Best Practices: Standing on the Shoulders of Giants?

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Best Practices Standing on the Shoulders of
Giants?

• Ronnie Detrich
• Wing Institute

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Function of Best Practice Guidelines

• Validated evidence-based practices 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 statements than EBP.

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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.

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Function of Best Practice Guidelines

• Romanczyk (2008) intended to inform consumers
  and service provides 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.

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How Best Practices Guidelines are Developed

• There are at least three approaches
• Individual experts develop guidelines.
• Expert Opinion.
• Group of experts develop.
• Represents consensus opinion.
• Draws on the experience of experts.
• 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.

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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.

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Method Group Consensus

• Large group of experts.
• Best practices represent consensus agreement.
• Some effective practices were left out because we
  could not gain consensus.

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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?

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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.

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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).

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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.

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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.