Assessment Process – Broken or Quality?
Hi everyone! My name is Gracie!
For PWS,
What is something you wish SLP’s would do during the assessment process looking back on your personal experience? Unless you felt like it was conducted perfectly, what did that look like?
Professional Panel,
How can SLP’s adapt their stuttering assessment to respect cultural differences when the client and/or their parents culture (depending on age) may be prohibiting them from getting the proper treatment needed?
Thank you for asking these important questions, Gracie!
I’m on the PWS panel, so I’ll answer the question posed to people who stutter. (I also have a graduate education in speech-language pathology, but I’m not a practicing SLP.)
I believe strongly that speech-language pathologists should take the time to do a careful assessment of a client before beginning speech/language therapy, and I think this is particularly important with a client who stutters.
I severely stutter. In my own extensive experiences as a client of therapy programs, very seldom was there any kind of assessment session beforehand. Too often, clinics and clinicians have a “one-size-fits-all” approach to stuttering therapy, which in my humble opinion is the wrong approach to take.
People who stutter vary greatly in what types of stuttering therapy benefit them the most. For some, it’s a fluency shaping approach; for others, it could be a stuttering modification approach, combined with reduction of avoidance; for many others a psychologically based program, of developing self-acceptance and self-confidence in everyday life, would be the most effective treatment method. For still others, a combination of some of these approaches could be optimally effective.
At the outset of a therapy program, a decision needs to be made about which approach to try first. To help determine this, it would be crucial to interview the client about his or her previous experiences (if any) with stuttering therapies. Were there particular approaches in which the client made the most gains – either in improving fluency, reducing disfluency, or developing a better life perspective of self-acceptance or self-confidence, as a person who happens to have a speech difference? It may help to explain different possible approaches, and ask the client which of these approaches sounds the most suitable for him or her at this time.
The clinician can also listen to the client’s speech to get an idea of the severity level; and also, from discussion, get a sense of how deeply stuttering is affecting the client’s life. These two could be entirely separate issues. For example, a client could have a severe level of stuttering, but it may not he inhibiting him or her much in their daily life activities. Or a client could have a very mild level of stuttering, but strong fears of stuttering in everyday life. In covert stuttering, there may be hardly any sign of disfluency at all, but still much avoidance of situations, or avoidances of particular words or sounds.
There is also the factor that a client’s speech in an assessment session may be significantly different from how the client speaks in most situations. It has been noted in the literature that often people who stutter, for some reason, speak more fluently when being evaluated, than in most of their situations. Or conceivably, the reverse could be true. The question needs to be asked if the client regards their speech during the assessment to be typical for them, more fluent than is typical for them, or more disfluent than is typical for them.
It would be best to limit assessment to one session, or a part of one session. People who stutter who come for therapeutic help would prefer not to wait through an extensive assessment process, before beginning to receive that help.
As mentioned above, I seldom received any assessments from clinicians when beginning a program. The clinicians simply presumed they knew what approach to stuttering therapy would be best. In too many cases, they used the same approach for all their clients who stuttered. (I knew this, because they informed me of that fact. “This is what we do to treat stuttering. Are you ready to begin our program?”)
Given the wide variations in stuttering – in levels of severity, in how much stuttering may be affecting one’s life, in how much the client may be avoiding (situations, words, sounds), in how much help the client may have received from different types of therapies in the past – imposing a “one-size-fits-all” approach for all stuttering clients just ignores therapeutic reality and individual differences.
I really wish that many of my speech clinicians took the time and effort to do a meaningful assessment before beginning therapy. That may be a large part of the reason why 80% of my therapeutic experiences were not helpful at all.
I estimate that I saw about 35 different clinicians over a stretch of about 35 years (late 1950’s to mid-1990’s, between the ages of 4 and 40). Of those I only count 7 who significantly helped me to any degree.
I hope this has all been helpful to you.
Good luck in your future caeeer!
– Paul