Criteria and Terminology Applied to Language Impairments (CATALISE): A qualitative exploration of dissemination efforts to guide future implementation.

Abstract

Developmental language disorder (DLD) is a condition which affects an individual's ability to use and understand language. Terminological confusion, and the use of non-evidence-based diagnostic criteria has impacted access to services for this population for several decades. Changes in terminology and diagnosis were proposed as part of a UK-based consensus study, Criteria and Terminology Applied to Language Impairments (CATALISE), in 2016 and 2017. Since the publication of the recommendations, there have been active efforts across several English-speaking countries to support uptake of these recommendations into policy and practice. The aim of the study was to explore the experiences of individuals who have been leading the dissemination of the CATALISE recommendations since their publication in 2017. The study was undertaken to inform future implementation efforts aimed at facilitating the adoption of the recommendations into policy and practice. Researchers, practitioners and parents from nine countries were recruited to the study (n = 27). Online focus groups and semi-structured interviews were conducted using topic guides informed by the Consolidated Framework for Implementation Research. Inductive thematic analysis was undertaken. Preliminary findings were member-checked prior to completion of the analysis. CATALISE recommendations were described as partially adopted by participants. Dissemination strategies included building a coalition, conducting educational meetings, and developing educational materials. Common barriers to implementation related to the complexity and compatibility of the recommendations, and practitioner confidence. Four themes were identified across the data set to guide future implementation efforts: (a) ride the wave, craft the narrative (b) reach across the divide, be brave (c) create space for multiple voices and, (d) support for speech and language therapistss on the front line. Individuals with DLD and their families should be included in future implementation planning. Engaged leadership is essential to address issues of complexity, compatibility, sustainability and practitioner confidence if CATALISE recommendations are to be integrated into service workflow and processes. Implementation science can provide a useful lens to progress future research in this area. What is already known on this subject Dissemination efforts have been undertaken to facilitate the uptake of recommendations from a UK-based consensus study (CATALISE) in relation to developmental language disorder since publication across several countries. What this study adds to existing knowledge The required changes in diagnostic practice are complex to implement. A lack of compatibility with healthcare processes and low practitioner self-efficacy were also identified as a challenge to implementation. What are the potential or actual clinical observations of this work? Parents and individuals with developmental language disorder need to be engaged as partners in future implementation planning. Organisational leaders need to facilitate the contextual integration of the changes within service systems. Speech and language therapists require ongoing case-based opportunities to enhance their confidence and clinical reasoning skills to implement CATALISE recommendations successfully in their everyday practice.