EBP and AAC
What does Evidence-Based Practice (EBP) entail? The ASHA Code of Ethics calls upon SLPs and SLPAs to “evaluate the effectiveness of services provided, technology employed, and products dispensed, and they shall provide services or dispense products only when benefit can reasonably be expected.” The foundation of our practice should be the use of treatment modalities that we can reasonably expect to be helpful to those we serve.
How do we determine what constitutes an evidence base for what we do? EBP can be thought of as a triangle with each corner pointing to a key factor:
- What does the research say?
- What do my clinical experience and data collection tell me?
- What is the perspective of the person/family I am working to support
These three points are interwoven to allow us to make a clinical decision. No one point is vastly more important than the other, but I have placed Research at the top for a reason. The ASHA code of ethics calls on SLPs to use treatments whose benefits have been studied. There may be times that a client seeks out a treatment that is popular, but not supported by the evidence. Look at these situations as opportunities for client education. And follow the evidence. If you want more information, you can turn to the ASHA website, which contains articles and tutorials on the topic of EBP.
Why is evidence based practice so important?
As clinicians, we want to make sure that we are doing our utmost to be of value to the people we serve. This means ensuring that the tools and strategies we use are the most effective possible for a particular context. Put simply, we don’t want to waste anyone’s time, including our own. Wasted time is harmful in that we are failing to use the limited time we have for implementation of effective interventions. Children with Complex Communication Needs (CCN) grow up. Too many of them are graduating from school without any effective means of communication. Lack of communication means that these human beings are not given access to their basic human rights. They are not able to direct their own lives.
We do not have time to waste.
The Evidence
AACCommunity.net contains information on tools and strategies that have been shown to be effective. Areas covered include:
- The 5 Areas of AAC Competence
- Aided Language Stimulation
- Core Vocabulary
- Communication Partner Training
- Best practices for AAC Evaluations
- Descriptive Teaching Method
- No prerequisites for communication access
Risks of Using Non-Evidence Based Treatments
The risks of failing to follow the evidence can be great. Some treatments have become popular with no proven benefit. One example is Facilitated Communication (FC). In this technique, a facilitator supports the person’s arm while they type or point to a letter board. Reliance on this practice has led to people with disabilities suffering physical abuse and emotional harm. FC has been studied by independent researchers. They have not been able to replicate the claims made for this method. A similar treatment is the Rapid Prompting Method (RPM). This may also be known as Supported Typing.
Another example of non-evidence based practice is Non-Speech Oral Motor Exercises (NSOME). How much time has been spent blowing into straws and whistles that could have been used more productively? Proponents of Oral Motor Exercise claim that it “strengthens” the articulators to support speech. However, research tells us that agility and precision, not strength, are important for speech sound production.
Dispelling AAC Myths
Myths about AAC have been used to “gatekeep” and deny services to people who could benefit. By failing to keep up with the research, we may be buying into some of these outdated ideas. Examples of myths include:
- Cognitive and behavioral prerequisites for using AAC (There are none)
- The child must master picture identification (or the use of the PECS system) before being introduced to robust AAC (We should focus on high frequency words that allow us to do more than request)
- A hierarchy of images exists so we must start with photos (Photos may be visually complex and people with CCN can learn abstract representations)
- The child is too young (
- “She’s just being lazy” is offered as the reason the child is not speaking yet
It behooves all of us to follow best practices and keep an eye on the research. After all, we all want to help the people we serve. We all want to do a good job. Stick with evidence-based practices. If questions arise, or you feel that you are being called on to participate in a practice that is not evidence-based, contact the ASHA Action Center. They can help you figure out the right path to take.
High Contrast copy of the BREATHE poster