Assessment Midterm

What are the purposes of assessment?

• gain and integrate information abt client

• determine diagnosis / lack thereof

• translate deficits and strengths into treatment planning

What kind of actions are included in the assessment process?

gathering, integrating, and interpreting multiple sources of evidence

Assessment should always be ________ and incorporate __________.

Person-centered, multiple methods

What are the clinical reasoning questions we have used throughout this semester? (5)

1. What do we know?

2. What are we assuming?

3. What is missing?

4. How could we find out?

5. What are we not yet ready to conclude?

What is the role of the referral question?

gives us a starting point; tells us what we should examine

What are we responsible for in terms of EBP and professionalism during the process of assessment? (5)

• Prioritize client welfare

• Maintain clinical competence

• Practice honesty and integrity

• Use assessments fairly

• Collaborate with other
  professionals

What is the purpose of norm-referenced assessment?

to compare a client’s skills to their same-age peers to see if their skills are developmentally appropriate (“How does my client compare to the average?”)

What is the role of the normative sample for an assessment?

they are the comparison group used to interpret performance; measure client’s scores against this sample; their scores are used to construct the normal distribution

mean

average score; calculated by summing all scores of normative group and dividing by n

standard deviation

the average amount that a score differs from the mean (in the normative sample); reflects statistical variation w/in the normal distribution

standard score

signals a score’s distance above or below the mean; is a score avg, above avg, or below avg?

scaled score

tells us how an individual compared to the norm; do not necessarily follow a normal distribution; have a mean of 10 and SD of 3

percentile rank

signals the percentage of the norm group who scored at or below that score

confidence interval

shows uncertainty; an estimate of the likely range one’s true score is in (eg. We are 90% confident that Johnny’s true score is between 66 and 78)

growth scale value

compare a client’s score to their own past performance; better show progress in Tx, especially if a client has severe deficits (at which point differences in ability don’t even show up in a standard score)

age-equivalent

compares the client’s raw score to the average raw score of an age group (e.g. Johnny’s “age equivalent” is 3;6 because his score was equal to the average raw score of kids this age)

Does a standardized test score alone justify a diagnostic conclusion?

NO!

What does standardized administration mean?

consistency in administration, scoring, and interpretation

basals

the starting point of an assessment; usually based on age or perceived abilities (e.g. start here for ages 5;0-7;0)

ceilings

the ending point for test administration; usually based on age or performance on assessment items up until that point (so many in a row wrong = discontinue)

What happens if you depart from standardized procedures?

standardized scores are no longer valid, BUT you can still get good information from the assessment

Why does considering the normative sample before giving an assessment matter?

Some normative samples are not very culturally, linguistically, socioeconomically, or racially (etc.) diverse, so the assessment might not be representative of people like your client and therefore the test may not be “normed” for them

reliability

the extent to which the results of an assessment are replicable

Why does reliability matter?

so we can measure our client’s progress over time and know it is due to genuine improvement rather than assessment inconsistency; resistance to outside influences

validity

the extent to which a test truly measures what it claims to measure

Why does validity matter?

so we can actually identify and treat the people who need therapy, and not unnecessarily treat those who don’t

sensitivity

how accurately a test identifies a disorder (true positive); sensitivity = TP / (TP + FN)

specificity

how accurately a test identifies normal (true negative); specificity = TN / (TN + FP)

If a test has proven psychometric properties, is it appropriate for all clients? Why or why not?

NO. Consider the makeup of the normative sample, access issues (physical limitations, hearing, etc.), cultural/linguistic considerations, administration time and format, age, suspected diagnosis, etc.

Why must hearing be considered during speech-language assessment?

if a client cannot access the assessment content, they will do poorly regardless of the ability levels; hearing loss may be the CAUSE of speech-language difficulties; we need to consider hearing access when writing our CTPs

What is the purpose of a hearing screening? What are its limits?

• Purpose: to determine if a client’s hearing needs further testing

• Limits: cannot diagnose hearing loss, susceptible to false pos. if OM or hidden hearing loss is involved, 500 Hz level is difficult to hear if there is any ambient noise at all

What is in the SLP’s scope of practice as far as hearing goes?

screening, referring to audiologist for comprehensive evaluation, referring to ENT/primary care for medical concerns, aural rehabilitation, parent education (NOT EVALS OR REMOVING WAX/OBJECTS FROM EARS)

How can hearing influence assessment performance and interpretation?

• grammar modifiers may be missed (-s, etc.)

• those with hearing deficits would have difficulty following spoken directions, perceiving quiet/high-frequency speech sounds, learning unfamiliar words (+protowords), responding in background noise, sustaining listening across long sessions, and understanding without visual/contextual support

What are some appropriate next steps after a client performs poorly on a hearing screening?

• ask parent about medical history, medications, last hearing screening, signs of ear infection?

• if a persistent concern, refer to audiology

• make sure ears are not blocked with wax/foreign objects

• postpone testing until access can be ensured

Compare and contrast norm-referenced and criterion-referenced assessments.

Norm-referenced

• client’s performance is compared to a normative sample

• always standardized

• Advantages: objective and evidence-based, efficient, requires little clinical skill

• Disadvantages: inherent margins of error, not individualized, may not be functional/representative of real life, may not be appropriate for some clients

Criterion-referenced

• compares client’s performance to an expected level/criteria

• sometimes standardized

• Advantages: easy to individualize and make it functional for the client, good for measuring specific skills, more fitting for diverse individuals

• Disadvantages: might not be backed up by as much evidence, may be more susceptible to bias and less reliable, requires more clinical skill

Which 4 elements must be present in a criterion-referenced probe?

skill, conditions, criterion, and opportunities

Criterion-referenced measures and informal evidence allow us to describe what a person ____ ___ and under _____ __________.

CAN do; what conditions

What are some strengths and limitations of criterion-referenced and informal procedures?

How do criterion-referenced and informal assessment measures complement standardized assessment evidence?

• Lets you see how a client performs in more naturalistic/functional contexts and if that differs from a more structured context

• allows examination of both the age-appropriateness of general abilities and the functional impact/presentation of any deficits

In addition to being reliable and valid, assessments must be appropriate for ___ _________, _______ ________, and ___________ _________ _____.

the individual, the referral question, the decision being made

What are some cultural and linguistic factors that may affect assessment performance and interpretation?

intrinsic bias, extrinsic bias, item bias, assessment is not in 1st language, multilingual individuals may develop language differently, unfamiliarity with pop culture/everyday items

Name some limits of standardized language scores for diverse individuals. (Girolamo et al., 2022)

doesn’t consider intersecting identities; may underestimate or overestimate abilities; not normed for these individuals; attempts to norm have included sample sizes that are too small

When should a score or procedure be interpreted cautiously?

assessment not normed for client’s background/age group, when you know there is intrinsic or item bias occurring, when personal factors such as fatigue or unfamiliarity with test items play a role, when dynamic assessment/modifications were performed

What should you do if you need to report assessment scores/performance for a client but you know there may have been biases involved?

DOCUMENT IT and INTERPRET how these biases may have impacted performance; can still salvage some useful information from assessment tho probably

What are some guidelines on clinical competence, appropriate test use, and professional responsibility in terms of assessment?

• Prioritize client welfare

• Maintain clinical competence

• Practice honesty and integrity

• Use assessments fairly

• Collaborate with other
  professionals

What are some clinical reasoning questions we can ask ourselves before trying to assign a diagnosis? (7)

1. What is the referral question or the decision we are trying to make?

2. What evidence do we have? What do these pieces of evidence contribute?

3. What factors could influence the evidence or its interpretation?

4. Where do findings converge or diverge?

5. What information is still missing?

6. What are we not yet ready to conclude?

7. What would be the most appropriate next step, and why?

What are the main elements/steps of the complete assessment process? (6)

1. Referral question and assessment planning

2. Case history and interviewing as sources of evidence

3. Observation and contextual information

4. Internal and external factors that may influence performance

5. Integrating information ACROSS SOURCES, not interpreting in isolation

6. Identifying additional needed evidence before concluding

What is the ICF?

• International Classification of Functioning, Disability, and Health; created by WHO

• aims to create a more holistic and biopsychosocial view of how disorders/disabilities affect the individual

What does the ICF include?

• body functions & structures

• activities

• participation

• environmental factors

• personal factors

psychometrics

the science of measuring human traits, abilities, and processes

What are the basic principles of psychometrics?

validity, reliability, standardization, freedom from bias

accommodations

adding supports that are allowed by a standardized test and won’t change its validity (more time, large print, etc.)

modifications

more drastic changes that void the ability to interpret a test as standardized (eg. editing or omitting items, providing cues

If you make any accommodations or modifications to a standardized test, you should…

DOCUMENT THEM and note that standardized scores may not be valid in the case of modifications

Why do basals and ceilings matter?

they help us obtain accurate scores and make administration more efficient

What are some factors that influence performance during assessment? (6)

• client characteristics and state

• communication access

• environmental/task demands

• communication partners

• assessment conditions

• clinician decisions

How can access concerns influence assessment performance?

may give the impression that a client’s skills are poorer than they actually are (eg. didn’t hear directions/test items, couldn’t read small print, colorblindness, can’t point/other physical deficits, sensory issues, length of test, etc. etc. etc.)

Limitations of norm-referenced measures?

Do NOT independently explain:

• why the performance occurred

• difference vs. disorder

• communication across contexts

• participation impact

• everything needed for diagnosis/intervention

When administering a criterion-referenced assessment/probe or informal assessment, you should always record….

performance, conditions, support, and limitations

In order for an assessment to be useful, it must be:

1. quality

2. appropriate for the individual