“What does this have to do with anything?”
Any SLP in the medical setting has likely heard these words from a patient after completing the standardized testing tasks we have traditionally used. And this question isn’t especially surprising when we are scoring patients on tasks they’ve never done before, such as repeating numbers backward, naming animals rapidly, or recalling five unrelated words.
Patients who ask this question are onto something—and long before we were. Research has shown that standardized test results are not correlated with a person’s ability to participate when they have a cognitive-communication disorder.1, 2, 3
If we can’t deduce how someone’s real life has been affected through standardized testing alone, we need other efficient options for getting this information.
Nonstandardized assessment is the answer for gleaning valuable information about activity, participation, quality of life, environment, communication partners, and the unique experiences and priorities each person has as they experience a cognitive-communication disorder. In fact, nonstandardized assessment is recommended as a best practice for many diagnoses, including aphasia, TBI, dysarthria, and apraxia.4
Are you ready to incorporate efficient, nonstandardized practices into your assessment time and yield rich information about your patients’ priorities and real-life needs? Consider adding the following items into your assessment toolbox.
1. Use Motivational Interviewing Techniques
Motivational interviewing, an evidence-based and person-centered interaction style, affects the words you use and how you phrase them. When you put careful thought into open-ended statements, reflections, and other techniques, you can help inspire change and goal-setting in therapy.
Instead of using a persuasive-style statement like, “I can see you are having memory challenges and we need to address that in speech therapy,” try a reflection like, “I noticed you made a face when you were trying to tell me where you worked and that you said that was a change from normal—tell me more about that.” This may inspire motivation to participate as well as establish a stronger, more empathetic working relationship.
2. Complete a Needs-Based Interview
The needs-based interview is a vital portion of nonstandardized assessment and includes a structured conversation that will help you understand the needs of the person you are treating. Remember—you don’t have to know every need on the first visit! A good place to start is by discovering two to three needs that will affect their life within the next week. As therapy progresses, you will be able to progress to future needs.
3. Consider a Person-Centered Outcome
Person-centered outcomes are scored questionnaires that give input on how someone experiences a cognitive-communication disorder. Many are validated, and because they are scored, they can be used to set a functional goal that measures real-life improvement.
4. Use Contextual Observation
Observing someone doing necessary tasks can provide further information about how their impairment is affecting participation. Imagine that someone tells you they are having difficulty making phone calls. Is it because:
- They can’t find the phone number?
- They are pressing the wrong buttons?
- They have a hard time expressing themselves while talking?
- They struggle to return to the conversation after not understanding something?
Observing a phone call during the assessment only takes a few minutes, yet it provides you with a wealth of information about where to start in therapy to meet this person’s need.
5. Select Standardized Testing That Enriches the Information You Have
Rather than obtaining multiple standardized testing scores, consider starting with a specific need the person has and then completing standardized testing that can color your understanding as to how that need can be met.
For instance, during the contextual observation activity described above you discover that the problem with making phone calls is poor attention and high distractibility while trying to dial a ten-digit number. This can lead you to focus your standardized testing on attention, which should provide insight into appropriate interventions and strategies to address that need.
6. Write Person-Centered Goals
If you’re truly focused on meeting real-life needs in speech therapy, person-centered goals will reflect that. You can start by incorporating the phrase “in order to” within your goals. An example goal might look like, “The patient will improve attention for typing ten-digit numbers on a phone in order to successfully dial a phone number on 75 percent of attempts (baseline 33 percent).”
As a clinical SLP, you are under pressure to gain important assessment information during a limited amount of time. These person-centered assessment strategies will help you get the information you need to devise an appropriate treatment strategy, all while working within the limits of your allotted assessment time and keeping your focus where it belongs—on the people you treat.