ACQ Vol 13 No1 2011

Ethical conversations

The role of speech pathologists in assessing children with language disorders Does the need for funding make a difference? Nerina Scarinci, Wendy Arnott, and Anne Hill

This edition of Ethical Conversations is one which many readers will find pertinent to their everyday speech pathology practice. In this column we will discuss the ethics of assessment and report writing for children with language disorders when funding for additional services for the child is being sought. Specifically, we will discuss (a) the speech pathology assessment process and the role of reports in disseminating results and recommendations to different recipients, and (b) potential changes in the perception of the role of the speech pathologist when the assessment process involves funding outcomes. This discussion will highlight ethical issues faced by speech pathologists working with paediatric language disorders. It is not our intention to offer answers to these issues but to facilitate discussion by posing reflective questions for consideration by readers. The speech pathology assessment There are many reasons for assessing a child’s language development. Assessment can be undertaken to screen for various conditions, to differentiate between language difference and disorder, to make a differential diagnosis, to determine goals for intervention, and to establish a baseline against which the efficacy of intervention can be measured (Hegde & Davis, 2010). Within the context of initial assessment and inclusive education, one of the critical roles of assessment is to assist teachers in the identification and implementation of realistic, relevant, and functional changes in the delivery of the classroom curriculum to promote the child’s activity and participation within their learning environment (WHO, 2001). Also significant is the need for confirmation of a diagnosis or categorical label where required, and the formulation of a holistic communication profile of each child’s strengths and weaknesses to determine eligibility for funding or access to additional resources (Speech Pathology Australia, 2004). Given the role of diagnosis in the funding process to determine eligibility for speech pathology services, a

question of interest for this column is “Does the purpose of the assessment and the intended recipient of information influence the assessment process and the subsequent written report?” An examination of best practice principles supports the argument that assessment is part of the cyclical nature of the clinical management process and that the role of the speech pathologist should not vary according to the reason for assessment. However, in everyday practice, do speech pathologists change their perception of their role in the assessment process depending on its purpose? For example, if confirmation of diagnosis of a language disorder is required in order for the child to access additional services, guidelines may mandate that the speech pathologist uses both formal (norm-referenced) and informal (criterion-referenced) tests in order to highlight the presenting language impairments and predict the impact of these on academic performance (Eger, 2007). Further, depending on the context of the situation, different service providers may have specific reporting standards to which speech pathologists must adhere. For example, they may require that a specific assessment battery consisting of the Clinical Evaluation of Language Fundamentals, 4th Edition (CELF-4; Semel, Wiig, & Secord, 2003) and the Peabody Picture Vocabulary Test, 4th Edition (PPVT-4; Dunn & Dunn, 2007) is undertaken in order to directly benchmark against established eligibility criteria. These protocols may be in contrast to what the speech pathologist would typically do in situations where funding is not being sought. The question arises then: Does this create an ethical dilemma for the speech pathologist? The need for a label or confirmed diagnosis in order to access additional support services is another ethical issue at the core of child language assessment. Understandably, families want the best for their child. Accordingly, parents and other medical and allied health providers may insist that the child receive a formal diagnosis or categorical label following the assessment process based on the perception that a label is needed in order to fulfil eligibility requirements for additional funding. This raises the further question: To what extent does this perceived notion influence the speech pathologist in their assessment and subsequent written summary and recommendations? The role of the assessment report Speech pathology reports are necessary for communicative, administrative, and legal purposes (Cranwell & Miller, 1989).

Nerina Scarinci (top), Wendy Arnott, and Anne Hill

41

ACQ Volume 13, Number 1 2011

www.speechpathologyaustralia.org.au