Reducing low-value practices: a functional-contextual consideration to aid in de-implementation efforts

Farmer, R.L., Zaheer, I., Duhon, G.J., & Ghazal, S. (2020). Reducing low-value practices: a functional-contextual consideration to aid in de-implementation efforts. Canadian Journal of School Psychology. https://doi.org/10.1177/0829573520974915

Low-value practices are practices that are either unproven or discredited by evidence. Low-value practices sometimes persist in practice, and may interfere with implementation efforts for competing strategies. The de-implementation of low-values practices may be a necessary step in an implementation science approach to the adoption of evidence-based practices. Steps in de-implementation include identifying a low-value practice to be reduced, evaluating variables that may affect the de-implementation process, determining and using strategies that should reduce or eliminate the practice, and evaluation of the effects of de-implementation. Strategies for de-implementation could include policy change at the system level or ‘unlearning’ at the individual.

The authors of this paper consider how applied behaviour analysis could inform de-implementation due to the focus on functional relationships between context and future behaviour (i.e., functional-contextual lens). Briefly, the authors explain that the likelihood of a behaviour can be altered by changing the reinforcement, salience of contextual cues, or effort to engage in the behaviour. Through this lens, the authors suggest that low-value practices viewed as behaviours have little consequences and are rather rule governed behaviours. Behaviour reduction strategies are described including extinction through removal of reinforcement, differential reinforcement where extinction is paired with targeting of alternate behaviour, increasing response effort by requiring approvals or extra paperwork to use a behaviour, and punishment involving the addition or removal of stimulus when engaged in behaviour. The authors argue that these behavioural reduction strategies have the potential to assist in de-implementation of low-value practices but stress the importance of pairing this goal with efforts to implement evidence-based practices. 

The focus on the persistent use of low-value practices as a barrier to implementation of evidence-based practice is interesting. When implementing a new evidence-based practice, clinicians would do well to consider how it fits in with existing practice and any need for change.

Blogger: Lisa Archibald

Relearn faster and retain longer: Along with practice, sleep makes perfect

Mazza, S., Gerbier, E., Gustin, M., Kasikci, Z., Koenig, O., Toppino, T., & Magnin, M. (2016). Relearn faster and retain longer: Along with practice, sleep makes perfect. Psychological Science, 27(10), 1321–1330. https://doi.org/10.1177/0956797616659930

Two of the most effective study techniques are spaced learning and sleep. Spaced learning (or distributed practice) is when learning is spaced out over multiple sessions rather than presented in one long session. Sleep, on the other hand, has many learning benefits. After sleep, newly learned information becomes more stable thereby enhancing learning. The goal of the current study was to determine if combining both strategies could lead to better learning.

The study had 3 parts, the studying session, relearning session, and delayed testing (1 week and 6 months later). In the studying session, participants read 16 Swahili-French word pairs (nyanya-tomate) and then studied each word (given nyanya-____, what is the French translation?). For words they recalled incorrectly, the correct translation was shown, and participants practiced until they got all 16 correct. The relearning session happened 12 hours later and proceeded in a similar way. Delayed testing occurred 1 week and 6 months later. Participants were divided into 3 groups: (i) sleep group: studied at 9 pm, slept, and then relearned at 9 am the next day; (ii) no sleep group: studied at 9 am and relearned at 9 pm on the same day; and, (iii) control group: studied at 9 pm, slept, and then completed a recall-only session at 9 am the next day. Findings revealed that sleeping after learning (sleep and control groups) led to better retention the next day than not sleeping (no sleep group). Further, the sleep group required fewer trials to successfully recall all 16 pairs correctly than the no sleep group (i.e., relearning happened faster). Strikingly, the benefits of sleep and relearning were amplified 1-week later and were maintained 6-months later: only the sleep group remembered significantly more word pairs than both the no sleep and control group.

The results suggest that sleeping after learning is a good strategy but additional learning after sleep is especially beneficial to long-term memory. It would follow from these findings that it would be beneficial to children’s learning if a clinician could introduce new learning in therapy one day and then incorporated a re-learning phase (perhaps with home practice materials) after sleep the next day.

Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald

Semantic effects in sentence recall: The contribution of immediate vs delayed recall in language assessment

Polišenská, K., Chiat, S., Comer, A., & McKenzie, K. (2014). Semantic effects in sentence recall: The contribution of immediate vs delayed recall in language assessment. Journal of Communication Disorders, 52, 65–77. https://doi.org/10.1016/j.jcomdis.2014.08.002

Sentence recall, the immediate repetition of spoken sentences, is used clinically to assess language skills. This seemingly easy task draws on different types of language and memory skills. For instance, phonological (speech sound) skills support the remembering of the word form itself. Semantic skills (knowledge of meaning) aid in remembering the meaning of the sentence. Typically, sentence repetition is tested by having the person repeat the sentence immediately after hearing it (immediate recall). The ability to recall a sentence after a delay (delayed recall) is usually not tested. The goal of this study was to understand the skills involved in immediate and delayed sentence recall.

Across two studies, participants completed immediate and delayed sentence recall. In study 1 involving adult participants, a distracting task was completed prior to delayed recall: either counting backwards from 10 (less demanding) or naming a series of images (more demanding). In study 2 with children, the task was either waiting quietly for 10 s (less demanding) or counting from 1 to 10 (more demanding). Further, sentences were either semantically plausible (The red bus was late so we drove by car) or implausible (The red grass was brave so we spoke to jam) with the idea that more familiar and meaningful sentences would benefit recall. The results were similar across both studies. Immediate sentence recall was better than delayed recall. Plausible sentences were recalled more accurately than implausible sentences. Finally, the more demanding the distracting task, the more participants relied on the semantics of the sentence to support recall (i.e., accuracy declined more steeply for implausible than plausible sentences).

Overall, results suggest that sentence recall draws on both phonological and semantic knowledge, but their contributions may differ. Phonology has a relatively greater role in immediate recall, whereas semantics has a relatively greater role in delayed recall. As well, familiar information supports memory overall. Clinicians who have a good understand about the language and memory skills involved in sentence recall will be in a better position to interpret their assessment findings. Further, there may be a need to incorporate delayed testing into practice.

Blogger: Theresa Pham is a student in the combined SLP MClSc/PhD program, supervised by Dr. Lisa Archibald