From Assessment to Intervention Part II: What Do We Assess, and How Do We Help After Assessment

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From Assessment to Intervention Part II What Do
We Assess, and How Do We Help After Assessment?

• By
• Mike McCall, M.A. School Psychology
• School Psychologist/Learning Specialist
• Sheara Fernando, M.A. School Psychology
• School Psychologist/Learning Specialist

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Presentation Outline

• Background information on psychological
  assessment
• Criteria for Assessments for Various Disabilities
• Description of the Parts of a Psychological
  Assessment report
• Using the Psychological Assessment to Help
  Students
• Case Studies of Psychoeducational Assessments
• Questions and Discussion

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Purpose of Psychological Assessment

• The goal of psychological assessment is to
  describe the clients functioning in order to do
  design interventions tailored to the students
  needs
• Part of the goal is to sort students, but that is
  not enough
• Effective assessment guides intervention

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Purpose of Psychological Assessment

• Kinds of assessment (Sattler, 2001)
• Screening brief to determine a second course of
  action
• Problem solving focus on a skill or one area of
  functioning
• Diagnostic surveys strengths and weaknesses
  across cognitive, academic, language, and social
  functioning
• Counseling/Rehabilitation completing daily
  responsibility
• Progress evaluation monitors intervention
  success

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Purpose of Psychological Assessment

• 4 Pillars of Assessment (Sattler, 2001)
• Norm referenced tests
• Interviews
• Observations
• Informal Assessment Procedures
• Good assessment relies on information from all 4
  pillars

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Types of Psychological Assessment

• Norm-Referenced Tests
• Assess intelligence, achievement, behavior, and
  social-emotional functioning
• Goal assign a numerical value to clients
  functioning
• See strengths and weaknesses within the client
  and compared to peers

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Types of Psychological Assessment

• Interviews
• Questioning the client and key individuals who
  play a role the clients functioning
• Goal helps determine what to assess by letting
  us know what the problem behaviors are
• May use unstructured, semi-structured, and
  structured formats

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Types of Psychological Assessment

• Observations
• Viewing the client as the behave during testing
  and in natural settings
• Goal assess behavior as it relates to the
  clients skills (e.g. frustration, reaction to
  failure, persistence, etc.)
• If psychologist cannot or will not observe the
  client, you can complete observation to give to
  the psychologist

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Types of Psychological Assessment

• Informal assessment
• Getting client to engage in naturalistic tasks to
  further understand strengths and limitations
• Goal better understand the clients
  functioning, test intervention strategies
• Supplying test scores (e.g. ACT, SAT), GPA, class
  grades, writing samples

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Facts of Psychological Assessment

• Cost
• 100 to 250 dollars per hour
• Full assessments take 6-8 hours with the client
  if done correctly
• Reports are going to take 2-4 hours of work
• 1 hour of review of the report
• Total 1,000 to over 2,000 for a full disability
  assessment
• ADHD screenings cost 300 to 600 dollars

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Determining Who Needs Assessment

• Reevaluation if a student has had services in
  the past, his/her testing may be out of date if
  the testing was over 3 years old
• ADHD testing many students self-refer, if
  student has trouble completing assignments or
  staying on task, seems to have average or better
  skill, coaches notice inattention, repeatedly
  miss appointments

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Determining Who Needs Assessment

• Specific Learning Disability if student has
  average cognitive ability but below average
  reading, writing, math, or communication skills
• Social/Emotional Disability student has
  anxiety, depression, bi-polar, schizophrenia, or
  any other disorder that negatively impacts
  academic functioning

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Determining Who Needs Assessment

• For everyone who will be newly diagnosed, refer
  to your disability offices requirements for
  services
• LD assessments will need less to be less than 3
  years old and on adult measures
• ADHD if just wanting to intervene with
  counseling and medication, student needs an ADHD
  screening, but disability services may require a
  full psychological assessment along with a
  medical doctors assessment (testing may need to
  be only a year old)
• Social/Emotional disorders just recognize the
  student has dysfunction that seems to be emotional

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LD Guidelines

• Current documentation is defined as three years
  old or less. Documentation older than this can
  still be submitted but may not be adequate to
  determine eligibility for accommodations.
• Must be typed, on letterhead
• Must include the summary of a comprehensive
  interview
• Comprehensive assessment of aptitude using adult
  scales.
• Comprehensive academic achievement battery using
  adult scales.
• An assessment of specific areas of information
  processing using adult scales.
• Detailed description of how this impairment
  significantly limits a major life activity in an
  academic setting.
• Report of explanations for academic problems that
  were ruled out, such as emotional problems, poor
  study skills, etc.
• Should include a detailed description of the
  disability, including a DSM-IV-TR code.
• Should include description of severity and
  longevity of the condition
• The evaluator should include any recommendations
  he/she has for appropriate accommodations for the
  students specific learning deficits within the
  context of the university environment.

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ADHD Guidelines

• Current documentation is defined as three years
  old or less. Documentation older than this can
  still be submitted but may not be adequate to
  determine eligibility for accommodations.
• Must include 2 parts
• Letter from MD with qualifications listed
• Diagnostic interview (should include any evidence
  of early impairment, evidence of current
  impairment, developmental history, family history
  of ADHD, relevant medical/medication history,
  description of current educational limitations)
• Ruling out of alternative diagnosis (mood,
  neurological, other disorders)
• Any prescribed medications for ADD/ADHD and the
  specific symptoms they help to control or manage
  for the student (i.e., inattention,
  hyperactivity, etc.)
• Specific DSM-IV-TR diagnosis and code
• Detailed description of how this impairment
  significantly limits a major life activity in an
  academic setting
• Suitable rating scales that might be included in
  the report are Wender Utah Rating Scale, Brown
  Attention-Activation Disorder Scale, Beck Anxiety
  Inventory, Hamiltons Depression Rating Scale,
  Connors Parent/Teacher Rating Scales
• Suitable tests of attention including
  Continuous Performance Test (such as Connors or
  IVA), Test of Variables of Attention (TOVA),
  STROOP, Trailmaking Test
• Tests should be completed using adult
  scales/versions.

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ADHD Guidelines Continued

• Psychoeducational evaluation
• Evaluation conducted by a psychologist or other
  appropriately credentialed psychoeducational
  professional
• Should include any recommendations for
  accommodations in the classroom setting
• Suitable tests for the Aptitude portion include
  WJ-III Tests of Cognitive Ability, WAIS-III, or
  Kaufman Adolescent and Adult Intelligence Test
• Suitable tests for the Achievement portion
  include Subtests from the WIAT, WJ Tests of
  Achievement, or Detroit Tests of Learning
  Aptitude-03 (or DTLA-A).
• Tests should be completed using adult
  scales/versions.

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Social Emotional Disorders

• Current documentation for psychiatric
  disabilities is defined as 6 months old or less
  due to the nature of psychiatric disabilities and
  medications for psychiatric disabilities.
  Documentation older than this can still be
  submitted by may not be adequate to determine
  eligibility for accommodations.
• Must state qualifications of doctor
• Must state the disability including a DSM-IV-TR
  code. Your doctor will be familiar with this.
  Should also include the date of diagnosis.
• Must describe how this impairment significantly
  limits a major life activity/activities in
  general and in an academic setting.
• Must include a detailed description of the
  disability.
• Must include a DETAILED description of the
  students current condition and how this
  condition interferes with or impacts the ability
  to participate in the educational process.
• If applicable, should include medical information
  relating to the impact of medication and/or
  treatment on the students ability to participate
  in all aspects (classroom, extracurricular
  activities, dorm life) of the academic
  environment
• The doctor should include any recommendations
  he/she has for appropriate accommodations within
  the context of the university environment.

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Process of Referral

• Use one or a few psychologists who are trusted by
  disability services
• Using the same people consistently can help build
  a working relationship so assessments happen in a
  timely fashion and are useful
• Ideally, programs may need to hire services of a
  licensed professional at least on a part time
  basis

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Process of Referral

• Expect full assessments to take 4-8 hours of face
  time
• ADHD assessments may take 1-2 hours of face time
• Students will get better results early in the day
  when they are not exhausted
• May need to find psychologist who can assess on
  weekends
• Reports take several hours to write, so there may
  be a week to a month delay from testing to when
  the report is ready

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Athletic Departments Role

• Send a packet of screening data to the
  psychologist
• Write a description of the students behaviors
  that you are concerned about
• Give a copy of the universitys disability
  criteria to the psychologist
• Make sure the student agrees to complete the
  testing
• Send a list of services that disability services
  and your office can provide

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Description of the Assessment Parts

• The report should be understandable to a parent,
  advisor, disability services, and most
  importantly the student
• The report should have objective data, but should
  also include subjective discussion of what may
  help the student
• There are 9 essential parts to the assessment

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Description of the Assessment Parts

• Identifying Information
• List of Assessment Instruments
• Reason for Referral
• Background Information
• Observations During the Assessment
• Assessment Results and Clinical Impressions
• Summary
• Recommendations
• Signature

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Description of the Assessment Parts

• Identifying information
• Name
• Date of assessment
• Date of birth
• Age
• Sex
• Year in school
• Names of anyone who contributes to the report
  (e.g. interviews, observations, ratings scale
  data)
• Name/Contact information of place sponsoring the
  testing
• Examiners contact information

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Description of the Assessment Parts

• List of instruments for the assessment
• Formal and informal assessments should be listed
• The list is important so that readers can know
  exactly what was completed with the child in one
  quick look
• Reason for Referral
• Who referred and why
• A description of problem behaviors and screening
  data that warrant testing
• Goal of the assessment

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Description of the Assessment Parts

• Background information
• Interview information from student, parents,
  coaches, or anyone else who may speak to the
  psychologist regarding the students difficulties
  
• Previous testing results
• High school grades and standardized scores
• Demographic information about high school and
  home town
• Description of family life and history of parents
  and siblings
• Medical history as relevant (e.g. concussions or
  hospitalizations)
• Statement of current functioning

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Description of the Assessment Parts

• Observations during an assessment
• Description of the students effort
• Description of students reaction to challenges
• Discussion of language usage, rapport, and
  attitude to self
• Statement of the validity of the results

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Description of the Assessment Parts

• Assessment Results and Clinical Impressions
• Describes test results in relation to peers and
  to ability to function in current environment
• IQ is based on age
• Achievement should be compared to college peers
  (since they function in a college environment)
• Description of strengths and weaknesses
• Diagnostic impressions

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Description of the Assessment Parts

• Summary
• Reviews and integrates the important information
  from the results and should lead to
  recommendations
• It is the big point(s) from each test and any
  relevant background information
• Recommendations
• Statement of diagnosis (if there is one)
• Statement of intervention strategies
• Who should be involved with carrying out the
  interventions

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Using the Report to Help a Student

• If they qualify for disability services, you need
  the report to register them, but disability
  services wont be enough
• Many students need more than extra time and books
  on tape or note takers
• Use the recommendations of interventions such as
  alternative study strategies, memory strategies,
  reading comprehension strategies

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Using the Report to Help a Student

• Slow processing speed help students better
  estimate and manage time so they can finish their
  work
• Weak working memory train students in various
  memory strategies (e.g. flash cards, elaboration,
  schemas, mnemonics)
• Weak verbal skills practice vocabulary,
  practice describing, have students discuss
  problem solving aloud, use visual aids to pair
  with verbal descriptions
• Weak perceptual skills pair pictures and
  diagrams with words

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Using the Report to Help a Student

• Weak decoding and fluency skills practice
  phonics and phonemic awareness skills, practice
  reading aloud, reread passage to reduce errors,
  practice reading fun material, train key
  vocabulary words to become sight words so they
  will recognize them on the test
• Weak comprehension auditory and visual
  presentation of reading (e.g. Kurzweil), teaching
  students how to create questions to answer while
  reading, teaching to read small parts and then
  reflect on the part, create visual
  representations of the material

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Using the Report to Help a Student

• Weak writing practice brainstorming, teach
  outlining, practice describing, have students
  talk aloud about what to write, use word
  processors, programs that record oral language in
  word processing programs, review grammar skills,
  journal writing, have students read good writing
• Weak Math use calculators, review math facts
  and processes, teach them to write out steps of
  problem solving, verbally and visually describe
  the problems

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Using the Report to Help a Student

• ADHD segment student time into smaller segments
  that are less taxing to focus, teach use of a
  planner, organize notebooks and folders, teach
  student how to find a good study environment,
  teach student how to monitor their own behavior

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Using the Report to Help a Student

• These are just some strategies to help students
  with various problems
• If the report indicates a weakness, the
  psychologist should recommend a solution
• If the psychologist does not recommend an
  intervention, call them and consult with them
• A psychologists responsibility is to assess and
  design interventions, which involves consultation

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Questions Discussion

• RTI on the horizon
• Communication with Disability Services
• Working with a Psychologist
• Others?

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References

• Sattler, J. (2001). Assessment of children
  Cognitive applications (4th ed.). La Mesa, CA US
  Jerome M Sattler Publisher.

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Presenter Contact Information

• Mike McCall , School Psychologist/Learning
  Specialist
• mccallmw_at_sc.edu
• 803 777 - 3581
• Sheara Fernando, School Psychologist/Learning
  Specialist
• fernando_at_mailbox.sc.edu
• 803 777 - 3581

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DSM-IV-TR (2000) Criteria for Students with
Learning Disabilities

• Diagnostic Criteria for 315.00 Reading Disorder
• A) Reading achievement, as measured by
  individually administered standardized tests of
  reading accuracy or comprehension, is
  substantially below that expected given the
  persons chronological age, measured
  intelligence, and age-appropriate education.
• B) The disturbance in Criterion A significantly
  interferes with academic achievement or
  activities of daily living that require reading
  skills.
• C) If a sensory deficit is present, the reading
  difficulties are in excess of those usually
  associated with it.

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Characteristics of Attention-Deficit/Hyperactivity
Disorder (ADHD)

• Three subtypes
• - Combined (314.01)
• - Predominantly Inattentive type (314.00)
• - Predominantly Hyperactive-Impulsive Type
  (314.01)
• Inattention manifests across situations (e.g.
  school, practice, free time, etc.)

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Characteristics of Attention-Deficit/Hyperactivity
Disorder (ADHD)

• Diagnostic criteria for Attention-Deficit/Hyperact
  ivity Disorder
• Either (1) or (2)
• six (or more) of the following symptoms of
  inattention have persisted for at least 6 months
  to a degree that is maladaptive and inconsistent
  with developmental levelInattention
• often fails to give close attention to details or
  makes careless mistakes in schoolwork, work, or
  other activities
• often has difficulty sustaining attention in
  tasks or play activities
• often does not seem to listen when spoken to
  directly
• often does not follow through on instructions and
  fails to finish schoolwork, chores, or duties in
  the workplace (not due to oppositional behavior
  or failure to understand instructions)
• often has difficulty organizing tasks and
  activities
• often avoids, dislikes, or is reluctant to engage
  in tasks that require sustained mental effort
  (such as schoolwork or homework)
• often loses things necessary for tasks or
  activities (e.g., toys, school assignments,
  pencils, books, or tools)
• is often easily distracted by extraneous stimuli
• is often forgetful in daily activities

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Characteristics of Attention-Deficit/Hyperactivity
Disorder (ADHD)

• six (or more) of the following symptoms of
  hyperactivity-impulsivity have persisted for at
  least 6 months to a degree that is maladaptive
  and inconsistent with developmental
  levelHyperactivityoften fidgets with hands
  or feet or squirms in seat
• often leaves seat in classroom or in other
  situations in which remaining seated is expected
• often runs about or climbs excessively in
  situations in which it is inappropriate (in
  adolescents or adults, may be limited to
  subjective feelings of restlessness)
• often has difficulty playing or engaging in
  leisure activities quietly
• is often "on the go" or often acts as if "driven
  by a motor"
• often talks excessively
• Impulsivity (g) often blurts out answers before
  questions have been completed(h) often has
  difficulty awaiting turn(i) often interrupts or
  intrudes on others (e.g., butts into
  conversations or games)

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Characteristics of Attention-Deficit/Hyperactivity
Disorder (ADHD)

• Some hyperactive-impulsive or inattentive
  symptoms that caused impairment were present
  before age 7 years.
• Some impairment from the symptoms is present in
  two or more settings (e.g., at school or work
  and at home).
• There must be clear evidence of clinically
  significant impairment in social, academic, or
  occupational functioning.
• The symptoms do not occur exclusively during the
  course of a Pervasive Developmental Disorder,
  Schizophrenia, or other Psychotic Disorder and
  are not better accounted for by another mental
  disorder (e.g., Mood Disorder, Anxiety Disorder,
  Dissociative Disorder, or a Personality
  Disorder).

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Interpretation of Discrepancy and Disability