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.
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 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 competence is imperative when selecting and using assessment tools. Standardized measures may not be appropriate for all populations. Service providers must validate that the assessment is being administered to the population for whom it was standardized. Inherent cultural and linguistic biases may be present. Assessments that are administered to populations who have not been included in the normative sampling process fail to meet standards. Therefore, they may only be used as information probes with no accompanying standard scores. SLPs should note alterations to the typical assessment process in the written report.
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, a rapid change in the individual’s status, or 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 and/or intervention, or terminate services. Re-evaluations also may 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.
SLPs may incorporate recent assessment information from another source, such as a school or inpatient setting, confirming that the reported status is consistent with the observed status and that the client demographics still match the normative sample demographics when the standardized test was administered. The goal of performing an assessment is to obtain valid and reliable information in order to develop an appropriate treatment plan while adhering to payer and/or employer requirements.
When an updated version of a test is published, SLPs should consider their 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 established by their employer or state licensure board. Clinicians can dispose of outdated tests in a manner that protects the copyright of the material, including secure shredding or shipping back to the publisher for secure recycling.
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. According to the American Health Information Management Association (AHIMA), source data that are interpreted elsewhere are generally not considered part of the designated record set. It is advisable that SLPs know all applicable state regulations and publisher copyright policies when considering scanning protocols to electronic medical record systems.
Employer and payer policies may require standardized test scores to establish a baseline or medical necessity. These policies may require a physician order or 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 firstname.lastname@example.org.