‘It depends’: Characterizing speech and language therapy for preschool children with developmental speech and language disorders

2020

Preprint

Background Implementation depends on healthcare professionals making sense of a new intervention in relation to their routine practice, a process Normalisation Process Theory refers to as coherence. However, specifying what it takes to achieve coherence is challenging because of variation in new interventions, routine practice, and the relationship between them. Frameworks for intervention description offer a way forward in specifying coherence, as they provide broad descriptive categories for comparing complex interventions. To date such frameworks have not been informed by implementation theory, so do not account for the coherence work involved in holding aspects of routine practice constant while doing other aspects differently. Using speech and language therapy as an empirical exemplar, we explored therapists’ experiences of practice change and developed a framework to show how coherence of child speech interventions is achieved. Methods We conducted a retrospective case-based qualitative study of how interventions for child speech problems had changed across three NHS speech and language therapy services and private practice in Scotland. A coherence framework was derived through interplay between empirical work with 42 therapists (using in-depth interviews, or self-organised pairs or small focus groups) and Normalisation Process Theory’s construct of coherence.Findings Therapists reported a range of practice changes, which had demanded different types of coherence work. Non-traditional interventions had featured for many years in the profession’s research literature but not in clinical practice. Achieving coherence with these interventions was intellectually demanding because they challenged the traditional linguistic assumptions underpinning routine practice. Implementation was also logistically demanding, and therapists felt they had little agency to vary what was locally conventional for their service. In addition, achieving coherence took considerable relational work. Non-traditional interventions were often difficult to explain to children and parents, involved culturally uncomfortable repetitive drills, and required therapists to do more tailoring of intervention for individual children.Conclusions The intervention coherence framework has practical and theoretical applications. It is designed to help speech and language therapists anticipate and address barriers to coherence in their context when implementing non-routine interventions. It is also a worked example of using theory to make intervention description user-focused and implementation-friendly.Contributions to the literature · Intervention descriptions identify what healthcare professionals need to do to implement new interventions but not how this is the same or different from their routine practice. We applied qualitative research and implementation theory to this problem of specifying ‘coherence’. · We focused on speech and language therapists because their work and the interventions they use are very complex. By understanding changes in their routine practice, we identified key elements for achieving coherence. · Our worked example of generating a coherence framework may be applicable in other professional areas where it is challenging to describe and implement complex behavioural interventions.

Section: Framing Coherence In Child Speech Interventionsupporting

confidence: 84%

Achieving Intervention Coherence in Routine Practice: A Qualitative Case-Based Study From An Implementer Perspective

Nicoll

Maxwell

2020

Preprint

“…While determining the critical components of an intervention approach is important, variation in how individual SLTs deliver interventions must also be considered, given the potential for additional impact on outcomes. Roulstone et al (2015) (Roulstone et al, 2015;Morgan et al, 2019). Some of these factors have been discussed in Furlong et al's (2018Furlong et al's ( , pp.1135 paper; namely, "child factors (e.g., age, severity of communication disorder), family factors (e.g., cultural differences, engagement and attendance) and contextual factors (e.g., staffing pressures, access to published programs)".…”

Section: Delivery Of Interventionsmentioning

confidence: 99%

An Exploratory Study of Speech and Language Therapy Intervention for Children Born With Cleft Palate ± Lip

The Cleft Palate-Craniofacial Journal

Harding

Wren

2020

Self Cite

Introduction: Children born with a cleft palate ± lip are at risk of developing speech and language difficulties, which may require intervention from a speech and language therapist (SLT). To date, there is no strong evidence to support one approach to intervention over another, neither is it clear which approaches or methods of provision are commonly used. Objectives: To describe the range of speech and language therapy interventions being used with children born with cleft palate in the United Kingdom up to 5 years of age. To explore the different ways, interventions are being delivered. Design: A prospective study to conduct 9 semi-structured focus groups. Iterative content analysis was completed. Setting: Regional Cleft Lip and Palate Centers in the United Kingdom. Participants: Sixty-two speech and language therapy professionals from specialist cleft teams and community services. Results: Four main codes were identified: “intervention approaches,” “service delivery models,” “decision-making and rationale,” and “patient-centered care.” Participants frequently discussed how they adopt an eclectic style when delivering intervention, the importance of an individualized approach for each child and service delivery constraints, such as a lack of resources. Conclusion: Insight into the multitude of intervention approaches used by SLTs, aspects which influence their decision-making and the variability of service delivery models were gained. Uncertainty regarding which intervention approaches and methods for delivery are most effective provides rationale for future research, to improve the effectiveness of speech and language intervention for children with cleft palate ± lip.

“…Describing interventions in a way that supports coherence work is particularly challenging in elds such as child speech therapy where there are high levels of intervention complexity, ambiguity and ambivalence (additional le 1). A mixed method study of speech and language therapy for pre-school children in England involving 245 therapists con rmed that, from their perspective, intervention and its variation is di cult to describe without the caveat of 'it depends' (7). While this suggests therapists put considerable work into creating coherence in everyday practice, we know little about how coherence is achieved when a new intervention is introduced, or how this is affected by context.…”

Section: Box 1 Coherence (3)(4)mentioning

confidence: 99%

Achieving Intervention Coherence in Routine Practice: A Qualitative Case-Based Study from an Implementer Perspective

Nicoll

Maxwell

2020

Preprint

Background Implementation depends on healthcare professionals making sense of a new intervention in relation to their routine practice, a process Normalisation Process Theory refers to as coherence. However, specifying what it takes to achieve coherence is challenging because of variation in new interventions, routine practice, and the relationship between them. Frameworks for intervention description offer a way forward in specifying coherence, as they provide broad descriptive categories for comparing complex interventions. To date such frameworks have not been informed by implementation theory, so do not account for the coherence work involved in holding aspects of routine practice constant while doing other aspects differently. Using speech and language therapy as an empirical exemplar, we explored therapists’ experiences of practice change and developed a framework to show how coherence of child speech interventions is achieved.Methods We conducted a retrospective case-based qualitative study of how interventions for child speech problems had changed across three NHS speech and language therapy services and private practice in Scotland. A coherence framework was derived through interplay between empirical work with 42 therapists (using in-depth interviews, or self-organised pairs or small focus groups) and Normalisation Process Theory’s construct of coherence. Findings Therapists reported a range of practice changes, which had demanded different types of coherence work. Non-traditional interventions had featured for many years in the profession’s research literature but not in clinical practice. Achieving coherence with these interventions was intellectually demanding because they challenged the traditional linguistic assumptions underpinning routine practice. Implementation was also logistically demanding, and therapists felt they had little agency to vary what was locally conventional for their service. In addition, achieving coherence took considerable relational work. Non-traditional interventions were often difficult to explain to children and parents, involved culturally uncomfortable repetitive drills, and required therapists to do more tailoring of intervention for individual children. Conclusions The intervention coherence framework has practical and theoretical applications. It is designed to help speech and language therapists anticipate and address barriers to coherence in their context when implementing non-routine interventions. It is also a worked example of using theory to make intervention description user-focused and implementation-friendly.Contributions to the literature · Intervention descriptions identify what healthcare professionals need to do to implement new interventions but not how this is the same or different from their routine practice. We applied qualitative research and implementation theory to this problem of specifying ‘coherence’. · We focused on speech and language therapists because their work and the interventions they use are very complex. By understanding changes in their routine practice, we identified key elements for achieving coherence. · Our worked example of generating a coherence framework may be applicable in other professional areas where it is challenging to describe and implement complex behavioural interventions.