Deck 15: Evidence-Based Practice in Practice

Question 1

List the seven-steps of the process for engaging in evidence-based practice.

Answer 1

The seven steps of the process for engaging in evidence-based practice (EBP) are as follows:

1. **Cultivate a spirit of inquiry and an EBP culture**: This involves creating an environment where questioning and exploring best practices are encouraged. It sets the stage for continuous improvement and a commitment to using the best available evidence to guide practice.

2. **Ask a clinical question**: Formulate a clear, focused question that addresses a need or problem. This is often structured using the PICO(T) format, which stands for Population/Patient, Intervention, Comparison, Outcome, and Time.

3. **Search for the best evidence**: Conduct a thorough search of the current literature to find relevant research, guidelines, and other resources that address the clinical question. This step involves using databases, journals, and other sources to gather information.

4. **Critically appraise the evidence**: Evaluate the quality, validity, and reliability of the evidence found. This step is crucial to determine the applicability of the results to the specific clinical context and to assess the strength of the findings.

5. **Integrate the evidence with clinical expertise and patient preferences**: Combine the best available evidence with the clinician's own expertise and consider the values and preferences of the patient or population affected. This step ensures that the EBP is both scientifically sound and tailored to individual care.

6. **Implement the practice change**: Develop and execute a plan to apply the evidence-based intervention or change in practice. This may involve creating new protocols, educating staff, and making necessary adjustments to ensure successful implementation.

7. **Evaluate the outcomes of the practice change**: After the new practice is put into place, it's important to assess the outcomes to determine the effectiveness of the change. This includes monitoring for improvements in patient care, satisfaction, and any other relevant outcomes.

These steps are iterative, and the process may lead to further questions and ongoing refinement of clinical practice. Engaging in EBP is a dynamic process that requires collaboration, ongoing education, and a commitment to improving patient outcomes.

Question 2

What is the difference between evidence-based practice, empirically supported practice, and practice-based evidence?

Answer 2

Evidence-based practice, empirically supported practice, and practice-based evidence are three terms that are often used in the context of healthcare, psychology, and social services to describe approaches to treatment and intervention. While they share similarities in that they all involve the use of data and research to inform practice, they have distinct meanings and applications.

1. Evidence-Based Practice (EBP):
Evidence-based practice is a decision-making process that integrates the best available research evidence with clinical expertise and patient values and preferences. It is a holistic approach that considers the quality and applicability of current research, the practitioner's own experience, and the patient's situation, rights, and preferences in making clinical decisions. EBP is often associated with systematic reviews and meta-analyses that summarize the outcomes of multiple studies to provide guidance on effective practices. The goal of EBP is to improve patient outcomes by applying the most current and robust scientific evidence to clinical decision-making.

2. Empirically Supported Practice (ESP):
Empirically supported practice refers to specific treatments or interventions that have been scientifically tested and demonstrated to be effective through rigorous research, typically randomized controlled trials (RCTs). ESPs are often identified through guidelines and standards set by professional organizations, which review the evidence and endorse certain practices for specific conditions or disorders. The focus here is on the intervention itself and its proven effectiveness for a particular issue, rather than on the broader decision-making process that includes patient preferences and clinician expertise.

3. Practice-Based Evidence (PBE):
Practice-based evidence is an approach that emphasizes the value of data and knowledge generated from real-world practice. It involves collecting and analyzing outcomes from everyday clinical settings to inform and improve practice. PBE is often used in situations where RCTs are not feasible or ethical, or where there is a need to understand how interventions work in diverse and complex real-life situations. PBE can help to validate interventions that are widely used and respected by practitioners but may not have been extensively studied through traditional research methods.

In summary, evidence-based practice is a comprehensive approach to clinical decision-making that incorporates research evidence, clinical expertise, and patient preferences. Empirically supported practice focuses on interventions that have been proven effective through high-quality research. Practice-based evidence emphasizes the importance of data and insights gained from actual practice settings to inform and improve the care provided to patients. Each of these approaches plays a critical role in ensuring that patients receive the most effective and appropriate care based on the best available information.

Question 3

List and define each of the four principles of ethical practice.

Answer 3

The four principles of ethical practice are autonomy, beneficence, non-maleficence, and justice.

1. Autonomy: This principle emphasizes the importance of respecting an individual's right to make their own decisions and choices. It involves providing information and allowing individuals to make informed decisions about their own care and treatment.

2. Beneficence: This principle focuses on the obligation to do good and promote the well-being of others. It involves taking actions that benefit others and contribute to their overall welfare.

3. Non-maleficence: This principle emphasizes the obligation to do no harm. It involves avoiding actions that could cause harm or negatively impact the well-being of others.

4. Justice: This principle emphasizes the fair and equitable distribution of resources and the fair treatment of individuals. It involves ensuring that all individuals have equal access to care and treatment, and that decisions are made in a fair and unbiased manner.

These principles serve as a guide for ethical decision-making and are essential for promoting the well-being and rights of individuals in various professional fields, including healthcare, social work, and business.

Question 4

Compose a PICO question that would address the following preliminary question: "Is group therapy for children with phonological impairment effective?"

Question 5

Compose a PICO question that would address the following preliminary question: "Is it better to schedule phonological intervention sessions three times per week or weekly?"

Question 6

List two constituted review groups that provide summaries or syntheses of external evidence.

Question 7

Describe the two parameters for evaluating published research evidence.

Question 8

Arrange the following levels of evidence (based on ASHA, 2004) in order of credibility:

A)Expert committee report, consensus conference,
B)clinical experience of respected authorities;
C)well-designed meta-analysis of > 1 randomized controlled trial;
D)well-designed non-experimental studies, i.e., correlational and case studies;
E)well-designed randomized controlled study;
F)well-designed quasi-experimental study (including single-case experimental designs [SCED] such as multiple baseline design across participants or behaviors);
G)well-designed controlled study without randomization.

Question 9

What is the difference between a feasibility study and an effectiveness study?

Question 10

What is the name of one law, policy, or position paper (either international or national) that influences the clinical management of children with speech sound disorders? How does this law influence clinical practice?

Question 11

Discuss two barriers that SLPs may encounter when trying to engage in evidence-based practice with children with speech sound disorders, and propose how those barriers might be addressed.

Question 12

How might children with speech sound disorders and their families make fully informed preferences about intervention options for managing speech sound disorders?

Question 13

Review the code of ethics for the professional speech-language pathology association in your country, and discuss how the code would influence your conduct of either assessment or intervention with children with speech sound disorders.

Question 14

Explain how you would gather and evaluate internal evidence from clinical practice, relevant to the management of the five different types of speech sound disorders in children.

Question 15

Discuss the challenges associated with keeping up-to-date, and outline how, in their own private practice, SLPs could remain update-to-date with the latest research on assessment and intervention for children with speech sound disorder.

Question 16

To what extent can school-aged children with speech sound disorders be fully informed and participate in making decisions about the management of their speech sound disorder?

Question 17

Discuss how colleagues could support SLPs in their conduct of evidence-based practice with children with speech sound disorders.

Question 18

Choose two associations that support children with speech sound disorders (e.g., The Childhood Apraxia of Speech Association of North America (CASANA); Afasic) and explain how they support children with speech sound disorder and their families, speech-language pathologists and the wider community.

Question 19

What would you do if a parent disagrees with your recommendation about the type of intervention suitable for his or her child with a speech sound disorder?

Question 20

Compare and contrast two international policies or conventions relevant to the management of speech sound disorders in children.

Question 21

In contrast with evidence-based practice (EBP) empirically-supported practice solely:

A) relies on evidence from day-to-day clinical practice to support practice.
B) relies on good-quality peer-reviewed published research to support practice.
C) relies on evidence from clients and their families to support practice.
D) considers clinical expertise rather than published research to support practice.

Question 22

Which of the following questions contains all the elements of a PICO question?

A) Is parent-delivered intervention effective, when the parents are trained to provide intervention and collect rating scales of their child's performance across intervention sessions?
B) What intervention approaches are suited to group intervention when compared to individual intervention?
C) In children with moderate-severe phonological impairment characterized by phoneme collapses, is minimal pairs more efficient than multiple oppositions for improving changes in children's percentage of consonants correct?
D) In children with moderate-severe phonological impairment, is group therapy as effective as individual therapy?

Question 23

Effectiveness studies:

A) are pre-cursors to efficacy studies and are designed to determine whether there is an effect of intervention.
B) are conducted once efficacy studies have been done, and examine outcomes of particular intervention approaches under everyday clinical conditions.
C) determine whether a clinical idea is feasible or doable.
D) determine whether an intervention has caused a desired change in a targeted skill, under tightly controlled experimental conditions.

Question 24

Jane (SLP) heard about a new intervention approach for children with a speech sound disorder at a conference but questioned the credibility of the evidence because:

A) the findings from the study were from a large randomized controlled trial.
B) the recommendation to use the approach was based on expert opinion.
C) the findings were based on a meta-analysis of six randomized controlled trials.
D) the findings were based on a series of nine quasi-experimental group investigations.

Question 25

Ellie (SLP) would like to examine the internal clinical case-based evidence associated with providing multiple oppositions intervention to children with moderate-severe and severe phonological impairment in weekly sessions. To do this, she needs to:

A) search for peer reviewed published studies on the outcomes of different models of service with multiple oppositions intervention.
B) critically evaluate the quality of the empirical evidence she finds on multiple oppositions intervention.
C) examine case-based data from her own clinical practice for the children she has worked with who received weekly multiple oppositions intervention.
D) examine the practice-based evidence gathered by the clinicians in her workplace focused on the outcomes achieved by children who have received weekly multiple oppositions intervention.

Question 26

Practice-based evidence is helpful for guiding clinical decisions because it:

A) provides evidence to tell you if intervention in the workplace caused the improvement in children's speech intelligibility.
B) has high internal validity.
C) provides causal evidence about the effectiveness of an intervention everyday clinical conditions.
D) can provide helpful descriptive measures of the outcomes of intervention provided by SLPs.

Question 27

The strategy that would not be appropriate for helping families make an informed preference about the management of speech sound disorders is:

A) showing a video of a mock session for a particular intervention approach.
B) compiling de-identified comments and feedback from previous children and their families about their experience with your speech-language pathology service.
C) providing an information sheet about a particular intervention approach.
D) allowing families to view the clinical records for the children you have worked with.

Question 28

When engaging in ethical practice, nonmaleficence means:

A) not making problem or situation worse.
B) doing good.
C) making the right decision in light of the proposed benefits, risks, and costs.
D) ensuring families are fully informed of the risks and benefits of a particular intervention.

Question 29

When engaging in ethical practice, beneficence means:

A) not making problem or situation worse.
B) respecting and supporting autonomous decisions.
C) doing good.
D) making the right decision in light of the proposed benefits, risks, and costs.

Question 30

Rosie (SLP) owns a private speech-language pathology practice focused on clinical services for children. To ensure that her practice meets the Code of Ethics developed by her professional association, she needs to:

A) ensure that accurate clinical records are maintained.
B) ensure that she maintains her professional competence through ongoing continuing education activities.
C) ensure that clinical decisions with families are fair, carefully balancing benefits, risks, and costs.
D) all of the above.

Question 31

Which of the following assessment tools reflects Articles 12 and 13 of the United Nations Convention on the Rights of Children (UNCRC) (UNICEF, 1989), and supports SLPs to listen to the views of children in matters that concern them?

A) Oral and Speech Motor Control Protocol (Robbins & Klee, 1987).
B) Speech Participation and Activity Assessment of Children (SPAA-C) (McLeod, 2004).
C) Nuffield Centre Dyspraxia Programme (Williams & Stephens, 2004).
D) Single Word Test of Consonant Clusters (McLeod, Hand, Rosenthal, & Hayes, 1994).

Question 32

The comment consistent with people first terminology is:

A) child with a phonological impairment.
B) lisping child.
C) dyspraxic child.
D) dysarthric child.

Question 33

Cheryl (SLP) has been asked by Mrs. Jones (the parent of a child with childhood apraxia of speech [CAS]) to provide an intervention approach for childhood apraxia of speech that Cheryl is unfamiliar with. Of the following responses, the most ethically responsible next step would be to:

A) not provide the intervention as Cheryl is unfamiliar with it.
B) develop a PICO question and compare the external peer reviewed published evidence on the unfamiliar intervention with the intervention approach that Cheryl is familiar with and may have used.
C) learn how to implement and use the intervention in light of the parent's preference.
D) provide the parent with internal evidence on the intervention approach that Cheryl current uses, and recommend that the unfamiliar intervention not be used.

Question 34

The PICO element missing from the following question: "Is my current approach to intervention as efficient as the new approach I just read about for children with articulation impairment?" is:

A) outcome.
B) patient.
C) comparison.
D) intervention.

Question 35

The PICO element missing from the following question: "For preschool-aged children, is cycles therapy the most efficient for improving children's speech intelligibility, as measured by PCC?" is:

A) patient.
B) intervention.
C) comparison.
D) outcome.

Question 36

From the list below, the highest level of evidence is:

A) well-designed correlational study.
B) well-designed single-case experimental design study.
C) well-designed quasi-experimental study.
D) well-designed control study without randomization.

Question 37

Internal evidence from everyday clinical practice is ideally:

A) gathered annually by the SLP, using a national measurement system.
B) a researcher conducting a well-controlled randomized controlled trial in an SLP's practice.
C) derived from systematic and regular data collection by non-SLP auditors.
D) based on SLPs systematically and regularly collecting and analyzing data from the children and families that they work with.

Question 38

Practice-based evidence is best derived from:

A) efficacy studies.
B) feasibility studies.
C) effectiveness studies.
D) a standard reliable outcome measure system from everyday clinical practice.

Question 39

Mrs. Wang's daughter Rachel is 3;2 years. Rachel has CAS. Mrs. Wang has told you that she is considering finding another SLP because her daughter it not making enough progress. An unethical response would be to:

A) talk with Mrs. Wang about the nature of CAS and provide her with written information about CAS.
B) provide Mrs. Wang with your internal case-based evidence on Rachel's response to intervention, and provide her with information about a CAS parent-support group.
C) tell Mrs. Wang that she is not permitted to seek another opinion because Rachel has been making progress.
D) acknowledge that Mrs. Wang is welcome to seek a second opinion.

Question 40

Natalie (SLP) has been in private practice for 2 years. Of the following continuing education activities, the least helpful for Natalie would be:

A) attending a convention relevant to speech-language pathology.
B) joining an evidence-based network of SLPs who read and discuss research evidence.
C) attending a workshop on speech sound disorders in children promoting an untested commercial intervention resource.
D) enlisting the support of an SLP mentor and observe the mentor conduct clinical practice.