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Chapter 6
Communication Assessment and Intervention: Evidence-Based Practices

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Focus Questions

What is evidence-based practice?

What is assessment?

What is intervention?

What are some common approaches to intervention for communication disorders?

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Introduction

People in the field of communication sciences and disorders fill a variety of roles.
Key responsibilities include assessment and intervention, or diagnosis and treatment.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Evidence-based Practice?

Integrate knowledge from several perspectives scientific evidence
Clinical expertise
Client perspective
Definition
Process by which the clinician integrates these three areas to arrive at the best plan of action for a particular client

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Assessment?

Assessment
the systematic process of gathering information about an individual’s background, history, skills, knowledge, perceptions, and feelings.
Involves may disciplines with diverse knowledge, skills, and experiences.
A test is merely part of a complete assessment.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Purposes and Processes of Assessment

To identify skills that a person has, and those the person does not have in a particular area of communication.
To guide the design of intervention for enhancing a person’s skills in a particular area of communication.
To monitor a person’s communicative growth and performance over time.
To qualify a person for special services.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Screening and Referral

This tasks are completed to identify those who may require a more comprehensive assessment.
Screening: test or task to conduct a quick check of performance.
Referral: when a professional’s help is formally requested.

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Designing and Administering the Assessment Protocol

Chart review
Interviews
Systematic observation
Questionnaire/survey
Formal test
Instrumentation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Formal Testing: Norm-Referenced and Criterion-Referenced Tests

Norm-Referenced Test
Used to compare performance with that of a same-age peer
Criterion-Referenced Test
Used to determine level of achievement in a particular area

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Norm-Referenced Tests

Standardization

Test must be given in a uniform and scripted manner so that it is given in exactly the same way to everyone who takes it

Normative sample

A group of individuals who were given the test to identify standards of performance at specific age levels

Standard scores

The index that identifies how a person’s test performance compares to that of their normative peers.

Diagnostic accuracy

The ability of a test to correctly describe a condition

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Standard Normal Distribution

Standard Normal Distribution
Derived from mathematical models of probability regarding how scores will range from a skill or aptitude that is assumed to be normally distributed within the population
Terminology
Raw Score
Normal Curve
Mean
Standard deviation
Percentile Rank

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Criterion-Referenced Tests

Criterion-referenced assessment
to determine an individual’s level of achievement or skill in a particular area of communication
Instruments
Require establishment of a clear standard of performance
Require design of specific tasks
Must provide clear guidelines for interpretation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Dynamic Assessment

Analyzes how much and what types of support or assistance are needed to bring an individual’s communicative performance to a higher level
Leo Vygotsky’s influence

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Interpreting Assessment Findings

Steps to interpret assessment findings
Diagnosis
Differential Diagnosis
Determine the severity of the disorder
Very mild, mild, moderate, severe, and very severe
Characterizing the client’s prognosis

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Developing an Intervention Plan

Components of an intervention plan:
Identifying treatment goals
Describing the possible length and frequency of treatment
Describing treatment contexts and activities

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Monitoring Progress and Outcomes

Not a one-shot deal that stops when the diagnosis is made
An ongoing process that monitors progress and outcomes for the client
Purposes
Monitor a client's progress during treatment
Modify the treatment plan as progress is made
Determine when a client should be discharged from treatment

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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What Is Intervention?

Definition
Refers to the implementation of a plan of action to improve one or more aspects of an individual’s communicative abilities.
Qualities
Effectiveness
Efficient
Feasible

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Purposes of Intervention

Prevention
Remediation
Compensatory

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Intervention Planning

Goal
Targeted communication achievement of an individual
Procedure
The clinician’s plan of action
Goal characteristics
Functional
Measurable
Attainable

Phases
Phase 1: the professional sets long-term for a client, the anticipated outcomes of therapy
Phase 2: the professional sets the short-term goals that will lead to the desired long-term goals
Phase 3: the professional sets session-level goals for a client that are written in measurable and observable terms

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Intervention Models

Pull-out/direct service
Co-teaching/parallel instruction
Intervention consultation

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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WHAT ARE SOME COMMON APPROACHES TO INTERVENTION FOR COMMUNICATION DISORDERS?

Behaviorist Approaches
Linguistic-Cognitive Approaches
Social-Interactionist Approaches
Family-Centered Interventions

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Behaviorist Approaches

Based on classic learning theory, which emphasizes the importance of the environment for shaping behavior and, in particular, the influence of consequences on behavioral change.
Terminal Behaviors
Clinicians are responsible for
Identifying observable and measurable goals
Specifying the level of mastery at each goal
Controlling each intervention session
Collecting data in each session

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Linguistic-Cognitive Approaches

Based on theories of developmental psychology and cognitive science, which emphasize the developmental sequences and underlying rule-governed organization of communicative behavior
Parameters
Goals of communication acquisition: when, how, and why
Helping the individual lean the rules that underlie successful communication
The learner is engaged fully in the intervention process

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Social-Interactionist Approaches

Based on theories of developmental psychology that emphasize the importance of social interactions among individuals as a critical means for development and learning
Vygotsky’s influence
Terms
Social plane
Psychological plane
Zone of proximal development
Scaffolding

Communication Sciences and Disorders: A Clinical Evidence-Based Approach, 3e Justice and Redle

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Family-Centered Intervention

Built upon the concept of family systems theory, which emphasizes that “the family as a whole is greater than the sum of its parts”.
Treatment goals emphasize an individual’s participation within and access to family activities and contexts, and may incorporate family members’ perspectives regarding viable treatment approaches.