Don’t Let the Issue of Evidence-Based Practice Get You Down!

By Pam Marshalla

Q: I have been reading your book Becoming Verbal with Childhood Apraxia. The ideas sound great and very interesting, but I did not see a complete reference list. Are there specific research studies that support the techniques that you were describing in your book? The examples included were helpful. I need some more support because of the emphasis on the evidence-based practice.

There is no reference list at the end of the book because these are all my original thoughts based upon the work of Jean Piaget, who also wrote his original thoughts. Piaget is widely considered one of the “fathers” of modern child development.

There is a complete and terrible misunderstanding today of what the term Evidence-Based Practice means. According to ASHA, the EBP is comprised of three aspects:

  1. Evidence from the research lab. ASHA calls it “Current Best Evidence.”
  2. Evidence gained from clinical experience– ASHA calls it “Clinical Expertise.”
  3. Evidence from the client himself– ASHA calls it “Client/Patient Values.”

The book of mine that you referenced regards the second arm of the EBP. It is a book about what my 35 years of clinical experiences have taught me as I have worked with hundreds of clients. It therefore represents the second arm of the EBP. Think of it as one very experienced therapist giving advice to other less experienced therapists, or to the parents of the children involved.

Please do not allow yourself to get into the trap that we can only do in therapy those things that have been researched. Most therapists do thousands of things that have never been researched. We do whatever it takes to help our clients, and we most certainly cannot limit our practice to only those things that have been studied in a laboratory. In fact, most of what we do has never been researched, and most of what is researched we must expand upon and generalize in order to apply it to our clients.

Consider this: If a technique is “proven” to work with five-year-old children, is that “proof” that the method can be used with three-year-old children? If we only can do in therapy those things that current research supports, then the answer to that is NO. And if that is the standard we are going to apply to our practice, then we are finished. Why? Because most of what we need to do has never been researched.

Consider this: Think about teaching something very simply, like pronoun “I.” Have you ever seen any research on how to teach pronoun “I”? No. Yet tens of thousands of therapists must teach pronoun “I” every day. What are they to do? They are to figure out how to teach it without the benefit of research. Often they pass their own original ideas on to other therapists who also are hungry for more ideas.

This is what I have done in that book. I gathered together the thoughts and experiences I had over several decades to share with other therapists who are stuck exactly in the same place I was stuck 35 years ago. This is what therapists always have done: They help one another.

You have to take what is in that book and compare it to your own experiences. If the ideas prove valuable to you, then you use them. If they don’t, then you don’t. This is what we do with every single method we come across, whether it’s been researched in a laboratory, or learned from another therapist, or dreamed up, or stumbled upon.

Please read further on my blog about EBP for more ideas. I have listed many resources that explain what EBP really is.

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