Presentation (Intro/why science imp in CDS)

Research makes a profession credible

• professional association that faciliates research

  • ASHA/NIH

• Profession produces its own research

• Professional peer reviewed journals published research

  • checked by other professionals in the field before publication

• professional meetings to present research

  • conventions workshops

• Code of ethics

• Accreditation of training programs exposing students to research

  • every 8 yrs at fredonia

• Cont. ed requirements/keeping up with research

  • 30 hours/3 years

• Licensure and certification

  • praxis - state license CCC = ASHA

Credentialing

• creates professional credibility (Certificate of Clinical Competence)

• issues a permit to provide the services a person is trained to perform

• research is not directly involved

• ASHA offers CCC in accredited program + passing national exam PRAXIS (license)

• state licensure

• demonstrate clinician has adequate training (clinical hours)

Accreditation of training programs

• Profession must define standards

  of training and practice,

  • ASHA developed criteria university

  programs meet to be sanctioned

  or “accredited” by the professional

  organization

  • Exposure to research provides

  basis for clinical practice including

  treatment

Code of Ethics

Professional organizations set ethical

standards for people who practice

under their watch

• ASHA has code of ethics that outlines

professional conduct

• In research it involves not

misrepresenting your research,

crediting authors with their

contribution to research

• NOT VIABLE/FALSE = retraction

• PURE MISTAKE/partial edit= post script errata

Continuing Education

• Requirement that practitioners

maintain current knowledge and

literature review to maintain

certification

• Reading or attending conferences,

workshops, online seminars (papers+take tests) SLP.com

• Prescribed amount of hours per

year

National Association

• Credibility established by national

organization such as ASHA

• Set guidelines for practice

• Define research agendas for a

profession/ grant support for

specific lines of research

Professional journals

• National organizations produce

professional literature

– Peer reviewed articles (i.e. American

Journal of Speech-Language (TX)

Pathology)

• JSLHR = basic science

• ALSO A SCHOOL ONE

– Access to new research

– Included in the cost of membership in

national association

Professional conferences

National organizations hold

annual meetings

– Present research

– Position papers

– CE opportunities

ASHA = clinical

Discipline-Specific Research and Research from

Other Fields

We need research in our field to make

our work credible

– National Association

– Journals

– Professional Meetings

– Grants to clinicians/students

• Don’t want other professions dictating

research for SLP

SLP literature + information base

Not all research is created equal

• We must become critical

consumers of research

• Where do we find information in the

field?

Information Base

• textbooks - peer review

• online courses

• conventions/presentations

• workshops

• university coursework

• professional journals

• interactions with colleagues

textbook

“Secondary” source —> citations

• “Primary” sources are articles that

support the textbook

• Important issues:

– Author qualified?

– Depth and breadth of literature review by

author

– Author may have misinterpreted studies

• Manuscript reviewers?

FOUNDATIONAL ARTICLE - everything spins off of this

Presentations at professional meetings

Local, State, Regional, National

& International

• Subject to peer review

– Abbreviated summary

• Short courses, mini seminars,

technical sessions (15min), posters

• Always critically evaluate what

you are hearing

Scientific Journals

Journal of Speech-Language-

Hearing Research (BASIC) JSLHR

• American Journal of Speech

Language Pathology (CLINICAL)

• Most articles are empirical

research (findings)

• How do I publish?

How do I publish

• 3-4 editorial consultants (have atleast 1 article published in the field)

• repeatability + subjects =gold standard

• associate - appointed by asha many years in the field (specifc area)

• editor revise w/ edits or reject

University coursework + online courses

All courses should be rooted in

research and science

• Needs to be current and

effective

Workshops

• Convention presentation or

lecture that has not been

subject to peer review

• Must lay a strong foundation in

EBP

• Be critical, ask questions of the

presenter.

Interactions with colleagues

• Have discussions with

colleagues (gain information)

• Informal and formal methods

Science

ONE way of acquiring knowledge

• Several other ways pre-date SM

• Some are still in use today

• GROUP QUESTION: How do you

KNOW if a therapy technique is

effective? —> client meeting measurable goals improve compared to baseline

Science best method for acquiring knowledge

Both a philosophy & a method

• “Logic of inquiry,” a specific method

for solving problems & acquiring

knowledge

• Sciences use scientific method (SM)

– Physical, natural, behavioral

• Five steps in SM (typically)….

Identifying the problem/forming hypothesis

Can be basic or applied

– Basic: phonation, hearing

– Applied: stuttering, CAPD [pathology]

• Not necessarily a “problem”

• Refine and narrow it —> get rid of variables

• Hypotheses state the predicted

relationships b/t variables

– Must be testable

Designing the experiment

• Single-subject or group

  • Number of groups

  • Specify variables:

  – Independent

  (manipulated)

  – Dependent

  (measured)

  – Control or extraneous

• Materials/equipment

  • Setting of study

  • Procedures

Conducting the experiment

Data collection

• Perform task/treatment

• Measure behavior of

participants

• Obtain “raw data”

– Test scores, speech rate,

language sample, etc.

• Can take days or months

Hypothesis testing

Analyze data

– Statistics

– Visual inspection

• Tabulate data

– Charts, graphs, tables, etc.

• Interpret results

• Explain results with reference to

original hypothesis

Communicate Results

Write the report in APA format:

– 1) Introduction: literature review,

purpose of study, hypothesis

– 2) Method:

• Participants

• Apparatus

• Procedures

3) Results:

• Data

• Tables, figures

– 4) Discussion:

• Interpret results

• Limitations

• Implications

• Future research

Characteristics of the Scientific Approach

Control: enables us to identify

causes of our observations

ISNT ALWAYS NECESSARY

– Experiments ask questions:

• why something happens

• what causes some event

• under what conditions an event occurs

– Need control to be able to get to —> unambiguous

answers HARD TO CONTROL HUMAN BEHAVIOR

CDS has to get tx at some point (1 gets 1, 1 gets the other) = ethical

Objectives of science Description

Description:

– Portray a phenomenon/behavior

– Identify variables that exist

• mental health/nutrition/age/healthage/weight/height etc.,

– Determine degree to which they exist

• e.g., Piaget’s theory of child

development Long. of own children

– Began with detailed observations

and descriptions of his own child BIAS/SINGLE SUBJECT

Objectives of Science New Areas

New areas usually begin w/

description

– Identifies variables that exist

– Then, we can explain why they

exist

– e.g., separation anxiety

Objectives of Science explanation

Requires knowledge of why the behavior

exists or what causes it

– Identify antecedent conditions that lead to

its occurrence

• Stimulus > response (Pavlov)

• A-B-C in psychology

– Most behaviors are multidetermined

– Explanations are replaced as more data

are collected

Objectives of Science Prediction

Prediction/hypothesis: the ability to anticipate

an event before it occurs

– e.g., eclipse of the sun

• relationship of sun and earth

– Need to know antecedents of

behavior

– If we can’t predict a behavior, we

have a gap in the understanding of it

• Predictors of academic success:

– GRE scores, GPA

Objectives of science CLINICAL Control

Control: manipulation of conditions

that determine phenomenon

– Knowledge of causes or antecedents

– Manipulate to produce desired

behavior

– Used frequently in CDS

SLOWER RATE = LESS STUTTERING

• Not the “control” used to minimize

influence of extraneous variables

IN CLINIC setting we accomodate patient for the world they live in not necessarily disability

Advantages of the scientific method

Data obtained through systematic,

empirical observation

• Allows us to make objective

observations

– Independent of opinion, bias, and

prejudice

– Empiricism is based on experience, but

doesn’t control for bias

REPEATED DOUBLE BLIND PLACEBO = no bias

Advantages of the SM usually done

• Usually done w/ a

different a experimenter

at a different location w/

different participants

• Few actually conduct

replication studies

NATURALIZATION = observation only

Characteristics of the scientific approach

We must eliminate influence of

many variables to identify Cause & Effect

– Observed effect could be due to

one or more uncontrolled variables

– e.g., alcohol on driving ability (could have taken drugs/no sleep)

Characteristics of the scientific approach operational definition

Operational Definition: a term is defined by

steps or operations used to measure them

– e.g., effects of “hunger” on maze running

• e.g., 8 hours of food deprivation

• e.g., defining a “good salesperson”

• Verbal statement: “good salesperson” NOT OPERATIONAL

• Operational definitions:

– Sells 20 cars/month

– e.g.: “good speech abilities”

Characteristics of the Scientific approach replication

Replication: reproduction of the

results of a study if it’s repeated

– Also known as “reliability”

– Intergroup, intersubject, or

intrasubject

• Reasons for failure to replicate:

– Results were due to chance

– Some element of experiment was

altered

• e.g., instructions from examiner (SCRIPT)

The need to study scientific methods legal/social considerations

Legal/social considerations:

– PL 94-142: 1977 Education for all

Handicapped Children Act

– Special ed. services must be oriented

to the individual child and family

– IEP and EIP; IFSP

– Service programs MUST have:

• objectives

• specific procedures

• evaluative criteria

The need to study scientific methods legal/social considerations emphasis on

 Emphasis on clinician

accountability

– Effects of tx must be

documented objectively so they DATA

can be verified by independent

observers

– Behaviors measured

systematically and continuously

The need to study scientific methods legal/social considerations 3rd party payments

3rd party payments/insurance

– Document need, procedures, &

outcomes

– EVIDENCE-BASED PRACTICE

– Increased public awareness, more

people seeking/paying for services,

asking more ?s

The need to study scientific method concern that

• CDS is not well recognized by some other fields

The need to study scientific methods professional/scientific considerations

Professional/scientific

considerations:

– Must put practice on scientific

footing

– Will make better progress

– Have a scientific discipline & clinical

practice in one (“clinical science”)

– Philosophy/methods of science can

provide better safeguards for the

profession & the public

The need to produce in-house knowledge; historically depended on

CDS has historically depended on

other disciplines for info., theories,

paradigms, models, methods, data

analysis, etc.

– Non-clinical areas: linguistics,

experimental psychology

– Clinical fields: medicine

– Basic sciences: physics, biology

Need to produce in house knowledge not always appropriate

Not always appropriate for

studying our subject matter

• CDS must train its practitioners to

do research to generate their own

data base

Need to produce in-house knowledge

 Medicine has chemists, geneticists,

etc. who supply “custom-produced”

research and technology

• Not always so for CDS

• Kent (1983): “A profession that

provides its own research base is

much more in charge of its own

destiny than a profession that does

not”

Need to produce in house knowledge scarcity of research

Scarcity of research

institutions & programs

• Some CDS programs not

research oriented

• No quick solutions:

– More gov’t/private funds (ASHA)

– More theses/assistantships

– Make it easier to get a Ph.D. $$$.

• ASHA

• NIH (INTERNATIONAL)

• Other sources

Need to produce in house knowledge recruit clinicians

Recruit clinicians for

clinical research

• “Scientist-practitioner”

model

• “Boulder Model” used in

clinical psychology (BEHAVIORAL)

Goal: Train professionals to be both:

1. Scientists → conduct research, understand evidence

2. Practitioners → apply science in clinical settings

Why dont many clinicians do research dont have

Don’t have the extra time

• Not in their job description

• Not emphasized in their setting

• Client scheduling:

– Difficulty getting participants

Why dont many clinicians do research? clinicians assumptions

Clinicians’ assumptions:

– Not prepared to do research

– Unrelated to their practice

– Not helpful to them, colleagues,

or clients

– Not rewarded

why dont many clinicians do research assumptions valid

Assumptions valid to some extent

– Limited research training

– Little “hands-on” experience

– Much research isn’t directly

applicable to practice

why dont many clinicians do research - other sources

Other sources for assessment &

tx techniques:

• Conferences

• Therapy manuals

• Other SLPs

– Difficult to identify successful

techniques because of

modifications of published

techniques (cont. ed)

problems with research practices

Not all types of research are

equally helpful in solving

current practical problems

• Clinical usefulness is not the

only criterion by which the

value of research is

determined (BASIC)

Problems with research practices basic research

Basic research:

– Not immediate, but possibly future

significance

– Might help explain a phenomenon,

suggest new research, discover

applications, etc.

• Experimental-clinical research:

– Uses SM to solve immediate problems

Problems with research practices much researcher is

Much research is neither type:not just basic or experimental

– Description, not treatment

– Speculative theoretical writing e.g., proposing a model of how auditory memory supports language learning.

– Differences between normal &

disordered groups

• Clinical implications are not

always translated into procedures

we can actually use

DONT TEST TX directly

Problems with research practices we need more

 We need more research which is

experimental and clinical! Tx with Real Patients!

– Different clinically-relevant target

behaviors

– Treatment variables and effects

descriptive/experimental-clinical/theoretical

• Descriptive research = “What does it look like?” (e.g., describing normal speech development).

• Experimental-clinical research = “Can we change it?” (e.g., testing a treatment).

• Theoretical research = “Why does it happen?” or “How can we explain it?” (e.g., proposing models).

problems with research practices lack of tx related

Lack of treatment-related

research supports notion that

research & clinic are unrelated

• “waste of time”

• Research & clinical activities are

more similar than different….

Problems with research practices TX

Treatment: manipulating of cause-

effect relations

– Changes in behaviors by rearranging

certain variables

– To be accountable, changes must be

causally related

• Not the result of some other variables

– The essence of experimentation

Evaluation of Research

We must evaluate it to use it

• Same knowledge needed to do it:

• Meaningfulness of questions – Are the research questions important and relevant?

• Testability of hypotheses – Can the ideas be measured or tested?

• Appropriateness of the design – Is the study method suitable for answering the question?

• Validity & reliability of results – Are the results accurate, consistent, and trustworthy?

• Interpretation of results – Are the conclusions supported by the data?

• Clinical implications – Can the findings be applied in real-world treatment?

Evaluation of Research; we must evaluate it to use it

We must evaluate it to use it:

– Detection of “bad products”

– Must keep reading so you don’t miss

what is relevant for your practice

– “Middle-man” problem: the research-

clinic gap