About seven years ago I met monthly on Saturday mornings
with one of my favorite undergraduate students—a senior in psychology who was
working on her senior thesis. One of my colleagues in language science who
shared our interest in theory of mind and the nature of autism joined our
conversations. This colleague had great insights as a scientist, which guided
our thinking about why theory of mind was an important construct to understand
and explore, especially as we sought to evaluate the effectiveness of social
communication interventions for children with autism spectrum disorder. We
would argue for hours about what theory of mind is, how we might assess it in
children with ASD knowing their response challenges, how to address the
limitations of theory of mind assessment reported in the literature, and how to
create a tool that can be used as an outcome measure for our intervention
studies. This went on for at least a year, and I kept thinking, "Why am I giving up my Saturday mornings to do this?" I suspected my husband was asking the same thing, although to his credit he would say when I returned home for our traditional Saturday afternoon walk, "I can see that you are energized from your meeting today. So what are you going to do with that information? How are you going to make a real difference?"
Well that is the question, isn't it? What happens with the research we are doing? Are we pushing ourselves to make connections to practice? I would like to think so, but are we moving fast enough to navigate the growing expectations for demonstrating outcomes in education and health care reform?
I have been thinking about our professions' focus on evidence-based practice, in which we consider not only the available scientific evidence, but integrate that with what we know clinically and what our clients value. Yet I worry that often the available evidence is limited, our clinical judgment has been informed by experience (but to what extent by those critical conversations with scientists about what is really important for us to know and understand?), and our clients are not always clear about what they value most or what is possible when a loved one has a significant communication disorder. We need more integrated approaches to acquiring and applying scientific knowledge to support practitioners in delivering effective services.
The current climate in health care and education reform
certainly has our attention, and I believe challenges us to rethink the
implementation of evidence into practice. In the last 20 years, progress has
been made in developing efficacious treatments; however, implementing these
interventions across contexts with fidelity, while achieving the desired
outcomes for people with communication disorders, remains elusive. To close
this widening gap between research and practice, we need to embrace
implementation science or implementation research—the scientific study of
approaches that promote "systematic uptake" of research results and other evidence-based practices and bring them into routine practice. How might we begin to do this? Is there some magic formula?
I am pleased to report that the American
Speech-Language-Hearing Foundation is not only up to the challenge, but is
taking the first bold step to launch The Implementation Science Summit, a
landmark conference on March 20–22, 2014. Building on work from other
disciplines, the conference will explore "real-world" problems and opportunities for developing research oriented toward implementing evidence into practice. Held at the Park Hyatt Aviara in Carlsbad, Calif., this conference promises to stretch your thinking, provide new strategies and tools, and offer opportunities to discover solutions together (e-mail firstname.lastname@example.org for information). As a teaser to this summit, you might consider attending an overview session (#1165) at the ASHA convention on Thurs., Nov. 14, from 4:30–5:30 p.m., for an orientation to this integrated, evidence-into-practice approach.
I am very excited about the ASHFoundation's pioneering efforts to support the science and practice of our professions—there must be magic in the air or, more important, in our thinking, as we step into some unknown territory—but, as Sidney Shelton states, "There is magic, but you have to be the magician. You have to make the magic happen." We have to capitalize on those Saturday morning debates about research.
My colleagues and I continue to push ourselves to implement
intervention projects in the homes, schools and communities of children with
ASD—where real differences can occur. But I know we would benefit from greater
understanding of the methods we might use to bring the data to the doorstep of
all those who need it. Clinicians must ask researchers to investigate things
that matter, and researchers must ask clinicians what is it that matters to
them. Both have the potential to work some real magic.
P.S. By the way, my former psychology student is now a
certified SLP in private practice working with children with ASD. She still
joins my language science colleague and me for more debates about how best to
make connections from science to practice!