Improving Autism Assessment Services in the Schools

1. Improving Autism Assessment Services in the Schools John Prickett Donald Oswald Commonwealth Autism Service

2. The Problem • 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. • Rural school divisions face particular challenges in providing interdisciplinary assessment and intervention. • Evidence suggests that local teams can be successfully trained to provide high-quality assessments of children with ASDs (McClure, MacKay, Mamdani, & McCaughey, 2010)

3. Overcoming Barriers to Early Identification of ASDs • Barriers to effective early identification include: • Long wait time for external evaluations • External evaluations may not translate easily into educational plans • External evaluations may foster an adversarial relationship between parents and school personnel • Single-discipline evaluations fail to capture the complexity of the child’s ability / disability profile.

4. goal of the project • To identify students with Autism Spectrum Disorders (ASDs) at an earlier age via: • A school-based interdisciplinary team trained in gold-standard, autism-specific assessments . • Generate reliable diagnostic decisions. • Used by Local Education Agencies (LEAs) for the purposes of eligibility and IEP development.

5. Collaborators • Commonwealth Autism Service (CAS) • Shenandoah Valley Regional Program (SVRP), a regional special education program consisting of: • Page County Public Schools • Shenandoah County Public Schools • Rockingham County Public Schools • Augusta County Public Schools • Harrisonburg City Public Schools • Staunton City Public Schools • Virginia Leadership Education in Neurodevelopmental Disabilities (Va-LEND)

6. Regional Autism Assessment Team (RAAT) • The Regional Autism Assessment Team (RAAT) is a school-based interdisciplinary assessment service serving six rural school divisions. • The objectives of the collaboration were to train RAAT members in: • The use of reliable, gold-standard diagnostic assessment instruments; • Interdisciplinary team functioning and family centered practice; • Integrating multi-disciplinary perspectives and contributions to the diagnostic assessment process.

7. RAAT membership • SVRP school-based interdisciplinary regional autism assessment team: • school psychologists • speech and language pathologists • occupational therapists • school social workers • behavior analysts

8. Training Activities • RAAT members receive formal training in: • Autism Diagnostic Observation Schedule (ADOS) administration and coding • Autism Diagnostic Interview – Revised (ADI-R) administration and coding • Interdisciplinary team functioning • Family-centered practice • Interdisciplinary assessment: Role of the occupational therapist • ADOS - Consensus coding • Evidence-based interventions

9. Training Activities • Principles of interdisciplinary team assessment: • Ecological validity of assessments • Recognizing uncertainty • Coordination and non-redundant 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

10. Training Activities (2010) • Previously provided trainings: • December 9th : ADI Training provided to SVRP RAAT • November 29th & 30th: ADOS Training provided to SVRP RAAT. • October 7th : Consensus scoring for the (ADOS). • February 22: Role of the occupational therapist in assessing, designing and delivering services to support learners with ASD. • School-based assessment team members and trainees regularly observe evaluations at the CAS Transdisciplinary Diagnostic Assessment Clinic.

11. Training Results • Trainees achieved the identified objectives and were satisfied with the training provided. • Survey of Trainees: • Before-session: Participants indicated they were ‘not at all ‘ to ‘somewhat’ informed about assessment issues. • After-session responses ranged from ‘somewhat’ to ‘well informed’ • Participants showed increased knowledge about the training topics. • Training participants indicated that training was useful and would change their practice/behavior. • Training participants indicated that they were satisfied with the overall training and that effective training tools were used.

12. SVRP and CAS staff worked with local school division personnel to devise an administrative process for: referral to the assessment team feedback of assessment results to the child’s eligibility team. RAAT Administrative Process

13. Referral to the assessment team • Student is identified by the student’s local special education director with input from: • The school psychologist, social worker, special education teacher. • Special Education Director makes a referral, in writing, to the RAAT Coordinator. • RAAT Coordinator recruits a trans-disciplinary team from a pool of 22 various team members.

14. Assessment Process • Referral is made by the relevant Special Education Director • Team is selected by the RAAT Coordinator • Classroom Observation is conducted by the behavior analyst (1.5 to 2 hours) • The ADOS is administered at the testing center, typically, the parent is present (2.5 to 3.5 hours) • The ADI is administered at the student’s home or at the testing center (2 to 3 hours). • Review of previous reports (1 to 3 hours) • Completion of summaries by the represented disciplines. • Report completion.

15. Feedback to the child’s Eligibility Team. • Team members complete discipline specific summaries. • School psychologist combines summaries and completes report • Report is submitted by the RAAT coordinator to the referring special education director. • Behavior Analyst from the referring district attends the student’s eligibility meeting.

16. Overall Project Results • A functioning Regional Autism Assessment Team consisting of 22 members that has over the period of 14 months, contributed to the eligibility determination and intervention planning of 15 children. • Of 12 parents who responded to surveys, 11 stated the assessment team: • Helped them to feel informed about the assessment process. • That they (the parents) were involved in the assessment process • That the assessment team made sufficient effort to get to know their child.

17. Engaging Primary Care Providers • Primary care providers in screening and interdisciplinary assessment: • Primary care physicians (PCPs) – a critical link in the process • April 14th, 2010: SVRP in conjunction with CAS hosted a dinner & provided presentations to provide information about the RAAT, screening & assessment issues for ASD.

18. Additional Issues • Issues addressed in the implementation of the project included: • 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).

19. References • Guralnick, M.J. (2000). Interdisciplinary clinical assessment of young children with developmental disabilities. Baltimore 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.

20. Contact Us • John Prickett, MA, BCBA • jprickett@autismva.org • Donald Oswald, PhD • doswald@autismva.org

21. Questions / Comments