Sound start study: Implementation of a computer-assisted intervention for children with speech sound disorders in Australian preschools

Speech-language pathologists aim to use evidence-based practice when making clinical decisions.However, tension can exist between implementing an intervention exactly as designed andmodifying the intervention to suit contextual needs (Odom, 2009). Adherence rates, or degree towhich implementation of an intervention adheres to its original design, can affect outcomes (Durlak &DuPre, 2008). Organizational, instructional and client barriers and facilitators can influenceadherence rates (e.g., availability of staff/resources to support the intervention, alignment of theintervention with organisation/community goals and philosophies, training and support,sustainability, time, intervention impact). Implementation evaluation is essential to determineoutcomes, adherence rates, and barriers and facilitators to implementation. This paper describes theimplementation of a computer-based intervention by preschool teaching assistants in the Sound Start Study. The study was designed to explore the effectiveness of this intervention in supporting the speech and pre-literacy skills of Australian preschool children with speech sound disorders. The recommended dose and number of practice sessions was set out in the protocol for teaching assistants. Adherence data was gathered via the computer software (which provides evidence regarding the actual dose and number of practice sessions undertaken by participating children), via teaching assistants records of practice sessions, and via interviews with a sub-set of teaching assistants regarding their views on the programme and the challenges involved in implementation.Comparison of the three types of data allows an examination of adherence to the implementation protocol. Barriers/facilitators to implementation will be outlined in light of the child outcomes achieved in this study.