The development of a meaningful approach to evidence based practice for primary school children with

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The development of a meaningful approach to
evidence based practice for primary school
children with speech, language and communication
needs Findings from the CIRCLE study
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Introduction
Gathering the evidence
Results
Reflections
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CIRCLE Collaboration
Introduction

• Child
• Inclusion
• Research into
• Curriculum
• Learning
• Education

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The CIRCLE Collaboration Team

• Prof. James Law SLT
• (Director, Centre for Integrated Healthcare
  Research)
• Lynne Bremner SLT
• (Speech and Language Therapist, NHS Lothian)
• Dr Marysia Nash SLT
• (Speech and Language Therapist, NHS Lothian)

Dr. Kirsty Forsyth OT (Senior Lecturer, QMUC)
Mandy Adamson OT (Occupational Therapist, NHS
Lothian) Dr. Donald Maciver OT (Research
Fellow, QMUC)
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Who is funding CIRCLE Collaboration?
Introduction

• Edinburgh City Council
• as a part of the Additional Support for Learning
  initiative
• Scottish Executive (2004)The education
  (Additional Support for Learning) (Scotland)
  Act Edinburgh Scottish Executive.

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Introduction

• The Funder asked for a
• Best Practice Framework for primary aged
  children

Provide a practical communication tool between
therapist, education and parents for primary aged
children
Provide transparency of SLT decision making
Be evidence based
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Introduction

• Evidence based practice.
• Knowledge of research and evaluation
• play an essential role in quality of
• healthcare
• (RCSLT, 2008)

Availability of relevant Information
Time !
(Brackenbury, Burroughs and Hewitt, 2008)
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How did we define evidence
Gathering the evidence
Scientific Evidence Perspective
Systematic Literature Review
Integrate Information
Expert Practitioner Perspective
Qualitative Study of expert therapy view
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Gathering the evidence

• The review had to
• Cover all areas of SLT practice with primary
  aged children (4 ½ -11 years)
• Provide clarity on what literature is out there
  and how it clusters for speech and language
  therapy
• Provide accessible and useful information for
  funder, educationalists and therapists

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Gathering the evidence

• Has a review already been done
• in this area?
• Yes- Cochrane review
• -Only considers a subset of the
• population we are interested in.
• -Covers a wider age range than we are
• interested in
• -Practitioners perspective

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Gathering the evidence

• The results of the searching process

The computerised strategy 1546 SLT articles
The hand search retrieved 13 articles
57 articles satisfied the criteria for in-depth
review
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How did we synthesise the information?
Gathering the evidence

• Clustered the literature by disorder
• Clustered studies by similar therapy approach
• Looked at the number of studies quality of
  study design in each therapy approach
• Used coloured circles to show the weight of
  evidence in each of the areas

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Areas of SLT practice reviewed
Results

• Autism spectrum disorders
• Cleft palate
• Dysphagia
• Global delay
• Hearing impairment
• Expressive speech sound difficulties
• Disorders of fluency
• Specific language difficulties
• Literacy

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Best evidence synthesis andthe use of
CIRCLEs
Results

• To make the rating of effectiveness more
  transparent a system of grading of study quality
  was developed using coloured CIRCLEs
• The CIRCLE system relates to the weight of
  evidence associated with the number of studies
  quality of study design. It does not necessarily
  reflect the best intervention itself.

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Results
 


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Results

• The majority of papers had an ICF classification
  of Body functions/body structures only.
• The majority of studies focussed on individual
  therapy provided in clinic or school settings.
• The majority of studies used qualified healthcare
  staff alone. Frequency and intensity could not be
  fully aggregated due to heterogeneity

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Three specific examples of SLT practice
Results

• Autism Spectrum Disorders
• Cleft Palate
• Stammering

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Results
Autism Spectrum Disorders
Social Skills Groups
2 studies
TEACCH home program
1 study
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Results
Cleft Palate
Whole Language Philosophy and Phonological
Principle Approach
1 study
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Results
Stammering
Lidcombe Approach
4 studies
Smooth Speech and Electromyography
1 study
Delayed Auditory Feedback and Gradual Increase
in Length
1 study
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Important to note
Results

• Does the systematic review reflect actual
  practice?
• NO
• Does the systematic review tell us what should be
  done in all circumstances
• NO
• It is suggestive of a range of effective
  practices based on the research available

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Reflections

• How to make it easy for SLTs to
• engage with the information from
• the Systematic Review?

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Communication Tool Intervention Description
Reflections
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Intervention discussiontool.
Reflections
INDIVIDUAL VS GROUP
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Reflections
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Next Steps
Reflections

• The Circle Collaboration is currently in
  consultation with education, parents and therapy
  colleagues
• Additional year of funding to test framework
• Build intervention manuals around framework

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Reflecting on the Process
Reflections

• Systematic reviews often end with their
  publication and the influence they may or may not
  have on the research and guideline agenda
• Practical tools have been well received in
  community
• Valuing therapists tacit knowledge supports
  gaps in literature

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Reflections

• CIRCLE Framework
• Useful for clinicians, teachers and parents?
• Improved outcome for children?

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• Thank-you
• for
• listening