Saturday, November 30, 2013

Saturday Soapbox: Just because they qualified with that score doesn't mean they should be judged by it.

My Saturday Soapbox series in November was focused on some of my "goal pet peeves."  You can check out my previous posts by clicking on the links below.

Over the next two weeks I'm wrapping up my pet peeves list.  Then I'm thinking about exploring specific intervention areas (answering questions, vocabulary etc, auditory comprehension) and ideas for goals in a little more in depth.

Goals that measure improvements based on standard scores.

Jessica will improve her receptive language skills to be 1 standard deviation below the mean when compared to her peers.  

This is a goal I've seen on IEPs and outpatient progress reports.  I get that this seems like a measurable goal.  In the schools, the first concern I would have is how you plan to measure it.  At least in Minnesota, we only test every three years so that would mean you would be asking the family to sign off on a yearly evaluation plan to complete the testing.

Deciding to measure progress based on standardized assessment is risky for several reasons.  
First, it encourages activities which teach to the test rather than focusing on more functional skills.

Second, there are many factors which may impact a child's score on standardized assessment which are out of your control.  What if the child is sick the day that you are testing?  What if they are distracted or in a bad mood?  It is difficult to measure progress from an entire year based on assessment scores from 1-2 days.  I realize the irony in this statement as this is a primary way we have decided to measure school achievements.  

Third, this goal is another one that gives me little to no information on what I should be working on in therapy.  Should I just give them little speech pop quizzes all year?  Do they have more difficulty with comprehension, sequencing, semantics, syntax, pragmatics?  I could spend half the year just trying to figure out what I should be addressing in therapy.

Improvements in a standardized score require the child to improve at a rate faster than their same aged peers.  I have some clients who are able to meet this, but I have many that don't.  With insurance companies, you need to discuss whether or not this demonstrates a plateau in abilities.  During IEP meetings you may need to explain what this means to parents and the IEP team.

Here is how I explain changes in standardized scores:

Example A: 
                              2010                   2013
Raw Score:            58                       85
Standard Score:      61                       72

This is a positive prognostic sign.  This student still demonstrates need areas, but with skilled intervention they are improving in the assessed skills at a faster rate than their peers.

Implications for Intervention Planning
Therapy is effective for this student.  I would continue to provide therapy in the same manner as the student is demonstrating progress.  This is a student that I'm hoping will continue to progress at the same rate and may eventually catch up to their peers.

Example B:  
                              2010                   2013
Raw Score:            58                       72
Standard Score:      61                       61

In this example, the student has demonstrated in increase in their ability to answer assessment questions correctly.  This student is demonstrating progress at the same rate as their peers.  

Implications for Intervention Planning:
Therapy is also effective for this student.  When I am documenting or explaining these scores to parents, I start by discussing the new skills that they were able to complete.  If they relate directly to goals in therapy I will discuss this as well.  Finally I explain that while Jessica is progressing at the same rate as her peers she is not closing the achievement gap between them.   I may think about how often I feel like I am reteaching skills or ideas to this student.  I might consider changing the frequency of therapy to see if we are able to improve their rate of progress.  

Example C  
                              2010                  2013
Raw Score:            58                       68
Standard Score:      61                       58

In this example, the student has demonstrated in increase in their ability to answer assessment questions correctly.  This student is demonstrating progress at the slower rate than their chronological peers.  

Implications for Intervention Planning: 
Therapy has even been effective for this student.  They are demonstrating improvements in their skills as seen in the increase in raw scores.  However, they are progressing at a slower rate than their same aged peers.  These are typically students who have more cognitive challenges.  I don't expect that they will close the achievement gap and may expect that this gap will continue to grow as the child gets older.  I might consider changing frequency or changing the types of goals that I am working on.  Maybe I need to work on some more basic foundational skills in order to support this student.  

Example D 
                              2010                   2013
Raw Score:            58                       54
Standard Score:      61                       55

In this example, the student has not demonstrated improvement and is showing regression or a plateau in skills.  

Implications for Intervention Planning: 
Therapy has not been effective for this student.  In this example, I'm going to consider how their attention and compliance was with the assessment tasks.  Was the assessment a good indicator of their skills?  I might think about changing duration, frequency or intensity as well as the types of goals I've written.  Is the student still making progress on their short term objectives in therapy?  If not, we may need to discontinue services as the child is demonstrating a plateau in skills.  

How about you?  Do you write long term goals based on improvements to standardized scores?  Ready to learn more?  Irene Gilbert Torres had a great article in last month's ASHA Leader:
Make It Work: Write Targeted Treatment Goals

Also Maria from Communication Station Speech Therapy, PLLC has a great freebie on writing goals for nonverbal children which could easily be adapted for other populations.  Thanks to Mary for bringing it to my attention!
Freebie Friday: Goals and Objectives for Nonverbal PK children

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Jill E, SLP said...

Thanks for writing about this! I am *forever* trying to write and follow good goals. I like how you used examples- I need those :). Perhaps I am reading them wrong, but I am confused about how Examples 1 and 2 demonstrate progress (e.g. going from a raw score of 72/ SS 61 in 2010 to a raw score of 58/SS 61 in 2013 for Example 2)? Could you explain how that is progress? Thanks so much! :)

Speech2U said...

Jill-You have a good eye for detail. I mixed up the dates on the examples which made them make no sense. It should have been reversed. I fixed it now. Thanks for noticing!

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