'To Know That You Are a Link in the Chain': A Realist Evaluation to Explore How Digital, Intensive, Parent-Implemented Interventions Work for Children With Speech Sound Disorder, Why, and for Whom.
Naomi Leafe, Emma Pagnamenta, Mark Donnelly and 2 others
PMID 40377479WHAT IT FOUND
Parents and therapists described a three-stage journey for home-based speech therapy: building trust, tailoring practice to family life, and maintaining momentum.
Digital tools were seen as helpful only when paired with active coaching and relationship-building, not as standalone replacements.
Key findings
01Stakeholders identified three distinct stages for successful parent-implemented intervention: readiness to engage, supported implementation, and sustaining momentum.
02Therapists reported that service pressures and high caseloads often prevent them from dedicating the necessary time to build the trusting relationships required for parents to engage in intensive home practice.
03Parents described needing to mimic the therapist's authoritative style and confidence to manage their child's behavior during home practice, which can conflict with their usual parenting role.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study did not test whether these strategies actually improve child speech outcomes; it reports stakeholder opinions on how they might work. Parent participation was low (6 out of 13 who consented attended), which may limit the range of views captured. The child's perspective was not directly collected, only inferred through parents and therapists. Findings are based on UK/Northern Ireland service contexts and may not transfer to other healthcare systems.
Declared interests
The authors declare no conflicts of interest. Funding was provided by the Department for the Economy.
The easy way to misread this
Do not interpret this as evidence that digital tools improve speech outcomes. The study only reports that therapists and parents believe these tools can help maintain practice if supported by coaching; no child outcomes were measured.