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142 JCPSLP Volume 17, Number 3 2015 Journal of Clinical Practice in Speech-Language Pathology
Although coaching is not included in the recommended
implementation supports for the programs featured in this
paper, it may be an effective way of ensuring treatment
fidelity that could follow training and provide a strong
focus on developing self-monitoring skills. Components of
coaching that may facilitate SLP practice include support
to combine what SLPs have learnt in training with their own
personal practice or beliefs. Coaching may also include
modelling or demonstration, support with the development
of self-assessment and monitoring of performance, and
the provision of emotional support in challenging situations
(Spouse, 2001). In order to implement interventions with
fidelity, SLPs may need support integrating newly learned
behaviour into practice, facilitating information sharing and
collaborative relationships with clients, and combining new
skills with previous knowledge and practices (Fixsen et al.,
2005). When supporting the implementation of evidence-
based programs at an organisational level, coaching
may have a compensatory effect for challenges such as
SLPs’ existing competencies or the quality of the program
training (Fixsen et al., 2005). Coaching may strengthen
implementation after training, or where there are differences
between the required skills and staff competencies.
Conclusion
Treatment fidelity is essential for the implementation of
evidence-based practice. Some manualised programs,
including the three discussed in this article, have a range of
recommended procedures for supporting SLPs to achieve
high fidelity. Some of the barriers to translating research into
practice, such as resource constraints and limited practice
support for monitoring and self-assessment of treatment
fidelity, have been highlighted. Organisations have a key
role to play in addressing these issues through the
management of resources and the provision of ongoing,
targeted supervision and coaching following program
training.
References
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Flippin, M., Reszka, S., & Watson, L. (2010).
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Practice support
Program supports
Kaderavek and Justice (2010) suggested that practitioners
will require training, guidance and feedback to be able to
deliver an intervention as intended. To this end, clinicians
who complete Lidcombe Program training are encouraged
to contact the trainers if they have questions about working
with clients with diverse needs (O’Brian, 2013). In contrast,
PECS is considered to have a relatively short training period
for implementation of 2 days (Flippin et al., 2010), with no
other follow-up mentioned. Similarly, the More than Words
program (Sussman et al., 2013) does not prescribe specific
post-training follow-up or feedback, although Hanen trained
SLPs are actively encouraged to access online resources
such as research summaries and e-seminars and attend
regional meetings with Hanen Centre trainers. Further
program supports could include opportunities for program
mentors to facilitate clinician’s self-reflective practice,
provide feedback on video recordings of clinician’s real-time
implementation, and be available for collaborative problem-
solving. This type of support has been particularly effective
in increasing treatment fidelity for clinicians implementing
Incredible Years programs which are manualised and use a
similar initial training model to the three SLP programs
discussed in this paper (Webster-Stratton, Reid, &
Marsenich, 2014).
Organisational supports
Informing SLPs about the range of procedures for
measuring treatment fidelity and approaching the
implementation of these measures from an organisational
perspective may facilitate monitoring of fidelity and
outcomes. The development of a workplace culture that
facilitates implementation of evidence-based practice at a
service delivery level requires organisational supports
(Cheung, Trembath, Arciuli, & Togher, 2013). A workplace
culture should include opportunities to meet as a
professional community that supports new ideas and
challenges existing ones (Timperley, Wilson, Barrar, & Fung,
2007).
Organisations can also support SLPs by ensuring they
have sufficient time and resources to deliver interventions at
the appropriate dosage and intensity (Yoder, Fey & Warren,
2012). For example, although the Lidcombe Program for
early stuttering recommends 45–60 minute sessions, a
sample of community clinicians were reported to offer
30-minute appointments (O’Brian et al., 2013). In order to
justify the allocation of sufficient resources, managers within
organisations need to be made aware that an intervention
is not being delivered with adequate fidelity, potentially
compromising client outcomes.
The provision of supervision or coaching is an
essential component of organisational support for SLPs
implementing evidence-based practice (Fixen et al., 2005;
Meyers, Durlak & Wandersman, 2012). Speech-language
pathology professional associations promote participation
in regular supervision as a key part of developing and
maintaining professional competencies (ASHA, 2008; SPA,
2007). Recommendations for supervision often include a
strong focus on developing self-monitoring and evaluation
skills through the use of coaching. Coaching is considered
to be an adult learning strategy that enhances skills,
supports understanding (Rush, Shelden & Hanft, 2003),
and facilitates practice changes (Timperley et al., 2007).