Making it Stick Private PracticeHospitalAgency Psychology Reports and

Making it Stick: Private Practice/Hospital/Agency Psychology Reports and the School Board Section for Psychologists in Education OPA Conference 2014 M. J. Gendron, M. Kokai, D. Lean, C. Lennox, P. Pires & K. Smolewska

Agenda Challenges for psychology providers who work outside of District School Boards (DSBs) Identification and Diagnosis Ontario Ministry of Education PPM 8 School Board Considerations

Dr. Paulo Pires & Dr. Kathy Smolewska Challenges for Psychology Providers Outside of DSBs

Private Practice Context Psychological assessment (and possibly diagnosis) may be required to provide information to the Board about educational need History of acquired brain injury (e. g. , TBI, stroke) or other neurological or psychiatric condition, which is affecting their functioning at home and/or school History of MVA involvement and require recommendations for cognitive/ psychological sequelae Query Autism Spectrum Disorder

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 implemented

Case Example – Private Practice 11 -year-old female in Grade 6 – A & B student Ax requested by parents due to concerns about her ability to retain info, learn math, understand maps, understand music, organize/plan her time, social skills Attended Waldorf school initially & French schools – now in an English school for 1. 5 yrs Not identified and no IEP - receives resource room support for math skills during music class

Case Example Assessment Results VCI: 100, PRI: 85, WMI: 86, PSI: 91 Single Word Reading: 100 Reading Comprehension: 116 Composite Math: 91 Composite Written Language: 80 Visual Memory < Verbal Memory Visuoperceptual/spatial skills < Language Difficulties with organization/planning BASC-II – Borderline/At Risk concerns re: Anxiety MASC 2 Total Score: Very Elevated

Case Example Struggles Informed that without a DSM-V diagnosis, the supports will be stopped & no further supports will be given Provided diagnosis of mild Non-Verbal Learning Disability (NVLD) Learns best with verbal language skills Strong vocabulary and rote verbal memory Weak visuospatial/constructional abilities Difficulty discriminating & recognizing visual details & visual-spatial relationships Difficulty with complex, non-linguistic perceptual tasks Academically, struggles with math [but not evident on testing] Trouble expressing herself in an organized manner through writing Difficulty with non-verbal communication , trouble making friends and maintaining friendships Problems with anxiety - fears new situations and has trouble adjusting to change This 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?

Hospital Context Children with a host of developmental, neurological and mental health concerns Treatment plans often require a school component – program modification, accommodation or alternative program Students often struggling in school across domains although needs may not be clear School refusal Behavioural/safety intervention plans

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 factors Treatment plans and specific recommendations for the emotional/behavioural problem

Case Example – Hospital 7 -year-old male in Grade 2 with social and behavioural concerns Diagnosed before psychological with ADHD & Vocal Tics; query ASD, query cognitive/learning potential Significant aggression at home and school Speech delay, family history of attention and learning problems Weak motor skills, organization and planning skills, and reactions to changes in plans/routines Not identified and no IEP - regular class with shared EA support

Case Example Assessment Results GAI: 123 (some variability), WMI: 83, PSI: 91 Above average: Reading skills, math problem-solving, spelling Average: all other academic skills Variable memory (average and below) Average VMI and below average visuo-motor precision Executive functioning deficits Mood/anxiety concerns Adaptive skills below average in many domains

Case Example Struggles At risk for Learning Disability in the future Need to ensure continual monitoring and future assessment Focus not just on behaviour – but the cognitive/skill weaknesses Current average academic skills, but requires support for both behaviour and academic (accommodations, not modifications) Qualifies for Identification? EA support? Formal IEP development?

Struggles Translating information from a context primarily operating from a medical model, to an educational model How 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 Staff

Common Challenges for Providers Outside of DSBs Understanding differences in services, models of special education support Understanding 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 providers Detail in reports (sensitive family/psychiatric information)

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

As a Provider outside the DSB… Sensitive to “not telling the school” what to do Try not to put the school system behind the eight ball – balance children needs with school resources Communicate to the parent that recommendations are not “guaranteed” Recommending IEP and/or Identification Inviting yourself to be part of school consultation/intervention planning

Dr. Maria Kokai Identification and Diagnosis

Identification History and background Categories of Exceptionalities Placement options

History of Special Education 1980: Bill 82 all children with disabilities have access to publically funded education; school boards must establish special education programs and services for exceptional pupils 5 principles: Universal access Education at public expense Appeal process Ongoing identification and continuous assessment and review (IPRC) Appropriate program

Identification in Special Education Mechanism for identification of special education needs: Identification, Placement and Review Committee (IPRC)

Identification, Placement, and Review Committee (IPRC) School board committees - decide whether or not students should be identified as exceptional Identify the student’s exceptionality Decide appropriate placement Review identification and placement at least once each year.

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 the categories and definitions of exceptionalities provided by the Ministry of Education. http: //www. edu. gov. on. ca/eng/general/elemsec/s peced/hilites. html

12 categories of exceptionalities Behaviour: o Behaviour Communication: o o o Autism Deaf and hard-of-hearing Language impairment Speech impairment Learning disability

12 categories of exceptionalities (cont’d) Intellectual: o Giftedness o Mild Intellectual Disability o Developmental Disability Physical: o Physical disability o Blind and Low vision Multiple Exceptionalities

Exceptionalities and Placements Ministry Definitions of Exceptionalities: http: //www. edu. gov. on. ca/eng/general/elemsec/speced/guid e/specedhandbooke. pdf Caution: DSB may have differing interpretations and additional identification criteria! 5 PLACEMENT OPTIONS: Regular class with indirect support Regular class with resource assistance Regular class withdrawal assistance Special education class with partial integration Full time special education class

Diagnosis What is a diagnosis Frequently occurring diagnoses in education

What is a diagnosis SPECIAL EDUCATION: A GUIDE FOR EDUCATORS http: //www. edu. gov. on. ca/eng/general/elemsec/ speced/guide/specedhandbooke. pdf “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

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

Frequently occurring diagnoses in education Learning Disability (40% of all students identified with special education needs) Autism ADHD ID ODD CD GAD Etc….

Psychological Assessments in Education Input from psychological assessment is critical: IPRC relies on psychological assessments IEPs rely on psychological assessments

The changing role of Psychological Assessments in Education Old “gatekeeper” model: assessment to determine identification for IPRC Current model: assessment to help understand learning profile, assist in programming (IEP); incorporated in a multi-tiered support Target audience for reports: regular class and SE teachers Caution: students do not have to be identified to get special education support!

Psychological Assessments in Education Not all identifications require a diagnosis Not all diagnoses lead to identification Caution: with requests to identify a specific exceptionality!

Identification May rely on diagnosis Learning Disability Autism Developmental Disability Mild Intellectual Disability Behaviour Without diagnosis Gifted Language Impairment Speech Impairment Mild Intellectual Disability Behaviour

Diagnoses May lead to identification LD ASD ID ODD CD No identification ADHD FASD Etc…

Working together: consult, collaborate to support parents to support teachers to support students

Dr. Carolyn Lennox Ontario Ministry of Education Policy and Programme Memorandum 8

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;

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.

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 practice Grey 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 board

Processing skills Phonological processing Memory and attention Processing speed Perceptional-motor processing Visual-spatial processing; Executive functions (self regulation, planning of behaviour and emotions, planning, organizing of thoughts and activities, priorizing, decision making.

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/or Academic achievement that can be maintained by the student only with extremely high levels of effort and/or with additional Notion of disability/need?

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).

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; socioeconomic 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.

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 Act If 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.

IPRC Multisource 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 history medical 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)

Program Planning students who have been identified as exceptional by an IPRC AND any 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

Program Planning The 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.

IEP Principals 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 disabilities Transition planning must be considered as part of the IEP development process Transitions 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

IEP Strategies The 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

Dr. Marie-Josee Gendron School Board Considerations

Diagnosis vs. Identification Diagnosis refers to the DSM V or other diagnostic criteria by a professional Identification 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.

Identification, Placement, and Review Committee (IPRC) School board committees that decide whether or not students should be identified as exceptional Identify the areas of the student’s exceptionality Decide appropriate placement for student Review identification and placement at least once each year

Categories of exceptionalities Behaviour: o Behaviour Communication: o o o Autism Deaf and hard-of-hearing Language impairment Speech impairment Learning disability

Categories of exceptionalities (cont’d) Intellectual: o Giftedness o Mild Intellectual Disability o Developmental Disability Physical: o Physical disability o Blind and Low vision Multiple Exceptionalities

Individual Educational Plan (IEP) IEPs are developed for students who: are identified as exceptional by an IPRC are receiving special education programs and services but are not identified exceptional by an IPRC

Special Education Programs Accommodated Provincial curriculum expectations are not altered Modified Expectations at different grade level, increase or decrease in number &/or complexity of expectations relative to grade-level curriculum Alternative Knowledge and skills that are not represented in the Ontario curriculum (e. g. , personal care, social skills, etc. )

Placements Options for placement: Regular classroom with indirect support Regular classroom with resource assistance Regular classroom withdrawal assistance Special education class with partial integration Special education class full time

Types of Accommodations Instructional: changes in teaching strategies that allow the student to access the curriculum Environmental: changes that are required to the classroom and/or school environment Assessment: changes in procedures that are required in order for the student to demonstrate learning

Considerations for recommendations To do To avoid Recommendations that are SMART Make many recommendations (10 -15) • Specific to an area of need Watch wording – needs one on one… • Measurable in relation to outcome Convey to parents that school must implement all recommendations • Attainable or doable Assume that students will be identified as exceptional based on diagnosis (e. g. , ADHD). • Realistic given ressources in school boards Confuse educational accommodations and curriculum modifications • Temporally-defined (elementary vs. secondary school)

Example of recommendations Instructional Accommodations • Duplicated notes • Reinforcement incentives • Assistive technology, such as text-to-speech software • Concrete/hands-on materials Environmental Accommodations • Alternative work space • Strategic seating • Reduction of audio/visual stimuli • Assistive devices or adaptive equipment Assessment Accommodations • Extended time limits • Verbatim scribing • Alternative settings • Assistive technology, such as speech-to-text software • Reduction in the number of tasks used to assess a concept or skill

Resources Ontario Ministry of Education: edu. gov. on. ca/eng/general/elemsec/speced/hilites. html Ontario Ministry of Education: edu. gov. on. ca/eng/teachers/buildingfutures/teach. Pres/ Supporting. Students. Special. Education. Needs. pdf

Dr. Debra Lean Summary/ Take Home Message

Private Practice/Hospital/Agency Context Best practice is to get consent from parent/student to discuss findings with school psychology staff Can be during assessment or after Diagnosis/identification and recommendations issues can thus be addressed As well, current language required for Special Equipment Amount can be addressed Communication with parents about these issues at feedback

Identification and Diagnosis Summary DSB’s different interpretations of IPRC and IEP Best understood through sharing with DSB Psychology Staff Multi-tiered support

PPM 8 Summary Much closer to LDAO definition Working toward a common understanding Multi-tiered Support Model with Screening and Strategies Issues with DSM-V Learning Disorders

School Board Considerations Categories of Exceptionalities Currently being revised Categories will not change Programming Accommodations Instructional Environmental Assessment Modifications Alternative Programs Placement Options Recommendations