Emma Pagnamenta - Making sense of it all: Explaining the evidence (or lack of it)


Using evidence to inform our practice with children and young people is integral to how we work with children with speech, language and communication needs.  Practitioners make important decisions every day; and these decisions are informed by evidence from a whole range of sources. A crucial part of the evidence landscape is evidence of effectiveness of interventions, and What Works offers us a great tool to help us find and use this evidence. Other information is also essential to informing what decisions we make – factors such as our experience and expertise as practitioners, the context in which we work and of course the perspective of the child and their family. 

But our decisions are not taken alone.  An essential part of our role is explaining the evidence to others and enabling ‘shared decision making’.  This may be at the level of an individual or a setting.  Without understanding of and engagement with the decision making process and the evidence behind our decision, we cannot expect a family and school team to understand and support the intervention that is subsequently provided.

Conversations about evidence and decision making can be challenging.  In some areas we have developed robust evidence of good practice, but in others we have less evidence on which to base our decisions.  This can be frustrating for everyone. We need to be transparent about this with our colleagues and service users, explain why this is the best intervention at this current time and describe the evidence that is available. In the best case scenario we would have plenty of evidence to show that an intervention works, is safe and efficient.   In reality we are working with children with speech, language and communication difficulties that may require complex and individualised interventions, and one size does NOT fit all.

Moreover families often do their own research and come to us as the ‘expert’ to ask questions about what they have read. They may query why we are not delivering another intervention that someone else they know has received or a ‘new’ intervention they have read about on someone’s blog or a website.

Even if we don’t know about every intervention available, and at times we won’t, we can commit to finding out more information about the interventions brought to us by families.  We can look into the evidence behind them – the quality of the evidence and whether there were positive or negative outcomes, and who participated in the research studies.  We can return with this information to enable a discussion about how we move forward (see Caroline Rowland - Avoiding the snake oil merchants: How to choose an evidence-based intervention program for the Early Years and Key concepts that people need to understand to assess claims about treatment effects for some pointers).

The good news is that we do not face these challenges alone.  Our peers, colleagues and networks are the ideal forum in which to discuss how we have conversations about what works in a professional, assuring and honest manner.  Resources are available to us, for example Testing Treatments provides a wealth of resources on critical thinking about interventions, more information on shared decision making is provided by The Health Foundation and Cochrane UK have launched an ‘Understanding Evidence’ campaign. The most important part of the process is to keep on having these conversations and sharing knowledge and expertise. Through collaboration between researchers and practitioners, our evidence base will continue to grow and develop, and our decision making will be enhanced and refined

By Emma Pagnamenta, Research Manager at the Royal College of Speech and Language Therapists  and Professor Victoria Joffe, City University.

Written by Emma Pagnamenta at 00:00