Assessment Procedures in SLP Exam 1

What is assessment?

a process of collecting as much information as possible in order to determine a client’s communicative ability or functioning

What 6 things can we determine after the analysis of information collected during an assessment?

1. the diagnosis

2. the prognosis

3. whether or not we need to refer the client to another professional

4. the need for treatment

5. if the client needs treatment, the frequency of treatment, and the length of treatment

6. the structure of therapy

The diagnosis: (assessment)

We determine if the client has adequate communicative functioning or not. If there is a deficit or impairment, then we determine what type of impairment

The prognosis: (assessment)

How you feel the outcome will be for the client with intervention

What are examples of other professionals that an SLP could refer their client to?

Audiologist, ENT, OT, PT, behavioral psychologist, general physician

The structure of therapy: (assessment)

• your goals will go under this category

• you will determine if therapy will be client based, clinician based, or a combination of those two

What 4 principles must we adhere to during an assessment in order to maintain integrity?

1. must be thorough

2. must use a variety of assessment methods

3. must be evidence based

4. must be tailored to the individual client

When you become a SLP you will see lots of clients from a wide variety of backgrounds, and we must remain ________ and ___________

unbiased; professional

You must only practice in areas where you are _______ and _________

trained; competent

T/F You need to be aware of your own personal biases

True

We are mandated to follow the code of ethics established by _______

ASHA

A breach of ethics could result in what?

Citations, revoking of license, probation period where you cannot practice

Principles of Ethics: (4)

1. Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities

2. Individuals shall honor their responsibility to achieve and maintain the highest level of professional competency and performance

3. In their professional role, individuals shall act with honesty and integrity when engaging with the public and shall provide accurate information involving any aspect of the profession

4. Individuals shall uphold the dignity and autonomy of the profession, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the profession’s self-imposed standards

It is important to maintain ________ ___________

current knowledge

What is the Code of Fair Testing and Education?

It was developed by the joint committee on testing practices to ensure ethical testing of all individuals regardless of their ethnic group, age, gender, sexual orientation, disability, linguistic background, or other personal characteristics

What code was primarily developed for use with standardized tests?

The Code of Fair Testing and Education

The guidelines of the Code of Fair Testing and Education: (4)

1. Selection of appropriate tests

2. Administration and scoring of tests

3. Reporting and interpreting test results

4. Informing test takers

Selection of appropriate tests (guidelines of code of FTE):

Examiners should select tests that meet the intended purpose and are appropriate for the intended test taker

Administration and scoring of tests (guidelines of code of FTE):

Examiners must follow established procedures for the administration and scoring of standardized tests

Reporting and interpreting test results (guidelines of code of FTE):

Examiners must interpret and report test results accurately and clearly

• this is done on a written evaluation report

Informing test takers (guidelines of code of FTE):

Examiners must inform test takers about the nature of the test, the test taker’s rights, how we will use the scores, and how they can resolve any challenges to the scores

• you must have written consent before you test any individual

What does HIPAA stand for?

The Health Insurance Portability and Accountability Act of 1996

Why was HIPAA enacted or created?

To protect client health information from being disclosed without consent or knowledge

Requirements of HIPAA that affect SLPs are: (6)

1. Clinicians must obtain a national provider identification number

2. All clients must be given a copy of the clinician’s privacy policies

3. All protected health information must be handled confidentially

4. National standards for electronic healthcare transactions must be followed

5. Clinicians must obtain a record of all instances when a client’s information is shared

6. Business associates who manage healthcare information on behalf of a provider must comply with HIPAA regulations

What does psychometric refer to?

It refers to the measurement of human traits, abilities, and certain processes

What are the psychometric principles that we as SLPs follow when evaluating clients? (5)

1. Validity

2. Reliability

3. Standardization

4. Sensitivity and specificity

5. Freedom from bias

Validity:

means that a test actually measures what it claims to measure

Types of validity: (4)

1. Face validity

2. Content validity

3. Construct validity

4. Criterion validity

Face validity:

Means that the test looks like it assesses the skill it claims to test

• this is not a valuable measure of validity because it’s only based on the appearance of the test not the content

Content validity:

Means that a test’s contents are representative of the content domain of the skill being assessed

• ex: a valid articulation test should elicit production of all phonemes. If it does, then it has content validity

Construct validity:

Means a test measures a predetermined theoretical construct which is an explanation based on empirical observations

• ex: there is a theoretical construct that a preschool child’s language abilities improve with age which is based on language development studies

Criterion validity:

Refers to validity that is established by the use of an external criterion

What are the two types of criterion validity?

1. Concurrent validity

2. Predictive validity

Concurrent validity:

refers to the test validity in comparison to a widely accepted standard

• ex: the Stanford-Binet intelligence scale is a widely accepted assessment of intelligence. Newer intelligence tests are compared to the Stanford-Binet, which serves as the criterion measure

Predictive validity:

refers to a tests ability to predict performance in another situation or at a later time

-it implies that there is a known relationship between the behaviors, the test measures, and the behaviors or skills exhibited at some future time

ex: GRE test

Reliability:

• The results of a standardized test can be replicated or repeated

• A test gives consistent results on repeated administrations or with different interpreters judging the same administration

Types of reliability: (4)

1. Test-retest reliability

2. Split-half reliability

3. Rater reliability

4. Alternate form reliability

Test-retest reliability:

Refers to a test’s stability over time

• This is determined by administration of the same test multiple times to the same group, then the scores are compared. If these scores are the same or very similar, then the test is considered reliable

Split-half reliability:

Refers to the internal consistency of a test. Scores from one half of the test should correlate with the results from the other half. These two halves of the test should be comparable in style, scope, and all items should assess this same skill

Rater reliability:

Refers to the level of agreement among individuals rating a test. This is determined by administration of a single test and audio or video recording it so it may be scored multiple times

Two types of rater reliability:

1. Intra-rater reliability

2. Inter-rater reliability

Intra-rater reliability:

This is determined if the results are consistent when the same person rates the test on more than one occasion

Inter-rater reliability:

Established if results are consistent when more than one person rates the test

Alternate form reliability:

Refers to a test correlation coefficient with a similar test

• It is determined by administration of a test form A to a group of people then the administration of the parallel form B to the same group of people. The results of both forms are compared to determine the test alternate form reliability

Standardization (Psychometric principle):

A standardized test provides standard procedures for administration and scoring of the test. You must adhere to those standard procedures, they cannot be modified or altered in any way

Most standardized tests are _____ - _________

norm-referenced

What are the test developers responsible for outlining?

The standardized and psychometric aspects of the test

What is described in the examiner’s manual?

The instructions for administration and scoring of standardized tests

Included in the examiner’s manual are: (7)

1. The purpose of the test

2. The age range for which the test is designed

3. The test construction and development

4. The normative information

5. Administration and scoring

6. Demographics of the normative sample group

7. Evidence of reliability and validity including standard era of measurement and confidence intervals

What is an example of normative data?

the mean is 100 with a standard deviation of 15

What is a confidence interval?

The degree of confidence that the test examiner has that the scores are accurate

Sensitivity and specificity (psychometric principle):

Measures of diagnostic accuracy

Sensitivity:

Tells how accurately a test identifies a disorder

• the higher a test sensitivity is the more likely it will expose or reveal the disorder

• you want you standardized test to have a high sensitivity

• if it has a low sensitivity, then it’s likely the disorder will not be identified which is a false negative

Specificity:

Tells us how accurately a test identifies normal or average (no disorder)

• The higher the test specificity, the more likely the result will indicate no disorder. This is a true negative

• The lower the test specificity, the more likely the test will falsely indicate the presence of a disorder. This is a false positive.

You want both sensitivity and specificity to be ____% or higher

80

Freedom from bias (Psychometric principle):

You want to make sure that your test is nondiscriminatory and so are you

Three types of test bias:

1. Item bias

2. Intrinsic bias

3. Extrinsic bias

Item bias:

This occurs when individual items within the test favor one group over another

Intrinsic bias:

Occurs when a test generally favors one group over another group. This means different groups would get different average scores

Extrinsic bias:

This occurs when outcomes between groups result from societal differences, not the test itself

• this is our own personal bias

What are the 3 basic assessment methods we use?

1. norm-referenced test

2. criterion-referenced test

3. authentic testing

How many assessment methods do we use in order to conduct a thorough assessment?

2

What is the purpose of a norm-referenced test?

allows the comparison of an individual’s abilities to a larger group

• this is called a normative sample

What are examples of norm-referenced tests?

GRE, ACT, SAT

How is the range of scores for a norm-referenced test shown?

it is shown on a bell shaped curve that is symmetrical

What is the average or mean for a standard score?

100

You should never give a norm-referenced test if you …

do not know how to explain the results

Standard deviation:

• how far away the scores are from the mean

• it is 15

What is the average score range a client must score within in order to not be considered impaired?

85-115

Some high functioning autistic clients may score close to ____ because these tests typically don’t test pragmatics

115

How many standard deviations away from the mean do you need to be to have a severe intellectual impairment

3 standard deviations

Mode:

the most frequently occurring score

Empirical rule for a normal curve:

• 68.26% of all outcomes will fall within one standard deviation of the mean

• 34.13% will fall left and right within one standard deviation of the mean

• 95% will fall within 2 standard deviations of the mean

• 99.7% of all outcomes will fall within 3 standard deviations of the mean

Never give a norm-referenced test without first doing what?

reading the manual

All norm-referenced tests are __________

standardized

Advantages to a norm-referenced test:

1. The tests are objective (there is no room for you to insert your opinion)

2. The performance of an individual is compared to a larger group, which means what is expected to be average

3. Test administration is efficient

4. They are widely recognized

5. Clinicians are not required to have a high level of clinical experience to administer and score tests

Disadvantages to a norm-referenced test:

1. they do not allow you to individualize

2. they are static (tells you what an individual knows but not how they learn)

3. the testing situation typically is unnatural and does not represent real life

4. evaluates isolated skills without considering other factors

5. they must be administered exactly as instructed

6. the test materials may not be appropriate for certain clients such as culturally and linguistically diverse clients

What must you know before administering a norm-referenced test?

the client’s chronological age

Raw score:

total number of responses that are correct

Each norm-referenced test has a ______ and a __________

basal; ceiling

How do you determine the basal?

When a client has 3 correct responses in a row

Once you have determined the basal…

everything above the basal is automatically correct

Ceiling:

the stopping point

• three consecutive wrong answers

How is a standard score determined?

by converting the raw score to a standard score based on the client’s chronological age

What does the standard score of a norm-referenced test tell us?

it tells us if the individual’s performance is average, below, or above average

Standard score above 115 =

above average

Standard score below 85 =

below average

Standard deviation:

the statistical variation within the normal distribution

What score is considered impaired?

test performance below 1 standard deviation of the mean

Percentile rank:

tells the percentage of individuals that are scoring at or below a given score

What is the difference between a standard score and a scaled score?

the mean and standard deviation are different

Mean of a scaled score:

10

Standard deviation of a scaled score:

3

When do you use a scaled score?

When a test has multiple subtests

• you convert the raw score to this type of score

Stanine score:

a standard 9

• a score based on a nine-unit scale

Each stanine unit except for ____ and ____ is equally distributed across the curve

1; 9

What is the mean of a stanine score?

5

What is the standard deviation of a stanine score?

2