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Teaching EBP in Preprofessional Education:

Teaching EBP in Preprofessional Education:. David Beukelman University of Nebraska ASHA DAAC Conference Feb. 2007. Acknowledgements. Kathryn Yorkston, University of Washington Liz Hanson, U. of South Dakota Laura Ball, UNMC Susan Fager, Madonna Rehabilitation Hospital

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Teaching EBP in Preprofessional Education:

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  1. Teaching EBP in Preprofessional Education: David Beukelman University of Nebraska ASHA DAAC Conference Feb. 2007

  2. Acknowledgements Kathryn Yorkston, University of Washington Liz Hanson, U. of South Dakota Laura Ball, UNMC Susan Fager, Madonna Rehabilitation Hospital Mark Hakel, Madonna Rehabilitation Hospital Gary Pattee, Neurology Associates Students at UNL Partners in the AAC-RERC

  3. Evidence Informed Decision-making Research Evidence Clinical Expertise Direct Stakeholder Preference Schlosser, R. & Raghavendra, P. (2004)

  4. EPB for AAC Personnel Range of AAC Stakeholders; however, not all participate in preprofessional preparation EPB Results important to all stakeholders

  5. EBP Related Roles Using EPB to guide AAC Practice Completing EPB reviews and development of practice guidelines Completing research on which EBP reviews can be based Supporting research on which EBP reviews can be based Who needs “what” preparation?

  6. Use of EBP Results in Clinical Practice KEEPING UP with current evidence HUNTING TOOLS for specific information CLIENT-CENTERED not EVIDENCE-CENTERED decision-making Slawson, D. & Shaughnessy, A. (2005).

  7. Completing EBP Reviews and Development of Practice Guidelines • Developing a cadre with knowledge and skill base to complete reviews • Managing clinical practice when the EBP knowledge base is limited • Dealing with unintended consequences of reviews completed with limited knowledge base.

  8. Completing Research on which EBP Reviews can be based • Who will do this work? • What collaborations will be necessary to complete it. • Changing roles of AAC practice that limit involvement in EBP relevant research • Research funding support for this research • Unique challenges for the AAC field • (Pre-professional preparation to deal with these needs)

  9. Treating People with information: Decision-Making about Health and Health Risks: • Decision - Making: Personal Perspective & Informational Factors • Personal perspectives include personal values, emotional response, • Informational factors include observational and experimental evidence. • Decision-making involves both factors; however, the relative contribution varies Information alone doesn’t change behavior. Schuettler, D. & Kiviniemi, M. (2006).

  10. Professional Personnel Framework Personnel Groups in Pre-Professional Ed. 1. Finders/Identifiers 2. Integrated Practice Clinicians 3. AAC Specialists 4. AAC Experts (Beukelman, Yorkston, & Garrett, 2007)

  11. AAC Stakeholders not Receiving Pre-professional Preparation Those who rely on AAC Other Decision-makers AAC facilitators Commercial Representatives????

  12. Finders • Roles: Find, identify, refer, & support persons with CCN who would benefit from AAC services. (See Table 1) • EBP: Incidence of CNN in Population Groups • Natural Course of Communication Need Profile • Preparing AAC Decision-makers • Acceptance of AAC Options • Length of AAC Technology Use • Impact of AAC on Communication, Participation, Social Network • EBP Preparation--Summary information as they probably will not do reviews in the AAC area.

  13. Preprofessional Preparation For Finders • 1. Course Content • Appropriate summary content • Affective + information content • Learning in Context • Durable information format • 2. Clinical intern/externships • (Updates: ?????)

  14. Clinicians in Integrated Practice • Role: Integrate AAC into Natural Speech & Language to Meet Communication Needs (See Table 1) • EBP: Same as Finders and • Implement Low Tech Options (Assess, Recommend, and Intervene) • Implement Routine High Tech Options (Assess, Recommend, and Intervene) • Instruct AAC facilitator • Instruct person who relies on AAC • Monitor AAC use and impact • Instruct AAC Finders • EPB Preparation: Awareness of current reviews and preparation of CAT reviews in some area of clinical practice

  15. Pre-professional Preparation • 1. Course Content?? • Appropriate summary content • Specialized AAC Content • Learn what they need to know • Personal perspective + informational content • Learning in Context • 2. Clinical intern/externships • Need to make mentors/supervisors aware of current intervention evidence • 3. Complete CAT Review (Critically Appraised Topic)

  16. AAC Specialists • Role: Advanced AAC Expertise (See Table 1) • EBP: CAT Reviews in AAC Area

  17. AAC Experts • University Faculty • Researchers (Including AAC EBP) • Policy Specialists • Coordinators of Unique Service Delivery

  18. Advanced EBP Methods (AAC Experts) Advanced Statistics EBP Coursework CAT reviews One systematic review (Unless specializing in EBP)

  19. Table 1 • A preliminary outline of evidence to support AAC intervention activities based on their role of finder (F), Integrated Clinician or Educator (I), and AAC specialist (S) Role Activity____________________________________ F I S 1. Identify Persons with Complex Communication Needs F I, S 2. Understand Appropriate Communication Options for Individuals with Complex Communication Needs. F I S 3. Prepare Potential Decision-Makers I S 4. Organize Decision-Making Process I S 5. Plan Communication Support for “Today” and “Tomorrow” F I S 6. Refer to Appropriate Intervention Providers I S 7. Integrate Restorative/Developmental & Compensatory Interventions & Substitutionary Interventions I S 8. Implement Multi-modality Interventions I S 9. Use of Low Tech AAC Materials in Restorative/Developmental and Compensatory Interventions I S 10. Implement “Appropriate” Low Tech AAC Options

  20. Table 1 Continued I S 11. Implement “Appropriate & Routine” High Tech AAC Options S 12. Implement Complex or Unique High Tech AAC Options S 13 Obtain Funding for Technology I S 14. Obtain Funding for AAC Intervention Services I S 15. Prepare and Support AAC Facilitators I S 16. Promote, sustain, enhance everyday services F I S 17. Monitor Impact of AAC intervention I S 18. Prepare & Update Finders S 19. Update and consult with Integrated Clinicians I S 20. CAT reviews S 21. Full reviews

  21. References • Beukelman, D. Garrett, K, & Yorkston, K.(Eds.). Augmentative communication strategies for adults with acute or chronic medical conditions. Baltimore, MD: Paul H. Brookes Publishing Co. • Glanz, K., Lewis, B., & Rimer, B. (2002). Health behavior and health education:Theory, research, and practice. San Francisco: Jossey-Bass. • Raczynski, J. & DiClemente, J. (Eds). (1999). Handbook of health promotion and disease prevention. Cambridge, MA: Springer Science + Business Media. • Schlosser, R. & Raghavendra, P. (2004). Evidence-based practice in augmentative and alternative communication. Augmentative and Alternative Communication 20, 1-21. • Slawson, D. & Shaughnessy, A. (2005). Teaching evidence-based medicine: Should we be teaching information management instead? Academic Medicine, 80, 685-689. • Schuettler, D. & Kiviniemi, M. (2006). Does how I fell about it matter? The role of affect in cognitive and behavioral reactions to an illness diagnosis. Journal of Applied Psychology, 36, 2599-2618.

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