Making waves in our profession: Using research to drive clinical practice

As a dynamic profession, research evidence is a crucial underpinning of speech-language pathologists' practice. This special issue reflects the aim of the 2016 Speech Pathology Australia National Conference to showcase dynamic, innovative and creative practice, challenging the profession to “Make Waves” in gaining the knowledge and insight through research to achieve this. The papers presented at the conference deftly rode these waves through a focus on research methodologies that rippled throughout the papers and which are reflected in this volume.

Three internationally regarded keynote speakers set the scene for this theme, setting out how research can be used to pave the way forward. Professor Whitehouse (2017), in his delivery of the Elizabeth Usher Memorial Lecture and subsequent paper, challenges the paradigm of diagnosing autism spectrum disorder (ASD) through clearly identifiable behavioural patterns between three and five years of age. Professor Whitehouse throws down the gauntlet, proposing we seek to identify younger children who might be at risk, and even asking whether ASD may be prevented if therapy is provided at a time that is optimal for brain development. Through discussion of a series of very early intervention trials, Professor Whitehouse develops a convincing argument for changing the way we approach ASD and the need for research to seek both the path and the evidence for this new approach. Keynote speaker Dr Ebbels’ (2017) paper stresses the need for clinicians to create the evidence in the clinical setting rather than wait for evidence to emerge. She demonstrates the different research designs that transfer well into practice and supports these with exemplars from her own research. Only through clinicians equipping themselves with the knowledge and implementation strategies around research methodologies will evidence emerge on the effectiveness of everyday clinical interventions. The requirements, advantages and disadvantages of different research paradigms are set out in Dr Ebbels’ paper to support clinicians to conduct research on any scale. Keynote speaker Professor Enderby (2017) raises a further set of challenges in her paper, encouraging clinicians to become Master Chefs in developing and delivering interventions and services more broadly, ensuring the right ingredients are used and recipes applied, and to stir the pot (in a metaphorical sense). Professor Enderby challenges speech-language pathologists to be relentless in their pursuit of high quality of life for anyone with a communication or swallowing disorder.

The theme of making waves in practice is captured in the nine papers that complement the invited manuscripts, with a range of different research methodologies being applied across different clinical settings. Armstrong, Scott, et al. (2017) extend the challenge of early identification, raised by Professor Whitehouse, to late talkers and later language outcomes in their longitudinal study of 783 participants. Consistent with previous research, this paper identifies one group of children whose language profile remains constant, another group whose language delay resolves, and another whose language skills deteriorate with age, relative to normative data. A key finding of this paper is the identification of risk factors for language difficulties at age 10 in children who were not late talkers. Unicomb, Hewat, Spencer and Harrison (2017) demonstrate the use of a phase 1 clinical trial to seek evidence as to whether concurrent treatment of co-occurring stuttering and speech sound disorder is effective. The findings indicate that for many children, particularly those with a phonological impairment, concurrent treatment of speech sound disorders and stuttering was successful, and resulted in changes in both speech sounds and stuttering. Treatment fidelity is an important consideration for researchers and clinicians alike as we strive to become evidence-based clinicians. McCormack et al. (2017) describe the implementation fidelity for the Sound Start programme for phonological impairment. This paper highlights the challenges for our profession in bridging the gap between intervention programmes, designed and tested in a research setting, and the practical demands of the clinical setting. The research team examine how many participants receive the number of intervention sessions prescribed in the Sound Start manual, using both clinician report and electronic data. Only approximately 25% of participants received the prescribed number of sessions, with some receiving more and some fewer sessions than prescribed. This finding has a number of important implications for clinicians and researchers alike. The focus on research set by the invited papers is extended by Heard, O’Halloran and McKinley (2017) from clients and clinicians to other members of the multidisciplinary team. This paper investigates the effectiveness of different Communication Partner Training protocols for health care professionals in an inpatient rehabilitation setting. The use of a parallel randomised trial enabled the authors to compare outcomes from an e-learning programme with more traditional methods on healthcare professionals’ confidence and knowledge in communicating with patients with aphasia.

As our profession responds to the challenge of making our services accessible to all, many speech-language pathologists have adopted telepractice into their clinical practice. A concern for many speech-language pathologists is whether fundamental clinical ingredients such as rapport between the clinician and client are maintained under such a different service delivery model. Freckmann, Hines and Lincoln (2017) use an online survey of clinician-reported clinical alliance to measure rapport in two groups of clinicians, one using face-to-face therapy and the other using telepractice. This paper suggests there is no significant difference in clinician reported therapeutic alliance between these methods. The paper also provides preliminary evidence for the validity of the Therapeutic Alliance Scales for Children. The testing of such assumptions using research methodologies available to us is essential if we are to evaluate new methods of service delivery critically and ensure high standards of care.

Armstrong, Ciccone, et al. (2017) provide a comprehensive review of the dearth in culturally sensitive assessment tools for use with Aboriginal people. With the need recognised for new measures, the literature review and consultation process underpinning the Aboriginal Communication Assessment after Brain Injury (ACAABI) are set out, demonstrating the importance of input from Aboriginal speakers embedded in the culture and linguistic demands of new populations. Taking a different perspective on cultural and linguistic diversity, Atrill, Lincoln and McAllister (2017) survey domestic and international speech-language pathology students from three Australian universities, with a view to informing the discussion around increasing the proportion of culturally and linguistically diverse (CALD) students and providing inter-cultural learning opportunities for all students. With the majority of CALD students from mainly Southern and South-Eastern Asian backgrounds and speaking related languages, this paper proposes how the broader socio-cultural knowledge and experience of these students may ultimately enhance the speech-language pathology profession, provide inter-cultural learning opportunities for all students, and thereby promote culturally responsive practices.

The application of qualitative methodologies is seen in Leitão et al.’s (2017) exploration of the impact of living with dyslexia from the perspectives of children and their parents. Arising from concerns around the elevated risk of mental health problems in children with dyslexia, this paper presents a phenomenological approach, using structured interviews with children and their parents. They situate their findings at different levels of Bronfenbrenner’s ecological model. Both clinical and educational implications are drawn out, showing how findings may be used to inform and educate families and teachers about the impact of living with dyslexia. The conference also stimulated discussion of new theoretical paradigms to facilitate the translation of research into clinical practice. Swift, Langevin and Clark (2017) provide an overview of the theoretical background and methods involved in Critical Realistic Evaluation (CRE), highlighting the potential application to speech-language pathology. Based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it is provided, this paper demonstrates how interaction of client factors and contexts with the treatment agent can substantially influence the outcome. The challenge here is to be open to building on tried and tested theoretical models and explore how other frameworks may offer new insights into evaluating treatment efficacy.

“Making Waves” was a fitting theme for this conference in challenging existing views on identifying client populations, developing new tools for servicing different cultural and linguistic groups, evaluating our service delivery beliefs as technology presents new opportunities, and exploring new research paradigms. Underpinning each of these, however, is the willingness and capacity of the authors to apply a range of research methodologies to address clinical problems within clinical settings. For those who have the clinical questions but may be teetering on the edges, Dr Ebbels’ tutorial and the papers included here will surely help to create new waves.