Communication assessment

Also called Speech and language assessment, SLT assessment, Language assessment

What happens when a speech and language therapist assesses someone, what a good report contains, and what to do with a bad one.

What it is

A communication assessment is the structured process by which a speech and language therapist works out what a person can understand, what they can express, how they do it, what gets in the way, and what would help. It ends in a written report with a formulation and recommendations. It is the foundation of everything that follows, including an EHCP, a care plan or an AAC assessment.

An assessment is not a test the person can fail, and it is not the same as a diagnosis, although it may contribute to one.

Who it can help

Anyone referred to speech and language therapy, at any age. For a child it is usually the first thing that happens after referral. For an adult after a stroke or injury it may happen on the ward within days. For someone with a lifelong disability who has never had one, it is overdue, and it is worth asking for at an adult care review.

It is not useful when done in a rush, in a strange room, at the wrong time of day, with a person who is in pain or frightened. A report that says "unable to assess" usually says more about the conditions than the person.

How it works

The therapist gathers a history from you and from anyone who knows the person, then observes the person communicating in as natural a situation as possible, then uses formal tools where they fit: standardised tests of understanding and expression for children, aphasia batteries for adults, intelligibility ratings for speech, checklists of pragmatic skills. For a non-speaking person the assessment is about how they communicate now, in every mode, and what they respond to: pictures, symbols, signs, objects, print.

A good report has four parts. What the person can do, in detail. What they find hard, in detail and with examples. A formulation: the therapist's explanation of why. And recommendations that are specific enough to act on and, where they will go into a legal document, quantified: what, by whom, how often, for how long.

Getting started

Before the assessment, send the therapist a short note of what you see at home or in class: three things the person does well and three things that worry you, with examples. Ask what will happen and how long it will take, and ask for it to be at the person's best time of day. Bring their usual aids and anything already written about how they communicate.

Ask for the report in writing, and read the recommendations with one question: could a stranger deliver this from the page alone? "Would benefit from language support" fails that test; "daily ten-minute sessions of aided language stimulation using a 40-cell core board, delivered by a trained teaching assistant, reviewed termly" passes it. If the report is vague, write back and ask for it to be made specific; therapists know why you are asking.

Where to get help

RCSLT sets the professional standards for assessment. Speech and Language UK explains children's assessments to parents. Afasic helps families understand reports. For England, IPSEA explains what an assessment report has to look like to be useful in an EHCP.