Evidence-Based Practice In Early Intervention/Early .

Evidence-BasedPractice inEarly Intervention/Early ChildhoodSpecial EducationSamuel L. Odom & Virginia Buysse

Objectives Frame the history and evolution ofevidence-based practice (EBP)Define terms commonly (mis)used in the fieldDescribe a model for EBP thatbuilds on empirical evidence andprofessional/family knowledge and valuesIdentify resourcesDescribe a problem solving process for using EBP

Evolution of Evidence-BasedPractice in EI/ECSE Developmentally Appropriate Practice byNAEYC (Late 1980s)DEC Recommended Practices(Early 1990s) Based on knowledge ofmultiple constituency groupsProfessionals Family Practitioners

Criteria forDEC Recommended Practice(Odom & McLean, 1996) Research- or plinaryDevelopmentally and chronologicallyappropriateNormalization

Evolution of Evidence-BasedPractice in EI/ECSE Revision of DEC RecommendedPractices in late 1990s.Review of decade of research on EI/ECSE Involvement of constituency group Linkage of empirical support andpractices

Parallel Movement in Education NRC Panel that criticized the quality ofeducational researchEducational Sciences Reform ActNo Child Left BehindEvidence-based medicine as a model

Evidence-Based MedicineThe integration of the bestavailable research evidencewith clinical expertise andpatient values.(Sackett et al., 2000)

A Reflection on Terminology Recommended practicesScientifically based practicesEvidence-based practices—A Noun Specific practices that have evidence ofefficacy or effectivenessEvidence-based practice—A Verb A process for using empirical research andknowledge and values of professionals andfamilies

Evidence-Based Practice (EBP)a decision-making processthat integrates the bestavailable research evidencewith family & professionalwisdom & values(Buysse & Wesley, 2006; Snyder, 2006; Winton, 2006)

Evidence-based Education(Whitehurst, 2002)Evidence searchEmpiricalInformation

Sources of Scientific Research Experimental ResearchExperimental group design Single subject design Standards for EBPs Established byProfessional OrganizationsCEC DR APA ASHA

The REVIEW PROCESS

Whatsources ofknowledgemay guideyour practice?

For What Kinds of PracticesDo We Find Evidence?(RCTs-Early Childhood) Response Contingent LearningCaregiver Responsive Style of Interaction Effects on language and attachmentParent-Child Interaction Therapy for Childrenwith Disruptive BehaviorUse of “social toys” to promote peer interactionPivotal Response Training for Children withAutism

For What Kinds of PracticesDo We Find Evidence?(RCTs-Early Childhood) Dialogic reading for toddlers & preschoolersResponsive home environment andsocioemotional developmentInterventions to promote parent sensitivityGuided design learning and adult problemsolvingContingent touch and infant responses

For What Kinds of PracticesDo We Find Evidence?(RCTs-Early Childhood) Incorporating child interest in teaching andlearning activitiesAdult reinforcement and child behaviorsTreadmill to promote walking (but feasibility forparent has not been examined)

For What Kinds of PracticesDo We Not Find Evidence?(RCTs-Early Childhood) Dolphin TherapyDiagnostic Practices for EC ADHDMelodic intonation therapyInfant MassageYoga and children with developmental delaysCraniosacral therapy

What Works Briefs: Summaries of Effective Practices for SupportingChildren's Social-Emotional Development and Preventing ChallengingBehaviors.Brief 1 Introduction to the What Works BriefsBrief 2 Understanding the Impact of Language Differences on ClassroomBehavior by R. M. Santos, M. M. OstroskyBrief 3 Helping Children Understand Routines and Classroom Schedules byM. M. Ostrosky, E. Y. Jung, M. L. Hemmeter, D. ThomasBrief 4 Helping Children Make Transitions between Activities by M. M.Ostrosky, E. Y. Jung, M. L. HemmeterBrief 5 Using Classroom Activities and Routines as Opportunities to SupportPeer Interaction by T. Bovey, P. Strain

Review Indicators in WWC

Review in Early Childhood for WWC

WWC Review inBeginning Reading

Consider a 5-step ProcessAdapted from Evidence-Based Medicine1.2.3.4.5.Pose an answerable question.Find best available research evidence. (Where?)Appraise evidence quality & relevance. (Who? How?)Integrate the research evidence with professional andfamily wisdom & values. (How?)Evaluate effectiveness of steps 1-4. (How?)

Step 1:Posing QuestionTarget Groupor IssueQuestion For young childrendisabilities 1 with disabilities PossibleSearchTermsyoung children,special needs,cerebral palsyInterventionComparisonCondition(if applicable)Outcomes ofInterest is hippotherapyeffective forimproving motor,social-emotionaland languagefunctioning?Hippotherapy,therapeutic riding,therapeutic horsebackriding, horsebackriding, equine therapy,riding therapy,therapeutichorsemanship[could includespecific outcomemeasures insearch]Adapted from: What Works for Children Group. (2003). Evidence guide: An introduction to finding,judging, and using research findings on what works for children and young people. London:Economic and Social Research Council. [MIND Grant – Evidence-based practice seminar]

Step 2:Finding “Best Available” Evidence:Example Search CINAHL databaseSearch terms“hippotherapy” and “cerebral palsy”Results of search evaluated against questionposed and study inclusion/ exclusion criteria

Search Results . McGibbon,McGibbon, N. H., Andrade C., Widener G., & Cintas H. L. (1998). Effect of an equinemovement therapy program on gait, energy expenditure, and motor function in childrenwith spastic cerebral palsy: A pilot study. Developmental Medicine & Child Neurology. 40,754-62. (58 ref) Debuse,Debuse, D., Chandler C., & Gibb C. (2005). An exploration of German and Britishphysiotherapists' views on the effects of hippotherapy and their measurement.Physiotherapy Theory and Practice, 21(4):21(4): 219-42. Meregillano,Meregillano, G. (2004). Hippotherapy. Physical Medicine and Rehabilitation Clinics of NorthAmerica, 5(4),5(4), 843-54. (17 ref) Casady,Casady, R. L., Nichols-Larsen, D. S. (2004). The effect of hippotherapy on ten children withcerebral palsy. Pediatric Physical Therapy, 16(3),16(3), 165-72. (37 ref)AN: 2004207975. Benda,Benda, W., McGibbon,McGibbon, N. H., & Grant K. L. (2003). Improvements in muscle symmetry inchildren with cerebral palsy after equine-assisted therapy (hippotherapy). Journal of(hippotherapy).Alternative and Complementary Medicine. 9(6):9(6): 817-25. (24 ref) Haehl,Haehl, V., Giuliani C., & Lewis C. (1999). Influence of hippotherapy on the kinematics andfunctional performance of two children with cerebral palsy.palsy. Pediatric Physical Therapy,11(2):11(2): 89-101. (26 ref) [See Bridges summary]Delinger,Delinger, C. & Cummins, T. (1997). Interview with a practitioner: Hippotherapy.Hippotherapy. AlternativeHealth Practitioner, Fall-Winter; 3(3):3(3): 161-5.How many of above might meet the inclusion/exclusion criteria?

Step 3:Appraising the Evidence Which approach? Levels of evidenceQuality indicatorsFunctional approachesIndividual studies versus group of studiesFunctional approach used in available researchsynthesisConsider quality, transparency, relevance ofevidence

Select Criteria for Appraising Research Syntheses:Transparency Is it clear what criteria were used to appraise theevidence?Do the criteria appear appropriate for answeringthe question?Are inter-coder agreement proceduresdescribed?Are conclusions about the interventionsupported by the appraisal evidence presented?

Select Criteria for Appraising Research Syntheses:Relevance How similar to your target group are theparticipants in the reviewed studies?How similar is your planned intervention to theintervention described in the synthesis?Do the results of the synthesis help informyour question?Do the results of the synthesis help informyour EBP decisions?

Select Criteria for Appraising Research Syntheses:Quality Is the question that focuses the synthesis statedor able to be inferred?Is a clear description provided for interventionunder consideration?Are search strategies used sufficientlydescribed?Are sources used in search listed?Is study inclusion and exclusion criteriaspecified?

Step 4:Integrating Integrate research evidence withprofessional and family wisdom & values

Step 5:Evaluation Evaluate the effectiveness of steps 1–4

Where do we go from here?

How can we reachagreement as a field aboutwhat evidence-based practicemeans?

Doesresearch trumpprofessional and familywisdom and values?

How can we make knowledgeaccessible and transparent toanyone who desires it?

Eminence-Based PracticeMaking the same mistakes withincreasing confidence over animpressive number of years.—O’Donnell, 1997, A Skeptic’s Medical Dictionary

This presentationis available online atwww.fpg.unc.edu/ handouts/EBP Odom Buysse.pdfFPG research and outreach has shaped how thenation cares for and educates young children.www.fpg.unc.edu

movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: A pilot study. Developmental Medicine & Child Neurology. 40, 754-62. (58 ref) Debuse, D., Chandler C., & Gibb C. (2005). An exploration of German and British physiotherapists' views on the effects of hippotherapy and their measurement.