Dancing with methodology

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Dancing with methodology
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The programme

• Background to current applied research agenda
  including needs of stakeholders
• Our understanding of the needs of members
• Present an example of research which draws on new
  approaches looking at What works for whom and in
  which circumstances?
• Reflections on the characteristics of research
  practitioners

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Take your partners please..
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Background the context

• Sustained UK government research agenda (NHSE,
  1997 DoH, 2000a, 2003b, 2006)
• National funding streams, cross government themes
  and Cabinet Office driving public services reform
• DoH Research programmes emphasising applied
  health research
• DfES Research Programme researching the social
  impact of education, Bercow Review

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Drivers for NHS research

• Best Research For Best Health (DoH, 2006)
  quality, a thriving research culture in the NHS
• UK Clinical Research Network
• Topic specific networks
• Comprehensive Research Networks
• Programmes including RfPB, NEAT, HTA, SDO
  Policy Research programme

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Wider influences on research

• Quality
• SCIE Research Register for Social Care
• http//www.scie.org.uk/publications/details.asp?p
  ubID182
• Inequalities agendas (The Black Report, 1980, The
  Acheson Report, 1988, DoH, 2003b)
• Workforce linked to public service reform

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An exiting and fast moving agenda
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Research EBP

• If the intention is to move towards an evidence
  based culture, it is essential that a critical
  mass of health care professionals is either in a
  position to conduct research or to implement
  scientific findings. (Hicks and Hennessy, 1997, p
  597).

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Everyone needs to be engaged..
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Other influences

• Increasing focus on cost effectiveness (Rafferty,
  2003)
• Introduction of the payment by results-incentives
  - national tariff for HRGs
• Patient choice from 2008, patient becomes
  commissioner
• Research as a key role (DoH, 2003) - KSF profiles

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The complex nature of SLT interventions

• Clinical treatment interventions
• Health programme interventions including Sure
  Start, BEST, On Track
• Health service delivery including models,
  workforce issues
• Innovation
• management
• regulation
• Health policy interventions linked with Public
  Health agendas

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Research to support practice

• High quality basic, applied and efficacy research
  base in communication sciences and related areas
  (as per ASHA, 2006) in order to
• Advance knowledge
• Demonstrate effectiveness
• Influence funders and commissioners
• Enable evidence based practice and policy

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A systematic review of environmental
interventions for child language

• An example of a current research study
• Applied
• Drawing on new methods
• Working with new partners
• Addressing research questions about what works
  for whom and in which circumstances?

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Questions and paradigms

• Basic science
• Efficacy, effectiveness impact
• Collaborative programmes
• Health policy

• Phonetics and linguistics
• Psychology
• Medical/health sciences
• Sociology

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What is the evidence for environmental therapy

• Sue Roulstone, Juliet Goldbart, Julie Marshall,
  Caroline Pickstone and Pam Enderby

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Modalities
Opportunity to communicate
Topics
Communication partners
Language models
Noise
Play and stimulation
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Systematic reviews

• Efficiently integrate valid information and
  provide a basis for rational decision making
• Limits bias and reduces chance effects
• Particularly suited to RCTs and questions of
  effectiveness
• Cochrane Handbook, 2006

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Issues

• Diversity breadth of the theories, research
  methods and intervention approaches
• Heterogeneity
• Social nature of language

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Evidence Synthesis
Pawson, 2006
Context
Mechanism Outcome
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Evidence appraisal

• Consequences measured
• Characteristics measured
• Consequences and characteristics measured
• Consequences and characteristics measured and
  explicitly related
• Consequences and characteristics measured and
  explicitly related and alternatives ruled out
• Relationship replicated in other studies
• Dunst et al, 20002

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Developing a theory of therapy
Understanding mechanisms
Professionals perspectives
The Systematic review
Purposive sampling of the literature
Purposive sample of professionals
Systematic literature search
Identify mechanisms
Interviews
Quality appraisal
Identify mechanisms
Identify mechanisms
Evaluate evidence
Green specified level of evidence Red evidence
exists against the mechanism Amber have not
been tested
Theory model
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Understanding the mechanisms
Compensation Its possible to vary the comm
environment in a compensatory way so that child
can overcome within-child impairments acquire
language
separate/integrated theories about how these
components operate, with whom, in what context
and with what outcomes
Language impairment Child fails to make use of
comm context (for a variety of within-child
reasons), therefore fails to acquire language
Normal language learning Children learn language
in response to functional need, social motivation
Comm context components Different components can
be varied to stimulate different
compensations (social, physical, linguistic,
cultural, emotional)
Parents/carers provide the context Parents dont
know how to provide the most supportive context,
therefore it is necessary to provide information,
advice, training.
Daily context Changing the childs communication
environment requires changes to their daily
context, not just a therapy session
Different cultures will view different
interventions differently depending on their
views of language development and other life
theories
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Book reading taskBlake et al 2006, British J
Educ Psych
Context Age Gender Dual vs single parent
family Mother vs father
Mechanism Parent verbalisations (during book
reading)
Outcome Increased
vocabulary size increased MLU
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Eclecticism a sign of incompetence or
competence?

• Isolationist
• Imperialist
• Pragmatist
• Complementarist

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The steps RCSLT Research strategy
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What could a research strategy include?

• Training
• Networking and collaborations
• Prioritisation and funding
• Mentoring
• Leadership for research
• Research facilitators and mentors
• Infrastructure at organisational level
• Ref Cooke et al, 2006, Recap Identifying the
  evidence base for RCD in health social care

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RCSLT research priorities

• Skills development in research awareness and
  critical appraisal
• Research capacity and capability building
• Funding and support
• Dissemination and development

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RCSLT priorities 2007-8

• Skills development in research awareness and
  critical appraisal
• Research capacity and capability building
• Funding and support
• Dissemination and development

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To achieve this..

• Two priorities for 2007-8
• Dissemination of research findings to managers
  and commissioners

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The need for information..

• A bespoke website
• to provide
• resources, information,
• details of funding, training etc

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Reflections on research and practice..

• Sustained interests
• Able to think
• outside the box.

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Reflections..

• Honest about what we know and what we dont yet
  know.
• Very pragmatic
• Opportunistic funding, collaborations.
• Good networks
• Bringing new information often from other fields
  (Knowledge Brokers)

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Wider engagement
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