Evidence Based Practice
In School Settings
By
Perry Flynn
Consultant to NC DPI in SLP
What IDEIA says:
“ The Special Education and related
services in the IEP must be based on
peer-reviewed research to the extent
practicable”
What is EBP?
• The goal of EBP is the integration of:
(a) clinical expertise, (b) best current
evidence, and (c) client values to
provide high-quality services reflecting
the interests, values, needs, and
choices of the individuals we serve.
Factors that influence
Clinical Decisions
Clinical Expertise
EBP
Research Evidence
Patient Preferences
Steps in the Process
1.Framing the Clinical Question
2.Finding the Evidence
3.Assessing the Evidence
4.Making the Decision
PICO
Step 1
Population, What population are you
investigating?
Intervention, What types of
intervention are being
considered?
Comparison, What other
interventions might be
considered?
Outcome, What are the desired
outcomes?
A 7 Step EBP DecisionMaking Process
(adapted from Porzsolt et al. (2003))
• 1
• 2
• 3
•
•
•
•
4
5
6
7
Create a clinical question
Find studies that relate to the question
Determine the level of evidence that the study
represents and assess the quality of the study
Assess the child/parent factors
Assess clinician/agency factors
Integrate the evidence
Evaluate the decision
Finding the Evidence, Step 2
1.Systematic reviews
2.Individual studies
http://www.asha.org/members/ebp/
compendium/
Cochrane Collaboration
Campbell Collaboration
What Works Clearinghouse (US Department of Education)
Psychological Database for Brain Impairment Treatment Efficacy
National Electronic Library for Health (National Health Service of the UK)
Evidence-based Communication Assessment and Intervention (EBCAI) Journal
Assessing the Evidence, Step 3
Level
Ia
Ib
IIa
IIb
III
IV
Description
Well-designed meta-analysis
of >1 randomized controlled
trial
Well-designed randomized
controlled study
Well-designed controlled
study without randomization
Well-designed quasiexperimental study
Well-designed nonexperimental studies, i.e.,
correlational and case
studies
Expert committee report,
consensus conference,
clinical experience of
respected authorities
Meta-analysis
A specialized form of systematic review in which the results from several studies are summarized
using a statistical technique to yield a single weighted estimate of their findings
Making the Decision, Step 4
Clinical Expertise
EBP
Research Evidence
Patient Preference
Evidence Maps
http://www.ncepmaps.org/
Autism Spectrum
Disorders
Parkinson's Disease
Traumatic Brain Injury
(Adults)
Traumatic Brain Injury
(Children
Where to find Everything
from ASHA on EBP?
http://www.asha.org/Members/ebp/intro/
References
• Ehren, B., Fey, M., Gilliam, R., SLP’s Start Your Engines:
Evidence –Based Practise in Schools, ASHA Schools
Conference, Indianapolis, July 8, 2005
• Evidence Based Practice Tool Available, ASHA Leader, June
13, 2006
• Perspectives on Language Learning and Education, Volume
13, number1 March 2006
• Porzsolt, f., Ohletz, A., Gardner, D., Ruatti, H., Meier, H.,
Schotz-Gorton, N., & Schrott, L. (2003) Evedence-based
decision making: The 6 step approach. American College of
Physicians Journal Club, 139 (3), 1-6.
• Scottish Intercollegiate Guidelines Network.
(2004). SGN 50 A guideline developer’s
handbook. Received November 27,2005
fromhttp://wwwisign.ac.uk/guidelines/fulltext/
50/section6.html
• Straus, S.E., Richardson, W.S. Glasziou, P.,
& Hayes R.B. (2005) Evidence-based
medicine: How to practice and teach EBM.
New York: Elsevier