Evidence-Based Practice: Integrating Research, Professional and Family Wisdom & Values Evidence-Based Practice: Integrating Research, Professional and Family Wisdom & Values Pam Winton & Sally Sloop Inclusion Institute August 2007 Chapel Hill, NC

Welcome and Introductions

Learner Outcomes Identify definition and key features of EBP Identify definition and key features of EBP Identify resources for identifying research-based practices that support inclusion Identify resources for identifying research-based practices that support inclusion Apply evidence-based practice framework to real life vignette Apply evidence-based practice framework to real life vignette

What is the main source of knowledge guiding your practice?

Sources of Knowledge Research Research Wisdom & experience Wisdom & experience Core values Core values Other? Other?

What is your definition of evidence-based practice?

Evidence-Based Practice (EBP) a decision-making process that integrates the best available research evidence with family & professional wisdom & values a decision-making process that integrates the best available research evidence with family & professional wisdom & values (Buysse & Wesley, 2006; Snyder, 2006; Winton, 2006)

Why did EBP Emerge? Evidence-based medicine Evidence-based medicine

Evidence-Based Medicine The integration of the best available research evidence with clinical expertise and patient values. (Sackett et al., 2000)

Why did EBP Emerge? Evidence-based medicine Evidence-based medicine Gap between research & practice Gap between research & practice

Why don’t practitioners do what the research says? Why don’t researchers study what really matters in practice?

Why did EBP Emerge? Evidence-based medicine Evidence-based medicine Gap between research & practice Gap between research & practice Accountability & standards movement Accountability & standards movement

How the Accountability Movement Led to EBP Government Performance & Results Act (1993) Government Performance & Results Act (1993) –Program Assessment Rating Tool (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)

Evidence-Based Education (Whitehurst, 2002) Integration of professional wisdom with the best available empirical evidence in making decisions about how to deliver instruction Whitehurst, G. J. (2002, October). Evidence-based education. Presentation at the Student Achievement and School Accountability Conference. Retrieved June 23, 2004 from

Evidence-Based Practice Integration of Integration of –Best-available research evidence –Professional & family wisdom and values For the purpose of making informed decisions For the purpose of making informed decisions Emphasize decision-making process Emphasize decision-making process (Buysse & Wesley, 2006)

Questions about EBP Definition?

Meet Tess…a success story 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 Process Adapted from Evidence-Based Medicine 1. Pose an answerable question.

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

Consider a 5-step Process Adapted from Evidence-Based Medicine 1. Pose an answerable question. 2. Find best available research evidence. (Where?)

Where are resources for scientifically based practices? “… Scientifically based research means research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs” (No Child Left Behind Act of 2001)

Center for Early Literacy Learning

Consider a 5-step Process Adapted from Evidence-Based Medicine 1. Pose an answerable question. 2. Find best available research evidence. (Where?) 3. Appraise evidence quality & relevance. (Who? How?)

Appraising the Research Transparency (e.g., how were conclusions reached) Transparency (e.g., how were conclusions reached) Relevance (e.g., how similar is your target child or group to the group described in the synthesis) Relevance (e.g., how similar is your target child or group to the group described in the synthesis) Quality (e.g., are sources used in the synthesis referenced) Quality (e.g., are sources used in the synthesis referenced)

Consider a 5-step Process Adapted from Evidence-Based Medicine 1. Pose an answerable question. 2. Find best available research evidence. (Where?) 3. Appraise evidence quality & relevance. (Who? How?) 4. Integrate the research evidence with professional and family wisdom & values. (How?)

What Constitutes Professional Wisdom? NAEYC National Boards for Professional Teaching Standards for early childhood/generalist (NBPTS) State Standards & Licensure Practice Guidelines from Professional Organizations?

What constitutes family wisdom? Explore at the Beach Center Community of Practice on Early Childhood Family Support Explore at the Beach Center Community of Practice on Early Childhood Family Support

What are the values of our field that guide practice decisions? Consider… Professional Codes of Ethics Professional Codes of Ethics Philosophical orientations, such as family-centered practices, inclusion Philosophical orientations, such as family-centered practices, inclusion Other Other

What about personal values? Recent survey indicated that many physicians do not feel obligated to share information or refer patients for legal but morally controversial procedures Recent survey indicated that many physicians do not feel obligated to share information or refer patients for legal but morally controversial procedures (Curlin et al, 2007, New England Journal of Medicine) (Curlin et al, 2007, New England Journal of Medicine)

Consider a 5-step Process Adapted from Evidence-Based Medicine 1. Pose an answerable question. 2. Find best available research evidence. (Where?) 3. Appraise evidence quality & relevance. (Who? How?) 4. Integrate the research evidence with professional and family wisdom & values. (How?) 5. Evaluate effectiveness of steps 1-4 (How?)

Small Group Activity Using EBP Framework

Directions Read the vignette (pink) Read the vignette (pink) Read CELLnotes handout (cream) Read CELLnotes handout (cream) Use the EBP Framework and 5-step process for guiding the discussion and making a recommendation (lavendar) Use the EBP Framework and 5-step process for guiding the discussion and making a recommendation (lavendar)

EBP Decision-Making Framework

Steps in Building a Research Question (PICO adapted from EB Medicine ) P: Characterize the person (child or family member) P: Characterize the person (child or family member) I: What is the intervention being considered? I: What is the intervention being considered? C: What are you comparing the intervention to (if relevant) C: What are you comparing the intervention to (if relevant) O: What is the outcome you are seeking? O: What is the outcome you are seeking?

Small Group Activity Using EBP Framework

Ultimate outcome… Success Story continues….

Factors that contributed to decision-making …. Context within which evidence is placed Context within which evidence is placed Process for facilitating decision- making Process for facilitating decision- making Nature of the evidence itself Nature 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 make a positive impact on the quality of educational practices?

Eminence-Based Practice Making the same mistakes with increasing confidence over an impressive number of years. —O’Donnell, 1997, A Skeptic’s Medical Dictionary

Wrap Up Remaining questions? Remaining questions? Quick write: Quick write: –Take 3 minutes to write a “quick” response to the questions: –“How has your thinking about EBP evolved over this session?” Evaluation Evaluation Thanks! Thanks!

Contact Information Pam Winton FPG Child Development Institute University of North Carolina at Chapel Hill Sally Sloop Family Support Network of NC University of North Carolina at Chapel Hill

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