Making evidence-based decisions about child language intervention in schools.
The results of recent survey studies suggest that speech-language pathologists base most of their clinical decisions on information they were taught during their graduate programs, their clinical experience, and the opinions of colleagues (T. Wolf & J. Balderson, 2005; R. Zipoli & M. Kennedy, 2005). This is contrary to the principles of evidence-based practice (EBP), in which clinical decisions arise from the integration of scientific evidence, clinician experience, and client needs. Our field's interest in EBP is relatively young. Currently, there are no published committee-derived EBP guidelines for providing language intervention services for children with language disorders. Until national or international organizations publish recommendations from EBP guideline writing panels, clinicians will need to make personal evidence-based decisions with relatively little assistance from outside sources. The purpose of this article is to summarize a seven-step process for making local EBP decisions. The authors provide information about a method for forming clinical questions, finding relevant scientific studies, and evaluating those studies that requires relatively little time and few external resources. The authors also provide a system for integrating scientific evidence with their own expertise and training within the context of their employment settings. Finally, an example is provided to show clinicians how to use the evidence-based decision-making process to answer a clinical question about clinical methods for improving grammatical morphology in children with speech-language impairment. It is possible for clinicians to make time- and resource-efficient evidence-based decisions that integrate scientific evidence, clinical expertise, and student-parent preferences.