The ninth #ResNetSLT Tweetchat of 2018 will take place on Wednesday, 31st October (7.30-8.30pm GMT).

The chat will be hosted by Sophie Chalmers (@SChalmersSLT) and Sukhi Aujla (@sukhpreet_aujla). It will focus on the following paper: Optimal intervention intensity (Baker, E. 2012). The publishers are kindly allowing #ResNetSLT time limited access.

This paper discusses the importance of understanding optimal intensity in order for speech and language therapists to provide clinically effective services to their clients.

In contrast to other fields where the importance of dosage is well-known (for example, pharmacology), there is relatively little known about the optimal intervention intensities for a number of areas of speech and language therapy practice.

The author suggests that intensity of intervention goes beyond factors of type, amount, frequency and duration of intervention, and requires consideration of the active ingredients within intervention; what needs to be learned and how intervention goals are addressed.

The challenges in identifying these active ingredients is acknowledged: unlike swallowing a pill, therapy sessions contain a complex set of tasks that the clinician does (therapeutic inputs), with interacting (and overlapping) responses to this from the client (client acts). The same treatment programme and dosage intensity may yield very different results in different clients.

How is intervention intensity defined?

Warren et al. (2007) proposed the following five main terms:
  • Dose form: how the intervention will be delivered, what is the task?
  • Dose: the number of times an active ingredient or teaching episode occurs during a session
  • Session length: time with client
  • Frequency: per day or week (e.g., three times a week)
  • Duration: how long will this last (e.g., six weeks)
  • Cumulative intervention intensity (e.g., dose x frequency x duration)
Key questions about optimal intensity posed within the paper
  • What do we know about the dose or optimal intensity of SLT interventions?
  • Is it possible to define, study, and measure interventions in discrete doses?
  • How much intervention is needed to achieve a particular dose?
For a visual guide and further discussion about treatment intensity please click here.

Our Tweetchat further links in this month's SpeechBITE research newsletter which focuses on the literature related to treatment intensity different clinical areas. We wanted to take use of this Tweetchat to contribute to the discussion about treatment intensity, highlight different factors that may need to be considered, and to better understand how this can be applied to clinical practice.

The following questions will be discussed:
  • When deciding on treatment intensity (the form, dose, duration and frequency) what factors do you take into consideration?
  • With the current lack of research guidance on optimal treatment intensity, what factors determine your clinical practice?
  • When reviewing an intervention where a client is not making progress would you, as a clinician, consider the intervention intensity as a contributing factor (e.g. frequency of session provided)?
  • How feasible is it in your clinical practice to provide high intensity intervention? Please give examples of how you have been able to provide this if required for a client.

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