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

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


1
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

2
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

3
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

4
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

5
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

6
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

7
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

8
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

9
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

10
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

11
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

12
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

13
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

14
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.

15
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.

16
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.

17
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.

18
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

19
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

20
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

21
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

22
Description of the Assessment Parts
  1. Identifying Information
  2. List of Assessment Instruments
  3. Reason for Referral
  4. Background Information
  5. Observations During the Assessment
  6. Assessment Results and Clinical Impressions
  7. Summary
  8. Recommendations
  9. Signature

23
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

24
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

25
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

26
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

27
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

28
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

29
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

30
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

31
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

32
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

33
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

34
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

35
Questions Discussion
  • RTI on the horizon
  • Communication with Disability Services
  • Working with a Psychologist
  • Others?

36
References
  • Sattler, J. (2001). Assessment of children
    Cognitive applications (4th ed.). La Mesa, CA US
    Jerome M Sattler Publisher.

37
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

38
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.

39
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.)

40
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

41
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)

42
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).

43
Interpretation of Discrepancy and Disability
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