Being an Informed SLP with Meredith Harold

Being an Informed SLP with Meredith Harold

This special episode was recorded in February 2020 at the Texas Speech-Language-Hearing Association’s (TSHA) Annual Convention in Houston, and is being released in conjunction with the 2021 Virtual TSHA Convention. In this episode, we speak with Meredith Poore Harold, PhD, CCC-SLP, about the importance of evidence-based practice, barriers clinicians face in implementing evidence-based practice, and how her business, The Informed SLP is helping clinicians to put research into practice.

About Meredith Harold

Meredith Harold is a speech-language pathologist, science communicator, speaker, and founder of The Informed SLP.  Meredith received her doctorate from the University of Kansas in developmental speech physiology and neuroscience. Since then, she has worked as a school-based SLP, an assistant professor at Rockhurst University in Kansas City, and has owned a private practice. Meredith's current professional endeavors focus on understanding, supporting and advancing research and clinical practice in speech–language pathology. She founded The Informed SLP, a website and series of email newsletters that provides speech-language pathologists with evidence-based research in an way that’s friendly, realistic and efficient. She is also president of the Kansas Speech–Language–Hearing Association, is on the Committee on Clinical Research, Implementation Science, and Evidence-Based Practice for ASHA, is an adjunct faculty at The University of Kansas. On top of all that, Meredith hosts a podcast called, Evidence & Argument.

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Stephanie (00:03):

This special episode of Unbabbled was recorded in February, 2020 at the Texas Speech Language and Hearing Association's annual convention in Houston, Texas, and is being released during the 2021 virtual TSLHA convention. In this episode, we speak with Meredith Harold, about the importance of evidence-based practice barriers clinicians face in implementing evidence-based practice and how her business, The Informed SLP is helping clinicians put research into their everyday practice. Meredith Harold is a speech language pathologist and science communicator speaker, and founder of the informed SLP. Meredith received her PhD from the University of Kansas in 2011. Since then she's worked as a school-based SLP and assistant professor at Rutgers university and owned a private practice. Mary's current focus is on understanding, supporting and advancing research and clinical practice in speech language pathology. She founded the informed SLP and runs that full time. She's also president of the Kansas Speech Language Hearing Association and an adjunct faculty at the university of Kansas. On top of all of that Meredith hosts, a podcast called Evidence and Argument. It was such a pleasure to speak with Meredith last year, and we can not wait to connect with people face to face at conventions again in the future.

Stephanie (01:22):

We're here, live on the TSLHA convention floor, talking to Dr. Meredith Harold from The Informed SLP. Welcome. And thank you for being a guest.

Meredith Harold (01:29):

Yes. I'm so glad to finally get to meet you in person and come chat for a little while.

Stephanie (01:35):

Yes. I've been a fan girling from a distance and a long time subscriber to The Informed SLP. I love it. I think it is a fantastic resource for everyone. So can you just give us a little synopsis of what the Informed SLP is?

Meredith Harold (01:48):

Yeah, so basically the informed SLP is a website that keeps practicing clinicians up to date with our fields research. So a lot of times people assume that a professional, like an SLP would just need to be reading research papers in order to know what to do, but in our scope of practice, there's on average, over 200 papers published every single month and our scope and each paper is about 10 to 15 pages long.

Meredith Harold (02:13):

So as you can imagine, that's a huge task and it's the same in most fields. So PTs have this issue, OTs, occupational therapists do nurses, pediatricians, um, all have difficulty staying up to date with their fields research. And so I wanted to create a solution to that for our field. So I'm someone with a background as a scientist. So I was doing research for many years, and then I switched to working as a school-based SLP. And as soon as I became a school-based SLP with that research background, it just kind of hit me how impossible it was, because I knew how to read scientific journal articles, but still just couldn't keep up with it. I just could not keep up. So I created the informed SLP as a solution to that. So we have a team of 30 people who re basically read all the journal articles in our field every month for clinicians. And then we tell them what they would need to know for clinical practice. And it's basically like CliffsNotes for our fields research.

Stephanie (03:10):

I love that I am excited every month when it comes to my inbox and there is on average, almost every single one that I pop up. I subscribed to the preschool and school aged level, and there's usually at least three that I put into practice. And some of them that I immediately print out and like make copies and hand to my friends that aren't subscribed yet as I badger them to subscribe. And I'm like, we need to read this. We need to talk about this. We need to start implementing it. And it's such a change from digging through journals or even just having the journalists themselves, come into my email inbox and having to scroll through and figure out which one through the abstract was important and then dig through and see like, Oh, is this actually relevant to me?

Meredith Harold (03:55):

Yeah. Yeah. And, you know, journal articles aren't created for clinicians in the first place across fields, like they're made for peer scientists, so people can read each other's work and build upon it. And so this is basically something that's just for clinicians.

Meredith Krimmel (04:12):

Yeah. So Stephanie, you mentioned you subscribed to like the school age population. So that's my question. Can you specifically request what type of articles you'd like to be informed about?

Meredith Harold (04:23):

So, right now, the way we have it designed is you can belong, um, per age group. So we have birth to three preschool and school, age, or adults. And so you can belong to one of those age groups, all three, if you want to. Um, and sometimes he will ask me, Oh, like, can we request just to get all the articles on feeding or just to get all the articles on autism. There's topic, drop-downs on our website where you can basically click on autism and only read things about autism, for example. Um, but that's actually something I'm planning on doing in 2020 is making it easy, easier for people to curate a feed of only the things they like. Cause we do have some people who, for example, are an AAC specialist and they really only want to learn about communication devices. Those, you know, iPads that people use in order to communicate, or it might be more of a standard device or something.

Meredith Krimmel (05:11):

Awesome. Because one of the things we were talking about getting your inbox inbox flooded with articles, which happens in my inbox, but I, I, it takes so much time just to sift through all that, to figure out what works for me or what applies to what I do in my job. So that's how it would be great. Yeah.

Meredith Harold (05:26):

So may make it quick and it's casual too. That's the other thing is I wanted, you know, there's no reason that we can't discuss research in a really casual format. It doesn't have to be jargon and words that are only known by people who are studying this small little niche area. And so it's easy to understand too. And so I myself have done a lot of training in science communication, which goes outside of our field. Like there's people who are in neuroscience, science communication and communicates findings of the brain to the public. I basically am doing that within our field and trying to learn from other fields too. That's awesome.

Stephanie (06:03):

Research articles. I mean, they have the big intimidating words in them and it's difficult to read through them. And then even for parents, if they're looking to try and make sure that their child is getting evidence-based practice, it's like Triply intimidating, unless they have a science background.

Meredith Harold (06:19):

Yes. For sure.

Meredith Krimmel (06:22):

Do you have any parents that subscribe to your articles?

Meredith Harold (06:26):

Um, yes, but for legal reasons, I do not recommend it to parents, right? Yeah. So like, um, and we have students who subscribe, but for legal reasons, we do not recommend it to students because really it's the way we write it assumes that you have a degree in speech pathology. We assume that you have all the background knowledge to know how to apply exactly what we're saying. And so sometimes that gets tricky if people don't have that background knowledge, and sometimes it's actually even hard for undergraduates or parents or like physical therapists trying to read our content to understand, because we do still use SLP jargon, right? Like for all of us SLPs sitting here, it doesn't feel hard at all, but it might feel a little bit much for parents and stuff and miss misunderstandings can happen. Yeah. And misunderstandings can happen. Yeah. If they don't have that background.

Stephanie (07:15):

And I love how much that you're an advocate for evidence-based practice. Can you give a little summary of what evidence-based practice is since it's a term that's thrown around very frequently?

Meredith Harold (07:22):

Yes. So evidence-based practice basically just means that when you're making a decision for a client or a child who has a communication disorder that you need to take into consideration the research data. So all the, you know, studies that are being done, trying to figure out what works best with kids, you need to take that into consideration. So that's thing. Number one thing. Number two is you need to use your clinical expertise and experience working with kids like the one you're seeing in front of you in order to inform what you're going to consider trying, um, that clinical stuff also includes, um, individual client data. So basically what's going on during your sessions over time with that child. And then the third thing you have to take into consideration is the client and family input themselves. Because, you know, sometimes just because a certain thing has research evidence to say it should work thing, number one. And just because there's clinical evidence to show that it should work thing, number two doesn't mean that, that client, that individual person it's going to be best for them. So those are the three things you're taking in mind as research clinical expertise, and then the client's perspective and preferences too. And so the informed SLP kind of takes things one off, we take one off your plate so that you can just deal with thing number two and thing, number three. That's great. Yeah.

Stephanie (08:46):

And for clinicians out there, why do you feel so strongly that having that evidence-based practice and getting the research on their side is such important thing for their practice?

Meredith Harold (08:56):

Because we need to use every information source we have. And I, you know, our field science is just one information source. And because sometimes if, like, for example, for clinicians who maybe have made no contact with the research side of our field and many, many years, it can be really easy to start going down a path that you think is okay, and you think works because you're seeing some amount of progress in your clients, but if you were doing it in a way that had been proven by large scale studies to actually be better, your clients could be getting, you know, skills met twice as fast as if you aren't using that data. So it's just knowing the research is just having the information that you need in order to make the best decision that you possibly can.

Stephanie (09:43):

Earlier today, we were talking to, um, fluency and stuttering expert, and she was talking about that same thing that, especially in that realm, that thinking about treatment and therapy for disfluencies and stuttering has shifted even within the past, like 10 years. And if people aren't keeping up to date with the research or how things are shifting, then they could be doing therapy in a really different way.

Meredith Harold (10:08):

Yeah. Yeah. And I'm also a really big advocate for not just science being pushed toward clinicians to make sure they understand it and use it, but also for clinicians to become more active participants and giving feedback. And that whole process, because it's not just a research to practice thing, it's also a practice to research thing. And so I'm seeing actually a lot more of that in the youngest generation of scientists. So people who are, you know, maybe recently got their PhD or got their PhD in the past 10 years, there's a lot more of a culture around getting input from practicing SLPs so they can make better decisions about what to study next and how to study it. Because really the only people who are starting to get ideas about, you know, maybe things that we could try, maybe things that we could consider are people who see clients on a daily basis. And some scientists don't see clients on a daily basis. They'll see them when they're running a study, but then they're, you know, applying for grants and crunching the data and doing other things related to being a scientist. You know, so I, I want to, in future years, spend more time figuring out better solutions to get our field science scientists, to, um, get that feedback from clinicians to, I've got some ideas for the website.

Stephanie (11:26):

That's another hurdle. Cause when you're practicing in it and you're in it, the daily and you keep coming up with these articles and you're reading it. And on paper, it's saying like in my lab where I got to pre-select, which kids could come to me and decide and have all this time and make sure that they've met this parameters, this therapy worked, and then you get into your clinic or your school and you don't get to pick which parameters. And they have multiple things going on. It's just frustrating then to be like, well, this said that this was going to work and how do I pick which kid this will work for because they have this, but they also have that going on.

Meredith Harold (12:02):

Yeah. And clinicians are ones that we'll see that happen, where there might be something that's evidence-based for speech sound disorders. So they try to implement to, with a child with intellectual disability or a child with autism. And they realize, okay, this only 70% works. Like there's a chunk of this that just isn't working for me. Right. Feedback back to our field scientists so they can help problem solve. Right. As well as really helpful. Yeah. I think that's a great partnership to have.

Meredith Krimmel (12:27):

I think that informed SLP is so neat because there is such a lag time between research and the research pushing out into the actual field. And you're kind of speeding that process along for the people who subscribed to you, which is great. I've heard, I heard something once. Like there's like a five to 10 year lag for research to actually be implemented and adopted into clinics and schools. And then by then new research has already come out with a new technique or a new model. So I love that you're getting it out there Quicker.

Meredith Harold (12:58):

Yeah. And depending on how you measure it, actually a lot of studies that show that across education and allied health fields. So not just us, but you know, nursing teachers, PTs, OTs, all of it. Um, that for a lot of things that takes up to 20 years for it to get into clinical practice, which is even worse. Isn't that crazy? Scary. I know. Yeah. Yeah. But it's, you know, it makes sense, you know, hundreds of papers being published every single month, somebody needs to go through and start sifting through the things and saying, Oh, Hey clinicians, you need to know about this one. Oh, Hey, you need to know about that one. Cause not all of them are relevant to practicing clinicians. There's a lot of research that informs theories, um, behind things like how the brain works and stuff like that, that isn't quite yet ready for clinical practice. And so that's a lot of the service that we offer is basically pointing out the things that you can use today that don't need two or three more follow-up studies before they're usable.

Meredith Krimmel (13:55):

So the newsletter that, that comes monthly, what does that look like?

Meredith Harold (13:59):

It looks like a blog.

Meredith Krimmel (14:01):

Oh nice.

Meredith Harold (14:01):

Yeah. And so it's really like casually written. We have links out to things. And so, um, if the study is on the evidence behind a specific test, we link out to that test. If there's other resources that can be helpful in explaining it, we link out to those.

Meredith Krimmel (14:15):

And this is a membership-based service, correct?

Meredith Harold (14:18):

Yep. It's a membership thing.

Stephanie (14:20):

Awesome. And you guys started doing it audio as well?

Meredith Harold (14:24):

Yes. We have audio versions as well. Um, and so those place, um, through your membership account right now, but one of the things on my to-do list for 2020 is to figure out how to start feeding them into people's podcast apps. I just need to set it up as a private podcast so that you have a login and all that stuff. Right? Yeah. That'll make it even easier if you can listen to it next to like your crime stories like that. Absolutely. I personally am a podcast lover, so I love that. Yeah.

Meredith Krimmel (14:52):

And that's why we started this podcast. We found that parents were accessing our information will be able to access our information faster and easier if it's on a podcast while they're commuting to school or work or whatever. So

Meredith Harold (15:02):

Exactly what my podcast feed is. My podcast feed is basically science stuff, news stuff, speech pathology stuff, and then like true crime,

Stephanie (15:12):

Everybody. Listen, I listen to everybody listens to true crime, not me. You're missing the outlier. There's gotta be one outlier scientifically. Right. So we brought up parents and that they wouldn't want to subscribe to it, to the informed SLP. But if we have some informed parents here that would like to look for ways to make sure that their SLP is following evidence-based practice, what are some things that they could ask their therapists to make sure that they're kind of following along up-to-date research?

Meredith Harold (15:43):

Yeah. I actually think the best thing that you can do is just come out and ask your therapist. So say you have a therapist who's treating your child for dyslexia. Literally just ask the question. How do we know that this is the best technique for my child, as opposed to some of the other ones out there based on our fields, most recent research or the current research. And if that question, like if the, if the SLP can't figure out a way to answer that question or seems intimidated by that question, there's a good chance that maybe that person isn't really paying very close attention to the evidence and all of the options. So just having a conversation with your SLP. And you know, sometimes parents who look things up on their own and bring them to us to a clinician. Sometimes that can be frustrating because a parent shows up and they're like, Oh, I want you to do this thing I found on the internet. And sometimes that's a bad idea, but I actually think that parents should do some of their own research and start looking things up, bring them to their SLP and say, Hey, why aren't we doing this? Or should we explore this? Or, you know, what do you think about it.

Meredith Krimmel (16:45):

Yeah, I think asking questions is so important, but also as a parent re reminding yourself that there were three things you said were important for evidence-based practice. And two of those things, parents can't really do. They can read research, even if they can understand it, but they don't have the clinical expertise or the clinical experience to make those decisions and see the progress. And they're not working with their own child in a clinical way, so they can do one of the three things. So I think asking questions is great, but also as a parent reminding yourself, this is just one part of the process. Yes.

Stephanie (17:16):

I always enjoy when parents come and ask me or say like, Hey, I was just reading about this thing because when I know that they're interested and an advocate and two, then I can kind of get geeky with them. Totally. It'd be like, yes, that's exactly what we're doing. I just packaged it. So it looked like fun instead of really research-based or I could be like, well, here are the other reasons why I've chosen this instead. And we can either have the conversation. If it's something that could be appropriate to bring it in, or if it's not then to have a discussion with them about why it wouldn't be appropriate for their kids. Yeah. Yeah. I mean, I love that conversation.

Meredith Harold (17:47):

I do too, but like not necessarily all SLPs will respond that way. Like we like it when parents bring us the stuff, because you know, we're staying up to date with things. And so it's a comfortable question, but there will, that's kind of a red flag. If you bring something to your clinician, I don't want to talk about it. I don't.

Meredith Krimmel (18:04):

Right, right. Because if they're informed, they should be able to have a comfortable yeah. They should be able to have a conversation about why it's not an appropriate way to conduct treatment for their child. Yeah. Yeah.

Meredith Harold (18:16):

And when, when parents are doing those kinds of searches on the internet for things, some, I guess some of the biggest red flags would be just over promising things. So if you come across something that almost seems too good to be true. It usually is. Right. Yeah. The only other way to really vet things, if you're uncertain is to read the research associated with it and that, as we know, sometimes can get a little bit tedious, but yeah,

Stephanie (18:42):

It is hard for parents because if they don't have the research background and we live in an age and society of being able to access information very quickly and being over inundated with ads. And so there are ads everywhere. You're not even knowing they're ads sometimes. Yes. That's the scary thing. Right.

Meredith Harold (19:00):

And some of the things that feel the best aren't necessarily, um, the things that are evidence-based like, if it feels really good, like, you know, Holy moly, this is going to, you know, change everything in two weeks and, you know, four vitamins, that's probably not. Sounds amazing, but it probably won't be unfortunately accurate.

Stephanie (19:20):

Yeah, no, it is true. If we could just give the kids vitamins right. Then that would fix everything. It'd be much easier as my job, as a teacher, we probably wouldn't have jobs,

Meredith Krimmel (19:32):

But I mean, I know I'm a parent and how often I see something with my child or see something on my child, like a rash. And I go down the Google rabbit hole and it always ends up with cancer. I mean, something really bad or scary. And I know that the last thing my pediatrician wants me to do is come in and say, I've done my research and they have blank. Right. That's their job to diagnose. But I also appreciate that my pediatrician is willing to hear my concerns and answer my questions. And I think we should be looking for that in our therapist. Just as much as our doctors.

Stephanie (20:06):

Oh yeah. My own kids too. Like my son's eczema recently, I got on and like searched and searched and searched and searched. And of course, like went to the pediatrician with how come we can't use this. Right. If we were to use this, you know, Witch Hazel, or is that not a thing?

Meredith Krimmel (20:22):

I know it is so confusing because I mean, people swear by different models or techniques or vitamins or oils or whatever it is. And it's hard to, it's really hard, even as an educated person in the field to, to, to decide what is real and what is like a hoax.

Stephanie (20:41):

And even with just going to these conventions and conferences, you might hear one talk and they're like, Oh, this is the absolute best way. And then you go to the next talk on the same topic. And they're like, no, this is the absolute best way. And maybe there is that lag and research where they're still trying to figure it out and it's coming through and it's hard.

Meredith Harold (20:58):

Yeah. Or the best for different reasons. So like, I'll see that, like, for example, with childhood apraxia of speech where, um, there's a lot of like actually really strong ways that you can treat childhood apraxia of speech that actually look a little different from one another. And the only way as a clinician, you can decide which one to use is by giving it a try and seeing which one works better for that individual kid, you know?

Stephanie (21:18):

And that goes back to keeping the data on the client and having the client side and making the basis of the decision off of the client and what they respond to instead of just, well, this is the one approach that I, I read about.

Meredith Harold (21:31):

Yeah. Right, right.

Meredith Krimmel (21:33):

What does it cost?

Meredith Harold (21:35):

Each section is $7 per month. If you belong to more than one section, it gets to be more because in some people like most SLP is belong to a section, but some want from birth through elderly because they want all the things, but it's $7 a month per section.

Stephanie (21:49):

Awesome. I think that it's worthwhile.

Meredith Harold (21:52):

And we've basically, so it's a ton of work. I mean, there's 30 of us working every single month going through hundreds of journal articles, but it's important to me that it's priced low enough that the, like most SLPs in our field, that's accessible to them because I want to get to the point where it's not just, you know, some SLPs learning the research, but I generally want, or genuinely want all of my peers or as many peers as possible knowing this stuff, because there shouldn't be a price barrier right between us in that information.

Stephanie (22:24):

So, reading that much research, do your eyes get crossed? Do you get lots of paper cuts?

Meredith Harold (22:29):

I'm kind of, so I'm kind of in a little bit of an introvert. I have a little bit of a home body and I love reading. And so actually it's one of my favorite things to do. So now that, you know, The Informed SLP is bigger. I spent a lot of time managing people and dealing with the business side of it. But actually my favorite times are like every so often there will be a writer who gets sick or something. And she's like, I can't take my stack of papers this month. And it's like, Oh, darn I, you know, have to stop everything else and stop and read. And I love those days. I just would like sit and read and highlight. And I think it's fun, but it's only fun because I don't have a caseload that I'm dealing with on top of it. You know what I mean? Because in the years that I was working full-time as an SLP at that time, I still loved it, but it was, it was too overwhelming to make time for it. You know what I mean? As much as I enjoyed it then too, it would just frustrate me because I'd be like, eh, I don't have four hours to sit down and do that.

Stephanie (23:19):

Yeah. I mean, I think about school-based SLPs who have like 60 to 80 kids on their caseload,when are they going to sit there and read papers about exactly the things that apply to all of those children.

Stephanie (23:28):

Yeah, exactly. And speaking of cost benefit to buy one research paper that you want to read, it could be like $15 or more. And I am lucky that my husband through his work has access to a large variety of scientific journals. And sometimes he can get access to them through his work and the amount of articles I've had to text him and be like, will you please get me this article? So then I didn't have to keep paying like 15, 30 or even just a hundred dollars to read two papers that I could stay up to date.

Meredith Harold (24:01):

Yeah. Yeah. We're basically the filter. So, you know, the things that you might really want to get your hands on the full paper, as opposed to grabbing stacks upon stacks.

Stephanie (24:10):

Spending $15 or $30 and then reading it and be like, Oh yeah, that actually is not what it was burning money. Yeah. Yup. Yup. Yes. I greatly appreciate that. All right. Well, at the end of every podcast, we ask all of our guests, we put them on the spot and if you had one piece of advice to give, what would it be?

Meredith Harold (24:30):

Hmm. I guess to everybody, just try to remain curious as much as you possibly can because you know, as adults with jobs and as parents and people with lots of responsibilities, it can be really easy over time to lose the joy and learning. But sometimes when you pick it back up and dig into things that, you know, you're curious about and you have that kind of like joyful interest in, it just feels good. If you can find some way to do it, whether that be, you know, reading a website that's, you know, like the informed SLP and related to something you're interested in or listening to podcasts on topics that are actually science-based. I think it feels good. Even if you haven't done it in a while or forgotten that it feels good.

Stephanie (25:16):

Yeah. Yeah. I like that. Yeah.

Meredith Krimmel (25:18):

I like to stay curious.

Stephanie (25:22):

So. All right. Well, thank you so much for agreeing to speak with us today. That's fantastic.

Meredith Harold (25:26):

Of course. It's so nice to meet you in person.

Meredith Krimmel (25:29):

Thanks. Thank you for listening to the Unbabbled podcast. For more information on today's episode, please see our episode description. For more information on The Parish School, visit parishschool.org. If you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice. And if you like what you're hearing, be sure to leave a rating and review. A special thank you to Stig Daniels, Amanda Arnold, Stella Limuel and Molly Weisselberg for their hard work behind the scenes. Thanks again for listening.