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Background: Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children's outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. Aims: To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. Methods & Procedures: A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda. Discussion & Conclusions: A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology.

Background: Current research investigating collaboration between parents and speech and language therapists (SLTs) indicates that the SLT role is characterized by therapist-led practice. Co-working with parents of children with speech and language difficulties is less frequently described. In order to embrace co-working during intervention, the SLT role may need to be reframed, focusing on acquiring skills in the role of coach as well as the role of planning intervention and treating children. Aims: To report (1) SLTs' conceptions about their own roles during intervention for pre-school children with speech and language difficulties; and (2) SLTs' conceptions of parents' roles during intervention. Methods & Procedures: A qualitative study used individual, semi-structured interviews with 12 SLTs working with pre-school children. Open-ended questions investigated SLTs' expectation of parents, experience of working with families, and the SLTs' conception of their roles during assessment, intervention and decision-making. Thematic network analysis was used to identify basic, organizational and global themes. Results & Outcomes: SLTs had three conceptions about their own role during intervention: treating, planning and coaching. The roles of treating and planning were clearly formulated, but the conception of their role as coach was more implicit in their discourse. SLTs' conception of parents' roles focused on parents as implementers of activities and only occasionally as change agents. Conclusions & Implications: Collaboration that reflects co-working may necessitate changes in the conception about the role for both SLTs and parents. SLTs and parents may need to negotiate roles, with parents assuming learner and adaptor roles and SLTs adopting a coaching role to activate greater involvement of parents. Applying conceptual change theory offers new possibilities for understanding and enabling changes in SLTs' conception of roles, potentially initiating a deeper understanding of how to achieve co-working during speech and language intervention.

Purpose: Little is known about how people living with dysphagia in rural, socioeconomically impoverished contexts in Africa are supported and manage their disability. This scoping review sought to map and synthesise evidence relating to the management of dysphagia in adults in community/home settings in Africa as a starting point for a broader study on this topic. Method: A multifaceted search strategy involved searches of electronic databases and grey literature, hand searches, ancestry searches, and consultation with expert advisors. Records were screened by two blinded researchers. Characteristics of included studies were summarised, and their findings synthesised using the Framework approach. Result: Six studies were included, relating to services for people with dysphagia secondary to various aetiologies. No grey literature was identified that provided service delivery descriptions or practice guidance. This limited evidence suggests little professional support is available to people living with dysphagia in the community. Individuals and carers use a range of strategies, including choosing different food and drink items and modifying how food is chewed and swallowed. Conclusion: Further research is required to understand current practice in managing dysphagia in the community in Africa, and the needs and priorities of community members who experience dysphagia and their carers. [ABSTRACT FROM AUTHOR]

Background: Several studies have suggested that practitioners hold speech and language therapy (SLT) practice as tacit and consequently it is difficult for the therapist to describe. The current study uses a range of knowledge elicitation (KE) approaches, a technique not used before in SLT, as a way of accessing this tacit knowledge. There is currently no agreed framework that establishes key factors underpinning practice for preschool children with speech and language disorders. This paper attempts to address that gap. Aims: To develop a framework of SLTs' practice when working with preschool children with developmental speech and language disorders (DS&LD). Methods & Procedures: A mixed-methods approach was adopted for this study. Data were collected iteratively, from 245 SLTs with experience of working with preschool children with DS&LD across sites in England, by means of focus groups and national events. There were three stages of data collection: local sites, specific-interest groups and two national events. KE techniques were used to gather data, with initial data being collected in local site focus groups. Findings from groups were taken to subsequent larger groups where a combination of concept mapping, teach-back and sorting exercises generated a more detailed description of practice, using discussion of consensus and disagreement to stimulate further exploration and definition and provide validatory evidence. Outcomes & Results: This paper provides a high-level framework of therapy for preschool children with DS&LD that makes practice explicit in this area. The framework proposes that therapists' aims for this group of children fall into three categories: addressing children's areas of impairment and skills; achieving functionally meaningful skills and carryover; and supporting adults to provide a supportive communication environment. The exact configuration is shaped by the child's context and needs. Conclusions & Implications: The framework highlights themes that are well researched in the literature (e.g., speech) and others that have been little studied (e.g., adult understanding), indicating a disconnect between research evidence and practice. The research also highlights the complex nature of interventions for preschool children with DS&LD and the importance therapists attribute to tailoring therapy to individual needs. The framework provides a scaffold upon which SLTs can focus their clinical practice and encourages the profession to understand and explore better the gaps between research evidence and clinical practice for preschool children with DS&LD.

Speech and language therapists' (SLTs) roles include enabling parents to provide intervention. We know little about how parents understand their role during speech and language intervention or whether these change during involvement with SLTs. The theory of conceptual change, applied to parents as adult learners, is used as a framework for understanding changes in parents' conception of roles during intervention. The aims of the study were (1) to investigate parents' conception of their own and SLT roles during speech and language therapy intervention and (2) to explore changes in parents' conception of their role as they work with SLTs. A qualitative study was conducted using semi-structured interviews with 14 parents of pre-school children with speech and language needs referred to speech and language therapy in the UK. A subset of 8 parents participated in a longitudinal study over nine months to track any changes in conception of roles during intervention. Interviews were analysed using Thematic Network Analysis to identify basic, organizing and global themes. Framework Analysis was used to compare participants over time and identify any changes reported by parents. Parents had a firm conception of their role as advocates but did not express a clear notion of their role as intervener before involvement with the SLT. During intervention, some described changing their conception of role including adopting roles as "implementer" and "adaptor" of intervention. In some cases, parents described changes in their approach to parenting which they associated with adopting more active roles as interveners. Policy statements about parental choice and co-working typically present parents' conception of roles as fixed. This research shows that parents may change their conception of role as they work with SLTs and become increasingly involved as interveners. Implications for practice include negotiating roles in the partnership before intervention begins and enabling parents to adopt an intervener role.

Background: Evidence-based practice includes research evidence, clinical expertise and stakeholder perspectives. Stakeholder perspectives are important and include parental ethno-theories, which embrace views about many aspects of speech, language and communication, language development, and interventions. The Developmental Niche Framework provides a useful theory to understand parental beliefs. Ethnotheories, including those about language development, delay and interventions, may vary cross culturally and are less well understood in relation to families who may be considered "under-served" or "hard-to-reach" by speech and language therapy services. Who is considered to be under-served and the reasons why some families are under-served are complex. Aim: To describe beliefs and reported practices, in relation to speech and language development, delay and intervention, of parents and carers from a small number of groups in England who were perceived to be under-served in relation to SLT services. Methods & Procedures: As part of a wider National Institute for Health Research (NIHR)-funded study (Child Talk), seven focus groups (with a total of 52 participants) were held with parents from three communities in England. Topics addressed included beliefs about language development, language delay and parents' reported responses to language delay. Data were transcribed and analysed using adapted framework analysis, which also drew on directed content analysis. Outcomes & Results: Four themes resulted that broadly matched the topics addressed in the focus groups: language development and the environment; causes and signs of speech and language delay; responses to concerns about speech, language and communication; and improving SLT. These produced some previously unreported ideas, e.g., about how language develops and the causes of delay. Conclusions & Implications: The findings are discussed in relation to previous literature and the Developmental Niche Framework. Clinical implications include ideas about issues for SLTs to discuss with families and the need to recognize that parents may see themselves as competent facilitators of language. Suggestions are made for future research, including: expanded investigation of a wider range of under-served groups, an exploration of who parents consult when concerned about their child's language, and how key community figures advise parents in relation to language delay.

Speech and language delay occurs in approximately 6% of the child population, and interventions to support this group of children focus on the child and/or the communicative environment. Evidence about the effectiveness of interventions that focus on the environment as well as the (reported) practices of speech and language therapists (SLTs) and other Early Years Practitioners (EYPs) in this regard are limited. One-to-one, semi-structured interviews were carried out with 12 EYPs from one city in North England in order to reveal their beliefs about the impact of the child's environment on language development and how they report assessing and intervening where they have concerns about child language development, in children aged from birth to 5;11 (5 years, 11 months). Interviews were analysed thematically. Results are presented as three themes: (1) environmental influences on language development (people, physical objects, experiences and opportunities, the auditory environment); (2) assessment of the child's environment, including how and what assessment is carried out; and (3) the interventions provided, including what interventions (interaction with children, the physical environment and play) and how they are carried out (strategies, individualization of intervention, sensitivity and modelling). Implications for services are discussed, including increasing parental awareness of the importance of early language input, the perceived value of home-based assessment, sensitivity in referral and individualized interventions. There remains a need to test out practitioners' expressed beliefs and practices and their impact on child language outcomes.

Background: School environment and policy changes have increased healthy eating and physical activity; however, there has been modest success in translating research ?ndings to practice. The School Environment Project tested whether an adapted version of Intervention Mapping (AIM) resulted in school change. Methods: Using a pair randomized design, 10 rural elementary schools were assigned to AIM or the School Health Index (SHI). Baseline measures were collected fall 2005, AIM was conducted 2005-2006, and follow-up measures were collected fall 2006 and 2007. Outcome measures included number and type of effective environment and policy changes implemented; process measures included the extent to which 11 implementation steps were used. Results: AIM schools made an average of 4.4 effective changes per school with 90% still in place a year later. SHI schools made an average of 0.6 effective changes with 66% in place a year later. Implementation steps distinguishing AIM from SHI included use of external, trained facilitators; principal involvement; explicitly stating the student behavior goals; identifying effective environment and policy changes; prioritizing potential changes based on importance and feasibility; and developing an action plan. Conclusion: The AIM process led to environment and policy changes known to increase healthy eating and physical activity. (Contains 3 tables.)

Systematic reviews are important as a key source of information for commissioners and for developing practice in speech and language therapy (SLT) and early years. Interventions in this field are often complex and are delivered in community settings. This paper applies a systematic review of environmental interventions in early years for children with speech, language and communication needs. Interventions for primary language impairment may be divided into those which are child-focused and those which are focused on the environment. In both cases, the aim is to effect changes in the child's language skills. The paper introduces the context of evidence-based practice and commissioning of such interventions and argues that systematic reviews may be combined with other evidence to provide information which is fit for purpose for commissioners and for practitioners in the field.

Background: Anecdotal and research evidence suggests that professionals may not fully understand the perspectives of families of children who need or use Augmentative and Alternative Communication (AAC). This may impact on the provision of appropriate services. Aims: The aim was to explore the lived experience of parents of children in Britain who used AAC, with particular emphasis on the ways in which children's need for and use of AAC impacts on family life and communication. Methods & Procedures: The parents/carers of 11 children aged 3-10 years, who lived in Britain and who were in the early stages of using AAC, were recruited to take part in the study. Individual semi-structured interviews were carried out in order to access rich descriptions of parents' experiences and views about having children who need to use AAC. The interviews were recorded, transcribed verbatim and analysed thematically to generate thematic networks. Outcomes & Results: Analysis revealed three thematic networks. The three Global Themes represented by the networks were concerned with the following areas: the child's communication and interaction; wider societal issues; and parents' views and experiences. Each Global Theme contained lower order Organizational Themes and these in turn were comprised of Basic Themes. Parents shared many common concerns, but the data also revealed some diversity of views. The themes and sub-themes are described with illustrative and representative quotes. Conclusions: These parents are experts on their children and may also be experts on AAC. Many factors impact on parents and the level and type of involvement they have with their children and their upbringing. Speech and language therapists need to acknowledge parents' knowledge and expertise regarding their children. They need to recognize that there are parent, child, family and external factors which impact on parents' ability and willingness to be involved in speech and language therapist provision, andthat these factors are not static over time. The use of ethnographic interviewing techniques should be considered a valuable aspect of speech and language therapist intervention. (Contains 2 tables, 3 figures, and 1 note.)

Background: Parental and speech and language therapist (SLT) explanatory models may affect engagement with speech and language therapy, but there has been dearth of research in this area. This study investigated parents' and SLTs' views about language development, delay and intervention in pre-school children with language delay. Aims: The aims were to describe, explore and explain the thoughts, understandings, perceptions, beliefs, knowledge and feelings held by: a group of parents from East Manchester, UK, whose pre-school children had been referred with suspected language delay; and SLTs working in the same area, in relation to language development, language delay and language intervention. Methods & Procedures: A total of 24 unstructured interviews were carried out: 15 with parents whose children had been referred for speech and language therapy and nine with SLTs who worked with pre-school children. The interviews were transcribed verbatim and coded using Atlas/ti. The data were analysed, subjected to respondent validation, and grounded theories and principled descriptions developed to explain and describe parents' and SLTs' beliefs and views. Outcomes & Results: Parent and SLT data are presented separately. There are commonalities and differences between the parents and the SLTs. Both groups believe that language development and delay are influenced by both external and internal factors. Parents give more weight to the role of gender, imitation and personality and value television and videos, whereas the SLTs value the "right environment" and listening skills and consider that health/disability and socio-economic factors are important. Parents see themselves as experts on their child and have varied ideas about the role of SLTs, which do not always accord with SLTs' views. The parents and SLTs differ in their views of the roles of imitation and play in intervention. Parents typically try strategies before seeing an SLT. Conclusions: These data suggest that parents' ideas vary and that, although parents and SLTs may share some views, there are some important differences. These views have implications for the provision of appropriate services. Although this is a small sample from one group in the UK, the results indicate the need to investigate the views of other groups of parents. (Contains 1 table and 4 figures.)

The purpose of this article is to report the process outcomes of a coaching methodology used in a study designed to increase fruit and vegetable consumption and physical activity in families. Eighty-eight families with second graders were recruited from a rural, biethnic community in Colorado and randomized to intervention and delayed intervention conditions. This article reports on the 27 families in the delayed intervention group. Families received up to 10 home visits over 10 months from a family advisor and completed activities to improve their dietary and physical activity behaviors. Coaching conversations took place during each home visit. Coaching process outcomes were evaluated by analysis of visit documentation, participant survey, and qualitative interviews. Results indicated that coaching, in conjunction with family activities, engaged families in the process of change and facilitated movement toward the achievement of their weekly nutrition or physical activity goals. Coaching methodology may be particularly useful for participatory research. (Contains 4 tables.)