Evidence-Based Practice
Beth Perra, Michelle Mercado,
Stephanie DeSamLazaro and Michelle Barton
Assistive Technology Evaluations in the
School System
Beth Perra, MA, OTR/L
Moundsview School System
EBP PROCESS
• Developing an EBP question:
– Practice Dilemna:
• IDEA 2004 mandates all students on IEPs be considered
for assistive technology (AT).
• School district wireless 2011-12
• OT leads AT team
• SETT framework used as guideline for AT assessment
(Zabala, 1995, 2005)
EBP Question- Take 1
• Can an AT evaluation tool be modified for
school systems?
• Can the SETT framework (Zabala, 1998, 2005)
be used to establish AT need & be ‘userfriendly’ to IEP team members?
Summary of Findings
Level I
• Models and instruments exist
– Lack of evidence-based procedures for AT selection
– Lack of standardized, reliable, and valid instruments
guiding AT selection process
– Instruments often used outside a model as a theoretical
framework (Bernd, Van Der Pijl, & Witte, 2009)
• Lack of individualized assessment of AT equipment
(Alper & Raharinirina, 2006)
• Inadequate AT assessment and planning processes &
Team model proposed (Copley & Ziviani, 2006)
EBP Question-Take 2
• Revised for Level II search: Is there evidence to
support best practice for identifying AT need?
Summary of Findings
Level II
• Team-based process had benefits for teams: more specific and
achievable goals, more effective teamwork (Copley & Ziviani, 2007)
• AT provided by multidisciplinary team helpful in improving
performance (Watson et al, 2010)
• Students’ perceptions of AT use: immediate benefits, students
using AT fit in, easily accessible (Hemmingsson, Lidstrom, & Nygard, 2009)
• AT assessment should be broad ranging and completed by
qualified, multidisciplinary team including family (Hoppestad, 2006)
Summary of Findings
Level II
Negatives:
• Little evidence exists for AT effectiveness in public schools.
• Lack of outcome measurement.
• Lack of validity or reliability testing with specific AT
evaluations.
Positives:
• AT provided by multidisciplinary team.
• Comprehensive team approach aligns abilities to
environments.
• Students’ perspectives, family input, cultural values.
Limitations & Future Research
• Small sample sizes
• Short data collection periods (1 school year)
• Team members difficulty finding time to commit
• AT outcome measurement needed
Feeding Difficulties in Toddlers: An
Overview of Feeding Interventions
and the Evidence
Michelle Mercado MA, OTR/L
Introduction to an Evidence Based
Problem (EBP) question
•
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Description of context
Stakeholders
Current approach to the EBP problem
Current outcome in the practice setting
The EBP Question
• The EBP Question: Is the Sequential Oral
Sensory Program more effective than
behavioral modification/interventions at
improving the amount/variety of food eaten
by toddlers who are “picky eaters”?
Evidence
•
Results:
– The behavioral methods studied included the following: nonremoval of the
spoon, physical guidance, sequential presentation of food, non-sequential
presentation food, reinforcement, escape extinction, presenting single items,
presenting multiple items (over the course of treatment) and “treatment
packages” (which included one to three of the previously mentioned
methods).
– Overall, it is apparent that behavioral methods are effective in increasing the
amount and variety of foods a child will eat. In the studies reviewed, it was
apparent that the majority of the above mentioned methods are effective
when working with children with significantly limited diets. In the case of a
single item versus a multiple item presentation, both methods were effective
in increasing food consumption, however, the presentation of single items was
the most effective (Ahearn, 2002).
– The results from Piazza, Patel, Santana, Goh, Delia, & Lancaster, (2002) found
that simultaneous presentation was more effective than sequential
presentation for all participants.
– The use of peer models also has positive outcomes on a child’s food
consumption. Greer, Dorow, Williams, & McCorkle (1991) found a positive
effect that peer eating models have on non-eating participants.
Themes
– Positive outcomes were noted for behavioral
interventions.
• Interventions included: non-removal of spoon,
simultaneous presentation of food, etc.
– No articles about the Sequential Oral Sensory
method were found.
– Additional information regarding the Sequential
Oral Sensory method is needed.
Summary
• Overall, it is apparent that behavioral methods are
effective in increasing the amount and variety of foods
a child will eat.
• The use of peer models also has positive outcomes on
a child’s food consumption. The use of peer models can
be used alone or combined with other behavioral
methods.
• One final method that demonstrated positive
outcomes on children’s eating behavior is the training
of parents to use behavioral methods at home.
• No journal articles were found for the SOS method.
Recommendations
• Implications for occupational therapy practice:
– Parents should be included in the planning and the implementation of
interventions.
– Occupational therapists and other providers should :
• use the information learned to assist with guiding their decisions to select
certain intervention methods for children who present with specific problems.
• present the evidence to parents of children and work together with parents to
select the most appropriate method for their child.
• consider a parent’s feelings towards certain methods as certain behavioral
methods may be considered offensive to certain parents (i.e. non-removal of
the spoon may be viewed as “force feeding”).
– Ongoing, continuous research is needed to build on the research
already completed.
• Research is limited and the sample sizes of previous studies are small.
• Results of studies may not be easily generalized to other populations.
– Research is needed to determine the effectiveness of the SOS method.
References
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Ahearn, W. H. (2002). Effect of two methods of introducing foods during feeding treatment on acceptance of
previously rejected items. Behavioral Interventions, 17(3), 111-127. doi:10.1002/bin.11
Ahearn, W. H., Kerwin, M. E., Eicher, P. S., & Lukens, C. T. (2001). An ABAC comparison of two intensive
interventions for food refusal. Behavior Modification, 25(3), 385-405. doi:10.1177/0145445501253002
American Occupational Therapy Association (AOTA) (2011). Critically appraised topics and paper series: early
intervention/early childhood. Bethesda, MD. Retrieved (2/25/12) from http://www.aota.org/CCL/EI/EIFeeding.aspx
Anderson, C. M., & McMillan, K. (2001). Parental use of escape extinction and differential reinforcement to treat
food selectivity. Journal of Applied Behavior Analysis, 34(4), 511-515. doi:10.1901/jaba.2001.34-511
Boyd, K. L., (2007). The effectiveness of the Sequential Oral Sensory Approach group feeding program. Colorado
School of Professional Psychology, 1- 97 pages; AAT 3298523
Greer, R. D., Dorow, L., Williams, G., & McCorkle, N. (1991). Peer-mediated procedures to induce swallowing and
food acceptance in young children. Journal of Applied Behavior Analysis, 24(4), 783-790.
doi:10.1901/jaba.1991.24-783
Linscheid, T. R. (2006). Behavioral Treatments for Pediatric Feeding Disorders. Behavior Modification, 30(1), 6-23.
Kerwin, M. E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal
of Pediatric Psychology, 24(3), 193-241.
McCartney, E. J., Anderson, C. M., & English, C. L. (2005). Effect of brief clinic-based training on the ability of
caregivers to implement escape extinction. Journal of Positive Behavior Interventions, 7(1), 18-32.
doi:10.1177/10983007050070010301
Piazza, C. C., Patel, M. R., Santana, C. M., Goh, H., Delia, M. D., & Lancaster, B. M. (2002). An evaluation of
simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity.
Journal of Applied Behavior Analysis, 35(3), 259-270. doi:10.1901/jaba.2002.35-259
Shore, B. A., Babbitt, R. L., Williams, K. E., Coe, D. A., & Snyder, A. (1998). Use of texture fading in the treatment of
food selectivity. Journal of Applied Behavior Analysis, 31(4), 621-633. doi:10.1901/jaba.1998.31-621
Stoner, J. B., Bailey, R. L., Andell, M. E., Robbins, J. & Polewski, K. (2006). Perspectives of parents/guardians of
children with feeding/swallowing problems. Journal of Developmental and Physical Disabilities, 18(4), 333353. doi: 10.1007/s10882-006-9020-x
Questions and Comments
The Transdisciplinary Play Based
Assessment – Revised Edition
(TPBA2) for intervention planning
and eligibility determination in
Early Childhood Special Education
Stephanie de Sam Lazaro, MA, OTR/L
OTD Candidate St. Catherine University
Birth-3 Program St. Paul Public Schools
Evidence-Based Practice Problem
• MN Rule for DD in Part B
– MINN. R. 3525.1321 (2009)
• Types of Assessments Currently Used in St.
Paul Public Schools
• Primary Service Provider Model and Routines
Based Intervention in St. Paul Public Schools
• What is the TPBA2 and why this tool?
Is there evidence to support using the Transdisciplinary
Play Based Assessment – Revised Edition (TPBA2) to plan
intervention and assist in eligibility determination for special
education services for children ages 3-5?
Preliminary Findings and Themes
• Parent concerns when used in
combination with standardized
assessments provide the best
information about child’s
development (Dworkin & Glascoe, 1995)
• Use of risk factors alone for
determining need for
evaluation is unreliable (Nelson, Nygren,
Walker, & Panoscha, 2006)
• Parent assisted intervention is
effective for developmental
progress (Nelson et al., 2006)
• Role of parents in assessment,
intervention planning
• Use of screening tools in
manner in which they were
intended should lead to
more referrals for early
intervention (Poon, LaRose, Pai, 2010)
• Use of parent concerns are
an important part of the
screening process (Poon et al., 2010).
• Use of curriculum-based
assessment tools for
eligibility and program
planning
Analysis of Themes
• “Authentic Assessment” (Macy, Bricker,
& Squires, 2005; Macy, Thorndike-Crist, & Lin, 2010; Myers & Others, 1996;
Bricker et al., 2008; Keilty, LaRocco, & Casell, 2009).
• Importance of both normreferenced and curriculumbased or criterion-referenced
(Macy et al., 2005; Sterling, Candler, & Neville, 2011; Bricker et al., 2008)
• Play-based tools role in
eligibility determination (Macy et al.,
2005; Myers & Others, 1996; Bricker et al., 2008)
• Curriculum-based or criterionreferenced related to program
planning (Calhoon, 1997; Myers & Others, 1996; Keilty et al.,
2009, Macy et al., 2005)
• Role of parents in assessment
(Eddey, et al., 1995; Macy et al., 2010)
• Increased ease and ability in
play-based tools (Macy et al., 2010)
• What is missing from the
literature?
• Need for more professional
development related to
assessment tools and
eligibility in Part C and Part
B
• Need for more research
related to specific types of
tools and specific tools and
eligibility requirements in
Part C and Part B
(Keilty et al., 2009; Harrington & Tongier, 1993)
(Bricker et al., 2009; Macy,
2012; Harrington & Tongier, 1993; Calhoon, 2009)
• Screening tools have high
variability in over- and
under-identification (Macy, 2012)
Implications for Practice
• MN has it right
– Part B triangulation approach to eligibility determination
– Part C – use of curriculum-based or criterion-referenced
with condition known to hinder
• Role of play-based tool results for program planning
– Play-based vs. age-norm checklist type tool
– Triangulation within curriculum-based or criterionreferenced tools
• Move towards developing more evidence related to
types of tools used for eligibility and program planning
Limitations and Future Research
• The level of evidence
– Limited comparative data
– Limited sampling procedures
– Small size studies
• Future Research
– Assessment tools, screening tools, and eligibility
– More RCT or comparative studies related to various
types of tools
– Caregiver’s role in assessment process (caregiver as
part of assessment administration)
Questions and Comments
References
Bricker, D., Clifford, J., Yovanoff, P., Pretti-Frontczak, K., Waddell, M., Allen, D., & Hoselton, R. (2008). Eligibility determination using a
curriculum-based assessment: A further examination. Journal of Early Intervention, 31(1), 3-21.
Calhoon, J. (1997). Comparison of assessment results between a formal standardized measure and a play based format. Infant-Toddler
Intervention, 7(3), 201.
Dworkin, P. H., & Glascoe, F. P. (1995). The role of parents in the detection of developmental and behavioral problems. Pediatrics,
95(6), 829-836.
Eddey, G. E., Robey, K. L., Zumoff, P., & Malik, Z. Q. (1995). Multidisciplinary screening in an arena setting for developmental delay in
children from birth to six years of age. Infant-Toddler Intervention, 5(3), 233-241.
Harrington, R. G., & Tongier, J. (1993). The compatibility between state eligibility criteria for developmental delays and available early
childhood assessment instrumentation. Diagnostique, 18(3), 199-217.
Keilty, B., LaRocco, D. J., & Casell, F. (2009). Early interventionists’ reports of authentic assessment methods through focus group
research. Topics In Early Childhood Special Education, 28(4), 244-256.
Macy, M. (2012). The evidence behind developmental screening instruments. Infants and Young Children, 25(1), 19-61.
Macy, M. G., Bricker, D. D., & Squires, J. K. (2005). Validity and reliability of a curriculum-based assessment approach to determine
eligibility for part C services. Journal of Early Intervention, 28(1), 1-16.
Macy, M., Thorndike-Christ, T., and Lin, Y. (2010). Parental reports of perceived assessment utility: a comparison of authentic and
conventional approaches. Infants and Young Children, 23(4), 286-302.
MINN. R. 3525.1321 (2009)
Myers, C. L., & Others, A. (1996). Transdisciplinary, play-based assessment in early childhood special education: An examination of
social validity. Topics in Early Childhood Special Education, 16(1), 102-26.
Nelson, H. D., Nygren, P., Walker, M., & Panoscha, R. (2006). Screening for speech and language delay in preschool children: systematic
evidence review for the US preventive services task force. Pediatrics, 117 (2), e298-e319, doi:10.1542/peds.2005-1467
Poon, J. K., LaRosa, A. C., & Pai, G. S. (2010). Developmental delay timely identification and assessment. Indian Pediatrics,47(5), 415422.
Sterling, S., Candler, C., & Neville, M. (2011). Comparison of developmental age derived from the Transdisciplinary Play-Based
Assessment and the Peabody Developmental Motor Scales-2. Journal of Occupational Therapy, Schools, and Early
Intervention, 4(2), 121-128. doi: 10.1080/19411243.2011.590738
By: Michelle Barton, MA OTR/L
What is the problem?
 Why is it a problem?
 Who wants this
information and why?
 What is the practice
setting and current
approaches to the
problem?

Research Question: Is a weighted blanket more
effective than behavioral extinction for decreasing
the amount of time it takes for a child 18-36
months of age with self-regulation issues to fall
asleep and stay asleep?
Level One Search: Systematic Reviews
Greenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.
Databases




used:
National Clearinghouse
 http://www.guideline.gov/index/aspx
SUMSearch
 www.sumsearch.org
OT Seeker
 www.otseeker.com
Physiotherapy Evidence Database
 www.pedro.org.au
Information found from the four most relevant articles:
 Little research on weighted blankets
 Strong support for behavioral interventions
Revised Question: Is deep pressure more effective
than behavior strategies to decrease bedtime
resistance and night awakenings for infants and
toddlers with sleep disturbances?
Level Two Search: Individual studies
Greenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.
Databases
 Google Scholar
 Scholar.google.com
 OT Search
 www1.aota.org/otsearch/

psychINFO
 www.apa.org/psycinfo/

SciVerse
 www.sciencedirect.com
Information found:
 Limited evidence to support deep pressure strategies
 Strong evidence to support behavioral strategies
Themes:
 Sleep interventions are important
 Strong support for behavioral strategies, routines, and parent
education
 Parent perceptions are important to consider
Summary:
 Sleep is important for development. At this time, behavior
extinction, bedtime routines, and parent education are the most
strongly supported.
Recommendations:
 Parents play an important role
 Additional research is needed
Galland, B. & Mitchell E. (2010). Helping children sleep. Archives of Diseases of Childhood.(95)850–53.
Germo, G., Goldberg, W. Keller, M.(2009). Learning to sleep through the night: solution or strain for mothers and young
children. Infant Mental Health Journal(30)3:223-224.
Greenhalgh, T.(2010). How to read a paper.West Sussex, United Kingdom: Wiley-Blackwell.
Hall, W. A., Clauson, M., Carty, E. M., Janssen, P. A. & Saunders, R. A. (2006) Effects on parents of an intervention to resolve
infant behavioral sleep problems. Pediatric Nursing(32)3:243–250.
Hall, W. A., Saunders, R. A., Clauson, M., Carty, E. M. & Janssen, P. A. (2006) Effects of an intervention aimed at reducing
night waking and signaling in 6-to-12-month old infants. Behavioral Sleep Medicine(4): 228–241.
Hodgetts, S. & Hodgetts, W. (2007). Somatosensory stimulation interventions for children with autism: literature review
and clinical considerations. Canadian Journal of Occupational Therapy(74)5:393-400.
Kuhn, B. & Elliott, A. (2003). Treatment efficacy in behavioral pediatric sleep medicine. Journal of Psychosomatic Research (54):
587-597.
Lou, J & Durando, P. (2008). Asking clinical questions and searching for the evidence. In M. Law & J.MacDermid
(Eds), Evidence-based rehabilitation: A guide to practice.. Thorofare, NJ: Slack
May-Benson, T. & Koomar, J. (2010). Systematic review of the research evidence examining the effectiveness of interventions
using a sensory integrative approach for children. American Journal of Occupational Therapy(64)3:403-414.
Mindell, J., DuMond, C. Sadeh, A. Telofski, L., Kulkarni, N., et.al.(2001). Efficacy of an internet-based intervention for
infant and toddler sleep disturbances. Sleep: Journal of Sleep and Sleep Disorders Research(34)4:451-458.
Mindell, J., Kuhn, B., Lewin, D., Meltzer, L. Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants
and young children. Sleep(10): 1263-1276.
Mindell, J., Sadeh, A., Kohyama, J., & How, T. (2010). Parental behaviors and sleep outcomes in infants and toddlers:
a cross-cultural comparison. Sleep Medicine(11):393-399.
Mindell, J., Telofski, L., Wiegand, B., & Kurtz, E.(2009). A nightly bedtime routine: impact on sleep in young children and
maternal mood. Sleep: Journal of Sleep and Sleep Disorders Research(32)5:599-606.
Skuladottir, A., Thome, M., & Ramel, A.(2004). Improving day and night sleep problems in infants by changing day time sleep
rhythm: a single group before and after study. International Journal of Nursing Studies(42):843-850.doi:10.1016/j.ijn
urstu.2004.12.004.
Tse, L. & Hall, W.(2008). A qualitative study of parents’ perceptions of a behavioural sleep intervention. Child: Care, Health,
and Development(34)2:162-172.
Underdown, A., Barlow, J., Chung, V. & Stewart-Brown, S. (2006). Massage intervention for promoting mental and
physical health in infants aged under six months. Cochrane Database Systematic Review (4).