Thread by @rkomesidou

Welcome to #ImplementationThursdays!!! Last week, we discussed a bit about what #ImpSci is and what it can do to improve uptake of #EBP. This week, I want to focus on implementation strategies - things that you do to change something in your context and facilitate implementation.

Usually, when you do #ImpSci work, you begin by examining what in your target context influences implementation and whether it is acting as a barrier or a facilitator. Identifying barriers to implementation is important because these are the things that you want to change.

And the way to change them, eliminate them, is by using implementation strategies: strategies that address barriers and enhance the adoption of a particular program. Here is a nice summary by @ImpSciUW
impsciuw.org/implementation…

There are many identified implementation strategies in the literature because there are many barriers that can prevent the adoption and maintenance of an EBP. Check out the compilation of strategies created by @Byron_Powell et al.
…plementationscience.biomedcentral.com/articles/10.11…

An adaptation of this compilation for school-based work was done by Cook et al. (THANK YOU! THANK YOU!): pubmed.ncbi.nlm.nih.gov/31152328/

Let me give you an example. @tiffanyphogan, myself, and others do a lot of work to improve the uptake of universal screening for #DevLangDis and #Dyslexia. A common problem that we see is poor data literacy.

Schools generate a lot of data. A LOT! But, often, data is disconnected and practitioners have a hard time reading the data and understanding how it connects with the rest of the information that they have for a child and their routine practices.

So it's a big barrier. Why are we even conducting screenings if generated data cannot be used to inform next steps? So, early on, we saw the need for targeted strategies to change this, e.g., better training, centralized data systems, and simple outputs for better readability.

Recently, I've been thinking a lot about implementation strategies and I think it was triggered by the presentation that @Nat_Douglas did for our doc students a few weeks ago.

@Nat_Douglas mentioned that she is working on scoping review with @megan_schliep and others about the current landscape of #ImpSci work in CSD (not published yet). They found that overall, the implementation strategies that we tend to rely on is training and education.

She discusses this work in this podcast episode: aphasiaaccess.libsyn.com/episode-72-imp…

I think an interesting question that comes up is why? Why do we feel more comfortable to focus more on training practitioners and educators than other implementation strategies (I definitely look forward to reading their paper and potential reasons).

Don't take me wrong. It is absolutely important to provide appropriate training opportunities and PD to our teachers and SLPs. The more they know the better they do. And I am glad that as a field we are moving toward more #ImpSci work.

But, as @Nat_Douglas mentioned, we still have a lot of work to do. And, I think, sooner than later, we must focus on other aspects of implementation and other strategies.

Routine settings (schools, hospitals) are complex systems making implementation even more complex. In #ImpSci, we try to understand how factors at all levels influence implementation efforts - from the program itself to the individual provider to the inner and outer settings.

I recommend reading about the CFIR framework by @LJDamschroder et al. and understanding the different levels or domains: …plementationscience.biomedcentral.com/articles/10.11…

From my experience, I definitely see a general tendency to focus more on individual providers than their surrounding systems. Let me tell why that is not enough.

In a sense, it puts the pressure on them and downplays the importance of considering and addressing organizational factors, e.g., structure, capacity, leadership, power dynamics, resources, support, culture, climate, current practices and whether they're evidence-based or not

In this article, Fulcher-Rood et al., talk about organizational constraints that affect the use of EBP by SLPs: pubs.asha.org/doi/abs/10.104…

There is tons of work from #ImpSci showing how organizational factors influence implementation efforts, beyond practitioner knowledge.

For example, Aarons & Sawitzky (2006) discuss organizational climate and culture: ncbi.nlm.nih.gov/pmc/articles/P…

JJJ van Dongen et al. found organizational factors that influence interprofessional collaboration, like shared vision and mission and support. bmcfampract.biomedcentral.com/articles/10.11…

Aarons et al., discuss about the critical role of leadership here:
jaacap.org/article/S0890-…

Again, increasing practitioner knowledge is important and empowering. But it's not enough. We must also focus on other elements in their respective systems that will likely influence how well they will implement and sustain EBP.

Let's say you work with schools and provide extensive PD about the science of reading to teachers, SLPs, reading specialists, special educators, etc. But the curriculum that the school recently bought and uses is NOT evidence-based.

So you are increasing their knowledge about what instruction they should implement and sustain for their students, but they will keep hitting a wall - a very expensive one that leaders chose to build. What do you do?