Bridging the Research-to-Practice Gap Part 2: We can make it better
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Intro
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Kate Grandbois: Hello, everyone. Welcome to SLP Nerdcast. We are so excited to welcome two guests who have been here before. We've had a great time catching up with the two of them for, I'd say, almost 40 minutes since our, since our recording time started. And we're really excited to share all of their brilliance, wisdom, and laughter, likely, uh, with the rest of our audience.
Welcome Natalie Douglas and Kathy
Cathy Binger: Binger. Thank you. We are very excited to be here again. For sure.
Amy Wonkka: Well, we're super excited to have you, and you are here to continue our discussion on bridging the research to practice gap in the field of speech language pathology. The laughter has already started, folks.
If you are not accessing this through YouTube, I'll just let you know, Kate is silently cracking up up there.
Kate Grandbois: I'm going to be [00:03:00] fine. We're going to be fine. It's going to be great. We're going
Amy Wonkka: to be fine. Uh, so before we get started. Um, Natalie and Kathy, can you please tell us a little bit about yourselves for our audience members who may not have listened to your prior episodes?
Cathy Binger: Go ahead, Natalie. Okay, great.
Natalie Douglas: So right now, I am a professor at Central Michigan University in a speech language pathology department. My background, I was a clinician for about 10 years and hospital skilled nursing home health settings before transitioning back into academia and I've actually been here at Central Michigan for 10 years, which.
I don't know how time flies, but it does. Um, but primarily, my research aims to improve quality of life and communication for people with dementia living in nursing homes. And what goes along with that, and why I'm here with Kathy today, is how we can merge the research to practice [00:04:00] gap with implementation science.
So, people living with dementia, their communication needs in nursing homes, that's just, you know, one small area of. People that we serve, but, you know, I've been really lucky to get to work with lots of people kind of across our scope because the principles and the tools of implementation science can really help to merge that gap kind of in whatever setting that you're in.
Um, so that's a little bit about me.
Cathy Binger: And I'm Kathy Binger. I'm a professor at the University of New Mexico. Um, I'm an SLP as well, and I practiced as an SLP for about eight years before I got my PhD. So, worked in, uh, lots of different settings, particularly with young children, um, Head Starts, preschool, that kind of thing.
And, um, I've had my PhD for a long time now, so I've been here at the University of New Mexico for about 18 years, something like that. And I've always been, I was [00:05:00] interested in implementation science before I knew that implementation science existed. I think like Natalie, I've always been interested in doing work that was going to have a real life clinical impact and was frustrated for a lot of years, seeing that a lot of the Quote unquote research evidence based work that had been completed was not necessarily being used commonly in clinics and in clinical settings and educational settings and certainly coming to realize a lot of that had to do with how that research was created to begin with and that it wasn't necessarily devised to be constructed to be culturally Well, culturally sensitive for one thing, but also, um, clinically feasible to do these things.
So that's my interest in implementation science. And it's, it's such a pleasure to be here with Natalie. We, we work with 2 very different populations, but our motivations for implementation science [00:06:00] come from exactly the same place. I really love
Kate Grandbois: the idea of two scientists, two researchers from such vastly different areas of interest really working together for with a shared common goal and understanding.
So I'm very excited to get into the content for today. I know we're really going to be unpacking the research to practice gap, which is something that we did in a previous episode that Amy already mentioned. So today's episode is a part two to that original episode that aired, I think in 2021, and we're recording this in October of 2023.
So this is a long time coming. If you have not listened to the part one, please feel free to go back in time. Give it a listen. Um, today we're going to do a little bit of a deeper dive into how we can, what action steps we can take to mend the research to practice gap and how we can make it better. Uh, before we get into the content, I do need to read our learning objectives and disclosures.
I will try to get that, get [00:07:00] through that as quickly as I can. Learning objective number one, describe levels of involvement for researchers and non researcher invested parties, depending on the project. Learning Objective Number Two lists the five key dimensions of research to practice partnerships, and Learning Objective Number Three lists at least two real world examples of research to practice partnerships in action.
Disclosures. Natalie Douglas's financial disclosures. Natalie receives a salary from Central Michigan University and the Informed SLP. She also receives book royalties from Plural Publishing and has research funding from the American Speech Language Hearing Foundation. Natalie is a member of ASHA SIG 2 and SIG 15, the Gerontological Society for America and the Aphasia Access Group. Kathy Binger's financial disclosures. Kathy is employed by the University of New Mexico. Her non financial disclosures, Kathy is a member of ASHA and Special Interest Group 12. Kate, that's me. I am the owner and founder of Grand Bois Therapy [00:08:00] and Consulting, LLC, and co founder of SLP Nerdcast.
My non financial disclosures, I am a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy. Amy, that's
Amy Wonkka: me. My financial disclosures are that I'm an employee of a public school system and co founder of SLP Nerdcast and my non financial disclosures are that I'm a member of ASHA Special Interest Group 12, which is AAC, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children.
Alright, disclosures are done. On to the good stuff. Um, Kathy and Natalie, why don't you start? So I'm going to start us off by giving us and our listeners just a little recap about implementation science. I think you both talked a bit in your introductions, um, about sort of what's drawn you to implementation science.
So maybe you can talk a little bit about why it's important for the field of speech language pathology. Like super Cliff Notes version because we do have the other podcasts for our listeners.
Go [00:09:00] for it,
Natalie.
Natalie Douglas: Okay. Yeah, so I think a sum up would be implementation science is technically the study of how we get interventions or assessments or really any practice of interest, something that might work really well in a lab or controlled setting and. Implementation science is the study of how we get that.
Into the real world. So, in our field, that's going to look like schools, hospitals, rehabs, places where we, our, you know, we're, we're serving the people that we serve. One thing that's happening, so the field of implementation science has been around for almost 20 years now, so they had their inaugural journal kind of started in 2006 and it we've been a little behind in kind of catching that train in our field, [00:10:00] but.
Even for the people that have been at this for a long time, they're asking questions like, perhaps there's still something fundamentally wrong with something being created in a research setting and then pushed into a real world setting. So, perhaps when we think about this kind of the next iteration, or what the future of implementation science.
Might hold and what I think is super valuable for our field is to stop and critically reflect on how evidence is even constructed to begin with, because if we're not able to, um, get that evidence from, you know, where the, in the context of where it's actually happening, then maybe it's not remotely relevant to where we're trying to push it in.
Maybe it's not even meeting a community need. So that's kind of my cliff notes version and Kathy, I [00:11:00] don't know if you have anything to add to that
Cathy Binger: Yeah, I just what you said reminded me of our, um, funny discussion about the ivory tower when we talked about this the last time. Um, and I believe the never ending story came up for some reason.
Oh, my gosh, it did. It just came up on my Netflix page the other day. So it made me laugh and think about that. That's why that was top of mind. Um, So anyway, you know, the, the old quote unquote old approach to doing research is for people to be in their ivory towers, thinking up these great ideas, all these PhDs who are supposed to know stuff and coming up with assessments, coming up with interventions, coming up with approaches to try to help people, um, in our, you know, in our world with communication disorders, and then, you know, Living a life of frustration and blaming clinicians for not doing the things that we've been spent we meaning academics have been [00:12:00] spending our lives and all of our wisdom, trying to impart to the clinical world out there and the reality.
Being, um, that really the flip side is what we need to be looking at, which is, as Natalie said, the work that academics are doing, um, is through an implementation science lens inherently needs to be tied to real life clinical practice and educational practice and medical practice, um, and that from that we should not actually be doing our work without involving these Very, um, key invested parties to informing us and working with us and working hand in hand with us to devise.
Programs and assessments and whatever it is that we're working on from the get go to make sure that they are responsive. So it's really a fundamental mind shift that's required as well as a fundamental [00:13:00] research practice shift. That's required. Um, I think there's a lot of needing to let go of ego and let go of, you know, it works in every direction.
You guys have done sessions and even written a paper with Natalie and others on power privilege and how people are looked at up and down, you know, different levels of the ivory tower, if you will. Um, and, um, you know, that those things need to be considered and And, Reconstructed, um, with different frameworks so that we are really all working together in functional ways from the beginning.
Amy Wonkka: Yeah, I mean, it's, it's super exciting as a clinician, you know, that this sort of shift from researcher as Keeper and disseminator of information to forming these collaborative partnerships. I know we were all at the implementation science conference, um, through MGH and awesome conference, by the way, if you're listening and you're interested in implementation science, it's [00:14:00] a wonderful opportunity to learn some more.
Um, and you know, one, one piece that's. Interesting is just thinking about within those different types of partnerships that might happen. And this gets a little bit into our first learning objective, but you know, there really can be flexibility. It sounds like there really can be some flexibility in terms of the different roles of the different participants, the researchers, the non researchers who are involved in implementation science.
Um, and I was wondering if you could speak a little bit just about what those. different levels of participation might look like.
Natalie Douglas: Yeah, sure. I'm happy to do that. And this, um, I've taken from, it's the international association for public participation in research, but I, I think that we can learn a lot when we think about how clinicians for ideally, even clients themselves and families and patients might participate in the.
Research process, but what you have is [00:15:00] essentially a continuum where the least level of involvement is that of informing right? So, this is, it's kind of very similar to what's happening now, right? You go to a conference and a researcher is informing the clinicians about. This is the results of the research, right?
So I'm letting you know, um, and I'm going to keep you informed, right? Like how this, you're, you're sort of doing that with this podcast in a way, right? So we were talking off mic earlier that Kathy has some new studies coming out and like, you know, getting something scheduled to like, let your audience know about some developments in her work, right?
That's kind of informing, right? And then the next level is consulting, right? So this is where you are. Bye. Really getting some type of feedback. Um, I think about maybe some focus groups here, [00:16:00] right? Like, this is kind of what we're doing. And what do you think about this? What are some of what your ideas are?
What are your concerns about this? And we're going to incorporate that feedback either into. the intervention development itself or into some type of the structure of implementing the intervention. And then you have involvement. So this is where you really are working closer together. So I think you're having more than just a pre and post kind of focus group meeting, but you're really working throughout the construction of that research to ensure that people are.
understood and that their, um, concerns are being fully addressed throughout the process. And then you have collaborating. So this is really when, if you're thinking about it from a clinician standpoint, the clinician and the researcher would really partner in each aspect of the decision making. And [00:17:00] you're really, as a researcher, would be looking to that.
clinician for advice and innovation on how to kind of form solutions and the researcher is incorporating those advice and recommendations. And then really the most involvement you could possibly have according to this continuum is the word empower. So really at this point, the researcher implements what the clinicians decide, right?
So I would envision something like the clinician saying, This is the area of need. This is where we need data. Um, and they're really calling the shots. And, of course, the researcher is there with, you know, perhaps the study design and the methods and the how to go about it. But in terms of, like, really, what is the research question that's coming from the clinician standpoint and really, you know, in terms of from the inform piece, all the way to the empower piece, I think it's important to realize [00:18:00] that none of those levels of involvement.
Um, Are wrong in and of themselves and I don't think Kathy nor I are coming on here to say every project for researcher does has to be empowering. Right? But I think it's important as researchers that we consider. How do we want to involve clinicians and at what level and to let clinicians decide based on their different capacity levels and what they're able not because we know they can do the job intellectually.
So it's not a matter of that. It's a matter of productivity. And can they get it done during their workday? Or do they have to like, what many clinicians do? Do this research participation is like a hobby. Um, outside of their normal work hours, because there's no, um, compensation for that during the day. Um, so those, you know, I think it's important to think about where [00:19:00] clinicians might want to be involved, where researchers might want to be involving clinicians, and again, patients and families, ideally, and be explicit about what the roles are and how you might want to proceed.
I so appreciate
Kate Grandbois: that you brought up the infrastructure related barriers here because I think there are a lot of clinicians who would love to participate in some research practice partnership, but like exactly like you said, there's no funding for it. They don't have time built into their day. They don't have the support from their administration.
They don't have time that they can take out of their personal lives. Um, and there are some, there are only some There are only some action steps that we can take to mitigate those infrastructure related barriers. One thing that you said, one of you said earlier that I want to just bring up again is this concept of ego and power differential.
I think another barrier. [00:20:00] At least from a clinician's perspective is feeling like we don't belong feeling like we don't, we shouldn't have a place at this table feeling like well I'm a clinician not a researcher I can't do research, or the researcher doesn't need me there or doesn't want me there, or, you know, there is this invisible
Cathy Binger: cultural construct
Kate Grandbois: that we're.
We don't belong. We don't have a place in the ivory tower. We don't have a place at this table. And I think that is something that we can actively work to change in ourselves and through conversations with other people. Um, and it's a very complicated mess. You know, these are not things that we're going to solve overnight, but I wanted to highlight those two particular barriers that you brought up because I think they're both really important.
Cathy Binger: Yeah, I, I totally agree, Kate. Um, they are, they are really challenging and they are really important. It's still, Natalie and I talk about this sometimes, you know, we go to conferences and people come up to us and, you know, talk to us like, we're all that. And we're like, no, we're not. [00:21:00] We're like, we're just getting paid to do a different job from your job.
We're getting paid to do a complimentary job to your job. And we can't actually do our jobs without you. Like we, you know, we, this is a. I mean, I like to think of it the same way I like to think about how I like to work with families, which is we're all in this together. We all have our areas of expertise.
You know, when I work with a family, one of the first things I always say to them is, I may have some expert expertise in speech and language or in augmentative communication or whatever it is. But you're the expert on your child, and we, I absolutely, you know, we need that expertise just as much as. We need my expertise.
So I'm really looking forward to working together with you. And I think of implementation science in this partnership work as being very much coming from that same frame of reference of we all really, you know, not just in a roses and sunshine and butterflies kind of world. Oh, we all need to work together.
We [00:22:00] really all need to work together. If we're going to change outcomes, improve outcomes for individuals who have communication disorders or swallowing disorders or whatever. Um, or impairments or differences or whatever we're talking about. We we genuinely all do need to work together. I
Amy Wonkka: wanted to. So now, Natalie and Kathy, you've both mentioned family components and I wanted to circle back to that for just a second because we've talked a lot and we talked a lot in our last podcast about the power differential and the dynamic between people who are in the researcher role and then speech pathologists who are in the clinician role.
And I was curious if you felt like now that you've done more with implementation science and learn more about it, have you felt any difference in it shifting your dynamic with your clients and their families? And if so, can you talk a little bit about. How that might be different when you're using an implementation science approach versus like a previous more traditional [00:23:00] research,
Cathy Binger: Natalie, why don't you take this one?
Natalie Douglas: Yeah, I think I can. I think that what your question is making me think of Amy, and it kind of goes along with what Kate and Kathy have said is we have to think about knowledge and what we consider to be Knowledge that is of value, because in the scientific community, the knowledge that is most valuable is data from a randomized controlled trial, traditionally, and that's so good for so many reasons.
Right? Like, I am so glad that I can take ibuprofen when I get a headache and that all of that data is supporting me. That right, like, we need that, but when you start to get [00:24:00] into behavioral treatments, which is most of what we do, right? We're trying to change behavior of somebody. Um, things get real complicated real quick and I think.
We have to wrestle with as a scientific community, and perhaps as a clinical community to how do we value the lived experience? Right of our clients and our families and what they are telling us. About what is happening to them, right? Like what their symptoms are, what they're experiencing. Um, and I think what implementation science does, and definitely implementation practice, or, like, really getting these things into the flow is kind of equalizing those different forms of knowledge.
Right? And to be able to take a wider view to say, Yes, it's not just, you know, whole, um, what almost every research methods class [00:25:00] is based on the hierarchy of research where a meta analysis is at the top and then a systematic review and then expert opinion is like the lowest. Right? And I just sort of wonder when we think about families, clients in particular.
Um, what are we doing with that? Right? And so that's what implementation science has helped me to do is to really reflect on my own perceptions as to what does knowledge mean, right? Whose knowledge do I value and why and starting to try to really say that this person who is in front of me. If it's a nursing assistant or a speech pathologist or a person living with dementia, this is their knowledge and it's equal to, right, some data that I might get from somewhere else because we're in this murky world of human behavior change and to make, to [00:26:00] try to make it any more linear, it just doesn't work.
Thank you.
Amy Wonkka: That was, that was helpful because it does seem like it's just, it's such a different, it's such a different way of thinking about research, at least as somebody who's just been on the consuming end of research for a long time. Um, so it does seem like it would have such profound effects, like shifting to implementation science on, on all sorts of parts of that.
Um, I, I know that we're, I'm trying to keep an eye on the time too, but we do, we should look at our next learning objective. We should not get on too many tangents. Um, And I wondered if we could talk a little bit just about some key dimensions of research to practice partnerships. Natalie. I know this is an article another article.
Natalie Douglas: Yes. And maybe Kathy, you want to chime in here with some examples from some of your projects. And we talked about this a little at the implementation science conference that any mentioned, but this is a. [00:27:00] Model that was kind of, um, really brought the light to our field by Crystal Alonzo and colleagues.
It's a in the American Journal of speech language pathology where it talks about if you're going to have like a successful research practice partnership. Right? So thinking back to that continuum that we talked about earlier. So this is more in like the collaboration phase. What makes that successful?
And so there are five dimensions that she talks about. And if you're interested in this, I really encourage you to check the article out. She's got a really cool infographic in there. But the first kind of dimension is building trust. And that's huge, especially when we have all of these barriers and power differentials and all of these.
Aspects that we're up against. The second is conducting research not just the positive but to inform action So it's really talking about something that's iterative and really probably never [00:28:00] ending Right, cuz you like you do a study and then you learn from it and then you do it again and then, um The third piece is supporting the partner organization in achieving its goals.
So I work with some health systems. I work with some nursing homes. You know, one of the goals of the health system that I'm working with is to reduce falls, right? And you might not think that that has anything to do with speech language pathology. We think it does, right? But that's their goal. So it's like letting them drive the bus in terms of.
What the practice organization, what their goals are, and then the 4th is producing knowledge. That's going to inform improvement efforts more broadly. And then the last and final dimension is to. Think about capacity building of whoever is participating. To allow them to engage in partnership work. So we talked a lot already about some of the infrastructural [00:29:00] barriers to doing this work.
So thinking about having those, like, frank discussions about bandwidth and priorities and what you're able to do and when all of those factors really contribute to a successful research practice.
And I know
Amy Wonkka: we talked a little bit, Natalie, at the implementation science conference just about how some of those infrastructure things, just thinking back to the different levels of involvement that you might see in a project. And to your point, that empower level might not be the best fit for everything.
So I might be somebody who has infrastructure barriers in my environment, but I really would love to. to be involved in some of this research. And so some of that flexibility and having those ongoing conversations about what is a realistic ask, like what's a barrier versus what's a roadblock. Um, I think where the terms we were using, you know, and I think that that's probably a helpful conversation to have on the clinician side as well as the researcher side.
I don't know. Um, [00:30:00] if either of you want to talk about some projects where you've maybe experienced barriers or roadblocks and like work through that with your, with your teams.
Cathy Binger: Yeah, I'll, uh, I'll talk about that. But, you know, maybe not even just the roadblocks and barriers, but some of the other pieces as well. So, you know, going back to that step 1 of building trust and cultivating partnership. Um, I'm working with a group here. And we presented at the Implementation Science Conference, the MGH conference together with Jessica Matney and Kitty Estrand at the New Mexico School for the Blind and Visually Impaired, and they both work at the school.
And they work with primarily preschoolers who have multiple impairments, including visual impairment. And, um, We, you know, I've known one of them for a long time, the other one, not so long, but we've spent a lot of time together, like, having really, I mean, really, we've been having weekly meetings for for quite some time now to work on [00:31:00] building that trust and cultivating that partnership together.
And, um, they, they, they're very ambitious. They have what's helpful in working with them as part of their school mission is to disseminate good information and for them to be creating information. So, um, you know, that fortunately, that's part of what they do. But even then, you know, even though they have some time that's supposed to be dedicated to that, it's very difficult.
Um, and so they've tried to do some research projects on their own. Um, Um, and they spent a lot of time, um, and have some expertise in that, but had some challenges with it. And so, you know, I kind of, as we've, as I've been shifting some of my focus and really wanting to take this relationship in a direction where.
We were bringing implementation science to bear. They were very excited about that, and we've been working together on that for a while now. So, um, one of the things that we've been working on is taking the data that they collected themselves, [00:32:00] and they really needed my expertise to kind of help them get it ready for publication, because there is a value of getting something out in the world that way, and they can go to conferences and do presentations and that sort of thing.
And so, like, I've been able to help them out with it. Um, offering some student assistance with analyzing their data and helping them develop things like fidelity checklist to see if they really were implementing, you know, what were they doing when they were doing their intervention and us working through that, like me looking at it from a researcher perspective and them looking at it more from a clinical perspective and us finding a place in the middle to be able to define what they're doing and just Just this week, just earlier this week, it was so, it was so sweet.
We, um, we've been working on, uh, doing a, uh, treatment fidelity checklist. One of my students has been looking at the sessions, which kind of freaked them out a little bit, like, okay, like somebody else is going to be looking at this to see what we've been doing. And my student, um, looked at them and came and shared the results.
And we, [00:33:00] you know, they had good fidelity with what they were doing. They were so excited that the operational definitions that we had worked on together and that the things that they thought they were doing they were actually doing in the intervention and it was just really just fun and exciting to to see their level of excitement and their level of investment in all of this and and I think because we've spent this time um building this trust and building this relationship it's really it's really contributed hugely to helping us move along and and and for me.
You know the um, we're really looking at I mean all not just for me for all of us We're looking at hoping to work together long term on larger projects And so we're looking at this smaller project right now that didn't everything didn't go right for them We're going back and doing some subsequent analyses to try to really figure out.
Okay, like this didn't actually change with this person Let's go back and see what did change Let's look at these things and and for them, you know as they've shared with me just [00:34:00] meeting with me weekly and having My eyeballs on the data to and having a little help from my students has made a huge difference for them and they feel like they've gotten further in this relatively short period of time than they were getting for a couple years.
Well, I was back here very much in the background, you know, not really directly helping them. So it's it's really shifted things for us. And it's been such a Such a positive experience. So I think the, you know, the bear the big barrier so far was more when I wasn't involved and we started overcoming barriers.
The more I got involved. One of the other really practical things is something I think Natalie brought up a little bit earlier that that is a bit of a barrier that we're going to have to figure out as we move forward. Um, is has to do with funding. So some schools will not allow Okay. Us as researchers to buy out the time of a teacher.
Um, so, like, I may be able to get grant funding to support our work, but the school, like, in this [00:35:00] case, the school saying, like, that was one of the first things that they were like, hey, we all have to meet. Like, and we would need to meet soon. If you're going to be applying for grant applications, because.
You, you can't basically, you're not allowed to buy out their time. This is, this has to be done as part of their regular work or in there. We were like, okay, well, what if it's on Saturday? Can we pay for their time? If we, you know, have some Saturday activities that we do, or, you know, trying to figure those things out.
Those can be some of the. Um, roadblocks that are that they're not necessarily. I don't even remember which one's worse, but some things that we can at least climb over, you know, we can figure these things out. But, oh, like, I haven't done this work in this way before. So I really need to think about this.
They need to think about it. We need to find a way to to work through this so that we can not allow that kind of thing to really prevent us from doing good work. But that's still going to be a way that's going to honor the time and not just be an. over, you know, create this hyper burden on my colleagues, my clinical colleagues, but find a way to make sure that [00:36:00] they're, you know, that they're okay as they're doing this work and that their level of involvement is appropriate and that it's not too much for them.
I think
Kate Grandbois: that's a great example of an infrastructure related barrier. I mean, and I'm, I'm thinking about this story, this example that you've, that you've shared. I'm thinking about any clinician who's listening, who's, you know, Excited about research, doesn't want to get their PhD, but is listening to this and going, yes, I want to be maybe not empowered, but I want to be consulted.
I want to be asked. I want to, I want to play. Let me in. Right. And where do we go? You know, well, how do we go about. Making or initiating those relationships. I'm, I'm asking this question. I'm not even sure that there is an answer. I'm asking this question to the universe. This is one of the problems that we haven't necessarily solved as a field, um, and Kathy and Natalie and, and, and Amy too, having participated, um, in the implementation science conference.
If there are resources [00:37:00] out there, I would love to hear about them. I'm sure our audience would love to hear about them. Just, you know, I think that there is this con, there is this feeling of being in a dead end. So back to what I said earlier about ego and power differential, not feeling like we are, we belong at the table, but even if we do feel like we belong at the table, what door do we walk through to get to the room where the table is?
How do we, how do we go about doing this?
Natalie Douglas: Yeah, I think that's such a legitimate question and it also points to there are really very, very few if any situations where researchers and clinicians are like, mixing it up in a informal way. Right? I mean, it's just doesn't happen. I can tell you that the large majority of my clinician collaborations is somehow connected to conferences, be it at the state level or at ASHA.
Yeah. Um, where people have come up to me [00:38:00] again, um, has Kathy said inappropriately or, you know, being like, Oh, wow. And I'm like, Are you
Kate Grandbois: trying to tell us that people fangirl over you, Natalie? Is that what you're saying?
Natalie Douglas: Not really. Yes.
Kate Grandbois: It's okay. It's a it's okay.
Cathy Binger: Natalie's so comfortable with that. She just like, she privately just can't wait for all the crawling out of her skin.
Kate Grandbois: For anyone who doesn't know Natalie, she's the most humble, approachable, like, brilliant human on the earth. And I can't I didn't, I didn't mean to put you on the spot, but I had to, I had to make a funny.
I apologize. Let's move
Cathy Binger: on. Uncomfortable. She's closing. She's like covering. We're going to
Natalie Douglas: leave.
Kate Grandbois: He's going to hang up on us. Don't go.
Natalie Douglas: Oh my God.
Kate Grandbois: Anyway, as you were. So people approach you at conferences.
Natalie Douglas: Yeah. And they're like, I really [00:39:00] love your work. Like, let me tell you how we might do this in this nursing home.
And literally I will be like. Well, do you want to try this in your nursing home? I'm not kidding, you know, and then, you know, we, and it doesn't happen to everyone, you know, it doesn't happen to like every person that we talk to, but, um, it's, you know, so I would say to clinicians, like the talks that you go to that you really like the articles that you read that you really like the logs or whatever you're, you're, you're getting your CEUs.
And you're like, I really resonate with this to reach out to that person. Would be, um, 100 percent appropriate and welcomed by the large majority of clinical researchers and again, you know, of course, humans are human. So you can't guarantee how people are going to respond, but at least in our field with implementation people who are doing.
This type of clinical research, they're doing it to, like, have [00:40:00] an impact. And so when clinicians who are working with a certain population want to collaborate or have ideas, it's just so welcome and I think that, you know, once you start to really get in the groove and develop that trust and partnerships, you realize, Oh my gosh, like we're both people, you know?
And Kate, when we first started working together, you called the Google folder fancy pants. It's still
Kate Grandbois: called the fancy pants. Who has the fanciest pants? It's the fancy pants party. Because you have fancier pants than me.
Cathy Binger: I told you from our very first interaction with you guys, that was my first email to you guys, that you can't call me fancy.
I
Kate Grandbois: know, but do you see how these, these concepts are so culturally ingrained that even as I've, I've had the privilege of having some academic work in the last two years and I am constantly butting up against my own [00:41:00] internal critic because I am not worthy. You know, I air quotes, and I think that these, these concepts of, you know, I don't belong at the table.
I am, I don't belong here. Nobody wants me here are, are very quick at work. I think without us realizing it, I think Natalie, it was you who brought up. Or even pointed out to us that originally on this podcast, we had a disclaimer that played at the beginning and you can, if you go back in time and listen to the earlier episodes, it's still there because I don't have the bandwidth to go back and edit all those files.
I'm not doing that, but it's still there and it says we are not PhDs, but we do research our material because we felt we had to disclaim
Cathy Binger: that we were not that
Amy Wonkka: fancy. Our pants are not that fancy.
Cathy Binger: Our pants are not fancy. If you want, I can stand up and show you how not. Let's see my pants are, I'm not sure that you want that.
So, but I
Kate Grandbois: think, I think it's worth just repeating for anyone who is listening, who is at a conference [00:42:00] and is, you know, in sitting in the chair and really resonating with the lecture and feeling intimidated to go speak to that person. Or it's just, you know, it's sort of like in those magazines where it's like, celebrities are people too.
Well, researchers are people too. There's it's, it's
Cathy Binger: not a thing. It's not a thing and well I think it used to be a thing, right? That's fair. I mean, it comes from a real place. When I think back, you know, I'm the oldest one of the group here, so I can think back longer. So, I told, I was talking about the 1970s to somebody the other day, and they were like, well, you weren't alive then.
I was like, yes, I was. I remember. But anyway, you know, academia that you think back, back, back, right? It's the. Older white guy with the white beard and the spectacles and the tweed jacket with the leather patches on his elbows kind of thing. Like that was [00:43:00] incredibly accurate and detailed. I've got my tweed jacket hanging up behind me, but I don't think you can see it.
So, but right, like this, this image is still out there, even though, especially in our discipline, it's changed. It hasn't changed enough from a, um, a racial ethnic perspective in terms of cultural diversity, but it's changed dramatically in terms of male female ratio, right? Like, when I was starting at, there were at least 50 percent of my professors were always male.
And that's just not the case anymore. Our department is, you know, has more, you know, we're like, Five to two ratio of female to male in my department for tenure track PhD faculty members. So, you know, that that has shifted dramatically. I think in most CSD departments over time, but that doesn't we still have this cultural residue.
I just made that term up, but I like that a lot. [00:44:00] That we still live with that. And yeah, so we have to, I think it's going to keep shifting as time goes on. Um, but we still have a long way to go. Another piece of it to encourage folks to reach out to us is that in the post COVID as much as we are post COVID world.
We've as academics, just like clinicians and everybody else, we really learn how to do things at a distance. So, you know, more and more projects are coming along where, um, researchers who are doing implementation science work as well as other kind of clinical research, um, can do their work. With people from all over the country.
So whereas, for example, the communication partner instruction work that I used to do, we would always do it in person, you know, if and when we get back to doing more of that work, we'll never do it the same way again. I'm sure that we'll do it using telepractice and that opens us up. That makes our lives easier as researchers [00:45:00] because our participant pool is wide open and it also opens up the opportunities for collaboration.
Clinicians who are in rural areas who aren't near universities, you know, all of those things. So that maybe, you know, maybe that's a little bit of a push to encourage clinicians who are interested in working with researchers to go ahead and work out or reach out to not just one person, but to many people because.
Who are doing some, you know, work that you're interested in, because you can, like, as a researcher, you can only take somebody on to a research project. If you have a research project, if with clients that meet those particular criteria, like, that's just a reality of it, but, you know, having some persistence and some grit with, with contacting people, um, I think is, is.
Uh, a good clinical practice if that's something that you're interested in, in doing.
Kate Grandbois: I know we have one more example that we need to get to for our third learning objective of examples of [00:46:00] research practice partnerships. But before we get into that, I wonder if. You could talk to us a little bit more about the role of cultural competency in this whole arena.
Um, you mentioned it a few minutes ago, and I know it touches everything we do. And we've already spoken about power differentials and, you know, different hierarchies and all of these cultural components that impact this problem. I just, I wanted to just give it a moment. If you wouldn't mind just telling us a little bit about how cultural competency touches all of these components and
Cathy Binger: variables.
Natalie, you want to take that 1 or you want me to take a stab?
Natalie Douglas: Well, I actually happen to have a paper that I was just reading for a talk. I'm preparing for that addresses this exact thing. But the article is by, um. Ana Bauman and colleagues, and it's called advancing health care equity through dissemination and implementation science [00:47:00] and essentially, um.
What they have in this article, um, they have a figure of. Guiding principles if you want to you achieve health care equity, um, in dissemination and implementation science. Um, and there's 4 of those. And the 1st is racism must be recognized as a fundamental driver of health care and equities. I think you could probably say the same thing about educational ones, um, equitable health care requires active engagement of community members and other relevant partners.
Equitable health care requires multi sector partnerships, and context is central to health care equity. So I think you could put. Substitute schools or educational environments for health care and all of those places, um, but they have those principles and then they have, like, 8 recommendations again. The onus of this is on the researcher, my opinion to consider, [00:48:00] you know, anchoring their.
Their work in this, but they actually have in their table, table one in the article, they have 60 opportunities for action for researchers in terms of how you might
Cathy Binger: structure 6 0, 66 0.
Natalie Douglas: Yeah. Six zero recommendations with 60 opportunities for action for researchers. Wow.
Well that's some homework work. . Yeah, it's everything I think. I think it's everything. I don't think you can really talk about. This work without it. I don't know what you think, Kathy.
Cathy Binger: Oh, yeah, of course. Absolutely. I mean, you know, we're just constantly learning about learning about this and, um. Yeah, I was thinking about the class that I, uh, one of my classes I was just teaching earlier today and we were, we were talking about cultural responsivity and, um, it was actually in the context of [00:49:00] doing early intervention work and the wonderful, um, some of you may be familiar with FGRBI that Molly Romano is directing that now the, um.
Oh, what's it stand for? Um, family guided FG family guided. Oh my gosh. I'm so embarrassed. Molly. I'm sorry if you're listening to this that I don't have it right. Um, routines based intervention. That's what it is. Family guided routines based intervention. And we were, you know, I was talking with my students about how.
Um, what a great program it is and how at its very core, it's the foundation of the program, um, part of the foundation is being culturally responsive and that you walk into every situation with every family from a very open perspective. stance. So I think this goes back to ethnographic interviewing too, which you guys have talked about on this podcast before, um, where you're going in and asking very open ended questions, not making assumptions.
So tell me what mealtime looks like within your [00:50:00] family and not even making an assumption. I think I was just listening to a podcast. Um, episode where you guys were just talking about this, you know, maybe they don't even eat breakfast or maybe there's a meal in there that isn't. So just asking really open ended kinds of questions so that they can tell you their own experience without me putting my judgment on them.
Right. It's important to be discerning. It's important to not be judgmental. Right, we can be discerning without being judgmental, and I think implementation science. It's one of the things that really draws me to implementation science as well is that, you know, are we perfect at it? Absolutely not. But if we're going to do this work with our partners, going back to that second learning objective of building trust and cultivating partnership relationships as step one of that, we have to do this from and we need to do this.
And we want to do this from this very open stance of wanting to understand, um, what's going on with our partners, whether those partners are [00:51:00] educators or medical professionals or families, whoever those partners are, um, we need to be open and understanding what, what the reality is of their environment.
So, in the FGRBI case, we're talking about families. If I'm working in a school, I'm talking about, you know, what's going on with the SLPs and the educational assistants and the special ed teachers and whoever it is, I'm gonna need need to be working with what are their caseloads like and what are their who's on their caseload and what's going on with these family members and, you know, blah, blah, blah, blah, blah, like all the things that have an impact.
And I need to be realistic about that in implementation science work, not try to Go in and change the system so that they can do my intervention, but for me to look at the current state of the system and, um, create interventions and assessments that can work within these existing systems. So the, the mindset is a very different one entering into [00:52:00] all of that.
So hopefully that got it, some of what you're asking.
Natalie Douglas: That's huge, Kathy. I mean, it's just so, it's just, it's just so fundamentally different, right? It's just so fundamentally different to go in. But, but at the same time, it's like, why in the world have we been waiting so long to do this? It just doesn't even make sense.
It's like, we're trying to, to go into, um, you know, and this is a lot of things. So, 1 of the things that we, um, I don't know if this fits with the learning objective, but in 1 of my partnerships with nursing homes, they weren't able to do the study and they felt terrible. Um, but I was like. No, like we need to know.
And so the structure where my intervention was being implemented would not allow it to be implemented. And it was no fault of any individual person, but the, you know, the nursing home. Are [00:53:00] having a huge crisis right now more than before cobit with staffing. And so what I'm trying to do with that is kind of walk that line of, like, yes, I need to get data for my grant accountability, but also.
I need to let these higher ups know what it's like in a nursing home. I need to let them know that there's no way that they can think about offering somebody a whiteboard to communicate key words when they've got eight people who haven't been toileted. Um, you know, this is the reality
Cathy Binger: of it. You know, Natalie, that to me goes directly back to what you talked about earlier with from a researcher perspective.
What is good data? Right? Good data is I have 8 people who need to be toileted and they can't be messing around with a whiteboard right now. You know, that that is important data too. And so 1 of the things I love about this is a little more research, but 1 of the [00:54:00] things I love about implementation science is this.
Um, ability to there's a value that's placed on different kinds of data. So not just the really clean cut. Um, Kind of numbers driven data, but using other kinds of methodologies, like qualitative methodologies, where we can talk about the real life lived experiences and interviews and focus groups and, you know, whatever it is to gather information about these kinds of things.
And so the things that we used to try to clean out. of our data set of, oh, that's noise. We now embrace the noise with implementation science, and we embrace the mess. And I've, I've always liked the mess. So that, that's really, um, I think that's, that's such an important fundamental piece of, of, um, implementation science world and work.
In our last
Kate Grandbois: couple of minutes, I wonder if You all [00:55:00] could give us one last example. I know we've already gone over two, but are there any other examples out there that might, you know, just give us another perspective of how a clinician might get involved in a research practice partnership. So you've talked about clinicians working in a nursing home.
You've talked about clinicians working in a school setting. Um, What else is out there just to give clinicians who might be interested in this work a little bit of a glimpse into into what this is what this work is like?
Natalie Douglas: Yeah, I kind of wonder about state conferences. I kind of wonder about the implementation science conference.
I know a huge Focus of that is, um, partnerships. And so there are a lot of ways to connect. I know it's hard to get the doc, Amy, you were a speaker and you could only like get off for the talk, which was just very [00:56:00] realistic.
Amy Wonkka: Clinician versus researcher landscape right there. That's a good.
Natalie Douglas: So, I mean, networking that way, um, I know social media is like a blessing and a curse, but a lot of there are a few researchers that are on social media and we'll have discussions and you can reach out.
You can slide into their if you will. You know, there are lots of ways to do that, but I think, you know, conferences networking. Um, social media, I'm trying to think what I'm missing.
Amy Wonkka: I mean, I, just for another plug about the implementation science conference as somebody who attended as a clinician, um, I, it was a super cool experience. It's a virtual conference, which is also for me, always a barrier remover because I don't have to travel. I don't have to get time off from work to like travel to go there.
And I do feel like at the end, there was. An actual form that people could fill out to show that you like your contact information. [00:57:00] I'm interested in this is where I currently work. I'm interested in research in this area. Um, so that's definitely something to keep to keep your eyes open for. I don't know if there's a list to get on.
We can email us to find out about that. Um, email also, if I've learned anything through this project, it is that you can email professors and they are generally very friendly people and will respond to you with kindness and generosity. So old fashioned
Cathy Binger: email. Yeah. And a way, one way that I think a lot of people don't know about to find researchers, right?
Like whatever your thing is, whatever your area of interest is, you can go on research gate. Um, is one place to go. Um, it's, just like it sounds, researchgate. com I think it's dot com, um, and you can look up your topic of interest, whether it's childhood apraxia of speech or AAC or what have you and put in some key words and find, [00:58:00] um, you know, A, you can find research articles if that's something that you actually want to do, um, on there that people have That are up and publicly available.
And once you find papers that you think are of interest, even just by reading the abstracts of, oh, like, this person's work is really interesting to me. You can follow that person and then you get notifications when they publish something new. And you also can, um. Oh, it's. net. It's researchgate. net. Thank you, Amy.
Um, thanks for checking that. Um, yeah. And so you can follow those people to, to learn, you know, about what they're doing, but you could also can like figure out who you want to follow and who's of interest to you and then contact them directly. And I think essentially every academic has an email address online that you can find on their university homepage or on their university page.
Natalie Douglas: As we wrap up, are
Amy Wonkka: there any parting final words of wisdom that you would like to leave us [00:59:00] and our
Natalie Douglas: audience with?
I mean, I, I don't know if this is what I would like to say to clinicians. Not only do you belong at the table, but in my mind, I think Kathy would agree. You are like the MVP at the table. Period. Like, you are the implementer. Like, it's, it doesn't happen without you. Both, not just from you implementing a research intervention that was developed without your input, but also in your, I mean, maybe that would work if it meets a need, um, that you have, but also in your ideas, right?
Because people in academia are very out of touch with what is happening. On the ground in day to day clinical practice and without your input. These cycles will continue, and I in no way want to imply that I think the burden is on you as a clinician to do that. [01:00:00] But if you have the desire and the capacity and you want to, um, you are so more than welcome and, and, and truly like the MVP for sure.
Mic drop.
Kate Grandbois: That was
Cathy Binger: really funny. I had to say that.
Natalie Douglas: We keep talking about the. Implementation science conference from the or the Massachusetts general hospital. Thank you. Yes, Institute of health professions. Um, and I don't know if we have show notes or anything that we can put this in, but it looks like even if you weren't there from this year's conference, you can purchase, um.
All of the talks, they call them the lightning talks, and this is where people give, um, it looks like it's 30 and you can get immediate access to all conference talks recorded on April [01:01:00] 2023, and it looks like they're going to, um, the conference talks are eligible for CEUs and you get a certificate of completion.
And I wonder, too, if that might help you get connected with that group. Um, so, yeah.
Kate Grandbois: Well, thank you both so much for being here and sharing all of this with us. Um, anything that you all mentioned throughout the course of this episode will be listed in the show notes, um, of, of, along with links, any links that are available. Um, And if you're, if you've made it this far in the podcast, presumably you've also listened to part one, um, and learned a lot about implementation science and the action steps that we can take as clinicians to bring ourselves to the table, participate in these research practice partnerships.
So thank you both so much for being here. This was incredibly helpful and, um, we'll have to have you back again soon.
Cathy Binger: Thanks so much, Kate and Amy. We [01:02:00] really appreciate it.
Natalie Douglas: Oh my gosh. Yes, you guys are fab. Thanks so much. This was a lot of
Amy Wonkka: fun. Thank you.
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Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
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thank you so much for joining us and we hope to welcome you back here again soon.
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