You can do it! Finding and Implementing Evidence for the Busy SLP

This is a transcript from our podcast episode published February 13th, 2023. The podcast episode is offered for .1 ASHA CEU (introductory level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.

A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.

[00:00:00] Kate Grandbois: Welcome to SLP nerd cast, the number one professional resource for evidence based practice in speech, language pathology. I'm Kate Grandbois 

[00:00:09] Amy Wonkka: and I'm Amy Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast.  

[00:00:16] Kate Grandbois: Each episode of this podcast is of course offered for ASHA CEUs.

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[00:01:43] Kate Grandbois: Welcome everyone to today's episode. We are really excited for today. We actually get to welcome one of the authors of Amy's favorite paper. So anybody who has been listening to the show for a while knows that Amy, out of the two of us is, is the [00:02:00] research maverick, um, in terms of reading every word in some of her favorite literature.

And, um, today we get the pleasure of welcoming Dr. Mary Beth Schmitt, who is the author, um, who is the editor and co-author of Evidence, Evidence Based Practice of Retrospective Overview and Proposal for Future Directions. Welcome, Dr. Mary Beth Schmitt. 

[00:02:22] Mary Beth Schmitt: Hi, thanks for having me. 

[00:02:24] Amy Wonkka: So, as Kate mentioned, Dr. Schmitt, you're here to discuss evidence fits based practice. Very excited for this conversation. Uh, but before we get started, can you tell us a little bit about yourself?

[00:02:34] Mary Beth Schmitt: Sure. Um, how long do you have? No, ? Um, so I, I, first and foremost as am a speech language pathologist, I worked for 11 years in a variety of settings, but with kids who had, um, language disorders.

And never in a thousand years ever anticipated going back to get my PhD. [00:03:00] Like you told me early on, I just would've laughed at you like that. It just wasn't on my radar. Um, but, um, you know, as life does got to a point where, um, I was struggling with this idea of evidence based practice and we were seeing effects with the kids I was working with and the families were wanting more of this particular program, and I just felt this ethical obligation, um, to go back and help our field contribute to the evidence.

I was like, I don't know why. Stuff is working that's working and why things aren't working that aren't working. Um, I knew that I was feeling like I was relying a lot on my kind of professional expertise, and while that has value, I knew it wasn't the only thing of value, right? And so, um, after much like mashing of teeth is, um, really a lot of discernment.

Went back and got my PhD in clinical science. So working to identify what works best for [00:04:00] kids in the public schools with the primary goal of giving, getting that evidence into the hands of speech language pathologists. And so now I get to do both, right? I get to work with SLPs and continue working with families and kids with LD, um, DLD, um, and then contribute to, um, the evidence in our field on what works best for working with.

So when I'm not doing that, I'm mama to two girls and two fur babies and, um, trying to survive Texas heat right now. 

[00:04:31] Kate Grandbois: That's amazing. Well, we've just had a heat wave here in New England, so we feel you, we don't, we don't often get the extreme heat, but I enjoy a lot of heat. You mean not so much? I don't. Um, but we're really excited for this conversation because one of the things that we talk about a lot on this podcast is how not only what constitutes, quote, evidence in our field, but also how difficult it can be for us to apply that evidence based on all the barriers we have in our workplace settings [00:05:00] between, uh, caseloads and caseload versus workload. I bring this example up a lot. I have a colleague here in the area who worked in a school with a caseload of 144.

Oh, and I can promise you she was not reading research articles in her spare time. So, no. Um, I know. So we have a lot of barriers, uh, in our, in the regular in and outs of our day to applying evidence based practices. And we're really excited to talk to you about what it is and how, what are some action steps that we can, uh, take to improve that.

But before we get started, I do need to read our learning objectives and disclosures. So, learning objective number one, describe the importance of clinically relevant answerable questions when engaging in evidence-based practice. Learning objective number two, list three ways a busy SLP can stay on top of the external evidence outside of continually reading research articles. 

Learning objective number three, discuss how to be a cautious consumer of information and ways in which external [00:06:00] evidence may be incorporated and applied in clinical practice disclosures. Mary Beth. Mary Beth Schmitt’s financial disclosures. Mary Beth receives salary support from NIH for a current study related to treatment intensity.

She receives compensation for her role as EBP brief editor Mary Beth is employed and receives a salary from University of Texas, Austin. Mary Beth received an honorarium for participating in this course. Mary Beth Schmitt’s  non-financial disclosures. Mary Beth is an ASHA member.

Kate, that's me, my financial disclosures.I am the owner and founder of Grandbois Therapy and Consulting, LLC and co and co-founder of SLP Nerd Cast. My non-financial disclosures. I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy and the Association for Behavior Analysis International and the corresponding Speech Pathology and Applied Behavior Analysis special interest group.

[00:06:57] Amy Wonkka: Amy, that's me. My financial [00:07:00] disclosures are that I'm an employee of a public school and co-founder of SLP Nerd Cast, and my non-financial disclosures are that I'm a member of ASHA. I'm in special Interest Group 12, and I serve on the AAC Advisory Group for Massachusetts Advocates for Children. All right.

We did it. We made it through the learning objectives and our disclosures. Dr. Schmitt, why don't you start us off by telling us a little bit about the importance of an answerable clinical question when engaging in evidence-based practice? And this is the piece that gets me very excited, because I think asking questions is such, such a key piece.

So talk to us a little bit about that, please

[00:07:37] Mary Beth Schmitt:. Yeah, thank you. You know, and this is one, Oh my gosh, I wish I had understood the value of this earlier on in my profession, honestly. Right? It's kind of that idea of focusing your intention. And we're in this profession where [00:08:00] thankfully, you know, the evidence guiding our profession and guiding our practice with our clients is growing, is growing exponentially.

That can also be really hard, right? There's a lot of information out there. And so if, if you go in thinking, Oh, I need to, I need to do more research, or I need to go get more continuing ed, or whatever the case may be, you run the risk of kind of either ending up down a rabbit hole, right? Or not really even being sure why you're going to gather more information in the first place.

Um, and so that just broadly speaking, it, it really helps narrow in and identify why are you even looking for more information? What is it that you're needing? Who on your caseload is needing support? Um, what's not working well? What, where are you stuck? Right. That can really kind of orient our thinking and orient our [00:09:00] focus so that when we do have a couple extra minutes to go find some extra information, it can be really targeted, um, and fruitful time.

[00:09:09] Amy Wonkka: And I feel like this, when I, when I read the article on EBP, that kind of sparked our, our desire to connect with you. Um, and we'll link it in the show notes. You know, It, it did for me. It's, it's, what is this saying? You're trying to take a drink from a fire hydrant or, you know, like, like there's so much, there's so much information out there, um, that the idea of having this pretty specific clinical question that you are using, to funnel your information just makes a lot of sense.

We've talked a lot on this show about the importance of clinical questions when we're conducting assessments, right? What are we, what are we trying to find out through our assessment or yeah, what are we trying to find out through our data collection and progress monitoring? Um, so I feel like the idea of having an answerable question in [00:10:00] mind when we're pursuing professional development or we're reading, trying to find what articles we want to read makes, makes such a big difference.

You know, I mean, Kate and I work in the field of AAC and there there are so many articles. Like if I was just saying I need to learn more about AAC, well geez, that is a fire hydrant worth of articles. Where do I start?

[00:10:23] Mary Beth Schmitt: That's right. You know, and the other piece of answering the asking a clinically relevant and answerable question is arguably there's a lot in your practice that's working well.

Right, Like there may be a lot of components that you don't wanna change. And asking that question really kind of helps you as the clinician disentangle those of like, okay, if I'm looking at it from outcomes perspective, or maybe I'm looking at it from just kind of overall wellbeing and [00:11:00] functioning, you know, my client's functioning in their, um, kind of in their given environment, You know, whether that's school or work or, um, with their family units or whatever the case may be.

And so knowing, okay, what's the metric that I'm looking at? What am I using to base my decision on? And then when I look at my clients like, Okay, what's working really well? Let that be. Not that we can't continue to finesse when we are presented with new information, but just if we're initiating this, what's working well?

Okay, awesome. What's not, you know, who's maybe not making progress that I'm surprised by, or who's somebody new on my caseload that maybe is carrying a diagnosis that I really don't know enough about and I'm not sure how to adequately and competently address. Um, maybe who's doing okay in my clinic setting that is really struggling to generalize and I'm needing some support there.

And so really [00:12:00] being able to kind of separate out what are you already doing well, and then where do we need to focus some time and some energy. 

[00:12:10] Kate Grandbois: That brings me to a question I, as you were speaking, Thinking about this component of the answerable question. So you know, there are a million questions we can ask about our clients, particularly if you're working in a setting as a quote generalist, right?

And our scope of practice is so wide and you're expected to treat everything on your caseload or anything that walks through the clinic door or what have you. And you do come in contact with an individual who carries a diagnosis, as you said, that you're not familiar with, or even if it's a diagnosis you're familiar with, but something about the clinical presentation feels out of your scope of competence and you have so many questions.

What, how do you identify what is an answerable question versus going to the literature and drink, trying to drink from a fire hydrant, it's such a [00:13:00] great analogy by the way. It just gives you this visual of like, it's just being so overwhelmed, fight by so much information. So what would you say is an, how can you reframe a question to be an answerable question?

[00:13:12] Mary Beth Schmitt: It's a great question. Um, it's a great question is my questionable question.

So I guess common, and I didn't come up with this, this is in the literature of, um, you know, even back, uh, rooted in medicine and potentially even before that. But, um, is this idea of a pico question. So it's standing for P I C O, the, so identifying the patient population. And so that can be very, very specific.

Um, or it can be. Um, kind of a larger population. So it might be, you know, for my, [00:14:00] for my six year old client who has, um, whatever apraxia and dysphagia and is an AAC user would, and then the I and the C are too contrasting or, um, competing interventions that you're curious about. Would I kind of, maybe some new approach that you've heard about or see something that's more like a control or more, more commonplace.

So see, you might think about as kind of what you're already doing, you know, so what is it that you're already doing, Whether that's, um, a therapy approach you're using, whether that's, um, maybe the setting in which. You're, you're providing intervention. Um, maybe it's the dosage, maybe you know, something, it doesn't always have to be an actual intervention, but something about the decisions you're making on behalf of that patient.[00:15:00] 

So the thing of that, as you see, then the eye is, well, what are some other options? Right? And so whether that came from, maybe you're, and we're gonna get to this a little bit later, hopefully, but, um, you know, maybe you're, you're listening at a conference and you hear a new approach that you've never heard of before, right?

And so that becomes your “I”. And then, “O”, is what are, what outcome are you looking for? You know, is it, um, you know, improvements on particular goals, you know, over the course of six months? Is it dismissal? Is it generalization to a new context? You know, what, what outcome are you looking for? Maybe it's a reduction in negative behavior.

Maybe it's an increase in communicative functions, right? So it kind of goes back to what even brought you to the question. What, what got you to the point of I'm stuck and I need to ask a question. What, what is it that's stuck? And that, [00:16:00] that's really your O 

[00:16:03] Amy Wonkka: when I see where that can be so much more helpful than just going into it saying, I need to learn more about apraxia and AAC.

Right, Right. Because then, then you're, you'r , I don't know, you're putting a, a nozzle on your fire hydrants to extend our, our, not that great analogy further, um, . But I think, you know, 

[00:16:23] Kate Grandbois: it's a perfect analogy. It's the perfect analogy for this experience

[00:16:28] Amy Wonkka:because the, the information that's out there, and we, and we've talked a lot about research because I think that that's, We typically think of, or it's what I typically think of anyway when I think about evidence.

But you've also mentioned things like conferences, you know, we'll talk a little bit more about some other places that we can get information as SLPs. Um, and when you add all of those pieces in there, you add in social media, you add in conferences, you add in books you might read. Right. Uh, it's a lot of information.

So by having these questions, and maybe we might have a few [00:17:00] questions related to this client. We have a client where, 

[00:17:02] Mary Beth Schmitt: you know, absolutely. 

[00:17:03] Amy Wonkka: We might say, Oh, the, I feel like we're not making effective pro, I'm a school based person. So I think in terms of like, FAPE and things like, so if we're not making effective progress, I might have a couple of different goals.

I might have a couple of different questions. Um, so it's really helpful to have that, that framework, that PICO framework to sort of help create those questions. 

[00:17:24] Mary Beth Schmitt: You know, when you raise a really important point with that, Amy, of, you know, when we talk about evidence, you were talking about the different forms of, of evidence.

You as the clinician bring evidence, right? And so maybe, maybe you are at a loss, you're like, it's not going well. But I don't even know where to begin on forming a question one one way. And this would just be one approach would maybe track some data for a little bit, right? Of, especially, especially if this particular client, if you have someone with seemingly similar [00:18:00] diagnoses, right?

To where just the diagnosis itself, your intervention itself, like everything else is, seems to be similar. What, what is it about this one? And, and track the data. Um, it doesn't have to be for long, you know, depending on what your, what your experience is. Um, but yeah, and see if you can narrow down of like, well, interesting, you know, this, I'm seeing this client for a different amount of therapy than the other one.

Or, I'm seeing this client with five kids and the other one I'm seeing individually and or, right, like it could be just the structure. I'm kind of leading to another, another way of thinking about it. Take data and look at, look at the client, but then look at kind of the other components of what does the structure of the therapy look like?

What does the process of it look like? So what interventions are you trying? What materials are you using? Um, and see if the data doesn't kind of [00:19:00] pinpoint some directions to let you then start, start asking some questions. 

[00:19:05] Amy Wonkka: Well, and that's really connecting to that. When we think about ASHA's evidence based triangle, you're connecting that clinical expertise with the internal evidence, Right?

Our observations about our individual client and another piece I loved that you brought up. I think sometimes we think a lot about the actual intervention or treatment package, right? Am I doing, am I gonna do, you know, a motor based approach? Am I gonna do a cycles approach? What type of approach am I going to use?

But there are other variables that could be at play. Like, it literally could be as simple, and I say that with air quotes because scheduling is, is anything but simple. But you know, it could be something as simple as the size of your group or maybe what time of day you see the client. Or you know, there's a lot of different environmental and client variables that could be at [00:20:00] play too that you might wanna just take a second to reflect on.

Like should that be a question too? And, And that question might not be so much answered in the research. Right. That's probably gonna be answered more through internal evidence. 

[00:20:14] Mary Beth Schmitt: That's right. Or at least initially, right. To be like, Oh, interesting my. We're just kind of stuck on the, Or I'm stuck on this one.

You know, like it's something structural, like I'm noticing a difference between my large groups and small groups. Interesting. I wonder if there's something there or, or I'm noticing something different in my afternoon groups versus my morning, you know, is there something connected to time of day or is there something with basic needs of food and just fatigue?

And you know, there's some studies coming out now about sleep and kids with, um, communication disorders, right? So it even that of just like pausing enough to take some data to be like, Oh, interesting. I'm seeing this pattern that can then lead you to some of the [00:21:00] external evidence. And as you say, not not end up so overwhelmed with like, I don't even, I don't even know where to start.

And then the flip side, I don't know where to start. I don't know what to read and then I have no idea whether or not to implement any of it. 

[00:21:13] Kate Grandbois: And I just for the sake of emphasizing the importance of this triangle, as you said, and how they all influence one another. Um, I know I mentioned this, um, in our conversation before we hit the record button, but so often as a professional culture, we're in the culture of our profession, I guess I should say.

We think of evidence as research articles. We think of evidence as, um, this, this component of external evidence, but there really are, there are. It's so important to consider your internal data collection and your client perspectives and values and your clinical judgment because all of these components work in tandem together and influence each other.

And I love the idea of relying on those to help bring you to the clinical [00:22:00] question, to find the external pieces of evidence as opposed to just going straight to the external evidence. Because that's when you get the, and I'm just gonna keep saying it, fire hydrant drinking experience

[00:22:11] Mary Beth Schmitt:. That's right. 

[00:22:14] Amy Wonkka: Which nobody really wants.

[00:22:15] Kate Grandbois: Nobody wants that. We want, That's what happens when you, like not a fire something or when you like, go to the as of wire and type in your research, your research terms, your question, terms like AAC, you're gonna get thousands and thousands of hits. That's not helpful.

[00:22:29] Amy Wonkka: Just this morning I was in a Google hole,

It's, it's real. 

Kate Grandbois: I believe you. 

Amy Wonkka:It's real. It happens. It's real. Um, . I think one other piece, just reflecting back on the evidence based triangle that may help you form your question to begin with is that client, patient and caregiver perspective. So we've talked a lot about, right, We've talked about generating that question based on our own feeling that something maybe isn't working, but maybe it's, it's something that a caregiver brings to you.

Maybe [00:23:00] they have a question and you're like, Hm, I'm not sure I can find out about it.

[00:23:03] Mary Beth Schmitt: Absolutely. Absolutely. And you know, this is something I've been kind of trying to disentangle with my students. Some of, sometimes I wonder if, if using this term, uh, with speech language pathologists as us being the experts, were the language experts, were the communication experts inadvertently puts us in this weird shame place where it's like, ah, I'm the expert.

Like I, I have to know. Like, I can't ask a question. I sure. I can't let anybody else know I don't know. And, and that's just a bunch of lies, you know, But I, but I see it happening more and more of like, This huge weight of responsibility. And um, and it's interesting, there's been some pieces I've read on [00:24:00] what do you even mean by experts?

And the people who study expertise talk about it as not knowledge but your process. They're like experts. 

Kate Grandbois: That's interesting. 

Mary Beth Schmitt: People who, right, who process information really, um, efficiently in their area to come to a decision. They're not the owners of all the knowledge. It's just based on their training and based on their years of experience, the way they process and implement data coming from research or, or, or information, um, is a more, much more efficient and effective process than that of a.

[00:24:41] Kate Grandbois: I love that. That makes so much sense. Yeah. I think 

[00:24:45] Amy Wonkka: and, and I think that, I mean, we talk all the, like our scope of practice is huge, so huge, physically impossible to know all of the things. And even when you sort of hyper specialize in one area, it's still impossible to know all the things. Yeah. [00:25:00] Nobody knows all the things.

Um, and so I think with that, it's also really empowering to like cut yourself some slack and remember like you are not a human dictionary or encyclopedia, I suppose, but you're, you're just somebody who's there to help filter through that information as, as a more informed consumer, um, who can integrate that information.

I think that's, that's such a good point. 

[00:25:26] Kate Grandbois: And sort of, and tying it back to what you said before about the process that we go through to come to a decision that is this, Would you say Pico, p i c o? Yeah. You know the framework to come to a clinical question. So if you are in a position or if you're listening and you have someone on your caseload or someone in your clinic that is very, feels very overwhelming to you.

You have a lot of clinical questions. You're feeling like you're out work, operating outside your scope of competence or on the fringe of your competency. Taking a minute [00:26:00] to use a framework like this PICO framework to bring yourself to a clinical question, I would have to imagine alleviate some of those feelings of fear or overwhelm or, or being overwhelmed and based on your description of expertise, continues to put you in a place of comfort and competence in using the knowledge that you have. Um, I, I feel like it's very uncomfortable for me to say that anyone is an expert in anything because I, I've been practicing for 15 years.

I feel like I know nothing. Right. You know? Cause like we are by our code of ethics beholden to life an exercise of lifelong learning. So it feels a little weird to say that we're experts in something. Um, but I think, you know, to your point, we do need to make sure we feel confident helping families and knowing that we do have master's degrees and we do have, you know, fighting off imposter syndrome by using frameworks like this to carve out the, the good clinical questions and seek the [00:27:00] information that we need to feel more competent.

Sorry, that was a long soapbox, sort of tying it all up together. 

[00:27:06] Mary Beth Schmitt: Yeah, no, that's exactly right. And then that's where that third piece of the triangle of your client comes into play of, if we redefine expert as being an efficient kind of, um, synthesizer of information, then it allows our families to be experts in their, um, their family member, you know, whether it's their spouse or their, um, parent or their child or, you know, whoever it is.

And then the clients themselves to be experts of themselves. Um, and I think just more and more, um, you know, especially when our. Our culture is different than that of our clients. Our linguistic background is different or just we're just different. And so allowing them to be experts in the position that they bring, in, the, the needs that [00:28:00] they have, their, um, their wishes and desires, then it allows them to be a part of that EBP triangle.

And it increases the likelihood then that whatever decision we end up making, um, is something that's gonna be working for them, right? That it, it'll be effective for the clients we're serving. 

[00:28:20] Amy Wonkka: I thousand percent agree. And I think that it's all almost impossible to allow other people into the expert club if you're holding onto your, your expert label so tightly.

And so, yeah, it really, to provide client centered care, you need to let that go. You need to let that, that expert hat hang up on the, on the hat rack. 

[00:28:45] Amy Wonkka: I'm going to ask a question that sort of brings us into our second learning objective, because we've talked a lot about forming that question. So let's say we have our question, It was informed by our clinical judgment, [00:29:00] internal evidence, caregiver perspectives and values.

How, how can we, how can we seek out sources of information? That could be research articles, but could also be other places, Like how do we stay on top of these types of things? Um, as busy SLPs?

[00:29:16] Mary Beth Schmitt: I appreciate this question so much because honestly, it's a question I'm always asking myself too, like, even as a researcher, I mean, it's my job to stay in the literature and it's hard to keep up with all the things and research is, let's just be frank, like it's hard to read. If I've got some time and I'm like, I would like to do a little extra reading, research articles are not gonna be what I choose. Like it's a different genre if we weren't trained in how to read that genre, that's hard. Um, and then understanding whether or not it's good research, right?

Whether or not we should even pay attention. Like that's hard. And [00:30:00] so that could be its own conversation that it is important to know the research. Like I, I think we can say that, right? Like to be at the top of our license to be experts in pr, in processing all this information, we do need to know, um, what the current research is, because I hope that our field looks different in another 10 to 20 years.

But I hope the evidence we have to guide individual, um, practice and specific care for our caregivers and our patients looks different in 10 to 20 years. But if I'm not connected to that, Then I run the risk of being very irrelevant and potentially even doing damage and causing harm. And so, so then I think the question is like, okay, maybe you wanna look at the research.

Awesome. And I've heard of SLPs that'll do like journal clubs with people in their community, whether, you know, if they're in the schools, it could be other teachers and maybe admins, [00:31:00] um, maybe it's other SLPs if they're in the hospital, you know, maybe it's their rehab unit. And they'll, they'll pick an article across these disciplines, right?

So like, even for SLPs, like in the schools, maybe it's an educationally relevant article. Maybe it's something in special ed. Maybe it's something you know, more specific to occupational therapy, you know, where it's related, right? But not specific, but they pick an article, everybody reads it, and then they have conversations about like, what did you get out of it?

How do you see this applying? And, and I love that model, right? For one, for busy SLPs, it becomes a little bit social, right? And so it's, it's section time, it's it's community building, and then you're with other people and other brains to really think about is this relevant? If so, what could this look like in our, in our field and in our specific setting?

Um, how would do we wanna try it and with whom? So I [00:32:00] think that's one way to stay pretty close to the research and the research articles, but doing it in a way that might be a little bit less overwhelming and less lonely. Honestly, you rely on other smart brains too, to really 

[00:32:13] Kate Grandbois:maybe pour yourself a glass of wine or, or have your journal club meetings and rest.

I'm just thinking of myself and what I, what would make it more enjoyable. But the other thing I love about that suggestion is the ability to digest it with peers. Uh, the ability to brainstorm actual application from the research. So, you know, this research article, so much of the research that's out there is not, exa is not about our exact client.

It's not about the exact presentation that we see in the school or in the clinic, right? It, it involves materials that happen in the lab or it, you know, it involves an intervention that's not replicable in your setting. So sitting with colleagues and trying to come up with ways to extend this research from the [00:33:00] lab into your setting in a way that is applicable and doable.

Is, is a huge, um, one of the things I think we're, we are missing so much of in our field is that extension of the research. So I love the idea of doing this with colleagues to brainstorm. More brains are always better than one brain. We say that here all the time. But the same is true for your own, for your own setting.

And anyone who is listening who is interested in this, I highly recommend having a conversation with your supervisor or your administration and advocating for something like this in your workplace setting so that it becomes a cultural norm of your job.  um, to any, you can, you can get cert, you can get CEUs for it if an administrator provides a certificate of attendance for you, so you can find a way to work it into your workplace setting.

Um, you can also schedule it at a bar. I, I, I fully support that choice after work hours, if that works for you, . Um, [00:34:00] but just trying a, trying to find a way to make something like that a part of your schedule is, I guess my point can be a really nice way to, to integrate it into daily habits or your monthly habits or what have you.

[00:34:11] Mary Beth Schmitt:Yeah. And thinking about, you know, you were saying, you know, lab focused in the research to, um, more like real world scenarios. But the other, the other thing to think about with the articles too is like, don't be afraid of the SLP to have an article that doesn't actually have kids. Or sorry, I default to kids.

That's just my world, but doesn't have persons with a communication disorder as the focus, I cannot tell you how much I have learned and how much has informed a pico question by reading educationally relevant articles. Where they were do, they were looking at mechanisms happening in classrooms. Cuz guess what?

That's where our kids are. And so by looking at that, that turns into a pico question. Like, oh, interesting. Peers matter for kids with typically developing language. Does that [00:35:00] matter for kids with who have a language disorder? Or, you know, maybe whatever that looks like in a hospital setting or in a nursing home or whatever.

So don't, don't automatically dismiss research that doesn't have your specific population in it, that that becomes your pico question. Could this also relate or have an impact? Maybe yes, maybe no. And then you take your data to, to find out. 

Amy Wonkka: It's such a good, Oh, sorry, go ahead. No, sorry, go ahead. 

Mary Beth Schmitt: Nope, I was gonna move on to another idea.

[00:35:33] Amy Wonkka: Oh, I was just gonna say, I, I think that that's such a good point too, that everything that we learn, whether it comes from our field, an allied field, um, is going to help inform. Everything that we're doing moving forward. Even if you read something and you think, ah, that that seems weird and I don't understand it very much, you're still more informed.

You know, it's something that somebody in a different discipline might be doing. It might raise some [00:36:00] questions for you. It gives you some background knowledge in the future if you encounter that approach again. Um, so there is this piece of, Yeah, we, it's, it's not just as, I mean I love me at ASHA Journal, but it's not just ASHA journals, um, that we can look at to gain information.

And I think you were gonna tell us maybe about some other ways to get this information too. 

[00:36:18] Mary Beth Schmitt: Yeah. These are just other ideas. Um, you know, but maybe stepping outta your comfort zone a little bit or widening your. Call it kind of diversifying your feed. It doesn't have to be over social media, but like what conferences are you going to, you know, and maybe, maybe you need to, you know, the state associations or Asha, maybe that makes the most sense just because you can go and get all of your continuing it.

Awesome. Then maybe carve out some sessions that are specific to research, right? And so you, you already have your pico questions in mind, or maybe not. Um, but in each kind of topic area, there's some that are more, [00:37:00] um, clinician focused. Like they're more practicality of like, here's what to do, you know, Monday morning with your clients and their new ideas.

And those are, those have a lot of value. Maybe one way you can start to broaden and get in some of this research is to go to a couple research focus talks that align with either a pico question or they align with one of your, um, population groups. Or there's something, there's something relevant in the title and the abstract of the research to your practice.

And it doesn't have to be your whole conference, right? But, I think going into these research presentations and even the posters like that could be an accessible way. You know, because there you can talk with the researcher, you can kind of engage in a more in depth way. And so that might be an easier entry point if you've never really considered going to a research talk before.

Um, and then [00:38:00] don't expect the research to have all the answers, right? It we're still going back to that triangle, so you're going to get a just more information to maybe guide your answer of your people question to guide kind of how you look at the data that you're collecting. And so don't expect it to have all the answers, it's just, it's just one more piece.

And so that would be something I would encourage you of just where are you when you're up for your continuing ad, What's your go to? And broaden that maybe to include some that are, are more research focused. 

[00:38:37] Kate Grandbois:That's a great suggestion. Thanks . Go ahead. 

[00:38:44] Amy Wonkka: I feel like that's a great tip. Um, I also have done, because I work in a school, I've done some continuing education geared toward educators, and I personally have found that to be very helpful.

Yeah. Because the school based SLPs, [00:39:00] we are there to help our students access the curriculum. And as an slp that, that can be really daunting. Um, an educator is usually responsible for curriculum within their grade band. Um, if they're a secondary teacher, you know, within their subject area, maybe a couple of grade bands, but an slp, you could be.

Responsible for curriculum K to five or K to six. And so having some understanding of what that means, what are, what are your state standards, all of those pieces, again, are really going to help, I find, inform that, that pico question that I'm asking. Uh, because without some of that background knowledge and under understanding what the classroom teacher is thinking about, it's really hard to know how to support our students in there.

[00:39:48] Kate Grandbois: And just to, uh, piggyback on that comment, um, there is, uh, one of my favorite terms that I heard over the last couple of years was disciplinary centrism. [00:40:00] So this concept that we think our discipl. Knows we are the experts of communication, as you said, but no, and no one else knows as much as we do, right?

That's absolutely not true, right? And so be the concept of looking, going out of our silos, going into occupational therapy, education, physical therapy, if it's relevant, psychology, um, you know, any additional other field to compliment what the knowledge that we have is incredibly helpful for deepening and understanding of a topic.

Um, that's, that's one comment. And the second is that continuing education, because we are required to do it, is a wonderful vessel through which to acquire more knowledge. And if you are listening, and this is news to you, write it down, tattoo it somewhere on your body, the ASHA CEU is not required. For your continuing education units, you can use courses through edu from [00:41:00] education.

You can use courses from occupational therapy, physical therapy, applied behavior analysis, psychology. As long as you are participating and getting that certificate of attendance and go to the ASHA website, it's real. People don't believe us sometimes when we, when we talk about this. So you can use coursework and webinars and articles and things from other disciplines for maintaining your CS and in some cases your state licensure check with your state licensure.

Um, but just again, just like you said, branching out of your comfort zone and considering other disciplines as part of your continuing education and knowing with confidence that it will count towards your certification, um, and continuing education requirements. It's a tiny soapbox. I had to get on it. I saw it there.

I just, I had to, I had to take it. 

[00:41:46] Mary Beth Schmitt: That’s not a soapbox, that's important information. I'm not sure I knew that. Even . That's good. It's, it's so important. It's huge. It's huge because we end up with this incredible bias, [00:42:00] right? When we're, and it's actually a thing called confirmation bias. When we go, we think we're doing pico, we think we're doing evidence based practice, but we go into our pico question with a huge assumption of what we know the answer to be.

Or we go in looking for confirmation that we're right. And so by broadening, by listening to other disciplines considering the wholeness of our clients, right? And they're not just this unidimensional creature that only needing support with communication, Maybe yes, maybe no. But they have all these other influences in their lives, like I think that's just really important information all around.

So thanks. 

[00:42:41] Kate Grandbois: You're welcome. I'm glad I was able to share something of value. 

[00:42:44] Mary Beth Schmitt: It is a lot of value. Yeah, 

[00:42:46] Amy Wonkka: we can, we can link some information in the show notes to the ASHA and CMH article maybe.

[00:42:49] Kate Grandbois: Yes. And they changed the name of it just to make it more confusing. It's now pdh. So professional development hours.

You need 30 professional development hours. Not Asha CEUs. Asha [00:43:00] CEU is a brand that they sell. And that's all I'll say. 

[00:43:03] Mary Beth Schmitt: Okay, I love that. You know, And then for another idea, um, they're speaking of ASHA too, but not just ASHA. There are some resources where, some of the work has already been done. So like ASHA has a, a team and there were, and it's an ongoing process of creating evidence based practice maps, um, through their practice portal.

Um, it is evolving, right? So there's not gonna be answers for all of your people questions, but there's a lot there and there's a lot of information, but it's kind of in one space where you can go through and you can, they link the articles if you wanna go look at the articles, but they also do a nice job of summarizing kind of the evidence across a particular topic and whether or not there's evidence to rely on from the research or whether it's still kind of uncertain.

And what that lets you know is how much [00:44:00] more you need to rely on the other pieces of. Right. So if, if information is kind of new, um, there's not enough there to be definitive about, great. You take that as more information, but then you, you go and rely on that other internal data your client needs and those perspectives to really make the, the decision if the evidence gets weighty enough.

Then you can use that with a little bit more certainty and then still consider the other pieces of the triangle. So those practice maps are real, um, huge asset I think, and something to just kind of keep an eye on and see if anything new is popping up. Um, but there's other, since we've been talking about this particular article, you know, EBP briefs, I'll put a plugin.

Um, it's free, you, it's indexed through Eric. So what that means is if you put in a Google term, there's a chance that some of those topics would come up, or you can go straight to that website and kind of click around. But these are not research articles like your normal research article. These [00:45:00] are written as clinical questions.

So the authors present a clinical scenario, they ask a pico question, they go through the process of kind of compiling different sources of external and internal evidence to come to a decision. And so your decision might be different, but it, the article itself models the process. Um, and then, is the name of the acronym.

E V C A I. I had to write it down for myself cause I, I always get the acronym mixed up, but it's evidence based Communication Assessment and Intervention. They choose one research article and have, um, another author review it. Right? And so they do a summary of the article, but then it's very much we geared towards clinicians of what aspects of this research article are worth paying attention to.

And here are some ways you might think about implementation and then maybe what are some of the limitations or cautions that you might [00:46:00] use moving forward. And so that is a little bit more narrow, right? Cuz it's just about one article. But they do a really nice job of choosing some, um, they choose high quality research articles to review.

Um, and then just the clinical connection piece that it's, it's really geared for clinician consumers I think makes it a really helpful resource. 

[00:46:23] Kate Grandbois: That's wonderfully helpful to know. Uh, and I think out of all of the, all of the ways that you've described the, you know, extending our, cont our coursework into different fields or making sure that it's research focused, um, journal clubs, the power of being able to quickly look something up online in between sessions.

I mean, for the backdrop of this is busy SLPs, right? Yeah. So if you have a minute, and you're, and this is also sort of leading us into our third learning objective in terms of where we find our information, right? If you do. Google something. I know we, it's funny to use Google as a [00:47:00] verb cuz it is a company.

Um, but if you're looking something up on the ASHA wire or if you're looking up something up on the ASHA website, um, the evidence based practice maps are very quick and easy at your fingertips in, in comparison to some of these other suggestions. Um, and the EBP EBP briefs, it sounds like it's also a little bit easier to find in terms of quickly looking something up on your lunch break.

Um, you know, in between sessions if you finish up your paperwork early, squeaking this in throughout your day as a means to get access to that information. I. Waiting six months until the ASHA Conference or waiting until, you know, you meet your friends at a bar. In my mind it's in a bar. Maybe that's just because, I don't know, it's just that time of day or something.

I don't know. Um, but, you know, instead of waiting, being able to look something up from a source that you trust, um, either through the EBP maps or the EBP briefs. 

[00:47:57] Mary Beth Schmitt: Yep, absolutely. [00:48:00] 

[00:48:00] Amy Wonkka: And there are other, I mean, I think this brings us to not like a, not a huge discussion, but there are, we're in the age of social media.

There are also private companies that do things like this, that sort of aggregate the research and try and give people the highlights and a digestible format. And I think, you know, one piece with having access to so much information is sort of the burden to use your expert filter processor role to help make good decisions about, you know, kind of the potential biases of the aggregator or wherever you are, you know, receiving your information.

Um, and using that just as another filter when you're assessing the quality of the information that you're getting, getting get, I'm, I'm a little too old for social media, I feel like, so I'm, I'm not a huge fan, but I do think, you know, it's nice to have access to so many things online, um, and. Having this ready access to so much information.[00:49:00] 

Just because something is on social media doesn't mean that it's bad information, but I think we do wanna be thoughtful about the type of information that we're getting. And if you see something on social media, maybe make sure that you confirm that information with some other sources. Um, just being a thoughtful consumer.

[00:49:20] Kate Grandbois: Yes. And here we are at our third learning objective with the, talking about the importance of being a cautious consumer of information. Uh, and you're right, there are private companies that are posting and using social media to disseminate evidence and research based information. And often they will cite a source.

There will be a reference or a research article that is posted in conjunction, uh, We encourage you to go look that up if you, if you see that or do your own investigating. Um, but there are also others that post things without a source, and that doesn't necessarily mean that it's not EBP, but maybe in that instance you could [00:50:00] send them a dm, send them a Facebook message, Hey, I was wondering if you had a reference for X, Y, and z.

And then there is other information that is, that is false, that was posted maybe with the, under the guise of it being EBP. Um, and I know the, the old adage, it's not that old, but everything you read on the internet isn't true. Well, the same thing applies here. Um, just because it is posted in, in, in on social media doesn't necessarily mean that it's gone through the scientific process of research and be, and, and the peer review process of ending up in a journal it may have.

Um, but I think it's really important to make sure in between sessions while we're Googling something or looking something up, or let's face it, 10 o'clock at night, we're exhausted. We're scrolling our feeds before we go to sleep and we see a post that resonates with us because it is related to that pico question that we have.

And we save it and we think, Ooh, I gotta look this up tomorrow. Making sure we consider what that source is. I don't [00:51:00] know if that, that's a mini soap box that I had to go and I speak just for myself, maybe for Amy A. Little bit too. You can correct me, but I dunno if you have anything 

[00:51:08] Mary Beth Schmitt: to add. No, it's very important to be discerning and I would just broaden it, right?

Any information you get, right, Whether it's, you know, published, peer reviewed journal or at a conference or on social media. Like you, you don't wanna check your, um, your brain at the door and just be, you know, be ready for the, the taking. Like really be, um, Yeah, that conscientious consumer I think is important.

But there was something you said cake that, uh, that I think is really important to distinguish when we're talking about EBP, like that, you're talking about Google becoming a verb, right? I think EBP is actually a verb that has become a noun, right? And it's noting yes, it's say more process evidence based, pro [00:52:00] evidence based practice is a process.

I have a hard time saying that, right? It's that process of integrating information that triangle, right? That external information from ideally from a highly credible research, gold standard, whatever, you know, that aspect of it, but your data as your clinician, the information from your client, it's the evidence based practice is the process we use as, um, professionals in integrating information from all of those components to making a decision.

For our clients. For our patients. It's not a product, so you cannot go by ebp. Right? When you're at the exhibit halls and somebody is saying like, Hey, we have an evidence based, um, tool to use Monday morning, no. Nope. Actually they don't. Right? That's a marketing tool. [00:53:00] No. There, there might be some value in that new material, right?

There might be something about that particular product that you wanna consider for your clients, but you can't go buy that and then check the box of, Now I have done evidence based practice, right? There's not any one thing that is EBP. It's a process that you are constantly using as the expert with your clients and the, the decisions that are made change it. They change when any element of that triangle changes. So if the client you're thinking about changes, if you get new information that changes, your data changes, it changes, right? And so it's, I think that's such a critical point. Like if, if people hear nothing else, right?

EBP is a verb. It is a process that we are supposed to constantly be [00:54:00] doing. You can't go by it. 

[00:54:03] Amy Wonkka: So would it be fair to say, just thinking about that third learning objective, that the way that we are incorporating that external evidence in our EBP is by engaging in that process, by engaging in that thought process.

And I think you make such a great point about. You know, it's, it's not just social media. Social media is where we see a lot of things in quick, quick and easily digestible bites. Yeah. Yeah. But it is also conferences. It is also the books that we read or the articles that we read and engaging in that process.

I, I love, I love the idea that EBP is not a noun it's a verb. Um, and I think that that gives clinicians also a little bit of flexibility to think about. Right. It's, it's not a place that we achieve. It's not a place that we get to. We don't reach the, the mountain of [00:55:00] EBP that're always working on engaging in EBP.

[00:55:03] Mary Beth Schmitt: Yeah. Yeah. It's constant. I mean, that's also a little exhausting,

[00:55:14] Kate Grandbois: Especially thinking about the backdrop of people with really high caseloads and. You know, no time to eat lunch and taking paperwork home and working on the weekends. If you're thinking, I mean that, I feel, I'm thinking about myself listening to this episode. I'm feeling very overwhelmed about not needing to know the research and needing to read the research.

And it's a process that's never over. But I, I, I, I wanna emphasize that this is a doable thing in small increments when, and something that we can integrate into our daily routines without it feeling like a really overwhelming process. Um, either through some of these strategies that we've already talked about [00:56:00] or just continually reflecting on your clinical question and coming back to that, um, over and over again.

[00:56:07] Mary Beth Schmitt: Right. Right. Cause I think that's important, right? It's, if e EBP is constant, then it's just, it's a mindset we stay in of. It would be easy enough to show up, do our therapy, go home and just show up, do therapy, go home, you know, on repeat, but show up and then be interrogating, right? Of ourselves and of our practice.

And so maybe you're not changing EBP also doesn't mean you're changing something every day, right? And it doesn't mean you're doing a total gut overhaul of how you're doing intervention. It's a process of you're constantly asking yourself questions. Is this working? How do I know? Where could I tweak? How can I like, kind of keep my toe right in the waters of new information coming out through the [00:57:00] research so that I do know when there's something interesting enough that I need to give it consideration.

And so I think that's important for listeners seeker too, by saying that we're constantly doing EBP. That doesn't mean you're constantly changing. It's just you're constantly kind of staying in that curiosity mode. 

What's working.

[00:57:19] Kate Grandbois: I love that curiosity mode. Yeah. That's such a, that feels doable. I can wear, I can wear a curiosity, but I'm gonna make a t-shirt that says curiosity mode

That's gonna be our maybe in our, in our makes a merch or something. Um, I wonder if, I know we've already talked a little bit about this in terms of, uh, when we were talking about discussing articles with colleagues in clinical application, but in our last couple of minutes, I wondered if you could tell us a little bit about how we can take some of that external evidence if we don't have access to colleague discussions or if we don't have access to a journal club, what are other ways in which we can consider the external evidence and make it [00:58:00] clinically applicable.

[00:58:01] Mary Beth Schmitt: Yes. So it's, Can I just say first that it's hard and there's no one right way to do it, but it can be if we say in curiosity mode, right? It can be, I think, accessible. And so what I would recommend is don't trade out on everybody unless you want to, Right? But, you're maybe you go to a conference and you hear something new, or you read an article and you're like, Oh, that's interesting and it gives you some information on your pico.

Maybe you start with one or two clients or one or two groups that, um, that inform the Pico question, right? The one or two who maybe aren't making yearly progress or you've been struggling to know exactly how. Start there, and then this is really important. Take your own data. If you can, I would even recommend, depending on what you, what it is you're wanting to change, take some weeks' worth of data before you change anything.[00:59:00] 

Maybe you already did that to lead up into your pico question, then implement it again just with a couple of your clients and take more data and then see are you noticing a difference? Um, is it working really well? And then you're like, Oh, that actually wasn't too hard. I'm seeing this noticeable change.

Maybe I wanna try it then with another client or with another group. Um, and that way too, it gives you the freedom to try new information or new evidence, even if your specific client wasn't represented well in the research. Right, because that for so many of us, that's true. Like we're working with very heterogeneous populations and if we're waiting for the research to give us exactly who we're working with, we're gonna be waiting a long time.

And so that EBP really allows us to, Okay, here's this tidbit that sounds interesting, but now I'm gonna implement it using my professional knowledge. I'm gonna take data on it. So [01:00:00] now I'm using my internal evidence plus their needs and their buy-in and looking at it holistically over time. 

[01:00:08] Kate Grandbois: I love this.

I love this, I love this. I think that's so often, at least I'm reflecting on myself as a new grad. Reading this research and thinking that if I didn't replicate it almost to a T. Or if I didn't take the whole intervention package, it, you know, breaking off a little bit, a little bit of it and applying it through with my clinical judgment and with measurement, internal measurement felt like cheating.

It felt like I was being naughty, like I was, I was doing, I wasn't doing the, the serve, doing the, the research justice is what I'm trying to say. Yeah. So being given permission to do that and also feeling comfortable and confident that that is our evidence based practice process. This feels, it just feels real nice.

So thank you for clearing that up. 

[01:00:56] Amy Wonkka: Well, and I love the data collection and internal [01:01:00] evidence piece as well, because it's just another way to think critically about that information. So we're thinking critically about the source. We're thinking critically about, you know, is this something that's been replicated a lot?

And then we're also thinking critically about, But what does it mean for my client? And, and I think you can't have that last question answered if you're not collecting some internal evidence and the idea of having some data from before you start the intervention, I also was like air fiving you in my brain because I think, you know, you need to sort of know what was going on before to know if it was helpful or not.

You know, when, when you, when you changed your intervention or you changed your approach or you changed some variable. So all of that makes so much sense. Um, and I think really allows clinicians to integrate all of those pieces of the evidence based practice triangle. So yes. Good stuff. 

[01:01:54] Kate Grandbois: In our last couple of minutes, do you have any parting words of [01:02:00] wisdom or if there are any SLPs or teachers or anyone listening who feels a little bit overwhelmed about embracing, truly being able to embrace EBP within their, within the restrictions of our very busy schedules?

What, what, what pieces of advice do you have?

[01:02:15] Mary Beth Schmitt: You know, I do. Um, A couple of things. One, I think it really does start with, we talked about the, the curiosity, um, redefining expert kind of growth mindset like that, that is a huge piece of EBP, right? So like starting there, you don't even change anything. Maybe it's just a year to be really curious.

and write those curiosity questions down. Maybe you spark conversation, right? There's no paper anywhere in, in sites. You're not reading anything. It's just like, Huh, this is something I'm noticing or this is, [01:03:00] this is has me thinking. Like, let's face it, we're all facing a lot of challenges right now. Um, there's a lot to be curious about that, that don't come with a lot of answers.

And so that's where I just like, give you permission, right? Like, I dunno that it's mine to give, but if it helps, 

Kate Grandbois: that's wonderful. I'll take it.

Mary Beth Schmitt: Okay. Well, and I just, I don't think we give ourselves enough credit for our, our mind and like our head space. And so staying curious, remember that this is growth mindset, so there is no idea of perfecting EBP It's just this showing up.

Showing up for ourselves, showing up for our clients, staying curious. You don't own all the knowledge, you're not supposed to own all the knowledge. So expertise is just this constant refinement of asking questions, being curious about it, gathering information. Um, and then if it's helpful, it [01:04:00] has been helpful to me honestly.

And so I'll share, um, I started on social media starting to follow researchers who try to get their work out there in a digestible form. My lab is trying to do that and we are so grateful for followers who are giving us feedback on like, what's helpful, what's not. 

[01:04:21] Kate Grandbois: Um, and how can our listeners find you?

Tell us, give us all your in contact information that you're comfortable sharing.

[01:04:26] Mary Beth Schmitt: Well, we had to have an acronym, right? Because Hello SLP. . So we are, and I'll give this to you guys, but we're @UT cuz I'm at UT Austin. Um, we're @UTCL3Lab cuz we're the children's language literacy and learning lab.

And a little alliteration there too, like Love it. All of it. . So @ut CL3lab. Um, and right now we're on Facebook and Instagram, but that is really part of our mission. Our mission is to [01:05:00] do research related to kids in the schools and parcel it down into digestible bits for SLP that they can take it and consider it.

Like just consider it. Um, and that's another, another thing that we've been doing, both on the, So you can find us on our website and then you can find us on social media, on our website. We also have these one page PDFs, um, of research articles that SLP can. To start conversations with parents that can take an into IEP meetings, to their administrators, teachers, to the journal club that is like, here's some evidence that I want to think about.

Can we use this? And so we're trying to put out that digestible information that, that SLPs can just take and use. Um, but why I started on all that, that is all true. We're also talking about like, okay, so here's some new research information, [01:06:00] right? And using this analogy of the swimming pool, because it's really hot right now in Texas.

So, so this idea of you don't have to completely gut your practice and start fresh, that maybe you're just at a point of sitting on the side and dipping your toe in. And that looks like starting conversations, right? Just asking questions, staying curious, engaging in conversations. Maybe you're ready to float.

Like, you don't wanna get your head wet yet. You're willing to get in the water. Um, and that's the gather data. Maybe you're already doing some of what research is suggesting works, you just haven't paid attention to that component of it because you're making a thousand decisions for your clients every day, right?

And so just gather your data, ask some questions, really look a little bit deeper into the research, and maybe you're ready to dive down into the defense, right? And so then we will, we'll give some strategies of like, Okay, if you're ready, here's what the research suggests. Here's how to [01:07:00] kind of shift the structure.

Here's how to shift your groups. Here's how to work within the constraints of your current situation. And so that's some of the work that we're doing behind the scenes to try to give that to SLPs. But I would just, I would also share that mindset with them, right? Of EBP. Again, it's that curiosity staying in that head space.

And so you get to decide what's feasible for you in terms of actual implementation. 

[01:07:32] Kate Grandbois: That was so massively helpful and so clear, and thank you so much for being here and sharing all of your wisdom with us. Um, we're really, really grateful for your time and we'll have all of the resources that you mentioned listed in our show notes.

We'll have your contact information and your website and all of the downloads, um, and resources listed there as well. So if anybody's listening in your commuting or jogging or folding laundry or whatever it is you're doing, all of those links will [01:08:00] be at your fingertips, available in your phone, your podcast player or what have you.

Thank you again, so, so much Mary Beth, and 

[01:08:09] Mary Beth Schmitt: thank you for having me. 

[01:08:12] Kate Grandbois: Yeah, this has been a real pleasure. Thanks so much.

Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

Brand block indicates course is an introductory level course offered for .1 ASHA CEUs. SLP Nerdcast is an ASHA Continuing Education Approved Provider.