Following on from my previous blog on this topic I’ll now briefly discuss one of the assessment tools I use and why.
When assessing a child, no matter what the diagnosis, I personally feel that it is helpful to be able to compare them with their typically developing similarly aged peers.
Whilst it may feel ‘unfair’ to compare a nonverbal (aka not-yet-verbal) child with a peer of the same age group it is in comparing that we are able to demonstrate that whilst “Theo” may be making gains in his Speech, Language and Communication skills he requires a hell-of-a-lot of adaptations, including potentially direct / indirect Speech & Language Therapy, to have a chance at meeting his potential AND without (sometimes even with) such interventions / resources the gap between Theo and his typically developing peers is getting wider each week.
I’ve always been a strengths based clinician – focussing on what a child CAN do and working out a therapy plan based on building on these strengths – however when writing SEN SLT appeal reports, which are destined to be read by an Expert Panel at an SEN Tribunal, it is vital that the child’s Speech & Language needs are not lost in the ‘noise’ of 1-2 inch thick (and some) legal packs. I need to hit home loud and clear that Theo has a mild / moderate / severe language disorder (in addition to his Autism / ADHD / Global Developmental Delay) and as such requires XYZ recommendations.
The Gold Standard assessment tool that Speech & Language Therapists (should) have access to is the Clinical Evaluation of Language Fundamentals 5 (CELF 5) which can be administered via the paper stimulus manuals or via 2 iPads. I’ve opted for the iPad version as I find assessing children this way is significantly easier and more accurate (the app records audio responses and scores everything for you, minimising potential errors).
The CELF 5 replaced the CELF 4 assessment, however unfortunately some SLT teams (private; charity; NHS and LA) still use the older CELF 4 assessment which has been superseded by the 5, and is an assessment that looks at:
Core Language Score – a measure of general language ability and provides an easy and reliable way to quantify a child’s overall language performance.
Receptive Language Index – a measure of a child’s performance on three tests designed to best probe receptive aspects of language including comprehension and listening.
Expressive Language Index – a measure of a child’s performance on three tests that probe expressive aspects of language including oral language expression.
Language Content Index – a measure of a child’s performance on three tests designed to probe vocabulary and word knowledge.
Language Memory Index – a measure of a child’s performance on three tests designed to probe memory dependent language tasks.
Now I won’t bore you with the details of each subtest however once a CELF 5 assessment is completed it is then possible to statistically compare Theo with children within his age group and demonstrate not only where his strengths are (often these strengths and relative strengths) but also what he is finding challenging; the potential impact of such challenges on everyday life (including school) and, where appropriate, the severity of language disorder Theo presents with.
Coupling Theo’s CELF 5 performance with further assessment tools including (but not exhausting), where appropriate:
- Classroom observation.
- The Children’s Communication Checklist 2.
- A Speech intelligibility assessment.
- An informal assessment of narrative skills.
Allows us to consider the functional impact of each of Theo’s strengths and challenges at school; at home and in the community and make recommendations with regards to whether Speech & Language Therapy is required; the model of such therapy and what the therapy should be targeting.
At the moment 90% of the local authority (ie NHS) SLT reports I read in SEN appeals not only have used the CELF 4 but the clinician has chosen to not follow the CELF 4 guidelines and has ‘randomly’ selected subtests and not carried out a complete assessment. Based on the information the SLT has acquired from the incomplete, and superseded, assessment the SLT has made recommendations (typically to discharge).
This makes my role, as advocate to the child no matter who I am commissioned by, in thoroughly assessing the child’s SLCN needs and making objective recommendations not based on what my service can provide (service led decisions) but what the child needs (needs led decisions) relatively easy and the reason why the vast majority of my reports, as part of a wider legal challenge typically via experienced Education Law Solicitors, are wholly accepted by the Local Authority. On the few occasions I’m required to ‘defend’ my report in a SEN Tribunal the Local Authority’s position tends to be the same-old-same-old “direct therapy doesn’t work” argument (obviously without providing evidence of such a ludicrous decision and typically put forward not by an experienced Speech & Language Therapist but by a LA legal rep ?).
As always I welcome thoughts / comments / challenges ?.