Thread by @rkomesidou

Welcome to #ImplementationThursdays!!! This week, instead of reviewing an article, I decided to introduce implementation science and compile useful resources for anyone who might be interested. Here we go! #ELAchat #ImpSci #DevLangDis #Dyslexia

Let's start with the problem. The problem is that high-quality, evidence-based programs do not always end up in routine practice like schools. For example, a review showed that it takes on average 17 years for only 14% of research to be integrated into practice.

17 YEARS AND ONLY 14%! This means that programs that we know work are not used in routine practice and do not benefit those who need them. This means that our children with #DevLangDis and #Dyslexia for example do not receive high-quality services.

This means that many of our students still can't read well. This means that our amazing #slpeeps and #teachers don't have the capacity to do what they do best. This means that our schools are left with band-aid solutions that are often inappropriate and unsustainable.

This is a problem that came out of the way research is traditionally conducted, the disconnection between researchers and practitioners, limited consideration of real-world contexts, ridiculous assumptions that once we have an EBP it'll immediately end up in settings,

discrimination against entire communities that leads to significant health and educational disparities, inadequate preparation programs for our #slpeeps and #teachers, misalignment of policies and practices, lack of common language

Is there a solution? The answer is ABSOLUTELY YES! It is by focusing on implementation and increasing the fit between EBP and real-world contexts that we will manage to reduce and hopefully eliminate this gap and what it implies for our communities.

This is where implementation science comes in. So, what is it? Well, it's the science of implementation!

Ok ok here is a better definition: "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services"
…plementationscience.biomedcentral.com/articles/10.11…

Implementation science allows us to first understand why an EBP is not routinely used (so what are the barriers that prevent it) and how we can improve its usage by systematically eliminating barriers and using effective strategies to promote implementation.

I love this @ASHAJournals tutorial by @Nat_Douglas and @vlbursh introducing implementation science and some of its history!
pubs.asha.org/doi/10.1044/20…

One important distinction between implementation science and traditional clinical research is the consideration of real-world contexts, their makeup, their strengths, and their weaknesses.

We must understand how our contexts operate, their history, their structure, the problems they face. Without this knowledge, anything that we will try to implement will likely fail.

Remember that evidence-based programs are usually developed under ideal conditions. Real-world contexts don't always have ideal conditions. And that is the gist. We must take our "perfect" programs and somehow help contexts adopt them and, most importantly, maintain them.

To do that, we definitely need rigorous planning and tools that will allow us to systematically increase implementation efforts. It's a very complex process and one that requires consideration of multiple levels, from the recipient of services to the outer context.

Over the years, people have created useful frameworks and guides to facilitate implementation. One of my favorite guides is the QUERI Implementation Roadmap by the Dept of Veteran Affairs:
queri.research.va.gov/tools/roadmap.…

Here are more resources that introduce implementation science and its methods.
This is an excellent @DyslexiaIDA Perspectives issue dedicated to implementation science for school-based practice:
mydigitalpublication.com/publication/?i…

@megan_schliep et al provide examples of the application of implementation frameworks and methods in speech-language pathology
tandfonline.com/doi/abs/10.108…

In this article, Kilbourne et al. discuss success stories from implementation science:
link.springer.com/article/10.100…

Here, @Nat_Douglas et al. ask the million-dollar question: pubs.asha.org/doi/10.1044/20…

Here, @rebeccasummy and I share some initial thoughts on the use of implementation frameworks to promote universal screening for #DevLangDis
psyjournals.ru/en/psyclin/202…

In this article, @MauraKCurran, myself, and @tiffanyphogan illustrate how we considered contextual constraints during the pandemic and simplified a complex program to continue essential services for students with language and reading needs
psyarxiv.com/pu6sa/

One important lesson from this work is that we must consider our practitioners' voices and honor their knowledge. We might know the science, but our #slpeeps and #teachers know routine practice. Both sides are needed to ensure quality education for EVERY child.

Another lesson is that this type of work requires a serious balance between adaptation and fidelity. From my experience, people are afraid of adaptation. But without it, we cannot expect programs to work well in real-world contexts. We CAN have our cake and eat it too!

A final thing to always remember is that the knowledge that comes out of implementation work belongs to practitioners. As researchers, we help and then we go away. So empower your practitioners and remove all these barriers that still make implementation science a mystery.