Competence and Confidence Partners in Policymaking (C2P2): Family Leadership for Inclusive Education in Non-Traditional SettingsFebruary 2015: Understanding Evaluations: What Do the Results Mean for Your Child? with PRESENTER Annemarie Clarke, Corporate Officer, SPINTRANSCRIPT

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>> Good evening. Welcome to Competence and Confidence Partnership in Policymaking Family Leadership for Inclusive Education in Non-Traditional Settings. Or as we call it, fondly C2P2FL. My name is Cathy Roccia-Meier. I am the project coordinator for this program. We are going to have our understanding evaluations training tonight. What do the results mean for my child? With Annemarie Clark, PhD, corporate officer from SPIN. A little information about C2P2 Family Leadership. It of course is brought to you by the Institute on Disabilities at Temple University. And our funding comes from the Pennsylvania Developmental Disability Council. Just some little basics about our program. It is designed to support families, and inclusive education in nontraditional settings, which include home schools, cyber charter schools, charter schools, private schools, and parochial schools. Of course all of our sessions have relevance to all individuals with disabilities. A little more information. We also, our project includes online leadership development training which is what you're participating now. We also offer free one-on-one parent consultant support from our trained parent consultants with PEAC, online resources, and we are having an upcoming live session in the spring of 2015. Here are a list of just some of the available archives that we have, webinars that we have archived on our site. If you look at the bottom you can see the address that you can't go to. You can always Google it, Institute on Disabilities at Temple University. We are under Programs for Family Leadership. And you can see all of the past webinars that we've had over the last few years. In addition to the webinars, the PowerPoints, other supporting materials are available at that location. And as you can see we've had several different topics as well. Additionally, our next save the dates is our next is our next webinar Wednesday which is the same date in March, March 18th. At this time we are going to be doing a session on cyber safety. It's going to be a really interesting, exciting session for all of our families. We're also adding a new component to this program. As you see we have an email address listed there cybersafetyC2P2FL @templeuniversity.edu. And we are going to be taking your questions up until March 17th. So at any point throughout the next month. Please send us your question. Whatever your area of concern is thoughts or interests. We're going to collect them and answer them online at the next session. It will also help guide our session to make sure you're getting the most out of the session and the information that you really need. And we are following up this year with our live event a transitions forum at Visions for Equality in Philadelphia, May 9th. It's going to be on secondary transitions. So if you have a child in middle school, late elementary school, and onward this is the session for you. You're going to get information on what you need to do to start preparing your child when they're younger, as well as what you need to do when they get older and when you want them to move forward. We will be taking applications for this session and space will be limited. It will give you a great opportunity to hear presenters as well as network with other families. So a little more details about the components of this program. We mentioned our one on one parent consultant program. This is through the Pennsylvania Education for All Coalition that we collaborate with. Our parent consultants will be matched with you to help you, assist you with any of your needs. And some of the support that can be offered is in person, over the phone, or over email. There is a link listed here that you can go to to complete the form and request a parent consultant. Additionally, if you have any questions you can always as I mentioned before, go to our website and you can scroll through it to get to this location as well. And some of the ways that, excuse me. Some of the ways that PEAC consultants can assist you are listed here. Whether it be getting resources and support, understanding your rights, going over your IEP, individualized education plan or evaluation report, suggesting strategies attending IEP meetings. Pretty much anything you need, we can help you support. We also have online resources. We have a Facebook page, which is a closed group. Again, the link is listed here and you can always reach this to our main website. You will be accepted within a few days, and we do keep it as a closed room so that we can comfortably speak about whatever we would like to discuss. We hope you will join our Facebook page. We are hoping to build a robust community of families for discussions. And some basic housekeeping items. If you go to the Q&A box and you have a question about tonight's topics. This is where you are going to type in your questions. You click the question mark symbol at the top right of your screen to open the Q&A box. And then you type your question. However, if you have a technical question. If you're having difficulty and you need support, you will go to the chat box at the lower portion of your screen, select the name tech help in the menu. So again it is Q&A for questions for our presenter and for technical support. It's the chat box. And again tonight's webinar is understanding evaluations. What do the results mean for my child's with Annemarie Clarke. I just want to remind everyone that at the end of the session you are going to be asked to do a brief evaluation on tonight's webinar. We greatly appreciate if you take the time to complete this evaluation at helps us know what we need to do to move forward. If you stay on your webinar as soon as the program closes your website should go right to this survey. You will not be able to click on the survey in the screen. It will automatically take you there. Additionally, after the session we will be emailing everyone with information about the session, including notice that the PowerPoint will be upgraded to the website as well as the archive webinar and other documents that relate to this session. So again, we are now going to move into Annmarie Clarke. And a little bit about Annemarie. She is the Corporate Officer for Behavioral and Developmental Services at SPIN, where she oversees SPIN's Philadelphia Autism Center for Excellence. She is a licensed psychologist and a certified school psychologist, with extensive experience working with young children and families, particularly those impacted by autism. She obtained her masters in counseling psychology from LaSalle University and a doctorate in school psychology for Temple University. She taught in the graduate psychology programs at La Salle University and Philadelphia College of Osteopathic Medicine for almost 20 years. She served as Commission Member on the Mayor's Blue Ribbon Commission on Children's Behavioral Health in 2006 and 7. And currently serves on the leadership committee for the Philadelphia Autism Project. I hope you enjoy her fabulous presentation.

>> Cathy thank you so much for that nice introduction. Hi everybody. I'm glad to be spending some time with you this evening. And hoping to help you understand evaluations that your children may be receiving in different venues. Our goals for this evening, we have about four of them, basically what I wanted to try and do is provide an overview of different types of evaluations that your child may be receiving. Consider how we could use those different evaluations together more effectively, perhaps. And look at how the results of the evaluations may link to interventions and services for your children through either the educational system or the behavioral health system perhaps. And then answer any questions you have about using evaluations to support success in school and beyond for your child. So I wanted to start with a few terms because I know over the time that I've worked with families different terms get banded about in terms of what exactly is an evaluation or what is an assessment. So essentially measurement I wanted to start with. That's the basic process where we're trying to figure out the different dimensions of an attribute. And really, if you think about a ruler as a measurement right we're using a ruler to try to measure the length of something and length is the attribute of an object. So the length of a table. The length of a chair. Something like that. And in psychology or education we also use measurement. We are using different tools to measure different attributes that children or adolescents may be experiencing such as reading level, math levels, and things like that.

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An assessment is building on different measurement and it's a process really, where we're gathering information to monitor progress or make decisions about a child. And it certainly includes tests and measurements, but it also would include observations, interviews, and things like that. Evaluation is a piece that builds on that and sort of integrates with it and essentially that's a process where we are looking to determine whether the person meets any preset criteria. And that could be in this case, what we are evaluating in schools. We are evaluating often to see if the child meets the preset criteria for eligibility for special education or perhaps in the behavioral health community, or the medical community. We may be evaluating to determine whether the child meets the criteria for a particular diagnostic assignment. So essentially, with that evaluation we're looking at the evaluation essentially as the most complex process. We're trying to figure out whether again as I said that child is eligible for a particular diagnosis, or particular educational classification through the evaluation. And related to that, then we're trying to make a determination of what kind of services and supports would promote that child's success either within the educational environment, or with some sort of related service that could promote success in the educational environment. I wanted to highlight for the listeners different types of evaluations. Because one of the things that is important to remember when we look at evaluations is that when they are obtained from different settings or different sort of venues such as medical evaluation versus a behavioral health evaluation, they have different mandates assigned to them. And we are going to talk about that in a little bit. But basically I think for children. The three types of evaluations overall, could be a medical evaluation a behavioral health evaluation, and an educational evaluation. With those three primary types of evaluations providing different information that could be useful, and could be integrated in order to better understand a child's developmental picture and again then make some decisions about what is useful for them within the school. The medical evaluations if we wanted to start there are completed by a physical health provider. So this could be a physician, such as a pediatrician or a pediatric specialist, like a pediatric neurologist. A developmental pediatrician or other pediatric subspecialty. It could also include other medical providers like audiology, speech pathology, occupational therapy, and so forth. A medical evaluation, it's important to remember results in the assignments of a medical diagnosis if that's appropriate. And the reason why I think it's important to talk about that is, we are going to look at some places where medical evaluations overlap with behavioral health evaluations and where those two diagnostic buckets overlap a little bit. And then some places where they're very separate. Some medical diagnoses that a child can receive or an adolescent can receive may help qualify a student for special education eligibility. You know, and that could be in the case of hearing impairment, a student with a medical diagnosis of paralysis or some sort of medical diagnosis, of traumatic brain injury, centralized auditory processing disorder or autism. Related to that when we see a child has had an initial medical evaluation the frequency of evaluation or excuse me up re-evaluation or a follow-up evaluation is always determined by that medical provider. They may ask the family to come back in six months, in a year. But basically that physician, that medical doctor is responsible for prescribing the course of treatment and intervention, and sometimes they will do that in conjunction with other specialists or allied health providers. So most of us have been to a primary care physician who then may refer us to a specialist. So again, in the case of a child who is having some difficulty learning. You may start with your primary care pediatrician. They may refer you perhaps to a pediatric neurologist for some sort of neurological evaluation. They may also then refer you to an occupational therapy or a speech therapy evaluation. Sometimes those evaluations will then come back and inform a course of treatment. Sometimes that could include medication or it could include the provision of other sorts of "medically based therapy" like OT or speech therapy. And that's done outside of the school setting. So I think that's important to think about. And obviously the families are very, very important there. As well as other parties along with the medical provider in determining the course of treatment that will come with that evaluation. On the behavioral health evaluation, this is a very, very common evaluation that is received by many students with learning differences or behavioral differences within the school setting. A behavioral health evaluation must be completed by a licensed behavioral health provider. And that is typically a licensed medical doctor or a psychiatrist, right. A psychiatrist is a physician with a specialty and psychiatric medicine. So they would be an MD. Or a licensed psychologist who would typically be a PhD or something that you may see on evaluation reports that will say Psy.d, which is a psy d degree. That's a doctorate in psychology. So a different type of clinical doctoral licensed degree in psychology. And occasionally you might see some license psychologist that have an EdD after their name. But the licensed piece is the critical part here. And again I'm going to differentiate that a little bit more when we get in to talk about school evaluations because in order for a behavioral health evaluation to be acceptable. The person has to be licensed in the state in which they're providing service. That evaluation will result possibly if it is appropriate and the assignment of a behavioral health diagnosis. There is some overlap between what's considered a medical diagnosis and a behavioral health or physical health. Let me restart out over there again. There is overlap in some areas between what is considered a behavioral health diagnosis than a medical diagnosis. And two good examples of that are autism and attention deficit hyperactivity disorder, or ADHD. Children can receive those diagnoses and either a medical community like a developmental pediatrician or a developmental neurologist pediatric neurologist office. But they can also receive those diagnoses from a licensed psychologist. Where that diagnosis is first rendered isn't necessarily critically important as long as an appropriate diagnosis is rendered. But the eligibility for treatment that comes after that may be different in the medical community versus the behavioral health community. So the course of treatment that each system would prescribe for that child could be very, very different. And as is the case for the medical diagnosis a behavioral health diagnosis may also help to qualify a student for special education eligibility in conjunction with some other factors. When you have a behavioral health evaluation, the schedule for reevaluation required to assess the ongoing appropriateness of the behavioral health treatment is established really by the insurance carrier. The medical insurance carrier. So they will tell the providers that are issuing those evaluations. How often they want them redone. Whether it's on an annual basis. A six-month evaluation or review but basically the insurance company kind of sets the tone or the schedule for when those re-evaluations need to be done to establish the necessity of those services. And as with most things, the determination of that is something that families have a right to appeal or to request some reconsideration for. A couple of things that I wanted to sort of zero in on particularly for folks and non-traditional school setting is one of the most common types of behavioral health evaluations that parents look for for their children are evaluations when the child has behavioral disruptions that interfering with his or her ability to access their education. So that is typically when people seek evaluation for Wrap-around or BHRS, which stands for Behavioral Health Rehabilitation Services. In order for those services to be approved for a student, the clinician and the family need to establish what is called medical necessity for those services. Which means that the clinician needs to the licensed clinician to be able to demonstrate some sort of higher level of need, which is typically a health and safety threat for the child within the school environment, if that level of care is not provided. Wrap-around services are considered a higher level of care.

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They need a prior authorization. And the evaluation is that piece that seeks the prior authorization. The evaluation launches the bed for an authorization of this higher level of care, medical service for this child on the behavioral health insurance path. So that's I think the key thing to remember there that behavioral health services are provided based on establishing a standard of medical necessity. And I think sometimes that gets a little confusing for families that I've heard from over the years about what constitutes that. And that's something certainly we can discuss in more detail with questions that people have them. Within the umbrella of behavioral health rehabilitation services or Wrap-around services, there are three distinct services that students can be made eligible for. One would be a behavioral specialist consultant who would develop and oversee the implementation of a specific behavior intervention plan that emerges from the evaluation. So for example if a child is having a lot of difficulty with maintaining their attention in a classroom without behavioral disruption. So maybe they're having behavioral outbursts in the classroom. The behavior intervention plan would have to target that behavioral goal that's identified as part of the initial evaluation. The therapeutic staff support or the TSS is the ongoing one-to-one behavior staff that is charged with the implementation of that behavior plan and the collection of data that will support the ongoing monitoring and management of that behavior plan within the treatment protocol. And then the third service that's available there is a service called mobile therapy which is provided by a Masters level therapist who can provide therapy to children or their families together to address emotional issues that are likely related to some of the problem behaviors that the child is demonstrating that have established a necessity for the BHRS service. Within behavioral health evaluations, the clinician often will use standardized tests for measurement. So we're using standardized measures to make some determination about the child's behavior or clinical presentation. In some of, I put some of the test acronyms here for your review that you might be seeing and reports. There's something called the BASC-2, which is the Behavior Assessment System for Children, Second Edition. The CBCL, which is the Child Behavior Checklist, is often being used in the behavioral health community. You may also see some depression or anxiety inventory that are being utilized. The Achenbach Scale is another way that people would refer to some other behavioral measures. And then, often times if a child has autism or has a question of whether they have a diagnosis of autism. You may see that behavioral health evaluation utilizing some autism specific instruments such as something called the ADOS2 or the Autism Diagnostic Observation Schedule, Second Edition, or the Social Responsiveness Scale, the Social Communication Questionnaire. Those are all other types of instruments that would be more specifically targeted to rule out a question of a diagnosis of autism. Within the behavioral health evaluation, the clinician is going to be integrating all the above sources of information and along with that a patient interview talking to the child or the adolescent. A parent interview. And wherever possible information from other providers as well such as input from teachers, input from other professionals within your child, you know support team, and then they will be coming to a determination of whether the child meets diagnostic criteria for a particular diagnosis. And once they determine whether there is a diagnosis applied to your child within the behavioral health arena. They would be making recommendations for behavioral health treatment across the whole continuum of services, from least intensive to most intensive. And then those recommendations would, of course, the also across environments. And I think recognizing that there is a continuum of services on the behavioral health treatment side is an important thing to remember. You know many of you are probably familiar with the continuum of options on the IEP side right. So obviously on the education side we are charged with going from least restrictive to most restrictive and always providing services in the least restrictive environment. This is sort of the corollary on the behavioral health treatment side as well. We typically don't jump to a highly restrictive or intensive progress. Unless we have some data that suggest that that is necessary, without trying something that could be least restrictive or intrusive, such as an outpatient service or outpatient group social skill or something like that. So the full continuum on the behavioral health site extends from outpatient services which don't require prior authorization all the way up to inpatient hospitalization or residential treatment. So essentially we are charged as licensed clinicians with establishing that standard of medical necessity for each level of care that we are recommending other than outpatient. So I mentioned this a little bit earlier but the full evaluation should, a good evaluation. If you're looking at evaluations that your children have received. Hopefully you are getting high quality evaluations. That would include a review of prior records, both behavioral health records and hopefully an integration of some educational records or any other medical reports that your child may have from medical specialties that could be relative relevant to behavioral health presentation. As I mentioned also a clinical interview with the child or adolescent in the family. Observation of their behavior within the clinic setting. And if we are able to get information about how that person behaves otherwise. But the behavioral observation within the clinic setting, you may sometimes see within the reports refer to as mental status exam. That's a key element that has to be included in every behavioral health evaluation. And then there will also be a review of psychosocial history. The family history and this is important. That would include a review of the family's behavioral health disorders as well, along with the child or adolescent immunity involvement or educational history. If they're an older child and perhaps they have a part-time job. Anything that would be related to occupation social relationships with friends and siblings, and so forth. I want to go back to the part where I mentioned that it has to include a review of the family's behavioral health and educational history as well. And I know that within my clinical experience. This is an area where I have a lot of questions from families. "Why are you asking me some questions about myself, my husband, my aunt, my uncle, when I'm here to be evaluated for my child?" And I think kind of like we know on the medical health site that when you have a parent with heart disease or cancer we become much more at risk for heart disease or cancer as their biological relatives. The same is true with behavioral health disorders. If you're presenting with a child with a behavioral health concerns whether it's a developmental disability concerns like autism or something like attention deficit hyperactivity disorder or depression anxiety. It is critically important that the diagnostician has all the information about what other people in your family may have struggled with. Because that helps us to our differential diagnosis in terms of figuring out what risk factors may be in play for your child. Diagnostically, in terms of behavioral data. So it gives us a nice framework for interpreting the behavioral data, the testing data that we are getting. So I would urge people to be honest and frank when you are participating in a behavioral health evaluation. And to be as candid as possible with the interviewer and revealing as much as you can about you know all the things that you know about the medical history of your family. So I want to switch finally to the third type of evaluation which would be an educational evaluation. Educational evaluations are completed by certified school psychologist and other school personnel. And I think that's important to recognize again how these personnel may differ in part from a licensed psychologist. Some school psychologists who are certified are also licensed psychologist. But they do not have to be. So for this reason with any school setting, for example, most schools will not be doing an initial diagnosis of autism. They may be doing and educational classification of that but they may not be doing the diagnosis because we can't do it within the school setting; they can assign the medical or the behavioral health diagnosis of autism unless they have a license. So that is an important thing. I think for families to recognize and tease apart when they are looking at their evaluations. Other school personnel such as regular education teachers, special education teachers, behavioral specialist, or other school based allied health providers, like occupational therapist, physical therapist, and speech therapist can also participate within an educational evaluation depending upon the referral question for that child.

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An initial evaluation to determine educational eligibility for special education results in the school evaluation or the educational evaluation determining whether that child's needs that two-part criteria that make them eligible for special education services. And I'm hoping most people may be familiar but I want to just review that because I think that this is very, very important. A child in order to be eligible for special education, which means in order to be eligible to have an IEP within a school system, a child's educational evaluation has to determine that that child has a recognized educational disability and requires specially designed instruction or special education services to make progress in the regular education curriculum. That two-part criteria have to be met. And were going to talk about that little more in a minute. So the initial evaluation decides whether that child, or determines excuse me, whether that child meets eligibility criteria for special education. And then if that child does meet begin eligibility and a special education course there is a re-evaluation that is required on a prescribed schedule. And that is every two years. If the educational classification is intellectual disability or every three years for a student who is classified under any other educational classification. I wanted again for folks who may not be fully familiar with what the whole range of educational disability classifications are. I just wanted to list them here for you and just briefly explain what they would be. Intellectual disability is a cognitive disability where a child overall IQ would fall at or below 70. An IQ score of 70 is measured by an IQ test of one kind of another. Serious emotional disturbance is another educational disability classification that would be for children with chronic behavioral health, disabilities. It could be for children with bipolar disorder, schizophrenia, other acute behavioral health disorders, conduct disorder, and so forth. Orthopedic impairment is for students with physical disabilities. Perhaps students with paralysis or who require some sort of physical mobility support. Wheelchair, crutches, things like that. Hearing impairment and deafness I think is fairly self-explanatory, as well as speech and language, impairment in visual impairment, including blindness. Autism obviously again I think is really for any students who have received an autism spectrum diagnosis. That would be there classification. Traumatic brain injury could be for a student that has some sort of brain-based injury, whether that would be a prenatal or an early childhood brain injury. So either a congenital or an acquired brain injury such as an in utero stroke or God forbid you know a serious fall gunshot wound something like that. That would result in a traumatic brain injury. Other health impairment is a broad category within which students can classify for educational disability if they have a physical or a medical condition such as, and ADHD falls into this category, that would result in difficulties accessing their education. Even this could be applied to a student with a very, very serious physical health condition. Perhaps a student with sickle cell disease or a student with a chronic health condition that has significant, significant impact on their ability to access their education. Also in this category, listing of categories would be students with specific learning disabilities. So this could be a disorder of written expression, verbal expression, or mathematics. Death blindness is something again. I think that is fairly self-explanatory. And then multiple disabilities is the category for students that may be have more complex support needs. So these could be students with both autism and an intellectual disability, and intellectual disability and an orthopedic impairment, and intellectual disability with a brain injury, traumatic brain injury, and orthopedic impairment. So on and so forth. So they tend to be that of students with the most complex support needs. So again, the educational evaluation can use results from other prior medical or behavioral health evaluation as appropriate. So an example of this would be a child may be transitioning to kindergarten, who was recently been diagnosed by autism, excuse me diagnosed with autism by a developmental pediatrician and the medical community. The parent could present to the school with that diagnostic evaluation and the school could accept that diagnostic evaluation of the child as a person who has been identified as being autism and not have to reevaluate whether or not the autism is present. What they would be doing the initial evaluation on would be integrating that diagnosis and then looking at the full package of what is the educational meaning of that diagnosis is for that child. Similarly, if you had a behavioral health diagnosis assigned to your child of something more serious, a serious psychiatric disorder, or something like that. You could present that to the school, and the school could accept the evaluation and to integrate that along with other aspects of an educational evaluation to figure out what exactly is the right course of special education planning that would perhaps be necessary for that child. I think the one thing that is always important for us to remember is the assignment of a diagnosis that results in a child falling into an educational classification doesn't guarantee eligibility for special education unless that second criteria, that two-part criteria, is met. So that's something that we want to pay attention to. I'm just looking the question that just came in that asks under the specific learning disability classification does there need to be a specific diagnosis that you get from a certain specialist. The specific learning disability diagnosis or classification is typically made by a school psychologist within the context of a school-based evaluation. So that is something that school psychologists are acutely well trained to be able to render specific learning disability diagnosis. So, I hope that answers your question but you don't necessarily need an outside professional to do that. That educational classification or diagnosis can be rendered within a school setting. Okay, so when might a parent request an educational evaluation? And I put this in here because not knowing who all was going to be on the call we would want, you know I would want people to be thinking about, gee, if my child is struggling, how do I know it's time to ask for an evaluation? And I think these are some of the presenting problems where I would encourage you to talk to the school about getting an educational evaluation. If the student is having consistent problems getting along with others. Whether that is getting along with them, specifically within the school setting or some things in the community setting that might be carrying over into the school. Whether they are having difficulty communicating their wants and needs, or understanding the things that other people are saying to them definitely want to be asking for an evaluation educationally. If the child appears to have a lack of interest and age-appropriate activities or a significant difficulty with ability for age-appropriate activity you would want to be talking to the school about evaluation. Similarly, resistance, and I would emphasize that resistance is a pretty big word there. You know the child is very, very resistant to change. There appears to be a rigidity or an inflexibility and their tolerance for disruptions in schedule, unexpected things happening, you may wish to talk to the school about an evaluation there. Anything seeing or hearing interfering with their ability to communicate. So if the child you know has gotten a vision evaluation and they are still having problems in school even with corrective lenses, that they don't appear to be making sense of the printed word or what the teacher has on the board for them. You may want to be talking to the school about that. As I mentioned earlier health problems that are affecting their educational performance. Which could include as I mentioned earlier attention problems. And then difficulty performing tasks that require reading, writing, or math. Or any kind of chronic behavioral or social problem. So we have a couple other questions coming in here one of them is would generalized anxiety disorder be considered an otherwise health impairment? And I think that's a maybe. The answer to that question is certainly a think it could be because it is a behavioral health diagnosis. I think some of that would depend on how acute that anxiety disorder would be for that child.

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And how much interference that would pose for that child educationally. Someone asked about the one-on-one consultation is available for people outside of in other parts of Pennsylvania and I am getting that question answered with a yes. And then here's another question where someone says I believe the prior attendees question may have been because you often see an educational eval identifying a student with eligibility criteria of an SLD, and yet the schools certified psychologists will not specifically identify what the SLD may be. I think they should be identifying what the specific learning disorder may be. I mean, I would if you are receiving any evaluation that says they've been identified as having a specific learning disability, you would want to press that school psychologist and that educational team to highlight for you what that specific disability is. Because that is going to turn into what sort of recommendations, and we're going to talk about that in a minute, that you might want to see put in place to adjust that within the intervention under the category of your IEP. So again, I would always encourage you to go back and look at that. So another question's some in asking for how we can get schools to accept private evaluations after the school evaluations are incomplete. How can we get?

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Okay the one about outside evaluations, I just muted that temporarily because I wanted to kind of get a sense of I was having a hard time reading the question there. Essentially the schools are encouraged to incorporate outside evaluations. I think the one thing when families go outside for evaluation. I encourage you to seek an evaluation by someone who is a certified school psychologist. Those evaluations often translate better back into a school accepting that evaluation. If you disagree with an evaluation obviously you could request an independent evaluation for your district if you don't believe that evaluation captures your child. You can certainly disagree with that, open a grievance process, and ask for you know an independent evaluation. The question is will we get a copy of the PowerPoint. The answer is yes tomorrow. It should be ready tomorrow I'm being told, on the website. Okay, so when you want to request an educational evaluation. You can do so at any time. My recommendation always is to make the evaluation in writing and then again a good school evaluation should include a review of the students records, including their attendance and report cards right, because if a kid is missing school 65% of the time that may be one of the reasons that they're having some difficulty in school. So you will often see that referenced in a good school evaluation. It should also include a review of students vision and hearing. I always want clinically to rule out any difficulties with vision and hearing. So the school may ask you or you know encourage you to get that checked through your medical provider to make sure that there aren't any things there that could be negatively contributing to the students' performance. If there are outside evaluations school evaluation should include those. I would encourage you to persist with at least their review and integration of that information into a school evaluation because in my professional opinion that makes those evaluations much, much stronger. Also will include some curriculum-based assessments to determine how that student is doing on school grade-appropriate performance standards within the core academic subject. Additionally, a school evaluation will include instruments that measure performance in the areas where the concerns have been raised. So again if the concern is about how well the student may be reading or writing, whether they're able to listen in school, you're probably going to see an evaluation that's focused more on some kind of ability or IQ measure. Some academic achievement measures. Some processing measures like visual processing, auditory, or sensory processing measures as opposed to a student that's having more of a behavioral problem where there is no concern. You know, suppose learning is great, all the grades are great. It appears to be much more of a behavioral or an emotional issue. The educational evaluation may arc more in that direction. You will also see sometimes for some students, some evaluation of motor skills. Fine motor which will be the small muscle ordination of the hands and so forth. And gross motor sort of walking physically sort of walking physically accessing the school environment. The school evaluation should also include systematic observation of the student's behavior in the classroom and or the areas where the student is displaying difficulty. So you want to get an idea eyes on that kid to see what the difficulty is presenting itself. And at this point, if there's a significant behavior component to it, the school evaluation may also include a functional behavior assessment if the behavior is interfering with the academic progress. So a question's just come in and says is it possible that, for example, if the first of the two-part criteria is met by a diagnosis of development or speech delay due to Down syndrome, the second part could be denied because the child technically could "Still make progress without special ed." I'm going to talk about that in a couple examples in a few minutes if you could be patient with me. I think we're going to get there in a minute. All right. And then the last part of the evaluation should be input certainly from the parent and the student, if the student is able to give input. School evaluation reports are going to result in an ER which is something you might hear, an evaluation report being presented to you. That evaluation report should focus not only on the areas of need of your child, but their skills and their strengths as well. And that individualized pattern of skills, strengths, and needs for the child should be what drives the determination about individual services and the supports that he or she is going to need. And then I also wanted to put that the evaluation, make sure everybody is aware, that an evaluation has to be completed within 60 calendar days of the written request and the signing of the permission to evaluate for the child. So that educational evaluation report will come to a conclusion and state whether the child has a disability, educational disability, and whether that child has been found to be in need of special education services. So the evaluation report may state which goes back to this last question, that your child isn't eligible and doesn't need special education services. There are times when a student may have a medical diagnosis. I mean the example that we've given with Down syndrome, it's more than likely that that student is going, in the case of a student diagnosed with Down syndrome, to be found to not or excuse me, it's more than likely that that student is going to be found eligible for special education. Given the nature typically of what we see with a Down syndrome diagnosis. It is possible, however, and I'll give you case years, and years, and years ago. For example, worked with a younger student that was transitioning to school that I had in in utero stroke and was born with some motor impairment. But had compensated so early in life that even though this young child had this well-documented medical diagnosis of an in utero stroke and a hemiparesis. She was not in need special education services because she wasn't having impact in her ability to learn within the educational environment. There were no documented cognitive delays, achievement delays, and the motor delays had been so well compensated for because this is how this kid accommodated in her life early on that there wasn't really any classification made eligible for the physical disability. So the report is going to tell you whether or not the child is eligible. And start to lead into recommendations for the type of service that your child will need. You receive a copy of the evaluation report and a written notice that tells you you have the right to disagree and that you can request an independent evaluation. And just remember that a copy of those must always be given to you. I have a question that's come in here let me see if there is two I think we missed one.

^M00:50:04

Okay a child transitioning from preschool to the school district who currently only receives speech services for a diagnosis of apraxia. The school district most likely would not do a full MDE and would wait until the school year began to do an evaluation. I think that this is what happens when we have students and this is not only in Philadelphia. I can tell you I worked in my career and other counties that sometimes when students have what are called "speech only" evaluations. The school district that's receiving them for kindergarten will transition them with the speech and language services. There's a term called pended. The IEP would be carried over a beheld pendant while that student starts kindergarten. So they don't necessarily do a full evaluation on those students but when they go into kindergarten, they continue to receive the speech and language services, and are monitored through that process of special education, and then are very able to be identified fairly quickly if difficulties with other areas start to emerge. So that is the process that is followed by many of the school districts in the region. Okay, so what I have just been told is that many of you are sending your questions through the chat box as opposed to through the Q&A box. So just make sure that you use the question and answer link so that I can see those and it is the question mark icon at the top of the center of that right column on the screen that you're viewing now. Okay so I just to make sure that we're able to get and respond to all of the questions. So, here comes a question. What should I know about the Woodcock Reading Mastery Test and its use to measure progress and regression? And its use in identifying IEP goals. Certainly know that Woodcock tests are extremely well regarded. I have not personally used the reading mastery test and many, many years. So I have not use the third edition. What I would encourage you to do is to talk to your school psychologist, maybe request an appointment with the school psychologist and asked him to speak with you specifically. I do know in a general sense that most of reading inventories or reading measurement instruments target specific areas of deficit. And are able to track progress for students over time and you know obviously if you're able to track progress. You're also able to look at regression and how that student's progress is falling out against the developmentally appropriate norm as they continue to age. Because sometimes as kids continue to age their scores may flatten out because their skill level in a particular area may not maintain pace. They may do well as a younger child but they may not maintain pace as they continue to get older. So it sometimes looks like their scores flatten out, or perhaps even decline a little bit. If that's kind of what you're getting at with that question. Okay, let me just move on to the next. We only have a couple more I wanted to talk about the terms that you might see in the evaluation and then certainly we're going to have a good bit of time to come back and answer the rest of the questions here. So terms that you might see cognitive ability is something that you might see in an evaluation report. And perhaps it's easiest to think about this is IQ right. We talk about IQ a lot, just in general conversation. Cognitive ability measures what we should overall expect of a child that they should be able to do right. So if I have an average IQ I should be able to achieve an average level within school. If I have a gifted IQ we would expect basically my achievement within school to be in the gifted range. If I have an IQ that falls in the below average or the intellectual disability range. My achievement should aligned with that. I think it's important to remember about IQ though is that it's not a single score. It's basically a measure of several different specific abilities that get combined and those abilities typically fall on most of the cognitive ability measures into two bigger bucket of sort of verbal and linguistic abilities and then nonverbal or visual-spatial abilities. Those are sort of the two broadest categories that most common test would measure and when students have a lot of what we would call scatter, which means their individual subtest scores on those different measures vary a lot. The overall score, often times is not the best score to use. It's less meaningful if there is a lot of scatter. And then if that's the case, it's important to look at the scattered pattern or the score profile for that student when you are thinking about services support that would be appropriate for them. And I would encourage you; I'm going to say this as a school psychologist myself. If you are a parent and you have questions about your child's data or your results ask for an appointment try to go to the school psychologist and talk with them about the report and ask them to answer your questions. I would love to believe that they're going to be very interested in doing that with you. So achievement levels. When you see achievement test scores or excuse me achievement test results on your evaluation report that's going to be talking about how the student is performing on an individually administered standardized test that would be measuring things like reading, writing, spelling, and math. We're going to be looking at those scores on the standardized test in relationship to how the child is actually doing in the school curriculum. Both in terms of how their grades are on the school curriculum. How they're doing in school-based standardized achievement tests. And essentially what we're looking to figure out here is do things line up. You know when I give the individualized test is it pretty similar if we're lucky, to how the child is doing in school. You know a child that's really struggling in school might be struggling and obtain some lower scores on the achievement tests, and then also their standardized you know PSSA scores or things like that may be falling in a difficult area to there. So we look for what we call mutually confirming data. Are multiple data points falling together and giving us a good picture of the student. The differences between the cognitive ability in the achievement measure sometimes may, if there are big differences, that may be an indicator of a learning disability. And the school psychologist in the educational team hopefully would be probing a little more deeply into that to identify it. Within achievement level test results you may see the following terms here things that talk about the basic skill levels of particular subjects. And that could be essentially how well is the child doing in spelling. How well can they read individual words? Decoding is a term which looks at how well can the student breakdown sounds when they're meeting new words. So for example the word cat can the student decode that I know what the sound of a C is, what the sound of an A is, what the sound of a T is and can they put that together and figure out that that is the word cat. Fluency is how well the student able and the applies obviously both in math and in areas of reading, how smoothly are you able to move through or how fluently is the student able to move through the reading of basic words or the completion of math problems. It has to, gives us a good picture of how well that student is able to access educational reading that they're doing. And then comprehension overall is does the student understand what they're being asked to read in reading for what they're being asked to perhaps play and more math problems or some higher order math problems. And if you can think about it, as a continuum. If you're having difficulty with basic skills you are likely going to be having difficulty with decoding. If you are not breaking down words well or math well, you're probably are going to be having some fluency issues. Think about people that you know who perhaps read very slowly, or read very discontinuously. They typically have a hard time remembering or understanding what they are reading. So these things kind of build one off the other and sometimes can lead to a more a greater picture of the overall problem. But by looking at it and these four different levels and helps give us, gives the school a good picture of where things are breaking down and where we may want to target intervention and put some services and supports in. Other evaluations or terms that you may see is we may be looking at some evaluations for adaptive functioning for students. So, how well do those students do with activities of daily living such as eating, dressing, toileting, protecting themselves in the community.

^M01:00:00

Do they understand the rules of safety in the community? And so forth. That often times to be more referenced in student with more complex disabilities like intellectual disabilities, students with autism, students with multiple disabilities. Other terms you might come across in an evaluation is the term of working memory, which is basically when somebody learns something or you hear something are you able to hold that in your memory long enough to transfer that into long-term memory and then be able to come back and access it. So essentially we're looking at that both verbally and pictorially for a person. Because obviously if we can't store things in short-term memory, and transfer them into long-term memory were going to have difficulty remembering, learning, and building on that meaningfully for more complex tasks and education settings. So that's a term that you'll often see referenced in educational reports. And then particularly we're also going to see for older students things about transition assessments being referenced. So what interests, skills, strengths and areas of need. Do we have to take into consideration for this student as we plan for life after high school? You know are they verbal, are they able to communicate in writing, today like working with cars, are they good working with their hands, are they do have difficulties working with people, following multi step directions. Those types of things are very, very important to weave into a transition evaluation. The other thing that I wanted to mention here just to make sure that everybody is clear is that all of us that we are talking about is not to be confused with the annual homeschool evaluation that is required by the Pennsylvania Homeschool Law. That evaluation is one that has to be done on an annual basis, for any of you who are homeschooling your children and has to be turned into the district in which you reside by June 30th. The purpose of the evaluation is to verify that the student has made educational progress, and that the requirements of the Homeschool Law have been followed, and fulfilled by the parent. You're responsible as a family member for locating and choosing the evaluator. And they have to be a certified teacher, or a clinical or a school psychologist conducting the evaluation. And that evaluation will consist, as it says there of a review of the portfolio of schoolwork. Some samples of the student's work, attendance logs, instructional logs, and an interview with the child. So once evaluation report is done we will then be moving, obviously, to an IEP or an individualized education report. Obviously the evaluation report should be driving directly into what's recommended in the IEP. So that IEP has to include a description of the type of support environment that the student needs. Whether it's a learning support environment, an emotional support environment, for a life skill support which tends to be for those students who have the greatest need to learn functional, vocational, and academic skills, that are going to help them to be independent later. Emotional support obviously for kids with serious emotional issues and then learning support for students with issues in learning in areas of reading, writing, math, or written expression, spoken expression. Also then could be looking at educational placement for students that are specifically blind and visually impaired, or deaf or hearing impaired. And then speech language supports could run a gamut again depending on what the level of severity of that student as to perhaps some speech therapy, some picture exchange system, to may be some sort of more sophisticated system of augmented communication that might be needed. And then again you could also see some environments for physical support for students that might have some more complex functional motor skills that need support within the school environment. You know autistic support for students with more complex needs related to their autism diagnosis. And then students who could go into an area of multiple disabilities support that would require, again as we had indicated earlier, supports over multiple areas such as cognitive functioning, physical functioning, and maybe some behavioral or emotional pieces there as well. The IEP should also list other allied health services or other support that might be needed for that student. And I have listed a few of them here like FM system, a computer, extra time on testing, preferred seating within the classroom. There are a number of accommodations that could come in there. And the IEP should also stipulate whether or not that student needs criteria for an extended school year based on their perceived need for extended school year to prevent regression. And that is very sort of prescriptive. And again, I would encourage you to talk with your school psychologist and your education support team if you have concerns about whether an extended school year program would be appropriate for your child. Okay, so I wanted to talk here about a few examples. And I sort of eluded to this one earlier. A student could be diagnosed with an autism spectrum disorder by a developmental pediatrician. That diagnosis could then be accepted perhaps by the school and used as the first part of the special education classification. The education team would then be evaluating that child within the school environment and figuring out what that child needs to be successful within the school. Do they need a particular class size, a student-teacher ratio, what kind of accommodations might they need based on behavior or language support needs. What types of supports might they need related to their restricted areas of interest or stereotypic behavior. And then they are going to be making the determination around all of those things as to whether or not that child meets the second prong of the criteria for special education. At that point, the family may if there are some serious behaviors such as elopement, some serious health and safety risks, head banging, others self-injurious behaviors, serious aggressive behaviors perhaps that may be interfering with that child's ability to be successful within the school. The parents may also want to seek out a behavioral health evaluation to see if they can establish a case with the clinician for the medical necessity of Wrap-around services or other behavioral health services within the school environment. So that is one example I would put out there. The second one could be for a student that is diagnosed outside by a medical evaluation or a behavioral health evaluation with attention deficit hyperactivity disorder, primarily inattentive type. Perhaps that child is prescribed a medication course by the psychiatrist to target their symptoms of ADHD and the child responds favorably to the medication. Their symptoms reduce. They do fairly well when they're on the medication. But the parent comes to the school and asks for an educational evaluation based on the diagnosis of ADHD. What we may find that student if there are no other related learning issues or other things that are complicating the situation the educational evaluation may determine that the student doesn't meet the second part of that criteria for special education. However, that student is likely eligible for the development of a 504 plan, which is an accommodation plan that students who don't qualify for special education can receive if they have other health impairments or can't meet the second prong of the criteria that makes medical or excuse me makes special education services are needed for the. So that the second example there. The third one I wanted to give you as if the student is acting out behaviorally in the school and the parent has a question about what is causing that behavior acting out. One of the things that we know is that sometimes students will act out behaviorally in school because it's easier than acknowledging that they are having difficulties learning the information. And sometimes we find that that can be particularly more so the case when it's boys right. It's easier to be a tough boy in school than it is to be a boy who can't read, or a boy who can't do math. So the parent could ask for an educational evaluation to make sure that there are no learning differences that could be causing or contributing, I don't want to say causing but contributing to that student acting out behaviorally within the school. And lo and behold that educational evaluation might render a diagnosis of a specific learning disability. And then the IEP would be developed for the student with a diagnosis or excuse me an educational classification of a specific learning disability.

^M01:09:55

But then there could be a behavioral support plan written and behavioral intervention written within the IEP that would be able to target that student's challenging behavior which might maybe happen and the subjects that he or she has the most difficulty with. So those are the examples that I have excuse me, I apologize my voice. I'm very happy to answer any other questions that people may have. I think I may take a look and see what else is scrolling down here. Okay, here's another couple of questions coming in from chat. Is it better to track scores on grade-based or age-based scores? That's a good question.

^E01:10:46

^B01:10:51

Standardized scores for students are best looked at when they are age equivalent. Grade equivalents are not usually the best indicators for students. So I would always encourage you to look at age-based scores. These standardized scores based on age-based criteria is what you would want your school psychologist to be doing. Another question is, is a nonverbal IQ test any less reliable than a regular IQ test? No. But I think you know all different tests and this is where you want to make sure. And again, I want to trust in the educational in me and the school psychology community here to know that when we're selecting tests, we would be ideally selecting tests with good reliability. Whether it is verbal or nonverbal IQ test. The decision to go with a verbal or nonverbal IQ test is going to be made by that school psychologist based on their determination of where they think they can get the best read on that child's overall ability. Obviously, we have a child with very limited verbalization who isn't necessarily able to give us a lot of verbal communication. It is going to be an unfair assessment to rely on a heavily verbal IQ test. If that student is able to respond and "Talk to us" through other nonverbal means, I think we would want to be doing that and actually getting a better picture of that student. So here's another question which is does prompting play a role in test scores? For example on WIAT3 testing below average in three areas and needing questions reread, explained, and prompting while testing. Would that affect results or is it still considered normal. What I can tell you and I don't want to limit this to specifically the WIAT, but all standardized tests have specific protocols for what the evaluator is allowed to query and what they're not. Whether they're allowed to reread the question, or whether they're not. Whether if they reread the question multiple times whether that impacts the score or not. So that is part of the standardized test administration. Sometimes, as school psychologist will make the determination to do what we call testing the limits. If we think, for example, that a student is not able and our professional evaluation opinion to perform optimally on say a time to test. What we may do is give that test, and a timed modality. But then do what's called testing of the limits or a nonstandard administration of the test to get a sense of how that student is responding when he or she is not operating under the standardized test instruction. They should be reporting both of those administrations separately. And again, I think if you have questions about that I would urge you to schedule an appointment with the school psychologist and asked them to walk you through the administration and the results of those test scores. Here is another question that says what can be done want to incorporate in independent educational evaluation? I mean, essentially, that is where you would exercise your due process rights. You would want to disagree with that decision. You would want to request mediation, then request due process hearing, and kind of go up through your procedural safeguards hierarchy. And I think certainly that would be one of the places where the consulting could be helpful to you. And I would encourage you to reach out to that through the other aspect of this program. Could I repeat the two-pronged criteria for special education? And so essentially you have to meet diagnostic criteria for one of those identified educational disability classifications that we talked about earlier. Let me see if I go back and put that slide up. So, prong one is you have to be able to be identified as falling into one of these educational disability buckets if you will. And then the second prong is there has to be a determination by the educational team that you need special education supports in order to make progress in the regular education curriculum. That you can't make progress with just an accommodation that could come with a 504 plan or something like that. That you're profile is such that you would require special education support services in order to be able to access your education. And again, I think of your questions about that I would encourage you to talk to somebody on the consulting part of this project, because they could have a more in-depth one-on-one discussion with you about that. So here's another one. What about evaluations from an agency such as CMU, which I'm not familiar with, or the equivalent or are we limiting this discussion to school-related evaluations? Or can these be helpful to the homeschooler. I apologize, but I'm not sure if I totally understand that question. If you want to try to send me something clarifying before we get off I think I could get back to that. Here's another one. It says a middle school student with ADHD and having problems making friends and getting along with others, what evaluations would be the best to identify key issues and how it can be addressed. I mean, I think I mean that's a very layered issue. I guess I would want first to make sure that the ADHD diagnosis is appropriate for that student. You know, anytime I see a parent raising a question about a student, excuse me, having difficulty making friends, keeping friends, getting along with others. Certainly the autism slide pops up for me, or a spectrum slide parts up for me. Is it more related to anxiety depression. I think the first step I would suggest is that you seek out some kind of behavioral health evaluation and you know talk about what the presenting symptoms are that your child is having. Are they anxious about meeting new people so they withdrawal, do they feel sad and irritable, which could be signs of depression. Irritability or anger can also, in children, be signs of depression. I would want to make sure that parents know that. That depression in children doesn't look like depression in adults looks. Children with depression are often overactive, irritable, and sometimes just difficult to engage behaviorally or socially. So you want to get those two things ruled out just to make sure that there isn't something else going on and that we're targeting the right type of treatment for that person on the right type of intervention. So this says for a child with hearing impairment if only a 504 plan is recommended by the school, but they're showing slow learning, should an educational evaluation be pursued. I think here again, my suggestion to you as a parent would be if you feel your child is falling behind educationally, you always have the right to request an educational evaluation and writing and the school is required to do that for you. So I would encourage you to advocate for your child for that if that is something that you feel is a problem for the child. You know, I think I would want to you know some of that might be influenced by how old the child is, you know how new they are to the education environment, and whether they've been given time within that school setting to make adequate progress and to adjust and accommodate. But I think all things being equal, if you still have concerns I would encourage you to talk to the school and request an evaluation and writing.

^M01:20:02

So here's a question that says is there anywhere that parents can get a comprehensive list of testing protocols that can be used for testing your child.

^E01:20:11

^B01:20:17

There is an exhaustive list. I mean, literally. There are thousands. You could overwhelm yourself with. I would think of what tests are out there. I think it's difficult sometimes even for us as psychologists to keep up with every test that is published. It is a large, large industry. And you know, most school districts have a pretty wide range of protocols and a pretty wide range of assessment instruments that they have available for their school psychologist to use. I think you now again I know I keep referring to go back to the school psychologist but I would love for you all to see them as a resource. If you have a question about things I would love for you to be able to request an appointment and go in to talk to them about you kid. What your concerns are what types of things and what, ask them for recommendations of what they think would best measure areas of difficulty that you think your child is having. Because truthfully there are thousands and thousands of instruments that are out there. And I think your best decision is always going to be to get the evaluation done by someone who is competent with that instrument for measuring that task. That's really a good recommendation I would think. So here's another question that says do schools have to be "state approved" for RTI, which is response to intervention. I had a district use process other than RTI and we were not allowed to identify the student eligible for special education because they did not have state approved RTI process in place. The student was not eligible via the discrepancies in test scores, but could have been eligible for a specific learning disability because the student didn't do well when intervention were put into place. Again, I think the implementation of response to intervention protocol should be fairly consistent. You know what constitutes tier 1 intervention in a tier 2 intervention. And you know I think within the parameters of this discussion today it's going to be hard to drill into that. But what I might suggest is that you go back to the school and ask them what was in that district constitutes a tier 1 intervention. What constitutes a tier 2 intervention? And what the school district would use as criteria for determining the student eligible based on their discrepancy model.

>> So thank you everyone. We are going to still continue to take more questions. At this time we are going to be turning off the recording. So if you have any private questions that you did not want expressed and recorded, this is the time to add them to the Q&A box. So again, thank you and we will begin.