The impact of the EBPIG Paediatric Speech on SP's approach to selecting treatment targets.

1. IS THE EVIDENCE ENOUGH? The impact of the EBPIG Paediatric Speech on SP's approach to selecting treatment targets. Elizabeth Murray Dr. Elise Baker Dr. Tricia McCabe

2. Evidence Vs. Tradition • Gaps between research and practice in paeds speech(Baker and McLeod, 2004, Col, 2005, Grol, 2001, Reilly, 2004, Vallino-Napoli and Reilly, 2004), • ‘Traditional practice’ used more frequently

3. Using EBP • Greatest perceived barriers for SPs are: • No. 1 = Insufficient time • Difficulty evaluating the research especially concerning statistics • Unsure of how to implement new research

4. Interactive Workshops • Interactive workshops (like EBPIG) - systematic reviews of RCTs – small to moderate change in practice (Davis et al, 1999, Thomson O’Brien et al, 2002) • Are interactive groups useful for SPs • Efficacy not tested

5. Phonological Target Selection

6. Phonological Target Selection • CURRENT EBP based on recent research = LEAST knowledge approach (Gierut, 2005, Gierut, 2001 and Williams, 2005) • SPs continuing to prioritise traditional target selection (McLeod and Baker, 2004) • TRADITIONAL approach = MOST knowledge approach.

7. Aims of study • To determine the efficacy of the EBP Paediatric Speech Group regarding: • target selection for children with phonological impairment, and • the participants perceived barriers to EBP. • Hypotheses: • Intervention group members significantly select targets more in line with evidence (null = all traditional) • Intervention group members with decreased EBP barriers

8. Study Sample Qualified SP’s Work in Community Health Centres in Sydney Intervention Group Control Group • Not members of any interactive workshops • Random sample using • telephone book • Members of the EBPIG • Paediatric Speech group

9. Data collection • Distribution of participant information forms, questionnaires and reply-paid envelopes Control Group Intervention Group • Mailed out and reminder - Another two attempts • Response rate: 15% (15/100) • Either in meeting or by • mail • Reminder • Response rate: 52% (13/25)

10. Questionnaire • Demographics and exposure to EBP • Three hypothetical case studies • Rating of perceived barriers using Likert scale.

11. Case Studies • Designed to determine if participation in interactive workshops promotes evidence-based decision making. • Case one – same characteristics as the research participants • Case two – same as one + concomitant expressive language disorder • Case three – same as one + reluctant to talk/ shy child.

12. Example of case information

13. Perceived barriers • 5 point Likert scale • Participants to rate extent they agreed or disagreed • All statements content but one based on Funk et al, 1991, Meline and Paradiso, 2003 and Upton and Lewis, 1998. • Other specific literature constraint.

14. Results & Discussion

15. Case study results

16. Case 3? • All participants chose targets consistent with TRADITIONAL practice (most knowledge) • Clinical expertise/ client needs prioritized • Most knowledge provides earlier success with easier sounds – clinicians felt this was important for a shy child. • Least knowledge not tested in literature for such children – going with something they know will work.

17. Efficacy of the interactive workshops • Regarding case 1 and 2 • Small positive change • Consistent with results from systematic reviews (Davis et al, 1999 and Thomson O’Brien et al, 2002). • Knowing the evidence was not sufficient for all members to change their practice.

18. Limitations • Potential participant bias (But no differences between groups for years of education (p=1.0) or frequency of PD activities (p=0.84).) • Response rate Not unusual for EBP studies (Meline and Paradiso, 2003, Peach, 2003)

19. Perceived barriers results • Intervention (EBPIG) group - fewer barriers for evaluating and implementing the literature. • Overall, intervention group members felt they had more barriers than the control group for 7/11 statements. • Perhaps more aware of five-step process/ what is involved.

20. Perceived barriers • Insufficient time again number one barrier • 100% - intervention, 84% - control • Preappraised evidence reduces time burden • Eliminates time and skill needed to search, read and appraise many articles • Problems… • Bias and distortion (Col, 2005 and Elliot, 2004) • IMPLEMENTATION • Not guaranteed clinicians will use the research in practice despite knowing what they should do (Zhen et al, 2001)

21. Constraint of phonological literature • Feeling uncomfortable working on harder, later developing targets with a three year old child. • Intervention = 92.3%, Control = 69.2% • Clearly more barriers involved than just 5-step process.

22. Learning Transfer Literature • Four conditions for new knowledge to be used:(Posner et al, 1982) • Must be dissatisfied with existing methods/ concepts • Must be intelligible • Must be initially plausible • Must be potentially fruitful • Meeting these conditions may be useful in changing practice.

23. Conclusions • Interactive workshops - small gain in EBP use in practice • Not enough alone: ??? Pre-appraised evidence + interactive workshops for steps 4 & 5 • Barriers likely to exceed those of five-step process • Focus group with intervention group members beneficial

24. What does this mean? • The EBP Network? • Determine and address other barriers to EBP • Use multi-faceted approaches? – what’s the next step? • How do you make people dissatisfied with something that works (but is slower?) • Managers? • Need to plan for implementation of EBP? • Need to give permission to change? • Need to value efficacy over expediency – value long term over short term • Clinicians?

25. Thank you