This is a transcript from our podcast episode published March 7th, 2022. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.
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So today we are talking about something very exciting and that, that I didn't think I was going to be so excited about if I'm going to be totally honest until we had a lot of really interesting discussions.
We are going to discuss the research to practice gap. And while that might sound sort of dry, we're going to talk about why we should care about it as clinicians, because as it turns out, there are some mind blowing pieces of information about the research to practice gap. And as clinicians, we, we know what the, we know that there is a gap.
Um, but what is it? So what is the research to practice gap and, and why is it that we, how does it affect our practice on a regular basis? Um, Amy, as our listeners know, Amy and I are both, um, working clinicians, working on the quote unquote frontlines of, you know, in schools [00:03:00] and, and with clients and students and all those kinds of things.
And as we prepared for this episode, um, with the two researcher, guests that we have on our show today, this really fantastic analogy came up. Amy, do you want to say what it is?
Amy Wonkka: No, I think that you should do it.
Kate Grandbois: So there was this analogy that came up about, about researchers being in the ivory tower, which of course made us think of.
[00:03:26] Amy Wonkka: I would sing it, but I don't know if we’re allowed to sing the song.
[00:03:29] Kate Grandbois: Why? Because of like copyright, I don't know.
[00:03:31] Amy Wonkka: Can you
[00:03:32] Kate Grandbois: sit, can you sing the Never Ending Story
so the ivory tower made us think of, of course the never-ending story. So the Ivory, Meaning it to make it parallel to what we're talking about. Not to go on a 1980s movie tangen,t researchers do sit in the ivory tower, doing their research in this beautiful, clean, pristine situation. And then the information from the research coming down from the ivory tower to us clinicians working on the front [00:04:00] lines.
And how long does it take the research to come down the ivory tower? What are the barriers that come down? What does that gap actually look like? Um, and for us, Amy and I, as the clinicians, we know that there are a lot of barriers, right? Um, so what, what of our barriers contribute to the research to practice gap?
Is it that we don't have time to read, to read the research? Um, is it that we have a hard time finding the research that we actually need for a particular student or client. Is it that the research is done in a lab under perfect conditions up in the ivory tower. Um, and we don't really know what's going on in there.
It's a super cool club. We don't get invited up there very often, you know, which is, gives us maybe, maybe it gives some people grumpy feelings. I don't know. There's like a whole world around this, this research to practice gap. That's really, really important because it affects our clinical practice. Um, and I think something that we've talked about and Amy correct me if I'm wrong, we've talked about a lot.
Is that [00:05:00] the, what happens in a research lab doesn't necessarily represent what's happening in your classroom?
[00:05:06] Amy Wonkka: Yeah. I mean, I think that we've talked a lot about the evidence-based practice triangle and thinking about that external evidence. And a lot of times you read those articles and you feel like, well, geez, these guys have no idea what my life is down here and internal evidence land.
Um, and you know, I really don't know what it's like up in that ivory tower. Um, and so I think that while we want to integrate this external evidence, it's hard sometimes as a clinician to know what to do with it. Even if you do read something and you're like, ah, Okay. It's hard to know how to turn that into something that makes sense for you as a clinician and for your clients.
Um, and then, you know, sometimes it's hard to even read the articles if you don't, you know, if you don't subscribe to the journals, which are super duper expensive, like you can't even read that article to have the thoughts about what that might mean for your practice. So there are lots and lots of barriers, uh, [00:06:00] and we're here today to learn a bit more about how we can break those down and how we can, how we can kind of work together.
To best serve our clients from people who were in all of these different places in the swamp or the ivory tower
[00:06:15] Kate Grandbois: In the swamp of sadness. This is the best analogy of all time. So if anybody's listening, who hasn't seen that movie, you need to go watch it immediately. Um, but I promise you'll be able to follow along, even if you haven't seen it.
So, um, you know, Amy, to sort of piggyback on what you were saying, there are all these hurd, there are all these hurdles to the research practice gap, and we have some strategies for them. So, um, for those of you who don't know the informed SLP, um, the informed SLP is a platform that produces digestible pieces of, um, summaries of the research that's out there.
So we have platforms like that. We have other continuing education platforms, um, but. The, it's really hard to understand what the research from, from the [00:07:00] lowly, from all the way down here at the bottom, in the trenches, underneath the shadow of the ivory tower, it's very hard to sort of see where, what the research to practice gap is and what variables contribute to it and only,
Like Amy said, only after we see the barriers, can we really sort of start to do some of the problem solving? So we're not researchers, we can't really solve this problem ourselves. So to get to the bottom of this, we invited two researchers, two researchers onto the show to answer some of our questions.
Um, these are two veteran SLP nerd cast guests, and we're very excited to have them back. We are, um, very excited to welcome Dr. Cathy Binger and Dr. Natalie Douglas, back to the show. Welcome, Cathy. Welcome back
[00:07:45] Cathy Binger: It's a pleasure to be here. Thanks for having us.
[00:07:48] Natalie Douglas: Yes. Thank you.
[00:07:50] Amy Wonkka: All right. Before we get started for listeners who haven't joined us on our wonderful adventures with Cathy, Natalie before, can you each tell us just a little bit about [00:08:00] yourselves?
Um, so people can understand why you're here to come talk to us.
[00:08:03] Natalie Douglas: Yes. So Natalie here, um, so I'm actually on the faculty at Central Michigan university right now. I've been here since about 2013. Um, but before that I had about a 10 year gap where I was providing clinical services, mostly an outpatient hospital and long-term care settings.
Um, so working as an SLP for about 10 years, Um, and actually one of the things that most propelled me back into academia was I was hoping that I was going to be able to have some tools to help me solve some of the problems that I was seeing on a day-to-day basis. That I didn't think that I could solve with the tools that I had based on my clinical training.
So, um, most of my work at this point works on implementing best practices for people with dementia in nursing homes. [00:09:00] So I'm really grateful to be here with all of you again today.
[00:09:04] Kate Grandbois: How about you, Cathy?
[00:09:06] Cathy Binger: Yeah, I'm Cathy Binger. I'm a professor at the University of New Mexico. And, um, like Natalie, I took the long and winding road back to getting my PhD.
Um, I went straight through school to become an SLP, thanks to career counseling, found the discipline, but then once I got out and practiced, um, I initially had thought that I would always get my PhD if I stayed in the field. Um, and then I ended up practicing for about eight years in there. I did some research, um, but mostly I was clinical, working clinically during that time.
And I worked in lots of different settings. I worked in headstarts. Um, I've worked in five different states. I've worked, um, doing elementary. I work for an elementary school, public schools, um, middle school for a little bit as well. Um, even, you know, older populations with developmental disabilities, so worked with different populations, mainly little [00:10:00] kids, um, mostly in, in public kind of settings.
And, um, I got really frustrated and as I think I knew I would even way back when, um, I was in school initially. And, uh, one of the phrases that kept coming back to me was from a high school teacher who was fond of saying if you're not part of the solution, you're part of the problem. Uh, so I had one foot out the door from the profession for a long, for a lot of those years during that time and really thought I would leave and go do something else at some point.
And then a series of things happened that took me back to school to go back and get my PhD and, um, with an eye toward really wanting to help solve real world real world clinical problems. So, um, and I've been, uh, here at UNM for 17 years.
[00:10:54] Kate Grandbois: And I should say to give credit where it's due. This issue of the research to practice gap is sort of what [00:11:00] brought us together.
So if we're all being honest, I, you know, with my tail between my legs got caught on a podcast, talking about how one research article in particular was quite boring. And I had to flip to the end and Amy, of course laughs, I love it. You know, our, we do our little shtick and lo and behold, it was your research.
And on top of it, you had the incredible wherewithal to reach out to me and say, yes, research is boring. Isn't that a problem? And here we are with this beautiful, you know, this, this issue that sort of brought us together, so kudos to you for not taking offense to my ridiculousness and reaching out across the aisle to try and discuss it and make it better
[00:11:45] Cathy Binger:, but it's not ridiculousness. Right? That's the whole point. And nor are you lowly, nor are you like, I'd like for you guys to throw out all of those attitudes because that's not, you know, we have, we need to be peers. We need to be colleagues. We need to work [00:12:00] together. If we're going to address the problems that we're going to talk about today. So,
[00:12:04] Kate Grandbois: I love that and I love it so much. That's making me think of like three or four more questions that I want to ask you, but I haven't run our learning objectives yet. So I have to stay focused. Otherwise it's going to be hot mess express from here on out, which is, but we're going to stay focused. We're going to stay focused.
Okay. So before we get into this and I ask all the questions you just made me think of, we're going to read our learning objectives. So learning objective number one, identify at least two common approaches to research that contribute to the research to practice. Learning objective number two, identify at least two barriers to dissemination of clinically applicable research findings. Learning objective number three, identify at least two strategies within practice-based research that researchers and clinicians can use to close the research to practice gap. Disclosures, Dr. Natalie Douglas financial disclosure as Dr. Douglas 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 [00:13:00] foundation. Dr. Douglas’s nonfinancial exclosures. Dr. Douglas is a member of AsHA SIG two and SIG 15, the gerontological society for America and the aphasia access group. Dr. Cathy Binger’s financial relationships.
Dr. Binger is employed by the university of New Mexico. Dr. Bingers non-financial relationships. Dr. Binger is a member of ASHA special interest group. Kate that's me, financial disclosures. I am the owner and founder of Grandbois Therapy and consulting LLC. And co-founder of SLP Nerdcast my non-financial disclosures.
I'm 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, Mass ABA, the association for behavior analysis international on the corresponding speech pathology and applied behavior analysis special interest group, Amy, um, Amy Wonka’s financial disclosures.
Amy is an employee of a public school system and cofounder of SLP Nerdcast. Amy's non-financial disclosures. Amy is a member of ASHA SIG 12, and serves on the AAC advisory group for [00:14:00] Massachusetts advocates for children. Okay. That was very, very long and boring. And I'm sorry, I had to read it ASHA makes me do it.
So now getting onto the good stuff. Um, something that you said right before we got through that long and boring piece brought me to a question. And I wondered if, um, before I, I have some general questions about what it's like to do research. So what goes on in the ivory tower, but I wondered if, from your perspective as a, as researchers, because we have such different workplace settings, right?
Like we have such different jobs. I mean, even though they influence one another, or they should influence one another more, do you feel that there is a great divide? Let's call it between the researching world and the clinical world.
[00:14:48] Natalie Douglas: Yes, there is a big one. And I just want to reiterate what Cathy said. It was actually making my stomach hurt. When you guys were talking about the ivory tower
[00:14:58] Kate Grandbois: I saw you cringe. I was going to text you later and [00:15:00] apologize. I didn't. I wanted to make sure your feelings weren't hurt, but I think it's real.
[00:15:04] Natalie Douglas: It is so real, but it's so. It just, it, I find it so heartbreaking. I just, it makes me so sad that we as, um, you know, we have to be part of the solution here.
And I just to think of my colleagues thinking of themselves in that way, it makes me just, we, it just points to such, um, systemic issues that we have to get out ahead of, you know, and I think, um, I don't know what happened, um, along the way, systemically that has made the research world and the clinical world, especially in a field like speech language pathology, where, you know, clinical research questions from a research and a clinician perspective, you know, those guide what we do.
And so it's just, it's [00:16:00] incredible to me that with such a common foundational principle of improving life for people with communication disorders, how things have gotten so siloed.
[00:16:14] Kate Grandbois: Um, I love the way you put that. I loved the way you put that.
[00:16:18] Cathy Binger: I wonder how much of it, or at least there's a piece of it. That's shame related.
You know, we talked about this a little bit. The last time we were on. And Amy, I think you mentioned something in an email about this recently about, um, just, you know, how, how researchers slash professors slash, and so, you know, can can say things to clinicians, um, about, well, you know, you really should be reading the research literature more or, you know, that sort of thing that there’s this, the shaming element to it. What do you guys think about that?
[00:16:51] Kate Grandbois: I definitely think so. And that was a, it was a conversation that I had had with a PhD level speech pathologist that I was collaborating with. [00:17:00] Um, and she said, well, you know, SLPs just don't read the research. And I went, whoa, well, you know, there was a, that was a fast generalization, you know, there are a lot of barriers to being a working clinician.
Um, and I also think there's a component of prestige. So it is more school. It's a lot more of a commitment, you know, it's a lot more money and time or time money as Amy always says one of the one in the same and you know, it's as a working clinician, you know, a lot of us, oh, what would it be like to have our name in print?
You know, it would be so cool. There is, there is this level of prestige that it is a higher, more important job.
[00:17:42] Amy Wonkka: I think too, for a lot of us, like our… Prior to this, my interactions with people who were researchers or faculty was in a power differential dynamics, such that I was there paying to learn from this [00:18:00] person who knew more and was essentially, you know, my superior in content. So I think that a lot of us who haven't gone forward, you know, into kind of the next step, like is kind of do view it as like a next step. If you're really serious, you go on and you do research or, you know, you get your doctorate. Um, you know, we still also carry that piece with us where like, that was the nature of our relationship.
I mean, even now I have professors who have like, told me a million times, like you can just call me Michelle and I'm like, no, no, I can't actually, I just, that is just not how your brain is, how your name is coated, my brain, you know? So, um, I think that that's, that's probably a piece of it too. And as somebody who works in the school, you know, I think depending on your work environment, there's also even sort of cultural differences in judgments that other, you know, I'm, I think it's pretty common Kate and I met in outpatient. So I think we've both worked there so we can speak a little bit to like sometimes what happens [00:19:00] outpatient is you think that you're better than everybody who works in the schools, you know, so there's, there's a lot of differences that we can, depending on the culture of our work environment that we may internalize or externalize that may or may not be true at all.
Um, you know, like I had through this, I've talked to a lot of people who are, who are in my mind, pretty fancy people and everybody's been lovely and generous and shared, you know, information. So I think some of this is also constructs that we build ourselves. And so that's something else for the clinician to be aware of.
If there's a paper you want to read, email the author, they might just share it with you. Like,
[00:19:36] Kate Grandbois: oh my God, every single author I have called through this project, I have cold contacted 10,000 million people. It's not even a number. It was a lot. Every single per every single researcher I've contacted is thrilled to hear from you.
I can't believe you read my paper. I'm so happy to hear and they want to talk about it. So I think, I think Amy you're right. A lot of this divide or the, the height of the ivory tower to [00:20:00] continue with this analogy is fictitious it's, it's not really there, but it is part of a construct that we've either perceived or created.
[00:20:09] Amy Wonkka: And there are institutional barriers to which we're going to talk about more now, um, through the rest of this podcast. But I think at least a piece of it is, is what we carry in our own brains. And we maybe need to challenge that a little bit, all of us, regardless of your work environment.
[00:20:24] Kate Grandbois: And I think that this is, you know, the whole point of this episode is really to untangle the complexity of the research to practice gap and identify these barriers and suggest some strategies. Um, and this is one of them, this perceived distance or prestige, or, you know, um, unreachable nests and, uh, exclusive club-ness of the research world. I think another piece of it is not really having a good understanding of what researchers do.
So not all re you guys were both clinicians. So you have, you were working clinicians before you were researchers. So you have [00:21:00] visibility. I won't say the swamp of sadness. I will say the beautiful field in which we frolic with our clients and students that make you feel better Natalie?
[00:21:10] Natalie Douglas: much better visual things.
[00:21:12] Kate Grandbois: There you go. So with Atreu, you riding the horse Atreyu through the beautiful field of flowers. So we don't really, as clinicians, we don't really know what goes on in the ivory tower. So can you tell us a little bit about. What shapes your job as a researcher. So when you're doing the research, are you thinking about the, the working clinicians or are you really tackling a million, other logistics, like grant writing and staffing?
We don't really know what goes into you, into your work as a daily, your daily lives as a researcher.
[00:21:50] Cathy Binger: Natalie you want to take that first or do you want me to take a shot at that
[00:21:54] Natalie Douglas: I will take it indirectly because I think it really is a [00:22:00] fascinating question. And it gets back to what you were saying in terms of creating constructs in our minds that serve as barriers.
So one example would be, I don't work at a research intensive institution. I still do research, but as you were asking that question, I was like, well I can't. I can't answer that. And you know, people at research one institutions, th they, they can answer that. And, you know, just so you know, I mean, even within academia and within institutions, you know, there are all kinds of situations.
Just like what you mentioned, where it's like, well, here I am at Central Michigan University and I love my institution, but it's not a research one institution. And so
[00:22:54] Kate Grandbois: I don't even know what a research one institution is.
[00:22:58] Cathy Binger: Yeah. There's, it's called the [00:23:00] Carnegie rankings. Every university is ranked in terms of his level of research intensivity.
That's not a word, but yeah. And even within that, even if you are like the University of New Mexico, is there a research it's an R one caused a research intensive university. Um, and it, it dictates things like what's your course load. Um, you know, what, what's your, what, how many courses do you teach each semester, each year?
Um, so a university, like Natalie's in all likelihood, she's probably going to teach more classes a year than I am. Whereas my output in terms of a researcher, they're at a higher level expectations for the amount of output that I have as a researcher. So there's a whole construct within all of that. And even at the R1 level, like, yeah, well, you know, UNM is not thought of as a whatever, like, you know, I could list them, but I won't, you know, other universities that are seen as more prestigious than a university, like UNM. So even within the, like, we're [00:24:00] constantly, it's a thing that we do is as people is, we're just constantly figuring out where we are in the social hierarchy. We often do ourselves no favors with that. I think
[00:24:09] Kate Grandbois:So well put, so let's get into some of those details. So you're at a race, you're at an institution that designates X percent of your working life to research versus clinical versus instruction. How long does it take you? So here we are in the beautiful fields. The researchers at the beautiful fields, the bottom of the ivory tower, you guys are at you think up some clinical question or you're peering out at us through the windows of the terror.
Oh, wait, that looks like a problem. I have a clinical question. How long does it take you to do the research? Like what is what isn't cause that's gotta be part of the research practice gap.
[00:24:49] Amy Wonkka: Or even like, what is the action? Like what are your action steps? You see, you see Kate, so you see her problem.
[00:24:54] Cathy Binger: Yeah. So let's start. How about, um, the two [00:25:00] very different questions? Well, the two highly related questions, but Natalie, let's just start with the big figures. So you start with that and then we can get, talk about like answering some of these other questions.
[00:25:09] Natalie Douglas: Sure. So there was a kind of review of mental health and education literature that was published several years ago, but you'll see this statistic kind of being flouted about, I don't know, flouted is a word either
[00:25:24] Kate Grandbois: We’re making up words today go with it
[00:25:28] Cathy Binger: bandied bandied about,
[00:25:30] Natalie Douglas: um, but essentially saying that it takes 14 years for 17% of research to reach routine clinical practice.
[00:25:45] Cathy Binger: Or was it 17 years and 14%, one or the other, fuck it up while we're chatting.
[00:25:54] Amy Wonkka: It’s a team. It's the team. And that's a lot longer than one.
[00:25:59] Kate Grandbois: That's [00:26:00] insane. I know, regardless of how those numbers, if those numbers. So basically that means that if you're a clinician working the research that's happening right now in the lab, down the street, isn't going to be implemented for between 14 and 17 years.
[00:26:19] Natalie Douglas: Right. Like less than a quarter of that research as well. Right. So like less than 25% of that research.
[00:26:28] Kate Grandbois: That's insane.
[00:26:29] Amy Wonkka: What about all the other percent? What happens to that research?
[00:26:34] Natalie Douglas: It sits in journals that are expensive behind paywalls
[00:26:37] Cathy Binger: that's right.
[00:26:38] Natalie Douglas: But might've helped you get promoted.
[00:26:41] Kate Grandbois: Oh, my God. Okay. This is like a, it says just problems on problems.
Okay. So I'm in the, I'm in the grassy field with my clinical problems, right. You guys are up in the ivory tower. That's getting shorter as we talk about this, because there's really no tower. We've made it up. Okay.
[00:26:55] Cathy Binger: And there's, God knows there's no ivory, which is a good thing.
[00:26:58] Kate Grandbois: Right? Exactly. It's [00:27:00] dingy. It's true.
Whitewash. So, so you see the clinical problem. You try to solve it by, by asking the clinical question and you probably have grant funding and there's no guarantee that, that the, the answers that you get from your research are going to be actually disseminated and implemented by the clinicians. And even if it does, it's going to take 14, 17 years.
[00:27:26] Cathy Binger: Yeah. I think they figured it was 17. Not that that's accurate to begin with, but yeah,
[00:27:29] Kate Grandbois: that's bonkers. So, so let's, so I have to assume that that 17 year gap. For you guys, you ha you see the clinical problem. You ask the clinical question, but like Amy said, what are your action steps? Like you have to procure it.
Do you have to procure funding, writing grants, find a coauthor? Like, what are you doing? What's happening in there?
[00:27:54] Cathy Binger: What's wrong with us?
[00:27:59] Kate Grandbois: That’s not how I [00:28:00] meant it
[00:28:00] Cathy Binger: yeah. Um, yeah, so it, as Natalie started to sit was saying, it looks really, it looks somewhat different depending on the research institution that you're at, the, um, what kind of research you're doing. Um, when, well, let's just focus to make this simple. We're just going to focus on clinical practice research, which is its own thing.
Um, and is a minority of the articles that get published are actual clinical practice research, right? There's a lot of theoretically driven research, which is not, you know, which is important as well, and can, can, and should change how we go about thinking about the, oh, go ahead, Kate
[00:28:45] Kate Grandbois:. I don't even know what though.
Can you explain the difference between theoretical research and what was it?Clinically
[00:28:51] Cathy Binger: clinical clinical practice research
[00:28:54] Kate Grandbois: clinical practice research
[00:28:55] Cathy Binger: the goal of clinical practice research ultimately from its [00:29:00] inception is to, um, learn things about and change clinical practice. It's really focused on clinical practice, but let's say for example, in my world, um, I have questions about how children go about learning language, right?
Typically developing children or children who speak different languages. You know, maybe I'm a linguist and I want to know how does language work in this branch of languages versus that branch of languages. What are the common themes that run across language learning, regardless of what language a child is learning.
There are pieces of things in there that can ultimately inform clinical practice, but it's a long way from studying, you know, languages, X, Y, and Z, and looking from a linguistics perspective to see what's similar and what's different to changing. How am I dealing with I'm teaching language to a child with autism who's sitting right here in front of me.
Right? [00:30:00] So that's more theoretical research, but there may be pieces in there that eventually could inform clinical practice, Natalie?
[00:30:07] Natalie Douglas: Okay. Yeah. I just wanted to point out for a little bit more context. So Megan Roberts and colleagues, um, in 2020, they published an article where over an 11 year period. So from 2008 to 2018, they reviewed articles from all the ASHA journals.
So that would be like ASLP, JSLAR the audiology journal and the language speech, and hearing services in the schools. And they had certain criteria, but they ended up with 2,483 articles and only 25% of them were clinical practice research. Meaning that the large majority of what's published in the ASHA journals does not meet that criteria that [00:31:00] Cathy was talking about in terms of being relevant to clinical practice
[00:31:05] Cathy Binger: directly relevant to clinical practice. Kate, you're going to faint. I think I'm going to,
[00:31:10] Amy Wonkka: she’s got a serious expression going on.
[00:31:13] Kate Grandbois: That's insane to me. So basically there are some, I'm making the assumption that there are some, you know, constructs in the research world through funding or different kinds of different kinds of, I don't know, incentive or interest where researchers are publishing research that just sits in the fancy expensive journals and maybe gets you promoted or whatever you said before.
Is that, is that a fair assumption based on those numbers? Or have I misunderstood that completely.
[00:31:46] Cathy Binger: Well, there are lots of people who are interested, I don't know about lots. That might be an overstatement, but, um, you know, people within a discipline and a subdiscipline are interested in learning about these things like are interested in knowing how [00:32:00] things work and the underlying mechanisms and, and all that kind of stuff.
Like there are lots of threads and pieces that go into, uh, let, let me say, if I'm going to develop an intervention, um, I'm going to look not just at what is it that has been, um, already proven to work, but I'm going to look at what do we know about language development that might be useful for me to feed into this intervention?
And so it's not, I don't want to leave the impression that that 75% of the work is garbage and we shouldn't be doing it anymore, but it's not directly. If it, it can and should in various ways inform what we do, but it's, it's a long and winding road and that's not enough. Like, I think Natalie and I are both, you know, happy to come forth, be forthright and say, and that's not where we live.
That's not where she and I want to live as researchers. We want to live more in the world of, okay, let's get to the direct clinical practice. Let's get to the finding ways [00:33:00] to change, help change media practice. But, but that's the system in which we work and live is this 75, 25% split that that's happening.
Um,
[00:33:12] Kate Grandbois:That is wild. I am shocked to hear this
[00:33:15] Natalie Douglas: Yeah, no, I agree. And I think to a certain degree, you know, um, we can both add this to a degree, right? So we need basic science. We need fundamentals, we need, um, mechanistic type work. Um, you know, we need that work. It needs to be done, you know, but I think what we want to hopefully call attention to as, just as Cathy said, is.
This system has a lot of barriers, you know? And so from the clinician's perspective, you know, I don't know what we'll end up titling this episode, but another title [00:34:00] might be, you know, evidence-based practice gap. It's not your fault, you know?
Right. You know, cleaning out, so many asks, you know, there's layer upon layer and we need that basic science, but we also need work that's going to systematically, you know, because the other problem is that, of that 25% of clinically practice, you know, clinically applicable research. And that's probably even a high estimate.
We don't know that that's changing human behavior. Right. Even that 25% is getting into where it needs to be.
[00:34:48] Kate Grandbois: I was just thinking about that. So I, you know, Amy and I are very familiar with the barriers on our end, at the, you know, in the field, but this is, and that's, that's astounding. I mean, I have a colleague who's [00:35:00] working in a school who has a caseload of 140.
She's not reading research in her spare time. She's crying in a dark closet trying to figure out when she's going to do all her paperwork. Right.
[00:35:10] Amy Wonkka: I also can't have Kate say this without saying advocate for reasonable working conditions, people, this is something that we need to do for our clients.
[00:35:15] Kate Grandbois: It’s nuts. So we have a massive amount of barriers, you know, aside from an I, I made a list here while we.
While we were preparing for this. So we have time and workload and caseload issues. We, uh, maybe don't necessarily think it's that interesting. So this is what, this is what Cathy, you caught me doing flipping to the last page. Like, ah, I'm not really interested in the statistics. What can I take away from this and use it in my, you know, using my job.
There's a lot of research is heavy with jargon and math that yes, I took research methods. I took it more than the average bear, because I had a second, you know, certificate educational training as a BCBA. So I've taken more of it than most people. And I still, I, I haven't used it in 10 years. It's not something that's [00:36:00] fluent to me.
So I'm really overwhelmed by it. And I'm not going to spend the extra time trying to really digest it from a mathematical, you know, research perspective. Um, the article I was dying to find this one article recently in preparing for an episode behind a paywall, had to pay the journal 300 some dollars to get access to it, which is absurd.
Um, I might be looking for an article for a student or client that's not even well-represented in the research that I'm reading. So then I'm trying to think about, you know, other ways to implement that the, the treatment that I want to do in a way that is congruent with the external evidence, but also with internal evidence in my own data collection, um, And, you know, we consume a lot of research as part of this podcast, and sometimes it can be really hard, even being more closer to it than the average bears.
I guess women bears the, it can be hard to sort of quickly and easily translate that into clinical implementation. So here we are in the clinical field with all of these barriers. And now you're [00:37:00] telling me that in the ivory tower, where in there are all of these additional barriers, guys, this is nuts.
This is a huge problem.
[00:37:10] Cathy Binger: It is. And it's not an insurmountable problem. Um, so yeah, I mean, I don't want to belittle any of that. And as we talked about a bit last time we were on the podcast. It. Research articles, I'm talking about peer reviewed research articles that are in, you know, true, um, solid research journals.
They're not written for clinicians. They're written to meet criteria of research rigor, right? They have to, they have to be conducted in a rigorous manner. Now what that rigor looks like is going to vary depending on the kind of study you're doing, right? What rigor looks like for a focus group study or a survey is very different.
And those two things are very different from conducting an intervention study, right? All of those things, but you have [00:38:00] to, the rigor needs to be there so that you can have faith in the findings. Then what needs to happen is, which doesn't is not rewarded in our jobs in the way that, um, you know, in terms of getting promotion and tenure and that kind of thing is then finding ways to more effectively disseminate those findings in all the different ways that we could do that, whether it's, you know, social media outlets and other online outlets and clinical newsletters and all that stuff. So it depends on where your job is, how much those things are valued as a, as a researcher in what, how intensive of a research institution you're working at, how much credit you get for doing that kind of work.
Um, so yeah, there's all of that. Um, but do you want to talk a little bit about, um, like what some of that day-to-day stuff is like, like how do we go about planning research projects and what kinds of things are involved?
[00:38:55] Amy Wonkka: Yeah, because I think it would be helpful as a clinician. Like, I want to be able to [00:39:00] read your research and I have read your research and like take step away from it and like, trust it and say like, okay, they found that this worked.
So there's at least a somewhat reasonable likelihood that this might work or, or elements of this might work for my client. I'm going to try it and feel more confident about doing that. Than like I saw this worksheet that my friend used, she liked it. I'm going to try that worksheet. Right. Like, so what do you, what are you thinking about and doing, that make me better able to trust what your information is telling me,
[00:39:35] Natalie Douglas: you know, I think that is really, that's such an interesting question.
And I think it really depends on what the question is. Right. And so. I can just kind of walk you through a little bit of what, you know, for as like a timeline of kind of how things have went. So part of why I went back to [00:40:00] school was because especially in the nursing home setting, I felt so extremely overwhelmed with not being able to provide people with what I thought were evidence-based practices, right?
So that was like a major problem I had in my mind. And so my first study, my first kind of published study along that line, um, was my dissertation study where we looked at whether or not clinicians were able to implement external memory aids for people with dementia in nursing homes. So as the beginning step, the question that we asked was essentially, are you able to implement external memory aides for people with dementia. So this was a survey based study. This was in the state of Florida. And we basically found out that [00:41:00] no, no we can't. And so an additional part of that study was to look at barriers and facilitators as to why. So then we asked, well, why can't you, when people would say very similar to what you have said, time, they said there's not, productivity standards.
Um, we might train the nursing assistant on how to use the external memory aid, and then they don't do it. Um, so then we publish that study and then my next study, after that was, well, we better talk to you certified nursing assistants and kind of see their perspectives on this. And they actually said the opposite.
So nursing assistants actually said, you know, we would be happy to implement this therapy tool for people with dementia, but no one has ever trained us. Um, and so that was their perspective and perception. [00:42:00] So it's like the SLP was like, we train the CNA, they don't do it. The CNA was like, what? We would love to do it, but no one's training us.
So there's kind of like, and so just between those two studies, I think was five years, which seems, I know that seems really wild, but like, are you asking the right questions? And you know, um, and then, you know, during that time I was working on designing kind of a collaborative coaching program between an SLP and a nursing assistant in a person with dementia.
So we did like a pilot program to look at outcomes. Um, and then that was published, but that was like another three years. And then even like right now, the next step is to try to see if that, that little program, you know, it can be kind of scaled up in, we're looking at, um, six nursing homes now. [00:43:00] Um, so basically you have from, you know, 2009 to now, we're like halfway through 2021, and there's a chance that we might have found something that hopefully addresses the barriers identified at the level of the SLP and the nursing assistant, um, to improve communication for people with dementia, but that was, you know, like a 10 year gap and we're still kind of gathering data on that. And as we talked about earlier, you know, I don't have, I do have an element of research expectation, but I don't, um, you know, my next step would be to apply for federal funding.
Um, all of my funding at this point has been foundation level funding. Um, but there are people who, you know, have to in academia that they have to have that level of federal funding or else they don't get to keep their position. Um, and [00:44:00] those are kind of more on a five-year cycle and that kind of thing.
Um, Cathy's trajectory, I think a little bit more.
[00:44:06] Kate Grandbois: Well, that whole process that you just described, first of all, that's a long time, right? That's definitely a contributing factor, but something that you said made me think of the, this part of the solution piece is I it's, I guess it's barrier and solution is this concept of dissemination.
So, you know, as your planning, as the researcher moving forward with the, you know, the research rigor and making sure that it meets certain standards and moving the sort of moving the ball forward, to answer your clinical question, thinking about the last day, the last stop on the train is getting the information out there, right?
It's disseminating all that information and. If either of you could talk quickly about what, you know, in terms of bridging this gap, it's not your fault or whatever the title of this is going to be. You know, [00:45:00] there are things that we I'm sure that we as clinicians can do when we can talk about that. But what are the things that researchers given all of those barriers, um, you know, can do?
Or what are the, you know, I'm sure it's different in every work setting, depending on what kind of university you're in, but what is that last stop in the train, you know, train line, the dissemination station. What does that look like for you guys?
[00:45:28] Cathy Binger: So there's an element of that. So, you know, again, depending on the university that you're at, um, what the expectations are.
I feel looking at it more from a job driven kind of perspective, The peer review publication is usually the gold standard, right? Like that you've, you have conducted rigorous research and that you have completed your research project or components of it, and you are publishing the results of that in a respected peer reviewed journal or journals.
Um, so that's really what counts in terms of [00:46:00] promotion and tenure, especially at the higher level research institutions right now, that's purely from a job perspective. Now, if you look at it from a, um, who we are, as people perspective, I think, you know, most folks who do what we do, um, certainly want to be informing clinical practice.
Like we got into this because we want to be changing, helping to change and improve clinical practice. So then there are those other components to, uh, for example, you know, publishing things in places like this, uh, the sig newsletters. Um, which are often, you know, more accessible, maybe more widely read, certainly by frontline clinicians, um, other kinds of clinical newsletters.
So that's a, still a reading sort of activity. Um, and then more and more, there's more and more focused on various social media, um, avenues. And that's the thing that I think we're going to be seeing a whole lot more of that there's also a whole science to dissemination that Natalie can [00:47:00] talk about and she knows more about that than I do.
So Natalie, you want to add to that?
[00:47:03] Natalie Douglas: Well, it's interesting that you said that because as, as I sit here and reflect on this, I think for Cathy and I who have kind of been in this world, you know, trying to. Be part of the solution. We see a peer review publication as the starting line, right? Like, whereas like, I think in traditional academic settings, that's your finish line, right?
Like, but you know, um, when we're thinking about dissemination, you know, and implementation, the peer, a peer reviewed publication is really only the beginning. Right? And so I think part of what we've hit on a lot of these issues in terms of dissemination, but, you know, we know that passive methods of dissemination do not [00:48:00] change behavior and we've seen that time and time again.
So even if you're getting something into you know, perspectives or like a sig journal, um, a special interest group journal. There's, it's very unlikely that that's going to change your behavior. So what we need is to look at our audience a little bit more closely, and I think that's where there's multiple empirical questions that we could ask.
So we could ask for one where our SLPs in these settings where we want the research to go, how do they want to get information, right? So what are their preferences and where are they already going? Um, if we look at some other fields, we might know that there are, that peers are really, um, popular place to get information.
And that can be really good. That can be not so good. Um, we know social media [00:49:00] is another one, but I think as researchers, the more that we can. Get to know the audience, right. And figure out patterns in terms of not just at the individual clinician level, but what's a typical day, right? What are these, what's the, what is the organizational context where these services are being provided?
Because unless you're in a private practice, your services are not being provided in a vacuum, but within another system. Right. And there's all the constraints at the level of the organization. So in terms of dissemination, I definitely think as we have talked about as much as we can have more open, open science, you know, and I think CSD disseminate is a, um, a volunteer organization that they're encouraging authors to provide preprints so that there's less of the paywall. So I think that a movement towards open science [00:50:00] is really part of it, but I think we need to take a more active approach. And even before we're studying, before we're answering our research questions, asking clinicians what they need, what are the problems?
What do you see as solutions and really collaborating upfront. You know? So there's a, um, there's a term, it's a phrase, um, that the University of Wisconsin, Madison, they did a training on it, but it's designing for dissemination. And it was like D for D right, where it's like, if we want to have these, this, if we want the information to go where it needs to go, we gotta be engaging people actively from the beginning and encourage that participation.
[00:50:53] Amy Wonkka: When I think as someone who's read, you know, I mean, I work in a very like narrow kind of [00:51:00] lane of the field. So there are researchers whose research I tend to read. And so if I see that something has come out by an author, I will read it. Um, and I have noticed that same thing that you were kind of talking about earlier, Natalie, we're like, okay, so this is a study, but then the next paper they publish is kind of connected to that study, but a little bit different.
Um, and you know, I wonder too, as a clinician, even if you guys feel like, like Natalie and your example, you're, you're trying to answer a bigger question. But for me, it's helpful. Maybe even to have some of that information before it's like, super-duper proven because you're still doing more controlling for those variables and you're in, you're still looking at it with a much finer lens than I'm able to do in my just like clinical practice level.
Um, and I guess this isn't really, it's not even a question. It's just like a thought that like, it would be cool if there was a way for us to kind of promote a bit of dialogue around some of this in-process research. [00:52:00] Um, and maybe thinking about like, Cathy, you had said that, that like peer reviewed, you know, journal is sort of the starting point.
I wonder if like maybe there could be like a parallel path that's sort of happening at the same time. Um, I dunno, it's, it's very interesting to think about how many parts go into what you guys are doing in terms of your research. But the time is long
[00:52:27] Cathy Binger: Oh, go ahead.
[00:52:28] Amy Wonkka: No, I was going to come back to, like, in terms of our strategies, um, you know, we've, we've talked about reaching out to people we've talked about, not like living inside of your construct that you've built for yourself. What, what else, what else are we doing? You guys are making changes at the institutional level in terms of the types of research that you're conducting.
[00:52:51] Cathy Binger: Yeah. That's I mean, that's, uh, one of the initial questions that Kate, I think Kate had asked was at what point in the [00:53:00] process do you think about the end point? Who's the clinician and the answer is, well, it depends on the kind of research that you're doing, but for, for research, like the kind of research that Natalie and I do, it's, that's day one, you know, Uh, trying to think about what's going on at the clinical end point, at the very start of what we're doing, otherwise, what we get to at the end, isn't going to be clinically relevant and we're getting better at, and Natalie's making a career out of doing exactly that from the very beginning of being, you know, getting input from clinicians before we collect data.
Um, before we, you know, again, not this old fashioned style of top down approach where, oh, I'm sitting in the ivory tower and I have a great idea and I I'm going to go get this sucker funded and go spend at least the next five years of my life working on this. And shouldn't you all be grateful but more, Hey, like we're all in this together.
We want to make sure what we're doing [00:54:00] is ultimately having an impact on clinical practice. Let's talk with clinicians from the very beginning, um, of the conceptualization stages and bguild our research that way and build our research, hopefully collaboratively, um, et cetera. And, you know, we're, I'm newer, as much as that sort of approach has always been in my head.
In reality, I'm newer to that approach. Natalie's really started off with that approach and it's really, um, I'm never going to do research the same way again, I shouldn't say never, like there are still components of projects that we have where it's still really valuable, um, to do certain things that are at that other not higher, just different level of research.
That's more maybe somewhat more theoretical, like for, I'll give you a hard and fast examples as quickly as I can. We're working on some measurement work right now. We don't really have any AAC world when [00:55:00] children are using picture symbols to communicate. We do not have valid, reliable, developmentally sensitive and socially valid um, measures for tracking progress. Um, and so we're working on we're in the initial stages of, of working on developing all of that. Now, is that going to have an impact tomorrow on your clinical practice? No. Um, but it can have a long-term impact on how everybody is, you know, measuring things along the way.
Maybe it's going to be more, primarily more researchers, but maybe there'll be clinically too, but that work still has to get done. Um, there needs to be some input from clinicians on all of that, but it's a little bit different from doing an intervention project, right? Like if I'm doing an intervention project and developing interventions, then that's the kind of project where from now on, I need to be tapped in from the get-go with, depending on who my audience is, parents [00:56:00] teachers, educational assistants.
You know, what have you, um, along the way, so there's still room for both, but we really want to be focused with certainly with certain projects, with getting input from the very beginning, from clinicians, et cetera, clinicians, families, et cetera,
[00:56:20] Kate Grandbois: while you were talking, it was making me think of, you know, thinking of myself as an, as a younger also, but greener clinician, um, and where I got my information.
Um, and I think. One thing from a clinician's perspective, that is, if anybody, you know, assuming that there are clinicians listening is making sure that we're being wise consumers of information. Um, you know, there are a lot of barriers to reading research as we've, as we've discussed. And I think the social component, like you said, a lot of people get their information from peers.
And I don't know if it's the, the invention of social media that is different from when I [00:57:00] was first practicing, but there is so much misinformation out there about, or, or twisted information or diluted information. There's just, I think we need to be, um, as clinicians and people who are working in the field of science need to be informed consumers of the information that we see and skeptical of the information that we see, um, and then combine that with other sources of easily consumable information.
I mean, I think, you know, if you guys are branching out from, with implementation science and all of, you know, all of this things that you're doing in the ivory tower, that's not so big and it's not so white, your other room, your other parallel field, I'll call it that over a bridge. Maybe that's a little more like friendly.
Um, you know, if you're building a bridge from one side, I feel like there are things that we can do from the other side as well. Amy, I don't know if you have any other brilliant. Lots of brilliance that you always do.
[00:57:57] Amy Wonkka: No, I think you oversell me. You're [00:58:00] overselling me. No, I think that, um, you know, it's it, I think that it's helpful as a clinician to know that there are all of these different pieces that are involved in research.
And to know, like there actually formerly are different types of research and we do still want you guys to be doing all of those types. I want to know about typical language development. I want to know all of that information because that should also inform my practice as well. Um, and you know, in, in speaking with both of you, I think that having that awareness and maybe feeling a bit more comfortable, being able to reach out and have those conversations is like an actionable step that everybody can sort of take right now.
[00:58:46] Kate Grandbois: I think, you know, we've, we've, we've covered a lot in this episode. Um, I think everything from examining our own internal biases and our thoughts and feelings that we might have about relationships [00:59:00] between about the research to practice gap, realizing that we're all part of organizations that, and and systems that have implicit biases and constructs that are barriers that we may or may not can't, we may or may not be able to control.
Um, and I think honestly, knowing that there are researchers out there, like you guys who are doing this great work in trying to, first of all, who are willing to talk about these, have these difficult conversations about bias and do it with a little bit of laughter on top of it. And, and, and acknowledging that this is a problem because you can't fix it if you don't know that it's there. Right. And doing that kind of research that tries to build that bridge and extend it is, is such a, is such a critical piece. So, um, thank you so much for everything that you do, and we're very grateful that you are willing to come on here and, and talk about these kinds of things that you're doing, the kind of research that you're [01:00:00] doing.
Um, and I hope that everybody listening has acquired some appreciation for what it is to be a researcher and all the barriers that you all face. And knowing that there are a lot of people who are working to close the research to practice gap, um, to the best of our abilities, given the different barriers that we face in our setting.
So thank you again for coming on and sharing all of your, all of your wisdom with us. Um, Do you have anything to say?
[01:00:27] Amy Wonkka: It's not an ivory tower. It turns out it's just been two fields all along. It's just two fields connected
[01:00:33] Cathy Binger: by right across the bridge.
[01:00:34] Kate Grandbois: That's great. We're going to have to like you so much get like a cartoon or something drawn of this at some point.
Um, so if you're still with us and you would like to use this episode for ASHA CEUs, you can do so at our website, www.slpnerdcast.com. If you have something to add to the conversation, you can email us anytime at info@SLPnercast.com. If you feel so inclined, please feel free to leave us a review [01:01:00] on your podcast player.
We love hearing from our listeners and that pretty much wraps us up for today. Thank you again for joining us. And we hope everybody learns something. Thank you so much.
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.
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