One of the reasons that you would want to go the implementation science route is that you are actually involving your stakeholders. The people who are going to actually have to do the innovation that you’ve developed, the evidence-based practice. You really are engaging with them from the beginning.
I know that in the Partnering for Change project, the process they used — and this was before I came into the project, but I think it worked very well — is they started with a core issue. That issue was a problem in the system of how you provide occupational therapy supports to children with disabilities in the school system. They identified a very core group of maybe three or four people who were really invested in trying to change the system to do a better job of supporting these kids.
A Stakeholder Engagement Day
It started with getting a small pot of funding to have a stakeholder engagement day. The central question was really around bringing people together who had an interest in this particular population of children and servicing them better. Some families were invited. Some educators, some health professionals, and some people from the health service system.
It started at a small level with the question of, “What would success look like?” If we were to think of a future — if we were to envision what we want these children to have — what would the elements be? What do we think we would want? What do we think the outcomes would look like? How would we want to support these kids?
That gave a very broad overview of what people wanted to see. People can have contradictory views, but I think when it came to what it is that would serve to help the children, people actually get on the same page. In terms of, if we put away all the constraints of funding, and system constraints, and competing priorities and talk about what we want for the kids. People then had a similar vision and passion.
“Trying Some Things Out” and Finding the Core Ingredients
From that meeting, the team applied for a small research grant. They had a unique situation where they had two occupational therapists who were clinician- scientists. They were still very much actively engaged in clinical practice, but they also had roles on faculty, and a very good understanding of research and of the vision that the team had.
They literally went out and said, “We’re going to go out in two schools, one day a week. An OT is going to each of these schools and will work with some educators to try some things out.”
They didn’t go in with “this is a curriculum we’re doing” or “this is an exact intervention.” So, it was very open-ended. And their job was simply to go out and say, “If we were to go into schools and embed an OT into schools, and try to provide wraparound services for children, what might it look like?”
The other part of their job was to say, “As a clinician, what would I need to know, what supports would I need to actually do this?”
The advantage was these were very seasoned clinicians, and they had the vision in mind. But the process started there. And from their insights, we developed the outline of what we thought the core ingredients would be, if you were going to provide services in a different way.
Building Up a Demonstration Project and Finding Champions
That led to a demonstration project. We looked at whether we can actually have OTs who aren’t researchers, who weren’t part of the team, who don’t have all of that. Could we see if we could get them to do this?
The building blocks started from there. But it starts with, I think, a core group of people who have a common vision and a common interest. And that’s where you begin.
You identify the champions. You don’t start by going out and saying, “I want to change a whole system.” You figure out, here is a speech-language pathology clinician who is really interested in improving practice and who really sees that we need to do something different. You start with a principal who is really motivated to do better, you start with a healthcare agency who is like, “We know we’re not doing this right. We want to do it better.”
So you identify who your local champions are, and that gives you the drive to start, and that gives you people who are then going to go out and say, “This is the greatest thing you’ve ever heard about.”
In fact, when we did our demonstration project, we actually had a teacher who approached us at the end of the year and asked to make a video. She said, “I just had the most wonderful experience with this occupational therapist working in my classroom. I was scared at first. I didn’t know what it would mean to have an OT in my classroom. I didn’t know if it would be more work for me. I didn’t know what she would want of me, if she could add something. And this experience turned out to be the best thing I have ever done. And I would like to tell every teacher out there who is ever going to hear about this program, that if you hear about it and you have the chance to do it, you jump at it.”
I can tell you that to this day, we show that video from that teacher at every presentation that we do. And it is by far the most powerful thing that we can do to get momentum. She’s a champion.