clinical problem solving speech pathology

Skip to primary navigation
Skip to main content
Skip to footer

SLP Now® Blog

A blog created for SLPs--by SLPs! Featuring therapy ideas and resources to helps busy SLPs streamline their caseload management.

10 Tools for Clinical Problem Solving

Last week, we talked about strategies to stick with our goals.

One of those strategies was to break our goal down into action steps.

When we’re talking about figuring out how to best treat a student with apraxia of speech or how to implement literacy-based therapy, those action steps can feel a little bit overwhelming. Where in the world do we start?

Here are some of my “go-to” resources when it comes to tackling clinical goals (in no particular order):

1. Research Articles

When I’m looking for information on a specific topic, I do a quick search on ASHA or Google Scholar.

SLP Hack: Many of the articles are paid. It’s not always feasible to spend $25 on ONE journal article, but you can often access the articles for free at your local university’s library.

2. ASHA Evidence Maps

This site includes resources for AAC, Late Language Emergence, and more! This is a great place to check if you want a quick review of the evidence in a particular area.

3. The Informed SLP

If you’re feeling overwhelmed by all of the research, The Informed SLP makes it so much more “digestible.” They review all of the latest (clinically relevant) research on a monthly basis. You can read the summaries on their website on in a PDF format. They also have an audio version (perfect for those of us with long commutes)!

4. Online Courses

There are so many options out there! Here are some of my favorites:

• Leaders Project : The site offers free CEUs, mock evaluations, narrative assessment tools, and so much more.

• SpeechTherapyPD : They have hundreds of courses that you can access for $89 per year!

5. Textbooks

Textbooks are a great way to get an overview of any given topic. Like The Informed SLP, they do some of the digesting for us. Two of my favorites are School-Age Language Intervention and Contextualized Language Intervention .

6. SLP Now Evidence Table

This is still very much a work in progress, but the table includes links to relevant research articles (with a quick synopsis). It also includes links to materials I created based on the research findings.

Whenever a parent or an administrator questions what I’m doing, I know I have evidence to back up my decisions. I don’t necessarily pull out the table (because that might be a little unexpected!), but I’m able to easily share the evidence, if needed. This gives me the boost of confidence that I need in those awkward situations!

If a student isn’t responding well to intervention, then I can also pull up the table for some ideas. Quick and easy (evidence-based) troubleshooting for the win!

7. Colleagues

Reach out to speech-language pathologists that you admire. Just having someone to talk through a problem with can be incredibly helpful. Bonus points if they have suggestions to share!

Don’t have someone to reach out to regarding a specific topic? Consider checking out a Facebook group! Check out this blog post for some group suggestions!

8. Assessments

When given a clinical problem but I’m not sure where to go next, I like to collect data. Stay tuned for some assessment suggestions in the next few weeks.

9. Reach out to the Team

Communicate with the teacher and other service providers. Ask them their perspective on the problem. They may not be an expert in communication, but they may have a unique way of looking at the situation.

10. Use Your Data

You can also use the data that you’ve already collected! Review the students’ past progress and read past reports to make sure you’re not missing anything. Reviewing and organizing the data can help you brainstorm solutions.

Stay tuned for more tips and suggestions from other SLPs. We’ll be interviewing six SLPs over the next several weeks. They’re going to give a “behind the scenes” look at how they tackled specific problems, including more resources and suggestions!

Tags: Confidence , Mindset , Motivation

Share Pin 276

Hi there! I'm Marisha. I am a school-based SLP who is all about working smarter, not harder. I created the SLP Now Membership and love sharing tips and tricks to help you save time so you can focus on what matters most--your students AND yourself.

Reader Interactions

You Might Also Like...

#172: 3 Steps to Easily Plan Your Speech Therapy Sessions

In this episode of SLP Now, Marisha shares a 5 step framework that helps SLPs stream line and structure their Speech Therapy Sessions.

#158: How to Structure a Speech Therapy Session

Join Marisha in this episode to learn how scheduling parties can revolutionize the way you handle school scheduling. From empowering teachers to pick their slots to fostering a seamless coordination process, Marisha's approach promises more than efficiency – it creates a more connected and productive school environment.

#157: Easy Scheduling Tips for School-Based SLPs

Terms & Conditions
Privacy Policy
SLP Membership
Caseload Management
Curriculum- and Literacy-Based Speech Therapy Planning & Lesson Plans
Organizing Your Speech Therapy Classroom and Materials
Outside the Speech Room

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Five heads are better than one: preliminary results of team-based learning in a communication disorders graduate course

Affiliation.

1 Department of Speech Communication Arts & Sciences, Brooklyn College, City University of New York (CUNY), Brooklyn, NY, USA.
PMID: 26399439
DOI: 10.1111/1460-6984.12184

Background: Clinical problem-solving is fundamental to the role of the speech-language pathologist in both the diagnostic and treatment processes. The problem-solving often involves collaboration with clients and their families, supervisors, and other professionals. Considering the importance of cooperative problem-solving in the profession, graduate education in speech-language pathology should provide experiences to foster the development of these skills. One evidence-based pedagogical approach that directly targets these abilities is team-based learning (TBL). TBL is a small-group instructional method that focuses on students' in-class application of conceptual knowledge in solving complex problems that they will likely encounter in their future clinical careers.

Aims: The purpose of this pilot study was to investigate the educational outcomes and students' perceptions of TBL in a communication disorders graduate course on speech and language-based learning disabilities.

Methods & procedures: Nineteen graduate students (mean age = 26 years, SD = 4.93), divided into three groups of five students and one group of four students, who were enrolled in a required graduate course, participated by fulfilling the key components of TBL: individual student preparation; individual and team readiness assurance tests (iRATs and tRATs) that assessed preparedness to apply course content; and application activities that challenged teams to solve complex and authentic clinical problems using course material.

Outcomes & results: Performance on the tRATs was significantly higher than the individual students' scores on the iRATs (p < .001, Cohen's d = 4.08). Students generally reported favourable perceptions of TBL on an end-of-semester questionnaire. Qualitative analysis of responses to open-ended questions organized thematically indicated students' high satisfaction with application activities, discontent with the RATs, and recommendations for increased lecture in the TBL process.

Conclusions & implications: The outcomes of this pilot study suggest the effectiveness of TBL as an instructional method that provides student teams with opportunities to apply course content in problem-solving activities followed by immediate feedback. This research also addresses the dearth of empirical information on how graduate programmes in speech-language pathology bridge students' didactic learning and clinical practice. Future studies should examine the utility of this approach in other courses within the field and with more heterogeneous student populations.

Keywords: graduate education; language learning disabilities; problem-solving; speech-language pathology; team-based learning.

PubMed Disclaimer

Related information

Linkout - more resources, full text sources.

MedlinePlus Health Information

Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
Am J Speech Lang Pathol

Evidence-Based Practice in Speech-Language Pathology: Where Are We Now?

Tamar greenwell.

a Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN

c Tamar Greenwell and Bridget Walsh share first authorship.

Bridget Walsh

b Department of Communicative Sciences and Disorders, Michigan State University, East Lansing

In 2004, American Speech-Language-Hearing Association established its position statement on evidence-based practice (EBP). Since 2008, the Council on Academic Accreditation has required accredited graduate education programs in speech-language pathology to incorporate research methodology and EBP principles into their curricula and clinical practicums. Over the past 15 years, access to EBP resources and employer-led EBP training opportunities have increased. The purpose of this study is to provide an update of how increased exposure to EBP principles affects reported use of EBP and perceived barriers to providing EBP in clinical decision making.

Three hundred seventeen speech-language pathologists completed an online questionnaire querying their perceptions about EBP, use of EBP in clinical practice, and perceived barriers to incorporating EBP. Participants' responses were analyzed using descriptive and inferential statistics. We used multiple linear regression to examine whether years of practice, degree, EBP exposure during graduate program and clinical fellowship (CF), EBP career training, and average barrier score predicted EBP use.

Exposure to EBP in graduate school and during the CF, perception of barriers, and EBP career training significantly predicted the use of EBP in clinical practice. Speech-language pathologists identified the three major components of EBP: client preferences, external evidence, and clinical experience as the most frequently turned to sources of EBP. Inadequate time for research and workload/caseload size remain the most significant barriers to EBP implementation. Respondents who indicated time was a barrier were more likely to cite other barriers to implementing EBP. An increase in EBP career training was associated with a decrease in the perception of time as a barrier.

Conclusions

These findings suggest that explicit training in graduate school and during the CF lays a foundation for EBP principles that is shaped through continued learning opportunities. We documented positive attitudes toward EBP and consistent application of the three components of EBP in clinical practice. Nevertheless, long-standing barriers remain. We suggest that accessible, time-saving resources, a consistent process for posing and answering clinical questions, and on the job support and guidance from employers/organizations are essential to implementing clinical practices that are evidence based. The implications of our findings and suggestions for future research to bridge the research-to-practice gap are discussed.

Promoting the understanding and use of evidence in clinical practice through explicit instruction in the classroom and clinic has long been an objective of graduate programs in speech-language pathology. A committee of the American Speech-Language-Hearing Association (ASHA) on evidence-based practice (EBP) was formed in 2004 to review clinical practices in the field at that time. The committee established the following position statement regarding EBP: “An approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions” ( ASHA, 2004 ). ASHA's statement reflects the influential position proposed by Sackett et al. (1996) that “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (p. 71). Since 2008, the Council on Academic Accreditation ( CAA, 2014 ) has required accredited graduate education programs in audiology and speech-language pathology to include research methodology and EBP principles into their curricula and clinical practicum. ASHA certification standards in speech-language pathology incorporate three principles into their definition of EBP: EBP is the integration of evidence, for example, from the scientific literature, with clinical expertise and experience, and client preferences. Graduate students aspiring to receive the Certificate of Clinical Competence must demonstrate a proficiency in these skills related to both evaluation and intervention. Familiarity with EBP and access to EBP resources are key components to promoting its use in clinical practice.

After ASHA released its EBP statement in 2004, Zipoli and Kennedy (2005) conducted a survey of 240 speech-language pathologists to explore the perception, use, and perceived barriers of providing EBP. Despite a growing body of EBP literature in other health professions, Zipoli and Kennedy's seminal study was among the earliest in the field of speech-language pathology. They found that greater exposure to EBP principles and research during participants' clinical fellowships (CFs) translated into greater reported use of EBP. Speech-language pathologists (SLPs) who reported greater exposure to EBP in their graduate program and/or CF experience were also more likely to view EBP more positively. Zipoli and Kennedy also found that SLPs who reported reading research articles and conducting database searches during graduate school were more likely to continue to do so in their professional practice. Of the three components of EBP, research evidence, clinical expertise, and client preferences, SLPs reported they relied on their clinical experience and the expertise of colleagues most often. Dollaghan (2004) argued that empirical findings, if available, should be emphasized over expert opinion in terms of evidence quality; however, it is clear that clinicians should also incorporate clinical expertise and client preferences to guide clinical decision making. Finally, Zipoli and Kennedy noted that SLPs most often reported a lack of time as the number one barrier to providing EBP.

Until a recent publication by Thome et al. (2020) , there had been surprisingly few follow-up EBP studies of the same magnitude and scope conducted over the past 15 years since Zipoli and Kennedy published their report. Many of these follow-up studies targeted specific groups of SLPs—for example, those practicing in the schools ( Hoffman et al., 2013 ) or from a particular state (e.g., Guo et al., 2008 ). The purpose of this study is to provide a critical update to Zipoli and Kennedy (2005) by assessing how increased exposure to EBP principles affects reported use of EBP and perceived barriers to providing EBP in clinical decision making.

Earlier studies report mixed findings regarding SLP's confidence with EBP principles. While knowledge and skills related to implementing EBP were not found to be barriers by Zipoli and Kennedy (2005) , other reports convey perceptions of insufficient training and uncertainty about what constitutes EBP. For example, Guo et al. (2008) used a needs assessment to identify how SLPs viewed their EBP training. The SLPs surveyed reported they lacked the appropriate training and resources to interpret the research and determine which practices were evidence based. Guo et al. found that only half of the 84 participants reported knowledge of EBP, yet nearly all participants answered questions probing clinical practice suggesting they implement EBP principles in their clinical decision making. Guo et al. surmised SLPs may not share a common definition of EBP and suggested that graduate training programs should support the development of EBP skills into course work and clinical practicums.

In a large study of 2,762 school-based SLPs, Hoffman et al. (2013) concluded that the amount and type of exposure to EBP principles is also important to consider. Although 75% of the SLPs in their study reported having formal training in EBP, 70% of participants reported a need for even more EBP training. For example, the clinicians in the study reported rarely posing and researching EBP questions (on average, 0–2 a year). Hoffman et al. concluded that SLPs, regardless of years of experience, do not rely on a consistent process to ask and answer clinical questions using research evidence.

Finally, Vallino-Napoli and Reilly (2004) investigated clinicians' definition of what EBP means to their practice. Although nearly all respondents (94%) identified applying research results to clinical practice, only 51% of respondents cited clinical experience/expertise as an additional important element of EBP. Even fewer, 28%, of clinicians recognized client preferences as the final component of EBP. Approximately one quarter of clinicians recognized all three essential components of EBP delivery. This contrasts with Zipoli and Kennedy's finding that SLPs most frequently relied upon clinical expertise to deliver EBP. Recent studies by Fulcher-Rood et al. (2020) and Thome et al. (2020) provided updated findings on clinicians' perspectives on the three EBP components. Participants in the Fulcher-Rood et al. study most often identified research as an essential component of EBP. Only two of their 26 participants (8%) stated all three components of EBP: research, clinical experience, and client preferences. Despite the lack of clear identification of all three components, however, the SLPs from the study self-reported using research, experience, and client needs to determine if they should use a practice clinically. Thome et al. (2020) surveyed 176 SLPs across the United States. Only 14% of SLPs identified the three components of EBP.

Together, these studies suggest that while most SLPs agree that EBP is integral to evaluation and intervention, there is a need for explicit, consistent training of EBP ethos and a process for asking and answering clinical questions.

EBP Resources

In their study of school-based SLPs, Hoffman et al. (2013) categorized EBP resources as tangible versus intangible. Examples of tangible resources, those that can be purchased or printed, include a computer, internet access, journal access, workshops, and continuing education. In contrast, examples of intangible resources, those which cannot be bought or purchased, include dedicated time to research and access to knowledgeable professionals (professional learning communities). We note that, in other EBP studies, dedicated time to research is categorized as a potential barrier to providing EBP ( Fulcher-Rood et al., 2020 ). The majority of SLPs surveyed reported adequate access to tangible resources, such as computers with internet access, but less adequate intangible resources, such as dedicated time for EBP. Additionally, few SLPs reported an established workplace statement regarding EBP practices. Zipoli and Kennedy (2005) also found that EBP and clinical guidelines were not commonly used by practicing clinicians.

Regarding external evidence, Hoffman et al. (2013) reported that, although 87% of respondents were aware that ASHA members have access to all ASHA peer-reviewed journals, they infrequently accessed ASHA journal articles (0–4 times a year) to support EBP. In contrast, Harding et al. (2014) found that “health clinicians,” or clinical practitioners across seven allied health disciplines, accessed databases once a month to research EBP. Several studies have suggested that clinical experience is the most frequently relied upon source of EBP ( McCurtin & Clifford, 2015 ; Zipoli & Kennedy, 2005 ). For example, respondents to McCurtin and Clifford's 2015 survey most often turned to the opinions of colleagues and experts to provide EBP.

A frequently noted barrier to EBP is insufficient time ( Fulcher-Rood et al., 2020 ; Harding et al., 2014 ; Hoffman et al., 2013 ; O'Connor & Pettigrew, 2009 ; Thome et al., 2020 ; Zipoli & Kennedy, 2005 ). Hoffman et al. (2013) reported that less than 10% of their school-based SLP respondents had dedicated time for EBP research and review. Respondents who were afforded dedicated time for research reported, on average, less than 1 hr per week. Considering that posing and answering clinical questions is estimated to take between 3 and 7 hr ( Brackenbury et al., 2008 ), this is clearly insufficient. Other oft reported barriers include high caseload/workload and lack of funds for resources such as journal articles ( Fulcher-Rood et al., 2020 ; Harding et al., 2014 ; Upton & Upton, 2006 )

The literature also reveals barriers related to specific components of EBP training, such as skills to search for and analyze research articles. While some studies probed perceptions of the adequacy of general training of EBP processes ( Harding et al., 2014 ; Hoffman et al., 2013 ), other studies queried whether clinicians possessed specific skills to implement research findings such as the ability to evaluate the results or comprehend statistical analyses. Metcalfe et al. (2001) reported that 78% of clinicians felt ill-equipped to evaluate statistical findings. Similarly, O'Connor and Pettigrew (2009) found 73% of less experienced and 43% of more experienced SLPs had difficulty understanding statistical analyses. Most recently, however, Thome et al. (2020) noted that most SLPs (73%) felt very to somewhat knowledgeable about accessing online databases and 84% were very to somewhat confident in interpreting findings from studies. Their recent finding may reflect EBP training routinely incorporated into graduate school curriculums—a suggestion we will explore in this study.

In 2015, ASHA's EBP committee was replaced with the Committee on Clinical Research, Implementation Science, and Evidence-Based Practice (CRISP) to fulfill a broader aim of upholding principles of EBP and expanding clinical practice research to advance treatment approaches ( ASHA, 2019 ). As EBP principles have become integrated into clinical training and practice over the past decade, there has been a dramatic increase in EBP resources and other tools available to clinicians to help incorporate current research findings into their clinical practice. Given the widely recognized research-to-practice gap that exists in the field, an emerging field of study, implementation science, is dedicated to bridging this gap and enhancing the dissemination of research findings into clinical practice (e.g., Olswang & Prelock, 2015 ). Resources such as ASHA Evidence Maps, websites dedicated to speech-language pathology training and materials, online access to journals, and searchable databases are a few examples of more readily available tools to promote the implementation of practices that are evidence based. Logically, increased exposure to EBP principles in clinical training combined with an increased availability of EBP resources should translate into increased acceptance, understanding, and use of EBP along with fewer perceived barriers to implementation of EBP. However, few studies have been undertaken in recent years to empirically examine this assertion. The purpose of this study is to provide a critical update on current EBP practices in the field of speech-language pathology. We surveyed practicing SLPs to determine how SLPs are using EBP in their clinical practice and their perceptions of barriers to providing EBP to assess the hypotheses that greater exposure to EBP in clinical training coupled with increased availability of EBP resources has led to increased EBP acceptance and use and reduced perceived barriers toward implementing practices that are evidence based.

Participants

We targeted multiple sources including social media, ASHA Special Interest Groups, and state speech and language associations to recruit practicing SLPs from diverse workplace settings to complete the survey. Participants accessed the survey through an electronic link that provided them with a brief description and purpose of the study. Participants were informed that their responses were anonymous, as no data linking a participant to their responses was collected. Informed consent was not explicitly requested because this study qualified as exempt research by the internal review board at Purdue University.

We received 324 responses to the survey; however, we excluded abandoned surveys and responses from participants who had not completed their CF. This resulted in a final data set of 317 participants. Forty-four percent of participants had been employed as an SLP for more than 20 years. Nearly 28% had practiced between 11 and 19 years, and 27.8% had practiced for ≤ 10 years. Most participants, 86.4%, were master's level clinicians, 1.3% of participants held a clinical doctorate and 11.7% of participants held a PhD. Seventy-seven percent of participants indicated they worked full time, and 19.2% indicated they worked part time. Nearly 95% of our participants were ASHA members. Figure 1 illustrates participants' primary practice settings, with the most common setting being elementary, middle, or high schools (37%).

An external file that holds a picture, illustration, etc.
Object name is AJSLP-30-186-g001.jpg

Primary workplace setting for survey respondents. Percentages of SLPs employed by workplace setting. The most common write-in responses for the “Other” category included telepractice, specialty clinics, and home health. Percentages yield greater than 100% accounting for practitioners employed in more than one setting.

We developed a 48-item electronic survey that was modeled after previously published EBP surveys in the field of speech-language pathology to facilitate comparison with earlier findings (e.g., O'Connor & Pettigrew, 2009 ; Vallino-Napoli & Reilly, 2004 ; Zipoli & Kennedy, 2005 ). The first section of the survey gathered demographic information such as participant's age, highest degree, years in practice, employment status, and primary practice setting. The second section probed exposure to EBP during graduate school and CF training. The third section asked about the type and amount of EBP training participants had received during their career. The next section probed EBP use by asking participants to indicate the frequency (i.e., daily, weekly, monthly, yearly, never) that they incorporated different sources of EBP into their clinical practice. These sources represented the three components of EBP—current research findings, clinical experience, and client preferences. The last section probed participants' attitudes and perceived barriers toward EBP by asking their level of agreement on a 5-point scale ranging from strongly disagree to strongly agree .

Six clinical professors of speech-language pathology employed at Purdue University independently reviewed an initial survey draft and provided oral or written feedback. Feedback included suggestions for additional questions and revising question wording to enhance clarity and streamline the survey. The final version of the survey incorporated the changes suggested by this panel of reviewers (see Appendix ).

Predictors of EBP Use

Participants' responses were analyzed using descriptive and inferential statistics. We conducted a standard multiple regression (enter-method) to determine which factors predicted use of EBP. We used the survey items probing sources of EBP in clinical practice in Section 4 along with two items from Section 5, “I routinely incorporate new research findings into my clinical practice” and “I consider my clients' preferences when making clinical decisions” as our planned outcome variable, “EBP use” integrating the three essential components of EBP. The independent variables, years of practice, degree, EBP exposure during graduate program and CF, EBP career training, average barrier score, and average EBP attitude score were used in the regression to predict EBP use. The coefficient of determination, R 2 , represents the proportion of variance in the dependent variable that is explained by variables in the regression model. Standard interpretation of the coefficient of variation— R 2 of .20 = small effect, R 2 of .50 = moderate effect, and R 2 of .80 = large effect—were applied ( Cohen, 1988 ). The independent variable, EBP exposure during graduate training and CF, was calculated by taking the total number of affirmative responses to each item in the second section of the survey with one additional item from the last section probing attitudes/barriers. Specifically, an additional point was added if participants indicated a degree of agreement (i.e., agree or strongly agree) to the statement, “The SLPs that I was in contact with during my CF incorporated EBP into their clinical practice.” Finally, to establish the independent variable EBP career training, the average response was taken across items in the third section of the survey. We assessed the internal consistency of the composite outcome variables (i.e., variables calculated using multiple items from the survey), “EBP use,” average barrier score, and average attitude score using Cronbach's alpha. A reliability coefficient of .70 or higher is considered acceptable internal consistency.

Post Hoc Analysis

Given that time is an often-cited barrier to implementation of EBP, we conducted Pearson correlations to examine the relationship between time and other barriers to assess the hypothesis that individuals citing time as a significant barrier to EBP would also be more impacted by other barriers. We also examined relationships between time and EBP graduate training and workplace training to explore the suggestion that clinicians who received increased EBP training would be less likely to cite time as a significant barrier to implementing EBP in their clinical practice.

The composite outcome variable, “EBP use,” achieved an acceptable internal consistency of 0.79 using Cronbach's alpha. We also examined Cronbach's alpha levels for two of the predictor variables that represented composite scores. The average barrier score achieved an acceptable internal consistency of 0.72. However, the average composite attitude score achieved unacceptably low reliability with coefficients ranging from –.02 to .25 (depending upon whether any of the four items were removed from the overall composite score). Therefore, the predictor, “average attitude score” was removed from the multiple regression model. The remaining five predictors, years of practice, degree, EBP exposure during graduate program and CF, EBP career training, and average barrier score, collectively accounted for a significant percentage, approximately 17%, of the variance of EBP use, F (5, 312) = 12.20; R 2 = .17, p < .001. The coefficient of determination R 2 represents a medium effect ( Cohen, 1988 ). The results of the multiple regression are provided in Table 1 . The correlation matrix for the six predictor variables and EBP use are presented in Table 2 . The three independent variables, exposure to EBP during graduate training and CF, EBP career training, and average barrier score each significantly predicted EBP use.

Multiple regression analysis for predictors of evidence-based practice (EBP) use.

Predictor
Years of practice	0.16	.09	.12	1.89	.06
Degree	0.89	.72	.07	1.23	.22
EBP grad/CF exposure	1.24	.37	.21	3.38	.001
EBP career training	0.06	.03	.14	2.59	.01
EBP mean barrier score	1.66	.57	.17	2.89	< .001

Note. CF = clinical fellowship.

Correlation matrix ( n = 317).

Variable	1	2	3	4	5
EBP use	.13	.16	.18	.23	.31
1. Years of practice	—	.12	–.47	.20	.27
2. Degree	—	—	–.01	.04	.33
3. Grad/CF exposure	—	—	—	.12	.05
4. EBP career training	—	—	—	—	.24
5. EBP mean barrier score	—	—	—	—	—

Note. EBP = evidence-based practice; CF = clinical fellowship.

We found that an increase in exposure to EBP principles during graduate school/CF and EBP career training each translated into an increase in average EBP use. Table 2 reveals modest correlations between EBP use and these predictors. Of the possible sources of EBP training in graduate school/CF exposure (i.e., dedicated EBP course, individual project related to EBP, EBP training embedded within a course, and EBP training embedded within clinical practicum), most participants indicated that they had received EBP training as part of a class in graduate school (65.4%). Approximately 89% of participants reported at least one affirmative response to EBP training in graduate school/CF. Approximately 87% of participants reported that they had received EBP training during their career (i.e., workplace training, online training, workshop/conference/seminar). The most often cited source of career EBP training was through workshops or conferences, with 95% of respondents selecting this option.

Finally, higher barrier scores were also associated with increased EBP use. It is important to note that higher barrier scores are interpreted positively, meaning the responder was less impacted by a particular barrier (e.g., indicating strong agreement to the statement “I have sufficient access to journal articles at my workplace” would yield a higher score—see Appendix ). Table 2 confirms a moderate correlation between barrier score and EBP use.

Sources of EBP

Participants were asked to indicate the frequency they turned to different sources of EBP with higher scores indicating more frequent use (see Table 3 ). The three overall components of EBP, client preferences, external evidence, and clinical experience represented the top three sources of EBP, respectively. SLPs considered their clients' preferences more frequently than any other source of EBP. Incorporating research into clinical practice earned the second highest score, indicating that SLPs turn to this source on a weekly basis. Relying on clinical expertise received the third highest score. The three most infrequently utilized sources of EBP were posting questions on listservs, presenting findings at conferences/workshops and completing online case studies.

Evidence-based practice (EBP) sources—average scores are based on Likert-scale frequency responses: 0 = never , 1 = yearly , 2 = monthly , 3 = weekly , 4 = daily.

EBP source		Average score
Considering client preferences	315	4.43
Incorporate new research findings into practice	314	3.99
Relying on my own clinical expertise	301	3.87
Input from qualified colleagues	312	2.95
Journal articles	295	2.84
Sharing ideas with colleagues	310	2.81
Internet browsing	313	2.76
Professional blogs	298	2.74
Special interest group material	304	2.64
Professional websites	305	2.37
Input from experts in the field	311	2.10
Discipline-wide publications	310	1.98
Textbooks	313	1.97
Clinical practice guidelines	302	1.93
ASHA Maps website	312	1.78
Research databases	312	1.38
Seminars, conferences, or workshops	297	1.28
Posting questions on listservs or e-mail lists	308	1.0
Presenting findings at conferences/workshops	312	0.73
Online case studies	308	0.44

Note. ASHA = American Speech-Language-Hearing Association.

Barriers to Providing EBP

Table 4 reveals the frequency of participants indicating disagreement (“2”) or strong disagreement (“1”) to each barrier type along with the mean and standard deviation for each barrier score. Recall that disagreement is interpreted negatively. Participants who responded neutrally––neither agree/disagree (“3”) or indicated some level of agreement (“4” or “5”)—were not included in the frequency counts. The two barriers earning an average score of less than 3 were allocated time and caseload size. Over 54% of respondents considered time to be a significant barrier, while over 43% considered caseload size to be a significant barrier. Post hoc correlations indicated a significant relationship between lack of time and several barriers in Table 4 . Participants indicating that time was a significant barrier were more likely to rate caseload size, r (307) = .47, p < .01; access to resources, r (309) = .36, p < .01; lack of training, r (309) = .26, p < .01; and workplace culture, r (309) = .29, p < .01, as barriers to delivering EBP. Although none of the types of EBP training during graduate school correlated with the perception of time as a barrier to implementing EBP (all r –.003 to .08; all p > .05), the barrier time was significantly correlated with EBP workplace training, r (268) = .26, p < .01; online EBP training, r (259) = .18, p < .01; and EBP workshop/conference/seminar training, r (297) = .16, p < .01. Participants who were less likely to rate time as a barrier to providing EBP reported receiving more EBP career training.

Perceived barriers to EBP.

Perceived Barrier	Frequency		Mean Score	Std. Dev.
Allocated time	169	310	2.64	1.46
Caseload size	133	307	2.91	1.28
Access to journal articles at work	110	311	3.28	1.53
Comfort with statistical analyses	105	317	3.26	1.16
Access to resources (unspecified)	93	314	3.47	1.25
Access to journal articles at home	69	311	3.80	1.32
Ability to appraise research	66	314	3.79	1.25
Ability to perform literature search	59	314	3.91	1.16
Lack of training	49	315	3.90	1.10
Workplace culture	46	314	3.90	1.13

Note. Items indicating disagreement or strong disagreement (i.e., lower scores on the 5-point scale) were considered significant barriers. Scoring was reversed for negatively stated items (e.g., “I do not have allocated time at work to research/read about my clients”). ASHA = American Speech-Language-Hearing Association.

Over one-third of participants also indicated that access to journal articles at home and comfort with statistical analyses were significant barriers. SLPs infrequently cited the ability to perform a literature search, lack of training, and workplace culture as barriers to providing EBP; these three potential barriers earned the highest scores.

Attitudes Toward EBP

Although we were unable to use the composite score representing average attitude toward EBP in the multiple regression model, we examined the relationship between individual items conveying opinions about EBP use through Pearson correlations and descriptive statistics. Most participants viewed EBP favorably, with 89.3% indicating they somewhat or strongly agreed with the statement, “I am an advocate of EBP.” However, the correlation between average EBP use and advocacy was not significant, r (315) = .05, p = .35. The percentage of participants disagreeing with the statement, “I am uncertain what necessarily constitutes EBP,” reached 79.5%, indicating that most participants had an overall understanding of EBP principles. Greater certainty of what constitutes EBP was associated with increased EBP use, r (312) = .18, p = .001. Overall, most participants, 81.4%, expressed that they were confident in their ability to determine the optimal intervention for their client in the face of conflicting evidence. The correlation between this item relating to confidence and EBP use was significant, r (312) = .12, p = .04. Finally, we noted a range in level of agreement to the statement, “I should increase the use of evidence in my clinical decisions.” Out of 314 responses, 11.7% strongly agreed, 42.3% somewhat agreed, 26.8% were neutral, 12.3% somewhat disagreed, and 6% strongly disagreed. The correlation between this item and average EBP use was not statistically significant, r (312) = –.09, p = .11.

The intent of this study was to document current EBP practices in the field of speech-language pathology by surveying practicing clinicians about their use of EBP in clinical practice, training in EBP, attitudes toward EBP, and perceived barriers to providing EBP. Our survey was modeled after those implemented in previous studies to assess whether increased exposure to EBP principles and access to sources of EBP has led to an increase in EBP use and decrease in perceived barriers. Training and exposure to EBP in graduate school and during the CF, training/exposure in the workplace, and barrier scores each significantly predicted EBP use. Overall, survey respondents reported positive attitudes toward EBP, demonstrated an understanding of EBP, and consistently applied the three components of EBP in their clinical practice.

This study confirms an earlier finding from Zipoli and Kennedy (2005) that exposure and training in EBP during graduate school/CF significantly predicts EBP use. Respondents who indicated more exposure during graduate school/CF were more likely to implement EBP principles in clinical practice. We also queried EBP training in the workplace to clarify how exposure during different career phases supports EBP use. An increase in EBP exposure through workplace training, independent online training, and/or through workshops and conferences also significantly predicted higher EBP use in clinical practice. These findings confirm the importance of EBP exposure during the initial and later stages of clinicians' careers to promote the incorporation of EBP principles into conventional practice.

Finally, barrier scores significantly predicted EBP use. As expected, clinicians indicating that they were less impacted by the practical barriers listed in Table 4 were more likely to report higher use of EBP. It is important to note that, although these three predictor variables accounted for a significant degree of the variability in EBP usage, clearly, there are additional factors we did not explore that contribute substantially to EBP use. We present directions for future research in the following sections to explore additional factors that affect EBP use.

Previous studies revealed a high reliance on clinical expertise; multiple studies found that clinicians relied on their own clinical judgment and the input of qualified colleagues to deliver EBP ( McCurtin & Clifford, 2015 ; Nail-Chiwetalu & Bernstein Ratner, 2007 ; O'Connor & Pettigrew, 2009 ; Togher et al., 2011 ; Zipoli & Kennedy, 2005 ). Although respondents to our survey also cited clinical experience and colleagues' opinions as often turned to sources of EBP, they ranked client preferences and research findings higher, as the No. 1 and 2 sources, respectively. Taken together, our results confirmed frequent––weekly or monthly––application of three principles of EBP, current research findings, clinical experience, and client preferences into practice. This finding may reflect a shift from relying primarily on clinical experience to the inclusion of research findings and client needs/preferences. It is possible that increased training and exposure to all three components of EBP has precipitated this change.

On the other hand, this result seems at odds with earlier findings suggesting that only 14%[en dash]25% of SLPs correctly identified the three components of EBP ( Thome et al. (2020) ; allino-Napoli & Reilly, 2004 ). Yet, Vallino-Napoli and Reilly's study predates a time when principles of EBP were routinely incorporated into graduate education programs. Participants in the recent Thome et al. (2020) studies were given a list of five possible answers that included the three components of EBP along with two foils and were instructed to select all that applied. It is important to note that many of the respondents correctly identified the three EBP components, but also selected the foils, accounting for the much lower reported understanding of EBP. When examining each possible answer individually, 97% identified research, 72% identified clinical expertise, and 57% identified client values. Our results align with studies suggesting that clinicians do indeed incorporate evidence-based principles into their clinical practice even if they cannot explicitly identify EBP components ( Fulcher-Rood et al., 2020 ; Guo et al., 2008 ).

There has been an increase in online EBP resources available to SLPs over the past decade. Interestingly, these comprise the more frequently reported (i.e., journal articles, internet browsing, blogs) and the least frequently reported (i.e., online case studies, listservs/e-mail lists) EBP sources (see Table 3 ). While many online sources are available to support EBP use, clearly, clinicians report a greater reliance on some sources over others. Participants in the study by Thome et al. (2020) ranked ASHA resources as being those most likely to be accessed and most helpful. The 2020 pandemic has brought an abrupt shift to telehealth practices. Many SLP master's students, for example, have had to rely on case simulation and teletherapy as part of their clinical caseloads. This may result in greater reliance on online EBP resources in the coming years.

Current EBP Barriers

Corroborating other studies, insufficient time and workload/caseload size remain the most often cited barriers to EBP implementation, with over half of respondents indicating they had insufficient time to research topics, and over 43% citing workload/caseload size as barriers to providing EBP ( Fulcher-Rood et al., 2020 ; Harding et al., 2014 ; Hoffman et al., 2013 ; O'Connor & Pettigrew, 2009 ; Sadeghi-Bazargani et al., 2014 ; Vallino-Napoli & Reilly, 2004 ; Zipoli & Kennedy, 2005 ).

Harding et al. (2014) espoused the importance of not only identifying barriers to implementing EBP but elucidating the nature of these barriers to effect changes that ultimately lead to an increase in EBP. It was unsurprising to find a positive relationship between time and caseload size as our results revealed. However, it is noteworthy that many clinicians who cited time as a significant barrier also indicated inadequate support in the workplace including lack of training and access to resources and workplace culture as additional hurdles to providing EBP. After an SLP has identified an EBP, the next step is to effectively apply it to their clinical practice. Implementation science has sought to identify strategies that promote the more efficient transfer of research findings into practice (e.g., Olswang & Prelock, 2015 ). Investigations into effective strategies for implementation of research findings often cite the need for support and guidance from employers/organizations ( Douglas et al., 2015 ; Powell et al., 2015 ).

While it could be argued that time to pose and answer clinical questions through research review is a compulsory component of clinical services, current demands on clinicians do not support this ideal. Health clinicians in the Harding et al. (2014) study reported that research and review for EBP was viewed as a part of professional development as opposed to an essential part of the workload, resulting in limited administrative support for research time within the workday. Limited time to ask and answer clinical questions is a direct result of requirements for productivity. Nonbillable indirect client services are often neglected in the establishment of workload responsibilities. In school settings, this translates to time required to meet student needs that cannot be counted as service minutes. Further integration of dedicated time to ask and answer clinical questions into workload is needed to reduce the barrier of time.

Previous studies identified insufficient training as a barrier to providing EBP. For example, Hoffman et al. (2013) found that 25% of school-based SLPs reported no formal EBP training. Other studies cited insufficient training in specific areas such as statistical analysis as a barrier. O'Connor and Pettigrew (2009) noted that a significant proportion, or 47%, of respondents reported difficulty understanding statistical results/analysis. We found that a smaller proportion––16% of respondents—identified a lack of training as a barrier to providing EBP. Fewer SLPs, or 33%, identified difficulties with statistical analysis as a barrier. The lower percentages in our study compared with earlier reports may reflect, in part, intentional training in research methodology in SLP graduate programs and increased exposure to research in the CF and beyond. However, given that one third of SLPs still view statistics as a barrier to EBP indicates a need for even more focused training in statistical analysis to facilitate interpretation of research findings.

Despite the fact that there were many more online resources available to clinicians when our study was conducted, clinicians still report limited access to online sources of EBP, a finding noted in several earlier reports ( O'Conner & Pettigrew, 2009 ; Vallino-Napoli & Reilly, 2004 ; Zipoli & Kennedy, 2005 ). Again, the 2020 pandemic and resultant move to telepractice could have a long-term impact on online resource availability and use. Access to free webinars and other materials was pervasive at the start of the pandemic. For example, in response to the public health crisis, ASHA made online access to continuing education, the ASHA pass, free to all members for 3 months. Access to this pass afforded practicing SLPs the opportunity to take courses promoting evidence-based telepractice they may not have had the opportunity to take otherwise.

We found that most respondents, over 89%, advocated for EBP, corroborating overall positive attitudes toward EBP by other studies (e.g., Alhaidary, 2019 ; Fulcher-Rood et al., 2020 ; Thome et al., 2020 ; Zipoli & Kennedy, 2005 ). Encouragingly, nearly 80% of respondents indicated they understood what constitutes EBP, with over 81% indicating they could select an appropriate treatment when there is conflicting evidence. This demonstrates an overall understanding of EBP principles and degree of confidence in implementing EBP by most respondents.

Although responses to items assessing attitudes toward EBP were generally positive, we noted a range in responses to the item, “I should increase the use of evidence in my clinical decisions.” Interpreting this range in responses is difficult. For example, it is possible that participants expressing neutrality or disagreement may feel that they already incorporate a sufficient degree of evidence into their clinical decisions. On the other hand, some respondents may feel that they are not able to increase their use of EBP in clinical practice given practical barriers such as time.

Considerations and Limitations

We did not ask participants to report their sex, race/ethnicity, or the state that they practice in. The latest ASHA 2019 profile reveals that over 96% of SLPs are female with 92% of members not identifying as a member of a minority group. Given the homogeneous demographics of ASHA-affiliated SLPs of which nearly all survey participants were members, we would have been underpowered to analyze these data in a meaningful way. We acknowledge, however, that we could have collected and reported these data to serve as a basis of comparison for future studies. The recent study by Thome et al. (2020) included these data along with U.S. regions and whether respondents practiced in rural, urban, or suburban settings, although they did not incorporate these demographic details into their hypotheses or statistical analyses.

Our survey was designed to provide an updated broad perspective of EBP rather than an in-depth probe of individual topics related to EBP. For example, although we asked SLPs to indicate whether they understood what constituted EBP, we did not explicitly ask them to define EBP or to list the components of EBP to document level of comprehension. Similarly, we asked clinicians whether items were barriers to providing EBP; however, we did not ask participants to detail why an item was necessarily a barrier. Follow-up research into prevalent barriers is crucial toward the development of viable solutions to lessen their impact and advance implementation theory and practice ( Powell et al., 2017 ). For example, although clinicians recognize the importance of external evidence, how often do they retrieve articles that help develop effective treatment plans? Building a pipeline of research findings to implement into clinical practice requires developing a substantial evidence base, yet a recent study re-affirms the paucity of clinical practice research publications. Roberts et al. (2020) reported that clinical practice research comprises only 25% of the articles published in ASHA journals over the past 10 years—and these articles were not distributed evenly across disorders. A direction for future study is assessing the initiatives that support and the barriers that hinder clinical practice research to narrow the research-to-practice gap.

Implications and Future Directions

There have been relatively few large-scale studies since Zipoli and Kennedy published their seminal study on EBP in speech-language pathology 15 years ago. Current findings suggest that clinicians' understanding and acceptance of EBP principles is shaped, in part, by laying the groundwork in graduate school and during the CF with continued opportunities for training and exposure in the workplace. Greater exposure to EBP in each of these settings was associated with higher reported use of EBP in clinical practice. While earlier studies identified a primary focus on clinical expertise to deliver EBP, we found the three most frequently cited sources of EBP comprised each of the three principal components: considering client preferences, incorporating new research findings into practice, and reliance on clinical expertise. Our field increasingly recognizes the importance of client and caregiver input into the therapy process to cultivate engagement and, ultimately, improved long-term therapy outcomes ( Braden et al., 2018 ; Jahromi & Ahmadian, 2018 ; Lawton et al., 2018 ; McCoy et al., 2019 ). Strides made to increase client input and feedback should be continued and expanded so that therapeutic alliance is an integral component of the initial assessment and plays an essential role in improved long-term outcomes.

Although we documented increased understanding and use of EBP, long-standing barriers remain. The most frequently cited barrier was insufficient time for research. An understanding of the process and time required to pose and answer clinical questions seems essential to developing strategies to reduce its impact as a barrier to EBP. Brackenbury et al. (2008) estimated that it takes 3–7 hr to pose and answer a clinical question. Considering this estimate, the amount of time (if any) that most clinicians are allotted for research is plainly insufficient.

Reiterating the importance of support from employers and organizations toward implementing EBP, we found a significant relationship between time and EBP career training. Clinicians indicating that they were less impacted by the time barrier were more likely to have received more EBP career training. Follow-up research is needed to clarify this relationship by delineating the type of EBP career training that clinicians receive and the potential impact on their professional time. For example, whether SLPs were trained on techniques that are evidenced based or on specific strategies to support implementation of EBP.

Recent evidence suggests that promoting the efficacy of a treatment does not ensure that it will be adopted into routine clinical practice ( Bauer & Kirchner, 2020 ). Douglas et al. (2015) identified effective strategies that may readily lead to changes in implementing practices that are evidence based, including informal knowledge sharing, onsite coaching/mentoring, consistent access to data/feedback of performance, positive reinforcement, and organizational support. Thus, investment in the implementation of EBP from all stakeholders (SLPs, workplace administrators, educational institutions/research centers, and professional organizations) is essential to advance EBP use.

Considering EBPs result in measurable returns, for example, improved health outcomes and a reduction in the cost of care, it is imprudent not to allocate time for research ( Melnyk et al., 2016 ). Resources that are both accessible and time friendly are also necessary to support the consistent use of EBP. The ASHA Evidence Maps ( https://www.asha.org/Evidence-Maps/ ) is one example of a resource created to facilitate EBP by increasing the efficiency of conducting a literature review. Currently, there are 43 topics covered by the Evidence Maps with several additional topics under development. Most participants, approximately 77%, reported using the Evidence Maps. Additional time-saving resources are needed to support implementation of EBP as well as explicit instruction into the process of asking and answering clinical questions ( ASHA, n.d .; Melnyk et al., 2010 ).

Although few respondents, 15.6%, identified lack of training as a barrier to providing EBP, over 33% indicated that they were not comfortable with the statistical analyses in research articles. Graduate school coursework should not be the only opportunity to learn about research methodology. Continuing education opportunities are needed to further the development of clinical research skills after graduate school. Continuing education offerings focusing on statistical approaches or how to appraise research findings, for example, could help clinicians extrapolate findings to their clinical practice. This would help, in part, advance the career-long development and implementation of EBP.

Acknowledgments

We would like to acknowledge support from our colleagues in the Department of Speech Language and Hearing Sciences at Purdue University. Specifically, we thank Teasha McKinley for her patience and attention to detail throughout the survey development and data collection process. We are grateful to the clinical faculty for their valued contributions to the development of the survey.

Section 1 Demographics

What is your age?

○ Under 25

○ 25–35

○ 36–45

○ 46–60

○ Over 60

What is the highest degree you hold in a speech-language or hearing science program?

○ Bachelor's degree

○ Master's degree

○ Clinical Doctorate degree

○ PhD

○ Other –Write In _______________________________

Comments (Optional): _______________________________

How many years have you been in practice since graduation?

○ 0–5

○ 5–10

○ 10–15

○ 15–20

○ 20+

What is your current employment status?

○ Part time

○ Full time

○ Seeking employment in the field

○ Employed outside of the field

○ Currently unemployed

Comments (Optional): ______________________________

Which best describes your primary work setting? Please mark all that apply.

○ Birth to three (0–3) agency

○ School

○ Hospital/Outpatient clinic

○ Hospital/Inpatient

○ Rehabilitation

○ Long-term care facility

○ University/College

○ Private practice

○ Other –Write In ___________________________________

Comments (Optional): __________________________________

Please mark all professional affiliations for which you are currently a member.

○ ASHA noncertified member

○ ASHA Clinical Fellow

○ ASHA CCC member

○ State organization member

○ Student organization

Comments (Optional): _________________________________

Section II. EBP Training Graduate School Training

During your graduate program indicate which of the following you completed. Please mark all that apply.

	Yes	No
Dedicated EBP course	○	○
Individual project (e.g., master's thesis, research Project, EBP project, etc.)	○	○
EBP training embedded within an academic course	○	○
EBP training embedded within clinical practicum	○	○
[Enter another option]	○	○

Section III. EBP Career Training

Select the type and amount of EBP training you have completed during your professional career. Please mark all that apply.

	1–3 hr	3–10 hr	10–20 hr	20+ hr
Workplace training	○	○	○	○
Online training	○	○	○	○
Workshop/conference/seminar	○	○	○	○
[Enter another option]	○	○	○	○

Section IV. Sources of EBP

Please select the amount of time you spend on each activity in your current clinical practice. If an activity does not apply, please skip to the next item.

Daily Weekly Monthly Yearly Never

Relying on my own clinical experience/expertise

Gaining input from qualified colleagues

Gaining input from experts in the field

Posting questions on listservs or e-mail lists

Attending seminars, conferences, or workshops

Sharing strategies or ideas with my colleagues

Reading textbooks for information

Reading journal articles for information

Reading clinical practice guidelines (e.g., National, state, and/or facility)

Reading professional blogs

Visiting the ASHA Maps website

Visiting other professional websites

Participating in online case studies (e.g., SimuCase or Master Clinician)

Reading special interest group material (e.g., ASHA SIGs)

Reading discipline-wide publications (e.g., ASHA Leader )

Searching research databases (e.g., Cochrane Library)

Internet browsing (e.g., Google or Google Scholar)

Presenting findings from my clinical practice at conferences or meetings.

Section V. Attitudes and Barriers

Please read each statement and indicate your level of agreement.

Strongly disagree Somewhat disagree Neither agree or disagree Somewhat agree Strongly agree

I am an advocate of EBP.

I have sufficient access to journal articles at my workplace.

I have sufficient access to journal articles at my home.

I do not have allocated time at work for research/to read about my clients.

The SLPs that I was in contact with during my Clinical Fellowship incorporated research findings into their clinical practice.

My workload is too large to keep up with latest research.

I am most comfortable relying on my clinical expertise to make clinical decisions.

I consider my clients' preferences when making clinical decisions.

A lack of access to resources hinders my ability to implement EBP.

I am not confident in my ability to appraise research articles.

I am uncertain what necessarily constitutes EBP.

If there is conflicting evidence, I am confident in my ability to determine the optimal intervention for my client.

I am comfortable with most of the statistical analyses in research articles.

A lack of training hinders my ability to implement EBP.

I should increase the use of evidence in my clinical decisions.

The culture at my workplace advocates EBP.

I am not confident in my ability to perform a literature search.

I routinely incorporate new research findings into my clinical practice.

Funding Statement

Funding for this article was provided by the National Institute on Deafness and Other Communication Disorders, grant R01 DC018000, awarded to Sharon L. Christ.

Alhaidary, A. (2019). Evidence-based practice patterns among speech-language pathologists and audiologists in Saudi Arabia . Communication Disorders Quarterly , 4 ( 4 ), 242–249. https://doi.org/10.1177/1525740119843681 [ Google Scholar ]
American Speech-Language-Hearing Association. (2004). Report of the Joint Coordinating Committee on evidence-based practice . http://www.asha.org/uploadedFiles/members/ebp/JCCEBPReport04.pdf
American Speech-Language-Hearing Association. (2019). Committee on Clinical Research, Implementation Science, and Evidence-Based Practice .. https://www.asha.org/About/governance/committees/CommitteeSmartForms/Committee-on-Clinical-Research,-Implementation-Science,-and-Evidence-Based-Practice/
American Speech-Language-Hearing Association. (n.d.) The Decide Framework . https://www.asha.org/Research/EBP/Evidence-Based-Practice-Toolkit/
Bauer, M. S. , & Kirchner, J. (2020). Implementation science: What is it and why should I care? Psychiatry Research , 283 , 112376. https://doi.org/10.1016/j.psychres.2019.04.025 [ PubMed ] [ Google Scholar ]
Brackenbury, T. , Burroughs, E. , & Hewitt, L. E. (2008). A qualitative examination of current guidelines for evidence-based practice in child language intervention . Language, Speech, and Hearing Services in Schools , 39 ( 1 ), 78–88. https://doi.org/10.1044/0161-1461(2008/008) [ PubMed ] [ Google Scholar ]
Braden, M. N. , van Leer, E. , McConville, K. , & Blakeslee, S. D. (2018). Patient, parent, and speech-language pathologists' perceptions of pediatric voice therapy through interviews . American Journal of Speech-Language Pathology , 27 ( 4 ), 1385–1404. https://doi.org/10.1044/2018_AJSLP-17-0226 [ PubMed ] [ Google Scholar ]
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum. [ Google Scholar ]
Council on Academic Accreditation in Audiology and Speech-Language Pathology. (2014). Standards for accreditation of graduate education programs in audiology and speech-language pathology . American Speech-Language-Hearing Association. http://caa.asha.org/wp-content/uploads/Accreditation-Standards-for-Graduate-Programs.pdf [ Google Scholar ]
Dollaghan, C. A. (2004). Evidence-based practice in communication disorders: What do we know, and when do we know it? Journal of Communication Disorders , 37 ( 5 ), 391–400. https://doi.org/10.1016/j.jcomdis.2004.04.002 [ PubMed ] [ Google Scholar ]
Douglas, N. F. , Campbell, W. N. , & Hinckley, J. J. (2015). Implementation science: Buzzword or game changer? Journal of Speech, Language, and Hearing Research , 58 ( 6 ), S1827–S1836. https://doi.org/10.1044/2015_JSLHR-L-15-0302 [ PubMed ] [ Google Scholar ]
Fulcher-Rood, K. , Castilla-Earls, A. , & Higginbotham, J. (2020). What does evidence-based practice mean to you? A follow-up study examining school-based speech-language pathologists' perspectives on evidence-based practice . American Journal of Speech-Language Pathology , 29 ( 2 ), 688–704. https://doi.org/10.1044/2019_AJSLP-19-00171 [ PubMed ] [ Google Scholar ]
Guo, R. , Bain, B. A. , & Willer, J. (2008). Results of an assessment of information needs among speech-language pathologists and audiologists in Idaho . Journal of the Medical Library Association , 96 ( 2 ), 138. https://doi.org/10.3163/1536-5050.96.2.138 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Harding, K. E. , Porter, J. , Horne-Thompson, A. , Donley, E. , & Taylor, N. F. (2014). Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians . Journal of Continuing Education in the Health Professions , 34 ( 4 ), 224–231. https://doi.org/10.1002/chp.21255 [ PubMed ] [ Google Scholar ]
Hoffman, L. M. , Ireland, M. , Hall-Mills, S. , & Flynn, P. (2013). Evidence-based speech-language pathology practices in schools: Findings from a national survey . Language, Speech, and Hearing Services in Schools , 44 ( 3 ), 266–280. https://doi.org/10.1044/0161-1461(2013/12-0041) [ PubMed ] [ Google Scholar ]
Jahromi, E. M. , & Ahmadian, L. (2018). Evaluating satisfaction of patients with stutter regarding the tele-speech therapy method and infrastructure . International Journal of Medical Informatics , 115 , 128–133. https://doi.org/10.1016/j.ijmedinf.2018.03.004 [ PubMed ] [ Google Scholar ]
Lawton, M. , Sage, K. , Haddock, G. , Conroy, P. , & Serrant, L. (2018). Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke . International Journal of Language & Communication Disorders , 53 ( 3 ), 550–563. https://doi.org/10.1111/1460-6984.12368 [ PMC free article ] [ PubMed ] [ Google Scholar ]
McCoy, S. W. , Palisano, R. , Avery, L. , Jeffries, L. , Laforme Fiss, A. , Chiarello, L. , & Hanna, S. (2019). Physical, occupational, and speech therapy for children with cerebral palsy . Developmental Medicine & Child Neurology , 62 ( 1 ), 140–146. https://doi.org/10.1111/dmcn.14325 [ PubMed ] [ Google Scholar ]
McCurtin, A. , & Clifford, A. M. (2015). What are the primary influences on treatment decisions? How does this reflect on evidence-based practice? Indications from the discipline of speech and language therapy . Journal of Evaluation in Clinical Practice , 21 ( 6 ), 1178–1189. https://doi.org/10.1111/jep.12385 [ PubMed ] [ Google Scholar ]
Melnyk, B. M. , Fineout-Overholt, E. , Stillwell, S. B. , & Williamson, K. M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice . The American Journal of Nursing , 110 ( 1 ), 51–53. https://doi.org/10.1097/01.naj.0000366056.06605.d2 [ PubMed ] [ Google Scholar ]
Melnyk, B. M. , Ford, L. G. , Thomas, B. K. , Troseth, M. , Wyngarden, K. , & Szalacha, L. (2016). A study of chief nurse executives indicates low prioritization of evidence-based practice and shortcomings in hospital performance metrics across the United States . Worldviews on Evidence-Based Nursing, 2016 , 13 ( 1 ), 6–14. https://doi.org/10.1111/wvn.12133 [ PubMed ] [ Google Scholar ]
Metcalfe, C. , Lewin, R. , Wisher, S. , Perry, S. , Bannigan, K. , & Moffett, J. K. (2001). Barriers to implementing the evidence base in four NHS therapies: dietitians, occupational therapists, physiotherapists, speech and language therapists . Physiotherapy , 87 ( 8 ), 433–441. https://doi.org/10.1016/s0031-9406(05)65462-4 [ Google Scholar ]
Nail-Chiwetalu, B. , & Ratner, N. B. (2007). An assessment of the information-seeking abilities and needs of practicing speech-language pathologists . Journal of the Medical Library Association , 95 ( 2 ), 182. https://doi.org/10.3163/1536-5050.95.2.182 [ PMC free article ] [ PubMed ] [ Google Scholar ]
O'Connor, S. , & Pettigrew, C. M. (2009). The barriers perceived to prevent the successful implementation of evidence-based practice by speech and language therapists . International Journal of Language & Communication Disorders , 44 ( 6 ), 1018–1035. https://doi.org/10.3109/13682820802585967 [ PubMed ] [ Google Scholar ]
Olswang, L. B. , & Prelock, P. A. (2015). Bridging the gap between research and practice: Implementation science . Journal of Speech, Language, and Hearing Research , 58 ( 6 ), S1818–S1826. https://doi.org/10.1044/2015_JSLHR-L-14-0305 [ PubMed ] [ Google Scholar ]
Powell, B. J. , Stanick, C. F. , Halko, H. M. , Dorsey, C. N. , Weiner, B. J. , Barwick, M. A. , Damschroder, L. J. , Wensing, M. , Wolfenden, L. , & Lewis, C. C. (2017). Toward criteria for pragmatic measurement in implementation research and practice: A stakeholder-driven approach using concept mapping . Implementation Science , 12 , 118. https://doi.org/10.1186/s13012-017-0649-x [ PMC free article ] [ PubMed ] [ Google Scholar ]
Powell, B. J. , Waltz, T. J. , Chinman, M. J. , Damschroder, L. J. , Smith, J. L. , Matthieu, M. M. , Proctor, E. K. , & Kirchner, J. E. (2015). A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project . Implementation Science , 10 ( 1 ), 21. https://doi.org/10.1186/s13012-015-0209-1 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Roberts, M. Y. , Sone, B. J. , Zanzinger, K. E. , Bloem, M. E. , Kulba, K. , Schaff, A. , Davis, K. C. , Reisfeld, N. , & Goldstein, H. (2020). Trends in clinical practice research in ASHA journals: 2008–2018 . American Journal of Speech-Language Pathology , 29 ( 3 ), 1629–1639. https://doi.org/10.1044/2020_AJSLP-19-00011 [ PubMed ] [ Google Scholar ]
Sackett, D. L. , Rosenberg, W. M. , Gray, J. M. , Haynes, R. B. , & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn't . British Medical Journal , 313 ( 7050 ), 170. https://doi.org/10.1136/bmj.312.7023.71 [ PMC free article ] [ PubMed ] [ Google Scholar ]
Sadeghi-Bazargani, H. , Tabrizi, J. S. , & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: A systematic review . Journal of Evaluation in Clinical Practice , 20 ( 6 ), 793–802. https://doi.org/10.1111/jep.12222 [ PubMed ] [ Google Scholar ]
Thome, E. K. , Loveall, S. J. , & Henderson, D. E. (2020). A survey of speech-language pathologists' understanding and reported use of evidence-based practice . Perspectives of the ASHA Special Interest Groups , 5 ( 4 ), 984–999. https://doi.org/10.1044/2020_PERSP-20-00008 [ Google Scholar ]
Togher, L. , Yiannoukas, C. , Lincoln, M. , Power, E. , Munro, N. , Mccabe, P. , Ghosh, P. , Worrall, L. , Ward, E. , Ferguson, A. , Harrison, E. , & Douglas, J. (2011). Evidence-based practice in speech-language pathology curricula: A scoping study . International Journal of Speech-Language Pathology , 13 ( 6 ), 459–468. https://doi.org/10.3109/17549507.2011.595825 [ PubMed ] [ Google Scholar ]
Upton, D. , & Upton, P. (2006). Development of an evidence-based practice questionnaire for nurses . Journal of Advanced Nursing , 53 ( 4 ), 454–458. https://doi.org/10.1111/j.1365-2648.2006.03739.x [ PubMed ] [ Google Scholar ]
Vallino-Napoli, L. D. , & Reilly, S. (2004). Evidence-based health care: A survey of speech pathology practice . Advances in Speech Language Pathology , 6 ( 2 ), 107–112. https://doi.org/10.1080/14417040410001708530 [ Google Scholar ]
Zipoli, R. P., Jr , & Kennedy, M. (2005). Evidence-based practice among speech-language pathologists . American Journal of Speech-Language Pathology , 14 ( 3 ), 208–220. https://doi.org/10.1044/1058-0360(2005/021) [ PubMed ] [ Google Scholar ]

Basicmedical Key

Fastest Basicmedical Insight Engine

BIOCHEMISTRY
GENERAL & FAMILY MEDICINE
HUMAN BIOLOGY & GENETICS
MEDICAL DICTIONARY & TERMINOLOGY
MICROBIOLOGY
PATHOLOGY & LABORATORY MEDICINE
PUBLIC HEALTH AND EPIDEMIOLOGY
Abdominal Key
Anesthesia Key
Otolaryngology & Ophthalmology
Musculoskeletal Key
Obstetric, Gynecology and Pediatric
Oncology & Hematology
Plastic Surgery & Dermatology
Clinical Dentistry
Radiology Key
Thoracic Key
Veterinary Medicine
Gold Membership

Speech–language pathology students: learning clinical reasoning

Chapter 37 Speech–language pathology students learning clinical reasoning Lindy McAllister, Miranda Rose CHAPTER CONTENTS Introduction 397 Seeking clinical reasoning in SLP 398 Emerging directions and challenges in SLP clinical reasoning 399 How do speech-language pathologists reason? 399 Other sources of knowledge about clinical reasoning in SLP 400 Teaching clinical reasoning in professional entry curricula 401 A problem-based learning approach to teaching clinical reasoning in SLP 402 Summary 403 INTRODUCTION In our chapter published in the previous edition of this book ( McAllister & Rose 2000 ) we wrote: Writing this chapter posed something of a dilemma because, in general, speech-language pathologists do not talk about clinical reasoning. … Firstly, speech-language pathologists (educators and clinicians) may well discuss or write about differential diagnosis, problem solving, decision making, critical thinking, professional judgment and diagnostic reasoning; they rarely discuss clinical reasoning. Secondly, the processes involved in clinical reasoning in our profession have been poorly researched and are little understood within the profession. (p. 205) Since we wrote that chapter, a paradox has emerged. Some discussions of applications of other professions’ models of clinical reasoning to speech-language pathology (SLP) models are appearing ( McAllister & Lincoln 2004 , Young 2001 ). However, there continues to be no substantial published research into the clinical reasoning practices of our profession. A 2005 search for references to research into clinical reasoning in SLP in academic databases and recent prominent texts on assessment and management of communication and swallowing disorders revealed minimal results. However, references to clinical reasoning are now quite common on university websites that describe their curricula, in professional association publications detailing professional competencies, and in texts describing clinically-related activities. Thus, while the profession appears to have become alerted to and interested in clinical reasoning as a necessary component of clinical practice, and is now using the term ‘clinical reasoning’ with greater frequency, it is used on the basis of a paucity of data about the actual clinical reasoning practices taking place in SLP. SEEKING CLINICAL REASONING IN SLP In this chapter we make a distinction between clinical decision making (a term more common in SLP) and clinical reasoning. We see clinical decision making as an end-product of clinical reasoning; that is, as the generation of tangible decisions about clinical management. In contrast we see clinical reasoning as the often intangible, rarely explicated thought processes that lead to the clinical decisions we make. We suggest that clinical reasoning utilizes metaprocesses , including an awareness or a becoming conscious of what we are thinking and what thought processes we are using. Reflection in and on action ( Schön 1987 ) has a major role to play in clinical reasoning. Based on our critical reading of the literature, we could describe the process of clinical reasoning in SLP as the ‘black box’ of information processing occurring between the input phase of data gathering and the output phase of producing decisions (concerning diagnosis and treatment) and taking action ( Fig. 37.1 ). The reasons for this ‘black box’ state of affairs lie in the history and operation of our profession wherein clinical reasoning, being (broadly) the thinking associated with clinical practice, was assumed to be a skill that could be absorbed without explication. Kamhi (1998 , p. 102), for instance, argued that ‘as clinicians become more experienced, they gradually internalise the framework of an assessment protocol and become proficient at analysing and interpreting test information and observational data’. The SLP profession seems to have adopted what Boshuizen & Schmidt (2000) referred to as a content-oriented approach to clinical reasoning. This approach assumes that knowledge and reasoning are interdependent. There is an expectation that with increasing knowledge and clinical experience, students and clinicians will be better able to reason and make clinical decisions. University curricula have concentrated more on knowledge acquisition and skills development while ‘issues specific to the decision-making process are relegated to the periphery of discussion’ ( Records et al 1994 , p. 74). Figure 37.1 Clinical reasoning in speech pathology – the ‘black box’ Another focus of our profession has been on outcomes and solving problems in clinical practice. Consider recent sources in the SLP literature: for example, Dodd’s 1995 text Differential Diagnosis and Treatment of Children with Speech Disorder contains a chapter on a problem-solving approach to clinical management. This problem-solving model begins at the stage of description of the current communication status (after diagnosis). Although it is an excellent model for problem solving in client management, it offers no clues to the clinical reasoning which lies behind the clinical problem solving. The Pocket Reference of Diagnosis and Management for the Speech-Language Pathologist ( White 2000 ) contains a wealth of useful information to assist in clinical problem solving or decision making. It does not consider the clinical reasoning thinking processes underpinning diagnosis and management. Another factor limiting understanding of clinical reasoning in SLP is that it has been seen as a linear or logical process, which obscures the ‘messiness’ and complexity of clinical reasoning in action. Duffy (1998 , p. 96) suggested that the processes of decision making ‘became obscured with training that views diagnosis as a linear, test-oriented, and mechanistic process, and that often “teaches” diagnosis by starting with the target disorder (the diagnosis) and then proceeding back to its defining symptoms and signs’. Yoder & Kent (1988) published an influential series of decision-making trees for the diagnosis and management of communication disorders. They stated that the trees were not to be seen as recipes, but rather as a series of guidelines and prompts for the clinician engaged in decision making. ‘Cookbooks cannot deal with the unknown or the uncertain, but clinical decision making frequently encounters them’ ( Yoder & Kent 1988 , p. xi). This approach has the advantage of providing guidance without rigidity and recognizing the need for professional judgement as part of decision making. However, the focus is again on the decision steps to be taken rather than on the nature of thinking in which clinicians engage and how they might respond to the prompts provided. The approach reinforces the view that clinical reasoning and decision making are basically linear and logical, whereas we argue that they are not. Further, the responsibility for learning how to think lies with the clinician. It is not made explicit. EMERGING DIRECTIONS AND CHALLENGES IN SLP CLINICAL REASONING In their edited text Differential Diagnosis in Speech-Language Pathology , Philips & Ruscello (1998) provided a broader picture of the process of diagnosis. Although they referred readers to decision-making trees they moved beyond a formulaic data collection approach to an acknowledgment that ‘the speech-language pathologist’s curiosity and inquisitiveness drive the process of differential diagnosis. The clinician who accepts diagnostic challenges, is curious about missing information and inconsistencies, constantly questions, and searches for possible answers is most likely to solve puzzles presented by difficult problems’ ( Philips & Ruscello 1998 , p. 3). It is argued here that clinicians need to be aware of missing information and inconsistencies and to be thinking about them, questioning self, the process and the data. In other words, clinicians need to be engaged in metacognition, or thinking about thinking, a key component in the Higgs & Jones (2000) model of clinical reasoning. Kamhi (1998) and Deputy & Weston (1998) have reminded readers of the importance of asking causal questions but cautioned them about assuming linear causality. Asking questions about factors that may or may not cause communication disorders and that contribute to the data obtained in evaluation is an important component of what we would call clinical reasoning. Records et al (1994) discussed clinical judgment. They emphasized not only the objective aspects of data collection, but also the subjective aspects of the decision-making process; the gut feelings, expertise and insights which are aspects of clinical reasoning. They considered clinical judgment to be a process poorly understood by speech-language pathologists. Scholten (2001) argued that both classroom and clinical experiences can be used to facilitate student clinical reasoning. She suggested that teachers should use authentic problems to develop students’ understanding of clinical problems and transfer of theoretical knowledge. However, again, such assertions were based on theory from medical education and student learning in general rather than specific evidence in speech language-pathology. HOW DO SPEECH-LANGUAGE PATHOLOGISTS REASON? In the relative absence of direct clinical reasoning research, writers in our discipline have resorted to supposition or analogy, drawing on research in other professions. Campbell (1998) outlined four approaches to diagnostic decision making found in clinical medicine that also apply to SLP: pattern recognition, decision-making trees, diagnosis by exhaustion (collecting all possible data), and hypothetical-deductive reasoning. Duffy (1998 , p. 97) stated that ‘most good diagnosticians reach conclusions through a hypothetical-deductive strategy, with frequent reliance on pattern recognition’. The paucity of research into decision making and clinical reasoning in SLP does not provide data to test Campbell’s or Duffy’s assumptions. However, in their reflection on comparisons with reasoning approaches in other disciplines, Campbell and Duffy began to question possible reasoning strategies in SLP. A promising discussion in our field comes from Hagstrom (2001) who presented a potential framework for using and building theory in clinical action in SLP. Hagstrom wrote about clinical action being guided by theory and proposed Bamberg’s (1997 ) six-element framework of theory analysis as a tool for reflection on practice. Table 37.1 illustrates the six aspects of Bamberg’s framework, with typical clinical questions that could be asked in SLP practice. Although Hagstrom did not directly discuss clinical reasoning and made no reference to research examining reasoning in other professions, it appears to us that there is a direct connection between her arguments and our discussion of clinical reasoning practices. Table 37.1 Bamberg’s aspects of theorizing in action and their potential applications to speech-language pathology Aspect Typical speech-language pathology clinical questions Domain of inquiry What knowledge base(s) could/should I be drawing on in working with this client/situation? Person Am I working with a client actively engaged in his/her care, or a passive client? Course of development Is change for this client/situation likely to happen step by step or can steps be merged or skipped? Telos What is the ideological endpoint for me and for my client in this situation? Mechanism What is likely to cause change to happen in this client/situation? Methodology What type of data should be collected? How will they be collected and documented?

Stay updated, free articles. Join our Telegram channel

Comments are closed for this page.

clinical problem solving speech pathology

Full access? Get Clinical Tree

Evidence-Based Practice in Speech-Language Pathology

Evidence-based practice in speech-language pathology is vital for effective practice. It involves three main parts: client perspectives, clinical expertise, and evidence (internal and external). In this article, we will dive into each of these areas.

Speech-Language Pathology: An Overview

The field of speech-language pathology includes the assessment, diagnosis, and treatment of communication disorders and differences as well as feeding and swallowing.

There are nine main areas of focus, which are often referred to as the “Big 9.” They include:

Articulation
Voice and Resonance
Receptive and Expressive Language
Social Aspects of Communication
Augmentative and Alternative Communication (AAC)
Aural Rehabilitation
Swallowing and Feeding

Speech-language pathologists (SLPs) may work with individuals across the lifespan in a variety of settings, including (but not limited to) the individuals’ homes, hospitals, clinics, and schools.

Evidence-Based Practice: An Overview

Evidence-based practice (EBP) is not unique to the field of speech-language pathology. It was originally developed for medicine but is now used across many disciplines, including social work, occupational therapy, nursing, and public health.

The purpose of evidence-based practice is to enhance informed decisions related to patient care.

Broadly speaking, it is a practice of combining client perspectives, clinical expertise, and evidence.

In the field of speech-language pathology, EBP may look like this:

Imagine you are working in an outpatient clinic and have a new client who recently had a stroke. You complete an assessment and determine they have nonfluent aphasia. While determining your next steps in treatment, you may consider these three areas:

Client Perspectives: What does the client hope to achieve during treatment?

Example: The client wants to be able to have phone calls with her adult children.

Clinical Expertise: What do you know about the client’s condition?

You have worked with clients with aphasia who have benefitted from script training to have short conversations, like phone calls.

Evidence: What does the evidence say about this treatment approach?

There are two types of evidence to consider: internal and external .

Though you haven’t worked with your client for a long time, you have seen them find success speaking verbally when phrases are written down for them to read.
Script training for people with aphasia to increase and improve spoken utterances has been researched extensively and shows clinically significant progress.

You conclude that a treatment approach that includes script training, with scripts related to phone calls, would be beneficial for your client.

As you can see, using EBP can increase both client buy-in to your services AND the effectiveness of treatment.

The Role of Research in Speech-Language Pathology

External evidence.

External evidence includes scientific literature, such as peer-reviewed research articles. In graduate school, future SLPs learn a lot about research-backed assessment and treatment approaches. Some graduate students may even actively complete research under professors who are experts in their field.

Research may provide information about various clinical areas of focus. Some examples include:

The effect of dietary changes in people with dysphagia
The use of minimal pairs in treating speech sound disorders
How individuals who use AAC develop communication skills
Training programs for teaching vocabulary to individuals with developmental language disorders

Being aware of research-backed approaches is important for effective treatment. For example, if you begin working with a new client with complex communication needs who is going to use an AAC device, you can look into scientific literature that researched how individuals who use AAC develop communication skills. This can help you make decisions about grid size, vocabulary to include, and methods for teaching communication.

However, just looking at the research is not enough . Why not? There are many limitations to research. Limitations may include:

Research that doesn’t reflect your client’s profile (e.g., the population studied was monolingual clients aged 6-8, and your client is 4-years-old and exposed to two languages)
The clients received services three times a week, and your client is only available one time a week
The treatment took place in a clinic setting, while you are seeing your client in their home.

Internal Evidence

Internal evidence includes collecting and analyzing subjective and objective information about the client you’re working with. This comes into play after you’ve been working with a client for some time. For example, if you are developing a new treatment plan for a client (e.g., a new IEP in the schools or a new plan of care), you can consider how your client has responded to your current treatment approaches.

For example, if you’re working with a younger child, you might ask yourself: Have they demonstrated good progress and participation when you had play-based sessions where they chose what to play with ? Has more progress and participation been observed when you have more structured sessions? Have they benefited from shorter sessions that occur more frequently , or do they need more time to transition into sessions and seem to benefit from longer sessions that occur less frequently?

Reflecting on the client’s progress and participation over a period of time is an important part of refining and updating treatment plans.

It can be challenging to find strong research studies (i.e., external evidence) that fully reflect your client’s experience. As we all know, the human profile can look so different! Additionally, if you are working with a new client, or are going to target a new goal with an existing client, internal evidence may not be enough.

That leads us to the other aspects of EBP…

The Role of Clinical Expertise in Speech-Language Pathology

Clinical expertise is an intricate part of EBP. This means SLPs use their background and experience to make decisions about assessment and treatment.

For example, an SLP may have worked in a preschool setting for a few years. They have completed over 50 evaluations for preschool-aged children with suspected speech and language delays. They may know what informal assessment measures tend to provide the most information in the shortest amount of time, which is important for young children with limited attention spans. The SLP may have consistent, positive outcomes when they bring in a specific toy or engage in a particular activity, which they know can help elicit a comprehensive speech and language sample.

However, just using clinical expertise (and evidence) is not enough . Why not? There are still limitations. Limitations may include:

No matter how long you have been in the field, you haven’t encountered all clients and all situations. You are bound to work with a new client whose background is different from what you’ve seen before.
Additionally, the client may have different preferences or perspectives from yours. It is important to be culturally-responsive and honor any cultural and linguistic differences of your clients.
In addition to EBP, this is also an essential ethical consideration that we are required to follow as skilled clinicians.

This leads us to the final aspect of EBP…

The Role of Client Perspectives in Speech-Language Pathology

Client perspectives include the goals, values, and expectations of them (and their caregivers). Understanding client perspectives is important for many reasons. The ASHA Code of Ethics states that clinicians must “ hold paramount the welfare of persons they serve professionally… ” and understanding their perspectives is an important aspect of ensuring welfare. Recognizing and honoring client perspectives is also important for gaining client/caregiver buy-in to services and promoting the generalization of skills across natural contexts and settings.

One way to gain information about client perspectives is through ethnographic interviewing and utilizing questionnaires. Ethnographic interviewing aims to gain a deeper understanding of the client’s cultural background, beliefs, and practices related to communication. Questions asked in ethnographic interviews tend to be more open-ended to provide a wider breadth of information related to the client’s personal experiences, perspectives, and values. Questionnaires may be used in order to gain information about a client’s strengths and preferences.

Once you have analyzed your evidence, utilized your clinical expertise, AND gathered client perspectives, you are ready to make your informed decision!

No biggie, right? We wish. Effectively engaging in EBP can be challenging…but we have (a few) solutions.

Challenges in Evidence-Based Practice

We recognize that there can be many barriers when engaging in EBP. Time can be the number one barrier; SLPs and other clinicians are often very busy and do not have extra time to search out external evidence resources for every single individual on their caseload (looking at you, SLPs with caseloads of 80+...) . There are often paywalls on research articles as well. Additionally, clinicians and families may be resistant to change or to consider exploring a new approach.

Below, we have listed and linked resources for engaging in EBP, including ASHA Evidence Maps , which can eliminate some of the time constraints.

Unpaywall.org has an open database with millions of scholarly articles. You can add a browser extension, which shows you articles you can access as you search Google Scholar. This can eliminate some of the paywall difficulties.

It may take time to discuss change or new approaches with other clinicians, clients, and their support team. Change does not always happen overnight, but being persistent, and continuing to demonstrate the rationale behind a change, including citing evidence, can be an effective strategy.

Sources for Engaging in Evidence-Based Practice

The American Speech-Language-Hearing Association (ASHA) provides a number of quality resources to promote engagement in EBP.

An Overview of EBP and the process of EBP
Step 1: Frame Your Clinical Question
Step 2: Gather Evidence
Step 3: Assess the Evidence
Step 4: Make Your Clinical Decision
Membership to ASHA provides access to many research articles, as well as Evidence Maps for many topics, ranging from apraxia to telepractice (and many many more).
The Informed SLP team reads over 4000 articles a year and provides summaries and resources about new research.

More EBP Resources

Based on our processes of EBP, we have created many resources covering a wide range of topics in speech and language assessment and therapy. As always, utilize your internal evidence, clinical expertise, and client perspectives when selecting resources 🙂. You can find all of them inside our Premium Membership Community . Find caregiver handouts, therapy activities, and assessment resources. Use the discussion forums to ask questions about clinicians’ expertise. Not ready to fully commit? Our Open Membership Community provides a selection of freebies and updates about our content!

References

ASHA Evidence-Based Practice

Cooley Hidecker, M. J., Jones, R. S., Imig, D. R., & Villarruel, F. A. (2009). Using Family Paradigms to Improve Evidence-Based Practice. https://doi.org/10580360001800030212

Westby, C., Burda, A. N., & Mehta, Z. (2003). Asking the right questions in the right ways. The ASHA Leader, 8(8), 4-17. https://doi.org/10.1044/leader.ftr3.08082003.4

Supporting Carryover in Speech Therapy

Using AI to Enhance Speech Therapy Sessions

Data Collection in Speech Therapy: Why It's Important and Tips for Success

National Speech-Language-Hearing Month | What Does a Speech-Language Pathologist Do?

What is Dysarthria? (7 Types, Causes, and Treatment)

Subscribe to new posts., subscribe to be notified of new content and support communication community, help keep this site independent..

American Speech-Language-Hearing Association

Certification
Publications
Continuing Education
Practice Management
Audiologists
Speech-Language Pathologists
Academic & Faculty
Audiology & SLP Assistants

Evaluating and Treating Communication and Cognitive Disorders: Approaches to Referral and Collaboration for Speech-Language Pathology and Clinical Neuropsychology

Technical report, diane paul-brown and joseph h. ricker, about this document.

This technical report regarding approaches to referral and collaboration represents a joint effort by members of the Ad Hoc Joint Committee on Interprofessional Relationships of the American Speech-Language-Hearing Association (ASHA) and Division 40 (Clinical Neuropsychology) of the American Psychological Association (APA). ASHA representatives included Pelagie Beeson, Susan Ellis Weismer, Audrey Holland, Susan Langmore, Lynn Maher, Mark Ylvisaker, and Diane Paul-Brown (ex officio). Alex F. Johnson was the ASHA monitoring vice-president (2000–2002). APA representatives included Kenneth Adams, Sharon Brown, Jill Fischer (chair, 1997–1999), Robin Hanks, Doug Johnson-Greene, Sanford Pederson, Steven Putnam, and Joseph H. Ricker (chair, 2000–2002). The report was prepared by Diane Paul-Brown (ASHA) and Joseph H. Ricker (APA) on behalf of the joint committee. This technical report was approved by ASHA's Executive Board (EB 17-2002) at their 2002 meeting.

The authors gratefully acknowledge the assistance of Carol Caperton in the preparation of this document.

Standards for training and credentialing in each profession, practice issues, areas of overlap and divergence in tests and measures, knowing competencies and recognizing limits of each profession, functional assessment and judicious use of norms, concluding statement, appendix a 1 pediatrics: cognitive-communication guidelines for referral to speech-language pathologists, appendix b 3 adults: cognitive-communication guidelines for referral to speech-language pathologists.

Speech-language pathologists and clinical neuropsychologists engage in areas of distinct and common professional practice. The purpose of this document is to encourage referral and collaboration between speech-language pathologists and clinical neuropsychologists, and to inform referral sources (e.g., physicians, rehabilitation and other health care professionals, educators, case managers) about the roles of both professions. The ultimate goal is improved quality of service for individuals affected by communication and cognitive disorders.

This paper describes the training and credentialing standards for both professions, and the roles of speech-language pathologists and clinical neuropsychologists in the assessment and treatment of individuals with acquired cognitive- communication disorders. Following these descriptions is a discussion on the overlap and divergence between the two professions in the use of tests and measures, as well as areas of treatment specific and unique to each profession. Next is a discussion of the use of norms related to published measures, age, and other demographic factors, and recommendations for collaboration between the professions.

Return to Top

Speech-language pathology. ASHA certifies individuals in speech-language pathology and audiology. ASHA's Certificates of Clinical Competence (CCC), which are granted in speech-language pathology and in audiology, allow the holder to provide independent clinical services and to supervise the clinical practice of service providers who do not hold certification, student trainees, and support personnel ( ASHA, 2000 ). Applicants for certification in speech-language pathology must meet the four requirements established by ASHA, including specific academic course work, practicum, national examination, and clinical fellowship.

Speech-language pathologists must hold a master's or doctoral degree. The master's degree must be earned from a program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). Applicants for certification must have earned at least 75 semester credit hours that reflect a well-integrated program of study dealing with the biological/physical sciences and mathematics; the behavioral and/or social sciences, including normal aspects of human behavior and communication; and the nature, prevention, evaluation, and treatment of speech, language, hearing, and related disorders ( ASHA, 2000 ).

The second requirement is supervised clinical observation and clinical practicum. After sufficient course work has been completed, students are assigned to practica provided by the educational institution or a cooperating program. The student must complete at least 25 hours of clinical observation and 350 hours of supervised clinical practicum involving evaluation and treatment of children and adults with communication disorders. Only direct contact with a client or a client's family in assessment, management, and/or counseling can be counted toward practicum ( ASHA, 2000 ). The practicum supervisor must hold a Certificate of Clinical Competence by ASHA. Applicants for certification also must pass the national examination in speech-language pathology within 2 years of the date of the course work and practicum.

The final certification requirement is the completion of the clinical fellowship. The fellowship consists of at least 36 weeks of full-time professional experience or its part-time equivalent, to be completed within a maximum of 36 consecutive months and within 4 years of the date the academic coursework and practicum were approved by ASHA ( ASHA, 2000 ). The fellowship must be completed under the supervision of an ASHA-certified speech-language pathologist. Requirements for supervision and activities are defined in the Certification and Membership Handbook ( ASHA, 2000 ).

It is important to note that the requirements for ASHA certification may or may not be the same as a state's licensure requirements ( ASHA, 2000 ). State regulatory agencies may be contacted for information on regulation of speech-language pathologists and audiologists. ASHA maintains a list of states that regulate audiology and speech-language pathology practice.

ASHA has a specialty recognition program for professionals with advanced knowledge and skills in certain areas in speech-language pathology. An ASHA-approved specialty recognition program in cognitive-communication currently does not exist. The Academy of Neurologic Communication Disorders and Sciences (ANCDS) offers Board Certification in Neurologic Communication Disorders in adults, children, or both on a voluntary basis. Eligibility is limited to speech-language pathologists who hold ASHA certification or a current state license, have at least 5 years of experience with neurologic communication disorders, and meet a rigorous set of standards.

Clinical neuropsychology. Clinical neuropsychology is a professional and scientific discipline that, broadly defined, deals with brain-behavior relationships ( Eubanks, 1997 ). It can involve both assessment of and intervention for cognitive and emotional disorders in children and adults. Clinical neuropsychology is a recognized specialty within the broader field of professional applications of psychology.

A clinical neuropsychologist holds a doctorate plus a state license to practice as a psychologist. However, there is a great deal of variability in training and credentials in the practice of clinical neuropsychology. Although a few programs train students exclusively in clinical neuropsychology, clinical neuropsychologists in North America are typically trained in clinical, counseling, or school psychology. Subsequent to this training, they are licensed as “psychologists” by their state board. Only one state board (Louisiana) offers a specialty license in clinical neuropsychology; all other states license clinicians only as “psychologists” in a general sense regardless of specialty training (e.g., neuropsychology, psychoanalysis, forensic psychology).

Division 40, the Clinical Neuropsychology Division of the APA, in conjunction with the International Neuropsychological Society (INS), has established a definition and guidelines for training in a report of the INS-Division 40 Task Force ( 1987 ; see also Division 40 of the APA, 1989 ). By this standard, a clinical neuropsychologist is defined as “…a professional psychologist who applies principles of assessment and intervention based on the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The clinical neuropsychologist is a doctoral-level psychology provider of diagnostic and intervention services who has demonstrated competence in the application of such principles for human welfare…” ( Division 40, 1989 ). The definition suggests several major domains of demonstrated competence:

Successful completion of systematic didactic and experiential training in neuropsychology and neuroscience at a regionally accredited university;

Two or more years of appropriate supervised training applying neuropsychological services in a clinical setting;

Licensing and certification to provide psychological services to the public by laws of the state or province in which he or she practices;

Review by one's peers as a test of these competencies.

Attainment of the ABCN/ABPP Diploma in Clinical Neuropsychology is the clearest evidence of competence as a clinical neuropsychologist, assuring that all of these criteria have been met. The statement reflects the official position of APA's Division of Clinical Neuropsychology, but is not to be construed as contrary or superordinate to the polices of the APA overall.

The American Board of Clinical Neuropsychology (ABCN), the affiliated specialty board of the American Board of Professional Psychology (ABPP), is responsible for the examination for the diploma in clinical neuropsychology. Attainment of the diploma in clinical neuropsychology indicates that a clinical neuropsychologist has had his or her credentials thoroughly reviewed, has undergone a rigorous examination of knowledge and practice by peers, and has been found competent to practice.

In September 1997, a conference of clinical neuropsychological educators and practitioners was assembled to discuss issues related to formal education and training in clinical neuropsychology ( Hannay et al., 1998 ; Houston Conference). Although these standards will almost certainly guide the training of future clinical neuropsychologists, they cannot be retroactively applied to current practitioners. Essentially, the conference presented education and training models for becoming a clinical neuropsychologist, with specific guidelines at graduate, internship, and postdoctoral training levels.

Speech-language pathology. Speech-language pathologists, in accordance with a Code of Ethics ( ASHA, 2001a ), diagnose and treat children and adults with speech, spoken and written language, and swallowing disorders, including cognitive-communication disorders. A primary purpose for addressing communication and related disorders is to effect positive measurable and functional change(s) in an individual's communication status in order that he or she may participate as fully as possible in all aspects of life—social, educational, and vocational. Key considerations for treatment include maximizing improvement and/or maintenance of functional communication, evaluation of communication outcomes, and enhancement of quality of life. Speech-language pathologists recognize that communication is always an interactive process, and that the focus of intervention may include training of communication partners (e.g., caregivers, family members, peers, educators, etc.) and modification of communication in schools, workplaces, and other settings.

ASHA has delineated specific roles of speech-language pathologists in the treatment of individuals with cognitive impairment ( ASHA, 1987 ). The Scope of Practice in Speech-Language Pathology ( ASHA, 2001b ), as it relates to cognitive-communication impairments, states that the practice of speech-language pathology includes:

Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up for disorders of cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).

Collaborating in the assessment of central auditory processing disorders and providing intervention where there is evidence of speech, language, and/or other cognitive-communication disorders.

The Preferred Practice Patterns for the Profession of Speech-Language Pathology ( ASHA, 1997a ) also address the assessment, diagnosis, and treatment of individuals with cognitive-communication disorders. Cognitive-communication assessment is defined as “procedures to assess cognitive-communication impairments, delineating strengths, deficits, contributing factors, and implications for functional communication” ( ASHA, 1997a ). Assessment of cognitive-communication impairment is expected to “…identify and describe strengths and deficits related to cognitive factors (e.g., attention, memory, and problem solving) and related language components (e.g., semantics and pragmatics)” and “…may result in a diagnosis of a cognitive-communication disorder, recommendations for treatment or follow-up, or referral for other examinations or services” ( ASHA, 1997a ). Treatment for a patient with a cognitive-communication disorder should result in improved, altered, augmented, or compensated speech, improved oral and written language, and improved cognitive-communication behaviors. Treatment may also lead to recommendations for reassessment or follow-up, or for referral for other examinations or services ( ASHA, 1997a ). The guiding principles that formed the basis of the Preferred Practice Patterns highlight the functional purpose of communication and the essential role of communication partners.

The practice patterns:

Acknowledge that a primary purpose for addressing communication and related disorders is to effect measurable, functional change(s) in an individual's communication status in order that he or she may participate as fully as possible in all aspects of life — social, educational, and vocational.

Recognize that communication is always an interactive process, and that the focus of intervention should include training of communication partners (e.g., caregivers, family members, peers, educators, etc.).

Consider outcomes including prevention of communication, swallowing, and other related disorders; improvement and/or maintenance of functional communication; and enhancement of the quality of life ( ASHA, 1997a ).

Clinical neuropsychology. Although clinical neuropsychologists and speech-language pathologists both assess cognition in intact and compromised individuals, clinical neuropsychologists are specifically trained and licensed to formally evaluate and treat mood disturbances and emotional functioning. Being typically trained as clinical, counseling, or school psychologists, clinical neuropsychologists routinely provide intervention in the form of psychotherapy, behavior therapy, or counseling with reference to emotional or behavioral problems. It is important to note that these emotional/behavioral problems may or may not be related to the individual's injury, illness, or most proximal reason for referral.

Clinical neuropsychological and speech-language assessments involve the application of psychometric principles and procedures (i.e., standardized testing, measurement, and structured observation) in the evaluation and treatment of brain-behavior relationships. Clinical neuropsychological assessment can provide a unique and necessary component to the evaluation and rehabilitative treatment of the potential cognitive and emotional dysfunction following stroke, brain tumor, and other types of central neurologic dysfunction.

Traditional medical tests and examinations provide information on gross anatomic structure as aspects of physiology and disease. Because of the psychometric and comprehensive nature of a detailed clinical neuropsychological evaluation, a clinical neuropsychological assessment can assist in identifying and quantifying potential functional effects of central neurologic dysfunction. Such deficits include impairments in attention, language, memory, spatial skills, problem solving, psychomotor abilities, and emotional functioning.

Extensive testing in the acute care setting immediately following the onset or exacerbation of cerebral impairment may be of only minimal benefit given the possibility of delirium, transient aphasia, or significant motoric compromise. Brief, focused testing (followed later with a more comprehensive speech, language, and clinical neuropsychological evaluation), however, can be of benefit in identifying and quantifying residual impairments, as well as in making appropriate recommendations for reducing disability and enhancing functional status and participation. This is important for rehabilitation programming, given the need to identify functional capacities that are available for compensatory strategies, as well as those areas that may need to be targeted for improvement. In many acute care settings, the speech-language pathologist conducts the brief, focused testing. As the patient is able to tolerate more testing, the speech-language pathologist may conduct an extensive speech and language evaluation and recommend a clinical neuropsychological evaluation. Clinical neuropsychological and speech-language evaluations can help in formulating plans for community re-integration following cognitive compromise. Complete evaluation in both professions is also useful in identifying and quantifying areas of improvement, which may be required for certain aspects of re-integration after brain impairment (e.g., re-establishing legal independence following appointment of a guardian). Documentation of improvement is likely to be of comfort to individuals (and to the families of these individuals) who have sustained central neurologic dysfunction. Formal assessment is also useful when formulating individual behavioral management plans, given the fact that such plans rely heavily on an individual's ability to learn and follow directions. Clinical neuropsychological and speech-language assessment can also, in some instances, be used as an index of efficacy for some types of treatment, such as interventions designed to reduce cognitive impairments (which may be one goal of cognitive rehabilitation), as well as to index changes following certain medical interventions (e.g., pharmacotherapy).

In some settings, clinical neuropsychologists and speech-language pathologists may provide services focused on ameliorating acquired cognitive problems. Clinical neuropsychologists and speech-language pathologists may also provide services to assist patients with learning new strategies to compensate for acquired cognitive impairments or to modify tasks and environmental demands to increase successful participation despite ongoing disability. These interventions are provided under a variety of names, such as cognitive rehabilitation, cognitive remediation, neuropsychological rehabilitation, and cognitive retraining. Although in wide use, these approaches vary greatly from facility to facility, and have only recently been subject to more rigorous empirical research (see Ylvisaker, Hanks, & Johnson-Greene, 2002 , for a literature review). When considering a referral for such services, it is important to consider the empirical basis for the intervention, the likely improvement in cognition from spontaneous recovery alone, the rationale for the intervention (e.g., retraining vs. teaching compensatory strategies), the effects of practice, and the qualifications and experience of the provider.

Clinical neuropsychologists and speech-language pathologists can also be of assistance in rehabilitation by identifying cognitive and behavioral issues that are of relevance in vocational re-integration, and can also assist clients and employers in identifying and developing realistic workplace accommodations in compliance with the Americans with Disabilities Act.

Although each discipline has its own measures, both professions use some of the same tests (e.g., Boston Diagnostic Aphasia Examination; Boston Naming Test; Scales of Cognitive Ability for Traumatic Brain Injury; Western Aphasia Battery ). Speech-language pathologists and clinical neuropsychologists should attempt to coordinate evaluation so there is no overlap in test selection. The issue of practice effects is directly relevant to this recommendation. Practice effects refer to an improvement in test scores, or even more broadly, a domain of cognition, as a function of exposure to similar (but not identical) tests, paradigms, or strategies. In addition, speech-language pathologists and clinical neuropsychologists should be aware of interventions and their impact on test results. Intervention by a speech-language pathologist may affect the results of a subsequent clinical neuropsychological evaluation (through exposure, practice, test sophistication, or improvement in function). Likewise, a clinical neuropsychological assessment has the potential to similarly affect performance on instruments used by speech-language pathologists. Repeated administration may lead to inflated recovery curves.

Speech-language pathologists and clinical neuropsychologists also should be aware of relevant guidelines for test usage. The Code of Fair Testing Practices in Education ( 1988 ) presents standards for educational test developers and users in several areas. In addition, the APA has adopted the Standards for Educational and Psychological Testing (1999). Some test-related issues that arise include the following:

Professionals with a particular license or credential may only purchase some measures. For example, the use of intelligence tests is typically restricted to licensed psychologists.

Some domains of practice for assessment/treatment (e.g., IQ testing, academic achievement testing, and personality testing) may be defined by state rules and laws of practice.

Differences in terminology used by insurers, institutions, and licensing boards may result in ambiguity in who provides given services (e.g., “higher level language disorders” and “cognitive disorders” may refer to the same processes, but the terms may have very different reimbursement implications).

Mood and emotional disorders. Because clinical neuropsychologists are typically trained as clinical psychologists, they are uniquely qualified to formally assess emotional states and to intervene using applied principles of clinical and experimental psychology. Such approaches include, but are not limited to, psychological testing (including objective and projective approaches), personality assessment, behavior analysis, psychotherapy, behavior modification, and group interventions. Speech-language pathologists also provide input on such areas, and assist with formulating a hypothesis regarding a patient's status, treatment needs, or possible outcomes. Furthermore, it is within the scope of practice for speech-language pathologists to evaluate, diagnose, treat, and counsel patients, family members, educators, employers, and other rehabilitation professionals in adaptive strategies for managing cognitive-communication disorders. Speech-language pathologists also must integrate behavior modification treatment techniques as appropriate for the management of associated problems, such as agitation and self-abusive and combative behaviors. Direct intervention for affective and anxiety disorders falls within the province of a clinical neuropsychologist, possibly teaming with a speech-language pathologist if a communication problem contributes to or is a consequence of the affective or anxiety disorder.

Communication and swallowing disorders. Speech-language pathologists, in addition to caring for individuals with cognitive-communication disorders, also diagnose and treat a wide range of speech (i.e., articulation, fluency, voice), language (i.e., comprehension and production; literacy; phonology, syntax, semantics, and pragmatics), swallowing disorders, or other upper aerodigestive functions ( ASHA, 2001b ; 2001c ). In conjunction with audiologists, they provide some services to individuals with hearing loss and their families/caregivers (e.g., auditory training, speech reading). Speech-language pathologists also provide services to modify or enhance communication performance (e.g., accent modification, transgendered care and improvement of the professional voice, personal/professional communication effectiveness). They provide these services for the full age spectrum, as well as for the full range of severity for these conditions. For example, speech-language pathologists establish augmentative-alternative communication techniques and strategies for individuals with severe communication disabilities, treat individuals with motor speech disorders (e.g., apraxia, dysarthria), with difficulties learning to read and write, and with language problems following strokes or traumatic brain injury (e.g., aphasia, anomia, agraphia, alexia) ( ASHA, 2001c ). ASHA has developed a wide range of guidelines and delineated knowledge and skills needed for appropriate assessment, diagnosis, and treatment for individuals with cognitive-communication, speech, language, swallowing disorders, and other communication needs ( ASHA, 1997b ).

Although the purpose of this document is to highlight those opportunities when referral to both professions is warranted, ASHA has available its own referral guidelines specific to referrals to speech-language pathology in the area of cognitive-communication for children and adults ( ASHA, 1998 ; see Appendix A and B ). These referral guidelines are not meant to be exclusionary, but rather to provide further delineation of the role of a speech-language pathologist in a treatment team in relation to other professionals.

As important as it is for both speech-language pathologists and clinical neuropsychologists to know their professional limits, it is equally important for referral sources, professional colleagues, and interdisciplinary teams to recognize limits. For example, to a colleague or payer source not familiar with the differences, a speech-language evaluation of higher cognitive-communication functions and a neuropsychological evaluation might appear very similar. It is necessary for each profession to educate consumers about the unique contributions and areas of overlap of speech-language pathology and clinical neuropsychology.

It is critical that speech-language pathologists and clinical neuropsychologists make every effort to approach cases from “the same page,” both conceptually and practically from a functional perspective. In other words, it may cause unwarranted confusion for patients and their families if one profession views a patient from a strict score-based or numeric cut-off perspective, while another profession views the same patient in the context of the patient's education, life experience, effort, personal goals, and values. Contemporary approaches to speech-language pathology and clinical neuropsychology services stress the value of functional assessment, which “measures the ability to receive and convey messages effectively and independently, regardless of the mode of communication in natural contexts” ( Frattali, Thompson, Holland, Wohl, & Ferketic, 1995, p. 12 ).

Functional assessment also recognizes the need for judicious use of norms (e.g., Heaton, Grant, & Matthews, 1991 ; Spreen & Strauss, 1998 ) involving issues such as the determination of baseline status and the interpretation of patients' abilities in light of their education and other experiences. Speech-language pathologists and clinical neuropsychologists must recognize the need to consider age, education, premorbid information, social history, present social context, cultural and linguistic background, and pre-injury vocational status in formulating realistic and functional treatment goals within the bounds of the cognitive disorder.

Speech-language pathologists and clinical neuropsychologists who conduct functional assessment also need to be mindful of other factors that affect the accuracy of an assessment. The World Health Organization definitions underscore the need for assessment to address involvement in daily life activities and social aspects of disability ( World Health Organization, 2001 ). Although there are many available tests and measures, most are normed and standardized on samples of educated, middle-class Caucasians (e.g., Boston Diagnostic Aphasia Examination, Ross Information Processing Assessment ). Accurate assessment of speech, language, and cognitive functions on standardized norm-referenced measures may be difficult for culturally and linguistically diverse populations, or with populations who may not have the same level of requisite skills or experiences to perform adequately on tests. Furthermore, unless the clinician maintains an open, objective approach to assessment, there can be a “clash” between clinicians' values and those of the patient and/or family (e.g., not everyone thinks reading is important; not everyone values competitive employment). This is another important reason to focus on the assessment of the patient determined by individualized goals and the culture and context in which that person functions.

Databases for determining test validity are rarely equivalent, and are virtually never identical. For example, a normative group used to establish norms for one particular test may differ dramatically and in clinically meaningful ways from the normative group used for another test. In other words, we know how a given standardization sample performs on one particular test, but we rarely have any data that indicate how these same individuals perform in other domains or on other neuropsychological tests. Therefore, speech-language pathologists and clinical neuropsychologists should consult multiple sources of data for accurate test interpretation.

Speech-language pathologists and clinical neuropsychologists certainly interact clinically, but they should also interact to a much greater degree regarding professional practice issues. Attempts to separate tests and interventions into two mutually exclusive proprietary domains are destined to fail in the provision of the highest quality of service to the patient. No discipline should dictate or attempt to legislate the practice of another without getting into “restraint of trade” issues. Ultimately, the focus of collaborative efforts must be on the clinical utility of information and how professionals with complementary knowledge and skills can affect functional outcome for patients in a beneficial manner.

American Psychological Association. (1985). Standards for educational and psychological testing . Washington, DC: Author.

American Speech-Language-Hearing Association. (1987). The role of speech-language pathologists in the habilitation and rehabilitation of cognitively impaired individuals: A report of the subcommittee on language and cognition. Asha, 29 , 53–55.

American Speech-Language-Hearing Association. (1997a). Preferred practice patterns for the profession of speech-language pathology . Rockville, MD: Author.

American Speech-Language-Hearing Association. (1997b). ASHA desk reference . Rockville, MD: Author.

American Speech-Language-Hearing Association. (1998). Guidelines for referral to speech-language pathologists . Rockville, MD: Author.

American Speech-Language-Hearing Association. (2000). Certification and membership handbook: Speech-language pathology . Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001a). Code of ethics . Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001b). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents (position statement). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2001c). Scope of practice in speech-language pathology . Rockville, MD: Author.

Division 40 of the American Psychological Association. (1989). Definition of a clinical neuropsychologist. Clinical Neuropsychologist, 3 (1), 22.

Eubanks, J. D. (1997). Clinical neuropsychology summary information prepared by Division 40, Clinical Neuropsychology, American Psychological Association. Clinical Neuropsychologist, 11 (1), 77–80.

Frattali, C. M., Thompson, C. K., Holland, A. L., Wohl, C. B., & Ferketic, M. M. (1995). Functional assessment of communication skills for adults . Rockville, MD: American Speech-Language-Hearing Association.

Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an expanded Halstead-Reitan Battery: Demographic corrections, research findings, and clinical applications . Odessa, FL: Psychological Assessment Resources.

Hannay, H. J., Bieliauskas, L.A., Crosson, B. A., Hammeke, T. A., Hamsher, K. deS., & Koffler, S. P. (1998). Proceedings of the Houston Conference on Specialty Education Training in Clinical Neuropsychology. Archives of Clinical Neuropsychology, 13 , 157–250.

INS-Division 40 Task Force. (1987). Report of the INS-Division 40 Task Force. Clinical Neuropsychologist, 1 , 20–34.

Joint Committee on Testing Practices. (1988). Code of Fair Testing Practices in Education . Washington, DC: Author.

Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests (2nd Ed.). New York: Oxford University Press.

World Health Organization. (2001). International classification of functioning, disability and health . Geneva, Switzerland: Author.

Ylvisaker, M., Hanks, R., & Johnson-Greene, D. (2002). Cognitive communication in press. Journal of Head Trauma Rehabilitation .

Index terms: cognitive-communication, referral, interdisciplinary teams, neuropsychology

Reference this material as: American Speech-Language-Hearing Association. (2003). Evaluating and treating communication and cognitive disorders: approaches to referral and collaboration for speech-language pathology and clinical neuropsychology [Technical Report]. Available from www.asha.org/policy.

© Copyright 2003 American Speech-Language-Hearing Association. All rights reserved. Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.TR2003-00137

ASHA Corporate Partners

Become A Corporate Partner

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 234,000 members, certificate holders, and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology assistants; and students.

All ASHA Websites
Work at ASHA
Marketing Solutions

Information For

Get involved.

ASHA Community
Become a Mentor
Become a Volunteer
Special Interest Groups (SIGs)

Connect With ASHA

American Speech-Language-Hearing Association 2200 Research Blvd., Rockville, MD 20850 Members: 800-498-2071 Non-Member: 800-638-8255

MORE WAYS TO CONNECT

Media Resources

Press Queries

Skip to main menu
Skip to user menu

Clinical Assistant Professor of Speech-Language Pathology (2543)

Job Details

Provide clinical instruction to SLP students and other students as appropriate;
Provide clinical services to patients in the NIU Speech-Language-Hearing Clinic;
Positively contribute to service within the university (program, school, college, university levels) and profession;
Provide student advisement and support student research;
Engage in scholarly activity (e.g. research presentations, publications, grants);
Contribute to curriculum development and program advancement.
Collaborate within the campus and community to promote the advancement of the program and the mission of the University.
Earned Master’s degree in speech-language pathology or related field by the time of hire;
Current CCC - SLP, and IL licensure in speech-language pathology;
Minimum of two years of clinical experience as a licensed SLP post Clinical Fellowship Year ( CFY );
Expertise in areas that complement expertise of existing faculty to ensure depth and breadth across the scope of practice as required by the Council of Academic Accreditation in Audiology and Speech-Language Pathology.
Demonstrated experience with committing to diversity and promoting an inclusive work and learning environments that foster creativity and innovation.
Ability and willingness to contribute to meeting the program’s instructional needs;
Strong oral, written, visual, and electronic communication skills;
Ability to communicate effectively and interact in a positive manner with diverse faculty, staff, patients, students, and clinicians as well as with people of varying economic and cultural backgrounds;
Strong organization, problem-solving, and counseling skills;
Demonstrated knowledge in evidence-based practice;
Ability to teach academic and clinical skills to students;
Ability to adhere to program’s immunization policies.
teaching in a speech-language pathology program;
clinic/program administration;
participation on university committees/departmental projects;
utilization of course management systems to deliver organized and meaningful content;
History of engagement and service to the profession at the local, state, and/or national level.
Expertise in providing services to clients from three to age twelve.
Professional Educator Licensure
Bilingual in Spanish and English or American Sign Language with the ability to professionally communicate in both languages to provide clinical care.
Additionally, preference will be given to individuals who have experience providing care to diverse populations.
Preference will be given to candidates with a record of professional service, research, and experience developing grants for programming is desirable.
Curriculum Vitae
Cover letter that includes discussion of how the candidate meets all the qualifications and requirements
Licensure information including licensure confirmation/certificate, that includes licenses number and expiration date
List of three professional current/recent references e.g. a supervisor, direct report, or peer who the candidate has worked with in the last five years
Unofficial transcripts (official transcripts required upon hire)
Resume/Curriculum Vitae
Cover Letter
Transcripts (unofficial with official required at hire)
Certifications/Licensure #1
Certifications/Licensure #2
Certifications/Licensure #3

Share this job

Get job alerts

Create a job alert and receive personalized job recommendations straight to your inbox.

IMAGES

Speech–language pathology students: learning clinical reasoning
10 Tools for Clinical Problem Solving
Identifying and Problem-Solving Biases in Speech–Language Pathology
PPT
Problem Solving Scenarios for Speech Therapy: Real Pictures, Visuals
Problem Solving Speech Therapy Materials

VIDEO

Moffitt Cancer Center's Meet the Experts: What is a Medical Speech Language Pathologist
Solving final exam paper pathology 2. مقابلة 2
Solving fin exam paper pathology 2. مفاضلة 6
Be a confident speaker
Conference Day 2 highlights
#23-1st Final Revision-Oral Pathology-Kasr ElAiny. حل اسئلة ومراجعة نهائية لأمراض الفم للقصر العيني

COMMENTS

Clinical Topics and Disorders in Speech-Language Pathology
American Speech-Language-Hearing Association 2200 Research Blvd., Rockville, MD 20850 Members: 800-498-2071 Non-Member: 800-638-8255. MORE WAYS TO CONNECT
What Is Clinical Evidence in Speech-Language Pathology? A Scoping
Recent Reworkings of Clinical Evidence in Speech-Language Pathology. ... American Journal of Speech-Language Pathology, (b) ... (n = 16) described aspects of organized thinking or stepwise problem-solving that were important for systematic practice. Twelve articles described the importance of explicit, organized knowledge that developed from ...
Clinical Problem Solving: Assessment of Phonological Disorders
No Access American Journal of Speech-Language Pathology Clinical Forum 1 Aug 2002. Clinical Problem Solving. Assessment of Phonological Disorders. ... American Journal of Speech-Language Pathology, 8, 347-363. ASHAWire Google Scholar. Miccio, A. W., Yont, K. M., Davie, J ...
10 Tools for Clinical Problem Solving
Here are some of my favorites: • Leaders Project: The site offers free CEUs, mock evaluations, narrative assessment tools, and so much more. • SpeechTherapyPD: They have hundreds of courses that you can access for $89 per year! 5. Textbooks. Textbooks are a great way to get an overview of any given topic.
Diagnostic Reasoning by Experienced Speech-Language Pathologists and
"trying to identify the problem accurately" in a patient or client (Harjai & Tiwari, 2009, p. 305). In the field of speech-language pathology, there has been very limited research in both the broad area of clinical reasoning and, specifically, in diagnostic reasoning. McAllister and Rose (2000) noted that
Five heads are better than one: preliminary results of team-based
Background: Clinical problem-solving is fundamental to the role of the speech-language pathologist in both the diagnostic and treatment processes. The problem-solving often involves collaboration with clients and their families, supervisors, and other professionals. Considering the importance of cooperative problem-solving in the profession, graduate education in speech-language pathology ...
Evidence-based practice: A matrix for predicting phonological
Clinical problem solving: assessment of phonological disorders. American Journal of Speech-Language Pathology. 2002; 11:221-229. [Google Scholar] ... The application of phonological universals in speech pathology. In: Lass N, editor. Speech and language: Advances in basic research and practice. Vol. 3. New York: Academic Press; 1980. pp. 75-97.
Evidence-Based Practice in Speech-Language Pathology: Where Are We Now?
Promoting the understanding and use of evidence in clinical practice through explicit instruction in the classroom and clinic has long been an objective of graduate programs in speech-language pathology. A committee of the American Speech-Language-Hearing Association (ASHA) on evidence-based practice (EBP) was formed in 2004 to review clinical ...
Clinical Documentation in Speech-Language Pathology
AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY (AJSLP) JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH (JSLHR) ... a diagnosis and description of the specific problem to be evaluated and/or treated. All conditions and complexities that may impact treatment are described. ... Clinical record-keeping in speech-language pathology for healthcare ...
Clinical Problem Solving: Assessment of Phonological Disorders
Clinical Problem Solving: Assessment of Phonological Disorders. November 2002. American Journal of Speech-Language Pathology 11 (3):221-229. DOI: 10.1044/1058-0360 (2002/023) Authors: Adele W ...
Speech-language pathology students: learning clinical reasoning
Another focus of our profession has been on outcomes and solving problems in clinical practice. Consider recent sources in the SLP literature: for example, Dodd's 1995 text Differential Diagnosis and Treatment of Children with Speech Disorder contains a chapter on a problem-solving approach to clinical management. This problem-solving model begins at the stage of description of the current ...
Speech-Language Pathology Clinical Handbook 2021
1. Provide high-quality services within the scope of practice of speech-language pathology 2. Apply sound problem-solving and clinical reasoning skills to patient/client diagnosis, treatment, and management 3. Work in a collegial and effective manner with colleagues and team members to manage
PDF Using Single-Subject Designs in Speech-Language Pathology Practicum
ABSTRACT: Clinical problem solving may be enhanced through more direct application of research principles in the therapeutic process. The use of single-subject designs during the speech-language pathology clinical practicum experience, with subsequent transition into routine clinical practice, would allow for development of a "clinician as
Problem-Based Learning in Speech-Language Pathology: Format and Feedback
space in order to work through the problem (Jonas-sen, 2000). This active involvement makes mastery of the information more likely (Weimer, 2007). Acquir-ing such problem-solving abilities should generalize to situations in which individuals gather, interpret, and integrate data from any clinical problem (Norman & Schmidt, 1992).
Clinical Education and Supervision
By actively participating in all aspects of the clinical process—including data collection, problem solving, and strategy development—the student ultimately develops the ability to use the strategies needed to function independently (Dowling, 2001). ... Interpersonal communication in speech-language pathology clinical practicum: A ...
Evidence-Based Practice in Speech-Language Pathology
The American Speech-Language-Hearing Association (ASHA) provides a number of quality resources to promote engagement in EBP. An Overview of EBP and the process of EBP. Step 1: Frame Your Clinical Question. Step 2: Gather Evidence. Step 3: Assess the Evidence. Step 4: Make Your Clinical Decision.
PDF Clinical Supervision in Speech-Language Pathology
Clinical Supervision in Speech-Language Pathology and Audiology (ASHA, 1985b). This 2008 technical report accompanies an updated position statement and knowledge and skills document for the profession of speech-language pathology (ASHA 2008a, 2008b). Although the principles of supervision (also called clinical teaching or clinical education ...
Knowledge and Skills Needed by Speech-Language Pathologists ...
Knowledge and Skills. This document accompanies ASHA's policy documents Clinical Supervision in Speech-Language Pathology: Position Statement and Technical Report (ASHA, 2008a, 2008b).ASHA's position statement affirms that clinical supervision (also called clinical teaching or clinical education) is a distinct area of expertise and practice, and that it is critically important that individuals ...
Update on a Clinical Measure for the Assessment of Problem Solving
The Rapid Assessment of Problem Solving test (RAPS) is a clinical measure of problem solving based on the 20 Questions Test. This article updates clinicians on the RAPS, addresses questions raised about the test in an earlier article (R. C. Marshall, C. M. Karow, C. Morelli, K. Iden, & J. Dixon, 2003a), and discusses the clinical utility of the ...
Management Roles for Speech-Language Pathologists in Health Care
According to ASHA's year-end membership counts, in 2007 only 10.7% of ASHA-certified SLPs reported an administrative role as their primary employment function. When you subtract the 0.4% who chair an educational or research program, we're left with 10.3% who work in an administrative role—and we don't know how many of those are in ...
Clinical Problem Solving? : r/slp
Clinical problem solving is what differentiates an SLP's skillset from any other person. For example, if I have a complex stroke patient who has a trach, a feeding tube, and an unknown language status because they're minimally responsive, when I evaluate I need to use my clinical judgment to 1. Prioritize the issues to focus on 2.
Evaluating and Treating Communication and Cognitive Disorders
Speech-language pathologists and clinical neuropsychologists engage in areas of distinct and common professional practice. The purpose of this document is to encourage referral and collaboration between speech-language pathologists and clinical neuropsychologists, and to inform referral sources (e.g., physicians, rehabilitation and other health care professionals, educators, case managers ...
Stimulability Measures and Dynamic Assessment of Speech Adaptability
Stimulability has a long history in the field of speech-language pathology. The purpose of this article is to show different procedures that have been used over time and how stimulability methodologies are variable across clinicians.
Clinical Assistant Professor of Speech-Language Pathology (2543)
Strong organization, problem-solving, and counseling skills; Demonstrated knowledge in evidence-based practice; Ability to teach academic and clinical skills to students; Ability to adhere to program's immunization policies. Preferred Qualifications. Experience in: teaching in a speech-language pathology program; clinic/program administration;