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Research With an Impact: Launching an Academic Career in Knowledge Translation and Implementation Science

Knowledge translation (KT) and implementation science (IS) are essential to enhancing the impact of clinical practice research in speech-language pathology and audiology. The presenters discuss how to build a career in KT and IS by providing practical exa

Wenonah Campbell and Natalie Douglas

DOI: 10.1044/cred-pvd-c16007

The following is a transcript of the presentation video, edited for clarity.

Wenonah Campbell

We’re here to tell you about some new fields that we think can inform communication sciences and disorders research, knowledge translation, and implementation science, and to tell you a little bit about how we’ve included them in our careers to date and to provide some insights on what our experiences have been and some tips and strategies. And then to have a discussion and answer your questions.

I’m Wenonah Campbell and I’m an assistant professor at McMaster University which is in Ontario, Canada. McMaster is just outside of Toronto, to give you sort of a geographical location. And just as part of my disclosures I did want to tell you that at McMaster I’m a part of a research center called CanChild. That’s a research and education center that does research around childhood health and disability research. But we’re also a center that is grounded in knowledge translation, and so a lot of what I’ll be talking about today will draw on the experiences I’ve had with that center. So I did want to disclose that, and I’ll just hand it over to Natalie for second.

Natalie Douglas

I’m an assistant professor at Central Michigan University, and then I have one CEU course for Northern Speech Services, and that’s it.

Wenonah Campbell

So what we thought we would do today is to take some time and give you a sense of what knowledge translation science and implementation science are, to give you a bit of background on that, and why we think it’s particularly important to think about in terms of communication sciences and disorders research.

We’ll take a few minutes to walk you through what our individual journeys have been. There’s no one right way to establish a career in implementation science or knowledge translation. I think both of these fields are very, very new in terms of themselves as fields, and its really very much emerging in terms of thinking about them in relation to CSD research. So we’re sharing our stories but there are many ways that you might go about doing this, and we’ll just share some of our experiences today. And then we’ll do some Q&A.

Before we get started we did want to take us a second and get a sense of who our audience would be here today. So in terms of what your backgrounds are, how many of you are doctoral students or postdoctoral fellows? Fabulous. How many of you are faculty members or researchers and you have your PhD? Wonderful. And do we have anybody here who is either a graduate student in a CSD program, thinking about a PhD? Okay, lovely, so we’ve got a full spectrum. And clinicians? Yes and clinicians today? Awesome. Or researcher-clinicians, that you do both? Fabulous. We’re so happy to have you here. You’re our early adopters, which is so exciting for us.

In terms of your familiarity with knowledge translation and implementation science, how many of you came here today where it’s like, “Huh? Never heard of this before. ” All right. And how many of you have some sense of what it is? Excellent. And do any of you consider yourselves to have positions where this is a part of what you do? We have a few, wonderful. So it would be great as we go along — we have a full spectrum of experiences, and it would be great during the Q&A if you want to bring any of that out and contribute and share your experiences, we would love that.

Why knowledge translation and implementation science

Wenonah Campbell

For those of you who are new, and this is sort of a “What is this all about?” Probably, if you’ve been in the field either you’ve practiced clinically in doing your own research you may have noticed that we often talk about a gap between research — so that’s our evidence, the what we know in our field — and then the practice — so what is it that’s happening in clinical practice, what is the action or do. So we often talk about it as a knowledge-to-practice gap, or it could be a knowledge to action gap.

We want to talk about today, well, what’s the importance or significance when you have a gap between the recent research evidence you have in your field and the practice that’s actually happening. Why does that gap happen? How come it’s not enough that if we do good research, and we publish that research, that that research isn’t implemented in daily practice? And then to talk about how the fields of knowledge translation and implementation science can really help us think about — in partnership between clinicians and researchers — how you close that gap.

And thank you to everybody for getting together to talk about these issues that we have here with this research-to-practice gap. Although the gap is no longer 368 years, we have from multiple sources when you combine several literature sources, that it still takes 17 years, when something is studied in a lab, for 14 percent of that lab work to reach routine clinical practice. So no matter what metric you’re using, and even if these studies are off a little bit which I don’t personally think that they are, this still is indicative of a huge huge problem that we really need to do something about.

What might this look like in CSD?

A lot of my work is in implementing external memory aids for people with dementia in skilled nursing facilities. I use this as an example to kind of show what that 17-year gap might look like with external memory aids. So Michelle Bourgeois in the early 90s looked at how we have this beautiful evidence base to support both communication and quality of life for people with dementia. That’s at year one. And she, over the course of these years she gave tons and tons of workshops. She did publish quite a bit. Some people are reading the publications, some people aren’t. You have clinicians that maybe attended one of the workshops and said, “No, this was awesome, I want to go implement this in my setting.” But then the years and years go by, and we see that for one reason or another — and we’ll talk about some of these reasons — clinicians are not doing it.

 

So I looked at some work when I was in Florida with skilled nursing facility speech pathology and less than half of them were using this treatment, and this was in 2012 and 2013 when I was collecting some of this data. So we have this evidence-based treatment not being implemented. The thing about implementation science is it’s a tool, and it’s a systematic way to address some of these issues without placing blame on anybody which is why I really appreciate it. We’re not going to say, “Oh it’s the clinicians fault. He or she needs to be reading the journals and doing this and doing that. Oh it’s the researchers fault.”

 

Well, it’s really no one’s fault, this is a broken system that we really kind of need to get all hands on deck to be able to fix some of these issues. So I’m going to turn it back to Wenonah for a second.

 

Wenonah Campbell

 

So in talking about what the issues are, the first thing you have to wrap your head around is terminology. And unfortunately, it’s kind of ironic actually, that one of the barriers in these fields is terminology. We have a lot of it. There are a lot of terms to refer to what we’re calling today knowledge translation and implementation science. I want to say more than 90 different terms. People use knowledge mobilization, knowledge utilization, transfer, it goes on and on.

 

We’ve chosen today to bring it together and use two terms, knowledge translation and implementation science, and to define those for you. Just as they overlap to some extent, they’re not exactly the same. They are both getting at the idea of trying to move research evidence into practice, and really what term you use actually tends to depend more on where you are in the world, and what field you’re in. So in my world in Canada, we always talk about knowledge translation. We very rarely used the term implementation science. And it’s probably the reverse here in the US, but we’re really trying to get at the same issue.

 

But we will also show you how, although these terms are overlapping, they do have complementary functions. That means they’re not completely the same, so it’s not true that you could exchange knowledge translation and implementation science and be talking about exactly the same thing, but you’re definitely talking about things that live together and work well together.

 

So if you look at this cartoon, I think the reporters are saying, “Tell us in layman’s terms what your breakthrough means.” “Certainly.” –and then it’s just gobbledygook, it’s a formula.

 

So one of the first things that you have to think about knowledge translation is you have to be able to get the right information, to the right people, at the right time, and in the right format, so they can actually use it. And as researchers, we tend or have tended to think about packaging our information in one main way — the peer-reviewed publication, or conference presentations like we’re doing today. Those are valued things, but we have to think about: Are those all the people that need to get messages about the kinds of research, particularly clinical practice research. Do families need messages? Clients? Clinicians? Our professional collaborators, whether they be in healthcare, education, or otherwise? The administrators and managers in the settings we work in? The funders who make decisions about what interventions get funded, what services get funded? Policymakers who create legislation that dictate the kinds of services we do? All of those are stakeholders in our research, and all of those parties need to know about the work we do. They are not all going to read a publication or come to a conference presentation, and even if they did they would not understand it, because it’s not tailored to them. So knowledge translation is all about thinking: Who is it that needs to know about this? And it’s important to recognize not all research needs to go to all stakeholders. Depending on where you are in the research process and how far along your evidence is, it may be that your target audience is other researchers. And then you may be fine if you want to focus on publications and conference presentations, because that’s a really good way to reach other researchers, as well as networking. But if what you’re doing is really about changing clinical practice, or if what you’re doing really has implications for how we structure healthcare services or how they’re reimbursed, then you need to be able to figure out which stakeholders need that message and how to best reach them and then tailor.

So it’s actually quite a big job to think about that. That the work that you do as a researcher, the publication phase is crucial because it does get it into the public domain and ensures that was published has met some amount of rigor. So it’s important. The publication process is crucially important, but it’s like, that’s a first step. And then you have to think about: what am I doing beyond that if I want to ensure that what I’ve done as a researcher is showing up in clinical practice, and if I want to make sure that gap is not 17 years. So I’m going to hand it over to Natalie who’s going to explain implementation science, and has a slightly different bent, but you’ll see how the packaging and targeting of information will complement the part in implementation science.

Natalie Douglas

So as we look at implementation science, this is a very systematic way to look at: what can influence practice change? What gets in the way of research kind of getting into the typical service provider setting? So those conditions could happen at the level of the organization or system. I will keep referring back to nursing homes because that’s where my clinical career and research career have been, and there are broken systems there that preclude best practices in terms of productivity requirements, in terms of restrictions in how long you’re allowed to see people, in terms of how many people are allowed to be in a group and whether or not you’re allowed to bill for that. So these are the issues that can impact whether or not we’re translating evidence-based programs into those typical settings.

This looks a little bit more at what we talk about when we look at these variables and conditions. If you’re looking — there are over 60 implementation science models. Somebody told me, it’s like a toothbrush: everybody has one, but nobody wants to use another person’s, so they make their own. So we have like way more implementation science models — over 60 of them. But all of them will take a piece of this, and even a lot of you have already even mentioned, how we’re not talking about a linear research program here. We’re talking about a process. It’s an iterative process. Its complex. There’s lots of things going on at the same time. So implementation science allows you to kind of take a piece of that and study it to see whether or not if I tweaked that piece is that going to help me bring my treatment into a routine typical setting. That could be looking at the attitudes of practitioners. It could be looking at the attitudes of leaders within the organization. Doing a skills and knowledge assessment. Training and mentorship — there are probably close to 100 different types of training in the literature, if not more. The same in regards to feedback: So how much feedback do I need to give you? What type of feedback? I’m looking at influences of the organizational culture. We as researchers have to recognize that when we want our treatments to move in an organization, it’s not within a vacuum. It’s within this huge organization — either school setting, an educational setting, it doesn’t matter. And there are issues of workplace culture and leadership and resources. Really when you talk about organizational culture, you’re talking about the way things are done. And that’s not necessarily explicit, it’s not necessarily in a manual somewhere, but it’s this underlying vibe of the way that a place is operating. And those factors really impact the research-to-practice transfer. And then we also have, as I mentioned earlier, issues with funding, reimbursement for our profession, funding mechanisms, and those are some of the variables and conditions that we can study with an implementation science model.

A little bit more about the organization. There are some — Ellen Hickey and I reviewed some work in terms of organizational culture and climate, and I’m happy to give you a reference to that if you are interested. But basically, organizational cultures and climates kind of break down into either positive or negative. And there are some organizations that at baseline are very ready to adopt a clinical innovation. So they present factors such as they want to risk, they’re patient-centered client-centered, they’re willing to kind of go out on the line for their clients and patients. Whereas contrasting organizations are more hierarchical structure. So it’s very much like follow the rules, do this, no risks, must do this at this time, and so on and so forth. These types of organizational issues really impact practice.

System factors also impact treatment fidelity. We were just talking about communication partner training in aphasia — and really communication partner training in anything that we do. And so if you write in your chart, I completed communication partner training with Mrs. Smith, what does that actually mean? Does it mean that you gave her a handout? Did you do like a role play scenario? Did you, how long did you spend with the person? Were they able to demonstrate the strategies? We don’t know, right. That’s treatment fidelity. So it’s like what were we actually doing?

Then the other thing that we need to consider is sustainability. So how do I know if I design this absolutely beautiful research project in this nursing home, but it only lasts for six months, and then I take my students, and I take my stuff, and I hit the road, and so does everything that I did. Right. That sustainability. That’s unacceptable — it’s not a wise use of our resources, and implementation science can really help us to design our treatments so that it will stick, if it is appropriate for that local culture and context.

So I think hopefully by now we’ve convinced you, and I’m sure all of you even thought that before you came in here, that if we want optimal clinical outcomes regardless of setting — if it’s kids, adults, it does not matter — we need to do better at merging this gap. There’s just too many resources, too many lives at stake. We need to do this. So I’m gonna pass it over to Wenonah and we’re going to talk to you a little bit about our personal journeys in entering these fields.

Getting started in implementation science

Wenonah Campbell
So in terms of how did I become interested in knowledge translation and implementation science. My journey kind of probably started not necessarily doing clinical work. So Natalie and I have very different perspectives, which I think will be helpful to the group. My interest in it really came during my PhD. I call that where it was planting the seeds. I wasn’t actually doing this kind of research, but what I did do during my doctoral studies was I wrote a conceptual paper, it was for my comprehensive exam, and what we had to do was we had to take a framework, and we had to do a scholarly paper that suggested something that would influence how people are thinking in our field. And so what I took on for my particular comprehensive paper was to think about how we could take the knowledge we have of children who on the outside have different types of disabilities, so it could be specific language impairment, attention deficit hyperactivity disorder, coordination issues, and look at the research and say, “Well you know they have different labels, but when you get into the meat of it a lot of the issues that they struggle with have a lot in common.” And how could we take that knowledge and how could we take some frameworks around how to organize our services and about how we do work in the school system differently. So I was interested in that particular system as my setting.

 

So I wrote this paper, I got it published, and I put it out there, I presented at conferences. I don’t know that a lot of people have read it, but what I can say is the right person red it. So I had one person read it who came to me and said, “You need to go talk to some people at McMaster University, and you need to get connected with CanChild.” And at the time I have to be honest, I hadn’t heard of CanChild even though I was just down the road from it in London, Ontario. And I was introduced to my postdoctoral mentor Cheryl Missiuna. She’s an occupational therapist by background, not a speech-language pathologist. And she she does what I would call health services research, so she’s very interested in how to improve the services that children are getting in terms of actually changing not just what occupational therapists, do but changing the entire system around them to support their ability to do new ways of practice.

 

So she read my paper, and I met with her and heard about her project, and I went, “Oh my goodness, this person is doing the thing that I wrote about.” The ideas that were in that paper are coming to life in that project. So I went off to McMaster University to do a postdoctoral fellowship. I left behind communication sciences and disorders. McMaster at the time didn’t have a speech-language pathology department. And I immersed myself into the interdisciplinary culture of CanChild. So CanChild as a research center has, I think at the moment we have maybe 40 different scientists. Their backgrounds include all of the health professions. We have educators, special educators, psychologists, statisticians, epidemiologists, sociologists, we have the whole gamut of people who are part of that Center. And you get to go work there and do very team-based research. And the team that I happened to join was a team called Partnering for Change. And that was a program of research that was just getting started at the time that I came to CanChild, that was looking at what it would take to change how occupational therapy services were delivered in Ontario in the school system. At the time they were operating in a in a really kind of crazy model, where the therapists were employed by healthcare third-party payers. Waitlists were about two to three years in length, and when a child finally got to the top of the waitlist they would get exactly six visits from an occupational therapist, three of which were used for assessment to document the child had a problem, and three of which were therapy. All of which had to be delivered one-on-one because the only way they could bill was a fee-for-service. Nothing ever went to the families. Nothing ever went to the educators.

 

So needless to say, I went to a team where it’s like, “We’ve got to figure out what to do.” And over the next — I’ve been part of that team since 2009 — and over that period of time I have had the incredible experience of being involved in community-based research, in action research, in research that’s all about working at all levels. So we do work with clinicians, we do work with healthcare administrators, we go in and we meet with policymakers, we do all of that work. And so I have to say I’ve lived and breathed KT for the last several years.

 

As a faculty member — so I transitioned in 2014 from a postdoctoral position and a contractual faculty position into an assistant professor role. And so since then I’ve been looking at, “Well how do I turn this into something that’s infused in my career and develop that over the long term.”

 

So one thing I will say is I am not the expert in the world on KT or implementation science. I am still learning. And so I try to do my own professional development, I seek out training opportunities in these fields. I sometimes go to conferences that are completely outside. I go to health policy research conferences ,all kinds of different places where this kind of work is happening to get exposure. I do a lot of team-based work. So one of the other things I will say is this kind of work is very hard to do one person on their own, because you have to work at so many levels and you need so much different kinds of expertise. So I infuse that into my research. I still work on Partnering for Change, but I’ve also branched out into other projects that use knowledge translation.

 

Last year I was able to take on a part of that expertise in my teaching, and so I now teach a knowledge translation course to masters and PhD students at McMaster, and that’s been a way to hone my own skills and to also ensure that there is capacity being built in the next generation. And then it’s part of my service, I’ve sought out opportunities to be involved at a community level, particularly in communication sciences and disorders, by joining most recently the ASHA committee called CRISP which stands for Clinical Practice Research Implementation Science and Evidence Based Practice. And so through that, I’ve been able to connect with and met with researchers in our own field and also to begin to look at what are initiatives that I can be involved in at ASHA that will help this move forward.

 

So I sort of see this as a journey, where it’s like, I’ve come from my own realization of, if I have a great idea, what is it going to take to get that idea moved into practice? Who do I need to partner with to do that? And then how do I actually take this and integrate it into my faculty career, so that it’s a whole part of everything I do in terms of my research, teaching, and my service.

 

So in terms of — just to give you an example from a knowledge translation perspective from the Partnering for Change team, and I will emphasize we’re a team — I am not the person out there on my own doing this. Since I joined the team we’ve done at least 35-plus peer-reviewed presentations, and we have 10 publications so far on Partnering for Change and more in the pipeline. So that’s our traditional mechanism of getting the word out there to other researchers and to get our work vetted and published.

 

Here’s everything else we do. So in terms of who you communicate and how do you communicate? We have developed webinars, we’ve developed webinars for policymakers, we’ve developed webinars for clinicians. We’ve developed videos of different lengths with different messages for our different audiences. We’ve looked at developing infographics that can communicate information about our study in a very visual and quick way. When you want to get information out to a stakeholder that doesn’t have a lot of time, like a policymaker who will give you maybe 10 minutes if you’re lucky, you need to — you can’t hand them something to read. It has to be quick, it has to be visual, and it has to have absolute key messages. And often they don’t want to know the details of exactly what you did. They want to know the reverse — it’s interesting in a publication we do a lot of background. We tons and tons of it. What were our methods, what were our results. We discuss them all, we criticize them and critique them and find all the flaws. And then at the very end we go, “and what does this mean?” And the policymaker wants to know the “What does this mean, and what do I need to do about it? So you have to think about how you actually give messages to policymakers in very different ways.

 

We’ve also actively looked to have media coverage, and one of the ways we’ve done that is through working with our partners in healthcare so that the public knows about the work that we do. We’ve had TV and newspaper coverage. We have given I would say close to 60 to 70 individualized tailored presentations to all of the stakeholder audiences. And when I say they’re tailored, we do not have a canned presentation that goes out. We have one that is for clinicians, one that is for educators, one that is for families, one that is for policymakers. And our team, the team person who belongs to that particular group is the person who goes out and delivers that. So even though it’s a model that started in occupational therapy, if we need to tell speech-language pathologists about it then I’m the one who goes and gives that presentation. We do workshops, we do training.

 

We did an interesting experiment this year — I guess it was last year — with our final report. We had funding from the Ontario Ministry of Health and Education, and they wanted a report. And usually they get a big PDF document or printed report that’s about this thick. We designed a web-based interactive report that had tailored sections for every audience. And one of the beautiful things is, we actually — they used it, but because you can measure web analytics you actually know if IP addresses associated with the government, or with hospitals, or with school board, where IP addresses are showing up and accessing. You can know what parts of the report they read, and you can know how long they stayed there. So it was an incredibly effective way for us to do knowledge translation of our project results.

 

So, what have I learned? And I think I’ve hit this one over the head. You need to know who needs to know about your research. And you need to think about exactly what the ways are to get that message to them. There’s a wonderful tool kit at kmbtoolkit.ca that is evidence-based. It was developed by the Ontario Center for Excellence in Child and Youth Mental Health, and it’s got some wonderful resources about how you actually tailor messages.

 

Seek opportunities to develop partnerships, and those partnerships may be with other researchers, they may be with organizations in your community, clinicians. And get your stakeholders involved. So even those of you who are doing what you might consider more basic research, and you’re thinking, “What I’m doing is not ready to be put into practice yet.” It can be so helpful to engage your stakeholders early on and bring them in, and help ensure that you’re addressing a question that’s relevant to them. That you’re thinking of the issues that are going to be important to them. And that you’re getting feedback and building ownership of those ideas along the way. And that will really go a long way to when your research does get to a point that you begin to want to look at implementation.

 

There are tools for creating — in Canada we call it a KT plan. So when we write grants in Canada, you always have to actually submit your plan about who it is that you need to disseminate your information to, and how you’re going to do it, what strategies you’re going to use and how you know that those are the appropriate strategies to be using. And what’s great as you budget for it. So KT plans go into the budget of your grant. So if you need to have a stakeholder symposium at the beginning and end of your grant to exchange knowledge, budget for it. If you need money to develop videos, or develop plain language resources, or to have materials translated, you build that into your budget. So that’s something I’ve learned over time.

 

And the other big lesson I would say is being open to being outside of CSD. It’s hard at first. For a long time I was the only speech-language pathologist CanChild, but it really was useful to be willing to say, this is where this is happening and this is where I need to be right now. And I found that really helpful to being open to looking at non-traditional pathways. And I’ll hand it over to Natalie.

 

Natalie Douglas

 

So this could also be known as: What everyone tells you not to do in entering a faculty position. But it’s what happened. So I worked in a traditional research lab at Ohio University, and then I had a ten-year gap between where I got a PhD in CSD and continued clinical career simultaneously. So I was just feeling a lot of angst is all I can say. Between some of the gaps between research and practice. Going to school one day, going to the nursing home the other day, and it was just it was just too much. And then one of my mentors Jackie Hinckley gave me this monograph by Dean Fixsen. And if you’re interested in implementation science, he’s really like the grandfather of implementation science. Most of his work is in education, but it was a monograph about this field called implementation science. And all of these issues that I was experiencing in terms of: I know what to do. I know the treatment that I want to provide. But I’m constrained by the organization, I’m constrained by XYZ and I can’t do it. It was kind of coming to to light when I was looking at this implementation science monograph. And I’m like, okay this is an actual method of scientific inquiry. So that’s me in the corner screaming and crying as I’m trying to sort this out. Because, I’m glad Winona is here, because that’s really — I don’t want to say a better way to do, it but it probably is because she was surrounded by people who knew about knowledge translation. Whereas in a traditional communication sciences and disorders program, we don’t we don’t have that yet. I’m super excited and I could not be more thrilled we are moving in that direction. What has helped me as, Wenonah mentioned is really diving deep into some of these implementation science organizations. There’s a great group in Seattle that I have referenced there. The Global Implementation Initiative provides a lot of mechanisms for training. And it’s amazing how no matter what field you’re in, if it’s mental health or education, these same principles really apply. So a lot of my work in the meantime has really been showing how organizational factors do impact clinical practice in nursing homes. So I’ve been using implementation science models in order to convey some of that data, which has been helpful.

 

So what I did as a postdoc, was I connected with very strong, well-known clinical researchers who were generous enough to work with me, to talk to me about why is it that their clinical research that has been published and in the mix for more than 30 years was not being routinely used in clinical practice. So that was kind of the journey that I took, and Michelle Bourgeois and Ellen Hickey were generous enough to kind of include me in some of their work, so that we could problem-solve and work together to say: Okay, how can we, from an implementation science perspective, take a treatment that we already have beautiful efficacy data for and really push that forward into routine clinical settings? And so my journey was a little bit different from Wenonah’s. I think that if you’re maybe not in a situation where you have access to a lot of knowledge translation or implementation science folks, but you’re really interested in this area. I think if you can team up and reach out to some of these very strong clinical practice researchers who’ve been doing this for a long time, it can be a real avenue to push their work forward, and ultimately give more people the right treatments at the right time. Which is what we’re all trying to do.

 

So I’m going to pass it over to Wenonah to just quickly let you know about some of the initiatives that ASHA has been taking on to really push this forward as well.

Conclusion and questions

 

Wenonah Campbell
So I’m just going to review these quickly because we want to leave some time for questions as well. But ASHA has been very supportive of encouraging our field to look at implementation science and knowledge translation, and to consider how to improve our clinical research in general, and also how to get more research into practice. There is a special issue that was published in JSLHR in late 2015, and the entire supplement issue was focused on implementation science. Some of the papers are introducing people to the concepts in the field and are tutorial in nature, and others are actually from researchers in our field who are doing work that would follow these models and use methods consistent with these. So that’s a really great place to start if you want to get a flavor for where our field is on this right now. The ASHFoundation in 2014 hosted an Implementation Science Summit, and if you go to their website you will find that all of the presentations and speakers from that are actually there, recorded with the PowerPoint slides. So if you weren’t able to go there but you want to have a sense of what was presented — and in that case they brought in a lot of people from other fields, who are experts in these areas to speak to researchers about what’s going on. Because again we need to build the capacity in CSD and we’re not there yet. So you would be really hearing from people who are considered world-renowned experts in these areas. And then the Clinical Research and Education Library that’s available through ASHA is an amazing resource that’s continuing to be built and an improved upon. It has all kinds of resources in clinical practice research, but there is a section there on implementation science specifically, and so I’d encourage you to check that out, and things will be added to those as its developed.

 

The other things we were going to talk about: training opportunities, funding, and where to go for more, we actually put together a handout that’s on the convention program planner, and actually everything that’s in those last three sides is there as well. So I think rather than speak to those individually what we’d like to do now is maybe just open it up for your questions for the last few minutes.

Audience Question:

Question inaudible.

Natalie Douglas

That is a great question, and it really depends on which source you’re looking at. So in some sources there is basic research that — which is research that never touches a human being. And then it’s translational to where you are able to, kind of like more of a traditional bench-to-bedside type model where you are testing out the safety of an intervention. And then there’s what would be traditionally referred to as treatment efficacy or effectiveness type studies. And so I think for some people, translational research is knowledge translational research, like what Wenonah was talking about. And then for other disciplines, it’s that middle-of-the-road point between what could be applicable to a clinical population and what is still in those basic testing phases.

Wenonah Campbell

If I understand your question, you’re sort of saying that the research that you do is still lab-based. Was your question how would you be using knowledge translation and implementation science?

Okay, I see what the question is now. It is again part of the terminology thing that we deal with, and it’s confusing. So translational research is a term that’s going to refer to research that somewhere between having done basic research where you haven’t involved humans. For example looking at just equipment, but you haven’t, you’re not involving human subjects. Its development studies that could be based on cell biology, doing animal research, where you haven’t taken it to the point of being able to apply your technique in humans yet. Translational research, you are now moving out into the realm of involving humans in research and human participants, but what you’re developing has the potential one day to be used as a tool in clinical practice. But it isn’t a point yet where you could actually say, “I’ve got a tool that I could go out, and it’s of a known effectiveness that I could use strategies to help clinicians actually use this on a day-to-day.” So when you think about developing assessments and tools and you’re collecting normative data or you’re doing testing like that, you’re somewhere in the translational area. You’ve got implications, but you’re not ready to actually do the implementation piece to say, “Now I know this is ready and I want to work on having clinicians begin to use this in routine practice.” So you’re somewhere in that middle part.

Natalie Douglas

Westfall, in 2007, published a really nice — it was in a medical journal I can get you the exact resource after. He has a beautiful outline and figure that really outlines a lot of your questions. Thanks.

Audience Question:

Do you see small labs and smaller research being promoted through ASHA in this way? We have a lot of other resources than other labs might have, even so we feel like our work is important, it still could go out in different avenues, and be supported better through ASHA.

Wenonah Campbell

So I think what ASHA has been doing, ASHA is putting quite a bit of thought and resources into different mechanisms for disseminating research that comes through the ASHA journals. I’m going to put Margaret — I’m not going to ask you to speak to it Margaret, but Margaret Rogers who’s right here — you would like to? Then please do Margaret.

Margaret Rogers

Knowledge translation is one of four components of our strategic pathway: To enhance the generation, publication, knowledge translation of research. I just want to say that we’re really doing a major transformation of the ASHA journals program. Ray Kent has written an article for Access Academics and Research describing it. We’re very much embracing the effects of social media to help. There are a lot of initiatives with that. We’re also very interested in helping researchers promote their own research. In fact there are all these tools authors of our journals are going to be shown and encouraged to really increase their reach.

Natalie Douglas

Of course and I should acknowledge to that my one of my implementation science studies was just supported by the ASHFoundation, which I think can be another great mechanism to spread the word.

Audience Question:

It looks like one way to close that knowledge-to-practice gap is through policy. As a doctoral student right now I’m taking a class through the health services, through the Masters in Public Health program. So I’m just wondering as an SLP and I’m at that point where it’s kind of scary thinking about also pursuing a PhD simultaneously. With my background as an SLP, what kind of role does an SLP have in being involved with policy.

Natalie Douglas

think that historically we haven’t had that much of a role, but I think that that as part of this movement and initiative, Academy Health is a great resource for health services research, and I think that the more speech language pathologists that we can get at the table in those types of policy situations. And I don’t think that you necessarily would have to get a masters in public health, but I think even just having that knowledge and awareness of the impact of policy on practice, we’ve moved forward with that just I think in the past five or ten years. I think as Wenonah said, engaging in some of the organizations outside of CSD, but yet bringing our face to those situations, I think could be really helpful with that.

Wenonah Campbell

One way that I have found to be helpful in building relationships with policymakers, as I think there is a piece of it that is educating ourselves. So I do think it’s great that you’re taking some course work outside of a traditional sort of what you you might do in in an SLP doctorate. I think that that’s huge. But other coursework that proves very helpful would be things in qualitative research methods, mixed research methods. There are there are a number of different areas that feed into doing this work. Even coursework around plain language communication or training opportunities around how do you actually communicate in a way that reaches a non-professional audience. So there are things that you can do to develop your skill set. In terms of how I’ve developed the partnerships. I think engaging, one thing I’ve done is connected with mentors. I’ve connected with people who are more senior in my field who have some relationships, and partnered with them and attended meetings, and I’ve delivered presentations become exposed to how does this actually work. With policymakers a lot of it is around: do you have that relationship with them. They tend to receive information in terms of it if its interactive it’s better. So we do a lot of face-to-face. We also invite policymakers to be part of our research grants, so when it’s a when it’s an issue that’s relevant to practice, we often approached them. And and in many cases, particularly if you have someone who is a senior mentor, we found that they’re really quite willing to have conversations to hear about ideas. But I think you what you need to learn first is, so if I’m going to go in there you’ve got to have very crafted messages that are very to-the-point and really figure out what your key ideas are first. There are there is a whole literature that’s out there around knowledge translation for policymakers and what works. And there is evidence to speak to strategies that do and do not work. There are documents to say how to put together a policy brief. So there’s certainly lots of resources, we just may not have always been tapping into them.

Wenonah Campbell
McMaster University
Natalie Douglas
Central Michigan University

Presented at the ASHA Convention (November 2016).
Copyrighted Material. Reproduced by the American Speech-Language-Hearing Association in the Clinical Research Education Library with permission from the author or presenter.

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