ACQ Vol 13 no 2 2011

Assessment

What’s the evidence? Evidence based practice in the assessment context Mary Claessen and Jade Cartwright

Scenario “As I sit in my office in a local health service drinking my morning coffee with a new client booked in to see me in an hour, I ponder what it means to work with a client in an evidence based manner.” This is a term I’ve read a lot about, and heard about in presentations, but how does it apply to me? I am an experienced speech pathologist who takes pride in keeping up to date with research and new treatment approaches. The other speech pathologists and I have developed an assessment protocol for new clients in our health service based on a combination of what we learnt at uni, professional development workshops attended recently and articles we’ve read. Surely that’s enough; evidence based practice (EBP) is for researchers, not for me.” This scenario may or may not apply to you personally but many clinicians comment about the applicability of EBP and the time it takes to “do all that EBP stuff”. When planning to see a new client, it is often easier to reach for the “old faithful” assessment. However, as speech pathologists we have a professional and ethical responsibility to approach each individual assessment with EBP in mind. This column of “What’s the evidence?” aims to guide clinicians through a series of questions that promote reflection on evidence based assessment and provide a framework for improving current practice. Questions to consider are: • What is my professional responsibility for using evidence based practice? • How can I balance use of craft and science in the assessment context? • How do conceptual frameworks and theory guide my selection of assessment tasks? • What are the psychometric properties of the assessments that I routinely use? What about the alternatives? • Have I considered the ecological validity of my assessment approaches, measures and tools? • How do the perspectives of my client influence my assessment choices? Evidence based practice Speech pathology is undergoing transformation from a craft- based profession into one that relies on clinical decision- making models underpinned by evidence based practice (Justice, 2008). It is the position of Speech Pathology Australia (2010) that speech pathology is a “scientific and evidence based profession” (p. 3) and clinicians have a responsibility to incorporate the best available evidence from research and other sources into their clinical reasoning

and client management. The processes for upholding this professional responsibility evolved from evidence based medicine, defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71). Evidence based practice requires reasoned evaluation and integration of different sources of evidence, which include the clinical expertise of a clinician (craft), the best external evidence (science), and the values and perspectives of the client (Sacket et al., 1996; Sacket, Straus, Richardson, Rosenberg, & Haynes, 2000). Evidence based practice should underpin all facets of speech pathology practice including not only treatment, but also the decision making that guides the planning, implementation and interpretation of diagnosis and assessment. Balancing craft and science for evidence based assessment All speech pathologists would agree with Tate (2010) that good assessment forms the foundation of evidence based clinical practice. Assessment serves many purposes such as determining whether a disorder is present, assisting differential diagnosis and prognostic reasoning, and measuring treatment success. Considerable care must be taken when making initial assessment choices as these decisions direct the choice of treatment goals and approaches, ultimately shaping the outcomes of intervention (Kagan & Simmons-Mackie, 2007). With clinical experience comes expertise and intuition that clinicians can use to guide the selection of assessment tools and measures. This craft-based knowledge develops over time from both theory and practice (Justice, 2010), allowing implicit judgements to be made about the client’s presentation, the referral question, the management required, or the expectations of the clinical context or service. An experienced clinician can quickly identify the assessments “appropriate” for the given client or situation. But as practitioners, how often do we ask ourselves what factors actually make an assessment appropriate, and which evidence based assessment principles consciously guide our decision-making processes? It is important to ask whether a better alternative to our “old faithful” exists and this is where science-based knowledge plays a critical role. In the era of evidence based medicine, these are questions that should guide routine assessment planning and client management ensuring that use of craft and science is balanced. A major barrier to achieving this balance in practice relates to the lack of tangible resources, evidence based

Mary Claessen (top) and Jade Cartwright

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ACQ Volume 13, Number 2 2011

ACQ uiring Knowledge in Speech, Language and Hearing