#094: A Quick Review of EBP

Marisha: Hello there and welcome to the SLPNow podcast, where we share practical therapy, tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLPNow podcast. This month, Monica and I are diving into all things evidence-based practice. So we'll start off just reviewing the evidence-based triangle that we've all seen probably 5 million times throughout our graduate school training and through our continuing education. But we're going to talk about that in a way that has been super helpful for us. And then we'll spend the next episodes really diving into each part of the triangle and what that looks like in practice.

Marisha: So, hello, Monica.

Monica: Hey, I am so excited to be here and talking about EBP. It's definitely one of my favorite things.

Marisha: We probably need a nerd alert or something on this podcast.

Monica: I'm sure.

Marisha: Who's excited about talking about the triangle? If you are excited and you're listening in, come hang out with us on social media. On Instagram is probably the best place at SLPNow. Anyway, so we have this triangle and let's do a quick recap of what the three parts of the triangle are.

Marisha: Do you want to walk us through?

Monica: For sure. So the three parts are evidence, so internal and external, clinical expertise and then client perspectives.

Marisha: Awesome. Because I think this will be a really helpful discussion, because I feel like we tend to lean towards one of the pieces of the triangle and it turns into not an equilateral triangle where it's a little bit skewed to one side or the other. And so I know that in my past experience, I've gone really heavily towards the evidence side and then really heavily towards the external evidence, where that was the main thing that I was focusing on. And that's one thing that I think is super interesting to think about, because it's internal and external evidence. So we can even get a little bit skewed in a specific part of the triangle too. Do you feel like you've had something like that too, Monica?

Monica: For sure. I feel like it's the same way. I either go to a CEU or I read an article and I get really stuck on, it has to be this way. But there is so much other stuff, like you're talking about, like the internal evidence and then what I know maybe that particular student needs, based on my time with them. Oh yeah, that's right. I need to also consider their family and how they're doing with that and all the cultural stuff. So it does sometimes then feel overwhelming with how do I connect everything together, even as an experienced clinician?

Marisha: Yeah, absolutely. So we talked a little bit about what we did wrong when looking at the triangle or something that we learned from it. So let's chat a little bit about what it could look like or how we can use it to benefit our practice.

Monica: So I feel like maybe even using a real life example might be where to start. For me, it almost is like if I had a mixed group in school, SLPs were always having mixed groups. So if I had one and by some stroke of luck, I was able to just get my speech sound kids together, even between that speech sound group, I might have an articulation kid and a phonology kid, but doing EBP, I'm not going to do the same approach with those kids. So the articulation one and the phonology one, I know I'm going to need a lot of trials, but one might need more phonological awareness than the other one. The phonological student, I might have to use a certain treatment approach because of the way their errors are. But then the one with articulation, the research external has shown that I need to really have a certain type of prompting to really have that motor focused approach with them.

Monica: So, you might have the same activity, but it's not your activity that's research-based, it's the method that you are using for each student that you've used your external and internal data with the progress monitoring that you're doing with them to figure out the best approach for each student, even if you're using the same activity for them, you're using that whole approach together, that EBP triangle to figure out what you're doing with each student. And then with the things that you sent home, or even your target list, you might've asked the teacher or the family for some functional word targets, especially if you're using a core word approach. And then if somebody came into your room, you look like you're doing one activity with two students. You have this whole entire process where you've narrowed down different things.

Monica: They're just supposed to look really seamless, but it is a process and it does, I think take a lot of time to make that a smooth thing. And sometimes it's not. That's the other part of the EBP triangle as well, I think, is that sometimes you try something and they're not making as much progress. And then you have to try something else and maybe re-examine that triangle again. Where do I need to make some adjustments in that?

Marisha: Yeah. I love that. There are two things that really stood out to me. You can't see this, but I've been bopping my head all the time, just nodding a lot. Yes, Monica, you got this. I love that what you mentioned about activity is not evidence-based. So we can have the most beautifully researched protocol with 5 million randomized controlled trials and meta analysis supporting it. Just because we're using that doesn't mean that it's evidence-based. It could be completely not evidence-based. There's a lot of external evidence there, but there's not the internal evidence.

Marisha: We're not using our clinical expertise and considering the client perspective. There isn't an activity, it's what we bring to the table. And I always say that you are your best therapy tool and really our brains, because it is a lot of work managing all of those different pieces. And it's no wonder that we're tired at the end of the day, thinking about all these things, because there's a tremendous amount of things going on. And I also really loved what you said about it being trial and error. We're supposed to stumble a little bit, as we figure out the ideal combination. I've definitely put on my blinders at times where it's like, this is what we're doing. I get laser focused on one thing and not always pulling in the different parts that we could be thinking about. And it's supposed to be that back and forth.

Monica: And I mean, sometimes it's hard. You plan this perfect lesson, you want to do the lesson and then you find that it doesn't work with your students. And you're just like, but I took so long and I prepped this thing. You might've even laminated it and cut it. So, it's rough.

Marisha: Oh, that's the worst. When you laminate and it doesn't work out, oh man.

Monica: Right.

Marisha: And we'll talk about specific areas that we can look into, strategies for the internal and external evidence and clinical expertise and client perspectives. But what are some good general resources that SLPs can start looking into as they're trying to navigate this?

Monica: I think the ASHA website really, they have a lot of graphics and videos talking about it, just PDFs that are, I think, summarized really well. So, if you just need to watch a video on it and listen to it and just get the basics to just refresh that a little bit before you get going, I think that's probably a great place to go.

Marisha: Yeah. So the evidence maps, they focus obviously a lot on external evidence. And we'll talk about this more later this month, but the client perspectives, they have some articles embedded there as well. So that can be a good resource to look at if you're like, "Oh wait, maybe my triangle is a little bit out of whack." That can be a good resource to look towards as well.

Monica: For sure. And then for anyone who hasn't ever been on the ASHA evidence maps, they have it tabbed. So there's three different tabs for each part of the triangle.

Marisha: Yes. So it couldn't get any easier. It's been a really cool resource to look into. So I think that's a good overview of the triangle as a whole. Next time, we'll start talking about the evidence and then we'll follow up with two more segments about the other sides of the triangle.

Marisha: Thanks for listening to the SLPNow podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you.

Marisha: See you next time.