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What are Evidence-based Practices?

An evidence-based practice is an instructional/intervention procedure or set of procedures for which researchers have provided an acceptable level of research that shows the practice produces positive outcomes for children, youth, and/or adults with ASD.

What EBPs have been identified?

The National Clearinghouse on Autism Evidence and Practice (NCAEP) recently released their new report idenityfing EBPs. The new report reviews literature published from 1990-2017 and identifies 28 EBPs and 10 manualized interventions that also met criteria. The list of EBPs is here.

The NCAEP and AFIRM teams are working to update our user-friendly materials and AFIRM modules to reflect these changes. Until then, please select an EBP identified in our 2014 review to access the AFIRM module about the practice. Each module provides an overview and general description, step-by-step instructions of implementation, an implementation checklist, and the evidence-base which includes the list of references that demonstrate the practice meets the NPDC's criteria.
To print out a specific EBP Brief Packet, access the AFIRM modules and download the EBP Brief packet.
Comparison of NCAEP and NSP EBPs

NCAEP (2020) and the National Standards Project (NSP, 2015) published reports of their systematic reviews of the literature and identification of evidence-based practices. Nineteen of the NCAEP EBPs were also identified as established interventions in the NSP report Five of the NCAEP EBPs were identified as emerging interventions (i.e., some evidence but not sufficient to be classified as an EBP). NCAEP identified four EBPs that were not included in the NSP previous report and NSP identified Language Training (Production) as an established intervention, whereas it was not included in the current NCAEP report. NSP also included Comprehensive Behavioral Treatment for Young Children, and NCAEP did not consider comprehensive treatment models in the current review. In summary, there continues to be a substantial overlap in EBPs identified by these two independent reviews.
To print out the NCAEP NSP Comparison table, download the table here and open using Adobe Reader.

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An evidence-based practice is an instructional/intervention procedure or set of procedures for which researchers have provided an acceptable level of research that shows the practice produces positive outcomes for children, youth, and/or adults with ASD. The National Clearinghouse on Autism Evidence and Practice (NCAEP) recently released their new report idenityfing EBPs.

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People who have large mutations associated with autism and schizophrenia share atypical patterns of brain connectivity, according to a new study, especially between areas that process sensory information.

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People who have large mutations associated with autism and schizophrenia share atypical patterns of brain connectivity, according to a new study, especially between areas that process sensory information.

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Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

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IIDC - Indiana Institute on Disability and Community

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For some individuals, especially those with an autism spectrum disorder, there may be sensory processing dysfunctions or difficulties.

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Most kids with mild sensory problems and no other issues do just fine learning and socializing at school with a bit of understanding, extra support, a sensory diet, and a few simple accommodations. You may be able to work this out informally with your child's school. However, a child with sensory processing disorder (SPD) may need more help to thrive in the classroom and elsewhere at school (the cafeteria, gym, art class, etc.).

If your child qualifies for special education services, he will receive an IEP (Individualized Education Plan), created cooperatively by you and the school, that spells out how the school will meet his unique needs, providing a free and appropriate education (FAPE) in the least restrictive environment (LRE). In plain English, that means that children cannot simply be placed in a special education classroom that doesn't meet their needs. The object is to figure out how to help the child function in a less-restrictive, appropriate classroom. As a parent or professional, you can help tremendously if you develop your sensory smarts, and use good observation skills and creativity to make the school environment and the child's needs a better match.

504 plans

If your child with sensory issues doesn't receive special education services, he can still get help through a 504 plan. A 504 plan is a formal document that states what accommodations must be made for your child, such as allowing her to eat lunch somewhere other than the noisy cafeteria, having more time allotted for taking tests, and so on.

IEPs

If your child receives special ed services, his IEP will spell out specifics such as school accommodations (preferential seating, sensory diet activities and others), assistive technology, therapeutic and educational goals, and mandates for related services such as OT, physical therapy, and speech therapy. A wonderful book for helping you understand the IEP process and your rights, deal effectively with the school system, and resolve disputes is The Complete IEP Guide: How to Advocate for Your Special Ed Child by Lawrence M. Siegel. You may also want to check Wrightslaw for articles, information, and a blog on special education rights.

Avoiding Sensory Overload at School

There's a big difference between "bad behavior" and "sensory overload." You can help the school recognize and manage this by describing what overwhelms your child, what overloaded behavior "looks like," and what actually helps to avoid getting overloaded in the first place. Doing so get school staff more invested in supporting beneficial activities, ideally for all students. While needs vary from child to child, opportunities to obtain the sensory input a child's nervous system craves and to avoid noxious sensory experiences should be provided across the board. We all need to "wake up" by moving after sitting for a long time, and an occasional break from the intense sensory stimuli in noisy, busy environments such as school, but for kids with sensory issues, brief respites may be crucial in order to remain focused, calm, and attentive throughout the school day.

A sensory diet at school might include:

Walking. Taking a brief walk at specified intervals, perhaps accompanied by an aide.

Brushing. Going to the bathroom, where he can enter a stall and brush himself using the deep touch pressure technique for sensory defensiveness taught by his occupational therapist.

Listening to calming music. Using an iPod or other audio player, the child can listen to music that helps him regain his composure: nature sounds, classical music, or even rock n' roll-whatever effectively organizes his unique nervous system.

Fidgeting with objects. Fidgets such as a Koosh ball, fabric tab sewn in to a pocket, or even a hair band can keep a student's hands busy so she can focus better. b Desk accommodations. A band of stretchy material around front chair legs that he can push his shins and ankles against may help. A carpet square or piece soft cloth he can touch attached to the underside of the desk or an inflatable cushion to sit on can make attending for long periods easier for every child.

Objects for chewing. Objects to chew on such as a Pencil Topper, ChewEase, or Chewable Jewel can provide soothing oral input to keep a student focused on learning rather than sensory cravings.

Push-ups and jumping jacks. Jumping jacks or just jumping in place, and push-ups done in a chair or against a wall provide organizing proprioceptive input at school.

Stretching. Stretching wakes up the body after a quiet activity. Everyone can benefit from stretching after sitting, but it's even more important for a child with sensory issues.

Playground and gym opportunities. All children-especially those with sensory challenges-need opportunities to move before, during, and after school: hang from monkey bars, throw or push objects, run, jump, and pull objects. Otherwise, it can be quite difficult to settle in to quiet classroom activities and obey school rules about "no throwing" and "no running." More progressive schools incorporate movement experiences such as Brain Gym, yoga, or other fun activities into classrooms to keep students on track and ready to learn. The best gym teachers let kids run laps around the gym to blow off pent-up energy before asking requiring them to sit down and listen to instructions for the day's gym class.

A sensory smart OT can help you identify activities that will be most helpful before, during, and after school. If your child's body needs movement to stay tuned in, make sure that recess and gym are never withheld as a punishment, and get this added to your child's IEP.

Appropriate demand for eye contact. A child with sensory issues may need to "block off" his visual sense in order to listen more effectively. He should not be required to maintain eye contact when answering a question requiring concentration. If increasing eye contact is a goal, it should be worked on at other times, not, for example, when he is making a nerve-wracking oral presentation.

Prepare for intense sensory experiences. The sensitive child should be warned in advance about fire drills, for instance, so she can be prepared for the intensity. She should be permitted to wear earplugs or sound blocking earmuffs during such a sensory onslaught.

Special place in line. When lining up with other children, the child should always be at the front or end of the line so she isn't disturbed by other children crowding or bumping into her. (You might ask the teacher to appoint her "line monitor" so this doesn't seem like a punishment.)

Special seating. A sensitive child needs a well-considered seat location in the classroom and other rooms such as art, music, and computer lab. The best spot varies from child to child and the parent, teacher, and OT may need to collaborate to determine the best location in a given room. Children with sensory issues often do best in the front of the classroom close to the teacher, away from distractions such as direct sunlight and vents and noisy radiators. A student may also need to sit where she can't see out the door or windows, or next to a wall for a sense of security.

Trouble at Circle Time and Listening Time

Most schools require children of all ages to sit still, be quiet, and listen for increasingly long periods as they mature. This does not come easily for many children, especially those who are sensory seekers. Accommodations might include:

An inflatable cushion that allows kids to wiggle a bit while remaining seated on a chair or the floor.

Hand fidgets that keep hands busy and out of trouble, such as poking the child next to him.

A Time Timer can help students "keep it together" by giving them a visual cue about how much longer they are expected to be quiet or focus on a given task.

A weighted lap pad or weighted vest. Weighted wearables provide calming sensory input as well as a physical cue to stay in place. Please see Raising a Sensory Smart Child for wearing recommendations and precautions.

Help the sensitive child to not feel singled out! Most kids resist looking "different" from peers, so be sensitive to the desire to fit in. Ask your child for ideas about how he can self-calm. Perhaps gum chewing helps, but the school won't allow it. An appropriate item to chew, such as a Pencil Topper placed on the pen, might work instead. Provide several of these for the classroom so your child isn't the only one with "funny pencils."

Tests, Classroom Assignments, and Organization

Test accommodations. A child with sensory challenges may need to take tests in a separate room with fewer children around (to reduce distractions), be given extended time (if she processes information slowly), and be allowed to record answers in any manner (for example, answers may be typed or dictated to someone else).

Accommodations for instructions. A child may need instructions or the day's schedule to be provided verbally and visually, either written on the board or in writing. This is particularly true for students with auditory and visual processing difficulties.

Organizational help. Children with poor sensory processing are often disorganized in terms of time, space, and objects. Providing accommodations to help him stay organized is not "enabling" him any more than giving a nearsighted child prescription eyeglasses. Over time, the child can be taught, step-by-step, how to become better organized. In the meantime, he may need more help than the average child to stay organized so he can get his schoolwork done on time, according to the directions. Here are some tips:

Backpack and homework check. The teacher or aide helps your child to check his backpack at the end of the day to be sure no items are left behind. He's given an assignment notebook, which is broken down by subject matter and has room for short notes between teacher and parent. Both teacher and parent sign off on the assignment notebook daily.

Back ups. Your child is able to keep a second set of books at home. If the teacher has an online class page, she can upload the directions for multipart assignments with multiple deadlines. At the beginning of the year, obtain phone numbers and email addresses of other parents who may be able to lend books or provide assignment directions in a pinch.

Concentration accommodations. Your child may sit at a desk by himself instead of a table when working on multi-step, complex assignments, for better concentration.

Visual accommodations. Your child may wear any prescribed eyewear, including colored lenses and sunglasses indoors, that has been determined necessary. He is to be provided with written directions, in a form he can easily read (for example, black on white paper rather than colored markers on a white board).

Help from School-Based Occupational Therapists

School-based OTs often have ingenious ways to help your child thrive at school. A school-based OT may provide direct services to your child simply be available on a consultation basis. The mode of service delivery must be specified in your child's IEP. Here are some of the ways in which school-based OTs help kids in the classroom, lunchroom, playground, gym, art room, music room, computer lab and elsewhere at school.

Handwriting ("graphomotor") difficulties, often due to decreased hand strength and stability or impaired proprioceptive processing (pressing too hard or too lightly). Poor writing can also be related to visual processing problems and/or motor planning issues (difficulty developing and carrying out a sequence of movements).

Transition difficulties, such as going from the noisy cafeteria or playground into a quieter activity, can be very challenging for kids with sensory issues.

Playground and physical education issues, including how to use equipment appropriately. An OT may help your child build core strength and endurance, and may show a student how to calm down and transition to quiet activities after intense movement input such swinging or participating in sports makes her wired.

Focusing, attending, and staying organized. A sensory smart OT can help a child learn how to calm and organize his system so that he can better focus and attend to learning.

Difficulties with specialty classes. The routines and environments in special classes such as physical education, art, music, and computer lab can be challenging. Such classes often involve extra background noise (e.g., classmates talking and moving at once) as well as unpleasant odors (e.g., arts and craft supplies) or irritating sounds (e.g., musical instruments or off-key singing). An OT can help a student and specialty teacher develop solutions to these issues, and we provide many suggestions in Raising a Sensory Smart Child.

If your child receives OT at school, check where service takes place. If the service is "pull out," it means the OT removes your child from the classroom to work in a separate location. That's great for working on skill development and doing more intense sensory diet work. Be sure, however, to ask the OT visit your child in the classroom too so she can identify and address any needs in the actual room where most of the day is spent. If your child is mandated for "push in" OT services, it means the OT works with your child in the actual classroom. Ask the OT whether she is able to effectively build your child's skills while in the classroom, and how she can help your child to not feel singled out. Keep in mind that the school-based OT really does want to hear from parents. She would love to hear what you've already discovered works well for your child!

Previous (Sensory Diet Activities)

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How to advocate for your child with sensory issues at school.

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Evidence-based practice (EBP) is very much the buzzword in educational and therapy programs for children, youth, and adults with autism spectrum disorder (ASD). By EBP, we mean intervention and instructional practices or programs having scientific evidence that shows that they are effective. The EBP movement came from the field of medicine and dates back nearly half a century to Dr. Archie Cochrane. He was a physician in the United Kingdom who was appalled that the practice of medicine and health care was not being based on scientific research. His work led to formation of the Cochrane Collaboration, which sponsors reviews of the scientific literature. You can read brief research summaries about practices for children and youth with ASD that are effective (for example, early behavioral intervention, social skills training) on Cochrane's website as well as summaries about practices that are not effective (for example, chelation therapy, secretion, auditory integration, hyperbaric oxygen therapy, etc.).

The evidence-based movements in clinical psychology and education very much followed the momentum created by Cochrane's work. For autism specifically, two research groups, the National Standards Project and the National Professional Development Center on ASD (NPDC), conducted systematic reviews and identified focused intervention practices that are evidence-based. These reviews provide a basis for teachers and clinicians to make decisions about intervention and service practices based on science. It is important to note that having the information about which practices are evidence-based is a starting place for treatment or instruction, but practitioners must also use their professional expertise in selecting the practices based on child characteristics, family priorities, and context. Also important is that federal laws governing education, such as the "Individuals with Disabilities Education Improvement Act" and the "Every Student Succeeds Act," require practitioners in schools to use evidence-based practices. Similarly, insurance companies are developing standards for reimbursement for services based on whether practices are evidence-based.

With any organization, introducing and supporting change is challenging. School and service agencies are no different. The common barriers to learning and using evidence-based practices are time (for training, consultation, and feedback), resources (having information about practices in an understandable format), and teacher beliefs or philosophy. The active field of implementation science can support organizations in their adoption of an evidence-based practices approach and training their service providers to use the practices with fidelity. Drawing from the principles of implementation science, the NPDC has developed one such approach in working with schools and their students with ASD.

One link in the transition from research to practice is translation of the scientific information from academic journal articles into practical instructional and intervention approaches that practitioners can use. To bridge this gap, NPDC has developed AFIRM, online training modules that present specific information in an understandable way about each of the 27 practices that NPDC identified. Currently, these modules have been accessed by over 35,000 new users in the United States and internationally.

Moving into the future, the evidence-based practice movement will have an ongoing effect on the lives of children, youth, and adults with ASD and their families. New research is coming out all the time, and the intervention research literature is moving quickly. In their review published in 2014, NPDC researchers found about 29,000 possible articles published between 1990 and 2011 that could qualify for the review (eventually narrowing the number down to 456). In an update of that review by the newly formed National Clearinghouse on Autism Evidence and Practices, researchers found about 25,000 articles just for the years 2012 to 2017! That adds up to almost as many articles in the last five years as were published in the previous 20 years. As this new information becomes available, the challenge for practitioners is to stay informed about the most current effective practices.

The laws requiring evidence-based practice noted above, as well as the increased awareness of parents and professionals, are going to push the demand for translating science into practice. The updated review by the National Clearinghouse on Autism Evidence and Practices will support practitioners' use of the most current scientific information available. Also, new and innovative models for supporting implementation in schools and service agencies continue to emerge. The field has taken a major step forward in basing practice on carefully examined research rather than intuition, unsubstantiated marketing, and even fabricated results of "scientific" studies that are later refuted. This evolution in the field holds great promise for the future lives of children, youth, and adults with autism and their families.
Kara Hume, Ph.D., is an advanced research scientist at the Frank Porter Graham Child Development Institute at UNC-Chapel Hill, as well as a research associate professor in the School of Education. She serves as principal investigator and co-principal investigator on several studies with children, adolescents, and adults on the autism spectrum. She serves as co-principal investigator for the Center on Secondary Education for Samuel L. Odom, Ph.D., is director of the Frank Porter Graham Child Development Institute and a professor in the University of North Carolina (UNC)-Chapel Hill School of Education. He is the author or co-author of over one hundred publications and editor or co-editor of eleven books on early childhood intervention and developmental disabilities. He is also an OAR-funded researcher. His current research focuses on autism spectrum disorder although his past research has addressed topics related to early childhood inclusion and preschool readiness.

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Use of Evidence-based Practices | Organization for Autism Research

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Evidence-based practice (EBP) is very much the buzzword in educational and therapy programs for children, youth, and adults with autism spectrum disorder (ASD). By EBP, we mean intervention and instructional practices or programs having scientific evidence that shows that they are effective.

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Page 2: Evidence-Based Practices

To improve the outcomes of children with ASD, educators should implement evidence-based practices (EBPs), strategies that have been shown to be effective in teaching appropriate behaviors and skills and decreasing inappropriate behaviors for a given population. There are evidence-based practices to improve academic and behavior outcomes for all students. However, this module will focus on strategies that have been shown to be effective in teaching appropriate behaviors and skills and decreasing inappropriate behaviors for students with ASD. The National Professional Development Center (NPDC) on Autism Spectrum Disorder has identified 27 evidence-based practices for improving outcomes for students with ASD.

Adapted from Wong, Odom, Hume, Cox, Fettig, Kucharczyk, Brock, Plavnick, Fleury & Schultz, 2014. Retrieved from http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/imce/documents/table7_working_definition_ebp.pdf

Click here to download and save a PDF version of the list.

With so many EBPs from which to choose, how can educators or practitioners determine which of them to use with a specific child? The four steps outlined below can help educators and practitioners make a more informed decision when they select an EBP.

The target behavior is the behavior the teacher wants to change. This should be a discrete behavior that is directly observable, measurable, and clearly defined. The definition of the behavior should:

Describe the behavior in an observable manner

Describe the behavior in measurable terms (i.e., instances of the behavior can be counted or timed)

Identify the setting in which the behavior occurs

Note the difference in the definitions below.

1. Ambiguous and subjective definition: Michelle violates other's personal space.

2. Clear and observable definition: When talking to someone, Michelle stands within a foot of that person.

Defining behavior in this manner allows multiple professionals to observe and collect objective data on the behavior. If multiple professionals gather data using the second definition of Michelle's behavior, they are more likely to collect data on the same behavior rather than on their subjective opinion of personal space violation.

To learn more about how to clearly define a student's behavior so that when it occurs it can be reliably identified, measured, or counted, visit the following IRIS Case Study:

Baseline data refers to the level (i.e., frequency, duration) at which a behavior occurs before a strategy or intervention is implemented. These data should be gathered for at least four days or until a pattern of behavior is evident. By comparing these data to data collected after the strategy has been implemented, educators can determine whether it is effective for the student.

To learn more about collecting observational data on a child or student's behavior, visit the following IRIS Case Study:

Once the target behavior has been identified and baseline data collected, the goal needs to be indicated in a child's individualized education program (IEP) or individualized family service plan (IFSP). The goal should include information about:

When or where the behavior will be performed

What behavior should be displayed

Specific, measurable criterion for mastery

Note the difference in the goals below.

1. Poorly written goal: Michelle will respect other's personal space.

2. Observable goal: When talking to friends or school personnel, Michelle will stand a minimum of 1½ feet from them at least 90% of the time.

The next step in this process is to determine which EBPs can address the target behavior. With those in mind, educators can select an EBP that is likely to be effective for a student. The IFSP or IEP team should consider the following when they choose an EBP:

The characteristics of the child and her or his family (e.g., the child's strengths and challenges, what strategies have or have not worked in the past)

The student's goal (i.e., what the student is expected to achieve and in what learning domain)

The expertise and experience of the teacher in successfully implementing specific EBPs

The availability of resources (e.g., equipment, personnel) necessary to implement a given EBP

When they select a practice to implement with a child or student, educators and practitioners should understand that:

When selecting a target behavior and EBP, it is important to collaborate with parents. A behavior that is problematic at school is also often problematic at home. When parents and teachers implement the same EBP, the probability that the strategy will be effective across multiple settings increases.

Just because a practice is deemed evidence-based does not guarantee that it will be effective for every student.

Information about treating and even curing autism is abundantly available on the Internet, but many of these practices are unproven, and are sometimes even harmful. For this reason, educators and practitioners should rely on trustworthy sources to identify evidence-based practices.

Once an EBP has been selected and implemented with a child, the educator or practitioner needs to collect data on the behavior to evaluate how the EBP is working for the individual student. It is also important to determine whether the EBP was implemented with fidelity (i.e., implemented as the developer intended), especially if the EBP was not effective for the student. Kara Hume and Ilene Schwartz discuss selecting an EBP, implementing a practice with fidelity, and evaluating whether an EBP is effective for a student.

Kara Hume, PhD

Research Scientist
Frank Porter Graham Child Development Institute
University of North Carolina-Chapel Hill

Ilene Schwartz, PhD

Professor, Special Education
Director, Haring Center for Research
and Training in Inclusive Education
University of Washington

To learn more about identifying and selecting an EBP, implementing it with fidelity, and evaluating its effectiveness for a given child or student, visit the following IRIS Modules:

For Your Information
Are the EBPs for students with autism also high-leverage practices?
High-leverage practices (HLPs) are practices often used by teachers that have been shown to increase student performance. HLPs that can be used with students with ASD include small-group instruction, functional behavior assessments, peer-assisted strategies, and organized and supportive learning environments. Listen as Kara Hume discusses some of these HLPs and the overlap with EBPs for students with autism (time: 0:59).

Kara Hume, PhD

Research Scientist, Frank Porter Graham
Child Development Institute
University of North Carolina-Chapel Hill

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To improve the outcomes of children with ASD, educators should implement evidence-based practices (EBPs), strategies that have been shown to be effective in teaching appropriate behaviors and skills and decreasing inappropriate behaviors for a given population. There are evidence-based practices to improve academic and behavior outcomes for all students.

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With the shift to CMS values-based model, attention to quality care can be maximized by implementing evidence based knowledge for continual improvements toward patient outcomes with occupational therapy, physical therapy, and speech therapy treatments.

We recently discussed the basics and barriers of evidence based practice for therapists. In this article, we will expand on the basics and describe how you can take evidence to action through a 5 step process.

A paper by Bennet and Bennet provides a clear process in implementation for therapists, which is outlined briefly below.

Person-Centered Treatment

Below you will see a practical 5-step process for evidence based practice.

Featured Image Credit: Department of Health Library Service

At the center of the circle lies the patient context, which encompasses the individual person, their preferences and values, along with the environment the therapy is conducted in.

With this in mind, the process begins with asking appropriate questions.

STEP 1: Asking Clinical Questions

As therapists dealing with a diverse range of situations, there could be many instances where new information is required to help resolve patient problems.

Bennet and Bennet suggest that questions predominantly land in three areas of concern:

Some of the basic questions to ask in each area may include:

What performance issues does my patient have?

Which test can be used to measure and how should data be interpreted?

Many questions regarding diagnosis can be answered through conversation with the patient and from patient history, assessments, observation, experience and reasoning.
Treatment/ Prevention

What choice of therapy treatment is most effective?

How can my choice of treatment be implemented for higher outcomes?

Are there difficulties associated with my choice of treatment?

How can risk factors be addressed?

How can I inform the patient to minimize risk factors in future?

Prognosis

What are the likely outcomes of selective treatments?

What is the expected timeline for this clinical course of action?

What are the consequences or complications with the patient's situation and how can they be managed?

Expanding Questions for Search

When a gap in knowledge arises, the need for additional information can be turned into a clinical question to help focus your search for answers.

Focused questions usually fall in four broad areas:

1. Around the patient or problem

2. About a selective treatment or indicator

3. Regarding an outcome measurement

4. Regarding comparison of treatments/ outcomes

Bennet and Bennet provide an expanded list of questions you might consider.

STEP 2: Search

Your next step is to search peer-reviewed journals to identify appropriate information - see our list of the best journal resources over here.

STEP 3: Critical Appraisal

The ability to think critically about the quality, validity and significance of the evidence is a skill that can be learned.

Here are some free resources for learning critical appraisal skills:

STEP 4: From Evidence to Action

The main question that arises once you have more information is: What does all this mean for the patient?

Always keeping the patient context and context of therapy in mind, further questions may include:

Do these results apply to my patient?

Or how could they apply?

Do the outcome measures suit my objectives?

Can this be implemented into treatment?

How can I build this into my treatment process?

Your task is to assimilate the information and implement your new knowledge into clinical practice.

STEP 5: Evaluation

Implementing a process for evaluation is also important as it helps you identify gaps in skills and implementation in practice. And more than that, the process of evaluation usually leads to more questions, which promotes the cycle of evidence based practice for continuous improvements.

Being informed with evidence based knowledge that answers a wide range of questions, not only improves your skills as a therapist, but helps you communicate and inform patients so they can understand, plan, cope and engage more effectively with their own treatment plan.

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5 Step Process for Implementing Evidence Based Practice

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With the shift to CMS values-based model, attention to quality care can be maximized by implementing evidence based knowledge for continual improvements toward patient outcomes with occupational therapy, physical therapy, and speech therapy treatments.We recently discussed the basics and barriers of evidence based

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Researchers now believe you can pick up signs of autism in a baby just under 4 months of age. Here are some signs that may indicate your baby should have a developmental evaluation, according to the Centers for Disease Control and Prevention.

By 3 months

Early diagnosis of autism can make a dramatic difference. Here are some signs that may indicate your baby should have a developmental evaluation, according to the Centers for Disease Control and Prevention:

She doesn't respond to loud noises.

She doesn't follow moving objects with her eyes.

She doesn't grasp and hold objects.

She doesn't smile at people.

She doesn't babble.

She doesn't pay attention to new faces.

By 7 Months

She doesn't turn her head to locate where sounds are coming from.

She shows no affection for you.

She doesn't laugh or make squealing sounds.

She doesn't reach for objects.

She doesn't smile on her own.

She doesn't try to attract attention through actions.

She doesn't have any interest in games such as peekaboo.

By 12 Months

She doesn't crawl.

She doesn't say single words.

She doesn't use gestures such as waving or shaking her head.

She doesn't point to objects or pictures.

She can't stand when supported.

By 24 Months

She can't walk.

She doesn't speak more than 15 words.

She doesn't use two-word sentences.

She doesn't seem to know the function of common household objects, such as a telephone, fork, and spoon.

She doesn't imitate your actions or words.

She can't push a wheeled toy.

She doesn't follow simple instructions.

Hallie Levine Sklar is a freelance health and fitness writer who lives in New York City with her husband, Jamie.

Originally published in American Baby magazine, November 2006.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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Researchers now believe you can pick up signs of autism in a baby just under 4 months of age. Here are some signs that may indicate your baby should have a developmental evaluation, according to the Centers for Disease Control and Prevention.