Effectiveness of Virtual Assessment: The Language Video Assessment Tool (VAT)
Validation Study for the Use of The Language Video Assessment Tool (VAT) in Telepractice
Effectiveness of Remote Virtual Assessment: The Language Assessment Tool (VAT)
Over the past few years, the need for valid and reliable remote assessments has become more evident. In March 2020, we saw many schools and clinics around the world close their doors and turn to virtual speech and language services due to the COVID-19 pandemic. Now, as we are moving our way out of the pandemic, we are continuing to see virtual speech and language services. The reason, possibly, is because virtual speech and language services work (Gabel, Grogan-Johnson, Alvares, Bechstein, & Taylor, 2013) and can be more convenient for some families and individuals.
When we consider the individuals who are receiving speech and language services, the majority are in a critical period of speech and language development (Nicholas & Geers, 2006), and thus, it is crucial that services continue on in order to avoid negative effects on academic performance, peer relationships, and overall quality of life (Wales, Skinner, & Hayman, 2017; Taylor, Armfield, Dodrill, & Smith, 2014; Kaiser & Roberts, 2011). Previous research has suggested that tele-practice can be an effective model for assessment and treatment (Wales, Skinner, & Hayman, 2017; Keck & Doarn, 2014; Theodoros, 2008; Gabel, Grogan-Johnson, Alvares, Bechstein, & Taylor, 2013). Additionally, the American Speech-Language-Hearing Association (2020) has approved tele-practice as an appropriate method for the assessment and treatment of speech and language disorders. In order to feel confident in the accuracy, reliability, and validity of remote assessments, clinicians can evaluate how scores obtained during remote assessment compare to those scores obtained from in-person administration.
The present study compares oral language and language comprehension performance results of in-person versus remote administrations of the Language Video Assessment Tool (VAT). In order to examine the equivalency between in-person and remote assessments, a test-retest design was used for this study. Each individual who participated in this study was tested twice with the Language Video Assessment Tool (VAT), once in-person and once remotely. The same clinician administered both the in-person and remote assessment for each participant. Additionally, the order of which assessment format (in person vs. remote) occurred was counterbalanced. The purpose of the present study is to determine if there are any significant differences in language performance results when testing in-person compared to testing remotely. The present study will also evaluate rater-reliability by evaluating if there are any differences in the clinician’s ratings of performance when testing occurs in-person vs. remotely.
The Lavi Institute provides a technical manual for the administration and scoring of the Language VAT. It is a requirement that the clinician administering the test read and become familiar with the administration, recording, and scoring procedures before using this, or any, assessment tool.
One hundred and six children, aged 5 years, 0 months, to 14 years, 0 months participated in this study. The sample consisted of forty-nine who were considered typically developing and fifty-seven with a previously diagnosed developmental language delay. Demographic characteristics are reviewed in Table 1. The study’s sample was balanced for age, gender, and race or ethnic group.
Four examiners participated and administered the assessment used in this study. All examiners were state licensed, ASHA-certified speech-language pathologists (SLPs). The SLPs collected data from September 2020 to December 2022. The SLPs were recruited through The Lavi Institute, a research and professional development company. All examiners received compensation for their participation in the study. The one hundred and six participants were also recruited through the Lavi Institute and received compensation (e.g., gift card) for their participation.
Materials and Procedures
Prior to all in-person and remote assessments, parent consent was provided to assess each child. Parents also provided consent to have their child’s data included for the purpose of this study. Examiners confirmed with parents the day before the remote assessment took place that each child had access to an electronic device, such as a laptop or tablet, with headphones and a built-in microphone. Remote administration was completed securely over the online Zoom platform. Individual meeting links with passwords were provided for each participant and additional licensing was provided for the examiner to secure HIPAA compliance.
The Language VAT is composed of short pre-recorded video segments. Therefore, clinicians used an electronic device during both in-person and remote administrations to access the video-based Language Video Assessment Tool.
During remote assessment, the examiner used the screen-sharing feature on Zoom to present and administer the Language VAT. After displaying a test item to the student, the examiner paused the test, stopped screen-share, and asked the test item questions per test instructions. The clinician would then listen carefully to the answers. Then, the examiner would start screen-share again and move on to the next item and continue the process until all of the Language VAT items were administered.
During each participant’s first assessment, he/she was fully assessed using the Language VAT. Each participant was then scheduled for his/her follow-up assessment at least three weeks later. A student’s speech sound production skills are not expected to change significantly during this time period. Thus, the test-retest method is beneficial in comparing the results of a student’s in-person versus remote performance. Additionally, due to this research design, the present study counterbalanced the order of the test format. For example, half of the participants in the typically developing group and half of the participants in the clinical group received an in-person assessment the first time they were assessed and then received remote assessment the second time. The remaining participants received the remote administration the first time they were assessed and an in-person assessment on the second test date.
During both in-person and remote assessments, examiners recorded each participant’s responses on the online digital protocol. The results of each assessment were then calculated on the test’s website page. The Language VAT yields a raw score, standard score, and percentile rank. Participants’ standard scores from both testing formats were compared to obtain test-retest reliability. Raw scores from both testing conditions were used to obtain rater-reliability.
Test-retest reliability is the ability for a test to reveal the same score and/or diagnosis when given more than once over a short interval of time. This method was used to determine if the remote administration of the Language VAT would reveal the same score and/or diagnosis as the in-person administration. The Language VAT was administered twice to one hundred and six participants, aged 5 years, 0 months, to 14 years, 0 months, once in-person and once remotely. The interval between the two testing dates ranged from 20 to 25 days. Participants had the same examiner during the first and second administration. The results are displayed below in Table 1. All participants were grouped initially for primary analysis. The test-retest coefficients for the in-person and remote formats were greater than .80 indicating strong test-retest reliability.
Mean raw scores and standard deviations for in-person and remote standard scores of the Language VAT are provided in Table 2. The variance in means across groups is composed of the expected range of performance for typically developing participants (ranging from 5 years, 0 months, to 14 years, 0 months) with the expected range of performance for those with a developmental language delay (ranging from 5 years, 0 months, to 14 years, 0 months). To calculate the effect size, the difference between the mean standard scores of the two testing instances was divided by the pooled standard deviation. An effect size range from 0.02 to 0.16 was realized for the entire sample. An effect size of 0.2 is considered small, 0.5 is considered medium, and 0.8 is considered large (Cohen, 1992). As such, the observed effect sizes were considered small meaning there is insignificant change between the two test conditions (i.e., in-person and remote). Additionally, there were no statistically significant differences found between in-person and remote administrations for the Language VAT.
In order to investigate the reliability of the examiner’s ratings, raw scores from in-person and remote testing were compared for each participant. To calculate rater reliability, the intraclass correlation coefficient was used, following the method outlined by Shrout and Fleiss (1979). The intraclass correlation coefficients were .97 for the Language VAT indicating a very high level of agreement across the test administration conditions (i.e., in-person and remote) for the same participant.