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2017-03-15
1
Promoting more effective
communication partner training in
speech-language pathology practice
Riva Sorin-Peters, PhD, Reg CASLPO, SLP©, CCC-SLP
Marie-Christine Hallé, MPO, PhD,
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.
1. Introduction
• 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
1. Introduction
• 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).
1. Introduction
• 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)
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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 evidence-
based 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
– Learning is a process that occurs within the
learner and is activated by the learner
• “Inside-out” learning
• A consequence of experience
2. Adult Education Principles
–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. Principles of Adult Education
2. The Kolb’s Experiential Learning
Model
Experience et
ressenti
Imagination et
lecture
Observation et
réflexion
Application
Concrete Experience
Reflective Observation
Active
Experimentation
Abstract Conceptualisation
3. Application of theory to practice:
Pilot project
• Subjects:
Sex Age # years of practice
Year of SCA training
Previous training in CPT
SLP1 F 35 10 2014 no
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’
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3. Application of theory to practice:
Pilot project
• Intervention: – Pre-workshop assignment
– 2-day workshop
• Included all 4 components of Kolb’s cycle
• 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
Concrete Experience
Reflection Active
Experimentation
Abstract Conceptualisation
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Familiar with adult learning principles
Know strategies to apply adult lng
principles to CPT
Comfortable training family members of
PWA
Effective in training family members of
PWA
Sco
re
Knowledge
Results Pre- and post- knowledge about adult learning
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?
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4. Points for Discussion
• How could you overcome these
challenges?
• What’s ONE thing you could do
differently in your practice of CPT?
Conclusion
• 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 References
• 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.
References
• Kolb, D. (2015). Experiential learning: Experience as the source of learning and development. 2nd 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.
References
• 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.
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References
• 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.
