2003 Conference Proceedings

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WHAT EVERY SCHOOL PROFESSIONAL SHOULD KNOW ABOUT EVIDENCE-BASED PRACTICE

Presenter
Katya Hill, Ph.D., CCC-SLP
Edinboro University of Pennsylvania

School-based teams play a major role in the assessment and implementation of assistive technology (AT) services. Team decisions should be based on qualitative and quantitative data about the student's performance and comparisons with the research.

Assistive Technology service delivery has been making a shift toward evidence-based practice. Professional organizations involved with rehabilitation service delivery support the use of systematic and scientific principles and evidence-based practice. The American Speech-Language-Hearing Association (ASHA) has recognized and encouraged the shift toward scientifically supported methods through the revised ASHA Scope of Practice. That document now articulates the expectation of data collection, outcomes measurement, and the provision of services in accordance with the principles of evidence-based practice. The Individuals with Disabilities Education Act (IDEA) mandates outcomes measurement to document educational performance in the individualized education program (IEP).

Evidence-Based Practice

The principles of evidence-based practice (EBP) require conscientious and judicious use of the best evidence to make decisions about the special services provided to individuals (Sackett, Rosenberg, Gray, Haynes, & Richardson 1996). EBP is an approach that promotes the collection, interpretation, and integration of client-reported, clinician-observed, and research-derived evidence (McKibbon, Wilczynski, Hayward, Walker-Dilks, & Haynes 1995). Skills and knowledge in the collection and interpretation of evidence is required to support EBP. Therefore, in terms of school practitioners, well thought-out and careful Individualized Education Program (IEP) planning involves both individual expertise and the best available external evidence in addition to data collected about the student.

Assistive technology external evidence is obtained from relevant and systematic research. Systematic research is identified in terms of levels of evidence. Various levels of evidence have been established as guidelines for reviewing the strength of the evidence from research studies. Levels of evidence take on significance when making decisions during the IEP development processes. Teams evaluate the strength of the evidence along with data collected about the student to support decisions. For example, the best available evidence regarding assistive technology can be used to invalidate previously accepted practices. In addition, current best evidence replaces old assumptions and beliefs about assistive technology approaches with more powerful, accurate, and effective service delivery strategies and techniques.

Tools to Support IEP Teams

School practitioners need practical guidelines in order to get started applying the principles of evidence-based practice to assessment, intervention, and IEP development. The tools for applying the principles of EBP include:

An evidence-based practice flow chart serves as a systems model for educational services. The model reflects the importance of data collection about the student's present levels, skills, and abilities in order to effectively measure outcomes. The model starts with characterizing the student and measuring the student's performance with and without assistive technology strategies in place. A record of quantitative data allows for the comparison of performance across time and individuals. In addition, systematic reporting of performance assists in formulating the best questions to conduct a search for the evidence. The performance of the student along with the performance documented in the evidence allows teams to effectively appraise the evidence to make decisions about implementation.

The results of these comparisons drive the assistive technology intervention process. For example, in order to evaluate several alternative access methods to a computer by a student with writing difficulties, teams may measure the selection rate (bits per minute) and the communication rate (word per minute) to make comparisons. Once the assistive technology has been selected, response to intervention is determined by reiteration of this process starting with performance measurement. When the student's characterization changes; such as with aging, education, transition planning, etc., these should be noted with corresponding changes to the evidence being used to make decisions. For example, teams may need to recollect and appraise evidence on the use of voice recognition technology in different educational settings. Documentation of progress and outcomes measurement needed for the IEP is inherent.

How to Start

How does the IEP team apply the principles of EBP? The investigation for assistive technology by IEP teams starts by a commitment to identify the strategies, processes, and/or technology that will lead to a student's maximum potential. With this goal in mind, the team:

  1. Collects data on the student's present levels and identifies specific areas of strengths and weaknesses within the curriculum based on qualitative and quantitative data.

  2. Asks questions that are based on the student's performance related to educational goals and objectives.

  3. Searches for evidence to address the questions.

  4. Appraises the evidence by evaluating the information about the student and the research evidence.

  5. Implements the intervention

  6. Evaluates the outcomes.

In "How to Get Started" (Oxman, Sackett, & Guvatt, 1993), strategies are provided to evaluate the literature. Three basic questions should be asked to evaluate the strength of the evidence for educational purposes: 1) Are the results of the study valid? 2) What are the results of the study? 3) Will the results help me in planning for my student?

As in good medicine, good school practitioners use both individual expertise and the best available external evidence to support practices. Only when the knowledge and skills of the professional team are blended with quantitative data will the services that result in a student reaching the maximum potential be achieved.

References

McKibbon, K.A., Wilczynski, N., Hayward, R.S., Walker-Dilks, Cynthia, & Haynes, R.B. (1995). The medical literature as a resource for evidence based care. Working Paper from the Health Information Research Unit, Mc,Master University, Ontario, Canada.

Oxman, A.D., Sackett, D.L., Guyatt, G.H. (1993). How to Get Started. In Users' Guides to Evidence-based Medicine. Journal of the American Medical Association. 270(17) 2093-2095.

Sackett, D.L., Rosenberg, W.MC, Gray, J.M., Haynes, R.B., Richardson, W.S. (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal. 321: 71-2


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