Clinical Forum  |   January 2011
Questions About Certainty and Uncertainty in Clinical Practice
Author Affiliations & Notes
  • Nickola Wolf Nelson
    Western Michigan University, Kalamazoo
  • Contact author: Nickola Wolf Nelson, Western Michigan University, 1903 West Michigan, Kalamazoo, MI 49008-5355. E-mail: Nickola.nelson@wmich.edu.
Article Information
School-Based Settings / Research Issues, Methods & Evidence-Based Practice / Attention, Memory & Executive Functions / Clinical Forum
Clinical Forum   |   January 2011
Questions About Certainty and Uncertainty in Clinical Practice
Language, Speech, and Hearing Services in Schools, January 2011, Vol. 42, 81-87. doi:10.1044/0161-1461(2010/09-0046)
History: Received July 7, 2009 , Revised January 14, 2010 , Accepted February 2, 2010
Language, Speech, and Hearing Services in Schools, January 2011, Vol. 42, 81-87. doi:10.1044/0161-1461(2010/09-0046)
History: Received July 7, 2009; Revised January 14, 2010; Accepted February 2, 2010
Web of Science® Times Cited: 2

Purpose: This article offers a critical response to Kamhi’s (2011)  essay regarding the need to balance certainty and uncertainty in evidence-based practice (EBP).

Method: 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.

Conclusion: 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.

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