Evidence
Medicine has a current and robust evidence
base (Sacket, Rosenberg, Gray, Haynes and Richardson, 1996) to
draw upon in the responsible implementation of the planned use of
humour and in funding further research in the
area.
In speech pathology, as in medicine, evidence-based practice
(EBP)
relies upon strong, contemporary treatment
efficacy findings as the
basis for "best practice" in the clinical management of each
client.
An efficacious procedure must provide a
benefit to a target population under ideal circumstances, as in a
strictly controlled laboratory research project. On the other hand, a
procedure may be deemed effective if the client group benefits from
the procedure under average or typical conditions.
Best practice
Practice guidelines arise from the
systematic review of efficacy research in a particular topic area
(e.g., developmental apraxia of speech, AAC, dysphagia). But best
practice is an optimal and reasonably achievable "typical
conditions" process that does not aspire to an idealised
"efficacy study" standard. It is recognised by professional
peers in comparable settings, is applicable across a typical range of
settings in terms of size and resources, and it takes account of
ethical, legal and moral responsibilities and
requirements.
Best practice
guidelines are designed to aid clinicians in addressing issues around screening, diagnosis and intervention.
When they work well, the guidelines permit clinician and client to be
involved in decision making that is systematic, logical, transparent, defensible,
practical, feasible, respectful, and understandable.
Outcome Measures
Outcome Measures (Enderby, 1997; Frattali,
1998) such as the Australian Therapy Outcome Measures (AusTOMs),
and its UK and US predecessors the Therapy Outcome Measures (TOMS)
and National Outcome Measures (NOMS)
provide a practical and efficient means of reporting, to a central
authority, the outcomes of best
practice in action. These are real-world figures based on what clients
and clinicians are accomplishing in typical treatment and
instructional settings.
For Australian
speech-language pathologists, the
benefits of having these figures will slowly emerge, promising to be
wide-ranging and concrete.
First and foremost they
have the potential to improve the quality of client care, enabling
more accurate estimates of desirable length and intensity of treatment
and type of treatment, and prognosis. They will enable the development
of national benchmarks, guide labour force decisions, provide
quantifiable data to back up marketing and research proposals,
facilitate grant applications, and inform social policy.
And they might even raise
the community profile of speech-language pathologists and all the
things we REALLY do! And maybe, just maybe, they will encourage
governments to send substantially more of the nation's wealth towards
people with communication impairments. Now that would make you laugh
out loud: reducing stress, improving your mood, geeing
up your immune system... what an outcome THAT would be!
