PURPOSE It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

中文翻译：

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先减后加：走向学校言语治疗中去实施方法的发展。

目的考虑到不断增加的病例量和无数其他工作量任务，学校言语病理学家 (SLP) 通常很难优先考虑为患有言语障碍 (SSD) 的儿童实施新的做法。我们认为，去实施科学与实施科学同样重要。去执行科学是对“低价值和浪费”领域的认识和识别。至关重要的是，取消实施的想法表明，我们首先从临床医生的工作量中删除一些东西，然后再要求他们学习和实施新的东西。方法 在“通过有效分配资源实现医疗保健的可持续性”（SHARE）框架内，我们回顾了去实施科学和当前的言语声音治疗文献，以了解持续使用不再受到科学或立法支持的实践背后的机制。我们使用小插图来突出临床医生在学校环境中可能面临的现实生活中的例子，并为这些常见挑战提供假设的解决方案、资源和/或后续步骤。结果 通过关注 SHARE 框架的第一阶段，我们确定了四种可以取消实施的主要实践，为新的基于证据的技术和方法腾出空间。这四种做法是根据对基于 SLP 的调查研究的深入审查而确定的：(a) 过度依赖语音规范来确定资格；(b) 评估中遗漏语音处理技能；(c) 服务提供的同质性因素，以及 (d) 对所有 SSD 儿童仅使用一种治疗方法。结论 取消实施需要付出努力，并可能导致一些困难的讨论。实施 SHARE 等框架可以指导 SLP 减少 SSD 儿童的工作量并改善其治疗结果。