Last fall I had the pleasure of teaching a graduate-level speech-language pathology course entitled Topics in Research: Evidence-Based Practice (EBP). The required textbook was The Handbook for Evidence-Based Practice in Communication Disorders by Christine Dollaghan. Dollaghan (2007) proposed a framework for thinking about EBP that was different than models previously proposed. Rather than primarily focusing on evidence from research studies as seen in previous models, the author suggested incorporating three types of evidence. Therefore, the author refers to this framework as E3BP.
Specifically, E3BP is defined as “the conscientious, explicit, and judicious integration of 1) best available external evidence from systematic research; 2) best available evidence internal to clinical practice; and 3) best available evidence concerning the preferences of a fully informed patient” (Dollaghan, 2007, p. 2). We already wrote about traditional EBP in AAC our 2018 PrAACtical AAC blog post EBP in Augmentative and Alternative Communication (AAC), which focused on external research evidence. Therefore, in today’s post we will be examining another side of the E3BP triangle, specifically the preferences of fully-informed clients.
Let’s break this down a bit. First, let’s review what fully informing clients might look like in AAC. When working with children who use AAC, parents are often the ones who have the responsibility of decision-making. However, many parents of young children may not even know what AAC is. This is our opportunity to discuss what AAC is, dispel myths about AAC like letting families know that AAC typically doesn’t interfere with speech production, and explain why their child might benefit from it.
Providing information extends to AAC evaluations as well. This includes demonstrating and trialing several systems with the features a child needs, not just one that is our favorite or one we’re most familiar with. In addition, pros and cons of each system should be discussed with the family and listed in the assessment report.
In addition, information is required to help families participate in the discussion around appropriate treatment techniques. We provide a number of handouts on our Free Resources page that summarize the research on techniques such as least-to-most prompting and partner-augmented input. Sometimes, we provide families with research papers as well, like on our SMoRRES® Training Program for families. If parents ask about techniques that lack evidence, we might also provide resources such as the corresponding ASHA Position Statements.
Parents are our partners – we know AAC and they know their children. Only when parents have all of the facts they need to make informed decisions can they choose what will work best for their child and the family. When families are excluded from the decision-making process, research suggests that AAC rejection and abandonment are more likely to occur. Families must always be provided with information and be given choices in the AAC decision-making process… and only then are we providing evidence-based practice.
Dollaghan, C. A. (2007). The Handbook for Evidence-Based Practice in Communication Disorders. Baltimore, MD: Paul H. Brookes Publishing Co., Inc.