ACQ Vol 13 no 2 2011

guidelines, systematic reviews, and high quality research available to support the “science” of evidence based assessment. Justice (2008) highlighted that for a profession to successfully undergo the craft to science transformation such tools and resources are of critical importance. It is apparent that speech pathologists now have ready access to a range of evidence based practice resources such as the speechBITE TM website (http://www.speechbite. com.au) and dedicated journals like Evidence-based Practice (EBP) Briefs (http://www.speechandlanguage. com/ebp-briefs), and “Evidence-Based Communication Assessment and Intervention” (http://www.informaworld. com/smpp/title~db=all~content=t744398443) to help clinicians identify intervention approaches that are based on the best available evidence. The website of the New South Wales Evidence Based Practice Network also provides useful frameworks for clinicians and examples of critically appraised treatment studies and topics to assist the translation of EBP processes to clinical practice (http:// www.ciap.health.nsw.gov.au/specialties/ebp_sp_path/). The book Evidence-based Practice in Speech Pathology reviews the evidence for a selected number of speech pathology areas, such as voice, stuttering, and aphasia (Reilly, Douglas, & Oates, 2004). While such resources have great clinical utility, overall the focus to date has been very much on intervention, with notably less attention devoted to the systematic review and compilation of research findings to guide evidence based assessment. This is a significant gap in the field that needs to be addressed. Although appropriate resources are being developed, clinicians require a framework to reflect on their own assessment practice and to guide decision-making. The astute clinician must not rely on intuition alone, but return to their theoretical and scientific knowledge to guide assessment choices. Selection of assessment tasks Given the paucity of systematic guidelines for evidence based assessment, it is not surprising that the selection of assessment tasks can be extremely challenging in practice (Turkstra, Coelho, & Ylvisaker, 2005). Clinicians are required to choose from a vast number of assessment options, sampling behaviours through use of structured tests, dynamic assessment, classroom and real-life observations, via questionnaires and interviews, or conversational and discourse analysis (Plante, 1996; Tate, 2010). It is apparent that use of standardised assessment tools continues to predominate in clinical practice (Verna, Davidson, & Rose, 2009), perhaps due to preconceived notions of their objectivity, reliability, and validity. However, how many times have you completed a standardised assessment and when you come to using the findings to formulate your plan and recommendations, find yourself struggling to clearly identify goals for therapy? Do you sometimes find yourself spending much of the first therapy session collecting more informal assessment data to help with goal-setting? This may be a consequence of how assessment tasks are selected and the decision-making models that are implicitly used. While standardised tools have potential use in determining the presence of communication impairment or a client’s eligibility for services, results from formal assessments often fail to translate into relevant and appropriate therapy goals. As clinicians we need to reflect on the purpose of each assessment session and ensure we utilise tasks that align with our overarching aims and goals. For example, if the purpose of an assessment session is to set therapy goals then one might consider using a range of

informal and dynamic assessment tasks (Hasson & Joffe, 2007). Such tasks allow a clinician to explore a client’s strengths and weaknesses and their ability to learn new information, rather than simply detecting presence and severity of impairment. Use of theory and broad conceptual frameworks are presented in the following section as important starting points for the selection of tasks and measures to meet the needs of individual clients and contexts as part of evidence based assessment. Why is theory important? Theoretical knowledge guides our clinical reasoning and decisions, allows us to explain and interpret our observations, and forms the foundation of our clinical predications and hypotheses about expected outcomes. Apel (1999) asserts that “armed with a theory of language learning, a scientist can develop creative ways to meet the individual needs of the child” (p. 102). Clinicians need to be clear and conscious in their own theoretical perspectives and to consider what frameworks they use to guide clinical reasoning. At a broader level, choice of theory or theoretical perspective should drive a clinician’s “approach” to assessment and also influence selection of “tools”. An approach is a theory-driven process, while products are just the tools that we choose to use (Apel, 1999). When treatment is provided without guiding theory, it is impossible to determine the mechanisms of change or why the treatment was successful (Apel, 1999). The same can be said for assessment. Kagan and Simmons-Mackie (2007) highlight that the selection of assessment tasks is often determined by a range of different factors including “available tests, allegiances to particular theories, and/or initial impressions of the client” (p. 310). It is argued that for assessment to be evidence based, theory is a critical overarching factor. A strong theoretical framework is important for the selection of appropriate tools and measures, but more importantly, for the interpretation and integration of assessment results. A range of theoretical models can be used to guide evidence based assessment and treatment, with a useful review provided by Baker, Croot, McLeod, & Paul (2001). Use of the ICF in assessment The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF; WHO, 2001) is a commonly used conceptual framework to guide the planning of assessment tasks and the interpretation and integration of findings. Researchers such as Sharynne McLeod, Travis Threats, and Linda Worrall have been key drivers in assisting the translation of the ICF framework to everyday clinical practice. While the ICF was developed for application across the lifespan, the International Classification of Functioning, Disability, and Health – Children and Youth Version (ICF-CY;WHO, 2007) was designed to capture some of the more specific health issues relevant to childhood (McLeod & Threats, 2008). McLeod and Threats (2008) provide a useful overview of studies that have used the ICF and ICF-CY to classify and profile childhood communication disorders. Similar examples exist in the adult field (Tate & Perdices, 2008; Threats & Worrall, 2004). According to Tate (2010) best practice requires evaluation of each domain of the ICF to ensure comprehensive and ecologically valid assessment. However, traditional speech pathology assessments have focused attention on the body structure level with the goal of identifying the presence and severity of impairment (McLeod & Threats, 2008). Through evaluating a client’s level of function within each domain of the ICF, the complex interactions and relationships between

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ACQ Volume 13, Number 2 2011

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