Evidence-Based Practice: Integrating Research, Professional and Family Wisdom & Values

Evidence-Based Practice: Evidence-Based Practice: Integrating Research, Professional and Integrating Research, Professional and

Family Wisdom & ValuesFamily Wisdom & Values

Pam Winton & Sally SloopPam Winton & Sally Sloop

Inclusion InstituteInclusion InstituteAugust 2007August 2007Chapel Hill, NCChapel Hill, NC

Welcome and IntroductionsWelcome and Introductions

Learner OutcomesLearner Outcomes

Identify definition and key features Identify definition and key features of EBP of EBP

Identify resources for identifying Identify resources for identifying research-based practices that research-based practices that support inclusionsupport inclusion

Apply evidence-based practice Apply evidence-based practice framework to real life vignetteframework to real life vignette

What is the What is the main source main source

of knowledge of knowledge guiding your guiding your

practice?practice?

Sources of Sources of KnowledgeKnowledge

ResearchResearch Wisdom & experience Wisdom & experience Core valuesCore values Other?Other?

What is your What is your definition of definition of

evidence-based evidence-based practice?practice?

Evidence-Based Evidence-Based Practice (EBP)Practice (EBP) a decision-making process a decision-making process

that integrates the best that integrates the best available research available research evidence with family & evidence with family & professional wisdom & professional wisdom & valuesvalues(Buysse & Wesley, 2006; Snyder, 2006; Winton, 2006)(Buysse & Wesley, 2006; Snyder, 2006; Winton, 2006)

Why did EBP Emerge?Why did EBP Emerge?

Evidence-based medicineEvidence-based medicine

Evidence-Based Evidence-Based MedicineMedicine

The integration of the The integration of the best available research best available research evidence with clinical evidence with clinical expertise and patient expertise and patient values.values.

(Sackett et al., 2000)(Sackett et al., 2000)


Evidence-based Evidence-based medicinemedicine

Gap between research Gap between research & practice& practice

Why don’t practitioners Why don’t practitioners do what the research do what the research

says?says?

Why don’t researchers Why don’t researchers study what really matters study what really matters

in practice?in practice?


Evidence-based medicineEvidence-based medicine

Gap between research & Gap between research & practicepractice

Accountability & Accountability & standards movementstandards movement

How the Accountability How the Accountability Movement Led to EBPMovement Led to EBP

Government Performance & Results Act Government Performance & Results Act (1993)(1993)– Program Assessment Rating ToolProgram Assessment Rating Tool (2002) (2002)

Head Start Act (1998)Head Start Act (1998) No child Left Behind Act (2001)No child Left Behind Act (2001)

– Good Start, Grow Smart (2002)Good Start, Grow Smart (2002)

Evidence-Based Evidence-Based EducationEducation (Whitehurst, 2002)(Whitehurst, 2002)

Integration of professional wisdom with the Integration of professional wisdom with the best available empirical evidence in best available empirical evidence in

making decisions about how to deliver making decisions about how to deliver instructioninstruction

Whitehurst, G. J. (2002, October). Whitehurst, G. J. (2002, October). Evidence-based educationEvidence-based education. . Presentation at the Student Achievement and School Presentation at the Student Achievement and School Accountability Conference. Retrieved June 23, 2004 from Accountability Conference. Retrieved June 23, 2004 from www.ed.gov/offices/list/ies/director.htmlwww.ed.gov/offices/list/ies/director.html

Evidence-Based PracticeEvidence-Based Practice

Integration of Integration of – Best-available research evidenceBest-available research evidence– Professional & family wisdom and valuesProfessional & family wisdom and values

For the purpose of making For the purpose of making informed decisionsinformed decisions

Emphasize Emphasize decision-making decision-making processprocess

(Buysse & Wesley, 2006)(Buysse & Wesley, 2006)

Questions about EBP Questions about EBP Definition?Definition?

Meet Tess…a success Meet Tess…a success story in inclusionstory in inclusion

•Three-year-old with special needs

•Enrolled in inclusive preschool

•Teacher is working on language and literacy IEP goals during circle time, using a read-aloud storybook process

•Tess has difficulties paying attention and learning during circle time

•Tess’ mother and teacher want to solve this dilemma

Consider a 5-step Consider a 5-step Process Process Adapted from Adapted from Evidence-Based MedicineEvidence-Based Medicine

1.1. Pose an answerable question.Pose an answerable question.

Practice DilemmaPractice Dilemma

How to make the reading How to make the reading instruction taking place instruction taking place during circle time more during circle time more effective for Tess and effective for Tess and supportive of her IEP literacy supportive of her IEP literacy and language goals.and language goals.



2.2. Find best available research Find best available research evidence. evidence. ((Where?)Where?)

Where are resources for Where are resources for scientifically based scientifically based practices?practices?

“… “… Scientifically based researchScientifically based research means research that involves the means research that involves the application of rigorous, systematic, application of rigorous, systematic, and objective procedures to obtain and objective procedures to obtain reliable and valid knowledge reliable and valid knowledge relevant to education activities and relevant to education activities and programs”programs”

(No Child Left Behind Act of 2001)(No Child Left Behind Act of 2001)

http://http://www.whatworks.ed.govwww.whatworks.ed.gov

Center for Early Literacy Center for Early Literacy Learning Learning http://www.earlyliteracylearning.orghttp://www.earlyliteracylearning.org//



2.2. Find best available research Find best available research evidence. evidence. ((Where?)Where?)

3.3. Appraise evidence quality & Appraise evidence quality & relevance. relevance. (Who? How?)(Who? How?)

Appraising the Appraising the ResearchResearch TransparencyTransparency (e.g., how were (e.g., how were

conclusions reached)conclusions reached) RelevanceRelevance (e.g., how similar is (e.g., how similar is

youryour target child or group to the target child or group to the group described in the synthesis)group described in the synthesis)

QualityQuality (e.g., are sources used in (e.g., are sources used in the synthesis referenced) the synthesis referenced)


1.1. Pose an answerable question.Pose an answerable question.2.2. Find best available research evidence. Find best available research evidence.

((Where?)Where?)3.3. Appraise evidence quality & relevance. Appraise evidence quality & relevance.

(Who? How?)(Who? How?)4.4. Integrate the research evidence with Integrate the research evidence with

professional and family wisdom & values. professional and family wisdom & values. (How?)(How?)

What Constitutes Professional What Constitutes Professional Wisdom? Wisdom?

NAEYC NAEYC

National Boards for Professional Teaching Standards for early childhood/generalist (NBPTS)

State Standards & Licensure

Practice Guidelines from Professional Practice Guidelines from Professional Organizations?Organizations?

What constitutes What constitutes family wisdom?family wisdom? Explore at the Beach Center Explore at the Beach Center

Community of Practice on Early Community of Practice on Early Childhood Family SupportChildhood Family Support

What are the values of our What are the values of our field that guide practice field that guide practice decisions?decisions?

Consider…Consider… Professional Codes of EthicsProfessional Codes of Ethics Philosophical orientations, such as Philosophical orientations, such as

family-centered practices, family-centered practices, inclusioninclusion

OtherOther

What about personal What about personal values? values? Recent survey indicated that Recent survey indicated that

many physicians do not feel many physicians do not feel obligated to share information or obligated to share information or refer patients for legal but refer patients for legal but morally controversial proceduresmorally controversial procedures

(Curlin et al, 2007, New England Journal (Curlin et al, 2007, New England Journal of Medicine)of Medicine)


1.1. Pose an answerable question.Pose an answerable question.2.2. Find best available research evidence. Find best available research evidence. ((Where?)Where?)3.3. Appraise evidence quality & relevance. Appraise evidence quality & relevance. (Who? (Who?

How?)How?)4.4. Integrate the research evidence with Integrate the research evidence with

professional and family wisdom & values. professional and family wisdom & values. (How?)(How?)

5.5. Evaluate effectiveness of steps 1-4 Evaluate effectiveness of steps 1-4 (How?)(How?)

Small Group Activity Small Group Activity Using EBP FrameworkUsing EBP Framework

DirectionsDirections

Read the vignette (pink)Read the vignette (pink) Read CELLnotes handout (cream)Read CELLnotes handout (cream) Use the EBP Framework and 5-Use the EBP Framework and 5-

step process for guiding the step process for guiding the discussion and making a discussion and making a recommendation (lavendar)recommendation (lavendar)

EBP Decision-Making EBP Decision-Making FrameworkFramework

Steps in Steps in Building a Research Question Building a Research Question

(PICO (PICO adapted from EB Medicineadapted from EB Medicine)) P: Characterize the P: Characterize the personperson (child (child

or family member)or family member) I: What is the I: What is the interventionintervention being being

considered?considered? C: What are you C: What are you comparingcomparing the the

intervention to (if relevant)intervention to (if relevant) O: What is the O: What is the outcome outcome you are you are

seeking?seeking?

Small Group Activity Small Group Activity Using EBP FrameworkUsing EBP Framework

Ultimate outcome…Ultimate outcome…Success Story continues….Success Story continues….

Factors that Factors that contributed to contributed to decision-making ….decision-making …. ContextContext within which evidence within which evidence

is placedis placed ProcessProcess for facilitating decision- for facilitating decision-

makingmaking NatureNature of the evidence itself of the evidence itself

Available from Winterberry Press as a CD-ROM or downloadable file.

Go to Winterberry Press website at wbpress.com and enter “Weaving” in the Search box (or go to page 2 of the Parenting category)

Price: $19.95 plus S&H for CD-ROM (no S&H if downloaded)

Will the EBP movement Will the EBP movement make a positive impact make a positive impact on the quality of on the quality of educational practices?educational practices?

Eminence-Based Eminence-Based PracticePractice

Making the same mistakes with Making the same mistakes with increasing confidence over an increasing confidence over an impressive number of years.impressive number of years.

——O’Donnell, 1997, O’Donnell, 1997, A Skeptic’s Medical DictionaryA Skeptic’s Medical Dictionary

Wrap UpWrap Up

Remaining questions?Remaining questions? Quick write:Quick write:

– Take 3 minutes to write a “quick” response to the Take 3 minutes to write a “quick” response to the questions:questions:

– ““How has your thinking about EBP evolved over How has your thinking about EBP evolved over this session?”this session?”

EvaluationEvaluation Thanks!Thanks!

Contact Information Contact Information

Pam WintonPam WintonFPG Child Development InstituteFPG Child Development InstituteUniversity of North Carolina at Chapel HillUniversity of North Carolina at Chapel [email protected][email protected]

Sally SloopSally SloopFamily Support Network of NCFamily Support Network of NCUniversity of North Carolina at Chapel HillUniversity of North Carolina at Chapel [email protected][email protected]

Bridging the gap between what we know and what we do for the benefit of children and families

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Evidence-Based Practice: Integrating Research, Professional and Family Wisdom & Values