Category: Appraising Change: The Book

1.0 Introduction

The application of effective data collection, visualization and accounting will transform modern clinical practice.

Therapy-Science, which includes this text and website (therapy-science.com), represents our firm belief that with the right set of tools, we can use client to guide our ongoing therapy efforts and produce better results than what is provided by current clinical practice.

2.0 Thinking Critically about Clinical Evidence: Introduction

It is not possible to be a good thinker and a poor questioner. Elder & Paul, 2005, p.3

As discussed in the first chapter, as clinical practitioners, we are continually challenged by caseloads, time constraints, practice policies and cost containment mandates. These realities serve as a backdrop in which we provide therapeutic services to our clients.

2.1 Thinking About Clinical Practice

In this section, I will discuss some of the problems that characterize everyday thinking, given our predisposition towards unreflective views about ourselves and the world, which in turn, impede our engagement in principled, thinking and decision making. As your first ‘assignment’, I encourage you to reflect on how you may engage in some of these unreflective beliefs and thinking practices.

2.2 Critical Thinking is Principled Mindfulness

Critical thinking is a purposeful, reflective, and externalized system of reasoning, and its methods are intentionally brought to bear on understanding particular phenomena and solving specific problems. Critical thinking involves self-reflection and mindfulness; that is, the process of becoming aware of your own thoughts and biases that can influence your decision making. Using explicit strategies such as socratic questioning,

2.3 The Critical Questions of Intervention

… data collection can be viewed as having a more integral part in the actual decision-making process — not serving after-the-fact to justify decisions, or prove effectiveness, but rather, serving as the means for making ongoing clinical decisions. In this view, data are a necessary part of the clinical process: without the data,Continue reading

2.99 Epilogue: Critical Thinking

No way of thinking or doing, however ancient, can be trusted without proof. Henry David Thoreau

This book is really about finding proof from a variety of external and internal evidence sources to help us make good decisions to help – and not harm our clients. I have chosen to start this book out by providing critical thinking perspectives,

3.0 Evaluating External Evidence: Introduction

This chapter will focus on the evaluation and integration of into your clinical practice. Specifically I will discuss:

Critical Thinking and Evidence Based Practice
Developing a critical question
Searching for and reviewing external evidence.
Using ASHA’s Evidence Map to answer critical questions
Integrating external evidence into your intervention

Although this chapter provides historical and critical perspectives on the use of external evidence with a framework,

3.1 Evidence-Based Practice as a Critical Thinking Approach

The term, Evidence-Based Practice (EBP) should be familiar to you by now, as it is used by many professionals, clinics and businesses seeking to advertize that their clinical practice or products are based on, or motivated by scientific research. Within clinical practitioner communities, EBP is held up as representing a model of doing best practice.

3.2 Developing a Searchable Question

The scientific mind does not so much provide the right answers as ask the right questions Claude Levi-Straus (1969) The Raw and the Cooked: Mythologiques (1969) (bio)

Developing a good searchable question is fundamental to finding a credible answer. When questions are ambiguously stated, the results are often just as vague and unclear.

3.3 Appraising External Evidence

Evidence Hierarchies and Evaluation of Research Quality

Some of the first critical thinking frameworks for assessing the intervention literature were , which attempted to identify the types of studies that – by design – are best suited to demonstrating causal relationships between treatment and outcome.

The Development of Evidence Hierarchies

Evidence hierarchies were first proposed by the Canadian Task Force on the Periodic Health Examination (1979),

3.4 Case Study: Using ASHA’s Evidence Map to Answer a Clinical Question

In this section, a case study will be presented, using ASHA’s evidence maps to search for, and evaluate current information about the effectiveness of AAC devices for promoting natural speech. This question frequently arises in my AAC classes and is often a concern for parents children using AAC, as well as, their teachers. Thus, for me,

3.99 Epilogue: Evaluating External Evidence

If you do not ask the right questions, you do not get the right answers. Edward Hodnett (Wilfred, Season 2, Episode 11)

In the above quote, Hodnett reminds us that what you find often depends on the question you ask. When searching for external treatment evidence, asking the right question is one of several important strategies you need to use to maximize your chances of finding the answer you seek.

4.0 Formulating Intervention Plans: Introduction

If we do not have goals, tools, and beliefs that encourage such questions, we are less likely to raise questions and seek answers. Gambril (2012)

To date, much of goal writing has been a craft, passed down from supervisor to student and refined over many years of practice. A number of my colleagues take pride in their goal writing skills and do a good job teaching students to write well-considered goal statements.

4.1 Developing an Outcome Plan

Over the past decade we have learned a great deal about the many factors involved in deciding “who,” “what,” and “when,” to treat. Based on burgeoning clinical data, we are now able to document the effectiveness of many treatment approaches that change the communicative behavior of various types of language-disordered children. Yet for many clinicians the answer to the question “How long should a particular child be treated?”,Continue reading

4.2 Constructing Goals

Arriving at one goal is the starting point to another. John Dewey Intervention Plan

In the previous section, I proposed using a functional outcome hierarchy to structure therapy and evaluate clinical change. An intervention plan is the organization of intervention ingredients needed to achieve your desired objective. It is a proposal of sorts,