JCPSLP Vol 22 No 1 2020

on a wider evidence base and focus on children with disabilities, with communication as a primary outcome of interest. Jacquie utilises the same eight databases, and this time conducts three separate searches in each database. The terms for each search are: • (interdisciplinary OR interprofessional) AND child* AND disab* AND communication • (interdisciplinary OR interprofessional) AND child* AND disab* AND allied health • (interdisciplinary OR interprofessional) AND child* AND disab* AND (therapy OR treatment OR intervention) This time Jacquie’s search returns over 330 results after removing duplicates, non-peer reviewed publications and non-English language papers. After scanning each title and/ or abstract, this time she looks for relevance to outcomes in communication for children with disabilities in an interdisciplinary service. After this process, Jacquie retains 20 publications. Jacquie reads all 20 papers, and discards 15 that, while relevant to her own professional development regarding AAC interventions, are not relevant to community- based services or applicable to the Australian context, key foci in her proposal. The five publications she retains comprise two non-experimental single-case descriptions, one framework review, one literature review and one expert clinical topic summary. Jacquie knows that single-case reports and expert opinion constitute the lowest levels of evidence according to the National Health and Medical Research Council guide (2000). However, she is aware that due to the heterogeneity of clients with a disability, these research designs can be prevalent. Nonetheless, she goes back to her broader search sample and decides that she should also consider one systematic review of interdisciplinary practice across a broad range of clinical contexts and populations, so that she can supplement her targeted report with references to trends in the wider evidence base. Details of the search strategy are included in Figure 1. 1 Jacquie searched Scopus, Web of Science, EBSCO, Google Scholar, PubMed, CINAHL, Cochrane Library and SpeechBITE, returning over 330 results after removing duplicates. 2 After scanning the relevance of each title and/or abstract, Jacquie retained 20 publications based on relevance to interdisciplinary service provision for her target population. 4 Her final search results consist of 5 publications including two single-case studies, one framework review, one literature review and one expert clinical topic summary. She decides to also draw on one systematic review of interdisciplinary practice in other settings and populations, giving her a total of 6 publications to consider. In addition to collecting the small amount of research evidence that she is able to find, Jacquie also consults Speech Pathology Australia (SPA) practice documents, as directed by Karen. She identifies four relevant clinical guidelines and core association documents, which she includes in her appraisal: • Augmentative and Alternative Communication Clinical Guideline (SPA, 2020) Figure 1. Search strategy 3 Jacquie read all 20 publications. She discarded 15 publications as they were not conducted in the context of community-based services.

• Scope of Practice in Speech Pathology (SPA, 2015) • Parameters of Practice: Guidelines for Delegation, Collaboration and Teamwork in Speech Pathology Practice (SPA, 2016). • Position Statement on Evidence Based Practice in Speech Pathology (SPA, 2010). Critical appraisal and evaluation Jacquie decides to look more closely at the Bruce and Bashinski (2017) literature review (see Table 1), as it has the closest application to her setting. She uses the research appraisal tool by Polgar and Thomas (2013) to guide her critical evaluation of the paper. Jacquie finds that this paper not only includes a literature review of studies relating to interprofessional collaborative practice (IPCP), but also demonstrates alignment of the findings to a proposed trifocus framework of communication strategies. The framework provides a practical exploration of five steps to intervention when working with people with severe disabilities with consideration of three key elements of the intervention: the learner, the communication partner, and the environment (Bruce & Bashinski, 2017). Jacquie feels that the framework will be useful to her team, as it describes practical strategies that they could implement during interprofessional meetings and case discussions. As a review piece, the Bruce and Bashinski (2017) article comprehensively synthesises the literature and provides well-evidenced definitions of relevant key terms, in particular defining IPCP, as “an exemplary practice for meeting ... learners’ complex needs [which] involves various team members sharing their unique experiences with one another, in a collaborative way, to build a broader base of collective knowledge” (p. 163). However, Jacquie notes that no definition is provided for “severe” disability, nor do the authors refer to formal measures or qualitative description of disability severity. Given the ambiguity of terminology, Jacquie feels that this is an oversight, as it places some restriction on clinical application of the framework to a treatment population. In considering the framework, Jacquie notes that it appears to align with the social model of health (Ryan, 2004), as it moves the focus of intervention from solely on the individual with communication impairment to also consider the roles of communication partners and the communication environment in assessment and intervention for AAC. The authors describe the five instructional strategies that are emphasised in the trifocus framework, and consider each of these in relation to the concept of IPCP: • Enhancing sensitivity relates to increasing the reactivity of communication partners to the idiosyncratic communication of non-symbolic communicators. The authors highlight the crucial need of all communication partners (inclusive of health professionals) having this sensitivity through an IPCP application, in order that all communication partners might recognise and respond to an individual’s communication. • Utilising routines refers to supporting receptive communication through use of predictable, consistent routines across a day. The authors emphasise that routines are most successful with the buy- in, understanding and consistent approach of all stakeholders, and advocate that this can be achieved through adopting an IPCP approach.

63

JCPSLP Volume 22, Number 1 2020

www.speechpathologyaustralia.org.au