CA 1

Alternate reliability

(also called parallel form reliability) Refers to a test's correlation coefficient with a similar test

components of the standard diagnostic report

1. Identifying information 2. Overview/background/patient complaint 3. Medical history 4. All assessment information 5. Summary 6. Recommendations 7. Signature with credentials

Assessment Information

Articulation and Phonological Processes Language Fluency Voice and resonance Dysphagia Orofacial examination

Non-Standardized Test

Checklists, clinician-made informal assessments, language samples, play samples

assessment

Is the process of collecting valid and reliable information, and then integrating and interpreting it to make a judgment or decision about something

Standardized Test - Formal

Norm-referenced test

What are universal precautions?

Protect all parties from possible contact with bodily fluids and infectious materials

split-half reliability

Refers to a test's internal consistency. Scores from one-half of the test correlate with the results from the other half of the test. The halves must be comparable in style and scope.

Test-retest

Refers to a test's stability over time. It is determined by administering the same test multiple times to the same group and then comparing scores.

Confidence Interval

Represents the degree of certainty on the part of the test developer that the statistical values obtained are true. They allow for natural human variability to be taken into consideration.

Name and identify the sections of a SOAP note.

Subjective Objective Assessment Plan

Face Validity

When a test looks like it assesses the skill it claims to assess. This is not a valuable measure of validity because it is merely based on appearance and quite superficial.

Construct Validity

When a test measures the theoretical information or behavior it claims to measure. "Does this measure behave like the theory says a measure of that construct should behave?"

Content Validity

When a test's contents are representative of the content domain of the skill being assessed. Judges the actual content of the test by individual's with expert knowledge.

IFSP meeting must include

a. Slp b. Audiologist c. Parents or legal guardian d. Nutritionist e. Social workers f. OT g. PT h. Service coordinator i. Psychologists j. Others (interpreters and/or translators)

Individualized Educational Plans (IEP).

a. Written document that describes the services and educational goals that will best meet the child's individual needs. a. These are school aged services (3-21 years old) b. The written document describes the services and educational goals that will best meet the school-aged child's individual needs c. Your assessment findings for a completed evaluation on a school-aged child will be presented in this document d. Special education services for school aged children with a disability are coordinated through local educational agencies, typically school districts * reviewed every year and reevaluated every 3

Norm Referenced Test

always standardized, allow a comparison of an individual's performance to the performance of a larger group, called a normative group Most commonly used for articulation and language disorders Compares your client's performance to that of a larger group (normative group) "norm-reference" You administer and score it according to the rules provided so that everybody does it the same way You can reliably compare your client to what others like them did on the test because the administration and scoring is standardized Helps them to answer the question "how does my client compare to the average?" Helps to answer the question, "How does my client compare to the average?" Test developers determine normative standards that will identify averages for a given test. They accomplish this by administering the test to a sample group, analyzing the sample to establish a normal distribution. The normal distribution proves a range of scores by which others are judged against when they take the same test. Produces a standardized score Examples: · Goldman-Fristoe Test of Articulation (GFTA-3), Preschool Language Scale (PLS-4) The normal distribution of scores and performance is often depicted with a bell curve

Mean

average performance, determines the peak of bell curve, you will use norm-referenced test results to ask yourself "how far away from the average was the client performance?"

All assessment information (SDR)

i. Articulation and phonological processes ii. Language iii. Fluency iv. Voice and resonance v. Dysphagia vi. Orofacial examination

Identifying information (SDR)

i. Client name ii. DOB/age iii. Parent or caregiver name iv. School/teacher/grade v. Address vi. Phone numbers vii. Email viii. Physicians ix. Billing party x. Diagnostic code xi. Date of evaluation

Subjective

i. Contains non-measurable and historical information ii. Statement of problem, current complaint, relevant past history, recent history, client's level of concern, degree of cooperation and overall affect

Individualized Family Service Plan IFSP

i. Early intervention services (stops at preschool age, 3) ii. The written document that describes the services to be provided to infants and toddlers with a disability or developmental delay and their families iii. Your assessment findings for an infant or toddler (2 years or younger) in early intervention services will be included in this document Reviewed every 6 months and is updated at least once per

Objective

i. Measurable findings, examination results

IEP is written by a team that includes

i. Parents ii. Regular and special education teacher iii. Local educational agency (LEA) representative iv. Interpreter/integrator

Overview/background/patient complaint (SDR)

i. Referral source ii. Dates and locations of previous evaluations and treatment iii. Presenting concern

Medical history (SDR)

i. Speech and language development ii. Medical iii. Hearing iv. Psychological/emotional v. Developmental/motor vi. Familial vii. Social viii. Education ix. Occupational

Summary (SDR)

i. Statement if diagnosis ii. Concise statement of most significant findings iii. Prognosis

Assessment

i. Summary, conclusions, and recommendations

Recommendations (SDR)

i. Treatment, no treatment, reassess at later time ii. Referral to other professionals iii. Suggestions to client and caregivers

Plan

i. What is the plan from here?

Z-score

is another expression of test-taker performance compared to the normative sample. Tells us how many standard deviations the raw score is from the mean.

Validity

means the teat measures what it says it measures with empirical and theoretical research that proves it

How to administer DDK

o 1. Instruct the client to repeat the target syllable as quickly as possible until told to stop o 2. Model the sequence and allow the client to practice ensuring the instruction is understood o 3. Say go and start the stopwatch o 4. Say stop and stop the stopwatch after 20 reps o 5. Redo the sequence if the client stops or intentionally slows down before the task is completed o 6. After assessing each syllable individually, evaluate the client for 10 reps of /puhtuhkuh/ o 7. Record finding on worksheet o (if young children have trouble they may say words like buttercup or pattycake instead. § Example · "Repeat the following sounds as quickly as possible until I say stop." (puh) o Model the sequence and allow the patient to practice o Say "Go" and start timer o Say "Stop" and stop the timer at 20 seconds · Repeat the instructions separately for 2 more sound groups (tuh) (kuh) · Repeat the instructions to evaluate the entire sequence together (puhtuhkuh) 10 times

Closing Phase of Interview

o 1. Summarize major points from the body of the interview o 2. Express appreciation for help, time, and information o 3. Say what will happen next (referral, check-in with insurance, etc.) o Summarize appreciation what's next? § Example · "Thank you for all of the helpful information. Now I'd like to spend some time with Sarah and evaluate her speech. In about an hour we will get together again. I will share some of my findings with you"

List the 3 components of the preassessment process

o A written case history (or medical chart review in medical settings) o An interview with the client, parents, spouse, or other caregivers o Information from other professionals

Authentic Assessment

o Also called alternative assessment or nontraditional assessment o Identifies what client can and cannot do o Places emphasis on contextualized and functional testing. o That means the test environment is more realistic and natural, generally in real-life situations. o This type of testing is ongoing - during diagnostic and treatment phases can occur through observation, language sampling, involvement with caregivers, video/audio taping, self-monitioring

speech and language sampling

o Assesses client's communication o Gives you critical information on speech and language abilities in functional contexts and within narratives o Time consuming but worth the effort

Speech and language sampling is good for

o Assessing conversational intelligibility (a patient may produce a specific word clearly but what happens when it is connected to other words in a sentence? We don't speak in single words - we speak in connected speech) o Evaluating rate of speech (and ability to self-monitor own rate) o Can help to determine Mean Length of Utterance (MLU) o Allows you to compare sound errors from standardized articulation tests vs. connected speech o Allows you to informally evaluate voice and resonance

Criterion-referenced test

o Designed to find out if the client has a set of skills not how the client's performance compares to a norm or anyone else's o Identify what a client can or cannot do based on a specific set of skills (criteria) o You will use criterion-referenced test results to ask yourself... § How does my client's performance compare to an expected level of performance? o Most common for adult language/acquired apraxia, swallowing disorders, adult speech production disorders, fluency disorders, voice disorders (may be used for some aspects of artic and language) o May or may not be standardized. Often produces a raw score o Example § The functional communication profile revised o How does my client's performance compare to an expected level of performance? o Criterion referenced tests compare a student's knowledge and skills against a predetermined standard, cut score, or other criterion o The performance of other students does not affect a student's score

Body Phase of the Interview

o Discuss § Communicative development § Abilities § Concerns about communication § Medical, developmental, social, and educational history o Clarify § Information from the written case history and documentation received from other professionals § Examples · "I see here that_______. Can you tell me more? " · "Can you describe _______ a bit more to me? " · I'd love to hear a little more about ______."

Tips for collecting a language sample

o Establish a positive rapport first o Minimize interruptions o Don't talk to fill the silence - be willing to wait for the patient to talk. o Alter the contexts (e.g. conversation, narratives, responses to pictures) o Audio or video record when possible. o Avoid yes/no questions or others that can be answered with only a few words.

How to evaluate and determine speech intelligibility?

o How much of the speech sample could be understood? How clear was the person's overall speech? o Use a speech and language sample (as discussed in a few slides) o Audio or video recording the sample will be helpful for analysis and comparison o Notes: § Consider reporting intelligibility in ranges (e.g. 65-75%) § Compare intelligibility on word-by-word and utterance-by-utterance bases § Word level § Phrase level § Sentence level § Conversational level § Oral reading level

how DDK is measured

o In 2 ways § Counting the syllables produced within a predetermined number of seconds § Measuring the seconds, it takes to produce a predetermined number of syllables

Opening Phase of Clinical Interview

o Introductions, describe the purpose of the meeting, explain the structure of the meeting, projected duration, transition of body interview. o Example: § "Hello, my name is _______, and I am a student clinician here at the University of Arkansas Speech and Hearing Clinic. I will be evaluating your child's speech today, under the supervision of my clinical instructor. Before we get started with the evaluation, I'd love to explain what you can expect from our time together. § 1. First, I'll ask you a few more questions about your child's speech and general concerns so that I can select the best assessment tools for them. § 2. Next, I'll spend some time with your child completing some formal testing. I'll observe their speech skills during some interactive play, storybook activities, and while interacting with other children. § 3. Lastly, we will meet back together to answer any final questions. The entire process should take about ____ hours. Does this sound alright with you? Do you have any questions about the process before we begin? I noticed in your case history report...

dynamic assessment

o Is a form of authentic assessment. Its purpose is to evaluate a clients learning potential based on his or her ability to modify responses after the clinician provides teaching or other assistance o Appropriate strategy when assessing clients with cognitive communication disorders or those from culturally and linguistically diverse backgrounds o Test - teach - retest method

Diadochokinetic Syllable Rates (DDK)

o It the measure of a client's ability to make rapidly alternating speech movements o Also called alternating and sequential motions rates o Provides information about a client's motor and speech planning

How long should a language sample be

o Long enough to obtain a representative sample o Minimum of 50 to 100 distinct utterances

activities to elicit speech and language sampling

o More challenging to complete with patients who are shy, quiet or already exhibit an impaired method of communication or cognitive difficulties (e.g. severe verbal apraxia, poor alertness, low attention). look at examples on study guide o Props to use to obtain a language sample o Speech and Language Sampling: Pictures CDIS narratives

List the 3 phases of a clinical interview

o Opening phase o Body of the interview o Closing phase

List 5 professionals that may give additional information for your evaluation

o Other speech language pathologists o Audiologists o Otolaryngologists (ENTs) o Neurologists o Physicians/ Pediatricians o Psychiatrists o Dentists o Regular/Special Educators o Occupational Therapists o Physical Therapists o Rehabilitation/ Vocational Counselors o School Nurses o Clinical Psychologists o Respiratory Therapists o Social Workers

how to obtain a case history

o Review is completed prior to meeting the client § Starting point for understanding client and reason for referral § Also referred to as an "intake report", "medical chart", or simple as the "case history" § Completed by client, caregiver, and/or spouse o Gives the clinician the opportunity to: § Clarify information § Anticipate areas that will need assessment § preselect appropriate assessment materials and procedures o Make a plan for getting the information you want § what can I get from the written case history? § what additional information do I need from the reports of other professionals § what can I clarify in the patient interview? o Ask yourself § what do I already know? · about this culture · about this disease process or medical condition · about this person · about these services § what do I need to know? § what is the best way to find out what I do not already know? o Limitations of a case history § Client may not understand the terminology § Client may not know or may barley remember certain information (especially if there is more than one child more than one problem) § May be cultural differences § There is not standard written case history form

Why complete a language sample

o Standardized tests § 1. Provide just a snapshot in time of a child's language abilities § 2. Remove the context, social cues, and linguistic demands that a child is confronted with when having to use their language skills in everyday life § 3. Place a high level of behavioral demands on the child, which often makes them inappropriate for clients with attention and behavioral difficulties § For all of these reasons, best practice states that we should be using multiple methods of assessment to be able to provide a complete description of a child's language abilities. § This means that we need to go beyond standardized testing to be able to fully describe a child's strengths and weaknesses, and to be able to write appropriate, functional goals. § Language samples address the weaknesses of standardized tests by providing information about a child's ability to use language in real-world situations.

Recognize common universal precautions.

o Sterilize equipment o Wash hands before and after o Gloves, remove gloves without touching stuff on them, dispose safety o Eye and mouth protection o Gown and shoe coverings o Change clothes if stuff gets on them o Never use single use equipment more than once o Follow policies

how to calculate chronological age

o The exact age of a person in years, months, and days 1. Record the test administration date as year, month, day 2. Record the clients birthday as year, month, day 3. Subtract birth date from the test date. If necessary, borrow 12 months from the year column and add to the month column, reducing the year by one, and/or borrow 30 or 31 days (based on number of days in month borrowed from) from the months column and add to the day's column, reducing the month by one

What are the components of a good assessment?

o Thorough o Uses a variety of assessment modalities o Valid o Reliable o Is tailored to the individual client

Ceilings

refers to the end point for test administration and scoring. The number is predetermined and stated by the test booklet.

Rater reliability

refers to the level of agreement amoung individuals rating a test and is determined by administering a single test and scoring it several times.

Basal

refers to the starting point for test administration and scoring

Reliability

refers to whether test rests are replicable. Does the test give consistent results on repeated administration or with different clinician's judging the same administration?

Standard Score

reflect performance compared to average and the normal distribution. Used to determine whether a test taker performance is average, above average, or below average.

Scaled Score

reflects performance compared to the normative sample.

Age Equivalence

reflects the average raw score for a particular age (or grade)

Standard Deviation

represents the distribution away from the group average (in either direction). We use this to count how far away from mean (average) the client's performance is. WITHIN NORMAL LIMITS = 1.5 to 2 standard deviations above or below the mean (or average). OUTSIDE OF THE NORM = 1.5 to 2 standard deviations above or below mean outside of the norm.

orofacial exam

structures and functions that affect speech and swallowing production

Percentile rank

tells the percentage of people scoring at or below a given score.

Raw Score

the initial score obtained based on the number of correct or incorrect responses.

Criterion validity

using external standards or principles. A test is related to an external criterion in a predicative or congruent way. § Concurrent - means the test compares to an established standard. § Predictive - means the test predicts performance, which is criterion, in another situation or in the future.

How to determine speech rate?

§ 1. Record a sample of connected speech (conversation, narrative, oral reading, etc.) (e.g., 20 seconds) § 2. In a 60-second interval, count the number of words produced and divide by 60 (e.g., 62 words) § 3. Divide the number of seconds in a minute (60) by the number of seconds in the sample (e.g., 60/20 = 3 § 4. Multiply the number of words (e.g., 62) in the sample by the number from Step 3 (e.g., 62 x 3 = 186, wpm = 186)

How to evaluate speech rate?

§ Speech rates vary among normal speakers and varies by cultures § Some people are fast talkers, other have a slower cadence § Evaluating speech rate is about evaluating the effectiveness of a client's communicative abilities § Speech rate can affect · Articulation · Intelligibility · Voice production · Fluency

authentic Assessment disadvantages

· May lack objectivity · Procedures are not standardized (thus not reliable or valid) · Implementation required a high level of clinical experience and skill · Approach is not efficient - takes a lot of planning time · May not be preferred by insurance companies

Norm-Referenced Disadvantages

· Not individualized · Tells us what they know but not how they learn · Unnatural and not a true representation of capabilities in real life · Assesses isolated skills - we don't communicate or function this way · Results may be invalid or unreliable if administration instructions aren't followed

authentic Assessment Advantages

· The approach is natural and most like the real world · Clients get to participate in self0evaluation and self-monitoring · Allows for individualized · Particularly beneficial with culturally diverse and/or special needs clients · Offers flexibility

Norm-Referenced Advantages

· Usually, object and efficient · Can compare client skills to a larger group · Widely recognized · Less experienced clinicians can administer · Preferred by insurance, school districts, and payment systems

Criterion-Referenced Tests Advantages

· also, usually objective, and efficient · some opportunity for individualization with non-standardized criterion referenced tests · also widely recognized · less experienced clinicians can administer · also preferred by insurance, school districts and payment systems

Criterion-Referenced Tests Disadvantages

· testing situation may be unnatural and not represent real life · evaluates skills in isolation · standardized criterion-referenced do not allow for individualization