A “special ingredient”: development of an intervention to implement structured and collaborative clinical planning processes for Comprehensive, High-dose Aphasia Treatment (CHAT)

Abstract

Purpose: Intensive Comprehensive Aphasia Programs (ICAPs) deliver personalised treatment to improve outcomes for people with aphasia. Structured, collaborative clinical planning may address challenges associated with personalising therapy, facilitating implementation of these programs. This study aimed to (1) understand speech pathologists’ perspectives of barriers, facilitators, and strategies to implementing clinical planning for one modified ICAP, Comprehensive, High-dose Aphasia Treatment (CHAT), and its telerehabilitation-delivered counterpart (TeleCHAT); and (2) develop a theory-driven intervention to implement clinical planning. Methods: Phase one: treating speech pathologists and speech pathology leaders involved in CHAT/TeleCHAT participated in focus groups/interviews. Reported barriers, facilitators, and strategies for implementation were analysed via mixed deductive-inductive content analysis and categorised using implementation frameworks. Phase two: findings from phase one were translated into an implementation intervention using determinant-strategy mapping tools. Results: Three themes were identified: (1) overall experience; (2) learning a new way of practice; and (3) the implementation context. Clinical planning was highly regarded by participants. However, barriers relating to its fit within a clinical setting were reported. Adequate social support may leverage this barrier. An implementation intervention including six evidence-based strategies was developed. Conclusions: Strategies to support implementation of clinical planning for CHAT/TeleCHAT have been identified, an important preliminary step for implementing ICAPs.