Questions about certainty and uncertainty in clinical practice.
OBJECTIVE
This article offers a critical response to Kamhi's (2011) essay regarding the need to balance certainty and uncertainty in evidence-based practice (EBP).


METHODS
Points of concordance and discordance (counterpoints) between Kamhi's essay and the author's frames of reference were considered.


RESULTS
In agreement with Kamhi, a major role is outlined for clinicians to use questions strategically (i.e., acting on uncertainty) to prioritize intervention targets and select approaches that best fit the context and stakeholders' values for purposes of planning, accomplishing, and evaluating change. The first counterpoint emphasizes a need for larger roles for theoretical frameworks involving systems theory and collaborative, contextualized approaches to assessment and intervention. The second notes opportunities for self-correction by using outcome data from relevant contexts outside of treatment sessions.


CONCLUSIONS
Clinicians should capitalize on Kamhi's ideas by working with other key stakeholders to make points of certainty and uncertainty explicit. By generating insightful questions that can guide the process of EBP and gathering evidence from broader outcomes, clinicians can gain external validation for the approach taken or for the need to consider alternatives.
Nelson
Nickola Wolf
NW
Western Michigan University, 1903 West Michigan, Kalamazoo, MI 49008-5355, USA. Nickola.nelson@wmich.edu
D002648:Child; D003299:Cooperative Behavior; D036262:Empirical Research; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D033183:Interdisciplinary Communication; D007805:Language Development Disorders / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D020377:Self Efficacy; D013064:Speech Disorders / Q000175:diagnosis / Q000628:therapy*; D013598:Systems Theory; D035501:Uncertainty