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The Crew. Auburn CHCChatswood CHCDubbo CHCForster CHC Hills CHCHillview CHCLismore CHC. Liverpool CHCMacarthur Health ServiceMt Druitt CHCNEXUS (John Hunter)Queenscliffe CHCSCHUni of Sydney. Where Did We Come From?. Difficulties with clinical questions and searchesDearth of positive useful dataMultiple baseline designsTopics covered included phonological awareness, models of service delivery, long term effects of language disorder, language therapy techniques, parent trainingOn t1141
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1: A Safari Amongst Language Research NSW EBPN: Paediatric Language Group
Clinical Network Leader: Brooke Funnell
Liverpool Health Service
9828 4776
2: The Crew Auburn CHC
Chatswood CHC
Dubbo CHC
Forster CHC
Hills CHC
Hillview CHC
Lismore CHC Liverpool CHC
Macarthur Health Service
Mt Druitt CHC
NEXUS (John Hunter)
Queenscliffe CHC
SCH
Uni of Sydney
3: Where Did We Come From? Difficulties with clinical questions and searches
Dearth of positive useful data
Multiple baseline designs
Topics covered included phonological awareness, models of service delivery, long term effects of language disorder, language therapy techniques, parent training
On the path to a CAT In the beginning we tried very hard to form clinical questions using the framework patient/problem, intervention, comparison and outcome.
We then did literature searches and often got no relevant studies.
However we did come across interesting articles in the process and so it came to pass that we did CAPs on these and wrote the clinical question post hoc. I know, not quite the right sequence, but it worked for us for a while and we followed up with studies from the reference list.
The language area is so broad and well- designed studies, according to guidelines, so few that we struggled to find positive useful data.
We returned to the more conventional approach of formulating a clinical question and covered topics such as the
long term effects of language disorder
the effect of phonological awareness therapy on literacy
the effect of therapy on school age children with SLI
parent training, group therapy vs. individual therapy
models of service delivery
spontaneous recovery of early language delay.
Our next move was to look at more practical research designs for speech pathology. We reviewed multiple-baseline designs and found some practical information.
We have now returned to the designated path towards a CAT.
In the beginning we tried very hard to form clinical questions using the framework patient/problem, intervention, comparison and outcome.
We then did literature searches and often got no relevant studies.
However we did come across interesting articles in the process and so it came to pass that we did CAPs on these and wrote the clinical question post hoc. I know, not quite the right sequence, but it worked for us for a while and we followed up with studies from the reference list.
The language area is so broad and well- designed studies, according to guidelines, so few that we struggled to find positive useful data.
We returned to the more conventional approach of formulating a clinical question and covered topics such as the
long term effects of language disorder
the effect of phonological awareness therapy on literacy
the effect of therapy on school age children with SLI
parent training, group therapy vs. individual therapy
models of service delivery
spontaneous recovery of early language delay.
Our next move was to look at more practical research designs for speech pathology. We reviewed multiple-baseline designs and found some practical information.
We have now returned to the designated path towards a CAT.
4: Where Are We?? Our CATs to date
What is the most Effective form of treatment for 4 year olds?…
Word Finding Difficulty…
EI SDM – Parent Training vs Clinician Led
Rx vs No Rx This one we’ve just finished the CAPS and only need to collate them into a CAT
In process
Completed
CompletedThis one we’ve just finished the CAPS and only need to collate them into a CAT
In process
Completed
Completed
5: Lost in the NH&MRC How can we achieve NH&MRC 1?
What makes a “pseudorandomised” control trial in language? Some of our quandaries
Linda will talk to these more
Some of our quandaries
Linda will talk to these more
6: A Good Trek Vasilyeva, M., Huttenlocher, J., & Waterfall, H. (2006). Effects of language intervention on syntactic levels in preschoolers. Developmental Psychology, 42(1), 164-174.
Level II
Current research
Still lots of questions (weaknesses) arose from it.
Study didn’t determine if the participants had any underlying language, development, or emotional/behavioural difficulties
Poor comprehension task – not statistically strong data
7: A Good Trek Hodge, T. & Downie, J. (2004). Together we are heard: Effectiveness of daily ‘language’ groups in a community preschool. Nursing and Health Sciences, 6, 101-107.
Level IV
Weak research but clinically good
Australian
The program wasn’t referenced, extraneous variables weren’t controlled for & there was no control group – why not? Multiple baseline design??
8: A Poor Trek Telleen, S., Wren, C. (1985). Acquisition of prepositions in language delayed preschoolers: is intervention effective? British Journal of Disorders of Communication, 20, pg 301-309
No strengths!
Couldn’t give it an evidence rating!!!
No control groups or randomisation
No statistical analysis
Poor description of procedure – testing, therapy, criterion
Poor description of subjects: reason for cognitive delay and there was a huge range
Poor inclusion/exclusion criteria - No information regarding other services the children were receiving i.e. SP
9: Our Challenges Lack of good research
Where are the randomised control trials??
Clinical Questions
Need to be specific
Lots to cover
Slow progress – is it more effective? A lot of our papers may be statistically sound or well researched but aren’t practical. Or they’re practical but not well researched
As mentioned in the history, writing a good clinical question that will get us a good number of papers has been difficult
We went broad but found it hard to complete a topic
Narrow it down too much and you don’t get many papers
We are averaging 1 CAT a year. This may seem like a slow process but we feel that in doing things this way we are understanding our papers better and everyone is involved in each paper. 3 articles are sent out for each meeting. Members select 1 or more of the articles to CAP. They’re brought to the meeting and discussed. Comments are added to each CAP and then it is edited for publishing.A lot of our papers may be statistically sound or well researched but aren’t practical. Or they’re practical but not well researched
As mentioned in the history, writing a good clinical question that will get us a good number of papers has been difficult
We went broad but found it hard to complete a topic
Narrow it down too much and you don’t get many papers
We are averaging 1 CAT a year. This may seem like a slow process but we feel that in doing things this way we are understanding our papers better and everyone is involved in each paper. 3 articles are sent out for each meeting. Members select 1 or more of the articles to CAP. They’re brought to the meeting and discussed. Comments are added to each CAP and then it is edited for publishing.
10: Where Are We Heading? General comprehension
Auditory Processing Disorders
Looking at the evidence for specific therapy programs – ‘Blades’ and ‘Prompt’
School language / Curriculum Based Learning
11: Thank You Come and join us next year.
Contact me on (02) 9828 4776 or
Brooke.Funnell@sswahs.nsw.gov.au
Our meetings are the 3rd Tuesday of February, May, August, & November
2.30 – 4.30