Implementation Support Practitioners: Unpacking the “How”

Megan MacPherson         Natalie Douglas

Written By: Megan MacPherson & Natalie Douglas, Ph.D., CCC-SLP

Communication strategies for people with dementia are really not anything new.  We packaged up this manual of strategies that you can freely download here, but what we’ve been learning from this work is that it’s less about the *what* and more about the *how.*

The emerging literature on implementation support practitioners (Albers et al., 2020) has provided me with tools to move this research into further action.  Metz et al. (2020) describe implementation support practitioners as requiring basic competencies under the domains of co-creation, engagement, ongoing improvement, and sustaining change.

I didn’t know it at the time, but Dementia Collaborative Coaching found some success in this pilot study because of these competencies.  For example, under the domain of co-creation and engagement, factors such as co-learning, brokering, addressing power differentials, co-design and tailoring support are made explicit.

I would encourage you to check out these open-access documents, as I’m becoming more and more convinced that the potential of Dementia Collaborative Coaching lies in addressing power differentials.

There are key activities suggested by Metz and colleagues to address power differentials, and a few that I think will advance the future of this particular program.

1. Include positioning the person you’re training at the center of decision making (e.g., why do you (CNA) think Mr. Smith is screaming every day at 4:00 PM?  What have you already tried?).

2. Recognize and acknowledge the loss of status and authority in the implementation process (e.g., I know you’re here until after dinner and I leave at 3:30, so let me know how we can problem-solve this to make it work better in the evening).

3. Develop a collective view or shared understanding of the problem as opposed to pushing for artificial consensus (e.g., thinking less about making sure the CNAs’ initials are on my training form and more about actually incorporating their input).

Guiding principles for implementation support practitioners include being empathetic, curious and committed, advancing equity, using critical thinking, and embracing cross-disciplinary approaches. These are values that we all hold closely.  As we move forward with our clinical and research programs, it may be a good idea to incorporate these principles more explicitly into our *how.*


Douglas, N.F. & MacPherson, M. (2021). Positive changes in certified nursing assistants’ communication behaviors with residents with dementia: feasibility of a coaching strategy. American Journal of Speech-Language Pathology.

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