Abstract
This chapter reviews the limitations of the evidence-based practice (EBP) framework adopted by American Speech Language Hearing Association for the field of speech, language, and hearing sciences (SLHS) in addressing systemic racism. The authors argue that a shift from a medically-based EBP model to a pluralistic EBP model would better serve the needs of black, indigenous, people of color (BIPOC) with communication impairments in the current sociopolitical landscape. The authors examine the three pillars of EBP through the lens of social justice work. They describe how the current EBP model limits the development of social justice work in SLHS. They describe the need to refine the EBP model by validating the contribution of qualitative research as scientific evidence, reevaluating the basis of clinical expertise in client-clinician cultural mismatch, and address the importance of integrating policy and culture in consideration of client and family preferences. These transformations are critical in light of the under-representation of BIPOC clinicians in the field of SLHS profession.
TopIntroduction
Evidence-Based Practice (EBP) in Speech, Language, and Hearing Sciences (SLHS) refers to a clinical decision making perspective, adopted from evidence-based medicine, which has been endorsed as a primary guiding principle to enhance the quality of clinical services (ASHA, 2004). This three pillar model is described as “…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients…[by] integrating the best available evidence, clinical expertise, and patients’ values and preferences” (Sackett, et al. 1996, as cited in ASHA, 2004, p. 1). In order to meet the demands of insurance companies and government agencies to ensure treatment efficacy and reduce reliance on “intuition” in practice, this three-pillar EBP model was adopted for financial and political reasons (Hazel, et al., 2019). This model sought to address the tendency of certified clinicians to rely on their own opinions in clinical decision-making (ASHA, 2004). Following the adoption of this model of EBP, several critiques came to light. Some of these critiques pointed to the model’s inability to evaluate the effects of therapies, therapists, or some combination of both on treatment outcomes (e.g. Ratner, 2006). Challenges were noted in integrating the scientific evidence with clinical practice (e.g. McCabe & Usher, 2018; Olswang & Prelock, 2015; Plante, 2004). Although there was a focus on evaluating external scientific evidence according to levels of evidence (Dollaghan, 2007), the model did not address the varying quality of work within the same level of evidence (e.g. Nelson & Gilbett, 2020).
Key Terms in this Chapter
Qualitative Research: Systematic research approaches that are based on nonnumeric data collection and analysis procedures. Qualitative research is typically based on inductive reasoning and conducted in the natural environment of the population under study.
External Scientific Evidence: Evidence published in the form peer-reviewed research or consensus statements from stakeholders.
Evidence-Based Practice (EBP): Clinical decisions that are based on the integration of best available scientific evidence, clinical expertise, and client preferences.
Clinical Expertise: Clinical knowledge and decision-making skills developed through self-reflection, experience, and lifelong learning.
Client/Family Preferences: Clinical decisions that acknowledge individual interests of clients and social norms.
Systemic Racism: Racial inequities embedded within policies, procedures, and rules across different organizations that are normalized by society.
Social Justice Work: Professional engagement that dismantles any form of inequity between groups of people.