Background: Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children’s outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. Aims: To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. Methods & Procedures: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda. Discussion & Conclusions: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology
BackgroundInterprofessional collaborative practices (IPCP) are considered to be a crucial factor in the optimal support of young children (3–6 years) with speech, language and communication needs (SLCN) in inclusive early childhood education and care (ECEC).AimsTo investigate IPCP in interventions using a collaborative approach for young children with SLCN in ECEC, by identifying mechanisms within IPCP and how these mechanisms relate to specific context factors and professional and child-related outcomes.MethodsA realist review of 22 empirical intervention studies, published between 1994 and 2019, was conducted to synthesise context-mechanism-outcome (CMO) configurations, combining context factors, IPCP mechanisms and outcomes at staff and child level.Main ContributionReciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development. Our review further suggests that collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, is vital for inclusive practices and functional communication of children with SLCN.ConclusionOur review has revealed indications for effective IPCP mechanisms, context factors at staff level, and positive outcomes for the professional development of staff working with children with SLCN. In addition, our findings support a link between IPCP and child-related outcomes regarding speech, language and communication development. Future studies should increase our insight into how practitioners, children and families profit from daily collaborative practices.WHAT THIS PAPER ADDSWhat is already known on this subjectInterventions using a collaborative approach for young children (3-6 years) with SLCN in ECEC are considered to be part of the optimal support of these children.What this paper adds to existing knowledgeConducting a realist review of 22 empirical studies on collaborative intervention offered the possibility to identify specific context factors, IPCP mechanisms and professional and child-related outcomes and to synthesise CMO configuations. Findings suggest multiple routes from effective delivery of SLCN services to improvement of speech, language and communication development, supporting the suggested beneficial function of collaboration between multiple professions. Collective ownership of intervention goals, combined with personal cooperation and communication skills of staff, seems to be vital for inclusive practices and functional communication of children with SLCN. Reciprocal IPCP mechanisms were reported together with interprofessional intervention practices, whereas one-directional IPCP mechanisms were restricted to gains in professional development.What are the potential or actual clinical implications of this work?High-quality collaborative intervention for children with SLCN in requires awareness of and critical reflection on IPCP mechanisms in order to improve outcomes for both professionals and children. Both, institutional structural support and individual communicative and cooperative skills are required to increase interprofessional collaboration with the aim to meet the needs of every individual child with SLCN.
Purpose: Most speech-language pathologists (SLPs) working with children with developmental language disorder (DLD) do not perform language sample analysis (LSA) on a regular basis, although they do regard LSA as highly informative for goal setting and evaluating grammatical therapy. The primary aim of this study was to identify facilitators, barriers, and needs related to performing LSA by Dutch SLPs working with children with DLD. The secondary aim was to investigate whether a training would change the actual performance of LSA. Method: A focus group with 11 SLPs working in Dutch speech-language pathology practices was conducted. Barriers, facilitators, and needs were identified using thematic analysis and categorized using the theoretical domain framework. To address the barriers, a training was developed using software program CLAN. Changes in barriers and use of LSA were evaluated with a survey sent to participants before, directly after, and 3 months posttraining. Results: The barriers reported in the focus group were SLPs’ lack of knowledge and skills, time investment, negative beliefs about their capabilities, differences in beliefs about their professional role, and no reimbursement from health insurance companies. Posttraining survey results revealed that LSA was not performed more often in daily practice. Using CLAN was not the solution according to participating SLPs. Time investment remained a huge barrier. Conclusions: A training in performing LSA did not resolve the time investment barrier experienced by SLPs. User-friendly software, developed in codesign with SLPs might provide a solution. For the short-term, shorter samples, preferably from narrative tasks, should be considered.
communicative participation, language disordersOBJECTIVE(S)/RESEARCH QUESTION(S) Speech and language therapists (SLTs) are the primary care professionals to treat language and communication disorders. Their treatment is informed by a variety of outcome measures. At present, diagnosis, monitoring of progress and evaluation are often based on performance-based and clinician-reported outcomes such as results of standardized speech, language, voice, or communication tests. These tests typically aim to capture how well the person can produce or understand language in a controlled situation, and therefore only provide limited insight in the person’s challenges in life. Performance measures do not incorporate the unobservable feelings such as a patient's effort, social embarrassment, difficulty, or confidence in communication. Nor do they address language and communication difficulties experienced by the person themselves, the impact on daily life or allow patients to set goals related to their own needs and wishes. The aim of our study is give our patients a voice and empower SLTs to incorporate their patient's perspective in planning therapy. We will Aangemaakt door ProjectNet / Generated by ProjectNet: 08-12-2020 12:072Subsidieaanvraag_digitaal / Grant Application_digitaalDossier nummer / Dossier number: 80-86900-98-041DEFINITIEFdevelop a valid and reliable patient-reported outcome measure that provides information on communicative participation of people with communication disorders and integrate this item bank in patient specific goal setting in speech and language therapy. Both the item bank and the goal setting method will be adapted in cocreation with patients to enable access for people with communication difficulties.STUDY DESIGN Mixed methods research design following the MRC guidance for process evaluation of complex interventions, using PROMIS methodology including psychometric evaluation and an iterative user-centered design with qualitative co-creation methods to develop accessible items and the goal setting method.RESEARCH POPULATION Children, adolescents and adults with speech, language, hearing, and voice disorders.OUTCOME MEASURES An online patient-reported outcome measure on communicative participation, the Communicative Participation Item Bank (CPIB), CPIB items that are accessible for people with language understanding difficulties, a communicative-participation person-specific goal setting method developed with speech and language therapists and patients and tested on usability and feasibility in clinical practice, and a course for SLTs explaining the use of the goal-setting method in their clinical reasoning process.RELEVANCE This study answers one of the prioritized questions in the call for SLTs to systematically and reliably incorporate the clients’ perspective in their daily practice to improve the quality of SLT services. At present patient reported outcomes play only a small role in speech and language therapy because 1) measures (PROMS) are often invalid, not implemented and unsuitable for clinical practice and 2) there is a knowledge gap in how to capture and interpret outcomes from persons with language disorders.
