Feuerstein Julie, Olswang Lesley B, Greenslade Kathryn, Pinder Gay Lloyd, Dowden Patricia, Madden Jodi
Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MDPsychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Speech and Hearing Sciences, University of Washington, Seattle.
J Speech Lang Hear Res. 2017 May 24;60(5):1285-1298. doi: 10.1044/2016_JSLHR-L-16-0189.
This research investigated a first step in implementing the dynamic assessment (DA) component of Triadic Gaze Intervention (Olswang, Feuerstein, Pinder, & Dowden, 2013; Olswang et al., 2014), an evidence-based protocol for teaching early signals of communication to young children with physical disabilities. Clinician attitudes about adopting external evidence into practice and implementation fidelity in DA protocol delivery were examined following training.
Seven early intervention clinicians from multiple disciplines were trained to deliver the four essential elements of the DA protocol: (a) provide communication opportunity, (b) recognize child's potentially communicative signal, (c) shape child's signal toward triadic gaze, and (d) reinforce with play. Clinician attitude regarding adopting evidence into practice was measured at baseline and follow-up, with the Evidence-Based Practice Attitude Scale (Aarons, 2004). Implementation fidelity in delivering the protocol was measured for adherence (accuracy) and competence (quality) during trial implementation.
Clinicians' attitudes about trying new evidence that at first was perceived as incongruent with their practice improved over the course of the research. Clinicians demonstrated strong adherence to the DA protocol; however, competence varied across clinicians and appeared related to child performance.
The results provided insight into moving Triadic Gaze Intervention into practice and yielded valuable information regarding the implementation process, with implications for future research.
本研究调查了实施三元注视干预动态评估（DA）部分的第一步（Olswang、Feuerstein、Pinder和Dowden，2013年；Olswang等人，2014年），这是一种基于证据的向身体残疾幼儿教授早期沟通信号的方案。培训后，研究人员考察了临床医生在将外部证据应用于实践方面的态度以及在实施DA方案时的实施保真度。
来自多个学科的七名早期干预临床医生接受了培训，以实施DA方案的四个基本要素：（a）提供沟通机会；（b）识别儿童潜在的沟通信号；（c）将儿童的信号引导至三元注视；（d）通过游戏进行强化。在基线和随访时，使用基于证据的实践态度量表（Aarons，2004年）测量临床医生在将证据应用于实践方面的态度。在试验实施期间，测量实施方案时的实施保真度，包括依从性（准确性）和能力（质量）。
在研究过程中，临床医生对于尝试起初被认为与他们的实践不一致的新证据的态度有所改善。临床医生对DA方案表现出高度的依从性；然而，能力在不同临床医生之间存在差异，并且似乎与儿童的表现有关。
研究结果为将三元注视干预应用于实践提供了见解，并产生了有关实施过程的宝贵信息，对未来研究具有启示意义。
