ACQ Vol 13 no 2 2011

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ACQ Volume 13, Number 2 2011 85
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
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 speechBITETM website .
) and dedicated journals like Evidence-based
Practice (EBP) Briefs .
com/ebp-briefs), and “Evidence-Based Communication
Assessment and Intervention”
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://
).
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