Kelley Kennedy
Tyler, A. A., Tolbert, L. C., Miccio, A., Hoffman, P. R., Norris, J. A., Hodson, B., et al. (2002). Five views of the elephant: Perspectives on the assessment of articulation and phonology in preschoolers. American Journal of Speech-Language Pathology, 11, 213-214.
TAP
The topic of this article is the difficult balance of what should be included in an assessment under ideal circumstances and what time and other constraints allow in real-life situations. The intended audience is the student in Communication Disorders wishing to become more effective and thorough in assessment. The purpose is to help the reader understand practical options when undertaking an evaluation.
Claims
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Successfully assessing communication disorders is one of the most critical components in a speech therapists clincial process, regardless of the type of assessment used. It is a challenge to balance efficacy and thoroughness when assessing a client.
Evidence
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Clinicians use assessment often and in many different ways. It can be used dynamically, to gauge progress, set goals, differentially diagnose, or even to decide if therapy is needed at all. Guidelines from ASHA state that an assessment must determine if therapy is warranted and be used for the purpose of clinical decision making. A thorough assessment is needed to have a basis for decision making, and to back up those decisions. A thorough assessment gives evidence for the decisions and the treatment that follows. Since time is a huge factor for clinicians and money is usually a factor for clients, an effective assessment is important for both parties. Time cannot be wasted and the assessment must be as effective as possible in a short amount of time.
Connections
text-to-self – I worked in a daycare for about a year at one point in time. During this time I saw many different professionals come in to evaluate the children in one way or another. Some were with birth to three and some were with other agencies. I remeber talking to an SLP who came once a week to see one of the 4-year-old boys. When she found out that I was in the program here at Marshall we talked for a while about her job. I remember her saying that one of her biggest complaints was with the time limit. She said that she always felt rushed in doing evaluations but had nothing she could do about it. The day that I spoke to her, she was doing therapy. It was in my classroom because the school-age kids were not there yet. I was setting up for the day so I listened in. She was only there for about 30 minutes. By the time she had delt with the behaviors that were occuring, she only had a few mintues to work on the computer with the boy. I believe they only got to practice two sounds. This was a good real-life example of time constraints. Time constraints were also always an issue when I worked at Prestera Center. My basic job was to perform the assessments done on the higher functioning clients every six months. We were pushed to do as many as possible for billing purposes. When I started I was told they would take me one to two hours. By the time I quit I was doing them in 30 to 40 minutes. Time and money were huge factors there too.
text-to-text – This article refers to ASHA’s Code of Ethics. I have had to read it many different times in my CD classes. I remember reading the guidlines regarding what assessment should be used for. I never realized how complex assessment really was from reading this text though. Now I know why those guidelines have to be included in the Code of Ethics. Assessment can be interpreted many different ways for different people. There is a need for a kind of baseline consistancy regardless of the approach a clinician chooses to take or the process perscribed to.
text-to-world – Often in school we learn about things that will not readily apply to the broader clinical world. However, the concept of balancing thoroughness and effectiveness is one thing that will come in handy. This need for balance is driven by outside forces that we as clinicians will not be able to control. We must learn how to best balance them to be successful. Having an awareness that the problem exists ahead of time will allow me to be better prepared in dealing with it when I begin practicing.
