Clinical Research—Considering Implementation as a Goal
Evidence for the efficacy of assessments and treatments of communication disorders has increased over the years; so, too, has the need to learn how to move these protocols into practice. Investigators are becoming increasingly aware of the need and the processes involved in impacting practice. We now appreciate that the approach of “pushing” evidence into practice by traditional pathways—such as publishing our findings in journals, relying on workshops and webinars, and mandating modifications in service delivery—falls short (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005; Green, Ottoson, Garcia, & Hiatt, 2009). Rather, a more active approach is being adopted whereby researchers and relevant stakeholders—particularly practitioners—partner to “pull” evidence into practice. Why is this approach preferred? Simply stated, researchers and practitioners working together are more likely to create circumstances that lead to sustained change in practice and, thus, that improve desired outcomes for clients. Researchers bring expertise in scientific methods for documenting valid outcomes. Practitioners possess intimate and practical knowledge about service delivery systems and the various facilitators and barriers to the adoption of innovative therapy approaches in clinical settings. Thus, a partnership is essential for improving the sustained delivery of evidence-based interventions.
Maximizing Change—Considering the Researcher–Practitioner Partnership
Historically, partnerships to promote implementation occurred toward the end of the research pipeline, only after extensive research documentation of efficacy (Green et al., 2009; Robey, 2004). Although this approach has proponents, it frequently results in major disparities between the tightly controlled conditions under which evidence-based protocols are validated and the realities of their actual implementation in clinical settings. Protocols that are difficult to adapt for real-world clinical practices or that require highly trained staff to implement are unlikely to be adopted or sustained.
Perhaps a more efficient and effective approach is to engage in an active partnership throughout the research and development process. If researchers become more knowledgeable about service delivery needs and realities, might they consider designing their protocols differently? This approach represents a more balanced way to address both internal and external validity while developing treatment protocols that are intended to be used in practice. The researcher is mindful of the scientific rigor of documentation; the practitioner contributes expertise about the communication patterns and needs of specific clinical populations, the intervention (or assessment) approaches, and the administrative demands likely to impact the implementation of evidence-based protocols. Essentially, the researcher–practitioner collaboration is a symbiotic partnership, whereby contributions of both are needed to understand factors affecting efficacy and factors affecting real-world implementation. In fact, one can argue that our science needs to address efficacy and implementation concurrently to make meaningful progress in advancing clinical practices and outcomes.
Building Strong Partnerships
Several core elements characterize successful collaborations. Mutual interest in a research area and a desire to solve a particular problem form the foundation for successful collaborative research. Initiating and forging strong researcher–practitioner partnerships require a plan, personal commitments, and ample time (Campbell, Camden, & Missiuna, 2016). First and foremost, researcher–practitioner partnerships work only if the members mutually respect and appreciate each other’s expertise (Epstein, 2009). Effective relationships acknowledge that the researcher will be ensuring that investigations are systematic and scientifically rigorous, and the practitioner will be ensuring that expectations are reasonable for enhancing supports and diminishing barriers within service delivery systems. Such shared appreciation of respective roles forms a foundation for true partnerships. Of course, mutual appreciation works only if communication is open, honest, and positive. It is essential for researchers and practitioners to recognize that they are approaching clinical problems from different perspectives—and often with different priorities, logic, and language. Creating a memorandum of understanding (MOU) at the beginning of a project may facilitate direct and useful communication. An MOU outlines plans and expectations for collaborators and can help minimize later disagreements about concerns, beliefs, and conflicts that may surface (Campbell et al., 2016). Finally, collaborative research is iterative; it relies on ongoing engagement, the revisiting of issues, and the recognition that modifications often are required. Incorporating these elements will validate the process and the ultimate success of the partnership.
Moving Forward as a Discipline
ASHA and the American-Speech-Language Hearing Foundation (ASHFoundation) are facilitating practitioner–researcher collaborations through several recent efforts, such as the ASHFoundation’s Implementation Summit in 2014; ASHA’s formation of the Clinicians and Researchers Collaborating (CLARC) program in 2013 and the Committee on Clinical Research, Implementation Science, and Evidence-Based Practice in 2015; and the Journal of Speech, Language, and Hearing Research supplement on Implementation Science in 2015. Also, in 2018, the ASHFoundation will begin offering a new research funding mechanism to support researcher–practitioner collaborative research.
As we look to the future, we must prepare our new investigators and practitioners with the knowledge and skills that they will need to engage in research collaborations with the goal of improving evidence-based services and outcomes in health care and educational settings. Academic programs can facilitate this by introducing and encouraging collaboration among researchers and practitioners as a part of their master’s and doctoral curricula. Collaboration can take many forms, from full research partners to consultants. The critical point is that the research and clinical worlds need to be connected as early as possible in the preparation of professionals in the communication sciences and disorders (CSD) discipline. Both parties need to appreciate the role that the other plays in attaining the best outcomes for individuals with communication disorders. It is time for graduate programs to go from merely discussing the need for more evidence-based practice in service delivery to explaining the role of practitioners in advancing the development and implementation of such knowledge. Graduate students can participate in, or read about, university community-based research programs that attained success in advancing science and practice. Doctoral students who are interested in improving services to individuals with communication disorders could be encouraged to collaborate with practitioners in a variety of community settings that are relevant to a particular student’s area of research. Appreciating the fact that curricular changes are difficult, academic programs can consider a variety of opportunities for discussing research–practitioner collaborative relationships, including informal discussions, webinars, community/laboratory rotations, and/or journal clubs. Our academic programs are key players in promoting a collaborative spirit in students. We need to find ways to demonstrate the merits of researcher–practitioner collaborations to rouse students’ passions and their earnest questioning of how to improve our assessments and treatments.
References
Campbell, W., Camden, C., & Missiuna, C. (2016). Reflections on using a community-based and multisystem approach to transforming school-based intervention for children with developmental motor disorders. Current Development Disorders Reports, 3(2), 129–137. Retrieved fromhttp://dx.doi.org/10.1007/s40474-016-0081-y.
Epstein, I. (2009). Clinical data-mining: Integrating practice and research. New York, NY: Oxford University Press.
Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature [FMHI Publication No. 231]. Tampa, FL: University of South Florida, The National Implementation Research Network. Retrieved fromhttp://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/resources/NIRN-MonographFull-01-2005.pdf [PDF].
Green, L., Ottoson, J., Garcia, C., & Hiatt, R. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30, 151–174. Retrieved from http://dx.doi.org/10.1146/annurev.publhealth.031308.100049.
Robey, R. (2004). A five-phase model for clinical-outcome research. Journal of Communication Disorders, 37, 401–411. Retrieved from http://doi.org/10.1016/j.jcomdis.2004.04.003.
Works Consulted
Camden, C., Shikako-Thomas, K., Nguyen, T., Graham, E., Thomas, A., Sprung, J., …Russell, D. J. (2015). Engaging stakeholders in rehabilitation research: A scoping review of strategies used in partnerships and evaluation of impacts. Disability and Rehabilitation. 37, 1390–1400. Retrieved fromhttp://dx.doi.org/10.3109/09638288.2014.963705.
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82, 581–629. Retrieved from http://dx.doi.org/ 10.1111/j.0887-378X.2004.00325.x.
Grol, R., Wensing, M., Eccles, M., & Davis, D. (2013). Improving patient care: The implementation of change in health care (2nd ed.). West Sussex, England: John Wiley & Sons.
Kieser, A., & Leiner, L. (2012). Collaborate with practitioners: But beware of collaborative research. Journal of Management Inquiry,21(1), 14–28. Retrieved fromhttp://dx.doi.org/10.1177/1056492611411923.
