Transcript Workshop handout - California Association of School Psychologists

FOR CEUs GO TO
attend.casponline.org
Choose workshop from dropdown menu: W-22
Enter Name/ SUBMIT
Instructions for sign-out will follow presentation
Comprehensive
social-emotional assessment
Michael Hass, Ph.D.
[email protected]
Focus of workshop
• Conducting comprehensive social emotional
assessments for:
– the purposes of establishing eligibility for special
education as a student with an emotional
disturbance
– establishing the need for school-based mental
health services
– creating well-formed treatment goals and systems
for progress monitoring.
Participants will better
understand…
• The definition of emotional disturbance and the
controversy around the distinction between ED
and social maladjustment
• The nature of a comprehensive assessment from
both a legal and best practice perspective
• How to integrate assessment information
gathered from record reviews, interviews,
observation and behavior rating scales to make
decisions about educational need
Participants will better
understand…
• How to conceptualize the role of culture in
social emotional assessment
• How to establish well-formed treatment goals
• How to develop systems for progress
monitoring.
Children’s Mental Health Needs
20%
5%
1-2%
Reflection
Consider the implications
Classification Systems
• DSM
• IDEA
• Dimensional approach
Thoughts on classification
• Both the DSM and IDEA are “medical” in the
sense that you either have something or not.
They are both categories that are “all or
nothing”
• They also assume children “have” a disorder,
i.e., the problem is inside the person
Issues and questions
• Disorders, syndromes, and disease
• Disorders are social constructs that involve
social judgements
• Boundaries between disorders are fuzzy
• Considerable variation within those who have
the same diagnoses
• Limited treatment validity
Standard of Review
A Typical Administrative Law Judge’s IEP Review and Analysis
includes…
• What are the student’s unique needs?
• Based on needs, what are the student’s present levels of
performance and were goals develop to address such need?
• Based on the goals, what placement and services were
offered to address those needs?
• Was the program and services offered reasonably calculated
to provide some educational benefit?
• Did the district implement the IEP?
• In the LRE?
Sec. 300.304 Evaluation
Procedures (IDEA, 2004)
• The evaluation should be comprehensive.
• The evaluator should use a variety of
evaluation tools or approaches that gather
functional and relevant data.
• The evaluator should be competent.
• The evaluation should be fair.
• The procedures used should be valid and
reliable.
Comprehensive (legally)
• The child is assessed in all areas related to the
suspected disability, including, if appropriate, health,
vision, hearing, social and emotional status, general
intelligence, academic performance, communicative
status, and motor abilities
• the evaluation is sufficiently comprehensive to
identify all of the child's special education and
related service needs, whether or not commonly
linked to the disability category …
Variety
• R.I.O.T = (a) record review/history, (b)
interviews, (c) observations and (d) tests
• Rule of two (Levitt & Merrell, 2009) = a
minimum of 2 settings, 2 informants, and 2
assessment methods.
Functional
• It is not necessary to include a definition of
‘functional’ in these regulations because we believe
it is a term that is generally understood to refer to
skills or activities that are not considered academic
or related to a child’s academic achievement.
Instead, ‘functional’ is often used in the context of
routine activities of everyday living. (Federal Register
/Vol. 71, No. 156 /Monday, August 14, 2006 /Rules and
Regulations, p. 4661)
Relevant
• Will it help identify unique needs?
• Will it assist those who work with the child?
• Will this information help the IEP team write
goals and accommodations?
Assessment Matrix
Informant
Student
Teacher
Parent
Assessor
other
History
Interview
Observation
Rating Scale
Where did the definition
of ED come from?
• Eli M. Bower and his colleagues were funded
by the state of California in 1957 to study
emotional disturbance
• They gathered data on 6,000 children,
including 207 identified as “ED” by clinicians
who saw these children in mental health clinic
Continued…
• When compared to their peers, ED children
were:
– poor learners although potentially able to learn
– had few if any satisfactory relationships
– behaved oddly or inappropriately
– were unhappy or depressed
– developed illness and phobias.
Continued…
• One of more of these characteristics was true
of most children at some point but the
difference for ED children was one of degree
and length of time.
Legally ED is…
• Emotional Disturbance "is a legal category
created by Congress to distinguish a narrow
range of pupils with emotional problems who
are eligible for special education services."
(Student v. Placentia-Yorba Linda Unified
School District (2009) OAH Case No.
2008100314, page 4.)
Not the same as a DSM diagnosis
• "The criteria regarding emotional disorders
in the medical and mental health fields are
significantly different than the educational
criteria for ED." (Student v. Placentia-Yorba Linda
Unified School District (2009) OAH Case No.
2008100314, page 4.)
IDEA Definition of E.D.
• The term means a condition exhibiting
one or more of the following
characteristics (or have a diagnosis of
schizophrenia) over a long period of time
and to a marked degree that adversely
affects a child's educational
performance:
Five Characteristics
• An inability to learn that cannot be
explained by intellectual, sensory, or
health factors
• An inability to build or maintain
satisfactory interpersonal relationships
with peers and teachers
• Inappropriate types of behavior or
feelings under normal circumstances
Five Characteristics
• A general pervasive mood of
unhappiness or depression
• A tendency to develop physical
symptoms or fears associated with
personal or school problems
IDEA Definition of E.D. Continued
• The term includes schizophrenia
• The term does not apply to children
who are socially maladjusted, unless
it is determined that they have an
emotional disturbance
“It is quite clear that the past and
current definition of ED is
ambiguous, circular, and logically
contradictory.” (Gresham, 2005)
ED vs. & Social maladjustment
• The term does not apply to children
who are socially maladjusted,
unless it is determined that they
have an emotional disturbance
Farmer, et al. two factor model of
externalizing problems
• Oppositional behavior (including
ADHD)
• Social norm violations
Reasons why viewing this as an either/or
choice does not make sense
• Comorbidity is the rule rather than the
exception
• For example, CD has higher risk of suicide risk
and depressive disorder than typical
population
Legal reasons for denying ED
on the basis of SM
• Bad conduct in the absence of other
evidence of ED
• Substance abuse as primary cause
although courts have acknowledged that
ED and substance abuse can co-exist
Rule out other
explanations
for the problem
An inability to learn that cannot be
explained by intellectual, sensory, or
health factors
Social competence
An inability to build or maintain
satisfactory interpersonal relationships
with peers and teachers
Odd, unusual or
inappropriate behaviors
Inappropriate types of behavior or
feelings under normal circumstances
Internalizing Problems
Withdrawal
Depression
Anxiety
Somatic complaints
Tripartite Model
Component
Internalizing problem
Negative affect or general emotional
distress
Both depression and anxiety
Withdraw
Both depression and anxiety but
function is different
Physiological arousal or somatic
tension
Mostly anxiety
Anhedonia or lack of positive affect
Mostly depression
Depressive disorders
A general pervasive mood of
unhappiness or depression
DSM V categories
• Major Depressive Disorder - 5 symptoms
present for 2 weeks nearly every day, most of
the day
• Persistent Depressive Disorder - 2 symptoms
present for 1 year nearly every day, most of
the day
Symptoms
• Depressed or irritable mood
• Markedly diminished interest or pleasure in all or almost all
activities
• Weight – gain or loss
• Sleep – too much or too little
• Psychomotor – restlessness or lethargy
• Lack of energy
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating
• Thoughts of death or suicide
Anxiety Disorders
A tendency to develop physical
symptoms or fears associated with
personal or school problems
Symptoms
• Excessive worry
• Somatic symptoms related to physiological
arousal or tension
• Avoidance
Long period of time
• Special education law does not define “long period
of time”
• Many DSM diagnosis require symptoms to be
present for at least six months but this is not
universal.
• The intent of the law is that “long period of time” be
decided on a case-by-case basis depending on a
child’s circumstances and individual needs (Student v.
Los Gatos-Saratoga Joint Union High School District (2004) 41 IDELR 227.)
Marked degree
• Pervasiveness of symptoms &
behaviors
• Intensity of symptoms & behaviors
• Distress caused by symptoms &
behaviors for the student or persons
in the environment
Adversely affects
educational performance
• NOT simply a judgment based on skills
measured on a standardized tests
• Can include grades, work completion,
attendance, tardiness, ability to work in
groups, etc.
Impairment
Protective factors &
Personal assets
Symptoms &
personal assets
Educational impairment
Grades
Skills
Academic
enablers
ED Organizer
Condition
Inability to build or
maintain satisfactory
interpersonal
relationships with
peers and teachers.
Evidence
establishing or
ruling out condition
Evidence for long
period of time
Evidence of
marked degree
Evidence that
condition adversely
affects educational
performance
Final thoughts on ED Assessment
• The answer to whether a social, emotional, or
behavior problem constitutes ED is always
going to involve informed subjective judgment
or PJs.
• Avoid over simplification
• Don’t flood yourself with data
•
General focus for record review
• Rule in or out other learning problems
• Evidence of an educational impairment
• Look for evidence for diagnoses that have a
developmental feature
• Look for evidence for “a long period of time”
• Look for medical or health problems that might
account for difficulties or need to be addressed
simultaneously
• Look for significant life events that might impact
functioning
Interviews
Advantages & limitations
• Flexible
• Takes training and
experience
• information is more
direct than rating
• Miss or forget
scales
information
• Provides opportunity • Reliability
to observe client
Purposes of interviews
• Collaboration is always an overarching goal
• Gather background information
• Gather information about the nature of the
problem and about strengths or resources
• Diagnosis/classification
Good practices in Interviewing
• Focus - think through goals and topics
beforehand
• Collaboration- use “skills for not
knowing”
Strategies
• Draw questions from previously completed
behavior rating scale
• O.F.A.I.D. - Focus on primary symptoms
Simple structure for interview
•
•
•
•
Start with small talk
Transition to structuring statement
Ask permission
Go to interview questions
Problem Description
•
•
•
•
•
•
What is the problem?
Who is involved?
To whom does the problem happen?
How is the problem a problem?
Video description
A-B-C
Attempts to solve problem that...
•
•
•
•
Failed to help
Helped (even a little)
Advised by others
Considered but not yet used
Background
H.E.A.D.S.
•
•
•
•
•
Home and health
Education
Activities
Drugs
Sexuality
Alternative Strategies
•
•
•
•
•
•
Waking-day interview
Self or family drawings
Self-anchored scaling questions
Ecomap
“Three wishes”
Sentence completion
Classroom Observation
• Direct rather than
• Won’t provide
indirect approach to
information about
assessment
student’s inner states
• Data gathered in natural • One observation is
setting
probably not reliable
• Direct link with
• Doesn’t necessarily add
intervention planning
to DX information
• Observing makes you
more credible
Basic observational structure
• Instructional environment
• Recommend BASC SOS because it
includes several components
– Time sampling of behavior
– Adaptive and problem behavior
– Behavior key and checklist
– Teacher’s interaction with student
Mental Status Exam
• Conducted as component of overall
assessment, interview, observation, or testing.
• Systematic way of reporting your observations
and “professional judgments” about a person
• Danger of over interpreting, stick as close as
possible to descrptive observations
Mental status “systems”
•
•
•
•
Physical Characteristics
Overt Behavior
Cognitive Functioning
Social emotional functioning
Mental Status
• Physical
Characteristics
– Appearance
– Posture
• Overt Behavior
– Activity level, body
movements
– Distractibility
– Speech
• Cognitive
Functioning
– Decision making and
judgment
– Thought content
– Attitude
– Perceptions
Social Emotional Functioning
• Affect
– current observable emotional status
• Mood
– emotional status over time as described by
client
• Interpersonal or Social skills
– eye contact, turn taking, reaction to praise,
etc
– Description of friends and activities
Classroom Observation
• Direct rather than
• Won’t provide
indirect approach to
information about
assessment
student’s inner states
• Data gathered in natural • One observation is
setting
probably not reliable
• Direct link with
• Doesn’t necessarily add
intervention planning
to DX information
• Observing makes you
more credible
Recording and Coding
•
•
•
•
Narrative recording
Frequency (interval, time sample)
Functional behavioral analysis
Direct behavior ratings (DBR)
Advantages
• Efficient way of gathering information
• More sensitive to low frequency behaviors
• More reliable than observations and
interviews
• Allows comparison to a norm group
• Allows comparisons between informants
Limitations
• Not diagnostic – essentially screeners
• Does not identify etiology or antecedents of
problem
• Does not lead directly to interventions or
diagnosis, should be combined with other
data gathering methods
• Assess perceptions in a standardized way but
are not “objective” measures
Keep in mind
• Comprehensive or general purpose versus
narrow
• Aggregation principle
• All raters possess some evidence of predictive
validity but don’t necessarily correlate highly
• Don’t be rigid about interpreting score
categorically
Steps in interpretation
• Typically, focus on individual scales rather than
composite scales
• Identify all scales with T-scores in the at-risk range
• For each scale identified, exam item responses
• Look for patterns in items and scales and generate
hypotheses
• Collect additional evidence via other methods to
confirm of disconfirm hypotheses
Rubric for goals and
recommendations
Needs
Services
Goals
Types of recommendations
•
•
•
•
•
•
Additional evaluations
Accommodations
Curriculum modifications
Interventions tied to identified needs
Specialized supports or services
Referrals to other providers
Assessing progress
•
•
•
•
Self anchored scales
Abbreviated rating scales
GAS
Commercial progress monitoring scales
Self Anchored Scale with Images
Self-Anchored Scale with numbers
Rate how much you worry on a scale of 1 to 5
1
2
I worry so
often that I
can’t. I get
stomachaches
and
headaches. I
start to shake
3
4
5
I worry but I can
manage
I am calm. I am
not worried about
a thing
Abbreviated rating scales
• Two strategies
– Choose items on scale that are rated the highest,
indicating a high level of distress or symptoms
– Choose the items that correlate the best with the
larger construct measured by the scale
Goal Attainment Scaling (GAS)
GAS Rating
Descriptor
+2
Significantly improved
+1
Improved
0
Baseline
-1
Worse
-2
Significantly worse
GAS example
Target Behavior: Stephanie will use relaxation techniques to reduce
nervousness and anxiety
(Based on BASC-2 item #108: I get nervous)
GAS Rating
Goal Descriptions
+2
Stephanie uses a relaxation technique 100% of the times she feels nervous
+1
Stephanie uses a relaxation technique 75% of the times she feels nervous
0
Stephanie uses a relaxation technique 50% of the times she feels nervous
(Stephanie’s current baseline performance)
-1
Stephanie uses a relaxation technique 25% of the times she feels nervous
-2
Stephanie does not use relaxation techniques
Visual Analysis
• Phase changes should be:
– Generally immediate
– Readily discernible
– Maintained over time
• Advantages:
– Quick to yield conclusions
– Graphing is relatively easy
– Minimal theoretical premises
• Limitations:
– Difficulty interpreting subtle phase changes
– Little guidance for variable or level data, or unclear trends
Visual Analysis Rating
GAS
Evidence of Progress
Rating (Visual)
70
60
50
40
Randy WPM
+2
Strong evidence of all of
below
+1
Desired Direction,
immediate, discernible,
but some overlap
between phases,
moderate change
0
Lack of any evidence
-1
Same as “1” but in
opposite direction
-2
Same as “2” but in
opposite direction
Goal WPM
30
20
10
0
Baseline
Intervention 1
Percentage of Non-Overlapping Data (PND)
• Percent of non-overlapping data points (higher or lower)
between baseline and treatment phases
• Calculated:
Number of data points in Tx phase that were higher than highest
baseline score
Total number of data points in Tx phase
• Advantages: Simple! No worries about nonlinearity or
heterogeneity
• Limitations: Potentially oversensitive to atypical baseline
data, adversely impacted by trends, may not discriminate
important treatment changes
Percentage of
non-overlapping data points
• Identify the lowest
baseline point
• Count the number of
non-overlapping
intervention points
• Calculate the
proportion of nonoverlapping to total
number of intervention
points
• Ineffective - 50%
• Questionable - 5070%
• Moderately effective 70-90%
• Highly effective - 90%
+
Michael Hass, Ph.D., January 2011
• INSTRUCTIONS FOR SIGN-OUT FOR CEUs
• attend.casponline.org
• Select workshop from drop down: W-22
• Enter Name
• Enter Email Address
• Enter BBS license number (if applicable)
• SIGN OUT CODE: KG29
• Complete Evaluation
• Must be filled out completely to receive CEUs!