Bridging the Divide Between EBP and Practice

becky blog

How well does your program integrate clinical practice and research education? It’s a question definitely worth asking. Today, clinicians are expected to use evidence-based practice in all of their clinical encounters, but does it ever seem as though research evidence is pulling clinicians in one direction while clinical experience is pulling the other way?

EBP requires you to consider current best research evidence, clinical expertise, and patient perspectives in your clinical decision-making. Clinicians who did not receive a proper balance and integration of research and clinical practice in their graduate classes may be feeling thinly stretched to meet these demands. In an ASHA survey fielded in 2011, 24 percent of respondents indicated that EBP created unrealistic demands on clinicians.  CSD programs need to provide students with the knowledge and tools to evaluate and apply research. Additionally, faculty members need to think about how well they model a fusion of research and clinical practice in their own teaching.

Some help

To help, ASHA has updated a tool, the Academic Program Self-Assessment: Quality Indicators for Integrating Research and Clinical Practice in Communication Sciences and Disorders (CSD) Programs. The Quality Indicators (QIs) were developed originally in 2007 and were updated in 2014. They can act as a tool to stimulate discussion among academic and clinical faculty members and students about the program’s strengths and needs in integrating clinical practice and research education. The QIs are divided into five sections:

1) Curriculum and Department Goals

2) Course Work

3) Faculty

4) Students

5) Clinical Practica

They are designed to be flexible in their application–some programs may choose to formally survey a broad group of faculty and students using the tool, while others may choose to use the QIs to guide discussion during a faculty meeting.

A test drive, if you will

Beginning in November of 2013, ASHA asked several academic programs to try out the updated QIs and report back on how they used the tool. Here’s what they said…

It took most responders about one hour to complete the QIs, and most programs judged the length, appropriateness, and comprehensiveness of the tool to be “good.” Most of the programs (82 percent, 9/11) had academic faculty, clinical faculty, and the program director/administrator complete the QIs individually and then discussed the results in a meeting. Alternatively, one program provided time for faculty members to complete the QIs during a faculty meeting rather than asking that the QIs be completed on their own time. A few programs (27 percent, 3/11) also included students in the process.

A handful of challenges also were reported. Some faculty members did not have time to complete the QIs, and some students and faculty were not familiar enough with certain aspects of the department to respond to all items. ASHA is currently working to address these challenges; for example, revising the QIs to include a “Don’t know” response option and providing additional online resources.

The QIs did reveal areas of need and areas of poor knowledge exchange between clinical and academic faculty for some pilot programs. Roughly half of the pilot programs used the QIs to develop department goals for further integration of research and clinical practice. Southern Connecticut State University developed and shared with us three of their goals:

  1. To provide opportunities for discussion of contemporary research and clinical topics, faculty will rotate presenting their research and related topics to faculty/staff/students each semester.
  2. The department curriculum committee (DCC) will conduct annual reviews to ensure that EBP concepts are included in syllabi in accordance with the department mission and vision.
  3. NSSLHA will host monthly meetings to discuss research topics of interest.

Jayne Brandel of Fort Hays State University stated that following completion of the QIs, “We are reviewing our curriculum at the undergraduate and graduate level. In addition, we are exploring new clinical opportunities and having clinical instructors participate in courses.”

ASHA plans to follow up with several of the participating CSD programs after 6 to8 months to gain more insight into the longer-term role of the QIs for these programs.

Whether you are a program director, faculty member, or student, the QIs are a great resource to check out to get your program thinking about and talking about the integration of research and clinical practice. It is imperative that new clinicians are adequately prepared for the changing healthcare landscape with knowledge and application of EBP as soon as they enter the workforce. Thus, Academic programs need to be focused on both providing and modeling the foundations of EBP consistently throughout CSD education. The QIs are freely available for download.

 

Rebecca Venediktov, MS, CCC-SLP, is a Clinical Research Associate for ASHA. 

 

Building Language and Literacy Skills During the Lazy Days of Summer

Podcast: Episode 31
Summers mean a break from academics for most kids, but that doesn’t mean learning should stop, particularly for elementary school children who are building so much foundational knowledge. In this podcast, certified SLP Lyndsey Zurawski offers tips and advice for parents about how to stimulate children’s language skills during everyday activities over the break—helping them build literacy skills and setting the stage for long-term academic success. Read the transcript.

Why Growing a Healthy Green School is Golden

green school

Remember dioramas from first and second grade? Last fall I was invited to attend the opening of the U.S. Environmental Protection Agency’s “Lessons for a Green and Healthy School” exhibit, a giant, life-sized, walk through diorama on how to create a green environment in schools. Located at the Public Information Center of US EPA’s Region 3 offices in Philadelphia, what I learned there about sustaining a healthy school for students, teachers, and community was exciting…and I heard it from the students themselves. [How to Build A Healthy School]

The Green Ribbon Schools Program is a joint endeavor between the U.S. EPA and U.S. Department of Education. The program honors schools and districts across the nation that are exemplary in reducing environmental impact and costs; improves the health and wellness of students and staff; and provides effective environmental and sustainability education, which incorporates STEM (science, technology, engineering, mathematics), civic skills and green career pathways.

A healthy green school is toxic free, uses sustainable resources, creates green healthy spaces for students and faculty, and engages students through a “teach-learn-engage” model. Examples of greening techniques include the using building materials for improved acoustics; installing utility meters inside the classroom as a concrete aid for teaching abstract concepts in math; and incorporating storm water drainage systems within a school’s landscape design to teach and practice water conservation. What are some environmental concerns to address when you are growing a healthy school?

  • Asthma and asthma triggers (indoor air quality)
  • Asbestos and lead (especially in older buildings)
  • Carbon monoxide (from old furnaces, auto exhaust)
  • Water fountains
  • Chemicals in the science lab (think mercury)
  • Art and educational supplies
  • Managing extreme heat
  • Upkeep of athletic grounds
  • Mold, lighting fixtures
  • Waste and recycling

Now more than ever, we must educate new generations of citizens with the skills to solve the global environmental problems we face. How can we have a green future or a green economy without green schools?

Benefits of green schools

1. Cost/Energy Savings:Daylighting” or daylit schools achieve energy cost reductions from 22 percent to 64 percent over typical schools. For example in North Carolina, a 125,000 square foot middle school that incorporates a well-integrated daylighting scheme is likely to save $40,000 per year compared to other schools not using daylighting. Studies on daylighting conclude that even excluding all of the productivity and health benefits, this makes sense from a financial investment standpoint. Daylighting also has a positive impact on student performance. One study of 2000 school buildings demonstrated a 20 percent faster learning rate in math and 25 percent faster learning rate in reading for students who attended school with increased daylight in the classroom.

2. Effects on Students: Students who attended the diorama presentation in Philadelphia expressed a number of ways how their green school changed personal behavior and attitudes. One young lady spoke of how a green classroom helped her focus and stay awake. Another student said being in a green school made them happier. There was more interest in keeping their school environment cleaner by monitoring trash disposal, saving water by not allowing faucets to run unnecessarily, picking up street trash outside the school, sorting paper for recycling, and turning off lights when room were no longer in use. Some students went so far as to carry out their green behaviors at home. Small changes in behavior and attitude such as these are the foundation for a future citizenry who will be better stewards of the environment.

3. Faculty Retention: Who wouldn’t want to be a speech-language pathologist in a green school? Besides, there would be so many opportunities for a therapist to embed environmental concepts in to their session activities. Think how a quieter environment would foster increased student attention. How about having the choice of conducting a small group session in the pest-free landscape of the school yard? Research supports improved quality of a school environment as an important predictor of the decision of staff to leave their current position, even after controlling for other contributing factors.

How to make your school green

  • Have a vision for your school environment. You can start small at the classroom level or go district wide. Focus on one area or many (healthier cafeteria choices, integrated pest management, purchase ordering options, safer chemistry lab) Maybe you already know what environmental hazards affect your school – if you do then start there.
  • Get a committee going. It helps to have friends. Is there someone you can partner with? School nurse, building facilities manager, classroom teacher, PTA, students?
  • Conduct a school environmental survey. This doesn’t have to be complicated, you can poll your colleagues, or discuss at the next department meeting, or over lunch. If you like, check out EPA’s “Healthy SEAT – Healthy School Environments Assessment Tool” for ideas.
  • Have a plan. Select a time frame, short term first and use it as a pilot to evaluate whether a green school is possible. Pick something small to work on.
  • Monitor and evaluation your progress. It’s always a good idea to collect data but it doesn’t have to be too sophisticated. Use “before and after “ photos or video student testimonials.
  • Embed the green environment into the student curriculum and activities. Create speech lesson plans with green materials or photos of your green school project. Growing Up Wild is an excellent curriculum for early childhood educators.

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools. 

 

 

 

The Effectiveness of Language Facilitation

 

 

natural talk

A while back, I posted on the ABCs of ABA. Within that post, I described the basics of ABA, a method of therapy that I believe is often a bit misunderstood. I also promised to follow that post with a more thorough description of the shades of grey that exist within the broader field of ABA.

Before I do that, though, I want to touch on the effectiveness of an approach that often seems to be the very opposite of ABA: indirect language stimulation. And before I do that (hang with me here), I’m going to briefly explain the idea of a continuum of naturalness that exists within the field of speech-language pathology. This term was first coined by Marc Fey in 1986 in “Language intervention with young children,” and I think it is a wonderful way to help us wrap our minds around the variables that exist when we think about the various methods of therapy.

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The ends of this continuum represent the relative naturalness of a treatment context. On one end of the continuum, we have indirect language stimulation approaches. These are highly natural, often embedded within the child’s daily routine, tend to be unstructured, and are built on the idea of being responsive to the child. On the other end of the continuum, we have highly structured ABA approaches, which tend to be highly decontextualized (*not* in the context of daily activities and play), very structured, and highly adult-directed.

In this post, I’m going to cover the left hand side of this continuum: indirect language stimulation. In a nutshell, this approach to language intervention involves describing what a little one is seeing, doing, and feeling. I’ve described different techniques within this broader method before, in various posts such as All Kinds of Talk, Self Talk & Parallel Talk, and Expansion and Extension. As you use these techniques, you are providing models of language that are a match for the child’s language level. So, if a baby mainly points and vocalizes, you use one and two word phrases; if toddler uses one and two word phrases, you use three and four; if a preschooler uses short sentences without grammar, you respond with longer sentences with appropriate grammar (you get the idea, right?).

These techniques are generally used in the context of on-going activities that happen every day, and are used in a way that is responsive to the child. In other words, you watch what the child is doing, listen to what she is saying, observe what she is watching, and then you respond to that. Watch. Listen. Observe. Describe. Put it all together, and general language stimulation looks a little something like this.

It pretty much looks like nothing is happening, right? Just a mom and her child having a snack. This is what it should look like! It’s natural- that’s why it’s on the far left hand side of the continuum of naturalness. But there is more going on than meets the eye. Notice how the language is simple, and related to the activity at hand. Also notice mom’s responsiveness–language models are provided in response to the child’s utterances (Child: “Please?” Mom: “You want apple.” “Apple please!”). And when the little one tries to get mom’s attention by saying “mmm,” again, mom responds with another “mmmm.” They go back and forth a few times–this is turn-taking, and within it lies the beginnings of conversation. Eventually, mom uses a language model directly related to the “mmmm”: “Yummy apple.”

One more example. This activity is a little more structured, but the approach used is the same. Notice how mom’s language is in response to the child’s language (Child: “Ride…” Adult: “You’re riding the bike!”) and take note of the fact what mom says is just slightly longer than the toddler’s language. And, as an additional bonus, observe how the child’s language changes– from one word sentences at the beginning, to a two-word phrase at the end of the clip. Indirect language stimulation doesn’t always work immediately in the moment like this…but it’s pretty cool when it does!

Despite the fact that indirect language stimulation looks quite simple, research shows that it can be very effective. As I described in All Kinds of Talk, research indicates that the more parents use conversational talk with their typically developing child, the larger that child’s vocabulary will be. When parents are responsive in their conversational interactions with their child, their child’s language grows.

Indirect language stimulation approaches have been shown to be effective for late talkers, too. In their article, Evidence-Based Language Intervention Approaches for Young Talkers, Finestack and Fey summarize the evidence in support of both general language stimulation and focused language stimulation. General language stimulation involves the techniques I just described in, well, a very general way. This means that there are no specific language targets (say, increasing verbs, or increasing nouns, or getting a child to use a specific type of two-word phrase). Instead, the goal is broad in nature: increase overall language skills. Finestack and Fey describe a randomized controlled trial (in other words, a well designed, scientific study) of a 12 week program that used general language stimulation (Robertson & Ellis Weismer, in Finestack and Fey, 2013). The researchers compared late-talking children who received general language stimulation to late-talkers who received no intervention and found that, compared to the children who received no intervention, children who received the intervention made more gains in vocabulary, intelligibility, and socialization. Importantly, the parents of the children who received intervention felt less stress. And who doesn’t want less stress in their life?!

Focused language stimulation is very similar to the general language stimulation except that it’s (you guessed it…) focused. The language models that are provided by adults are chosen specifically for that particular child. So, an adult might model mainly verbs if these are lacking in a child’s language. Or, the adult might model specific nouns. Or, the adult might model a specific type of early grammar marker, such as -ing (one of the earliest ways that children start marking verbs). This type of language stimulation, too, has been shown to be effective. Girolametto, et al, 1996 (in Finestack and Fey, 2013), taught parents to use focused language stimulation with their children. They compared the gains made the children of these parents to the gains made by children whose parents were not trained in use of these methods (don’t worry – the non-trained parents got trained at the end of the study, too!). By the end of the study, the children whose parents were trained in focused language stimulation had significantly larger and more diverse vocabularies, used more multi-word phrases, and had better phonology.

It’s important to note that general and focused language stimulation enjoy the most research support when used with late-talkers who don’t have any other delays. The research is mixed when it comes to the efficacy of these methods with children with more significant delays and disorders, such as those with autism or cognitive disorders. Because of this, having other tools in our toolbox is very important. This is where the rest of the continuum of naturalness becomes important – and where my passion for contextualized ABA approaches begins. But, that’s a post for another day. For today, we’ll stop here, secure in the knowledge that when we surround our typically developing children and late-talkers in language models, their language grows.

Finestack, L. and Fey, M. (2013). Evidence-Based Language Intervention Approaches for Young Talkers. In Rescorla & Dale, Eds. (2013). Late Talkers: Language Development, Interventions, and Outcomes

Becca Jarzynski, M.S., CCC-SLP, is a pediatric speech-language pathologist in Wisconsin. You can follow her blog, Child Talk, and on Facebook.

Seven Lessons for Newly-Minted SLPs

graduation

It’s graduation season and I can’t help but notice all of the brand new speech-language pathologists coming out of graduate programs across the country. What’s more is that I can’t help but be so happy for them! Here’s why: It seems as if it was just yesterday that I was a free spirited sophomore who decided to take a random class in phonetics. Little did I know this class would influence my life’s work. The class was taught by a young Ph.D., Gloria Weddington, who helped to focus me and, much to my mother’s delight, give me a purpose.

As a senior, Dr. Weddington took me to my first ASHA Convention where she introduced me to all the leaders in our profession.  What impressed me most was how well liked and respected she was by everyone. She would introduce me to her colleagues  as her “little student”  who was going to be a great addition to our profession.  She believed in me and I believed in myself. Once I received my master’s degree, I was ready to set the world on fire!

I vividly remember my first experience as an itinerant SLP in Los Angeles Unified School District. I was so eager and excited to have my first real job with my first real paycheck. I loved my schools and my kids and had a great master teacher who served as my CF supervisor.  I enjoyed my work and continued to grow seizing every new opportunity that came my way.  I absolutely loved my job! A few years later I left my very secure job to strike out on my own and opened a small private practice. I was the secretary, the receptionist, and the SLP,  but most importantly, I was happy again.  That was 35 years ago and I have never looked back.  In fact, I discovered another side of myself, that as an entrepreneur who was able to develop and sustain a thriving private practice in Los Angeles.

Today, many of my friends and colleagues are happily retiring. I have to admit, I feel a little conflicted when I think of what it must be like to wake up each morning and to not having any professional responsibilities.  However, I also can’t imagine life without my professional responsibilities, especially since there is so much more for me to do. The truth of the matter is that I feel as passionate today about our esteemed profession as I did when I was 24.

Young staff often ask me what’s my secret?  It’s no secret–it’s living and learning from life’s experiences. I am approaching 40 years “young” in our great profession and here are seven lessons learned along the way that continue to feed my spirit and nourish my soul:

  1.  Find a role model, a hero whom you admire, respect and trust. Listen, watch, and learn from him or her. If you are lucky they will be your mentor.
  2. Make your CF year count. Get the clinical supervision and support that you need to grow strong and healthy in our profession.
  3.  Be willing to rebuild your dreams.  Protect the joy and excitement that you experienced upon entering the profession. Remember there are no victims, just volunteers.
  4. Continue to grow, learn, and maintain high standards.  Make it a priority to attend ASHA conventions or at the very least your state conferences.  Learning is critical in our ever-changing profession
  5. Keep plenty of mirrors around.  Look closely at whether the person you see is the person you really want to see.  And, when in doubt refer to our ASHA Code of Ethics.
  6. Don’t burn bridges. You never know who you will need to give you that last cup of water.
  7. Have fun.  There is always work to be done!

Congratulations and welcome to our great profession!

Pamela Wiley-Wells, Ph.D., CCC-SLP, is the president of the Los Angeles Speech and Language Therapy Center, Inc. and the founder of The Wiley Center, a 501 (c)(3) organization dedicated to providing direct services and support to children with autism spectrum disorders or other developmental disabilities. The practice includes early intervention programs located in South Gate, Lawndale, Los Angeles, and Culver City as well as two satellite speech therapy clinics in Studio City and Downey. Wiley is a frequent lecturer on how to effectively deliver services to the increasing number of children diagnosed with ASDs who have social cognitive deficits.  She has written several professional articles and has co-authored two therapy workbooks; Autism: Attacking Social Interaction Problems for children 4-9 and 10-12 years of age as well as a separate parent resource guide available in English and Spanish. You can follow her private practice on Facebook.