As members of a college-regulated profession, speech-language pathologists must consider the best ways to practice, keeping scientific evidence and the individuality of their clients in mind. This is done through two main tenets of our practice: evidence-based practice, and client-centred practice.
In current healthcare practice, professionals often state the importance of “evidence-based practice”… but what is that? What does evidence-based mean, and why does it matter?
Given that speech-language pathology is a science-based discipline, like nursing or medicine, we need to ensure the methods we used are proven to be successful, otherwise we are just taking shots in the dark at how to help someone!
One definition of evidence-based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research. It is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology.” (Sackett D, 2002)
The use of evidence-based practice is always mixed with an understanding of who a client is – not every evidence-based strategy will work for every client, and sometimes, strategies which are equally effective may work better for one client than another. This is why we use client-centred practice along with evidence.
Client Centred Practice
Another key part of current practice is the importance of the individual client’s personality, lifestyle, culture, abilities, challenges, goals, and motivation level.
Client-centred practice means considering who the client is, and also involving the client in decision making around assessment and treatment. While the professional will guide the session, she does so based on what the client expresses as priorities. For example, two clients who stutter may both benefit from the same strategy, but one client might benefit more from being taught one strategy one week, and one the next; whereas another client might benefit more from being taught both strategies, and having two weeks to practice them. Another example would be three clients who want to work on voice volume; one might benefit more from developing insight into how loud she is, and auditory feedback; the other might benefit more from exercises designed to increase his confidence; the third may benefit most from increasing the power behind her voice.
The Intersection of Evidence-Based Practice and Client-Centred Practice
Because client-centred practice is important, a speech-language pathologist will ask questions about your individual history, work, leisure, family, goals, and will ask you about your areas of priority for therapy. Many clients will respond with, “well, you’re the expert, what makes the most sense?”
It is part of the role of the speech-language pathologist to keep in mind both the research and science which guides their lesson planning, and also consider how a given strategy will fit with a client’s individual needs. The speech-language pathologist will share information with the client so the client can decide. For example, the speech-language pathologist may say, “The evidence shows people benefit most from practicing a little bit of each goal every day, rather than all at once, the day before a session. But, if you are too busy to practice each day, given your busy work schedule and family life, perhaps you can find time to practice every-other day, or every second day.” It is the speech-language pathologist’s job to provide the client enough information to make informed decisions about their therapy plan, but not to provide so much information as to be overwhelming or confusing! It is also part of the speech-language pathologist’s role to advise clients when their decisions do not reflect evidence-based practice. For example, if a client says, “I don’t need to practice, I’ll just come in three times a week,” it is the speech-language pathologist’s role to share that the evidence has shown the best outcomes come from spacing out practice and therapy sessions, and that practice is key to achieving speech and language goals.
In summary, a speech-language pathologist will take the time to get to know you in order to choose the best of evidence-based strategies, and will encourage you to share your priorities using a client-centred approach in working toward your speech or language goals.
To speak with one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.