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Implications of evidence-based practice for selecting targets in phonological intervention Angela Ullrich(1), Roswitha Romonath(1), Barbara Bernhardt(2) (1) University of Cologne, Germany (2) University of British Columbia, Canada Quality management is an ever-increasing requirement for health care professions, including speech-language pathology. Within the framework of quality management, evidence-based practice offers an opportunity for clinicians to change their perspective and organize, structure and reflect the intervention process. Evidence- based pratice claims ,,the conscientous, explicit and judicious use of current best evidence in making decisions about the care of individual patients" (Sackett et al., 1996, British Medical Journal 312, 71-72.). In treating children with phonological impairment, the clinician is faced with the challenge of selecting assessment tools and treatment methods that show evidence of efficacy and at the same meet the individual client's needs in applying their clinical expertise. Selecting therapy goals is the crucial connection between the assessment and therapy process and needs special considerations. Thus, it is important to investigate not only the evidence base of assessment tools and therapy programmes, but also the criteria on which clinicians base or should base their decisions when selecting therapy goals for children with phonological disorders. Gierut (2005), after comparing different phonological intervention approaches, comes to the conclusion that no treatment approach has proven to be better than another in terms of efficacy. Gierut's findings imply that goal selection may be more important than the actual treatment approach chosen. The following paper presents a proposal for a theoretically derived set of ideal criteria within an evidence-based framework for goal-setting in phonological intervention. First of all, goal selection is based on the outcomes of a phonological assessment. From the many tools available, currently a constraint-based nonlinear assessment offers the most detailed description of the child's phonological system. Within a nonlinear framework, phonological strengths and needs (as determined by negative constraints) are identified within and between the different levels of the phonological hierachy: the phrase, the word, the foot, the syllable, subsyllabic units such as onset, rime or stress-attracting units (moras), segments (phonemes) and hierarchically organized features. Other information about the child is then taken into account in order to determine the ultimate target selection and type of intervention plan (Bernhardt 2005). Before an intervention plan can be constructed, other factors about the child have to be taken into account in order to integrate the different components of evidence-based practice, i.e., cognitive and linguistic abilities, personal factors (including oral mechanism, perceptual and social factors) and a child's environment. A major delay in other lingusitic domains and/or other aspects of cognitiion may slow down the pace of the intervention process and thus, a more protracted plan may need to be constructed, with multiple opportunities for recycling targets and practice. Morphological and syntactic goals, for example may need to be worked into an intervention plan. Personal (including perceptual, oral mechanism) and social factors are another crucial criterion for selecting targets in the individual client. Here the International Classification of Functioning, Disability and Health (WHO 2001), with its emphasis on the whole person in his or her unique environment, is a helpful tool for demonstrating the impact of personal and contextual factors that might indicate strategies to enhance success in intervention. When all of the information is taken together, clinicans then have to de-

cide whether or when to adopt a developmental perspective, targeting segments and word structures according to the normal acquisition process, or one based on markedness, targeting more complex, marked units in order to facilitate generalization across other phonological forms. During the intervention process, targets addressed will change, based on the individual evidence of the child, i.e., success or lack thereof on the original targets. The current paper will focus on the factors mentioned above in order to describe a comprehensive decison-making framework for phonological intervention planning. The ideal set of criteria will be compared in terms of similarities and differences with observations on criteria currently in use by speech and language pathologists. The paper concludes with an outlook on future studies in clinical research regarding evidence-based management of the clinical decision-making process, under special considerations for goal-setting. Implications for student training and continuing education will also be suggested. References Bernhardt, B. (2005). Selection of phonological goals and targets: not just an exercise in phonological analysis. In: Phonological Disorders in Children. Clinical Decision Making in Assessment and Intervention. Baltimore: Paul H. Brookes , pp. 109-120. Gierut (2005). The how or the what? In: Phonological Disorders in Children. Clinical Decision Making in Assessment and Intervention. Baltimore: Paul H. Brookes , pp. 109-120. Sackett, DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312:71-72. WHO (2001). ICF: International Classification of Functioning, Disability and Health Geneva: WHO, 2001.


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