Parent-to-parent support for parents with children who are deaf or hard of hearing: A conceptual framework

Background: Parent-to-parent support for parents with children who are deaf or hard of hearing (D/HH) is identified as an important component of Early Hearing Detection and Intervention (EHDI) programs for children with hearing loss

An integrated knowledge translation experience: Use of the Network of Pediatric Audiologists of Canada to facilitate the development of The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP v1.0).

The goals of this project were: (1) to determine the important factors that influence implementation of evidence-based practice by Canadian audiologists; and (2) to utilize the knowledge-to-action process (Graham et al., 2006) during the development of a guideline for outcome measures to evaluate the auditory development and performance of young children who wear hearing aids, to facilitate clinical uptake and identify barriers to implementation (Bagatto, Moodie & Scollie, 2010; Bagatto et al., 2011; Bagatto, Moodie, Seewald, Bartlett, & Scollie, 2011; Moodie, Bagatto et al., 2011; Moodie, Kothari et al., 2011). Two projects (Chapters 3 and 4) included the participation of The Network of Pediatric Audiologists of Canada. The outcome measures guideline to evaluate the auditory development and performance of young children who wear hearing aids is called The University of Western Ontario Pediatric Audiological Monitoring Protocol (UWO PedAMP). This body of work includes a chapter on knowledge translation and how it can be used to promote the clinical implementation of evidence in audiology (Chapter 3). It also includes three studies: (1) an examination of factors influencing the use of evidence by Canadian audiologists [Chapter 2]; (2) an initial evaluation by the Network of Pediatric Audiologists of Canada of the individual components considered for inclusion in the UWO PedAMP [Chapter 4]; and (3) a final evaluation by the Network audiologists of the released version of the UWO PedAMP and associated training materials [Chapter 5]. Results of the first study indicated that Canadian audiologists rate themselves as competent in finding, evaluating and using research evidence to change practice. Their greatest barriers to evidence-based practice are related to time. By partnering with Canadian audiologists and using the knowledge-to-action framework to guide us (Chapter 4), we were successful in developing the UWO PedAMP guideline into what they rated as being a high-quality, systematic, hearing aid outcome evaluation tool that improves the quality and effectiveness of audiological care received by young children with hearing loss. The results presented in Chapter 5 indicated that the UWO PedAMP is appropriate for clinical implementation, and is recommended by these Canadian audiologists as preferred audiology practice

An examination of clinical uptake factors for remote hearing aid support: a concept mapping study with audiologists

© 2020 The Authors. Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of British Society of Audiology, International Society of Audiology, and Nordic Audiological Society. Objective: To develop a conceptual framework around the factors that influence audiologists in the clinical uptake of remote follow-up hearing aid support services. Design: A purposive sample of 42 audiologists, stratified according to client-focus of either paediatric or adult, were recruited from professional associations in Ontario, Canada, as members of the six-step, participatory-based concept mapping process. Analyses included multidimensional scaling and hierarchical cluster analysis. Results: Six main themes emerged from this research according to overall level of importance: (1) technology and infrastructure; (2) audiologist-centred considerations; (3) hearing healthcare regulations; (4) client-centred considerations; (5) clinical implementation considerations; and (6) financial considerations. Subthemes were identified at the group-level and by subgroup. These highlight the importance of TECH factors (accessible Technology, Easy to use, robust Connection, and Help available), as well as the multi-faceted nature of the perceived attitudes/aptitudes across stakeholders. Conclusion: Findings can be utilised in tailored planning and development efforts to support future research, knowledge dissemination, best-practice protocol/guideline development, and related training to assist in the clinical uptake of remote follow-up hearing aid support services, across variable practice contexts

Barriers and Facilitators to Implementation of a Preschool Outcome Measure: An Interview Study with Speech-Language Pathologists

Barriers and Facilitators to Implementation of a Preschool Outcome Measure: An Interview Study with Speech-Language Pathologists Abstract Introduction: The Preschool Speech and Language Program in Ontario, Canada implemented the Focus on the Outcomes of Communication Under Six (FOCUS), an outcome measure, in 2012. This study aimed to investigate commonly experienced facilitators of and barriers to implementing the FOCUS in clinical practice from the perspectives of speech-language pathologists (SLPs). Methods: Thirty-seven SLPs participated in semi-structured interviews to share their experiences adopting the FOCUS in clinical practice. A deductive content analysis of interview transcripts was conducted using the Theoretical Domains Framework (TDF), followed by an inductive analysis to identify sub-themes within each domain. Results: SLPs frequently encountered barriers within three TDF domains: Environmental Context and Resources (e.g., difficulties integrating the FOCUS into assessment sessions and intervention schedules), Beliefs about Consequences (e.g., beliefs that data collected using the FOCUS lack relevance to clinical practice), and Social Influences (e.g., administration of the FOCUS harmed rapport with families). Commonly reported facilitators were found in the Behavioural Regulation (e.g., reminder system) and Environmental Context and Resources (e.g., availability of administrative personnel and technology support) domains. Conclusions: SLPs identified barriers and facilitators to implementing an evidence-based outcome measure into practice. Insights drawn from SLPs’ perspectives will support the design of new methods to improve the implementation of functional outcome measurement tools within programs

Mindfulness and therapeutic relationships: insights from a phenomenological study of occupational therapists' practices

Background A well-established body of literature highlights the importance of the therapeutic relationship when working with children and youth. A growing body of literature points to the potential of mindfulness to enhance the quality of relationships, including the therapeutic relationship. To date, little attention has been paid to this topic within the profession of occupational therapy. Aim The aim of this study was to inquire into paediatric occupational therapists’ experiences of mindfulness in the therapeutic relationship with children and youth.  Methods Heideggerian-informed hermeneutic phenomenology was employed as the methodological approach. Two key Heideggerian concepts of being-with and care served as theoretical underpinnings of the study. Semi-structured interviews were completed with eight North American occupational therapists to elicit their first-hand accounts of mindfulness in the therapeutic relationship with their paediatric clients. Interviews were transcribed verbatim and analyzed using a phenomenological approach. Results Four key themes were identified and include: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. Conclusions The findings offer insights regarding the potential affordances of mindfulness to support clinicians as they form of therapeutic relationships with children and youth. This study highlights research priorities for future inquiry.&nbsp

A Scoping Review of Virtual Focus Group Methods Used in Rehabilitation Sciences

Virtual methods for conducting focus group studies are increasingly being used in many fields, including rehabilitation sciences. This is partly due to the current pandemic, and the need for social distancing, however, may also relate to factors such as convenience and practicality. Virtual research methods enable investigators to collect data at a distance from the participant(s) through the use of technology-mediated data collection methods incorporating new tools and technologies. The aim of this scoping review was to identify, synthesize, and present current evidence related to the methods for conducting virtual focus groups. A comparison of asynchronous and synchronous data collection methods was conducted. The objectives, inclusion criteria, and scoping review methods were specified in advance and documented in a protocol. The 40 articles in this review included virtual focus group research conducted in rehabilitation sciences including data collection conducted using both synchronous (22.5%) and asynchronous (77.5%) models and using a defined moderation method. Three modes of focus group discussion were reported including email, chat-based, and videoconferencing; these were facilitated through the various technology platforms reported in the review. Reported barriers and facilitators to conducting virtual focus group research were extracted and summarized. Commonly reported facilitators to virtual focus group research included the ability to recruit participants from diverse geographical locations and the participants’ ability to engage at times convenient to them. Both computer literacy and access to technology were reported as common barriers. This review highlighted the need for further research and guidance around virtual focus groups conducted using face-to-face synchronous methods and with younger participants groups

“It gives me confidence”: Caregiver Coaching From the Perspective of Families of Children Who Are Deaf or Hard of Hearing

Caregiver coaching is utilized in early intervention services with families of children who are deaf or hard of hearing to increase caregivers’ skills and confidence in supporting their child’s language development, but few studies have examined coaching from the perspective of the caregivers. The purpose of this study was to increase understanding of caregivers’ experiences of coaching in the context of listening and spoken language intervention services. Using semi-structured, qualitative interviews, this study examined 13 caregivers’ perspectives at three intervention sites in the US and Canada. Results indicate that caregivers perceive that practitioner characteristics, expectations, and the evolution of the coaching relationship over time contribute to a positive caregiver coaching relationship. This study contributes to the understanding of the caregiver coaching experience and has implications for new and experienced practitioners working to improve their practice by establishing and strengthening collaborative caregiver coaching relationships with the families they serve

“It’s About Walking Alongside a Family”: Practitioner Perspectives on Caregiver Coaching With Families of Children Who Are Deaf or Hard of Hearing

Practitioners utilize caregiver coaching in early intervention services, but coaching principles and practices are not well understood in the context of listening and spoken language (LSL) services with families of children who are deaf or hard of hearing. The purpose of this study was to examine practitioners’ experiences with coaching, including definitions, training, and practices they utilize in their work with families. Using semi-structured, qualitative interviews and video observation discussions, this study examined the perspectives of 14 practitioners providing LSL services to families at three intervention sites in the US and Canada. Results indicate that practitioners’ underlying beliefs about their coaching proficiency and caregivers’ capacity impact their coaching practices and how they engage with caregivers. Results highlight practices such as mentoring and accountability that supported practitioners’ coaching skills. This study contributes to the understanding of caregiver coaching in LSL practice and has implications for practitioners working to improve their coaching skills, which may improve LSL services and optimize child outcomes

Selecting and tailoring implementation interventions: A concept mapping approach

© 2020 The Author(s). Background: To improve the uptake of research into practice, knowledge translation frameworks recommend tailoring implementation strategies to address practice barriers. This study reports our experience pairing the Theoretical Domains Framework with information from multiple stakeholder groups to co-develop practice-informed strategies for improving the implementation of an evidence-based outcome measurement tool across a large community health system for preschoolers with communication impairments. Methods: Concept mapping was used to identify strategies for improving implementation of the Focus on the Outcomes of Communication Under Six (FOCUS) in Ontario Canada\u27s Preschool Speech and Language Program. This work was done in five stages. First, we interviewed 37 speech-language pathologists (clinicians) who identified 90 unique strategies to resolve practice barriers to FOCUS implementation. Second, clinicians (n = 34), policy-makers (n = 3), and members of the FOCUS research team (n = 6) sorted and rated the strategies by importance and feasibility. Third, stakeholders\u27 sorting data were analyzed to generate a two-dimensional concept map. Based on the rating data from stakeholders, we prioritized a list of strategies that were rated as highly important and highly feasible, and summarized the practice barriers addressed by each of the prioritized strategies. Fourth, we validated these findings with stakeholders via an online survey. Fifth, the mechanisms of action of the prioritized list of strategies were considered based on available evidence from the Theoretical Domains Framework and associated behavior change literature. Results: Stakeholders categorized the 90 unique implementation strategies into a six-cluster concept map. Based on stakeholders\u27 ratings, a list of 14 implementation strategies were prioritized. These implementation strategies were reported to resolve barriers within the environmental context and resources and beliefs about consequences domains of the Theoretical Domains Framework. All but one of the prioritized strategies have a demonstrated link in resolving existing barriers according to the behavioral change literature. Conclusions: Our study contributes to a growing literature that demonstrates the process of tailoring implementation strategies to specific barriers. Practical drawbacks and benefits of using concept mapping as a way to engage stakeholders in implementation research are discussed

A critical review of audiological outcome measures for infants and children

Outcome evaluation is an important stage in the pediatric hearing aid fitting process, however a systematic way of evaluating outcome in the pediatric audiology population is lacking. This is in part due to the need for an evidence-based outcome evaluation guideline for infants and children with hearing loss who wear hearing aids. As part of the development of a guideline, a critical review of the existing pediatric audiology outcome evaluation tools was conducted. Subjective outcome evaluation tools that measure auditory-related behaviors in children from birth to 6 years of age were critically appraised using a published grading system (Andresen, 2000). Of the tools that exist, 12 were appraised because they met initial criteria outlined by the Network of Pediatric Audiologists of Canada as being appropriate for children birth to 6 years of age who wear hearing aids. Tools that were considered for the guideline scored high in both statistical and feasibility criteria. The subjective outcome evaluation tools that were ultimately chosen to be included in the guideline were the LittlEARS Auditory Questionnaire (Tsiakpini et al., 2004) and the Parents\u27 Evaluation of Aural/Oral Performance of Children (PEACH) Rating Scale (Ching & Hill, 2005b) due to the high grades they received in the critical review and their target age ranges. Following this critical review of pediatric outcome evaluation tools, the next step was for the Network Clinicians to evaluate the guideline (Moodie et al., 2011b)