A qualitative exploration of speech-language pathologists’ intervention and intensity provision for children with phonological impairment

Abstract

Purpose: To explore the reasons behind speech-language pathologists' (SLPs') current clinical practices (intervention and intensity provision) for children (0-18 years) with phonological impairment.Method: Three focus groups each with five SLPs and six 1:1 interviews with SLP managers from one region of the UK (n=21) were carried out. A thematic analysis was undertaken.Results: SLPs often used an eclectic mix of familiar approaches with easily-accessible therapy materials. SLPs only reported deviating from their core approach if the child did not progress in therapy. Mixed responses were gathered on the perceived feasibility of transferring evidence based intervention intensities into clinical practice. The importance of parents to increase intensity provision at home was noted. Barriers to SLPs' evidence-based decision-making included: time; confidence levels; service-related restrictions and; difficulty replicating research in practice. Having peer support and access to decision-making pathways and manualised intervention protocols were considered ways to overcome these barriers. Conclusion:There is a research-practice gap in which SLPs' current practices are driven by organisational factors, their own preferences and child-specific factors. To narrow this gap, SLPs suggested the development of time-saving, evidence-based tools.

Treating Childhood Speech Sound Disorders: Current Approaches to Management by Australian Speech-Language Pathologists

“…It is widely reported that SLPs frequently adopt an eclectic therapy approach (Brumbaugh & Smit, 2013;Hegarty et al, 2020;Joffe & Pring, 2008;McLeod & Baker, 2014;Oliveira et al, 2015;Pascoe et al, 2010;Roulstone & Wren, 2001) rather than a single approach. An eclectic approach involves blending different therapy approaches or elements of different methods (Lancaster et al, 2010;McLeod & Baker, 2014).…”

“…The external scientific evidence for SSDs relating to target selection, therapy approaches, and (to a lesser extent) the structural and procedural aspects of therapy sessions has been well considered within the EBP framework; less has been done on the professional and clinical expertise side of the EBP triangle to privilege the voices of SLPs working in this area of practice (Hegarty et al, 2020). The aim of the current study was to gain an in-depth insight into the intervention processes used by SLPs for treating children with SSDs.…”

“…Furlong et al: Treating Children With Speech Sound Disorders 591 term hybrid has been used previously to describe clinical practice (Brumbaugh & Smit, 2013), along with the term eclectic (Brumbaugh & Smit, 2013;Hegarty et al, 2020;McLeod & Baker, 2014;Pascoe et al, 2010). For SLPs in the current study, hybrid interventions switched between or introduced elements of other therapy approaches.…”

“…Lack of knowledge about newer therapies, lack of training, and limited access to these therapies (or therapy resources) accounted for 51% of reasoning for nonuse (McCurtin & Healy, 2017). For children with SSDs, lack of familiarity with newer therapies has also been reported (Brumbaugh & Smit, 2013;Hegarty et al, 2020). Brumbaugh and Smit (2013) identified multiple oppositions, PROMPT, and maximal oppositions to be among the nine least known therapy approaches for SSDs.…”

“…Other than PROMPT, SLPs' familiarity with newer therapy approaches (developed post-1985) was not related to the number of years since graduation; that is, more recent graduates were no more familiar with newer therapies (Brumbaugh & Smit, 2013). Participants in the study by Hegarty et al (2020) tended to use long-standing approaches such as minimal pairs and speech discrimination therapy, despite recognizing that newer and more complex approaches could be more appropriate for specific presentations (Hegarty et al, 2020). These combined findings raise questions around how information about newer therapy approaches is obtained and suggest that the uptake of newer therapy approaches into clinical practice may take time, particularly for approaches requiring formal training or specialized resources.…”