Referrals, Screenings, & Assessments

Week 2

Referral Process: Who refers children with suspected communication disorders?

Parents

Pediatricians/medical specialists (ENT, dentists)

Community Organizations (Regional Centers)

Teachers/school staff

Referral Process: How are referrals handles?

Each school/agency handles their referrals differently. Usually a checklist or referral form. Paper trail should be established when starting a referral.

What are some Preventative measures for young children not keeping up with their age and or grade?

Can be referred to a program that can provide..

Language Enrichment

Socialization

(Often offered by preschools)

Programs for parents (Hanen)

Response to Intervention (RTI)

Response To Intervention (RTI)

School based approach to supporting students who need extra help in subjects like reading and math

Response to Intervention: purpose

An approach designated in the individuals with Disabilities Education Act (reauthorized in 2004; last amended in 2015 with the Every Student Succeeds Act) to identify students with learning disabilities and determine their eligibility for services.

Response to Intervention: who and what is it for?

Students with learning disabilities.

If despite high quality instruction and remedial instruction, the student is still struggling academically, they will then be referred for a special education evaluation.

Response to Intervention: Who is it NOT for?

Students with disabilities such as Autism Spectrum a disorder, Intellectual Disability, and severe speech-language disorders will NOT benefit from RTI.

What is the goal of RTI? What are the tiers?

To provide universal screenings, high quality instruction, progress monitoring, and multi tiered instruction that gradually narrows, in regards to what students need.

Tier 1: School-wide Interventions 80-90%

Tier 2: Core Instruction + Targeted Interventions 5-10%

Tier 3: Core Instruction + Intensive Interventions 1-5%

Case history: Where to find the information?

A thorough interview with a parent can get you most of the information needed. However sometimes you will need it from other professionals. IEP can have information as well.

Case history: what information are we looking for?

Identifying information: Full name and date of birth; If parents live together; Primary address, etc

Language(s) exposure and preference

Current and past communication skills

Past history of speech-language therapy

Prenatal and birth history(many communication issues can be caused by this)

Medical history

Allergies/reactions to medication

Developmental history (language and motor skills)

Hearing history (had hearing tested? Chronic ear infections?).

Case History: What are we looking for? (Continued)

Educational History

What support services are already in place?

Social skills/ behavioral skills

Case History goals? To find out…

a) Date of onset difficulty (birth, toddler, preschool aged)

b) nature of communication problems

c) how communication impacts daily life

d) is child aware of it

e) how parents respond to communication difficulty

f) has child received SLP services in the past?

HIPPA?

Health Insurance Portability & Accountability Act of 1996

Why was HIPPA enacted?

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

True or False: It is illegal to request information bout a client that is not reasonably necessary for the clients care.

True

What is assessment?

An assessment is the systematic process of obtaining information and then using that information to make a judgment or a decision about something.

For an assessment to be beneficial, what must it have?

Foundational Integrity

The foundational integrity of an assessment may be ensured if each adheres to these principles:

A good assessment is thorough.

A good assessment uses a variety of assessment methods.

A good assessment is evidence based.

A good assessment is tailored to the individual client.

True or False: A SLPA CAN NOT administer a full standardized assessment tool.

True

How long should a screening take?

15-20 minutes. Should be rehearsed ahead of time.

Procedures: What should a SLPA look for in a testing manual?

Administration of test

Scoring directions should be clearly described in the test manual.

Appropriate for the local population

Procedures for test interpretation (SLP only) should match the local population and be described

Why might a standardized test not be appropriate for a student with linguistic/cultural background?

Does not always align with the cultures of the students we are assessing.

Language used in the test and items presented may not be appropriate.

Is a dialect a disorder? What is a dialect?

A dialect is NOT a disorder. A dialect is a variation in the grammar and phonological rules that are adhered to by identifiable groups of people.

When screening, what specific skill(s) do you need to assess? What should you check for before screening?

Making sure screening/baseline includes items that are easier and more challenging for student.

Background information (for hearing, vision, allergies, etc)

What are the three types of tests/assessments?

Norm-referenced

Criterion-referenced

Authentic assessments

What are Norm-referenced tests?

Always standardized. Commonly used for assessing individuals with language or articulation disorders.

It compares a child’s performance to the performance of a larger group (normative sample). Test developers can establish the average by administering the test to a representative sample group which establishes the normal distribution.

What are the pros to norm-reference tests?

Tests are most objective way of assessing skills.

Skills of one child can be compared with his age-normed peers.

Test administration usually efficient.

Straightforward administration and scoring.

Cons of Norm-referenced tests

Do not allow for individualization

Tells what a person knows, not what a person learns.

Decontextualized setting, not conductive to real-life use of skills.

Must be administered uniformly to ensure validity and reliability

Not appropriate for may individuals who do not fit cultural profile of normative sample.

What is a Criterion-referenced test?

They identify what a client can and cannot do compared to a predefined criterion.

It assumes that there is a level of performance that must be met for a behavior to be acceptable.

Are Criterion tests standardized?

They may or may not be standardized.

Who are Criterion tests targeted towards?

Used most often when assessing clients for neurogenic disorders, fluency disorders, and voice disorders.

Pros for Criterion Referenced Tests

Objective

Efficient

Widely used

Opportunity for Individualization

Preferred by insurance companies and school districts for reimbursement and legal purposes

Cons of Criterion-Referenced tests

Testing situation is unnatural

Evaluates isolated skills

Standardized criterion-reference test does not allow for individualization and must be administered exactly as instructed to be considered reliable and viable.

Authentic Assessment

Provides context and attempts to measure speech and language skills for relastic everyday functional communication.

Typically ongoing and informal.

Skills are assessed qualitatively.

Can be used for self-monitoring and evaluation

Examples of Authentic Assessment

Systematic observations

Real-life simulations Language Sampling

Structured symbolic play

short answer and extended answer responses

self-monitoring and self-assessment

Audiotaping/videotaping

Involvement of caregivers and other staff.

Pros for Authentic Assessment

Natural approach, simulates real world

Client Participation

Allows for Individualization(useful especially for those who communicate using AAC)

flexible

Cons for Authentic Assessment

May lack objectivity

Procedures not standardized, less reliable and valid

Implementation requires high level of clinical experience and skill

Approach not efficient, requires planning time

Impractical in some situations

Insurance companies and districts prefer known tests.

What are the 3 Psychometric Principles?

Validity, Reliability, and Standardization

Test Validity

A test is valid if it truly measures what it claims to measure

Types of validity

Face validity: looks like it assesses what it says

Content validity: the tests contents are representative of the domain being assessed.

Construct validity: measures a predetermined theoretical construct, a behavior or attribute based on empirical observation

Criterion validity: validity established by a external criterion, 2 types

Two types of criterion validity

Concurrent validity: a tests validity in comparison to a widely accepted standard

Predictive validity: a tests ability to predict performance in another situation or at a later time

Test Reliability

A test must be replicable over repeated administrations and across administrators of the test.

What are the three main types of test reliability?

Test-retest, split-half reliability, rater reliability

Test-retest: a test’s stability over time, compares the scores from multiple administrations; if scores are similar the test is considered reliable

split-half reliability: a test’s internal consistency; the scores from one half of the test are compared to scores from the other half (often odd-numbered compared with even numbered questions)

rater reliability: level of agreement among individuals rating a test.

a. Intra-rater reliability: if results are     

       consistent when the same person rates the 

       test on more than one occasion

  b. Inter-rater reliability: if results are 

       consistent when more than one person 

       rates the test