Why Did You Use That Test? Exploring Speech-Language Pathologists' Clinical Decision Making in Bilingual Language and...

Our overarching goal is to advance our understanding of clinical decision-making processes in bilingual language and literacy assessment. When evaluating bilingual children, speech-language pathologists (SLPs) use static norm-referenced assessments (SAs) developed for English monolinguals more frequently than less-biased dynamic assessments (DAs). To date, no research has considered why SLPs use SAs over DAs or examined SLPs' conceptualization of validity beyond knowledge of psychometrics. In this study, we explore factors that affect SLPs' choice and use of assessments and how clinicians conceptualize and employ validity through the lens of modern validity frameworks.

Canadian SLPs (N = 21) participated in semistructured interviews, using a guide informed by the Theoretical Domains Framework and Kane's Validity Framework. Reflexive thematic analysis was used to generate themes.

Clinicians rarely report using "dynamic assessment" but did "assess dynamically" by incorporating teaching in testing. When assessing oral language, SLPs acknowledged that using SAs with bilinguals may be inappropriate but that they continue to do primarily because scores from these measures are necessary for diagnosis and accessing services. To contend with this friction between clinical beliefs and workplace requirements, most SLPs report caveats alongside SA scores to contextualize findings. Though individual clinical knowledge of psychometrics and validity in assessment varies, systemic issues play a key role in perpetuating current assessment practices with bilinguals. Finally, bilingual literacy assessment practices differ. Clinicians use a wider variety of assessments and rely less on scores to achieve desired outcomes for students.

Clinical decision making in bilingual language and literacy assessment is influenced by both individual and contextual factors. Accordingly, efforts to shift practice patterns cannot solely focus on individual clinical knowledge but must also examine and address these systemic issues.

https://doi.org/10.23641/asha.29474237.