Measuring and Assessing Severity of Involvement for Children with SSD

 Communication access realtime translation (cart) is provided in order to facilitate communication accessibility and may not be totally verbatim. The consumer should check with the moderator for any clarifications of the material.  This text-based course is a written transcript of the live seminar, "Measuring and Assessing Severity of Involvement for Children with SSD,” presented by Peter Flipsen.>> Dr. Flipsen:  Thank you, Amy, for inviting me and thanks to Greg for setting up this great forum for us.  Greg knows that severity measurement is also a small piece of my research interests so I am quite happy to be able to talk to you folks about this topic.  Before I get into it, though, I wanted to point something out. If we have any Canadian participants here, this will not be news to you.  But for those of you who are not, you will see that in the middle of that alphabet soup after my name, after the Ph.D., it says S‑LP [C].  That means I am certified speech‑language pathologist in Canada.  I am Canadian by birth and I got my Canadian certification before I got my ASHA CCC, just in case you were wondering. Outline Just to give you a brief outline of where we are going to do, it is a fairly straightforward organization here.  We are going to talk about what we mean by severity, about some factors that affect severity, things like defining severity categories, and the issues related to age differences.  Then we are going to spend about half of our time talking specifically about assessing severity, because I know that for many of you that is the big issue here.  You want to know how to do it.  I have a number of possible approaches that hopefully you will be able to make use of by the time we are done today.  Severity of Involvement Let's start at the beginning.  Severity of involvement - here we are talking about how bad the problem is.  Typically we are talking about applying some sort of a label.  Is it mild?  Is it moderate?  Is it severe?  Most of us know that that does depend on the disorder to some extent.  In this particular case, we are talking about speech sound disorders.  We could have been talking about voice disorders or language disorders or something else, but we are going to be focusing on children with speech sound disorders.  For those of you for whom that term is a little less familiar, just to orient you, that is now ASHA's preferred term for what we have historically referred to as both articulation disorders and phonological disorders.  It would also include childhood apraxia of speech.  I am not going to talk about those specific sub‑types in this presentation.  This is really more generic in that sense.  We are talking about assessing across the spectrum of speech sound disorders in this presentation.  Why is Severity Important? The question comes up sometimes as to why it is important that we might want to measure severity.  I have to admit that sometimes it is not that important.  It may simply be enough to say that there is a disorder.  You do your assessment and you decide that the child is eligible for services or they are not eligible for services.  If they are eligible, that's enough.  You may not find it necessary to come up with a severity adjective to apply to the disorder.  That is sort of less the case these days.  Most of the time, in fact, we do have to come up with some kind of label. There are a number of motivations for that.  One that comes up quite often is that it may affect access to services.  Some payors will actually limit what they will pay, depending on severity.  If we rate a child as having a mild problem, they are going to pay for less service than if we rate it as moderate or they rate it as less service if we rate it as severe.  It may be particularly important to determine what the severity is, for that reason.  Another reason assessing severity can be important is it may affect the way we manage our caseloads.  It is not uncommon for clinicians to group clients by severity.  If our caseload demands it or if we feel it is appropriate, we may decide to put our clients into groups.  We may decide that we are going to put all the mild cases in one group and the moderate cases in another group or the severe cases in another group. It may be useful for us to have that severity rating to do that.  It may be the case that again, often for reasons of managing the caseload, we may decide that we are going to see our severe clients -- who are going to likely be fewer on our caseloads than the mild ones -- more often, and our mild clients less often.  That is another reason why we might need to assign severity.  Finally, another reason that comes up sometimes in terms of managing severity is that it may influence our treatment choices.  There is emerging evidence to suggest that milder cases or more severe cases may respond better to different kinds of assessment or treatment approaches.  There is some suggestion now that conventional minimal pair therapy may be better for milder cases, whereas something like a cycles approach or multiple oppositions approach or even a complexity approach may be better for more severe cases. Again, those are other reasons why we might need to assign a severity rating.  What Factors Might Affect Severity? When we talk about assigning a rating of severity, we need to think about what factors might affect severity before we get into a discussion of what we do.  If we know what factors to consider, then we are likely to get a better handle on how severe the case actually is.  In general terms, when we talk about severity, we can take a couple of different perspectives on this.  One is...