Va-LEND: Collaborating with Rural School Divisions to Train Interdisciplinary Autism Assessment Teams

Donald Oswald,1 Joann Bodurtha,1 Donna Gilles,1 Judy Sorrell,2 Jessica Philips,3 John Prickett3 1Virginia Leadership Education in Neurodevelopmental Disabilities (Va-LEND), 2 Shenandoah Valley Regional Program (SVRP), 3 Commonwealth Autism Service (CAS)

MethodsA school-based interdisciplinary regional autism assessment team was formed at the SVRP; the team included school psychologists, speech and language therapists, occupational therapists, school social workers and behavior analysts from six rural school divisions.

School-based assessment team members were enrolled as medium-term Va-LEND trainees and received formal training in the following areas:

•Autism Diagnostic Observation Schedule (ADOS) administration and coding•Autism Diagnostic Interview – Revised (ADI-R) administration and coding•Interdisciplinary team functioning (see Table 1.)•Family-Centered Practice•Interdisciplinary Assessment: Role of the Occupational Therapist•ADOS - Consensus coding•Evidence-Based Practice

To provide support and mentoring for trainees, school-based assessment team trainees observed an evaluation at the VCU Developmental Disorders Assessment Clinic and Va-LEND training team members observed two evaluations at the Shenandoah Valley Regional Program site.

SVRP and CAS staff worked with local school division personnel to devise an administrative process for referral to the assessment team and for feedback of assessment results to the child’s eligibility team (See Figure 1.)

A dinner meeting was held for primary care physicians in the region to provide information about screening for ASDs and to introduce them to the RAAT.

ResultsEvaluation data indicated that trainees achieved the identified objectives and were satisfied with the training provided (see Table 2.).

The project yielded a functioning Regional Autism Assessment team that has, over the period of 10 months, contributed to the eligibility determination and intervention planning / IEP development of 10 children (see Figure 2.).

Assessments routinely included:

•Administration of the ADOS and ADI-R•Classroom observation•Informal assessment by Speech/Language Pathologist and Occupational Therapists

The assessments yielded a report which was submitted to the child’s eligibility team and a member of the RAAT routinely participated in the eligibility meeting to discuss assessment results.

Clinic evaluation data indicated that most parents were satisfied with the assessment process and the resulting report.

Eleven physicians and one allied health professional participated in the dinner meeting. In addition to an introduction to the RAAT, participants received copies of the American Academy of Pediatrics Toolkit, “Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians,” and information about the Autism Treatment Network and the Autism Intervention Research Network on Physical Health

DiscussionBarriers to effective early identification are significant, but smooth and accessible processes can improve transitions from evaluation to school-based intervention. The project sought to address the following barriers:

•There is typically a long wait for external evaluations.•The results of external evaluations may not translate easily into educational plans.•External evaluations may foster an adversarial relationship between parents and school personnel.•Single-discipline evaluations may not capture the complexity of the child’s ability / disability profile.

We chose to develop a modification of the school evaluation process as the means to address these barriers.

Issues encountered in the implementation of the project including: •administrative concerns of participating school divisions about the quality of the reports from outside assessments, delays, etc.•distinguishing a clinical evaluation from an educational assessment •advertisement / marketing of the service; •advantages of ongoing contact with the children and families through school services; •possibility of further comprehensive single-discipline evaluations (e.g., in-depth OT and Speech/ Language evaluations if needed).

The vision of the collaborators is to extend the project to other parts of the state.

ReferencesGuralnick, M.J. (2000). Interdisciplinary clinical assessment of young children with developmental disabilities. Baltimor,e MD: Paul H. Brookes Publishing Co.

McClure, I., MacKay, T., Mamdani, H., & McCaughey, R. (2010). A comparison of a specialist autism spectrum disorder assessment team with local assessment teams. Autism, 14, 1–15.

Zwaigenbaum, L. (2010). Advances in the early detection of autism. Current Opinion in Neurology, 23, 97-102.

IntroductionThere is general agreement that children with Autism Spectrum Disorders (ASDs) who receive early diagnosis and intervention experience better outcomes (Zwaigenbaum, 2010). Interdisciplinary diagnostic assessment is the accepted state of the art for diagnostic evaluation of young children. Rural school divisions face particular challenges in providing interdisciplinary assessment and intervention. There is evidence that local teams can be successfully trained to provide high-quality assessments of children with ASDs (McClure, MacKay, Mamdani, & McCaughey, 2010)

The goal of the project was to identify children with ASDs at an earlier age by training a school-based Interdisciplinary team to administer gold-standard, autism-specific assessments in order to achieve reliable diagnostic decisions to be used by Local Education Agencies (LEAs) for the purposes of eligibility and IEP development.

Va-LEND, CAS, and SVRP, a regional special education program, collaborated in planning and developing a school-based interdisciplinary assessment service, the Regional Autism Assessment Team (RAAT). The objectives of the collaboration were to train assessment team members in: (a) the use of reliable, gold-standard diagnostic assessment instruments; (b) interdisciplinary team functioning and family centered practice; (c) integrating disciplinary perspectives and disciplinary contributions to the diagnostic assessment process.

The project also sought to clarify the role of local primary care providers in the screening and interdisciplinary assessment process, emphasizing primary care as the starting point. Local primary care physicians are a critical link in the process and project staff worked to integrate them into the process.

Figure 1.

Figure 2.

Table 2. Training evaluation data•Before session questions about how well informed individuals were about the topic(s) included in the training ranged from not at all to somewhat. After session responses to the same questions ranged from somewhat to well informed about specific training topic(s), with nearly all participants showing increased information/knowledge about the training topic(s).

•100 % of training participants (n=27) “Agreed” or “Strongly Agreed” that the information presented in the training was useful, clear and understandable, and would change their practice/behavior.

•100% of training participants “Agreed” or “Strongly Agreed” that they were satisfied with the overall training and that effective training tools were used

Table 1. Principles of interdisciplinary team assessment•Ecological validity of assessments•Recognizing uncertainty•Coordination and nonredundant testing•Dynamic nature of the assessment •Respect for contributions of other disciplines•Cultural competence•Role of the family•Role of community providers•Inclusion and support