as possible (Embry & Biglan, 2008). Think about paracetamol (i.e., acetaminophen): the active ingredient is the drug itself, but it can be delivered as a liquid or tablet, in various concentrations, and using a spoon, syringe, or IV. Changing these irrelevant details can be critical for adequate use of this pain killer and fever reducer. Similarly, to best deliver an intervention like Lee Silverman Voice Treatment (Ramig et al., 2004) in a way that serves a wide variety of clients requires knowing which of the practices you need to keep and which can be modified. For instance, if the appointment frequency is a barrier for some clients, can it be delivered over a more extended period of time (Spielman et al., 2007) or using a telehealth approach (Howell et al. 2009)? Implementation science works seeks to understand how much variation is acceptable while still maintaining the core elements of a program or practice. Language Learning Lab. Her work has been funded by the ASHFoundation, the National Institutes of Health, and the National Science Foundation. Dr Owen Van Horne’s research employs treatment studies to better understand language learning mechanisms in children with language disorder. The hope is that, by better understanding the active ingredients in the treatments, we will be better equipped to strengthen access to these treatments across settings and populations. Amanda Owen Van Horne (@TELLlab) is a faculty member in the Communication Sciences and Disorders Department at the University of Delaware, where she directs the Treatment Efficacy and

Too often you read a paper and think to yourself: the kids in this journal article don’t resemble the clients I serve. Indeed, treatment programs developed under laboratory conditions frequently select the participants carefully, because they want to be sure they know why something works—or, perhaps more importantly, why it does not work (Bauer & Kirchner, 2020). This effort at isolating variables can lead to unrealistic inclusionary and exclusionary criteria, and treatments provided by providers trained to near perfection at delivery. Effectiveness trials—the staple of implementation work—look at application in real-world settings with a wide range of practitioners and clients (Landes et al., 2020). Thus, the participants are much more likely to align with the clients you see in your practice and the providers are more likely to be like you. 4 Implementation science is about your setting When wondering about whether or why an EBP is put into place, implentation science calls on us to examine the pressure of the larger system. For instance, the Consolidated Framework for Implementation Research (CFIR; Damschroeder et al., 2009) asks us to examine the outer context. This refers to various pressures that might affect adoption: are reimbursement methods aligned with the practice? What does public policy mandate as key practices or outcomes in your setting? Who qualifies for services and why? What is your unit’s culture like? Implementation science draws attention to things like caseload size, service delivery priorities, and public policy as it affects how practices are taken up. 5 Implementation science is about your boss Key stakeholders influence which practices are used and whether or not they are used fully. This is what CFIR terms the inner context (Damschroeder et al., 2009). Within your setting, is leadership supportive of the practice? How are goals communicated within the organisation? How are employees evaluated? Getting the leaders of an organisation on board by aligning the practices with leaders’ goals—or persuading leaders to value the outcomes of the new practices—can be key to implementing change (Aarons et al., 2015). For instance, Douglas (2016) reports that skilled nursing facility (SNF) leadership was a key barrier to group-based language intervention. Suhrheinrich et al. (2019) report that school leadership qualities predicted uptake of pivotal response therapy by teachers in 98 southern California classrooms.

Amanda Owen Van Horne

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JCPSLP Volume 23, Number 2 2021

Journal of Clinical Practice in Speech-Language Pathology