Abstract
Background: Many speech sound disorder (SSD) interventions with a long-term evidence base are ‘new’ to clinical practice, and the role of services in supporting or constraining capacity for practice change is under-explored. Innovations from implementation science may offer solutions to this research-practice gap but have not previously been applied to SSD.
Aim: To explain variation in speech and language therapy service capacity to implement new SSD interventions.
Methods & Procedures: We conducted an intensive, case-based qualitative study with 42 speech and language therapists (SLTs) in 3 NHS services (n=39) and private practice (n=3) in Scotland. We explored therapists’ diverse experiences of SSD practice change through individual interviews (n=28) or self-generated paired (n=2) or focus groups (n=3). A theoretical framework (Normalisation Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes.
Outcomes & Results: We identified six types (‘cases’) of practice change, two of which involved the new SSD interventions. We focus on these two cases (‘Transforming’ and ‘Venturing’) and use Normalisation Process Theory’s Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming
was the result of a favourable service structure, a sustained and supported ‘push’ that made
implementation of the new interventions a service priority, and considerable collective time
to think about doing it. ‘Venturing’ happened where the new SSD interventions were not a
service priority. It involved individual or informal groups of therapists trying out or using one
or more of the new interventions with selected children within the constraints of their service
context.
Conclusions & implications: New, evidence-based SSD interventions may be challenging to
implement in routine practice because they have in common a need for therapists who
understand applied linguistics and can be flexible with service delivery. Appreciating what it
really takes to do routine intervention differently is vital for managers and services who haveto make decisions about priorities for implementation, along with realistic plans for
resourcing and supporting it
Aim: To explain variation in speech and language therapy service capacity to implement new SSD interventions.
Methods & Procedures: We conducted an intensive, case-based qualitative study with 42 speech and language therapists (SLTs) in 3 NHS services (n=39) and private practice (n=3) in Scotland. We explored therapists’ diverse experiences of SSD practice change through individual interviews (n=28) or self-generated paired (n=2) or focus groups (n=3). A theoretical framework (Normalisation Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes.
Outcomes & Results: We identified six types (‘cases’) of practice change, two of which involved the new SSD interventions. We focus on these two cases (‘Transforming’ and ‘Venturing’) and use Normalisation Process Theory’s Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming
was the result of a favourable service structure, a sustained and supported ‘push’ that made
implementation of the new interventions a service priority, and considerable collective time
to think about doing it. ‘Venturing’ happened where the new SSD interventions were not a
service priority. It involved individual or informal groups of therapists trying out or using one
or more of the new interventions with selected children within the constraints of their service
context.
Conclusions & implications: New, evidence-based SSD interventions may be challenging to
implement in routine practice because they have in common a need for therapists who
understand applied linguistics and can be flexible with service delivery. Appreciating what it
really takes to do routine intervention differently is vital for managers and services who haveto make decisions about priorities for implementation, along with realistic plans for
resourcing and supporting it
| Original language | English |
|---|---|
| Number of pages | 16 |
| Journal | International Journal of Language and Communication Disorders |
| Early online date | 6 Nov 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 6 Nov 2023 |
Bibliographical note
AcknowledgementsThank you to all participants who gave so generously of their time to share their experiences of practice change, and to the services and other people who facilitated access, including the Scottish Speech and Language Therapy Managers’ group. Thanks also to the Specialists in SSD Network, Caroline Bowen, Sharynne McLeod, and to team leaders in a fourth Scottish service whose SSD intervention initiative informed the study design. Finally, thank you to retired speech and language therapists Linda Armstrong and Jen Reid for critical feedback throughout the study.
Funding statement
This paper is based on work carried out as part of an ESRC funded PhD studentship awarded to AN at the NMAHP Research Unit, University of Stirling. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The paper was written after AN moved to the University of Aberdeen.
Data Availability Statement
Data availability statementThe signed participant consent form included item 6: ‘I understand that at the end of the study anonymised transcripts will be donated to a secure archive for future use by researchers.’ This will be done when publications are complete. This paper builds on a thesis where further data is available: Nicoll A. Speech and language therapy in practice: a critical realist account of how and why speech and language therapists in community settings in Scotland have changed their intervention for children with speech sound disorders. http://hdl.handle.net/1893/27257: University of Stirling; 2017.
Keywords
- implementation science
- practice change
- speech sound disorder
Access to Document
- Nicoll_etal_IJLCD_Understanding_Capacity_For_VoR
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists https://creativecommons.org/licenses/by/4.0/