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Chapter 7 • Alternative and Augmentative Communication 201

identify and evaluate their own preconceptions in relation to the clinical case in hand.
Linked to this, it seems, are the ways in which practitioners draw on their own and others’
clinical experience; a second component of EBP.
Clinical Experience

Clinical experience may be described as an individual’s or team’s ‘proficiency and judge-
ment’ (Sackett et al., 1996), based on the build-up of theoretical and clinical knowledge,
patient engagement and reflection on past patient outcomes. As such, the importance of
reflective practice is enshrined in best practice standards. Equally, practitioners’ continu-
ing professional development (CPD) would seem a cornerstone of clinical proficiency and
judgement. However, while the need for training is recognised (Enderby et al., 2013), train-
ing in AAC as part of professional qualification (e.g., for speech and language therapists)
appears limited, and postqualification AAC-related CPD is patchy and often limited in
focus. Often, CPD is related to operational aspects of technologies (Wallis et al., 2017) and
not to wider issues of clinical assessment and implementation.

Best Research Evidence

The third component of the EBP framework concerns research evidence. For clinicians,
difficulties can exist in acquiring, identifying and then evaluating the quality of research
evidence. Gaining access to published evidence can be difficult for some clinicians, and
the numbers of clinicians specialising in AAC may decrease as focus falls on other areas of
public spending, further reducing the ‘pool’ of expertise available.
The identification and evaluation of evidence also presents challenges to clinicians
in the field. A recent review of research published in the Augmentative and Alternative
Communication Journal in the last 30 years identified a growth of research activity in four
key areas: (1) intervention research; (2) descriptive studies; (3) experimental studies; and
(4) instrument and measurement development (McNaughton and Light, 2015). Of the
intervention studies, the vast majority (85%) focused exclusively on the person using AAC,
although the authors note that a growing proportion of the other studies (15%) examine
training and change in communication partners. This would seem encouraging given that
the field of AAC is, by default, concerned with human interpersonal interaction, which is
itself a collaborative enterprise between conversationalists albeit with varying communi-
cation resources at their command (Clarke, 2016).
While a growing body of evidence is available, a universal issue for practitioners,
patients and their families and their advocates concerns evaluating its value, that is,
its trustworthiness (Smith, 2016). To tackle this, a number of guidelines for evaluating
existing evidence have been made available (Hannes et al., 2010). However, the assump-
tions on which guidelines are based have been questioned by some researchers. For
example, the traditional hierarchy of evidence positions randomised controlled trials
(RCTs) as the gold standard for generating trustworthy evidence. However, as Gugiu
notes, this can mean that poorly conceived and constructed RCTs can be rated more