Implementation of the Comprehensive High-dose Aphasia Treatment (CHAT) program: “A different way of operating”

Abstract

Background: Despite growing evidence supporting the clinical efficacy of Intensive Comprehensive Aphasia Programs (ICAPs), there are implementation challenges that may prevent widespread adoption of ICAPs by healthcare services. To address these barriers, a tailored implementation intervention was developed to facilitate the delivery of a modified-ICAP called the Comprehensive, High-dose Aphasia Treatment (CHAT) program within the Australian healthcare context. Aims: 1) To evaluate the feasibility, acceptability and potential effectiveness of a tailored implementation intervention to support the delivery of CHAT within a clinical service. 2) To evaluate the feasibility, acceptability and the potential effectiveness of delivering CHAT with respect to clinician and patient outcome measures. Methods and Procedure: This Phase 1 feasibility study utilised a mixed-methods hybrid Type III implementation effectiveness design. A single health service was recruited for the implementation trial and two speech pathologists received training and resources to support the delivery of CHAT. Four adults with chronic post-stroke aphasia were recruited to participate in the eight-week CHAT program. Qualitative data, obtained through in-depth interviews, were used to explore speech pathologists’ perspectives of the tailored implementation strategy and to identify the potential barriers and facilitators to delivering CHAT. Furthermore, quantitative data evaluated the feasibility (i.e., dose of intervention), acceptability (i.e., satisfaction ratings) and potential effectiveness (i.e., clinical outcomes) of the CHAT program. Outcomes and Results: Speech pathologists perceived CHAT to be feasible, acceptable, and potentially effective to implement into the healthcare service. Improvements across measures of patients’ language impairment, functional communication and quality of life post-CHAT were observed. Reported facilitators to implementation included the provision of support and access to information and resources, while barriers included time constraints, scheduling issues and clinician fatigue. Conclusions: This is the first study to report the successful clinical implementation of a modified-ICAP into a health service. Findings from this study will be used to inform future adoption of the ICAP model into rehabilitation services.