Applying critical realistic evaluation methods to speech-language pathology

Increasingly, service managers and funders are insisting that speech pathologists (SPs) prove that their interventions and practices are evidence-based. Evidence-based practice involves translating empirical research to practice by integrating research findings, client factors, clinician skills and knowledge within the service delivery context. As a busy “on the coal face” SP, wouldn’t it be helpful to have research evidence that included information about how client, clinician and service delivery factors facilitated or restricted positive treatment outcomes to help inform your clinical practice?
While randomised controlled trials (RCTs) are often held up as the “gold standard” of efficacy research, there is a lot of valuable information that is lost through the RCT process. RCTs in their nature are designed to wash out individual client factors and contexts that might influence the outcome in order to present the “true” impact of the intervention. The problem with this is that in the area of behavioural interventions, the interaction of client factors and contexts with the treatment agent can make a big difference to the final outcome.
Critical realistic evaluation (CRE) is based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it was provided. While the ways in which contextual aspects and treatment mechanisms interact may seem endless, critical realistic evaluation methodology attempts to operationalise them into hypotheses that can be empirically tested. This poster will outline the theoretical background and methods involved in CRE, before discussing its current and potential application to SP practice.