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Assessment
84
ACQ
Volume 13, Number 2 2011
ACQ
uiring Knowledge in Speech, Language and Hearing
Mary Claessen
(top) and Jade
Cartwright
What’s the evidence?
Evidence based practice in the assessment context
Mary Claessen and Jade Cartwright
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
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