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Evidence-Based Practice

FHC Statement on Evidence-Based Practice

The Family Hope Center considers the following in regards to evidence-based practices:

  1. the varied definitions of and standards for evidence-based treatment within the diverse fields represented by the FHC’s team member
  2. the difference between evidence-based treatment and evidence-based practice (two well-defined terms with very different clinical implications).

First, the term “evidence-based” has been defined separately, and differently, by many fields. In their summary of the history of the term, Cook et al. (2009) tell us that the use of evidence-based treatments was first advocated by the medical field in the 1990s. Since then, fields such as clinical psychology, occupational therapy, special education (Travers, 2016), and many others have developed their own standards for defining what constitutes an evidence-based treatment or intervention.

We mention this to point out that while “evidence-based” is a well-defined term within fields, it is not yet well-defined across fields. Moreover, the coding systems indicating the quality and amount of evidence for a particular intervention are also different (with differing standards for research design methods, number of studies needed, size of effect, etc). Further, as Odom et al. (2005) point out in their discussion of research design methods, the vast variability in function even among individuals with the same diagnosis or classification makes it difficult to establish equivalent groups, to specify clearly for which individuals particular treatments are effective, and most importantly, in what environmental context these treatments may be effective.

All of this variability makes it difficult for the average consumer (parents) to compare interventions across fields or to understand how different treatment modalities might complement (or oppose) each other.
Rather than utilizing one or two evidence-based or non-evidence-based treatments, the FHC uses an interdisciplinary approach, incorporating a diversity of interventions across fields that, taken together, are designed to address development in cognitive, communicative, sensorimotor and physiological areas. Therefore, it is much more accurate to characterize our model and approach as evidence-based practice (EBP) as defined by Torres et al. (2012) and similarly by Slocum et al. (2014).

Torres et al. and Slocum et al. define EBP as a complex decision-making process that relies on both clinical expertise and sensitivity to the values, needs, and capacities of the parents and children involved in the interventions designed by practitioners. Thus, EBP is not a list of empirically proven treatments. Instead, it is a framework from which clinicians use multiple factors (research being foremost) to decide on a treatment course. In doing so, evidence should be analyzed according to whether it fits the individual characteristics of a child and family, the functional abilities parents are interested in improving, and the environment (for our purposes, the home) in which the intervention will take place.

Thus, as Slocum et al. defines it, evidence-based practice is a complex, dynamic, and nuanced decision-making process that involves integrating multiple interventions (and therapies) but also assessment, evaluation, and the consideration of the values and input of key stakeholders (parents) in the development of an appropriate treatment plan (2014). Importantly, this process relies on an integration of the best available evidence with clinical experience and the value systems of the families being served.

These principles much more accurately define the philosophical and clinical approach of the FHC. Moreover, at all times, the FHC and the treatment plans we utilize are subject to rigorous, transparent, and objective therapeutic outcome measures (WeeFIM) as part of the dynamic process of treatment design — a continuous data-driven monitoring process whereby our protocols and therapeutic approaches are updated and modified at regular intervals.

References

Cook, B. G., Tankersley, M., & Landrum, T. J. (2009). Determining evidence-based practices in special education. Exceptional Children, 75(3), 365-383.
Odom, S. L., Brantlinger, E., Gersten, R., Horner, R. H., Thompson, B., & Harris, K. R.
Research in special education: Scientific methods and evidence-based practices. Exceptional children, 71(2), 137-148.
Slocum, T. A., Detrich, R., Wilczynski, S. M., Spencer, T. D., Lewis, T., & Wolfe, K. (2014). The evidence-based practice of applied behavior analysis. The Behavior Analyst, 37(1), 41-56.
Torres, C., Farley, C. A., & Cook, B. G. (2012). A special educator’s guide to successfully implementing evidence-based practices. Teaching Exceptional Children, 45(1), 64-73.
Travers, J., Cook, B. G., Therrien, W. J., & Coyne, M. D. (2016). Replication Research and Special Education. Remedial & Special Education, 37, 195-204.