The following is a transcript of the presentation video, edited for clarity.
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.
I’m an assistant professor at Central Michigan University, and then I have one CEU course for Northern Speech Services, and that’s it.
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
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?
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.
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
Conclusion and questions
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.