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Best Practices: Standing on the Shoulders of Giants?
Ronnie Detrich
Wing Institute
Characteristics of Best Practice Guidelines
• Validated evidence-based interventions inform practitioners about which interventions to use.Very specific set of statements about a specific
intervention.
• Best practice guidelines provide broader set of statements about practice.More comprehensive/prescriptive statements than
validated interventions.
Characteristics of Best Practice Guidelines
• Practice guidelines often reflect:Diverse conceptual viewsClinical experienceRecommendations based on weak or non-existent
evidence when a clinician needs to act.
• Practice guidelines are explicitly intended to draw on treatment evidence.
Kazdin, 2000
Function of Best Practice Guidelines
• What Works Clearinghouse (WWC): “bring the best available evidence and expertise to bear on the types of systemic challenges that cannot currently be addressed by single interventions or programs.”
Function of Best Practice Guidelines
• Romanczyk (2008): “intended to inform consumers and service providers about optimal care guidelines as compared to generally accepted practice for conditions or disorders.”Guidelines set a higher standard for care.Many groups purport to having BP guidelines but
they fail to follow accepted methodology for evaluating treatments.
How Best Practices Guidelines are Developed
At least three approaches:1. Individual experts develop guidelines.
Expert Opinion.
2. Group of experts develop. Represents consensus opinion. Draws on the experience of experts.
3. Systematic review of literature: Experts base recommendations on results of
systematic review and expand to more general guidelines for practice.
The “gold standard” for Best Practice Guidelines.
Method: Individual Experts
• Chapters written by single or few authors about comprehensive range of topics in traditional literature review format. Lack of transparency
regarding: Process for selecting
practices. Process for selecting
experts.
How Group Consensus Best Practices Guidelines are Developed
• How the expert panel is developed is important.
If panel is drawn too broadly there is risk of not reaching agreement about:
What is best practice?Which research base to consider?How to decide what constitutes best practice?
How Group Consensus Best Practices are Developed
If expert panel drawn too narrowly:Panel may not be seen as credible.Research base is too narrow and represents only
small range of relevant research.Recommendations may not have high social validity
with larger audience.
Method: Group Consensus
• Large group of “experts.”
• Best practices represent consensus agreement.
• Some effective practices were left out because we could not gain consensus.
Method: Systematic ReviewGold Standard
• U.S Institute of Medicine:Guidelines are based on systematic reviews of the
literature.Expert panel develops broad recommendations
along with the strength of evidence for each recommendation.Process used by New York State Department of Health
Early Intervention: Clinical practice guidelines (1999).National Research Council: Educating Children with
Autism (2001).
Systematic Review Approach
• Applied WWC Evidence standards to review RtI and reading literature.
• Experts developed guidelines for implementing in schools.
• Offers transparency for basis of recommendations.
QuickTime™ and a decompressor
are needed to see this picture.
Strengths and Limitations of Best Practice Guidelines
Strengths• Bridges the research to
practice gap.• Adds details to
validated evidence-based practices.
• Provides guidance in absence of validated interventions.
Limitations• Recommendations are
generally broad.• Only as good as the
process for developing the recommendations. The “gold standard” is
recent innovation. Has not been
universally adopted.