Presentation on theme: "Section for Psychologists in Education OPA Conference 2014"— Presentation transcript:
1 Making it Stick: Private Practice/Hospital/Agency Psychology Reports and the School Board Section for Psychologists in EducationOPA Conference 2014M.J. Gendron, M. Kokai, D. Lean,C. Lennox, P. Pires & K. Smolewska
2 AgendaChallenges for psychology providers who work outside of District School Boards (DSBs)Identification and DiagnosisOntario Ministry of Education PPM 8School Board Considerations
3 Challenges for Psychology Providers Outside of DSBs Dr. Paulo Pires & Dr. Kathy SmolewskaChallenges for Psychology Providers Outside of DSBs
4 Private Practice Context Psychological assessment (and possibly diagnosis) may be required to provide information to the Board about educational needHistory of acquired brain injury (e.g., TBI, stroke) or other neurological or psychiatric condition, which is affecting their functioning at home and/or schoolHistory of MVA involvement and require recommendations for cognitive/ psychological sequelaeQuery Autism Spectrum DisorderBoards seem to differ in terms of whether these assessments or in fact diagnosis are necessary for accessing accomodations, and this is confusing to the Private Practitioner.
5 Private Practice Context Complete a neuropsychological or psychological assessment (depends on referral question and client’s history)Many clients do not clearly meet diagnostic criteria (or schools vary on what criteria they use)Inform parents that our recommendations are not guaranteed – it is up to the school to decide whether recommendations will be implementedThis includes cognitive, academic, socio-emotional components – plus additional testing for a neuropsychological assessmentTeacher questionnaires are always included. I may also speak with the school during the assessment phase, depending on the nature of the problem and what the parents want.
6 Case Example – Private Practice 11-year-old female in Grade 6 – A & B studentAx requested by parents due to concerns about her ability to retain info, learn math, understand maps, understand music, organize/plan her time, social skillsAttended Waldorf school initially & French schools – now in an English school for 1.5 yrsNot identified and no IEP - receives resource room support for math skills during music class
7 Case Example Assessment Results VCI: 100, PRI: 85, WMI: 86, PSI: 91Single Word Reading: 100Reading Comprehension: 116Composite Math: 91Composite Written Language: 80Visual Memory < Verbal MemoryVisuoperceptual/spatial skills < LanguageDifficulties with organization/planningBASC-II – Borderline/At Risk concerns re: AnxietyMASC2 Total Score: Very Elevated
8 Case Example Struggles Informed that without a DSM-V diagnosis, the supports will be stopped & no further supports will be givenProvided diagnosis of mild Non-Verbal Learning Disability (NVLD)Learns best with verbal language skillsStrong vocabulary and rote verbal memoryWeak visuospatial/constructional abilitiesDifficulty discriminating & recognizing visual details & visual-spatial relationshipsDifficulty with complex, non-linguistic perceptual tasksAcademically, struggles with math [but not evident on testing]Trouble expressing herself in an organized manner through writingDifficulty with non-verbal communication , trouble making friends and maintaining friendshipsProblems with anxiety - fears new situations and has trouble adjusting to changeThis is not a DSM-V diagnosis – will the school accept it?There is not a large discrepancy between Ability and Achievement scores – is this a problem?Informed that without a DSM-V diagnosis, the supports will be stopped & no further supports will be givenProvided diagnosis of mild Non-Verbal Learning Disability (NVLD)Learns best with verbal language skillsStrong vocabulary and rote verbal memoryWeak visuospatial/constructional abilitiesDifficulty discriminating & recognizing visual details & visual-spatial relationshipsDifficulty with complex, non-linguistic perceptual tasks (e.g., trying to read music; interpreting maps; understanding directions and where she is in space)Academically, struggles with math [not evident on testing, but has received a lot of extra help & tutoring over the past two years]Trouble expressing herself in an organized manner through writingDifficulty with non-verbal communication (e.g., interpreting social cues) and has trouble making friends and maintaining friendshipsProblems with anxiety - fears new situations and has trouble adjusting to changeThis is not a DSM-V diagnosis – will the school accept it?There is not a large discrepancy between Ability and Achievement scores – is this a problem?
9 Hospital ContextChildren with a host of developmental, neurological and mental health concernsTreatment plans often require a school component – program modification, accommodation or alternative programStudents often struggling in school across domains although needs may not be clearSchool refusalBehavioural/safety intervention plansKS: Paulo, do we want to include the pediatric neuropsychologists here as well (e.g., epilepsy, concussions, pre-post tumour resection)? One of the challenges they face is that some doctors don’t care about school recommendations. For example, the neurologists/neurosurgeons will say they only want 1-2 page reports with treatment recommendations or pre-post surgical comparisons. They say they don’t have time to read our 10+ page reports and that our service isn’t responsible for providing school recommendations.
10 Hospital Context Diagnostic assessments completed Comprehensive psychological assessments as a specialized (consultation) service in hospital programs – who may not be able to receive a psychological assessment through the school board due to eligibility, wait-lists and other factorsTreatment plans and specific recommendations for the emotional/behavioural problemComprehensive psychological assessments include cognitive, academic, social-emotional components
11 Case Example – Hospital 7-year-old male in Grade 2 with social and behavioural concernsDiagnosed before psychological with ADHD & Vocal Tics; query ASD, query cognitive/learning potentialSignificant aggression at home and schoolSpeech delay, family history of attention and learning problemsWeak motor skills, organization and planning skills, and reactions to changes in plans/routinesNot identified and no IEP - regular class with shared EA support
12 Case Example Assessment Results GAI: 123 (some variability), WMI: 83, PSI: 91Above average: Reading skills, math problem-solving, spellingAverage: all other academic skillsVariable memory (average and below)Average VMI and below average visuo-motor precisionExecutive functioning deficitsMood/anxiety concernsAdaptive skills below average in many domains
13 Case Example Struggles At risk for Learning Disability in the futureNeed to ensure continual monitoring and future assessmentFocus not just on behaviour – but the cognitive/skill weaknessesCurrent average academic skills, but requires support for both behaviour and academic (accommodations, not modifications)Qualifies for Identification? EA support?Formal IEP development?
14 StrugglesTranslating information from a context primarily operating from a medical model, to an educational modelHow is diagnostic and treatment planning information translated to potential identification and formal educational planning?Who should child psychologists in the community/hospital setting communicate with at the school/Board?.... School Psychology StaffKS: I think these struggles are similar in private practice. Diagnosis vs. identification is a big one. Some individuals I have spoken to at the schools say many hospital/community psychologists are overinclusive in their recommendations and there is no way they could be applied (i.e., the resources are not there). This came up a lot during the first LD forum – parents think that once something is in a report, it guarantees that their child will get it (e.g., they almost think they’re legally entitled to it). Our school counterparts asked us to make it very clear to parents that our reports don’t “guarantee” anything.
15 Common Challenges for Providers Outside of DSBs Understanding differences in services, models of special education supportUnderstanding exceptionalities – and nuances in how a particular Board has defined the exceptionality (specific criteria)Understanding what the Board requires to address the needs of students (because identification is not the only route to getting support)Accessing relevant school board providersDetail in reports (sensitive family/psychiatric information)
16 Specific Challenges What language is most effective to use in reports? How do we ensure the right people have access to the information?How does the Board view Learning Disorders (DSM) diagnoses?Concern about stigma of mental health – ensuring understanding
17 As a Provider outside the DSB… Sensitive to “not telling the school” what to doTry not to put the school system behind the eight ball – balance children needs with school resourcesCommunicate to the parent that recommendations are not “guaranteed”Recommending IEP and/or IdentificationInviting yourself to be part of school consultation/intervention planning
18 Identification and Diagnosis Dr. Maria KokaiIdentification and Diagnosis
19 Identification History and background Categories of Exceptionalities Placement options
20 History of Special Education 1980: Bill 82all children with disabilities have access to publically funded education;school boards must establish special education programs and services for exceptional pupils5 principles:Universal accessEducation at public expenseAppeal processOngoing identification and continuous assessment and review (IPRC)Appropriate program
21 Identification in Special Education Mechanism for identification of special education needs:Identification, Placement and Review Committee (IPRC)
22 Identification, Placement, and Review Committee (IPRC) School board committees - decide whether or not students should be identified as exceptionalIdentify the student’s exceptionalityDecide appropriate placementReview identification and placement at least once each year.
23 Identification in Special Education Who is identified as an exceptional pupil?“a pupil whose behavioural, communicational, intellectual, physical or multiple exceptionalities are such that he or she is considered to need placement in a special education program....”Students are identified according to thecategories and definitions of exceptionalities providedby the Ministry of Education.
24 12 categories of exceptionalities Behaviour:BehaviourCommunication:AutismDeaf and hard-of-hearingLanguage impairmentSpeech impairmentLearning disability
25 12 categories of exceptionalities (cont’d) Intellectual:GiftednessMild Intellectual DisabilityDevelopmental DisabilityPhysical:Physical disabilityBlind and Low visionMultiple Exceptionalities
26 Exceptionalities and Placements Ministry Definitions of Exceptionalities:Caution: DSB may have differing interpretations and additional identification criteria!5 PLACEMENT OPTIONS:Regular class with indirect supportRegular class with resource assistanceRegular class with withdrawal assistanceSpecial education class with partial integrationFull time special education class
27 Diagnosis What is a diagnosis Frequently occurring diagnoses in education
28 What is a diagnosis SPECIAL EDUCATION: A GUIDE FOR EDUCATORS “Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of an individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.”Regulated Health Professions Act (RHPA) 1991
29 What is a diagnosis“In the course of engaging in the practice of psychology, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to communicate a diagnosis identifying, as the cause of a person’s symptoms, a neuropsychological disorder or a psychologically based psychotic, neurotic or personality disorder.”Psychology Act, 1991
30 Frequently occurring diagnoses in education Learning Disability (40% of all students identified with special education needs)AutismADHDIDODDCDGADEtc….
31 Psychological Assessments in Education Input from psychological assessment is critical:IPRC relies on psychological assessmentsIEPs rely on psychological assessments
32 The changing role of Psychological Assessments in Education Old “gatekeeper” model: assessment to determine identification for IPRCCurrent model: assessment to help understand learning profile, assist in programming (IEP); incorporated in a multi-tiered supportTarget audience for reports: regular class and SE teachersCaution: students do not have to be identified to get special education support!
33 Psychological Assessments in Education Not all identifications require a diagnosisNot all diagnoses lead to identificationCaution: with requests to identify a specific exceptionality!
34 Identification May rely on diagnosis Without diagnosis Gifted Learning DisabilityAutismDevelopmental DisabilityMild Intellectual DisabilityBehaviourGiftedLanguage ImpairmentSpeech ImpairmentMild Intellectual DisabilityBehaviour
35 Diagnoses No identification LD ASD ID ODD CD ADHD FASD Etc… May lead to identificationNo identificationLDASDIDODDCDADHDFASDEtc…
36 Working together: consult, collaborate to support parentsto support teachersto support students
37 Ontario Ministry of Education Policy and Programme Memorandum 8 Dr. Carolyn LennoxOntario Ministry of Education Policy and Programme Memorandum 8
38 Ministry of Education Definition of Learning Disability ... one of a number of neurodevelopmental disorders that persistently and significantly has an impact on the ability to learn and use academic and other skills and that:results in (a) academic underachievement that is inconsistent with the intellectual abilities of the student (which are at least in the average range) and/or (b) academic achievement that can be maintained by the student only with extremely high levels of effort and/or with additional support;affects the ability to perceive or process verbal or non-verbal information in an effective and accurate manner in students who have assessed intellectual abilities that are at least in the average range;results in difficulties in the development and use of skills in one or more of the following areas: reading, writing, mathematics, and work habits and learning skills;
39 Ministry of Education Definition of Learning Disability may typically be associated with difficulties in one or more cognitive processes, such as phonological processing; memory and attention; processing speed; perceptual-motor processing; visual-spatial processing; executive functions (e.g., self-regulation of behaviour and emotions, planning, organizing of thoughts and activities, prioritizing, decision making);may be associated with difficulties in social interaction (e.g., difficulty in understanding social norms or the point of view of others); with various other conditions or disorders, diagnosed or undiagnosed; or with other exceptionalities;is not the result of a lack of acuity in hearing and/or vision that has not been corrected; intellectual disabilities; socio-economic factors; cultural differences; lack of proficiency in the language of instruction; lack of motivation or effort; gaps in school attendance or inadequate opportunity to benefit from instruction.
40 Cognitive abilities“At least in the average range”: Some issues for us as experts are:What is salient depends on test, student, subtest scatter, entire profile – clinical judgment based on evidence-based practiceGrey and discussion!How is average determined in diagnosis of learning disability?Not a cut-off score but common understanding of interpretation and functional information for boardMinistry is thinking about implementation of this and is encouraging us as psychologists as a common understanding. This is what I would take away but exploring with colleagues. We need to apply so we need to come to a common understanding.
41 Processing skills Phonological processing Memory and attention Processing speedPerceptional-motor processingVisual-spatial processing;Executive functions (self regulation, planning of behaviour and emotions, planning, organizing of thoughts and activities, priorizing, decision making.
42 Academic underachievement Processing difficulties results in difficulties in the development and use of skills in one or more of the following areas: reading, writing, mathematics, and work habits and learning skills;Inconsistent with intellectual abilities and/orAcademic achievement that can be maintained by the student only with extremely high levels of effort and/or with additionalNotion of disability/need?
43 Assessment guidelines Measures should be based on Canadian norms; culturally sensitive; use accessible format (e.g., sign language, Braille, large print). Assessment results conveyed using standard scores instead of grade levels or age and/or grade-level equivalencies.All psycho-educational and psychological assessments must be performed by or under the supervision of a qualified member of the College of Psychologists of Ontario, with informed consent from the parent(s).The results of the assessments must inform the development of the student’s Individual Education Plan (IEP) (whether or not the student has been identified).Ortiz's chart re: reduction in language load
44 Associated and exclusionary factors may be associated with difficulties in social interaction (e.g., difficulty in understanding social norms or the point of view of others); with various other conditions or disorders, diagnosed or undiagnosed; or with other exceptionalities;is not the result of a lack of acuity in hearing and/or vision that has not been corrected; intellectual disabilities; socio-economic factors; cultural differences; lack of proficiency in the language of instruction; lack of motivation or effort; gaps in school attendance or inadequate opportunity to benefit from instruction.
45 Prior to Psychological Assessment School boards are required to implement procedures for early and ongoing identification of the learning abilities and needs of student. See clause 8(3)(a) of the Education ActIf assessment and instruction, including early intervention strategies, have been tailored over a period of time to a student’s strengths and needs; if the student’s progress has been closely monitored and assessed; and if the student persistently demonstrates key characteristics of potential learning disabilities, the student should be considered for more in-depth assessments.
46 IPRCMultisource Information presented to IPRC typically should include the following:information provided by the parent(s), the student, and the educator(s) (e.g., the language spoken at home, developmental history, observations in the classroom)educational historymedical information (e.g., information on vision, hearing, and physical condition)educational assessments and/or other professional assessments (e.g., psycho-educational and/or psychological assessments, other assessments by health professionals)
47 Program Planningstudents who have been identified as exceptional by an IPRCANDany other students who demonstrate difficulties in learning and who would benefit from special education programs and/or services that are appropriate for students with learning disabilities
48 Program PlanningThe determining factor for the provision of special education programs or services is not any specific diagnosed or undiagnosed medical condition, but rather the needs of individual students based on the individual assessment of strengths and needs (professional assessment not needed, could be classroom assessment).Assessment (my words: classroom or professional) results should inform the description of a student’s strengths and needs and be used to determine special education programs and/or services for the student. The school principal may decide to develop an IEP for a student who demonstrates difficulties in learning and who would be likely to benefit from a special education program and/or services appropriate for students with learning disabilities.
49 IEPPrincipals should ensure that parents, students (where appropriate), and relevant school personnel are invited to participate in the development of the IEP of students with learning disabilitiesTransition planning must be considered as part of the IEP development processTransitions are entry to school; between grades; from one programme area or subject to another; moving from school to school or agency to school; elementary to secondary; secondary to post-secondary or work
50 IEP StrategiesThe IEP of students with learning disabilities may include the following strategies,:• Instructional, environmental, and assessment accommodations so that the student is able to access grade-level curriculum expectations and to demonstrate learning.• Modification of learning expectations may include the use of expectations at a different grade level and/or an increase or decrease in the number and/or complexity of expectations• Alternative expectations and/or courses that are not derived from an Ontario curriculum policy document (e.g., expectations focused on social skills, self-advocacy, transition planning, study skills) will be developed as needed
51 School Board Considerations Dr. Marie-Josee GendronSchool Board Considerations
52 Diagnosis vs. Identification Diagnosis refers to the DSM V or other diagnostic criteria by a professionalIdentification is a ministerial requirement that defines exceptional students “whose behavioural, communicational, intellectual, physical or multiple exceptionalities” are such that they require placement in a special education program.
53 Identification, Placement, and Review Committee (IPRC) School board committees that decide whether or not students should be identified as exceptionalIdentify the areas of the student’s exceptionalityDecide appropriate placement for studentReview identification and placement at least once each year
54 Categories of exceptionalities Behaviour:BehaviourCommunication:AutismDeaf and hard-of-hearingLanguage impairmentSpeech impairmentLearning disability
55 Categories of exceptionalities (cont’d) Intellectual:GiftednessMild Intellectual DisabilityDevelopmental DisabilityPhysical:Physical disabilityBlind and Low visionMultiple Exceptionalities
56 Individual Educational Plan (IEP) IEPs are developed for students who:are identified as exceptional by an IPRCare receiving special education programs and services but are not identified exceptional by an IPRC
57 Special Education Programs AccommodatedProvincial curriculum expectations are not alteredModifiedExpectations at different grade level, increase or decrease in number &/or complexity of expectations relative to grade-level curriculumKnowledge and skills that are not represented in the Ontario curriculum (e.g., personal care, social skills, etc.)Alternative
58 Placements Options for placement: Regular classroom with indirect supportRegular classroom with resource assistanceRegular classroom with withdrawal assistanceSpecial education class with partial integrationSpecial education class full time
59 Types of Accommodations Instructional: changes in teaching strategies that allow the student to access the curriculumEnvironmental: changes that are required to the classroom and/or school environmentAssessment: changes in procedures that are required in order for the student to demonstrate learning
60 Considerations for recommendations To doTo avoidRecommendations that are SMARTMake many recommendations (10-15)Specific to an area of needWatch wording – needs one on one…Measurable in relation to outcomeConvey to parents that school must implement all recommendationsAttainable or doableAssume that students will be identified as exceptional based on diagnosis (e.g., ADHD).Realistic given ressources in school boardsConfuse educational accommodations and curriculum modificationsTemporally-defined (elementary vs. secondary school)
61 Example of recommendations Instructional AccommodationsEnvironmental AccommodationsAssessment Accommodations• Duplicated notes• Reinforcement incentives• Assistive technology, such as text-to-speech software• Concrete/hands-on materials • Alternative work space• Strategic seating• Reduction of audio/visual stimuli• Assistive devices or adaptiveequipment• Extended time limits• Verbatim scribing• Alternative settings• Assistive technology, such as speech-to-text software• Reduction in the number oftasks used to assess a concept or skill
62 ResourcesOntario Ministry of Education: edu.gov.on.ca/eng/general/elemsec/speced/hilites.htmlOntario Ministry of Education: edu.gov.on.ca/eng/teachers/buildingfutures/teachPres/SupportingStudentsSpecialEducationNeeds.pdf
63 Summary/ Take Home Message Dr. Debra LeanSummary/ Take Home Message
64 Private Practice/Hospital/Agency Context Best practice is to get consent from parent/student to discuss findings with school psychology staffCan be during assessment or afterDiagnosis/identification and recommendations issues can thus be addressedAs well, current language required for Special Equipment Amount can be addressedCommunication with parents about these issues at feedback
65 Identification and Diagnosis Summary DSB’s different interpretations of IPRC and IEPBest understood through sharing with DSB Psychology StaffMulti-tiered support
66 PPM 8 Summary Much closer to LDAO definition Working toward a common understandingMulti-tiered Support Model with Screening and StrategiesIssues with DSM-V Learning Disorders
67 School Board Considerations Categories of ExceptionalitiesCurrently being revisedCategories will not changeProgrammingAccommodationsInstructionalEnvironmentalAssessmentModificationsAlternative ProgramsPlacement OptionsRecommendations