If you’re an SLP working in the schools, students with language disorders might take up a good portion of your caseload.
That’s why one of the most common questions that pops up in the groups of SLPs that I mentor is how to do a good language screening.
Common questions include things like:
“What language screening tool should I use?”
“How do I know when to initiate a language evaluation?”
“What if I don’t think the screening results are accurate or don’t have access to a good language screener?”
“What should I do if people are pressuring me to evaluate when I don’t think it’s appropriate (or not evaluate, when I think I should)?”
“What if I think other domains need to be evaluated besides language?”
Today I’m going to answer those questions.
We’ll start out with when to get consent, then move to screening tools, and follow-up with the decision-making process.
When to get parental consent for screenings.
Schools do a lot of different screenings to identify which students might need supplemental support.
Some require that we get special consent to screen, while others don’t.
You need to know when to get that consent so you can ensure you stay compliant.
Information about evaluation and screening procedures as outlined by Individuals with Disabilities in Education at of 2004 (IDEA, 2004) can be found in Subpart D, but you'll also want to be familiar with your state and district regulations.
Based on the IDEA (2004) regulations, you do not need to get consent if ALL the students are getting the same treatment.
For example, districts often administer benchmark screenings to ALL students to identify students in need of Tier 2 interventions.
Staff also may do grade-level assessments, or even assessments with specific classes.
In this case, if these procedures are being done with all the kids in that district, grade, or class, we do not need to get consent to stay in compliance with IDEA (2004).
Parents will typically be notified of screenings and results, but they do not get special consent because it’s part of the standard general education protocol.
Now let’s say you have a student who is struggling.
They’ve completed the district-wide screening, and staff have concerns. They want you to do a formal language screening.
In this case, the student is getting something above and beyond standard general education protocol.
IDEA (2004) requires you to get consent for special education evaluations and to provide special education services, so a general rule of thumb is that you'd also want to get consent for a screening to consider a special education evaluation.
Since state laws may vary, I recommend going ahead and getting consent to cover your bases if you’re going to formally screen, observe, or consult with the teacher for the purposes of determining if an evaluation is needed.
So that that we’ve covered our bases legally, let’s talk about how to actually do that screening.
How I do a formal language screening?
When we think of a “language screening”, most people think of some kind of test.
However, we need to shift our focus to thinking of screening as a “test”, or “tool”.
A screening isn’t a “test”. It’s a process that help us to determine if there are enough red flags to warrant an evaluation.
That means it can involve a number of different tasks and tools that help us come to an educated decision.
This way, we have checks and balances in the system; so we aren’t basing our decision on one test score.
Those test scores of course play a part in our decision, but we want to use multiple sources of information so we’re getting the full picture, not just a contrived snapshot.
There are a handful of language screeners out there, some that are standardized, and some that aren’t.
I’m going to make some recommendations for formal screeners, plus some non-standardized tasks you can do to supplement those.
There are a number of good screeners out there.
The one that I used most in the school was the Clinical Evaluation of Language Fundamentals-5th Edition (CELF-5) Screening Test.
The CELF-5 screening gives a criterion score and is appropriate for students age 5:0 through 21:1, has an administration time of 15 minutes, and will give you a norm-based criterion score by age.
For younger students, there is also the Preschool Language Scale-5th Edition (PLS-5) Screening Test which is used to screen kids from birth to age 7:11, takes 5-10 minutes to administer, and will give you a norm-based criterion score for children ages 3:0-7:11.
Other SLPs may choose to supplement these with rating scales.
For example, the CELF-5 full evaluation kit has some supplemental scales you can give teachers to complete, and you can also use this Academic Language Skills-Rating Scale, which is part of the manual I offer my students in my Language Therapy Advance course.
Finally, it's also a good idea to supplement these rating scales and formal assessments with non-standardized tasks if you need more information.
Non-standardized language tasks may include things like:
Having kids retell stories or answer questions about paragraphs they’ve read or heard
Doing sentence repetition tasks
Having kids answer questions about sentences with complex syntactic forms
Having kids write/say vocabulary words in a sentence
Having kids explain/define word meanings
Doing blending/segmentation tasks
Having kids follow directions with complex syntax/grammar/vocabulary
(Non-standardized assessment tasks taken from: Carrow-Woolfolk & Allen, 2014; Hammill & Newcomer, 2008; Kelm, Melby-Lervåg, Hagtvet, Lyster, Gustafsson, and Hulme, 2015; Newcomer & Hammill, 2008; Wigg, Semel, & Secord, 2013)
This is not an exhaustive list, nor is it required that you do ALL of these things.
Remember, this screening is supposed to identify RED FLAGS, not diagnose.
You’ll have the opportunity to dig deeper once you do a full evaluation.
The goal right now is to get enough information to be able to say, “There’s something going on here…and we need to look further in to it.”
Gathering Academic Data.
We've all had those frustrating situations where a student failed a screening, but we know they weren't putting for their full effort.
Many of us have also had cases where the student "technically" passes based on the overall criterion, but we know we're not getting the entire picture.
That's why basing our decision on multiple pieces of information is best practice.
We might get this information from observations, interviewing teachers, and collecting work samples/academic data.
The goal is not to add hour of work to your plate, but rather to get enough information to make a good decision.
This is why I include a detailed checklist for gathering academic data in Language Therapy Advance.
Some of the things on that checklist include:
Reading comprehension test scores
Extended written responses on tests
Math assessment scores (especially word problems)
Vocabulary assessments (content areas, language arts)
The point here is to get a sample of what’s going on with the student and play detective so you can determine if the student is struggling with any of the above; and most importantly if it could be due to a language issue.
The relationship between reading comprehension and vocabulary assessments is self-explanatory; and with any type of written work, you can get a feel for the student’s use of grammar, syntax, and vocabulary.
Even if there aren’t grammatical errors, if the student is writing much less than the other students, lacks complexity in their writing, or repeats the same sentence structures over and over again, that could be a red flag (Zipoli, 2017).
With math and other content areas, poor scores can often be due to not understanding the vocabulary in the test questions, or struggling to complete multiple directions at once (Wigg et al., 2013).
Look for indications in their answers to see if they responded in correctly because they didn’t understand the question.
When it comes to interviewing the teacher or anyone else working with the child, I recommend using some type of behavioral rating scale that asks the teacher to rate a student's performance on language-related academic tasks.
The CELF-5 has one, or you could use a tool like this Academic Language Skills-Rating Scale that’s part of the manual that comes with Language Therapy Advance.
Rating scales like this can be used in a couple ways.
First, you can use them to structure the conversations you have with teachers or caregivers of the child you're screening.
Another option is to simply give this form to the teachers, and have them fill it out.
A final option is to use rating scales as guide for reviewing the academic data you collect and for looking for specific behaviors if you were to do a classroom observation.
You can download the rating scale here to see an example of what things you'd want to look for.
Now that we’ve talked about the screening process, let’s talk about what to do once you’ve collected some data.
Clinical decision-making after the screening.
Now that you have all the data, you might be asking yourself, “I’ve screened. Now what?”
According to Subpart D of IDEA (2004), you need parental consent to initiate an evaluation; but before you do that you're going to want to communicate with the other members of the special education team.
At my former district, we had a student problem solving team that would field all the academic referrals.
Typically, the screening process could look like this:
Step 1: Teacher comes to me with a concern; I get parental consent and collect screening data.
Step 2: The student is referred to the problem-solving team and at the next week, the teacher and I present our data.
Step 3: Once the team hears all the information we come to a decision about next steps.
Next steps could include things like:
Starting a Tier 2 intervention in the students' academic area of struggle and monitoring the student (and reconsidering an evaluation if progress is not made).
Initiating a speech and language evaluation.
Psychologist and/or social worker (or other personnel) collecting more screening information.
Move to a full-case study evaluation to evaluate multiple domains.
I worked at the district I mentioned above for 14 years, and through that time I had a couple “rules” I established for myself as I went through those steps.
These "rules" helped reduce tension between staff about when a student should be evaluated.
They also reduced the number of students who slipped through the cracks as “speech and language only” students when it wasn’t appropriate.
Rule #1: Make friends with the other related service personnel.
I can’t tell you how many times I’ve heard horror stories about SLPs and psychologists butting heads.
And I can’t tell you many times I avoided those disasters by having good communication with other related service personnel.
You may or may not have access to a problem-solving team at your district, so you might not have a formal referral team like I did.
In that case, your screening process could look very similar to what I described above; but instead of having a formal problem solving meeting, you might just have a conversation with your psychologist and/or social worker.
But the point is, whenever I have a language referral I was keeping the other related service personnel in the loop.
That way we could stay on the same page and avoid students falling through the cracks.
There were times that I did end up being the only personal evaluating, but only when that was the most appropriate thing for the student.
Rule #2: Don’t do a language evaluation until the student has been referred to the “problem solving team”
In the past in my district, SLPs would simply bypass the problem-solving team and initiate a language evaluation.
However, I created the strict policy for myself that I would not go through with a language evaluation until I had an open dialogue with the entire problem-solving team.
The purpose of this was to ensure that the student was going to be monitored by the team to ensure they’d get additional services if language therapy wasn’t enough.
This ensured that the other professionals, like the psychologist and social worker, were involved not just in the initial screening, but on an ongoing basis to track the students’ progress.
There were many times students qualified under “speech and language”, and then a year or two later qualified under a different eligibility because the other staff were aware of when we needed to reopen the evaluation.
Now for other areas like voice, fluency, or articulation; I was comfortable bypassing the team.
But if there was a language concern, the team was always involved because those cases are more complex.
If you don’t have a problem-solving team at your district, you may simply adopt a “no language evaluation without an open conversation with (insert relevant personnel) policy.”
Rule #3: Don’t create excess work for yourself:
If you have enough information based on work samples, observations, and other academic data, you aren’t required to do a formal language screening.
IDEA (2004) Subpart D outlines that you need to use multiple sources of information, including formal test scores as part of an EVALUATION.
This is because you're doing detailed diagnostic work during an evaluation.
But for a screening, all you're doing is identifying red flags; so federal guidelines don't require that you need to have certain scores in order to move to an evaluation (as always, you'll want to be familiar with your state guidelines in case they're more specific).
In fact, parents can simply request an evaluation in writing and you can move forward.
Do the screening if you need ADDITIONAL information; but it’s not a good use of time when you're fairly certain an evaluation is inevitable.
Now that we’re wrapping up, I wanted to leave you with the takeaway that a screening is a PROCESS, not a TEST.
If you have this PROCESS down, you’ll be more effective than any test will ever be in isolation.
I go in to more details about the processes you need to treat language disorders effectively in my course, Language Therapy Advance.