Prologue: Implementation Science in CSD and Starting Where You Are

Abstract

In this prologue, we introduce readers to the Forum: Clinicians and Researchers Navigating Implementation Science in CSD. Implementation science (IS), or the study of the adoption of evidence-based practice in real-world settings, is a key area of development in communication sciences and disorders (CSD). The goal of this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD. This goal culminated in a scoping review of IS in CSD, a tutorial on incorporating IS into clinical practice research, three articles on stakeholder engagement, and three examples of IS studies in CSD included in this forum. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS in CSD.

Implementation science (IS)—the study of the adoption of evidence-based practice in real-world clinical settings—is increasingly a focus of communication sciences and disorders (CSD) researchers and professionals (Glasgow et al., 2012). The traditional research pipeline, which prioritizes randomized controlled trials, is often slow (roughly 17 years) with limited adoption into routine clinical practice (Green, 2008; Olswang & Prelock, 2015). Frequently, the lack of adoption is due to weak external validity—that is, the controlled contexts of some intervention research do not reflect real-world clinical practice. IS research works to consider the breadth of real-world settings and populations to rigorously and scientifically integrate interventions and ensure adoption into real-world settings. Inherent in this process is the collaboration of clinicians and researchers, as well as other key stakeholders (e.g., patients, caregivers, administrators, payers, policymakers). Clinicians understand the contextual challenges involved in day-to-day clinical care and researchers aim to systematically identify, describe, and address these challenges to improve the translation of best practices into routine care.

Importantly, IS research is a key area of development in CSD. In 2008, the American Speech-Language-Hearing Association (ASHA) identified eight objectives to address by 2025, the third of which is to “enhance the generation, publication, knowledge translation, and implementation of clinical research” (ASHA, n.d.). The idea of IS was first formally introduced to CSD researchers in March 2014 at the American Speech-Language-Hearing Foundation (2014) Implementation Science Summit. Since that time, researchers have begun expanding their methods to include IS. However, IS remains an understudied area in CSD, perpetuating the delay of evidence into practice (Douglas et al., 2022; Olswang & Prelock, 2015). To achieve the objective of ASHA's Strategic Plan and reduce the research-to-practice and practice-to-research gaps in CSD, it is necessary to explore opportunities to equip both clinicians and researchers with the skills to collaboratively work together to improve the assessment and adoption of evidence-based practices.

To address this need and connect with others interested in IS, we established the Implementation Science Study Group, which is a national grassroots group of clinical practice researchers in CSD across career stages that meets monthly to discuss the application of IS to CSD. Through our discussions, we identified that one of the hardest steps of IS was getting started. The purpose of this forum was to demonstrate how researchers and clinicians in the field of CSD are using the principles of IS to bridge the research-to-practice and practice-to-research gaps. Our aim in putting together this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD and to provide insights, tutorials, and examples of starting where you are in navigating IS in CSD.

This forum provides demonstrations and applications of IS in CSD. However, our intent is not to provide an educational guide on IS methodology. For interested readers, we refer you to resources within and outside of CSD. A few places outside of CSD include the Active Implementation Research Network (https://www.activeimplementation.org/), the National Implementation Research Network (https://nirn.fpg.unc.edu/national-implementation-research-network), and the Dissemination & Implementation Models in Health Research & Practice Webtool (https://dissemination-implementation.org/index.aspx). CSD-specific resources include the ASHA Clinical Research Education (CREd) Library Implementation Science Guide (https://academy.pubs.asha.org/cred/implementation-science-cred-guide/); the Implementation Science Resources for Clinical Research, Implementation Science, and Evidence-Based Practice Committee guide in the CREd Library (https://academy.pubs.asha.org/2017/06/implementation-science-resources-for-crisp/); the supplement on IS in the Journal of Speech, Language, and Hearing Research (https://pubs.asha.org/toc/jslhr/58/6); and the Perspectives of the ASHA Special Interest Groups forum on putting research into practice (https://pubs.asha.org/toc/persp/4/1).

In this forum, you will find a scoping review on IS in CSD (Douglas et al., 2022), a tutorial on moving from clinical practice research to IS (Binger et al., 2022), several articles with “behind-the-scenes” looks at and examples of research engaging diverse stakeholders (Alonzo et al., 2022; Magnusson et al., 2022; Quinn et al., 2022), an article on evaluating training for providers to improve implementation fidelity (Caron et al., 2022), an article examining the extent to which current clinical practices in aphasia rehabilitation reflect a multifaceted approach to care (Tierney-Hendricks et al., 2022), and a protocol paper for a Type 1 hybrid effectiveness-implementation trial (Studts et al., 2022). As a reflection of the importance of IS research to the field of CSD, these articles span across multiple clinical topics and disorders in speech-language pathology, including aphasia, augmentative and alternative communication, severe disabilities, deaf and hard-of-hearing individuals, and child language disorders across health and education settings. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS. While the CSD field has begun to make progress in moving evidence-based practices into the real world, more work is needed using the principles of IS to bridge the research-to-practice and practice-to-research gaps. To advance the adoption of research into practice, clinicians and researchers need to collaboratively work together in the advancement of IS in CSD. We hope this forum helps you start where you are.

Author Contributions

Meghan M. Davidson: Conceptualization (Equal), Writing – original draft (Equal), Writing – review & editing (Equal). Crystle N. Alonzo: Conceptualization (Supporting), Writing – review & editing (Supporting). Andrea Barton-Hulsey: Conceptualization (Supporting), Writing – review & editing (Supporting). Cathy Binger: Conceptualization (Supporting), Writing – review & editing (Supporting). Mindy Bridges: Conceptualization (Supporting), Writing – review & editing (Supporting). Jessica Caron: Conceptualization (Supporting), Writing – review & editing (Supporting). Natalie F. Douglas: Conceptualization (Supporting), Writing – review & editing (Supporting). Julie L. Feuerstein: Conceptualization (Supporting), Writing – review & editing (Supporting). Lesley Olswang: Conceptualization (Supporting), Writing – review & editing (Supporting). Jennifer Y. Oshita: Conceptualization (Supporting), Writing – review & editing (Supporting). Megan E. Schliep: Conceptualization (Supporting), Writing – review & editing (Supporting). Emily Quinn: Conceptualization (Supporting), Writing – review & editing (Supporting). Megan A. Morris: Conceptualization (Equal), Writing – original draft (Equal), Writing – review & editing (Equal).

Funding Statement

This work was supported by F31 DC020118, National Institute on Deafness and Other Communication Disorders.