JCPSLP Vol 23 Issue 2 2021

Implementation science

Using the RE-AIM framework to guide the implementation and evaluation of interventions for children with communication disorders Elise Baker, Kate Short, and Katrina Tosi

Clinical decisions in speech-language pathology practice are ideally informed by experimental evidence, with the randomised controlled trial considered the ‘pinnacle’ of best available evidence for new interventions. Although tightly controlled experimental studies are valuable, they do not necessarily provide guidance on how interventions should be implemented in routine practice. Implementation science emerged out of a need to close the gap between research and practice. In this article we describe how Russell Glasgow and colleagues’ RE-AIM framework could be used to plan and evaluate intervention implementation. Drawing on a hypothetical clinical scenario about a team of speech-language pathologists (SLPs) seeking to implement a program for late talking toddlers, we explore the type of information and issues SLPs need to consider to ensure optimal reach, effectiveness, adoption, implementation, and maintenance of an intervention in clinical practice. T he conduct of evidence-based practice in paediatric speech-language pathology can be challenging. This is partly due to the evidence-base being weighted towards efficacy studies rather than effectiveness studies, implementation research, and practice-based evidence (Crooke & Olwsang, 2015; Schliep et al., 2017). Efficacy studies focus on internal validity—they determine if a clear cause–effect relationship exists between an intervention and a desired outcome under carefully controlled experimental conditions. Children eligible to participate in efficacy studies usually need to meet strict inclusion criteria such as not having comorbid conditions and only speaking English at home (e.g., Girolametto et al., 1996). Although efficacy studies are important for determining if an intervention causes a desired outcome, the findings can have limited generalisability to the children on speech- language pathologists’ (SLPs) caseloads. For instance,

it cannot be assumed that experimental intervention outcomes for a cohort of monolingual children will be the same for multilingual children. By contrast, effectiveness studies focus on external validity—they determine if interventions work under real-world conditions. Inclusion criteria usually more closely reflect the heterogeneity of children on SLPs caseloads. Although effectiveness studies offer better generalisability, they still focus on the effect of an intervention under experimental conditions. Effectiveness studies are not designed to provide information about how an intervention might be faithfully implemented at a local level to yield results in routine practice. The field of implementation science was born out of a need to close the research–practice gap, accelerate the implementation of empirical research into day-to-day practice, and evaluate both the process and outcome of implementation (Crooke & Olswang, 2015). One of the advances within the field of implementation science over the past 20 years has been the development of theories, frameworks, and models for studying, guiding, and evaluating intervention implementation (Fixen et al., 2005; Nilsen, 2015). In this paper we reflect on how one of these popular frameworks, the RE-AIM framework (Glasgow et al., 1999) could be used to guide the planning and evaluation of intervention implementation. We draw on a hypothetical example from our experience in clinical practice to illustrate the value of the RE-AIM framework. Hypothetical SLP practice scenario: Improving parent training for late talkers Astrid is a senior SLP working for an organisation providing paediatric SLP services across a local government area. Astrid leads a team of nine SLPs across three different sites. During a planning meeting, the team discuss the need to improve their engagement with families of children who are late to talk (i.e., any young child whose parents or referring agents are concerned about the child’s communication) and subsequent implementation of parent training interventions. The team discuss the need to shift towards an effective group-based model of service delivery focused on parent training. While the team are aware of prior literature suggesting that SLPs could use a “wait-and- see” approach with some late talkers (Whitehurst et al., 1991), they are aware of evidence indicating that as these

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS CHILDREN COMMUNICATION FIDELITY IMPLEMENTATION INTERVENTION

Elise Baker (top), Kate Short

(centre) and Katrina Tosi

59

JCPSLP Volume 23, Number 2 2021

www.speechpathologyaustralia.org.au