A Broader Perspective: Counseling Psychology?s Emphasis on Evidence

Quality of language intervention provided to primary-grade students with language impairment

This study had two aims: (a) to describe the quality of language intervention provided by school-based speech-language pathologists (SLPs) to children with language impairment in the primary grades with respect to the quality of emotional support, instructional support, and proactive management during SLP-child interactions, and (b) to determine if key characteristics of the SLPs are predictors of variance in intervention quality. Participants were 174 children nested within 40 SLPs' caseloads from various districts in two Midwestern states involved in a larger study of speech-language therapy practices in the public schools. A total of 208 videotaped language intervention sessions were coded for emotional support, instructional support, and proactive management using the Classroom Assessment Scoring System (CLASS; Pianta, La Paro, & Hamre, 2008). The quality of language intervention varied widely and was generally mid-range to high with respect to emotional support and proactive management, and low to mid-range in terms of instructional support. The quality of interactions varied and a large percentage of the observed variance in quality was attributed to SLPs. Time pressure was a strong predictor of the quality of emotional support, instructional support, and proactive management, and job satisfaction was a significant predictor of instructional support and proactive management. This descriptive information about school-based language intervention highlights the impact of the individual SLP in terms of the quality of the interactions taking place and the potential need to ease job pressures and promote job satisfaction.

LEARNING OUTCOMES

Readers will be able to: (1) identify and define three aspects of SLP-child interaction quality during intervention as framed in this study using the CLASS observation tool (Pianta, La Paro, et al., 2008); (2) discuss the relevance of those three aspects of quality to children with LI; and (3) identify SLP-level factors that significantly predict SLP-student interaction quality during intervention for children with LI.

Balancing Certainty and Uncertainty in Clinical Practice

Purpose

In this article, I question how practitioners can balance the certainty and confidence that they can help their patients with the uncertainty that makes them continually question their beliefs and assumptions.

Method

I compare the mechanisms of science and models of clinical practice that may help practitioners achieve the right balance between total acceptance of the status quo and an open willingness to explore and accept new ideas.

Conclusion

Clinical practice, unlike science, has no independent self-correction mechanism that leads to consensus about best clinical practices. Evidence-based models provide principles and guidelines for clinical practice, but ultimately, clinical decisions may be influenced most by a practitioner’s epistemology (belief systems) and propensity for rational thinking.

Evidence-based practice: an examination of its ramifications for the practice of speech-language pathology

PURPOSE

The purpose of this article is to consider some of the ramifications that arise when a discipline newly endorses evidence-based practice (EBP) as a primary guiding principle. Although EBP may appear straightforward, events experienced by peer disciplines that have preceded us in the implementation of EBP raise questions about defining acceptable forms of evidence for treatment effectiveness and efficacy, the potential roles of nonspecific or common factors, therapist quality in achieving therapy outcomes, and eventual applications of EBP that may overly confine which treatments are considered acceptable and reimbursable.

METHOD

Through narrative review of the literature, the article examines valuable as well as controversial features of EBP in addition to obstacles that may impede the transition of evidence (research findings) to clinical practice.

CONCLUSION

EBP is a valuable construct in ensuring quality of care. However, bridging between research evidence and clinical practice may require us to confront potentially difficult issues and establish thoughtful dialogue about best practices in fostering EBP itself.