Whether you're new on your journey of therapy or you've been doing this for years, you've probably had an experience with an initial evaluation. With complex communicators and children with high support needs, it is all too common to participate in an evaluation and feel like (1) your child did not fully represent his or her abilities or (2) the therapist did not seem to understand your child. You may receive a report that seems to focus on all the things your child can NOT do and you may see goals that either are below the child's ability or don't seem to apply to what will be meaningful and motivating to your child. Our goal at Connect Therapy Services is to conduct initial evaluations using a different approach than typical outpatient therapy centers.
Evaluations allow a therapist to understand how a child is using and understanding language and help the therapist to create goals in a treatment plan. Evaluations are very important when starting out with a new client or monitoring progress, but the approach can affect whether or not the goals lead to meaningful growth.
Unfortunately, our healthcare system operates on a medical model of disability. Insurance companies like to see how a child compares to their peers using standardized assessments, and there is a focus on all of the language and communication deficits. For children with complex communication, standardized assessments often give very limited information, especially as children get older. The tests may be assessing whether they can use and understand pronouns and verb tenses when your child is still working on using gestures to communicate or putting together two words. In addition, many standardized assessments are not meant to be used with AAC. When we use standardized assessments with complex communicators, we usually end up with a report that states they have a standard score of 50 and a percentile rank of <.1%. The write up lists all of the skills they do not have and the goals target those deficits.
A standard score of 50 and percentile rank of <.1% give us very, very little information about what the child IS doing and what we hope to see next. Many of our complex communicators are on a slower or different developmental sequence than their peers, and it is not helpful to compare. Instead, we need to focus on informal assessments that give us meaningful information and create a path for next steps.
There are many different types of informal assessments! The best combination of assessments depends on the child being evaluated. At Connect Therapy, we focus on a few key areas to get the best information....
Parent report, interview, questionnaires
Observation of play and routines
Informal assessment tools
Parents are the experts on their child, and especially when working with complex communicators, it's so important to get parent input for the evaluation and goals. We want to use parents to get the best picture of the child's strengths, interests, current skills, and areas of needed support and growth.
Including parents allows us to determine what the family priorities are. This helps to make goals more meaningful and applicable to their day to day life. More meaningful goals could lead to buy in from parents to work on the goals at home and in turn, greater progress.
Parent input can come from structured interviews or questionnaires, informal assessment tools like the Communication Matrix, or just through unstructured conversation.
Language samples allow us to see what the child is currently doing to communicate. With complex communicators, it's so important to observe both spoken language and nonverbal communication. Nonverbal communication includes things like gestures, reaching/grabbing, leading an adult, facial expressions, vocalizations, body language, etc. Understanding the areas that the child is not using spoken words or AAC can help us create goals to expand communication. It can also help us to coach parents to think of words to model in the moment using spoken language or AAC.
We do language samples in the child's home which allows us to see language in a comfortable environment. We can see how they interact and use language with their favorite toys and in familiar routines. If your child is hesitant around new people, it may be helpful to record videos during times where they communicate best! We also use communication logs for parents to fill out during the week. It can be hard to remember everything your child does and says, so a log helps us to get the best representation of their communication. Logs also allow us to monitor progress over time! Google Docs or the notes app are great ways to keep track of language in the moment.
Observation of Play and Routines
Observation allows the therapist to see all of the subtle ways your child uses language to interact and express themselves. Sometimes, as parents, we don't notice all of the nuanced ways that our child communicates. A speech pathologist can help identify nonverbal communication attempts and strategies to support communication.
Observation can also provide insight into the child's interests, preferences, and sensory needs. This information helps us to make therapy more meaningful. We may notice that your child enjoys movement, doesn't like loud noises, or prefers things in a certain order. This observations can help us better connect with your child and create motivating language opportunities.
Informal Assessment Tools
Informal assessment tools help provide a structured way to observe and report on communication skills. These tools are usually checklists or questionnaires, but they do not compare a child to peers like in standardized assessments. During the process of therapy, informal tools can be a great way to monitor progress. We can use the tool again after 6 months or a year to assess the child's growth compared to when we first started. Many informal tools provide a developmental path or sequence for language and communication growth. This sequence can help us to create goals to continue progressing.
At Connect Therapy Services, our evaluation reports aim to paint a picture of the whole child. We want to focus on what they ARE doing rather than what they are not. Nobody wants to read a report that just lists every area that their child is behind. At this point, many parents and families are already aware of their child's deficits, because they have been told repeatedly by well-meaning doctors, therapists, teachers, etc. But it's such a negative way to start the therapy journey, and at Connect Therapy Services, we hope to be different than that. We want to show parents that there are many beautiful and amazing things that their child is already doing. Like everyone in the world, we have areas to improve and grow, but we are all more than just our "deficits"!
Families are coming to therapy to help their child's communication, and our job is to give them the tools and support to do that. Our reports will highlight strategies and possible approaches that we will try in therapy. We will discuss possible learning styles and sensory needs that will support communication development.
We look at language and communication from the lens of expanding communication functions. There are many different ways and reasons to communicate. These reasons include but aren't limited to protesting, requesting, commenting, labeling, and asking questions. We want to determine HOW and WHY a child is communicating. Often times, therapy has focused on requesting, and we want to expand beyond just requesting to make language about connection, shared joy, and interaction rather than just expressing basic wants and needs. Our reports and goals will reflect many different reasons and ways to communicate!
Our goals focus on
1. Building on strengths and interests
We want goals to be motivating so that language is fun! If the child isn't interested, we won't make meaningful progress. By building on strengths, we can help the child feel successful. For example, if the child seems to do best with visuals, we will include visual supports in the goal!
2. Family and child priorities
We want the family to feel like the goals are meaningful and apply to their daily routines. It doesn't always matter most what we, as therapists, think is important.
3. Including and honoring multi-modal communication
Children with complex communication need access to AAC to support language development. Our goals will incorporate visuals and AAC and will honor the use of multi-modal communication. This means that we will never ask the child to communicate something more than once. If the child communicates using gestures, we may model a word by speaking or using AAC, but we will never require a child to say something in another way.
Evaluations are crucial in building the therapeutic relationship and developing a plan for therapy. However, evaluations don't have to mean standardized tests and deficits based goals. Evaluations can highlight all of the wonderful things your child is already doing and create a plan that fits what is motivating and relevant to your child and family.
If you're interested in scheduling an evaluation, please reach out via our website, email, or phone! We can also provide support if you're wondering how to talk to your therapy center about more well-rounded report and goals.