Practice change in speech and language therapy: from PhD thesis to Plain English

It’s embarrassing as a speech and language therapist to admit this: I find it difficult to communicate the findings of my PhD in a way that can be easily understood.

My thesis is open access, but access doesn’t make it accessible. I’ve therefore been working on a Plain English summary.

I’ve tried to take into account the “I don’t know what you’re talking about” feedback. This relates to broad fields including speech and language therapy, client groups, qualitative research, sociology, implementation science, and critical realism. Here’s the latest version.

How speech and language therapists have changed their practice: a summary of my PhD in 400 words

Why did I think this research was needed?

Speech and language therapists work with people who have communication difficulties. For each person they see in clinical practice, therapists try to use approaches that will make the biggest difference. This takes skill because there are a lot of approaches to choose from and different combinations suit different people. On top of this, when therapists want to use a new approach, they need to be able to change what they are used to doing. I wanted to find out what it really takes for therapists to change their usual clinical practice.

How did I go about it?

I asked speech and language therapists how and why they had changed their clinical practice with children with speech problems. I considered how this was the same and different across three NHS speech and language therapy services and therapists working privately. I paid attention to how long these practice changes had taken and who and what had been involved. I noticed why some new therapy approaches seemed easier for therapists to use than others.

What did I find out?

Therapists had changed their usual clinical practice in six main ways:

1. using new approaches
2. organising therapy more often for particular children for a set period of time
3. trying out new approaches with particular children
4. making therapy very personal
5. teaching parents to do the therapy
6. constantly adjusting therapy to improve or freshen it up

I identified patterns in what had happened to make these changes to usual clinical practice possible. I found that the service where therapists worked had a big influence.

What do I think is the key message?

Changing usual clinical practice is hard work and careful planning is needed.

Knowing or learning about a new approach is not enough. To use even one new approach (‘Intervention’) in clinical practice can take a lot of thinking, organising, adapting and imagination. For it to be possible, therapists might also have to change two other things. The first is how they decide who gets therapy and when they get it (‘Candidacy’). The second is how they organise their work (‘Caseload’). In addition, the service where the therapists are based (‘Service’) might have to support the extra work involved for a number of years.

Changing therapists’ usual clinical practice may be more successful if Intervention, Candidacy, Caseload and Service are all considered.

So am I getting there? What questions does this summary leave you with? And does it matter that there is no space to acknowledge any of the work the thesis was built on? I’d also be interested to hear other ways people have gone about tackling this communication gap.

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