Speech pathologists have expertise in speech, language, literacy, social communication (pragmatics), voice, fluency and feeding/swallowing difficulties.
They are often required to assess a client’s abilities in a particular area and report in writing on the outcomes of the assessment.
For more information about speech pathologists and speech pathology refer to What do speech pathologists do.
Prior to the assessment
Before a speech pathology assessment is conducted the speech pathologist will gain the client’s explicit consent to proceed with the assessment, discuss the cost of the assessment (and report) and an estimate of how long the assessment process will take and when a report will be provided.
Consent
To gain consent the speech pathologist must inform the client about:
- What sort of assessment is to be conducted (e.g., screening, formal/diagnostic).
- When the assessment is to be conducted.
- Where the assessment will be conducted.
- How long the assessment session will take.
- How many assessment sessions will be required.
- What areas are going to be assessed.
- How these areas will be assessed.
- Examples of situations whereby the assessment may be discontinued.
- What the client can do if they wish the assessment to be discontinued.
- Any other factors (e.g., expectations of parents observing assessments).
The client is encouraged to seek clarification and/or ask questions at any time during the assessment session(s) if they are unsure of something.
Types of assessments
The speech pathologist may conduct a screening assessment to determine if there is a difficulty requiring further formal assessment, or help them measure the progress that has been made following therapy, or upon review after a break from therapy. The speech pathologist may use screening tools, informal observations, checklists or formal assessment tools, or a combination of these assessment methods.
The speech pathologist conducts a formal assessment when comprehensive and detailed information about a client’s speech and/or language difficulties is required. This may be at the request of the client, the client’s parents or in some instances from a third party funding body such as the Department of Veterans’ Affairs or WorkCover. The assessment may be required to assist with the formal diagnosis of an underlying speech, language, literacy and/or swallowing difficulty and/or to assist with the development of treatment goals. In some cases a formal language assessment may be conducted to assess a client’s progress following therapy. To conduct a formal speech pathology assessment the speech pathologist will use a range of standardized assessment tools.
The speech pathologist will decide which areas need to be assessed depending on the presenting difficulties however a comprehensive diagnostic speech pathology assessment involves assessment of the following areas:
- Receptive Language.
- Expressive Language.
- Speech (Articulation/Phonology).
- Voice
Fluency
Social Communication (Pragmatics).
Other areas which may be assessed depending on the presenting difficulties and the age of the client include:
- Play.
- Feeding.
- Literacy (possibly including phonemic and phonological awareness, reading, writing, and spelling).
A swallowing or mealtime assessment usually involves gathering a history, conducting a physical examination of the mouth and throat muscles, and observing the eating and swallowing pattern whilst the patient tries different foods and fluids. If more detailed information is required the speech pathologist may recommend the patient undergo one of two possible instrumental procedures conducted in a hospital: a videofluroscopic swallowing study (VFSS), or a fibreoptic endoscopic evaluation of swallowing (FEES).
Assessment procedure
In general, a speech pathology assessment is conducted one-on-one in a quiet and comfortable setting free from distractions.
Parents or significant others may observe the assessment session, and the speech pathologist will explain what is going to happen and what the observer can or cannot do during the assessment (e.g., the observer may not prompt the client to respond by repeating the questions during the assessment).
The assessment may take on average 30-60 minutes, however, a standard speech pathology assessment can be over an hour in duration and in some instances up to 3 hour long sessions may be required.
As part of the assessment procedure the speech pathologist will obtain a comprehensive case history looking at the client’s presenting difficulties, past medical history and prior attendance at
speech therapy or involvement with other health professionals. This usually occurs at the beginning of the first assessment session.
After the speech pathologist has obtained a case history they will continue with the planned screening or assessment tasks.
Assessment frequency
Speech and language screening assessments are generally conducted no sooner than three months apart, however, in some cases they may conducted more frequently based upon the
client’s needs and the reason for conducting the screening. Clients are encouraged to discuss with their speech pathologist how frequently their progress is going to be reviewed and thus how frequently screening assessments may be administered.
Formal speech and language assessments are generally conducted infrequently (due to the length of time they take to conduct and the need for sufficient time to have elapsed between assessments to provide meaningful information). In some cases, several years may have elapsed before a formal speech and language assessment is re-administered. There may be some instances (e.g., in support of a funding application) where the formal speech and/or language assessment is re- administered more frequently, however, as a general rule of thumb it should not be conducted more frequently than once every 12 months. There is no restriction on how frequently swallowing or mealtime assessments are conducted as this is based on a client’s need and potential risk and particularly in the case of progressive neurological disorders/diseases a client’s swallowing capabilities may change rapidly.
A client who is accessing speech pathology through their NDIS funding may require a report regarding their progress to be provided prior to their funding being reviewed. A speech pathologist may need to conduct another assessment in order to provide accurate information to the NDIA. If you are an NDIS participant and require an updated assessment and report, you will need to discuss this with your speech pathologist with sufficient time for this process to be completed before your plan review.
Providing a report
A speech pathology report is an essential part of the assessment process.
The report provides information about:
- the client’s background(e.g., medical history),
- the client’s current level of skills,
-
a comparison of their skills compared to children/adults in their age group,
- and
recommendations regarding therapy and/or other referrals or assessments needed and/or how liaison with other professionals can be used to support the client.
Sometimes the speech pathologist also includes tips or information for the client’s family, carers or other professionals (such as teachers), which can assist them to support the client’s future progress.
The assessment report is a legal document and belongs to the client. The client decides if the report is to be given to anyone else or not. The speech pathologist cannot give the report to anyone, or discuss its contents, without the client’s permission.
If the report has been commissioned by and paid for by a third party (e.g., TAC or WorkCover) then the report is given to the third party and they decide on its distribution. The third party usually provides the client with a copy of the report and the speech pathologist will retain a copy of the report for their records.
If a child’s parents are separated or divorced a copy of the report should be provided to both parents unless a Court order prohibits one parent from accessing information about the child.
Speech pathology assessment and report writing fees
Speech pathology assessments and reports are usually provided free of charge if you attend a public service. There is no recommended Schedule of Fees for private speech pathology services as this would contravene the Trade Practices Act (2010). It is important for the speech pathologist to provide information to the client regarding all of the costs associated with conducting an assessment and providing a report before the client agrees to the speech pathologist commencing the assessment process.
Assessment and report writing that is requested by the NDIA will usually covered by the client’s NDIS package, however the speech pathologist should discuss the cost and the length of time required to conduct the assessment and write the report beforehand. Diagnostic assessments and reports that are required in order to gain access to the NDIS will need to be paid for by the client privately.
For more information about finding and choosing a speech pathologist see Choosing a speech pathologist.