Assessment Considerations in Speech-Language Pathology Private Practice

Assessment of speech, language, and swallowing disorders is a complex and dynamic process. Each practice setting has its own considerations that influence the assessment process. Speech-language pathologists (SLPs) in private practice use screening and assessment tools. Most screenings are pass/fail with recommendation for further evaluation. Clinicians balance the clinical needs of their clients with test choice, state regulations, and payer requirements.

Client Needs

Clinicians use their clinical judgment when selecting screening tools, standardized tests, and other assessment materials. In the absence of other requirements, clinicians may use approaches as outlined in the following ASHA resources:

The Scope of Practice in Speech-Language Pathology does not specify tests that can or cannot be administered. In addition to having established competence to administer the test, the SLP should be aware of licensure restrictions, if appliable, and publisher guidelines. Some assessments require the professional to have C-level qualifications, which are defined by the publisher. The publisher may require you to register your qualifications before purchasing the test.

Cultural Considerations

Cultural responsiveness is imperative when selecting and using assessment tools. Standardized measures may not be appropriate for all populations. Service providers confirm that (a) they are reporting standard scores and (b) the assessment is being administered with the population for whom it was developed and standardized. Reporting standard scores from assessments that are administered with populations who have not been included in the normative sampling process may not be appropriate, and the interpretations that are made from standard scores may not be valid. In such cases, standardized assessments can be used as information probes with no accompanying standard scores. SLPs note any alterations to the typical assessment process in the written report.

Testing Intervals and Frequency

Clinicians in private practice determine the interval and frequency of assessment along with employer policy and payer considerations. A re-evaluation is usually indicated when there are new significant clinical findings, when there is a rapid change in the individual’s status, or when there is failure to respond to speech-language pathology interventions. The decision to provide a re-evaluation should be based on the individual’s current intervention plan and whether there is a need to

continue care,
modify goals or intervention, or
terminate services.

Re-evaluations may also be appropriate at a planned discharge. ASHA does not provide recommended timelines for re-evaluation. Clinicians should also consider the test publishers’ recommendations for re-testing intervals.

Test Materials

SLPs may use recent assessment data from other sources—such as schools or inpatient settings—to confirm that

the client’s status aligns with the observed status and
the demographics match those of the normative sample used during the standardized test.

The goal of the assessment is to gather valid, reliable information for creating an appropriate treatment plan while continuing to meet payer and employer requirements.
When a publisher releases an updated version of a test, SLPs should consider a timeline for transitioning to the newer version. Updated tests may have changes in normative data or test stimuli. Ethical implications may arise from using older versions of tests.

To maintain up-to-date standardization data, publishers may recommend a 1-year maximum to implement the newest version of a given test. SLPs should also be aware of guidance or policies that their employer or state licensure board establishes. Clinicians can dispose of outdated tests in a manner that protects the copyright of the material, including securely shredding the tests or shipping the tests back to the publisher for secure recycling.

State Regulations

States define what information should appear in the medical record—in addition to how long clinicians should keep records. Whether or not test protocols are considered part of the medical record is not standardized; it may be specific to setting, state, or payer. It is advisable that SLPs know all applicable state regulations and publisher copyright policies when considering whether to scan protocols to their employers’ electronic medical records systems.

Payer Requirements

Employer and payer policies may require standardized test scores to establish a baseline or medical necessity. These policies may require a physician order or a referral to reimburse. For information regarding coding and payment, see Medicare CPT Coding Rules for Speech-Language Pathology Services and Coding and Payment of Cognitive Evaluation and Treatment Services. For more information, contact ASHA’s reimbursement team at reimbursement@asha.org.