2007 EHDI Conference1 New York State Department of Health Bureau of Early Intervention Clinical Practice Guidelines

2007 EHDI Conference2 What are the Clinical Practice Guidelines (CPGs)? How was the evidence base used in the development of the CPGs? What is the structure/content of the CPGs? How can the CPGs be used? How can copies of the CPGs be obtained?

2007 EHDI Conference3 What are the Clinical Practice Guidelines?

2007 EHDI Conference4 Purpose of the Guidelines To provide parents, clinicians and others with recommendations based on the best scientific evidence available about best practices for assessment and intervention for young children with developmental delays and disabilities.

2007 EHDI Conference5 Promote Research Improve Knowledge Facilitate Program Evaluation/ Quality Improvement Efforts Enhance Communication Specific Objectives

2007 EHDI Conference6 Where Do We Find Answers? Families? Service Providers (Therapist)? Early Interventio n Officials? From: Texts, teachers, journals, mentors, consultants, conferences, Internet, i.e., from credible sources The child Clinical practice guidelines

2007 EHDI Conference7 Methodology The methodology for these guidelines was established by the: Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR) ( Support the use of clinical opinion in the form of panel consensus opinion.

2007 EHDI Conference8 Guideline Development Panel The panel consisted of: Specialists/Topic Experts -multiple disciplines Generalists/Parents

2007 EHDI Conference9 Contributions of Panel Members Specialists/Topic Experts Know the topic well Can identify important current issues and recent research Explain complex issues Identify current controversies in the field Have decisive and well-developed opinions Add credibility to process/product

2007 EHDI Conference10 Contributions of Panel Members Generalists/Parents (end users) Know the needs Are open-minded Demand clarity/simplicity Evaluate usability Preserve the individualizing element

2007 EHDI Conference11 Multidisciplinary Panel Advantages: –Supports whole child –Lends greater credibility and impact –Facilitates compromise –Facilitates consideration of a broader range of approaches –Discourages development of independent, possibly conflicting, guidelines Disadvantages: –Can require longer process/more time in development –Diverse perspectives may cause conflict –Can be difficult reaching consensus –Compromises can lead to vagueness

2007 EHDI Conference12 How Was the Evidence Base Used in the Development of the Guidelines?

2007 EHDI Conference13 Why Evidence-Based? How do evidence-based guidelines benefit children and families? They provide the best opportunity for favorable outcomes. They better estimate potential benefits and harms. They promote informed decision making.

2007 EHDI Conference14 Why Evidence-Based? How do evidence-based guidelines benefit the field? Research base provides credibility. Development process helps to organize the available research information. State of the evidence regarding costs vs. benefits and harms is illuminated. Needed areas of research are identified.

2007 EHDI Conference15 Applicability of the Evidence Subject characteristics Settings Outcomes Special situations (clinical conditions, social settings) - primary focus for guideline - dealt with in a limited way - outside scope of the guideline

2007 EHDI Conference16 Criteria for Evidence on Efficacy Studies of assessments use reference standards to measure efficacy Studies of assessments use measures of sensitivity and specificity to make judgments about efficacy Studies of interventions use outcome measures to measure efficacy

2007 EHDI Conference17 Limitations of Evidence-Based Promising interventions can lack scientific evidence. Standards of evidence focus on quantitative rather than qualitative evidence (the medical model). Anecdotal evidence is downplayed. Use of only higher quality studies can limit the available pool of research.

2007 EHDI Conference18 Transforming the Evidence Amount and quality of evidence for efficacy Magnitude of effect found for the method Consistency of findings between studies Clinical applicability Attention to harms and costs

2007 EHDI Conference19 Limitations of Evidence-Based How can these limitations be addressed? These interventions can still be provided. -Parents and professionals can make informed decisions. Guidelines can promote research on promising new approaches. Use of panel consensus.

2007 EHDI Conference20 Types of Guideline Statements Recommendation for use Evidence shows method has efficacy Potential benefits outweigh potential harms and costs Recommendation against use Evidence shows method has no efficacy Potential harms or costs outweigh potential benefits Insufficient evidence to make a judgment

2007 EHDI Conference21 Strength of Evidence Ratings A = Strong research-based evidence B = Moderate research-based evidence C = Limited research-based evidence D = Panel consensus opinion D1 = research did not meet the criteria for adequate evidence D2 = literature search not done

2007 EHDI Conference22 What is the Structure/Content of the Guideline Series?

2007 EHDI Conference23 Guideline Versions Most of the guideline topic comes in five versions: Guideline Technical Report Report of the Recommendations Quick Reference Guide Evidence Tables Compact Disc (includes all of the above)

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2007 EHDI Conference25 Organization of Guidelines Table of Contents I.Introduction II.Background Information III.Report of the Research* IV.Assessment V.Intervention VI.Appendices *Note: The placement of this information in the Technical Report varies depending on the guideline topic

2007 EHDI Conference26 Hearing Loss Overview Operational definitions Considerations Early identification Recommended assessments General approach to interventions Communication interventions Amplification devices Medical & surgical interventions

2007 EHDI Conference27 How Can the Guidelines be Used?

2007 EHDI Conference28 Tool for the Individual Level How can the guidelines be used at the individual level? Clarify, validate an initial concern Structure evaluations Select effective interventions Monitor progress of child/family outcomes Promote informed decision making Identify and get help with associated conditions Support fuller participation of all team members

2007 EHDI Conference29 Tool for the Community Level How can the guidelines be used at the community or systems level? Enhance and refine child find efforts Assess current practices Identify ways to improve quality Identify gaps in services Target capacity-building efforts

2007 EHDI Conference30 What They Are Not Guidelines Are Not Regulations! Guidelines offer practice recommendations – they are not required practice standards. Guidelines are not regulatory. Guidelines are designed to be used in the context of program regulations and policies. Guidelines should not limit the tailoring of care to the individual.

2007 EHDI Conference31 Implementation What is implementation? Ensuring access to the guidelines Using the guidelines to promote effective practices Monitoring guideline use Who are the stakeholders? NYS Department of Health Early Intervention Officials/Counties Service Providers Families Primary Referral Sources Researchers Local EI Councils

2007 EHDI Conference32 How Can Copies of the Guidelines Be Obtained?

2007 EHDI Conference33 To Obtain Copies Communication Disorders Autism/Pervasive Developmental Disabilities Down Syndrome Motor Disorders Hearing Loss Vision Impairment (due Summer 2007) Contact: NYS Department of Health, Box 2000, Albany, NY Fax: (518) Or Visit: early_intervention/index.htm

2007 EHDI Conference34 Bibliography Noyes-Grosser, D.M., Holland, J.P., Lyons, D., Holland, C.L., Romanczyk, R.G., Gillis, J.M. (2005). Rationale and Methodology for Developing Guidelines for Early Intervention Services for Young Children with Developmental Disabilities. Infants and Young Children, 18(2), New York State Department of Health. (1999). The Guideline Technical Report – Autism/Pervasive Developmental Disorders: Assessment and Intervention for Young Children (age 0-3 years). New York: Author. New York State Department of Health. (1999). The Guideline Technical Report – Motor Disorders: Assessment and Intervention for Young Children (age 0-3 years). New York: Author. *To excerpt from any of the Clinical Practice Guidelines, you must obtain permission from the New York State Department of Health. You can write to:

2007 EHDI Conference35 Thank You!