'Why Aren't We Fighting Our Case?': Speech and Language Therapists' Perspectives on Intervention for Preschool Children With Oral Comprehension Difficulties.

backgroundOral comprehension difficulties are prevalent amongst preschool children with language needs and are related to academic, social and emotional outcomes. Speech and language therapists (SLTs) frequently deliver comprehension intervention to preschool children, but the influences on their clinical decisions are unknown. Understanding these influences and how chosen interventions align with models of evidence-based practice (EBP), particularly in an area where research evidence is sparse, is crucial to developing effective intervention and supporting the implementation of research to practice.

aimsTo investigate SLTs' perspectives on the delivery of intervention to preschool children with oral comprehension difficulties and to examine these in the context of models of EBP. METHODS AND PROCEDURES: Semi-structured interviewing gathered the perspectives of 14 UK-based SLTs, representing a range of years of experience, work settings and employment models (NHS and independent). Data were analysed using reflexive thematic analysis. OUTCOMES AND

resultsThe overarching theme 'Flexibility and Constraint' described a complex and challenging process whereby SLTs respond to sometimes conflicting influences from external drivers, the needs of the child and adults around them, perspectives on who has responsibility for effecting change, and their own perceptions of clinical autonomy. CONCLUSIONS AND IMPLICATIONS: SLTs' practice aligns with components of EBP, but the need to be flexible and responsive to individual circumstances is frequently in conflict with constraints affecting the ability to deliver individualised intervention. Implications include how individual SLTs and speech and language therapy services promote the ways in which they are evidence-based practitioners and advocate for their specialist role in supporting preschool children with oral comprehension difficulties. WHAT THIS PAPER ADDS: What is already known on this subject Models of EBP emphasise the considered application of research, patient preferences and clinician-related factors. This process can be a challenge where few research studies reflect the wide variety of approaches used by SLTs, and contextual factors such as organisational culture and funding may take precedence in decision-making. What this paper adds to existing knowledge This study describes a very wide variety of practices, with some elements aligning with the principles of EBP and others deviating from them. The lack of time and resources is a common constraint that affects the ability to deliver individualised intervention and therapy which reflects up-to-date research in this area. What are the potential or actual clinical implications of this work? Perspectives on clinical autonomy and the need to advocate for the specialist role of the SLT have far-reaching implications. These include how therapy for individual children with oral comprehension difficulties is planned and delivered, how speech and language therapy services are structured, and how the profession as a whole advocates for its role with preschool children experiencing comprehension difficulties.