Research-driven decision making is becoming more necessary in the field of speech-language pathology (ASHA, 2004; Frattali & Worrall, 2001; Reilly, Douglas, & Oates, 2004). The medical field pioneered the terminology associated with evidence-based practice and has embraced the concepts associated with melding research and practice (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Sackett, Rosenberg, Gray, Haynes, and Richardson (1996) define evidence-based practice as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research" (p. 71). They add that in addition to clinical expertise and external evidence, the practitioner must consider the patient's wishes (Sackett, Rosenberg, Gray, Haynes, & Richardson).
The field of education has mirrored the medical field by implementing policies and guidelines requiring teachers and other education professionals to follow research-based approaches to instruction (No Child Left Behind Act, NCLB; 2001). The emphasis on research-based instructional approaches is especially adamant in the area of special education (Hardman & Dawson, 2008; Individuals with Disabilities Education Act, IDEA; 2004). Speech-language pathologists have the unique position of being both medical practitioners and education service providers (Johnson, 2006). The push for justification of clinical practices from both the medical and educational side of the profession makes the need for evidence that much more important.
According to Vallino-Napoli and Reilly (2004), speech-language pathologists typically support the need for following research-based practices. However, few practitioners truly understand how to actually make decisions based upon the evidence (Johnson, 2006; Gillam & Gillam, 2006). Zipoli and Kennedy (2005) report that in many circumstances speech-language pathologists are making decisions less on evidence than they are on personal experience and the advice of others.
The present state of research in the field of speech-language pathology is one that addresses the theoretical and etiological questions of the profession with relatively little direct application to clinical issues (Johnson, 2006). However, to successfully defend the professional practices of speech-language pathologists, to increase accountability, and to increase credibility, practical research needs to be conducted and disseminated (Justice & Fey, 2004; Dollaghan, 2004). The current body of knowledge available to practicing speech-language pathologists concerning instructional practices is weak in both quality and quantity (Reilly, Douglas, & Oates, 2004).
Speech-language pathologists are essential members of the special education team and as such they should be well-versed in the benefits and costs of serving students with special needs in a general education classroom setting. It is intended that this article will reinforce the importance of making decisions concerning service delivery based upon the evidence. In particular, the questions addressed are: "What is the foundation for inclusive education?" "What, if any, specific attributes and attitudes are associated with successful inclusion programs?" and "What evidence exists to support a full inclusion model over pull-out services?"
Legal and Historical Foundations for Inclusive Service Delivery
The education of students with special needs was specifically addressed in Section 504 of the Rehabilitation Act of 1973. Section 504 is a civil rights law that prohibits discrimination against individuals with disabilities. It states, "No otherwise qualified individual with a disability in the United States, as defined in section 705(20) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance or under any program or activity conducted by any Executive agency or by the United States Postal Service" (29 U.S.C. ?794(a)). It guarantees a disabled child equal "access" to an education and stipulates that a child may receive accommodations and modifications in order to obtain that "access." It does not specify that the "access" must include individualized instruction or support services.