It’s not the ball, it’s you. Why “Is it Evidence-Based?” is a Complicated Question
I’ve been figuratively sitting on this blog post for ages.
It might be unpopular, and so, I’ve been afraid to say it. That’s just how I am. I don’t want to ruffle any feathers. I don’t particularly want any angry comments on my post or social media.
But you know what? This pedestal on which we’re placing “evidence-based practice” is all wrong.
Actually no, EBP has the right to be on a pedestal…when we’re interpreting what EBP means correctly. But when we’re throwing around the term haphazardly…it’s a problem.
It’s confusing, it’s alienating, and it’s not leading to better therapy.
What makes it “Evidence-Based?”
Listen, according to ASHA, “Evidence-Based Practice” contains THREE components.
1. External Scientific Evidence (we get it, you know this part)
2. Clinical Expertise
3. Patient/Client Perspectives
Also, according to ASHA, “The notion that external research evidence somehow “trumps” all other considerations is one of the big myths surrounding EBP.”
Can we please say that louder for those in the back?
Yes. external research is very important, but it’s not the end-all, be-all of having evidence guide your practice.
Additionally, I so often hear people look at a product/program/tool and go, “But is it evidence-based?”
Good question? Yes.
Often misplaced? Yes.
Because you know what? A ball likely doesn’t have a lot of external research supporting its use in articulation therapy. That doesn’t mean it’s not a valuable therapy tool.
If you use that ball to encourage a student with apraxia to get 100 reps in a session, it might be used effectively. (Harold, 2011, Murray et al., 2014).
However, sitting in the therapy room and rolling the ball back and forth in silence likely doesn’t increase articulation skills.
It’s not the ball. It’s you.
Flashcards can be a useful therapy tool. I’m not sure that anyone is doubting their utility or arguing over their effectiveness (silly me, of course, someone is).
Pair them up and use them for minimal pairs? You’re on to something.
Balance them on your coffee mug and have the kids stare hard at them. Not so much.
It’s not the cards; it’s you.
Teacher Involvement Makes the Difference
Intermittent reinforcement, when reinforcement is not given on every trial, is widely accepted to be superior to continuous reinforcement when it’s given each and every time. It leads to the desired behavior lasting for a longer period of time after the reinforcement is removed (oh, sweet carryover) (Hula et al. 2008). It is well-researched across disciplines.
But, If you’re providing reinforcement on the wrong thing, then no amount of research-based intermittent reinforcement will help you achieve the desired behavior. The combination of that intermittent reinforcement and your clinical expertise as a speech-language pathologist will provide the best outcomes.
Good therapy is in the delivery (that’s you!), not the vehicle.
It’s possible to use almost anything in a way that is evidence-based (yes, I also mean supported by external research).
It’s also possible to use a research-based intervention incorrectly, in which case you’ve negated its value.
So let’s stop asking,
“Is this product / program / tool evidence-based?”
and start asking,
“How are you using this product? I’d love to hear more about how you’re making this work and how that connects with current research.”
EBP got your Super Duper bag in a twist? I’d highly recommend you keep up with it in the easiest way possible with The Informed SLP. They summarize relevant research articles every month so you can spend your time implementing the best therapy possible!
(Not an affiliate link, I just feel like research is really, really important)
References
Austermann Hula, S. N., Robin, D. A., Maas, E., Ballard, K. J., & Schmidt, R. A. (2008). Effects of Feedback Frequency and Timing on Acquisition, Retention, and Transfer of Speech Skills in Acquired Apraxia of Speech. Journal of Speech, Language, and Hearing Research, 51(5), 1088–1113. https://doi.org/10.1044/1092-4388(2008/06-0042)
Blache, S. E., Parsons, C. L., & Humphreys, J. (1981). A minimal-world-pair model for teaching the linguistic significance of distinctive feature properties. The Journal of Speech and Hearing Disorders, 46(3), 291–296. https://doi.org/10.1044/jshd.4603.291
Evidence-Based Practice (EBP). (n.d.). Retrieved December 4, 2019, from Asha.org website: https://www.asha.org/Research/EBP/Evidence-Based-Practice/
Harold, M. (2011). Treatment Intensity. Retrieved December 7, 2019, from The Informed SLP: Speech Language Pathology Research website: https://www.theinformedslp.com/qa_intensity.html
Mullen, R. (n.d.). Evidence-Based Practice: An Opportunity for Continuing Education Providers. Retrieved December 5, 2019, from Asha.org website: https://www.asha.org/CE/for-providers/Evidence-Based-Practice-CE-Providers/
Murray, E., McCabe, P., & Ballard, K. J. (2014). A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech. American Journal of Speech-Language Pathology, 23(3), 486–504. https://doi.org/10.1044/2014_ajslp-13-0035
Weiner, F. F. (1981). Treatment of Phonological Disability Using the Method of Meaningful Minimal Contrast. Journal of Speech and Hearing Disorders, 46(1), 97–103. https://doi.org/10.1044/jshd.4601.97
