JCPSLP Vol 17 No 3 2015

Practice support Program supports

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 American Speech-Language Hearing Association (ASHA). (2008). Clinical supervision in speech-language pathology [Technical report]. doi:10.1044/policy.PS2008-00295 Brandel, J., & Loeb, D. F. (2011). Program intensity and service delivery models in the schools: SLP survey results. Language, Speech & Hearing Services in Schools , 41 (4), 461–490. Carter, A., Messinger, D., Stone, W., Celimli, S., Nahmias, A. & Yoder, P. (2011). A randomized controlled trial of Hanen’s “More than words” in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry , 52 (7), 741–752. Cheung, G., Trembath, D., Arciuli, J., & Togher, L. (2013). The impact of workplace factors on evidence-based speech-language pathology practices for children with autism spectrum disorders. International Journal of Speech- Language Pathology , 15 (4) 396–406. Fixsen, D., Naoom, S., Blase, K., Friedman, R., & Wallace, F. (2005). Implementation research: A synthesis of the literature . University of South Florida, Tampa, Florida. Retrieved from http://nirn.fpg.unc.edu/sites/nirn.fpg.unc. edu/files/resources/NIRN-MonographFull-01-2005.pdf Flippin, M., Reszka, S., & Watson, L. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology , 19 , 178–195.

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).

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology