Babywearing consultation and education is blossoming in America and Canada. It is a fairly new field in the English-speaking world, and many educators, retailers, and manufacturers in the industry are struggling to make sense of the myriad opinions floating about. This is where evidence-based practice in babywearing consultation can make things easier.
Evidence-based practice in babywearing consultation
Evidence-based practice has been successfully applied in many fields, but it is especially well-studied within the medical community. “Evidence-based practice encompasses evidence from high-level research, expert opinion, patient needs and values, along with the context within which the treatment is conducted,” explains Leanne Togher, PhD, SLP, in her “Call for Advocacy to Garner Government Support for Evidence-Based Treatments” on the Asha Leader Blog.* In the case of evidence-based practice in babywearing education, I would rephrase her comment as follows:
“Evidence-based practice encompasses evidence from high-level research, empirical evidence, expert opinion, parent or caregiver needs and values, and your own clinical experience, along with the context within which the consultation is conducted.” That is to say, your role as a consultant is to bring together various pieces of information, bring your client in as an equally important piece of the consultation puzzle, and facilitate an outcome that is comfortable for the parent/child dyad and meets everyone’s babywearing needs in an optimal way.
It’s a big job. No wonder people get so overwhelmed.
In evidence-based practice, the first step is to unpack your previous education, knowledge, experience, and assumptions. Most critically, you should examine beliefs you hold strongly and hold them up to the process below. It can be a lot of work to assess information continually. However, data indicates that applying evidence-based practice (or: Research on evidence-based practice suggests that evidence-based practice) provides superior outcomes in the clinical situations in which it’s been studied.
I’ll take a moment here to shout out the BOND Conference in New York City. If you are in the field of working with parents and you’d like to increase your knowledge of the cutting edge research and science related to infant attachment, this is the professional conference for you. Wrapsody is a sponsor because we want you to have access to the information BOND will provide you. There is still time to register — and if you miss the 2016 conference, you should absolutely consider attending in 2017.
Begin applying evidence-based practice to your babywearing consultation work
Critical analysis in evidence-based practice has five steps. It’s best to begin by applying these steps to the information and ideas you already have.
ASK yourself what your beliefs, ideas, or ideals are and form clear, measurable statements for each. For instance, some people may say, “Baby’s knees should be higher than his bum.” This statement needs to be clarified before moving on to the next step. How much higher than his bum? How old is “baby?” Is there a difference between a newborn and a 3 year old? So, perhaps you rephrase your first statement to read, “100 degrees is the optimal angle in which to position a child’s hips between the ages of birth and 5 years.” Turn each belief into a question. For example, ASK: “Is 100 degrees the optimal angle in which to position a child’s hips between the ages of birth and 5 years?”
ACQUIRE the best available evidence regarding the question. Babywearing-specific research is sparse, so you may need to reach out into other relevant fields to find information. Often, you’ll realize that your information came from someone you consider an expert — reach out to find out where THEY got their information so you can analyze it in the next step.
ANALYZE each piece of evidence you’ve collected. Use the hierarchy of evidence chart below. The closer your information is to Level I, the greater the weight you should give it. As you analyze each piece of evidence, go back to your first question until you feel satisfied.
I particularly like this article from the Ebling Library at the University of Wisconsin for information on analyzing information. If you cannot answer the question with quality evidence, then your belief is merely an opinion rather than evidence-based fact. It may still be valid, but you should set it aside for now. The last step of ANALYSIS is to rephrase your question from the ASK step into a statement you might use to frame a high-school paper. “The optimal angle for an average newborn is between x and y, according to [research/data]. This is most important for [population.] By age [x], the precise angle of an infant’s hips becomes less important, but research suggests that [whatever you have concluded.]”
Here, it is important to note that the information you’ve acquired and the examination of your biases/ideas will likely leave you with four central categories of statements. It may be helpful, depending on your learning style, to actually write each statement on a slip of paper or post-it note and file it into one of these four categories: Ideas supported by research (such as a study comparing oxygen saturations of babies in reclining carseats vs. flat crib mattresses); ideas supported by science (such as the statement, “The risk of developing hip dysplasia is drastically reduced in babies over the age of six months”); opinions based on anecdotal/clinical experience that you feel are well-supported after your analysis; opinions you no longer believe are clinically significant/supported by empirical evidence after your analysis (these last ones you’ll likely wish to discard and stop referencing during your consultations — it’s possible you’ll find some of these opinions are based on your own personal experience and preferences).
APPLY your new set of evidence-based information to your clinical practice.
ASSESS previously held ideas regularly as well as new ideas you encounter, regularly moving through this process to ensure you are mindful of the opinions you form and have a self-awareness of your biases.
Sorting out evidence
The process of encountering, re-examining, searching for, and fact-checking ideas is an ongoing process. You will not always begin with “ASK” in the process above. Sometimes, you’ll find yourself acquiring new information. You may analyze that information for validity, then move back to “ASK” to decide whether it applies to a currently held belief of piece of knowledge, or if you wish to add a new idea based on the evidence.
It may be ideas that once passed through the “ANALYSIS” stage and were sorted into a box based on sound evidence will later be discarded based on new information.
And sometimes, you and your colleague may have the same piece of information, you may use the same tests and analyses, but one of you will find it lacking in validity while the other will assimilate it into their practice. That’s ok, as long as each of you have taken the time to examine the evidence. While there are some pieces of information that would seem indisputable — for instance, the force of gravity — there are other things that can be more murky. Sometimes, there is contradictory research, for instance, and you have to measure information against your own experience and other learning.
This is where clinical practice and anecdotal experience can be useful. For instance, if one piece of evidence suggests babies will be best oxygenated in an upright position, and another suggests oxygenation will be best when they are lying flat, you’ll use the information and experience you’ve collected to evaluate both studies and then dive further into the research to suss out the details. Perhaps you’ll connect with colleagues in the same field as your own or in relevant fields. Or, perhaps you’ll encounter a family who have observed that their own baby does better in one position than in another, and you’ll add their experience into the mix.
All of this is ok. It’s the reason why multiple practitioners can exist in the same community — whether that is doulas, babywearing educators, or speech therapists.
The other thing to hold in mind as you sort out evidence is that evidence directly related to your babywearing practice is not enough. You will also want to assess your beliefs about teaching, about follow-up, about learning, and more. All of these things will be subject to the same processes outlined above.
Practicing evidence-based babywearing education
Now that you’ve evaluated each of your ideas, beliefs, and pieces of information, you are ready to bring them to the table at your consult. Don’t forget to leave the “set aside” and “discard” piles at home!
High quality education is about more than sharing research-based and scientifically-sound pieces of information with your customer or client, of course. They are integral to providing high quality service, but there are two very important ingredients to add to the mix.
A quality educator is able to create the perfect cocktail with each experience, adding in equal parts: Research-based evidence, scientifically-sound ideas, their own experience and knowledge gained from consultation work (or other work in their field), and the ideas/values/experience their customer brings to the table.
None of these pieces should hold greater weight than the others. A quality consult balances these four aspects beautifully, using a dynamic interaction to help the client achieve a goal.
ASCERTAIN your client’s goals. Work together to name one or two goals and ensure you’re on the same page.
ASSIMILATE the expertise you bring to the table. This is likely to be a swift and silent calculation. A quality pre-consultation conversation can allow you more time if you are a slow processor of information or like to ponder things for a bit. This includes mentally rifling through the stacks you made earlier — science, research, and clinical experience. You should also consider your client’s preferences before moving on.
ACKNOWLEDGE the pros and cons as you explain your proposed solution. Listen to your client’s feedback and make adjustments to your plan.
APPLY the solution you’ve agreed upon after filtering the four major components of evidence-based practice. This likely means teaching your client to use a carrier, do a certain carry, or make adjustments to the carriers/carry they are already using.
ASSESS whether the solution is a good fit. Does your client or her baby hate it? Do they love it, but you feel the carrier doesn’t fit well? If you need to, move back to through the steps.
Using an evidence-approached to your babywearing business offers you an active and continual loop of self-critique. It offers your clients and customers the benefits of your experience and the confidence that you are bringing them good information that is up-to-date whenever possible. It can influence your product design and instructions if you are a manufacturer, your employee training if you are a store owner, and of course, your consultations if you are in the business if babywearing consultation.
Further, these principles can apply to almost any field, not just babywearing.
Tell me: Are you using evidence-based practice already? Will you begin using it now? I’d love to hear your thoughts!
*”Call for Advocacy to Garner Government Support for Evidence-Based Treatments” on the Asha Leader Blog by Leanne Togher, PhD, SLP
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