Very useful site which lists many of the s/lt interventions used with children as well as their evidence base..

[moondog]

or lack of.

What works

I applaud the profession for getting this up and running but in many ways it makes depressing reading as so much of what is standard practice has no evidence.

SULP, for example, a widely used social skills programme. Yet when compared to 'lego therapy' the lego therapy kids had better outcomes.

It may help many of you have the courage to ask searching questions of the professionals who work with your child and come to decisions about what is really useful and what is quite simply nothing more than a time filler.

[MareeyaDolores]

I think Lego therapy is actually very useful though. It's ABA

When done right, the Lego itself should be incidental, it's there as a powerful motivator and a useful shared interest. Which makes dc engage and then the communication and social skills practice is sneaked in. Like Annabel Karmel does with vegetables

[moondog]

I agree.
The point is however that what is the purpose of an expensively administered publically funded profession if it isn't evidence based and making a measurable difference?
I'd put a walk on a mountain way up above an hour in one of those ghastly 'sensory rooms' any day.

This applies to many professions of course.
I have a colleague who work in drug and alcohol counselling and cheerfully admits that he hasn't experienced one of the people he works with overcoming these issues.

There's a little anecdote in ABA circles about some alpha male types doing all sorts of fancy stuff to their yacht until eventually when yet another frippery is suggested, a voice pipes up with 'Yes, but will it make the boat go faster?'
Once you keep that in mind or rather its equivalent in your chosen profession, it's a remarkably effective litmus test and a way of stopping yourself getting involved in pointless schemes.

[MareeyaDolores]

Long term methadone has a fab evidence base, and other harm reduction strategies like needle exchange, injecting rooms etc have a fair bit. So... the government talks about abstinence programmes, and ear acupuncture is funded instead .

[moondog]

Mmmm.
A very well known researcher involved in the Food Dudes programme gave a memorable lecture once about his meeting with top bods at Dept. for Health and discussing the issue that for all their action, there was very little in terms of outcomes.

One of the mandarins told him quite clearly that the perception of being seen to be doing something was more important than the outcome. That is an attitude endemic in the Special Needs industry.
Busy, busy busy with SENCOs and OTs and School Action + CAMHS and OT and S/LT and so on and so forth.
To what end?

I think Food Dudes stuff would interest you, Maryeea.
I was initially a bit because I dislike anything that fetishizes or disguises food but knowing that this is a behaviourally based intervention devised by very respected academics, I checked out the evidence.
It's incredible.

[MareeyaDolores]

Oooh

[moondog]

Yes, it works dammit.
Every school in Ireland uses it.
They've even got it running in Italy.
The shame.

[MareeyaDolores]

Yep. Ireland (both bits) seems quite scientific when it comes to SEN. Like Wales . Look at this evidence-based alternative to brain-gym.

[MareeyaDolores]

You'll like this

[MareeyaDolores]

But then, you need to ask the right question in any trial.

Like the expensive RCT for 'do they sleep longer with melatonin? Result: yes, but only a tiny bit. Not a surprise to any parent who'd ever used it.

The really important questions of 'which subgroups of dc fall asleep fast with it' and 'how should you choose the dose' could have been worked into the primary end points. But they weren't.

[moondog]

Interesting. at Quackwatch moniker.

This is a good quote from the leading s/lt peer reviewed journal.


S/LT and EBP (quote from article in EJCD February 2011)

'Research evidence can only be constructed as a threat because it forces the scientist in us to engage, confronts lazy and easy practice, and demands each clinician brings thinking to the process. If we accept that science is a way of thinking more than it is a body of facts (Sagan
1996), research evidence can be seen as a facilitator enabling the profession to grow.

Embracing it indicates the profession?s commitment to best practice and keeps us bound to the scientific tradition. Plante (2004) argues that the increasing emphasis on evidence rather than intuition for guiding SLT practice signals disciplinary maturation. The use of non-scientific and pseudoscientific practices in our midst is surely sufficient reason to view research evidence as a valuable tool for a scientifically based profession. Ignoring the research literature keeps therapy, as Hubble et al. (1999) say ?trapped in a ?mythological world?.

[ilikemysleep]

This website (don't know how to embed in a sentence, sorry) does the same for literacy / dyslexia - summarises evidence and efficiacy. Toe by Toe does not too well, Phono-Graphix does well...

www.interventionsforliteracy.org.uk/

[MareeyaDolores]

Ilike
Why don't people ask themselves questions about effectiveness. It does my head in that staff are expected to plod through programmes that clearly aren't working at individual level. And then there's research about which programmes work best on a larger scale. And it's ignored

[MareeyaDolores]

Maybe not enough 'awkward squad' types go into teaching. Perhaps they need to co-opt some stroppier, less compliant allies.

[MareeyaDolores]

[moondog]

Join the queue ladies.

[ilikemysleep]

Mareeya

Why? I think because education doesn't have a great research tradition, because teachers are busy and like easy off the shelf things that don't take much time or effort to put into place, because people tend to 'like' things and be satisfied with them, because no one programme works for every kid...however I do think those things are reasons but don't really excuse it!

[moondog]

Its. unfair to expect teachers and indeed s/lts to teach/administer therapy as well as to expend lots of energy researching interventions. There just isn't the time (and neither are they trained to do so). It's also unfair. As my pedagogical hero, Vicki Snider points out, that would be like expecting a racing car driver to not only build but maintain his racing car. No! His job is to drive it. Others need to have built the car and keep it in tiptop condition.

Teachers and s/lts deserve access to easily accessible 'what work's data bases, so these things are a good start and a brave and honest admission that to date, we have very little idea about what really is effective in paediatric s/lt.

Assuming that s/lts and teachers have access to these interventions of course. The reality is also that you are limited by what is available in the department cupboard.

There are also various very simple ways of ensuring to some extent that you are examining the efficacy of a particular intervention with a child. Carry out baseline assessments for a start, then re-administer after intervention has finished. That's not a robust enough protocol (alone) to pass muster in a formal piece of research, yet it is acceptable in a clinical setting. The reality is, such a protocol is rarely carried out.

[inappropriatelyemployed]

"His job is to drive it.Others have to build the car..."

Well yes, but the racing car analogy doesn't really make sense in the case of people who demand to be respected for their skills and knowledge as health care professionals.

So, taking another analogy, I can, for example, see that a GPs job isn't to develop new drugs. However, patients have every right to expect the GP to know which drugs are available and what medicine is most appropriate for a given situation. In fact, GPs may well be negligent if they don't. This is why good doctors spend times reading journals and attending conferences. They have a professional responsibility to keep their skills up to date.

This is the same for many very busy professionals: lawyers, chemists, pharmacists, teachers, accountants etc. They all have busy case loads and all have professional responsibilities. I'm not sure why we should feel particularly sorry for SLTS or permit them latitude with children's treatment and excuse them pumping out guff because they're busy.

So, like zzz, I do expect SLTs to know which intervention may be effective based on evidence. I expect them to do a professional job and that is a very basic part of it.

[MareeyaDolores]

SLT were traditionally considered of less value than pharmacists and psychologists. They were considered a second-tier profession, without scientific rigour, and paid less because of this.

After a high-profile battle in which it was proven this argument was straightforward sex discrimination, they won pay parity. So... a bit of an excuse for teachers. But no longer any excuse for SLT...

[MareeyaDolores]

(although in fairness, NHS psychotherapists are also in the early stages of building an evidence base...)

[MareeyaDolores]

Maybe we should start by challenging those staff with relevant degrees... initially science and psychology teachers. We could begin in secondary level, and work backwards till primary has caught up