SLT beliefs about collaborative practice: Implications for education and learning

1 Drivers for collaborative practice

The SEND code of practice (Department for Education and Department of Health, 2014) sets out requirements for local authorities and clinical commissioning groups to make joint commissioning arrangements for education, health and care provision for children and young people with special educational needs or disabilities in England. It assumes that collaborative practice is taking place at strategic and operational levels, and particularly between professionals involved in developing and implementing integrated support plans for children and young people with special educational needs. Although research has indicated the benefits of joint working (Wright and Kersner, 2004), there is less clarity regarding how staff should work together most effectively and overcome barriers for effective collaboration.

2 Barriers to and enablers of effective collaborative practice

Although there are exceptions, children in the UK usually receive speech and language therapy within their school setting, either directly from a SLT or, more typically, indirectly via teaching staff (Boyle et al., 2009). There are fundamental differences between the education system, in which teaching staff are based, and the NHS service, in which SLTs are based, which act as barriers to effective collaboration: these are structural (the formalized way that services work together), functional (the differences in philosophy) and systems-environment (e.g. how services work with parents; McCartney, 1999). At a functional level, Stringer and Lozano (2007) highlighted that teachers’ reduced understanding of speech, language and communication needs and the role and responsibilities of the SLT impacts effective collaborative practice. SLTs, who tend to adhere to a prioritization model, may also not fully appreciate that teachers must manage the needs of all the children in the school (Baxter et al., 2009). Differing philosophies often lead to differing terminologies, and poor communication has also been identified as a barrier to collaboration due to poor mechanisms for the exchange of information between health and education (Dunsmuir et al., 2006) and differing approaches to consent (McConnellogue, 2011).

Hartas (2004) explored teacher and SLT perceptions of collaboration in a special-school setting through the use of questionnaires and group discussions. The questioning in this study is likely to have identified issues specific to the nature of this setting; however, its broad themes are also echoed in other studies. Clarification of roles and expectations was seen as an important enabler of collaboration, and this was also found by Dunsmuir et al. (2006) who used questionnaires to explore SLTs’ and Educational Psychologists’ (EPs) perceptions of roles and found conflicting opinions on how and why a child’s non-verbal skills should be assessed, and by whom this should be done. Organizational structure was also viewed as in important factor in the Hartas (2004) study, with shared expectations of team work. The setting in the Hartas (2004) study is atypical for the UK, as the drive for inclusion over the last 20 years has seen the reduction of special schools and provisions and an increase in SLTs providing a peripatetic service to mainstream schools. Baxter et al. (2009) sought to explore the perceptions of school staff regarding the SLT service to mainstream schools through the dissemination of questionnaires to schools in one locality. They received a 38% success rate and analysed the data both qualitatively and quantitatively, although the majority of questions were only answerable through five-point Likert scales, and therefore it is unlikely that this study allowed for in-depth explorations of the participants’ perceptions of the SLT service. However, they did identify some challenges relating to power struggles between SLTs and school staff, and conflict over the implementation of intervention, which could support Hartas’ (2004) suggestion that SLTs are likely to be seen as visitors within a school, potentially creating a social barrier affecting the ‘mutual trust and respect’ between the professionals. Hartas’ (2004) study, employed the use of a questionnaire consisting of multiple-choice and open-ended questions about the individual’s notions of collaboration, followed by group discussions allowing for further exploration. The ability to evolve questions and explore perceptions in this way was possible due to the location of the participants in one school; the uniqueness of such a setting has already been discussed. Achieving a similar level of in depth responses for participants across a range of settings across the country is likely to necessitate alternative qualitative data collections methods, such as phone interviews.

3 The effectiveness of collaborative practice in supporting children with speech, language and communication needs

As the nature of collaborative practice continues to be explored in the research, it is important to consider whether collaborative practice creates better outcomes for children at an equal or lower cost than individuals working independently with the child. There is a dearth of research demonstrating the effectiveness of collaboration in terms of delivery of intervention targeting specific speech and language skills. This is in part due to relatively limited effectiveness studies within the field of speech and language intervention overall (Lindsay at al., 2012), and also due to limited literature indicating the effectiveness of speech and language interventions carried out by non SLT professionals (Broomfield and Dodd, 2011; Law et al., 2001). With many SLT teams now operating a consultative service, it is important to explore further whether professionals at this grass roots level perceive collaboration to be effective in the delivery of intervention, what it looks like in practice, and whether children do, in fact, show measurable progress in their speech and language skills. The initial part of this study aims specifically to address this first point by exploring newly qualified SLTs’ beliefs about collaborative practice.

4 Teaching collaborative practice

A recent Cochrane Review (Reeves et al., 2013) indicated an increase in studies relating to inter-professional interventions, which it subdivides into: inter-professional education, inter-professional practice, and inter-professional organization interventions (Goldman et al., 2009). The systematic review focused on the positive impact that practice-based collaboration can have on healthcare processes and outcomes, but there has been less investigation into the impact of education-based interventions. Gilligan et al. (2014: 2) define inter-professional education as an occasion when ‘two or more professions learn with, from and about each other to improve collaboration and the quality of care’. The literature does not detail a specific environment in which this learning should take place and incorporates both university and practice-based learning. As the Commission on Education of Health Professionals for the 21st Century (Frenk, et al., 2010) published an analysis of the disjunctions between traditional health professions’ education and global health and health workforce, the World Health Organization (2010) issued the call for a ‘collaborative practice-ready’ health work force. As a consequence, the Inter-professional Education Collaborative Expert Panel (2011) was asked to recommend a common core set of collaboration competencies relevant for all professions, along with appropriate learning methods. Reeves et al. (2013) report that the use of competency frameworks is helpful to define professional competence, set consistent standards of practice and identify performance indicators. There has, however, been criticism of the proposed competency frameworks in respect of their ability to meet the needs of all the necessary trainee healthcare professionals, and therefore how their effectiveness can be measured. Gilligan et al. (2014) sought to obtain newly qualified practitioners’ views about their experiences of inter-professional education, with a view to understanding the short- or long-term learning outcomes of inter-professional education. Thematic analysis of focus group interviews with 68 medics, nurses and pharmacists who were up to 2 years post qualification from a range of Australian universities showed that the inter-professional learning experiences valued most highly at university were those that involved genuine engagement and opportunities to interact with students in other professions working on a relevant problem. They reported that clinical placements were a missed opportunity with few structured meaningful inter-professional learning experiences. There has, however, been very little research into student SLTs’ experiences of inter-professional learning. In order to meet the standards of proficiency necessary to qualify from UK pre-registration courses, SLT training typically encompasses a combination of medical and educational approaches (Health and Care Professions Council, 2013), and therefore SLTs’ experience of inter-professional learning could differ significantly.

5 Aims of the study

With the development in the teaching of inter-professional practice, in conjunction with the introduction in the UK of Education, Health and Care Plans that place collaboration at their core, it is important to explore SLTs’ current beliefs about how prepared they are to work collaboratively, and to consider how universities can develop their roles in supporting the development of this competency. This study seeks to take preliminary steps to address this by answering the following research questions:

1 Design

As the purpose of this study was to obtain participants’ views about their own experience, an experiential qualitative approach was taken, which is in keeping with the existing literature seeking to obtain perceptions of collaborative practice and university learning experiences. Sofaer (1999) argues that qualitative research is effective in healthcare research as it can give voice to those whose views are rarely heard and is useful for conducting initial explorations into new areas of research. Bias is an inevitable criticism of qualitative data analysis and, due to the small scale nature of this study, it was not possible to cross check analysis with co-researchers or study participants, or use more than one method of data collection. However, the findings were cross checked with data from published studies investigating the collaborative practice experience of other students and professionals in an attempt at triangulation. A threat to the validity of the study was the possibility that participants would not provide honest or reliable answers. In an attempt to reduce this threat participants were informed that there was no right or wrong answer and that their answers were not being judged. Participants were also made aware that the researcher was a practising SLT, and this awareness could have encouraged participants to share honest answers with a colleague who could appreciate the nature of their work.

2 Tools for data collection

Semi-structured interviews were used to explore participants’ views in order to answer the research questions. The use of semi-structured interviews was chosen to ensure that key areas for discussion were introduced, and also to give the freedom for both interviewer and interviewee to explore and provide additional information as necessary. Bernard (1988) states that semi-structured interviewing is beneficial when a researcher is unable to interview a participant on more than one occasion, as was the case in this study, and can provide reliably comparable qualitative data. As the research questions involved reflecting on past experiences, observations were not appropriate and questionnaires were considered insufficiently flexible for gathering meaningful data. Unstructured interviews, on the other hand, were felt inappropriate for this study as the researcher had clear research questions. Semi-structured interviewing through focus groups was not appropriate as participants were recruited from across the country, and it was unlikely that busy clinicians would have been able to give up the time to attend. Phone interviews were chosen rather than face-to-face interviews as they were deemed a more economical method of obtaining the necessary data in terms of both cost and time. Since participants were recruited from across the United Kingdom, phone interviews allowed for more flexibility should rescheduling have been required, and allowed for participants to choose the timing of the interview to suit their work and personal schedules. All participants were qualified SLTs, and it was therefore assumed that they would have the necessary communication skills to participate successfully in a phone interview.

Six questions for the interview schedule were chosen to reflect the findings of the literature review and are detailed below with supporting rationale. Prompt questions were used, where appropriate, to encourage the participant to provide as much detail as possible; however, their use was dependent on the participant’s initial response. The questions were:

In light of the varying definitions found in the literature pertaining to collaborative practice, Question 1 sought to establish whether SLTs were, in fact, applying similar or different meanings to the term. Question 2 explored whether those who carry out collaborative practice actually perceive it to be effective, and for what purpose. The literature over the last 20 years has highlighted a number of barriers to collaborative practice, and Question 3 sought to determine whether newly integrated working practices might have overcome some of these, and/or whether SLTs faced new challenges. Turning to Question 4, with the drive to introduce inter-professional learning on many healthcare courses, it was felt pertinent to determine whether SLT courses were already providing approaches to support the learning of collaborative practice. The intention for Question 5 was to determine the perceived effectiveness of any collaborative practice learning opportunities at university. In Question 6 participants were given opportunities to make suggestions, where appropriate, as to how collaborative practice could be better taught.

3 Participants

Ten qualified SLTs were recruited to take part in the study through purposive, non probability self-selection sampling and snowball sampling. Participants were recruited through contact with the London Speech and Language Therapy Managers’ Network, whereby an email was sent to all London SLT managers who were asked to cascade to members of their team who fitted the criteria for the study. All participants had to have graduated from a UK speech and language therapy course within the past two years, and all had to have been working in paediatric posts for at least five months. SLTs who participated in the study also passed on details to colleagues and friends outside the London area. Of the 10 participants, four had attended City University, London, two had attended University College London, two were Manchester University graduates, one a University of East Anglia graduate, and one had attended Cardiff Metropolitan University. Six participants held clinical positions in London, one in Berkshire, one in Hertfordshire, one in Bath and one in the North West of England. Due to the small sample size, in order to preserve confidentiality the above table only states the participant code, work setting and length of time in practice.

OPEN IN VIEWER

Table 1.

Participants’ work setting and length of time in practice.

Participant code	Work setting	Length of time in practice (months)
A	Mainstream Primary Schools	12
B	Child Development Team	12
C	Mainstream Primary Schools	5
D	Mainstream Primary Schools	5
E	Mainstream Primary Schools	5
F	Mainstream Primary Schools	12
G	Mainstream Primary and Secondary Schools	5
H	Clinic and Mainstream Primary Schools	5
I	Mainstream Primary Schools	12
J	Child Development Team	9

4 Ethical considerations

Prior to data collection, a risk assessment was carried with reference to the British Psychological Society (BPS) Code of Human Research Ethics and Code of Ethics and Conduct. It was felt that participants could have been at risk of professional embarrassment and/or reprisals from colleagues should their identities become apparent, and therefore measures to ensure confidentiality were employed. Ethical approval was obtained from the Institute of Education, London, Ethics Committee prior to commencement of the study. Participants were emailed an information sheet detailing the study’s aims and interview procedure. They were asked to read, sign and return a form giving consent to participate in the study and permission to audio record the interview. Verbal consent was also obtained prior to the commencement of the phone interview. Each participant was assigned a letter, and on all documentation this letter, rather than their name, was used. In transcribing the interviews, any identifying information relating to the participant, their place of work, clients or professionals with whom they worked was anonymized. All documents and audio recordings were stored securely using encrypted software.

5 Procedure

The interviews were carried out over the phone at a time that was convenient to the interviewee, and each lasted between 30 and 40 minutes. Prior to the commencement of the interview questions, a brief informal conversation was held to put the interviewee at ease and to gather information including; qualifying university, qualifying year, current geographical place of work, current work setting, and length of time in practice. The aims of the study were then explained, and the interviewee was informed of their right to withdraw from the study at any time. If the interviewee had no further questions, the interview questions commenced, at which point the interviewee was informed that audio recording had begun using a Dictaphone. The interviewer asked the same interview questions in the same order to all participants, and also asked additional prompt questions as necessary. The purpose of these additional questions was to clarify a response and/or obtain further information or examples, and to explore relevant themes raised by the interviewee that were not covered by the interview questions. All interviews were carried out by the same researcher, who also transcribed the audio recording orthographically following completion of the interview ready for data analysis.

6 Pilot study

A pilot study was carried out with two of the researcher’s colleagues who fit the participant criteria using the procedure described above. This was to determine the length of time the interview would likely take, and to make adjustments to the questions if necessary. Feedback from the pilot interviewees indicated that the first question: ‘please could you explain to me in your own words what the term “collaborative practice” means?’ was quite confrontational, and put a high amount of pressure on the interviewee. There was also a concern that the interviewee might get the answer ‘wrong’ which would impact on the rest of the questions. One pilot interviewee suggested giving a definition of collaborative practice prior to commencement of the interview. The researcher decided that an important aspect of the research was to determine whether there was a common understanding of the term collaborative practice, and therefore chose not to include a definition prior to seeking the interviewee’s understanding of the term. However, a definition could be provided if the interviewee could not offer one, or if they provided a completely unrelated definition. The researcher amalgamated Hornby’s (1993) and Lacey’s (2001) definition to provide the following explanation:

Collaborative practice describes a relationship based on working together for a common purpose (Hornby, 1993: 11). It includes processes such as sharing, trusting and handing over skills, joint assessments and mutual training. Professional boundaries are crossed naturally in an effort to meet a complexity of needs (Lacey, 2001: 11).

To ease the interviewee into the line of questioning, an initial question was inserted; ‘Have you come across the term collaborative practice in either your studies or working life?’ This question also allowed for a baseline measure of the participant’s exposure to the term collaborative practice. This was considered important, first to explore whether SLTs apply a common label to the practice of working together and, second, to establish a shared terminology for use throughout the rest of the interview. The pilot study also checked the reliability of the research tool to determine whether questions were interpreted equally across the two participants. Since only one researcher carried out the data collection, ambiguity over the meaning of the question was avoided as the researcher was able to rephrase the question if necessary to ensure all were offered the opportunity to answer the same question.

7 Data analysis

The interviews were transcribed orthographically immediately after each interview. This allowed the researcher to be immersed in the data, reflect on and develop the questioning style and consider the addition of further questions if necessary. Thematic analysis was chosen as ‘an accessible and theoretically flexible approach to analysing qualitative data’ (Braun and Clarke, 2006: 77). This study hoped to explore participants’ experiences, and therefore thematic analysis was chosen to reflect and unpick their realities in order to interpret their needs and those of future speech and language therapy students.

A theoretical approach to data analysis was carried out as the researcher wanted to answer specific research questions and therefore engagement with the literature occurred prior to analysis, and the data was coded to answer the specific research questions. Participants’ responses were read with reference to existing literature to confirm existing themes and identify new ones. Each transcript was read through by the researcher and open coded. This involved generating codes to represent ideas or themes associated with specific phrases or words in the transcript. Each individual coded chunk of wording was recorded in a table along with its definition. Once initial coding had taken place, codes were collated into themes. This necessitated cutting and pasting of transcripts, and allowed for coded data extracts to be analysed alongside each other, and to determine whether they did in fact represent the same theme. Themes were then organized into mind maps to search for relationships between themes and establish overarching themes and sub themes. Both prevalence in the data and the researcher’s perceptions of the importance of the data influenced the coding. Themes were then reviewed, expanded or collapsed as necessary, and again the data extracts were reviewed to ensure that they matched the theme. Following this, themes were defined in relation to the data set and research questions.

1 The value and purpose of collaborative practice

Despite the participants in this study using different names to refer to collaborative practice, the data suggested they all carried out their interpretation of collaborative practice and that collaborative practice occurred to best meet the needs of the child.

If you can’t work collaboratively with other people based round the child’s life then it’s just not going to be as useful for the child and you’re not really doing your job properly. (Participant A)

In defining what collaboration meant to them, the participants focused more on its purpose rather than the process of collaborating. All participants considered its role important in information gathering and information sharing and goal setting.

You’re linking up with other people around the child, to get their ideas and views of how a child is performing, what their skills or strengths and needs are. (Participant C)

Although a range of professionals – including health visitors, paediatricians, GPs, school and nursery teaching staff, physiotherapists, occupational therapists, behavioural support workers and social workers – were named as collaborators for information gathering and sharing, only education staff were named as collaborators for goal setting. The majority of participants also considered collaborative practice with education staff important for delivering speech and language intervention.

2 The SLT’s role in collaboration

The participants typically described their role as a provider and receiver of information about a child, but only as a provider of skills, for example modelling intervention sessions for school staff and/or training school staff to carry over work in the absence of the SLT and in functional environments such as the classroom. No participants commented on a reciprocal relationship in which SLTs might carry out intervention related to other health or education disciplines.

I think in my role at the moment is basically integral to working especially in schools there’s a lot of ground work in terms of building relationships with different people, getting them on side so that what you say gets implemented. (Participant G)

3 Barriers to and enablers of collaboration

Participants reported barriers to collaboration already identified in the literature on this topic, including time constraints, understanding of roles and responsibilities, and organizational goals. Additionally, two participants commented on individual professionals as barriers to collaboration.

You sometimes come across an individual who might cause a bit of blockage, they might be wrapped up in their own role and their own perspective. (Participant E)

All participants suggested that barriers should be addressed rather than ignored. Nine participants considered barriers as external factors and typically commented on the need to engage with senior school management to address these.

They [SLT colleague] had to have quite serious chats with fairly senior management, like the SENCo [Special Educational Needs Co-ordinator] and just have to be quite brave and clear what their role is and how they can all work together. (Participant E)

I think it’s helps if teachers know that the SENCos are on board, that helps with partnership and the team. (Participant D)

Only one participant focused on her own inter-personal skills in the success of collaboration.

I think you have to use your people skills, you have to be quite pragmatic and open to people, you have to be quite patient, sometimes you have tricky characters, you have to express an interest in them and awareness of their attitudes, beliefs and skills they’re bringing. (Participant E)

Additionally, two participants identified the relationship between SLTs and schools as a barrier or enabler to collaboration depending on the school’s role in the commissioning process:

In my current job I work in a mainstream school that is buying in speech and language provision and as such they’re engaged with the speech therapy process. In my previous job the collaborative working was very different and the school staff were really not engaged or aware of the role of the SLT. (Participant I)

One participant considered its value in promoting the SLT service:

Schools can choose to buy in speech therapy, so schools will obviously decide to buy in or not depending on the relationships they’ve had with therapists. (Participant G)

4 Exposure to collaborative practice as a student

The majority of participants commented on the fact that opportunities to experience collaborative practice were different for each student according to their placement experience. Many considered this to be due to the individual practice educator’s opinion of collaborative practice and their priorities for learning opportunities:

I think it’s about luck. If your placement educator cares about collaborative working then they will ensure that over your time they will send you off with a dietician or with a physio[therapist]. (Participant A)

As a student I felt quite sheltered from actually being able to be part of a multi-disciplinary team. They’re happy to leave you with a child and run a session, but for them to let go and say ‘you can go and speak to these professionals about what you’re planning,’ I think that’s difficult. (Participant B)

At university most participants agreed that they had been exposed to the concept of collaborative practice, even if this was under a different name; however, they felt that it was alluded to but not formally taught:

I don’t think we were taught about it, we had quite a lot of exposure to other roles but it was kind of indirect ‘this might be useful in your practice. (Participant H)

Some participants suggested that it was not given the gravitas that it deserved, and that it needed to be an assessed clinical skill:

I don’t think you really think about it as a clinical skill, I think probably it’s quite important that it is and there’s something more explicit about it. Whether there’s something that says ‘It’s not just about being able to be flexible and nice, you need to think about this as an important part of your clinical learning.’ (Participant B)

For many, it was felt that if and when collaborative practice was covered at university, the links to practice were not made clear:

It’s a very different thing isn’t it hearing about it and then knowing how you should actually do it. (Participant J)

5 Recommendations for change

Most participants felt that university teaching of collaborative practice might have been satisfactory had they been guaranteed opportunities to experience it on placement:

I feel that it [knowledge of collaborative practice] was in the back of my mind, but I think that unless you really saw it in practice, well it’s a very different thing isn’t it? (Participant J)

All participants agreed that opportunities to engage with other trainee professionals at university would be beneficial in learning about collaborative practice, particularly with regard to learning about other professionals’ roles:

I think joint study or lectures would be really good so everyone knows a little bit more about each other […] I think if people could be included in a focus day it actually brings it to life. (Participant E)

I think it would be really useful if people talked to each other properly about what they really do […] and stopped pretending that we knew what everybody did and how they worked. (Participant B)

And some felt that the timing of this learning experience needed to be carefully considered:

I remember being in MDT [multidisciplinary team] training and thinking this is a complete waste of time because really I need to learn about speech therapy. So I think it should be in your final year when you have the knowledge on your role. (Participant H)

1 Collaborative practice in paediatric work settings

In keeping with current research demonstrating positive healthcare outcomes resulting from inter-professional collaboration (Zwarenstein et al., 2009), all participants in this study valued collaborative practice, stating that without it the needs of the child cannot be fully met. The participants focused on the purpose of collaboration rather than process of collaboration and, when probed, described their role in the exchange of information for assessment, but in the dissemination of skills for the delivery of intervention. The transferring of skills across traditional disciplinary boundaries is key to Lacey’s (2001) definition of collaboration; however, Baxter et al. (2009) acknowledged power struggles between staff around the implementation of intervention, and the lack of reciprocity identified in this study may be an additional barrier to effective working relationships with school staff. This was not overtly recognized as a barrier by the participants; however, like the SLTs in Hartas’ (2004) study, participants did identify clarification of roles and expectations as an important enabler of collaboration for the purpose of intervention. Interestingly, all but one of the participants focused only on external factors in the success of collaboration for intervention, with only one participant considering their role and personality in the collaborative process. This participant reflected that as an SLT, and therefore a skilled communicator, she needed to adapt in order to manage interpersonal barriers. Interestingly, she was the only participant who had been a mature student, and perhaps life experience allowed for greater self-reflection of her role in the collaborative process. It would be interesting to explore further how SLTs’ beliefs about the barriers and enablers of collaborative practice evolve over time and with experience. Positive interpersonal relationships between SLTs and school staff were seen as an enabler of collaboration for two participants who had experience of working in schools that directly commissioned speech and language therapy services.

For the participants in this study, collaboration was particularly important for the delivery of intervention in mainstream school settings. The findings suggest that these SLTs consider interventions carried out by non SLT professionals to be effective despite limited supporting evidence (Broomfield and Dodd, 2011; Law et al., 2001). It is encouraging that grass roots level practitioners perceive positive outcomes for children through effective collaborative practice, and it would be beneficial to explore this further through research measuring the effectiveness of collaborative practice on children’s speech and language outcomes.

2 The effectiveness of the teaching of collaborative practice on their pre-registration university course

Most of the participants in this study report that at university collaborative practice was alluded to but not specifically taught as a concept. This may in part be because the process of collaborative practice is so difficult to define, as is reflected in the multiple definitions found in the literature (Leathard, 1994). Likewise, although an important skill in the work of SLTs, due to its undefined nature it is difficult to conceptualize it as a clinical skill which must be demonstrated in order to qualify. This is in line with criticisms of the competency model devised by the Inter-Professional Education Collaborative Expert Panel (2011) and supports Hepp et al. (2015) who suggest that competencies should be tailored to reflect the different practices of individual professional groups. In support of previous findings (Gilligan et al, 2014), for participants in this study experience of collaborative practice on placement varied greatly, and opportunities for students to develop more traditional clinical skills were prioritized over engagement with collaborative practice. It might be the case that practice educators focus on traditional clinical skills on placement, believing that collaborative practice develops when in post, particularly if collaboration is facilitated by interpersonal relationships which students on placement may not have time to foster.

3 How the teaching of collaborative practice on university courses could be improved

Hepp et al. (2015) argue that current literature has focused on knowledge of and attitudes towards collaborative practice, rather than the applied component of how inter-professional working is enacted in a practice setting. This is reflected in the responses of participants in this study, who focused on the purpose rather than the process of collaboration. The participants offer a means of qualifying collaborative practice in the context of speech and language therapy, to inform information gathering, and to provide intervention. These purposes are not cross professional; however, they do provide some conceptual clarity. In considering the code of practice (Department for Education and Department of Health, 2014), joint target setting could be included as a third purpose, and universities could consider teaching collaborative practice for the purpose of information gathering, joint target setting and delivering intervention. Lack of a collaborative purpose could underlie some of the difficulties that universities face in linking theory to practice, a criticism of current teaching that a number of the participants in this study make. Using a clearer definition of collaborative practice as a competency for achievement on placement could be one way to encourage more practice-based experiences, even if the student observes others carrying it out and reflects on the process.

Another suggestion is for universities to embed collaborative practice in the curriculum through inter-professional learning opportunities. A number of participants recommend the use of complex case studies to facilitate inter-professional discussions, and to appreciate each others’ roles and viewpoints. Some participants feel that they do not have a thorough understanding of the roles of other professionals, and this lack of understanding of roles and responsibilities has been shown in the literature to be a barrier to collaborative practice (Dunsmuir et al., 2006).

4 Limitations

As with all qualitative research projects, obtaining demographic representativeness was not the aim of this project, but rather to obtain the in-depth views of a cohort of SLTs regarding the aforementioned topics, which might lead to explanatory theories for the experiences of other individuals who are in comparable situations (Horsburgh, 2003). Convenience sampling, as used in this study, is considered to be the least rigorous sampling method (Sandelowski, 1995), and it would have been preferable to obtain the views of participants from a broader range of universities across the United Kingdom. Although opportunities to cross check the analysis of the data with a co-researcher in order to provide credibility and confirmability of the data (Liamputtong, 2010) was not possible due to the small scale nature of this study, the researcher could have undertaken member checking to ensure interpretations of the data reflected participants’ views.