Practitioners of all descriptions are busy people. Our jobs are full to the brim. There are so many pressures, and evidence based practice can sometimes feel like another thing to do.
The demand for evidence based practice (EBP) has never been greater. A few years ago, schools never thought about outcomes of interventions. Now it is standard practice for a headteacher to ask, ‘what is the evidence base of that intervention?’ An individual, and indeed professions, which reply ‘I don’t know,’ are going to face tough challenges. NHS commissioners are also making tough decisions on where to spend their funds, and practitioners who are most conversant with the evidence base will stand the greatest chance of investment.
But most of all it is about the children and young people we work with. How can we do the best for them if we are not familiar with the best evidence?
Access to journals was once a major hurdle, and unless you were able to gain entry to a university library you were pretty much stuck. Luckily things have changed. Google Scholar is a good starting point, and often it will also guide you to free access copies of articles. There are also open access journals such as ‘Autism & Developmental Language Impairments’ which are totally free to use. NHS employees have free access to a large range of journals via Open Athens and members of the Royal College of Speech and Language Therapists have access to a range of large range of online journals including the ‘International Journal of Language and Communication Disorders’, which now even comes as an app. Conferences such as those run by NAPLIC are an easy way in if you prefer live interaction to reading.
Reading the literature on its own is not enough. As Caroline Rowland points out in her blog, practitioners must be cautious about what they read if they are to ‘avoid the snake oil merchants.’ As Emma Pagnamenta and Vicky Joffe emphasise, practitioners need to develop critical thinking in order to make sense of the evidence.
Time is still a factor, so databases such as What Works and the Education Endowment Foundationare useful tools. Personally, we are looking forward to the forthcoming publication of Caroline Bowen and Pamela Snow’s book ‘Making Sense of Interventions for Children’s Developmental Disorders’ which looks set to be a short cut to sifting through evidence for professionals and parents. But perhaps the most under-rated evidence based tool is discussion. Talking with colleagues about evidence, either at a formal journal club or informally is a sure-fire way to make sure evidence informs our regular practice.
It is still a great mystery why so many commonly used interventions in the speech, language and communication field have never been researched, or are woefully under-researched. For instance, the Derbyshire Language Scheme has been around for years, is widely used, but almost no one has researched it. At a recent presentation, Nathaniel Swain from the University of Melbourne presented the slide below showing how Evidence Based Practice (EBP) and Practice Based Evidence (PBE) can fit together. We are at risk of oversimplifying this concept, but Practice Based Evidence is good quality clinical practice, and tasks such as assessment, creating SMART goals and measuring response are all very familiar to practitioners. Over time the cycle can be repeated and patterns will emerge that can then develop into evidence based practice. Starting with Practice Based Evidence is particularly useful in fields where there is little or no evidence. Once evidence emerges it will then influence typical practice and so on. In the (many) areas where evidence is lacking we can start with what is typically happening now, and use this as a basis for developing a more robust evidence base.
Finding time for evidence based practice will support clinical practice, but also crucially influence the research of the future.
Swain, N (forthcoming thesis, 2017) Speech-language pathology intervention for young offenders. The University of Melbourne
Knowles, W and Masidlover (1982) The Derbyshire Language Scheme, Published by Derbyshire County Council
Stephen Parsons has worked as a Speech and Language Therapist for over 25 years. He is an SLT Service Manager in Hackney in London.
Anna Branagan has over 20 years experience as a Speech and Language Therapist. In her specialist role she supports schools to develop inclusive practice. She also works within a Youth Support Team.