There were lots of good sessions when I was at ASHA this year and just as many helpful ones when I was attending and presenting at ISHA. As usual, many were discussing research or new studies. Sessions that I attended that sounded like they would be discussing new techniques or practical ideas, usually just ended up talk about the research behind a technique or compare studies between two treatments, nothing that I could really take back to my kids on Monday and put into practice. Now, there were some very good ones that had practical, useable ideas, but there weren’t a lot. EBP, for years the ‘E’ stood for evidence. Today I ask, why can’t the ‘E’ stand for experience based practice?
Now before things get heated, I just want to say I am not knocking Evidence Based Practice or research. We need them to learn, create, and shape new techniques and technology. I am simply saying when it comes down to it, why can’t experience be just as important as evidence? At ASHA I met so many amazing people. One person was a professor who wondered what evidence I based some of my TpT activities on. I stood there for a second because I wasn’t sure how to answer. While I do have some materials that hours of research went into, many of my activities are based on what my kids need and what has worked, not on an article I read or chart I studied. Does that make them any less effective or engaging? No, not in my opinion.
I learned what would be the foundation for my career in grad school, from professors lecturing about research, theory, and evidence base practice. However, what has taught me the most has been all the days I have spent working with clients/students trying this and that to see what works and what doesn’t, attending workshops on how to use therapy tools or being trained in new techniques, and reading blog posts about what other SLPs have tried. I read a blog post by the late, great, Pam Marshalla on how to elicit vocalic /r/ and I tell you it was amazing! Guess what, it was based on experience. Does that mean the information isn’t worthwhile? No. The article is here if you want to take a look and if you are working on /r/ with any kiddos I highly recommend you do.
My point for writing this is hoping to encourage you to not dismiss blog posts, TpT activities, or CEU sessions because they may not be evidenced-based, but are experienced-based instead. I am hoping to raise the point that evidence and experience do not out way each other, but go hand in hand. After all, it was probably someone’s experience that helped to inspire the need for evidence.
How do you feel about all of this? Do you think experience or evidence is more important, or are they equal?
I could be very wrong about this, but I’ve always viewed EBP as guidance for how to conduct speech therapy sessions, rather than what activities to use in my sessions. The fact that my students are making progress with the activities and tasks that I’m presenting ARE evidence. Have I published research on it? Nope. Because each of my kids has a different background and learns in different ways, and what works for one or two in the group doesn’t necessarily work for the others. Progress is my evidence. I’m not going to claim that yoga in speech therapy improves outcomes. However, I have data that supports the fact that once I started incorporating whole body movement via yoga into my preschool groups, their participation (and hence, their response to therapy) increased, thereby increasing their opportunities to practice their goals. Guess what…they’ve made progress! EBP supports multi-modal instruction and whole body participation for kids with autism, sensory disorders, and attention issues. I made the choice to achieve that via yoga. I feel like, for most of the items that I purchase on TpT, that the evidence to support my using those activities (worksheets specifically), is the EBP of repetition. If I need to present the same concept 48 different times, in 12 different ways before it makes sense, and then we have to practice it 2000 more times to make it a learned skill, you’d better believe I’m going to be scouting out resources that are engaging and interesting.
In my opinion, I think SLPs either look at Evidence Based Practice as a guideline for how to present information during sessions or as the specific way a task needs to be done. There are some professionals out there who feel that if it does not have a study behind it, it is not worth acting upon. I agree that our evidence for ‘experience based practice’ tasks is our data that we collect during sessions and that those numbers can be just as powerful as something that was published in a journal.
ASHA lists three parts of the EBP triangle — evidence, clinical experience, and client values/preferences, with no leg of the triangle being more or less important than the others. It sounds like you are using EBP to me.
I try my best too 🙂 My point that it seems most professionals only view EBP as the ‘evidence’/research/study portion of the triangle you mentioned. You are right we need to think about all aspects as evidence.
One thing I have always struggled with during language therapy is that a lot of the materials available are just drill practice. I don’t think language therapy can always be approached like articulation therapy. For example, working on synonyms, we practice synonyms to improve vocabulary but I personally don’t feel like any connections are made when you drill synonyms over and over. Same with answering “wh” questions, I don’t feel like kids always generalize when we drill in speech therapy. I’m curious if others feel the same way…
I’m not sure my comment above is exactly what you were asking, but I thought of it while reading your article. I think both experience and evidence are important; however, I feel like there isn’t a lot of evidence for language therapy still. I rely more on my experience and other SLP’s experience for my older kiddos with language impairments, and wonder about the efficacy of treatment.
You bring up many good points. I was looking at the ASHA Evidence Maps the other day and it would take me weeks to research all the information I use in therapy.
Well said! Yes to the comment above that ASHA does recognize clinical experience in the Evidence Based Practice triangle, but I agree that it seems less valued than research. But when one looks at the levels of evidence, it is quickly apparent that our profession doesn’t have a lot in the highest level…randomized clinical trials and systematic reviews of that type of study. I have been a follower of Pam Marshalla since the start of my career in 1988. She would say…I do. Whatever Works. Me too. And we should absolutley be sharing more of that info.