Promoting more effective communication partner training in speech-language pathology practice Riva Sorin-Peters, PhD, Reg CASLPO, SLP, CCC-SLP riva@revivespeechtherapy.com Marie-Christine Hallé, MPO, PhD, marie-christine.halle@mail.mcgill.ca Learning Objectives 1. To be aware of the current gap between best practice and SLPs routine practice with regards to communication partner training (CPT). 2. To learn how existing theories and theoretical frameworks in adult education and knowledge translation can support professional practice change. 2. To learn how theory was applied to a training program for speech-language pathologists to improve their practice of CPT. 3. To identify the barriers and facilitators influencing your use of CPT and the strategies that can help you overcome barriers and enhance facilitators. Communication Partner Training (CPT) CPT is intervention aimed at people other than the individual with aphasia with the intent of improving communication with the person with aphasia (Simmons- Mackie, Raymer, Armstrong, Holland, & Cherney, 2010) Why is it important? Evidence: Simmons-Mackie, 2010 Simmons-Mackie, 2016 Current SLP Practice: SLPs rarely and only under specific conditions train SOs to communicate better with the PWA (Halle, Le Dorze, Mingant, 2014) SLPs perceive work with significant others and CPT as a challenging bonus to therapy, rather than as a feasible necessity (Halle, Le Dorze, Mingant, 2014). Barriers & Challenges: SLPs perceive their role with significant others as one of offering information about aphasia and obtaining information about the PWA for the purpose of treatment. SLPs perceive CPT as being linked to only the chronic phase of aphasia and as less compatible with hope for language recovery. SLPs perceive CPT skills as more challenging, including addressing more difficult family emotions and issues. 2. Knowledge Translation What is it? A dynamic and iterative process What is its primary purpose? Address the gap between what is known from the research and what is done in clinical practice with the intention to: Improve health outcomes Provide more effective health services Strengthen health care system How does it occur? In which context? Within a complex system of interactions among stakeholders (researchers, practitioners, consumers, policy makers) (Graham et al., 2006) 1
2. The Knowledge to Action Framework A model illustrating the process of translating research into practice and involving two concepts: 1. Knowledge creation 2. Action cycle 2. The Theoretical Domains Framework (TDF) Specifically developed to study the implementation of evidencebased practice. Consists of a list of 14 domains that can act as barriers and facilitators to behaviour change. 1. Knowledge 8. Intention 2. Skills 9. Goals 3. Social/professional role and identity 10. Memory, attention and decision process 4. Beliefs about capabilities 11. Environmental context and resources 5. Optimism 12. Social influences 6. Beliefs about consequences 13. Emotion 7. Reinforcement 14. Behavioural regulation Cane, O Connor, and Michie, 2012 2. Adult Education Principles Learning is a process that occurs within the learner and is activated by the learner Inside-out learning A consequence of experience 2. Principles of Adult Education Learning involves a restructuring of previous knowledge, experience and learning Involves the whole person and the multiple factors in the system A cyclical process of change Lifelong learning 2. The Kolb s Experiential Learning Model Concrete et ressenti 3. Application of theory to practice: Pilot project Subjects: Application Active Experimentation Imagination Abstract et Conceptualisation lecture Observation et Reflective Observation réflexion Sex Age # years of practice Year of SCA training SLP1 F 35 10 2014 no Previous training in CPT SLP2 F 36 8 2011 Discussed in master s pgm SLP3 F 50 15 2010 no SLP4 F 55 30 > 10 yrs It Takes Two to Tango 2
Score 2017-03-15 3. Application of theory to practice: Pilot project Intervention: Pre-workshop assignment 2-day workshop Included all 4 components of Kolb s cycle Active Experimentation Concrete Abstract Conceptualisation Reflection Included role play activities and the opportunity to practice skills learned with selected couples. Included measurement of CPT. Follow-up assignment Follow-up conference call with workshop participants 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Results Pre- and post- knowledge about adult learning Familiar with adult learning principles Know strategies to apply adult lng principles to CPT Comfortable training family members of PWA Knowledge Effective in training family members of PWA Pre Post 3. Results Change in Practice of CPT 4/4 applied the new knowledge and strategies to their practice of CPT 3. Follow up Results Reported results of applying the adult learning techniques: more positive results training client and his wife more positive results training client and his friend partners were way more invested than before worked beautifully, seemed like a different couple when they came back they are now mentors for other couples 3. Implications Commonalities between knowledge translation and adult learning theory: They involve change They begin with the recognition of a problem They are iterative, dynamic and long-term processes They involve individual factors and organizational factors that may act as barriers and facilitators They require one to reflect on experience, integrate concepts and apply learning to practice. These components should be taken into account when planning to support professional practice changes among SLPs, for instance towards a more systematic use of CPT 4. Points for Discussion What is your current experience implementing CPT? What works well? What are your challenges? 3
4. Points for Discussion Conclusion How could you overcome these challenges? What s ONE thing you could do differently in your practice of CPT? Common core components in adult learning theory and knowledge translation theory. The Kolb s experiential learning model can help us promote change in clinical practice to provide more evidence based interventions in CPT. Our learning process is similar to the change process we aim to facilitate in our clients. Questions Cane, J., O Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation science, 7(1), 37. Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: time for a map?. Journal of continuing education in the health professions, 26(1), 13-24. Hallé, M. C., Le Dorze, G., & Mingant, A. (2014). Speech language therapists process of including significant others in aphasia rehabilitation. International journal of language & communication disorders, 49(6), 748-760. Kolb, D. (2015). Experiential learning: as the source of learning and development. 2 nd edition. Englewood Cliffs, NJ: Prentice Hall Inc. Mezirow, J. (1991). Transformative dimensions of adult learning. San Francisco, CA: Jossey-Bass. Simmons-Mackie (2010). Communication partner training in aphasia: a systematic review. Archives of Physical Medicine and Rehabilitation. Simmons-Mackie, N., Raymer, A. & Cherney, L. (2016). Communication partner training in aphasia: an updated systematic review. Archives of Physical Medicine and Rehabilitation, 97(12), 2202-2221. Sorin-Peters, R. (2003). Viewing couples living with aphasia as adult learners: Implications for promoting quality of life. Aphasiology, 17, 405-416. Sorin-Peters, R. (2004). The evaluation of a learner-centred training programme for spouses of adults with aphasia using qualitative case study methodology. Aphasiology, 18, 951-975. 4
Sorin-Peters, R. & Patterson, R. (2010). The implementation of a learner-centred conversation training programme for spouses of adults with aphasia in a community setting. Aphasiology, 28(6), 731-749. Turner & Whitworth (2006). Conversational partner training programmes in aphasia: a review of key themes and participant roles. Aphasiology, 20(6), 483-510. 5