2007 EHDI Conference1 New York State Department of Health Bureau of Early Intervention Clinical Practice Guidelines

2007 EHDI Conference 1

New York StateDepartment of HealthBureau of Early Intervention

Clinical Practice Guidelines

http://www.nyhealth.gov/community/infants_children/early_intervention/


• What are the Clinical Practice Guidelines (CPGs)?

• How was the evidence base used in the development of the CPGs?

• What is the structure/content of the CPGs?

• How can the CPGs be used?

• How can copies of the CPGs be obtained?



What are the Clinical Practice Guidelines?



Purpose of the Guidelines

To provide parents, clinicians and others with recommendations based on the best scientific evidence available about “best practices” for assessment and intervention for young children with developmental delays and disabilities.



Promote Research

Improve Knowledge

Facilitate Program Evaluation/

Quality Improvement Efforts

Enhance Communication

Specific Objectives



Where Do We Find Answers?

Families?Service

Providers (Therapist)?

Early Intervention Officials?

From:• Texts, teachers, journals, mentors, consultants,

conferences, Internet, i.e., from credible sources• The child• Clinical practice guidelines



Methodology

The methodology for these guidelines was

established by the:• Agency for Healthcare Research and Quality

(AHRQ), formerly the Agency for Health Care Policy and Research (AHCPR) (www.ahrq.gov)

• Support the use of clinical opinion in the form of panel consensus opinion.



Guideline Development Panel

The panel consisted of:

• Specialists/Topic Experts - multiple disciplines

• Generalists/Parents



Contributions of Panel Members

Specialists/Topic Experts• Know the topic well• Can identify important current issues and

recent research• Explain complex issues• Identify current controversies in the field• Have decisive and well-developed opinions• Add credibility to process/product



Contributions of Panel Members

Generalists/Parents (end users)• Know the needs• Are open-minded• Demand clarity/simplicity • Evaluate usability• Preserve the individualizing element



Multidisciplinary Panel

Advantages:– Supports whole child– Lends greater credibility and impact– Facilitates compromise– Facilitates consideration of a broader range of approaches – Discourages development of independent, possibly

conflicting, guidelinesDisadvantages:

– Can require longer process/more time in development– Diverse perspectives may cause conflict– Can be difficult reaching consensus– Compromises can lead to vagueness



How Was the Evidence Base Used in the Development of

the Guidelines?



Why Evidence-Based?

How do evidence-based guidelines benefit children and families?

• They provide the best opportunity for favorable outcomes.

• They better estimate potential benefits and harms.

• They promote informed decision making.



Why Evidence-Based?

How do evidence-based guidelines benefit the field?

• Research base provides credibility.• Development process helps to organize the

available research information.• State of the evidence regarding costs vs.

benefits and harms is illuminated.• Needed areas of research are identified.



Applicability of the Evidence

• Subject characteristics

• Settings

• Outcomes

• Special situations (clinical conditions, social settings)- primary focus for guideline- dealt with in a limited way- outside scope of the guideline



Criteria for Evidence on Efficacy

• Studies of assessments use reference standards to measure efficacy

• Studies of assessments use measures of sensitivity and specificity to make judgments about efficacy

• Studies of interventions use outcome measures to measure efficacy



Limitations of Evidence-Based

• Promising interventions can lack scientific evidence.

• Standards of evidence focus on quantitative rather than qualitative evidence (the medical model).

• Anecdotal evidence is downplayed.• Use of only higher quality studies can limit the

available pool of research.



Transforming the Evidence

• Amount and quality of evidence for

efficacy

• Magnitude of effect found for the method

• Consistency of findings between studies

• Clinical applicability

• Attention to harms and costs



Limitations of Evidence-Based

How can these limitations be addressed?

• These interventions can still be provided.- Parents and professionals can make

informed decisions.• Guidelines can promote research on promising

new approaches.• Use of panel consensus.



Types of Guideline StatementsRecommendation for use• Evidence shows method has efficacy• Potential benefits outweigh potential harms and

costsRecommendation against use• Evidence shows method has no efficacy• Potential harms or costs outweigh potential

benefits• Insufficient evidence to make a judgment



Strength of Evidence Ratings

A = Strong research-based evidence

B = Moderate research-based evidence

C = Limited research-based evidence

D = Panel consensus opinion

D1 = research did not meet the criteria for adequate evidence

D2 = literature search not done



What is the Structure/Content of the

Guideline Series?



Guideline Versions

Most of the guideline topic comes in five versions:

• Guideline Technical Report• Report of the Recommendations• Quick Reference Guide• Evidence Tables• Compact Disc (includes all of the above)





Organization of Guidelines

Table of Contents

I. Introduction

II. Background Information

III. Report of the Research*

IV. Assessment

V. Intervention

VI. Appendices*Note: The placement of this information in the Technical

Report varies depending on the guideline topic



Hearing Loss Overview

• Operational definitions• Considerations• Early identification • Recommended assessments• General approach to interventions• Communication interventions• Amplification devices• Medical & surgical interventions



How Can the Guidelines be Used?



Tool for the Individual Level

How can the guidelines be used at the individual level?

• Clarify, validate an initial concern

• Structure evaluations

• Select effective interventions

• Monitor progress of child/family outcomes

• Promote informed decision making

• Identify and get help with associated conditions

• Support fuller participation of all team members



Tool for the Community Level

How can the guidelines be used at the community or systems level?

• Enhance and refine child find efforts• Assess current practices• Identify ways to improve quality• Identify gaps in services• Target capacity-building efforts



What They Are Not

Guidelines Are Not Regulations!

• Guidelines offer practice recommendations – they are not required practice standards.

• Guidelines are not regulatory.

• Guidelines are designed to be used in the context of program regulations and policies.

• Guidelines should not limit the tailoring of care to the individual.



Implementation

What is implementation?• Ensuring access to the guidelines• Using the guidelines to promote effective practices• Monitoring guideline use

Who are the stakeholders?• NYS Department of Health• Early Intervention Officials/Counties• Service Providers• Families• Primary Referral Sources• Researchers• Local EI Councils



How Can Copies of the Guidelines Be Obtained?



To Obtain Copies• Communication Disorders• Autism/Pervasive Developmental Disabilities• Down Syndrome• Motor Disorders• Hearing Loss• Vision Impairment (due Summer 2007)Contact: NYS Department of Health, Box 2000, Albany, NY

12220 Fax: (518) 486-2361

Or Visit: http://www.nyhealth.gov/community/infants_children/ea

rly_intervention/index.htm



Bibliography• Noyes-Grosser, D.M., Holland, J.P., Lyons, D., Holland, C.L.,

Romanczyk, R.G., Gillis, J.M. (2005). Rationale and Methodology for Developing Guidelines for Early Intervention Services for Young Children with Developmental Disabilities. Infants and Young Children, 18(2), 119-135.

• http://writing.colostate.edu/references/research/observe/com2d3.cfm

• www.ahrq.org• New York State Department of Health. (1999). The Guideline

Technical Report – Autism/Pervasive Developmental Disorders: Assessment and Intervention for Young Children (age 0-3 years). New York: Author.

• New York State Department of Health. (1999). The Guideline Technical Report – Motor Disorders: Assessment and Intervention for Young Children (age 0-3 years). New York: Author.

*To excerpt from any of the Clinical Practice Guidelines, you must obtain permission from the New York State Department of Health. You can write to: [email protected]

http://writing.colostate.edu/references/research/observe/com2d3.cfm

http://writing.colostate.edu/references/research/observe/com2d3.cfm

http://www.ahrq.org/

mailto:[email protected]



Thank You!


http://www.ny.gov/

Documents

2007 EHDI Conference1 New York State Department of Health Bureau of Early Intervention Clinical Practice Guidelines