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Comprehensive social-emotional assessment

Michael Hass, Ph.D.mhass@chapman.edu

Focus of workshop

• Conducting comprehensive social emotional assessments for:– the purposes of establishing eligibility for special

education as a student with an emotional disturbance

– establishing the need for school-based mental health services

– creating well-formed treatment goals and systems for progress monitoring.

Participants will better understand…

• The definition of emotional disturbance and the controversy around the distinction between ED and social maladjustment

• The nature of a comprehensive assessment from both a legal and best practice perspective

• How to integrate assessment information gathered from record reviews, interviews, observation and behavior rating scales to make decisions about educational need

Participants will better understand…

• How to conceptualize the role of culture in social emotional assessment

• How to establish well-formed treatment goals• How to develop systems for progress

monitoring.

Children’s Mental Health Needs

20% 5% 1-2%

Reflection

Consider the implications

Classification Systems

• DSM• IDEA• Dimensional approach

Thoughts on classification

• Both the DSM and IDEA are “medical” in the sense that you either have something or not. They are both categories that are “all or nothing”

• They also assume children “have” a disorder, i.e., the problem is inside the person

Issues and questions

• Disorders, syndromes, and disease• Disorders are social constructs that involve

social judgements• Boundaries between disorders are fuzzy• Considerable variation within those who have

the same diagnoses• Limited treatment validity

Standard of ReviewA Typical Administrative Law Judge’s IEP Review and Analysis includes…• What are the student’s unique needs?• Based on needs, what are the student’s present levels of

performance and were goals develop to address such need?• Based on the goals, what placement and services were

offered to address those needs?• Was the program and services offered reasonably calculated

to provide some educational benefit?• Did the district implement the IEP?• In the LRE?

Sec. 300.304 Evaluation Procedures (IDEA, 2004)

• The evaluation should be comprehensive.• The evaluator should use a variety of

evaluation tools or approaches that gather functional and relevant data.

• The evaluator should be competent.• The evaluation should be fair.• The procedures used should be valid and

reliable.

Comprehensive (legally)

• The child is assessed in all areas related to the suspected disability, including, if appropriate, health, vision, hearing, social and emotional status, general intelligence, academic performance, communicative status, and motor abilities

• the evaluation is sufficiently comprehensive to identify all of the child's special education and related service needs, whether or not commonly linked to the disability category …

Variety

• R.I.O.T = (a) record review/history, (b) interviews, (c) observations and (d) tests

• Rule of two (Levitt & Merrell, 2009) = a minimum of 2 settings, 2 informants, and 2 assessment methods.

Functional

• It is not necessary to include a definition of ‘functional’ in these regulations because we believe it is a term that is generally understood to refer to skills or activities that are not considered academic or related to a child’s academic achievement. Instead, ‘functional’ is often used in the context of routine activities of everyday living. (Federal Register /Vol. 71, No. 156 /Monday, August 14, 2006 /Rules and Regulations, p. 4661)

Relevant

• Will it help identify unique needs?• Will it assist those who work with the child?• Will this information help the IEP team write

goals and accommodations?

Assessment MatrixInformant History Interview Observation Rating Scale

Student

Teacher

Parent

Assessor

other

Where did the definition of ED come from?

• Eli M. Bower and his colleagues were funded by the state of California in 1957 to study emotional disturbance

• They gathered data on 6,000 children, including 207 identified as “ED” by clinicians who saw these children in mental health clinic

Continued…• When compared to their peers, ED children

were:– poor learners although potentially able to learn– had few if any satisfactory relationships– behaved oddly or inappropriately– were unhappy or depressed– developed illness and phobias.

Continued…• One of more of these characteristics was true

of most children at some point but the difference for ED children was one of degree and length of time.

Legally ED is…

• Emotional Disturbance "is a legal category created by Congress to distinguish a narrow range of pupils with emotional problems who are eligible for special education services." (Student v. Placentia-Yorba Linda Unified School District (2009) OAH Case No. 2008100314, page 4.)

Not the same as a DSM diagnosis

• "The criteria regarding emotional disorders in the medical and mental health fields are significantly different than the educational criteria for ED." (Student v. Placentia-Yorba Linda

Unified School District (2009) OAH Case No. 2008100314, page 4.)

IDEA Definition of E.D.

• The term means a condition exhibiting one or more of the following characteristics (or have a diagnosis of schizophrenia) over a long period of time and to a marked degree that adversely affects a child's educational performance:

Five Characteristics

• An inability to learn that cannot be explained by intellectual, sensory, or health factors

• An inability to build or maintain satisfactory interpersonal relationships with peers and teachers

• Inappropriate types of behavior or feelings under normal circumstances

Five Characteristics

• A general pervasive mood of unhappiness or depression

• A tendency to develop physical symptoms or fears associated with personal or school problems

IDEA Definition of E.D. Continued

• The term includes schizophrenia • The term does not apply to children

who are socially maladjusted, unless it is determined that they have an emotional disturbance

“It is quite clear that the past and current definition of ED is ambiguous, circular, and logically contradictory.” (Gresham,

2005)

ED vs. & Social maladjustment

• The term does not apply to children who are socially maladjusted,

unless it is determined that they have an emotional disturbance

Farmer, et al. two factor model of externalizing problems

• Oppositional behavior (including ADHD)

• Social norm violations

Reasons why viewing this as an either/or choice does not make sense

• Comorbidity is the rule rather than the exception

• For example, CD has higher risk of suicide risk and depressive disorder than typical population

Legal reasons for denying ED on the basis of SM

• Bad conduct in the absence of other evidence of ED

• Substance abuse as primary cause although courts have acknowledged that ED and substance abuse can co-exist

Rule out other explanations for the problem

An inability to learn that cannot be explained by intellectual, sensory, or

health factors

Social competence

An inability to build or maintain satisfactory interpersonal relationships

with peers and teachers

Odd, unusual or inappropriate behaviors

Inappropriate types of behavior or feelings under normal circumstances

Internalizing Problems

Withdrawal

Anxiety

Somatic complaints

Depression

Tripartite Model Component Internalizing problem

Negative affect or general emotional distress

Both depression and anxiety

Withdraw Both depression and anxiety but function is different

Physiological arousal or somatic tension

Mostly anxiety

Anhedonia or lack of positive affect Mostly depression

Depressive disorders

A general pervasive mood of unhappiness or depression

DSM V categories

• Major Depressive Disorder - 5 symptoms present for 2 weeks nearly every day, most of the day

• Persistent Depressive Disorder - 2 symptoms present for 1 year nearly every day, most of the day

Symptoms

• Depressed or irritable mood • Markedly diminished interest or pleasure in all or almost all

activities • Weight – gain or loss• Sleep – too much or too little• Psychomotor – restlessness or lethargy • Lack of energy• Feelings of worthlessness or excessive guilt• Difficulty concentrating• Thoughts of death or suicide

Anxiety Disorders

A tendency to develop physical symptoms or fears associated with

personal or school problems

Symptoms

• Excessive worry• Somatic symptoms related to physiological

arousal or tension• Avoidance

Long period of time

• Special education law does not define “long period of time”

• Many DSM diagnosis require symptoms to be present for at least six months but this is not universal.

• The intent of the law is that “long period of time” be decided on a case-by-case basis depending on a child’s circumstances and individual needs (Student v. Los Gatos-Saratoga Joint Union High School District (2004) 41 IDELR 227.)

Marked degree

• Pervasiveness of symptoms & behaviors

• Intensity of symptoms & behaviors• Distress caused by symptoms &

behaviors for the student or persons in the environment

Adversely affects educational performance

• NOT simply a judgment based on skills measured on a standardized tests

• Can include grades, work completion, attendance, tardiness, ability to work in groups, etc.

Impairment

Protective factors & Personal assets

Symptoms & personal assets

Educational impairment

Grades

Skills Academic enablers

ED Organizer Condition Evidence

establishing or ruling out condition

 

Evidence for long period of time

Evidence of marked degree

Evidence that condition adversely affects educational

performance 

Inability to build or maintain satisfactory interpersonal relationships with peers and teachers.       

       

Final thoughts on ED Assessment

• The answer to whether a social, emotional, or behavior problem constitutes ED is always going to involve informed subjective judgment or PJs.

• Avoid over simplification• Don’t flood yourself with data

•

General focus for record review

• Rule in or out other learning problems• Evidence of an educational impairment• Look for evidence for diagnoses that have a

developmental feature• Look for evidence for “a long period of time”• Look for medical or health problems that might

account for difficulties or need to be addressed simultaneously

• Look for significant life events that might impact functioning

InterviewsAdvantages & limitations

• Flexible• information is more

direct than rating scales

• Provides opportunity to observe client

• Takes training and experience

• Miss or forget information

• Reliability

Purposes of interviews

• Collaboration is always an overarching goal• Gather background information• Gather information about the nature of the

problem and about strengths or resources• Diagnosis/classification

Good practices in Interviewing

• Focus - think through goals and topics beforehand

• Collaboration- use “skills for not knowing”

Strategies

• Draw questions from previously completed behavior rating scale

• O.F.A.I.D. - Focus on primary symptoms

Simple structure for interview

• Start with small talk• Transition to structuring statement• Ask permission• Go to interview questions

Problem Description

• What is the problem?• Who is involved? • To whom does the problem happen?• How is the problem a problem?• Video description• A-B-C

Attempts to solve problem that...

• Failed to help• Helped (even a little)• Advised by others• Considered but not yet used

BackgroundH.E.A.D.S.

• Home and health

• Education

• Activities

• Drugs

• Sexuality

Alternative Strategies

• Waking-day interview• Self or family drawings• Self-anchored scaling questions • Ecomap• “Three wishes”• Sentence completion

Classroom Observation

• Direct rather than indirect approach to assessment

• Data gathered in natural setting

• Direct link with intervention planning

• Observing makes you more credible

• Won’t provide information about student’s inner states

• One observation is probably not reliable

• Doesn’t necessarily add to DX information

Basic observational structure

• Instructional environment• Recommend BASC SOS because it

includes several components– Time sampling of behavior– Adaptive and problem behavior– Behavior key and checklist– Teacher’s interaction with student

Mental Status Exam

• Conducted as component of overall assessment, interview, observation, or testing.

• Systematic way of reporting your observations and “professional judgments” about a person

• Danger of over interpreting, stick as close as possible to descrptive observations

Mental status “systems”

• Physical Characteristics • Overt Behavior• Cognitive Functioning• Social emotional functioning

Mental Status• Physical Characteristics

– Appearance– Posture

• Overt Behavior– Activity level, body movements– Distractibility – Speech

• Cognitive Functioning– Decision making and judgment– Thought content– Attitude– Perceptions

Social Emotional Functioning• Affect

– current observable emotional status• Mood

– emotional status over time as described by client

• Interpersonal or Social skills– eye contact, turn taking, reaction to praise,

etc– Description of friends and activities

Classroom Observation

• Direct rather than indirect approach to assessment

• Data gathered in natural setting

• Direct link with intervention planning

• Observing makes you more credible

• Won’t provide information about student’s inner states

• One observation is probably not reliable

• Doesn’t necessarily add to DX information

Recording and Coding

• Narrative recording• Frequency (interval, time sample)• Functional behavioral analysis• Direct behavior ratings (DBR)

Advantages

• Efficient way of gathering information• More sensitive to low frequency behaviors • More reliable than observations and

interviews• Allows comparison to a norm group • Allows comparisons between informants

Limitations

• Not diagnostic – essentially screeners• Does not identify etiology or antecedents of

problem• Does not lead directly to interventions or

diagnosis, should be combined with other data gathering methods

• Assess perceptions in a standardized way but are not “objective” measures

Keep in mind

• Comprehensive or general purpose versus narrow

• Aggregation principle• All raters possess some evidence of predictive

validity but don’t necessarily correlate highly• Don’t be rigid about interpreting score

categorically

Steps in interpretation

• Typically, focus on individual scales rather than composite scales

• Identify all scales with T-scores in the at-risk range • For each scale identified, exam item responses• Look for patterns in items and scales and generate

hypotheses• Collect additional evidence via other methods to

confirm of disconfirm hypotheses

Rubric for goals and recommendations

Needs

GoalsServices

Types of recommendations

• Additional evaluations• Accommodations• Curriculum modifications• Interventions tied to identified needs• Specialized supports or services • Referrals to other providers

Assessing progress

• Self anchored scales• Abbreviated rating scales• GAS• Commercial progress monitoring scales

Self Anchored Scale with Images

Self-Anchored Scale with numbersRate how much you worry on a scale of 1 to 5

I am calm. I am not worried about a thing

I worry but I can manage

I worry so often that I can’t. I get stomachaches and headaches. I start to shake

1 2 3 4 5

Abbreviated rating scales

• Two strategies– Choose items on scale that are rated the highest,

indicating a high level of distress or symptoms– Choose the items that correlate the best with the

larger construct measured by the scale

Goal Attainment Scaling (GAS)GAS Rating Descriptor

+2 Significantly improved

+1 Improved

0 Baseline

-1 Worse

-2 Significantly worse

GAS example

GAS Rating

Goal Descriptions

+2 Stephanie uses a relaxation technique 100% of the times she feels nervous

+1 Stephanie uses a relaxation technique 75% of the times she feels nervous

0 Stephanie uses a relaxation technique 50% of the times she feels nervous (Stephanie’s current baseline performance)

-1 Stephanie uses a relaxation technique 25% of the times she feels nervous

-2 Stephanie does not use relaxation techniques

Target Behavior: Stephanie will use relaxation techniques to reduce nervousness and anxiety

(Based on BASC-2 item #108: I get nervous)

Visual Analysis• Phase changes should be:

– Generally immediate– Readily discernible– Maintained over time

• Advantages:– Quick to yield conclusions– Graphing is relatively easy– Minimal theoretical premises

• Limitations:– Difficulty interpreting subtle phase changes– Little guidance for variable or level data, or unclear trends

Visual Analysis Rating

0

10

20

30

40

50

60

70

Randy WPMGoal WPM

Baseline

Intervention 1

GAS Rating

Evidence of Progress (Visual)

+2 Strong evidence of all of below

+1 Desired Direction, immediate, discernible, but some overlap between phases, moderate change

0 Lack of any evidence

-1 Same as “1” but in opposite direction

-2 Same as “2” but in opposite direction

Percentage of Non-Overlapping Data (PND)• Percent of non-overlapping data points (higher or lower)

between baseline and treatment phases• Calculated:

Number of data points in Tx phase that were higher than highest baseline score

Total number of data points in Tx phase

• Advantages: Simple! No worries about nonlinearity or heterogeneity

• Limitations: Potentially oversensitive to atypical baseline data, adversely impacted by trends, may not discriminate important treatment changes

Percentage of non-overlapping data points

• Identify the lowest baseline point

• Count the number of non-overlapping intervention points

• Calculate the proportion of non-overlapping to total number of intervention points

• Ineffective - 50%• Questionable - 50-

70%• Moderately effective -

70-90%• Highly effective - 90%

+

Michael Hass, Ph.D., January 2011

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