Breakin’ the Law

4 Sep

Something that has been on my mind lately is following the rules.

As an undergrad when I was first introduced to testing protocol it was hammered into our heads, “DO WHAT THE MANUAL SAYS.” No extra prompting, no coloring outside the lines, just do what you are supposed to do or the test is invalidated and you suck.

And I’m okay with this, but only in the case of eligibility. You give a test to determine eligibility for services, then you want the results to be reliable and valid. So follow the rules.

However, tests have a lot of purposes. You can use a test to probe a specific area of concern, to screen, to compare to previous results. As an SLP I am certainly curious about my clients’ problem areas and I want them to qualify for skilled services. But I also want to know how they perform with prompts and cues. I want to alter protocols to explore my clients’ strengths and weaknesses. I want to make goals that truly suit their needs. And in these cases I say, go ahead and break the rules! (Do it, I dare you.)

The same goes for specific therapy techniques. There are a lot of programs out there that you must attend the workshop, obtain a certification, and follow the rules! This program won’t work unless you follow those rules! And you know what – some of these programs genuinely work, have excellent evidence backing them up, and are truly wonderful for our clients.

But by suggesting that “the rules” work for every single client is unrealistic. Our clients are individuals and between them, their needs are so different. I say take those rules and stick with the main basis and the main theory, but alter them as needed! I want my clients to experience success and I’ll change up things if I determine that it is appropriate to do so.

You’ll often hear “You aren’t doing X-program if you aren’t following the rules outlined by said program.” And to that I say, “So be it.” I don’t particularly care if I’m following the rules so long as I’m making therapy beneficial to my client. Obviously you should NOT run around saying you’re a provider of a specific kind of therapy or program if you haven’t actually been certified (that’s a quick way to get yourself sued), but if you have and you want to make some changes I think you should be able to. I understand and respect companies’ desire to charge money to certify and educate SLPs in their specific program, but I also think it is a little backwards that companies have resources and ideas that WORK that aren’t open sourced to all clinicians. We should all have equal access to important research and programs.

As CSD professionals we are lucky enough to have an incredible amount of resources at hand. Tests and tools and strategies that are becoming more and more evidence based. With the #slpeeps on Twitter we can discuss what we like and don’t like, and explore what really works. It is really wonderful. I think we should use each other’s skills, expertise, and ideas for adapting protocols even more than we do now, and really encourage the concept of open-source therapy. Share the adaptations that work, so we can all help our clients benefit!

NP: The Cure – Pictures of You

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3 Responses to “Breakin’ the Law”

  1. slpecho September 9, 2012 at 10:51 pm #

    I 100% agree with you! Especially about using the #slpeeps on Twitter. When people hear that I use Twitter, they assume I’m tweeting every second of my life’s happenings. Yet it has been a wonderful tool for therapy ideas and reading what others are saying and doing in therapy…where else can you find that?
    Love the song too, by the way 🙂

  2. slotaag September 10, 2012 at 3:38 pm #

    Just playing some devil’s advocate here.

    Tests have very specific protocols for a very important reason: those tests were proctored by researchers using those protocols in attempt to control for extraneous variables that might affect scoring. Straying from protocol will affect data collection and thus interpretation, which will then affect your treatment plan. Sure, a test may not account for everything you want to know, but you can still follow protocol while getting other information. You say you want to find out how stimulable the patient is. Go ahead and do that, but maybe abstain from doing so during a standardized test. As you practice, you will build a repertoire of questions and probes to get some data informally. And that is very important; just as important as sticking to proctoring methods.

    The same goes true for tx regimes, like LSVT. The reason they have such strict practices is because that’s what they’ve done during research. If you do your own thing, you are no longer practicing what the research has established, and can you no longer call it LSVT.

    This probably sounding very drone-ish. But your assessment and interpretation should be steeped in evidence, otherwise you’re making shit up. Your clinical acumen will lead you to determine what assessments should be done and when a test didn’t adequately acquiesce the data you sought. Your clinical judgement will lead you determine the proper treatment regime, one that is individualized, can be adapted to the changing skills of your client, and can be used as ongoing assessment of skills. However, when it comes to a standardized test or certified treatment program, they’re probably best followed as intended. That’s not to say you can’t incorporate their concepts into less formal treamtments, of course you can!

    Anyways, there’s my prolonged devil stirring the mud 🙂

    • weathersby September 10, 2012 at 3:46 pm #

      I totally agree with everything you said (prolonged as it may be). I don’t break from test protocol when it’s important, I just think there’s a time and place for when it’s okay to break away a little. Not in the case of eligibility, but more when you’re screening or probing for your own knowledge. Disclaimer everyone: this is not me telling you to not read and do as the manual says (which I just spelled as “Manuel”). And definitely don’t use broken protocol against standardized scores!

      You’re such a shit starter Adam. 🙂 in a great way of course – glad to see you’re back from your social media hiatus!

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