Standardized Scores are not the complete picture
Welp, it happened again.
Sometimes I feel like I need to give a little more grace to insurance companies. It’s something I wrestle with daily. Because, you see, I don’t think that everyone who works for Cigna, BCBS, or any other provider is a bad person. They are just doing their job. Which, I get.
But.
Yesterday, a client I have been seeing for about 4 years came to me to tell me that their provider, in this case CIGNA, wants to deny all future therapy, due to ‘lack of progress.’
As a side, CIGNA also once denied a kid I know of due to making too much progress. They were fixed!!!! He didn’t need therapy anymore. We had to explain to them that standard scores weren’t necessarily reflective of his real-world abilities. He still had, and will always have, autism. This is not a bad thing, just a fact. Scoring 87 on a standardized test didn’t change that. And it certainly didn’t change the fact that he would still need therapy.
Now, back to my first friend. Yes, with regards to standardized testing, he has made little progress. In fact, his scores are almost the same. But let’s break this down because it’s not so clear cut.
There are many reasons why we can't just look at standardized scores.
The client may have started with scores that were very, very low. Like, the one percentile low. Therefore, making huge gains is not likely. It’s hard to jump from 1% to 50%. It might be impossible. The testing norms/scores change with the child’s biological age. So, if we test them at 3 years of age, and they score closer to 1.5 years of age, they must make up 2.5 years of developmental milestones before their next assessment at 4 years of age. That’s a tough ask. And it brings me to my next point.
The lack of an increase in standard scores does not mean that there is a lack in newfound abilities or skills. Once, I had a child in a similar situation as the child noted above. They bombed their first eval, because they could not fully participate in it. Then they bombed their second one a year later. Then, in year 3, they participated fully in the evaluation but still didn’t do great. They got denied services. BUT this child participated fully, of their own volition, in an assessment. This was a HUGE step for this client. HUGE. And it took three years. Which leads us too….
Circumstance. A lot of the kids we work with have environmental or personal events that impact progress. For example, if a client must spend 4 months in a hospital, or homebound due to a major surgery, then they will likely not make progress. If a child has a seizure disorder, and has a major, or even minor neurological event, then progress can be lost or muted. Some children come from complicated backgrounds, where aparent’s own education, personality, or socioeconomic status can impact the overall progress of the child.
These are just 3 examples of what can lead to minimum change in standard scores. There are more, for sure. Also, there are ways to fight this by setting appropriate goals and explaining things in reports clearly. We’ll get to that in a later post.
Right now, it’s important to understand that not every kid is going to make progress on standardized scores. That does not mean that therapy needs to be discontinued. We must look at the complete picture.
