What ‘Using EBP’ Really Means Using evidence-based practice is sometimes easier said than done. What can you do to make sure you are serving your students properly? School Matters
School Matters  |   October 2014
What ‘Using EBP’ Really Means
Author Notes
  • Deborah Dixon, MA, CCC-SLP, is ASHA director of school services. ddixon@asha.org
    Deborah Dixon, MA, CCC-SLP, is ASHA director of school services. ddixon@asha.org×
  • © 2014 American Speech-Language-Hearing Association
Article Information
School-Based Settings / Research Issues, Methods & Evidence-Based Practice / School Matters
School Matters   |   October 2014
What ‘Using EBP’ Really Means
The ASHA Leader, October 2014, Vol. 19, 28-29. doi:10.1044/leader.SCM.19102014.28
The ASHA Leader, October 2014, Vol. 19, 28-29. doi:10.1044/leader.SCM.19102014.28
School-based speech-language pathologist Marina has decided that she really wants to do things differently this year and wants to work with students using different service delivery models. How, though, should she make decisions about which models will work best with her students who have various needs?
Evidenced-based practice is a term that has been around for a long time, but is often misinterpreted and misused. School-based SLPs report that they are being told they cannot use a service delivery model, intervention technique or assessment strategy unless they can produce the research to support it. And on the surface, that requirement sounds reasonable.
The problem is that EBP is more than just the external scientific evidence—it refers to an approach in which “current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions,” as indicated in ASHA’s EBP in communication disorders position statement (on.asha.org/ebp-csd). All three principles—research, practitioner expertise, and client preference and values—are equal and important.
Why evidence alone won’t work
Of course using external scientific evidence and research is fundamental to providing quality services. However, there are many challenges:
  • There isn’t enough research out there. Although we have solid, high-quality research on many clinical and professional topics, there are many areas in which the research just isn’t there. For example, Marina wants to use different methods of service delivery, but that area needs more research, as noted in a 2010 review in Language, Speech, and Hearing Services in Schools. Another systematic review by ASHA’s National Center for Evidence-Based Practice in Communication Disorders concluded that speech-language service delivery to young children is “woefully understudied.”

  • Not all evidence is high-quality or relevant. ASHA offers many resources to help practitioners assess evidence. For example, if you are in a meeting with parents who are asking for a specific treatment based on something they read in a less-than-scholarly journal, you need to discuss the quality of the research. Is this research relevant? Is it evidence-based? Who wrote and published the guidance?

  • How much research is enough? Will one article fulfill a supervisor’s need for “research”? If so, is that practice really appropriate? Can one rely on any research without evaluating its quality? Is an SLP’s experience and expertise considered appropriate “evidence”?

What should you do?
So, what should you do when a supervisor dictates that you can carry out only things that are supported by evidence?
  • Work with the supervisor to reflect on the three key EBP tenets: research, practitioner expertise, and client preference and values. Discuss the steps in the EBP process: framing the clinical question, finding evidence, assessing the evidence and, finally, making the clinical decision.

  • Ask for assistance to identify quality research. Continue to look for research and expand your clinical expertise through professional development, reading and communication with colleagues.

  • Discuss your expertise and experience and how it has resulted in positive outcomes for students. Review EBP methods and procedures together and determine how to proceed with and without quality evidence.

These suggestions are not a message to abandon research evidence when making decisions. As stated earlier, all three components of EBP are equally important and relevant. The message is that there is not always high-quality, relevant, formal research to support all necessary decisions. Rather than tossing aside everything you find successful (but for which “research” does not exist), demonstrate good decision-making skills, discuss how and why the decisions are made, and be open to sharing knowledge and expertise among all team members.
So what did Marina decide to do? First, she searched for evidence, but didn’t find much except descriptions of service delivery. Then, she posted some questions on the ASHA Community, and got some good ideas about different options for providing services and expanding collaboration with teachers. She also spoke about service delivery with other SLPs in her region at a faculty meeting. Several classroom teachers agreed to work collaboratively with her in their classrooms. They decided on a model that worked for each of them.
To determine the impact of the services, Marina took baseline data on communication skills and the teacher provided other baseline data. Marina began to use a classroom-based model with some students and a small-group pull-out model with others, and she included some individual sessions, using the full continuum of service delivery. She also spoke with families to explain the issue of service delivery and set the stage for changes in the frequency, duration and location of services throughout the school year, based on students’ progress and other factors.
She will compare the impact of the different models on the students’ progress and on teachers’ knowledge of the work that she does and her knowledge of what goes on in the classroom.
Marina was able to use all three factors of EBP and come up with a solution that, although evolving, capitalized on her knowledge and expertise, is being monitored for success, and, most of all, meets the needs of her students.
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October 2014
Volume 19, Issue 10