Lecture 1 - intro.pdf

Assessment in Speech-Language Pathology Dr Shabnam Abdoola From: Shipley, K. G., & McAfee, J. G. (2023). Assessment in Speech-Language Pathology A Resource Manual (7th ed...

Assessment in Speech-Language Pathology Dr Shabnam Abdoola From: Shipley, K. G., & McAfee, J. G. (2023). Assessment in Speech-Language Pathology A Resource Manual (7th ed). Plural Publishing, Incorporated Stein-Rubin, C., & Fabus, R. L. (2018). A guide to clinical assessment & professional report writing in speech-language pathology (Second edition). SLACK Incorporated.  Systematic process Overview Diagnoses Purpose of of Prognoses Referrals assessment Treatment Assessment recommendations Principles of Thorough Variety of methods foundational Evidence-based integrity Tailored to the client The Integration of Cognitive, Physical, and Social Factors  CPSED: Cognitive Physical Social Emotional Development  It is only in human development that speech and language emerges from the combination of the three. The Art of Active Listening Communication problems are behavioural in presentation They are often complex in etiology. Professional empathy – Clinical trust– Should be maintained throughout treatment LISTENING Providing diagnostic labels Purpose:  Categorize and Describe Disorders  Guide Treatment Decisions  Facilitate Professional Communication Criteria  Comprehensive Data Collection  Use of Evaluation Tools and Observations  Client History Providing diagnostic labels Implications for Clients and Families  Access to Services and Resources  Potential for Misunderstanding  Impact on Treatment Effectiveness Challenges  Avoiding Stigma  Ensuring Accuracy  Preventing Overgeneralization Providing diagnostic labels Ethical Considerations  Adhering to Ethical Guidelines  Transparency About Diagnostic Basis  Sensitivity to Client Impact Providing diagnostic labels  Disorders of behaviour have to be defined behaviorally. How?  an agreed-on convention of criteria (through research and study)  Diagnostic and Statistical Manual of Mental Disorders (DSM-5)  This catalogue of disorders provides a scholarly basis on which trained health professionals may make a diagnosis. Providing diagnostic labels A competent and active SLP needs to speak about findings using the latest and most agreed-on diagnostic-labeling entities. This helps to:  establish clinical expertise and can also help create and maintain client trust,  it allows the client and his or her family to investigate corresponding literature and support groups and to conduct personal research involving the disorder,  thereby increasing knowledge and enabling informed participation in the treatment process.  disorders of communication might need to be treated by multiple partners of varying training or disciplines. ifspeech and language are the product The SLT as a of CPSED, then those health professionals who deal primarily with healthcare cognitive (e.g., psychologist, psychiatrist, professional teacher), physical (e.g., physician, occupational therapist, physical therapist), or social-emotional (e.g., psychologist, social worker, psychiatrist) issues may play an equal or even primary role in the treatment process. D- developmet  Maintaining professional integrity Distinguishing between imposter Professional syndrome vs. lack of knowledge Expectations for Clinicians Seeking knowledge by accessing resources Being aware of biases and prejudices Code of Ethics Related materials Ensures the Provides ASHA website has welfare of our framework for additional Scope of Practice clients and professional information about Preferred Practice protect the activity the Code of Ethics Patterns for the reputation of our Profession of Speech- profession Language Pathology Position Statements Practice Guidelines and Knowledge & Skills Practice Portal  Principle of Ethics I Responsibility to hold paramount the welfare of persons they serve Rules of Ethics Principle of Ethics II Code of Responsibility to achieve and maintain the highest level of professional competence and performance Ethics Rules of Ethics Principles of Ethics III (cont.) Act with honesty and integrity Rules of Ethics Principles of Ethics IV Uphold the dignity and autonomy of the professions, maintain inter- and intraprofessional relationships, and accept self-imposed standards “I don’t think I am ready” Rules of Ethics Code of Fair Testing Practices in Education Developed by JCTP SLPs are obligated to follow guidelines Developed primarily for use with standardized tests in educational settings Principles also apply to informal testing situations and settings   Selecting appropriate tests that meet intended purpose and are appropriate for intended test takers Code of Fair  Administering and scoring tests Testing correctly and fairly Practices in  Reporting and interpreting test results accurately and clearly Education  Informing test takers about the nature (cont.) of the test, rights and responsibilities, use of scores, and procedures to resolving challenges Important The science of measuring human traits, abilities, and processes Psychometric  Validity Principles  Reliability  Standardization  Freedom from bias   Test truly measures what it claims to measure  Face validity  Content validity Validity  Construct validity  Criterion validity  Concurrent validity  Predictive validity   Results are replicable  Test-retest reliability  Internal consistency, also called split- half reliability Reliability  Rater reliability  Intrarater reliability how consistent an individual is.  Interrater reliability how consistent different individuals measuring the same thing  Alternate-form reliability, also called parallel-form reliability Standardization you must interpret with caution if the child is not in that age range  Standardized tests, also called formal tests, provide standard procedures for administration and scoring  Standardization is accomplished so that bias or other influences do not affect outcomes  Technical manuals should include information about  Purpose  Age range  Construction and development  Administration and scoring  Normative data and demographics of sample group  Evidence of validity and reliability Sensitivity and Specificity  Measures of diagnostic accuracy  Sensitivity - How accurately a test identifies a disorder  Specificity - How accurately a test identifies normal (i.e. not disordered)  Sufficient sensitivity and specificity typically defined as.80 (80%) or higher Freedom From Bias  Test is wholly appropriate and nondiscriminatory in all aspects  Types of test bias  Item bias  Intrinsic test bias  Extrinsic test bias  Results obtained from poorly constructed assessments are potentially harmful  Purpose is to draw a conclusion about an individual’s communicative abilities  Obtaining information from others Assessment  Ethnographic interviewing Methods  Direct observations  Analyzing speech-language samples  Assessing dynamically  Administering standardized tests   Information gathered from client or caregiver patient report outcome measure  PROMS are standardized tools  Gathering information from various sources and perspectives Information  Multiple options Case history forms from Clients   Questionnaires and inventories and Others  Rating scales  Checklists  Interviews  Advantages  Disadvantages  Enables clinician to understand and appreciate concern from client/caregiver’s point of view Ethnographic Allow for open-ended informant- Interview driven responses to build trust, to listen to client’s concerns Provides a safeguard against bias   Direct observation provides information about client’s communicative function in natural situations  Different forms of observation  Naturalistic observation Observation  Systematic observation and contextual analysis  Simulated observations and structured play  Advantages  Disadvantages   Critical for understanding client’s communication skills  Ranging from 50-200 utterances Speech-  Obtained in spontaneous situations and then analyzed Language Many disorders can be better Sample  understood when a speech-language Analysis sample is obtained/analyzed  Advantages  Disadvantages   Purpose is to evaluate learning potential  Test-teach-retest method  Skill is measured to determine current performance Dynamic  Clinician teaches strategies (MLE) Assessment  Skill is measured again and results are compared  Allows clinician to determine baseline ability and identify appropriate goals  Advantages  Disadvantages Standardized Tests  Also called formal tests  Norm-referenced tests  Always standardized  Criterion-referenced  Identify what a client can and cannot do compared to a predefined criterion  Most are standardized  Advantages  Disadvantages Standardized Tests (cont.) Administering and Interpreting  Read the manual Accommodations and Modifications  Detail changes main in final report  Accommodations: minor adjustments that do not compromise a test’s standardized procedure  Modifications: changes to standardized administration protocol Standardized Tests (cont.) Determining Chronological Age  Exact age of a person in years, months, days  Chronological age calculators available online and as apps  When assessing prematurely born infants/toddlers, determine adjusted age  Also called corrected age  Less relevant for children over age 3 Standardized Tests (cont.) Basals and Ceilings  Basal: starting point  Ceiling: ending point Obtaining a Raw Score  Initial score based on number of correct/incorrect responses  Not diagnostically meaningful, alone Standardized Tests (cont.) Normative Data  Also called norms  Establish a distribution of results; depicted using bell-shaped curve  Height and width of the bell dependent on  Mean  Standard deviation  Median/Mode  Empirical rule for a normal curve  Established by testing a norm group, or standardization sample Standardized Tests (cont.) Understanding Normed Scores  Standard score  Standard deviation  Percentile rank  Scaled score  Z-score  Stanine  Age equivalence Standardized Tests (cont.) Confidence Intervals  Range of scores in which the test taker’s true score is likely to be  Increases reliability of a test  Many test developers report a confidence interval of 90% and 95%  Useful for clients who obtain borderline scores An Investigative Rationale When we conduct an evaluation to determine eligibility for services, we may often use a static assessment. In this approach to an evaluation, there may be a requirement to use a particular test or battery of tests or to adhere to some arbitrary or pre-established protocol. When we conduct an evaluation in a clinical problem-solving context, our ongoing interaction with the client is essential. An Investigative Rationale This kind of interaction requires rapid clinical decision making and often greater skill in its execution. This investigative approach is a dynamic assessment and, although more challenging in nature, it is much more rewarding for both the client and clinician involved in the process. A dynamic assessment begins with the first contact (often via the interview). The task at hand is to respond to the actions, questions, statements, concerns, and performance of the client(s) as effectively and efficiently as possible. An Investigative Rationale It continues throughout the evaluation and is part of subsequent treatment sessions as well. Observing the response of the client to the therapy Important to consider which questions should be asked