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BestPracticesinMultidisciplinaryAssessmentofEmotionalDisturbance-1.pdf
Journal of Counseling & Development ■ Fall 2008 ■ Volume 86494
Assessment & Diagnosis
© 2008 by the American Counseling Association. All rights reserved.
In 2004, the American School Counselor Association (ASCA) issued position statements concerning counselors’ involvement with children with disabilities and suggested that they serve as members of multidisciplinary evaluation teams and act as consultants to parents, teachers, and other school personnel. Furthermore, the most recent education and school counseling reform movements (No Child Left Behind [U.S. Department of Education, 2002], the ASCA National Standards for Stu- dents [ASCA, 2003, and the ASCA National Model [ASCA, 2003]) have also emphasized the counselor’s role in meeting the needs of all children, including children with disabilities. According to Frye (2005), counselors currently do not seem to possess sufficient training to work with children with dis- abilities, despite the focus of these recent reform movements on counselors’ increased involvement with these children. As a result, counselors are experiencing pressure to modify their roles in school with limited training and with little guidance regarding best practices approaches.
Counselors frequently work with children with emotional disturbances (EDs). Children who have an ED currently con- stitute one of the fastest growing disability populations served in school systems across the country. In the 2000–2001 school year, 473,663 children and youth with an ED were provided special education and related services in the public schools (U.S. Department of Education, 2002). However, the U.S. Surgeon General estimates that, nationwide, 5% of school-age children have mental health impairments resulting in extreme functional limitations, and 11% have mental health impairments that cause significant functional limitations (U.S. Department of Education, 2001). The Individuals With Disabilities Education Improvement Act (IDEIA, 2004) defines ED as 1 of 11 areas
of educational disabilities that can entitle children to receive special education services. Although the earlier Individuals With Disabilities Education Act (IDEA) was first passed by Congress approximately 15 years ago, states continue to lack systematic and standardized procedures for screening and evaluating children with emotional or behavioral problems. IDEIA is the most recent revision of IDEA.
Currently, counselors frequently serve as an essential mem- ber of school-based multidisciplinary evaluation teams. They conduct important components of the overall assessment to determine a child’s eligibility for special education services, and they are often relied upon long after such evaluations are complete to implement group or individual counseling with children who have been identified as having ED. As a result, counselors are in need of a best practices approach to working with students in need of emotional support services. A best practices approach is defined in this article as strate- gies, methods, and approaches that are consistent with those identified in the professional literature and have been shown through research and evaluation to be effective.
Although it has been estimated that 70% to 80% of children who receive mental health services receive them through their school (Burns et al., 1995), there are many children who re- ceive mental health services in community settings or through both community-based and school-based services. Because of the complex nature of ED, it has been recommended that education professionals and mental health professionals from outside agencies collaborate to allow the development and implementation of more comprehensive services, such as wraparound services (Wagner, 1995). Wraparound services involve the child, family, and school and offer mental health
Heidi L. Rudy, Dubois Area School District, Lanse, Pennsylvania; Edward M. Levinson, Department of Educational and School Psychology, Indiana University of Pennsylvania.Correspondence concerning this article should be addressed to Edward M. Levinson, 242 Stouffer Hall, Department of Educational and School Psychology, Indiana University of Pennsylvania, Indiana, PA 15705 (e-mail: [email protected]).
Best Practices in the Multidisciplinary Assessment of Emotional Disturbances: A Primer for Counselors Heidi L. Rudy and Edward M. Levinson
Emotional and behavioral difficulties often interfere with children’s acquisition of academic, career, and social skills. Counselors assume an important role in the mandated multidisciplinary evaluation of children with emotional distur- bance (ED), but the field lacks a standard battery of assessment procedures for working with children who have ED. The authors review the current issues related to students with ED, describe instruments and procedures used to assess ED, and discuss the counselor’s role in the assessment process.
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services within the context of the community. Wraparound services use a team approach that is based on the belief that positive relationships among the child, the family, and the school coupled with community support will foster posi- tive behavior outcomes. The use of wraparound services is widespread, with programs available in 47 of the 55 U.S. states and territories (Burns, Schoenwald, Burchard, Faw, & Santos, 2000).
School-based counselors alone cannot meet the mental health needs of children with ED; collaboration with community-based counselors is essential to provide adequate wraparound services that meet the needs of the child (Wagner, 1995). Therefore, children who have been identified as having ED may benefit from collaboration between school and com- munity counselors at all points during service delivery, especially during the development of interventions and testing (Ringeisen, Henderson, & Hoagwood, 2003). Both community-based counselors and school-based counselors are often involved in assessing and providing services to children, therefore, it is important for these counselors to have an understanding of the assessment techniques and interventions used in both school and community settings.
In this article, we first address the plight of children with EDs and highlight concerns specific to this population of children. Legal issues surrounding the identification of these children and providing services for them are then discussed. A best practices approach to assessment is outlined, and individual assessment methods and instruments are presented. Finally, the counselor’s role in the assessment process is discussed.
The Plight of Children With ED Effectively serving the needs of children with ED and their families is a national concern. Children with ED have the least favorable outcomes of any group of individuals with disabili- ties, and they often display characteristics that threaten the likelihood that they will experience success in or out of school. Children with ED are often unable to maintain appropriate social relationships with others; have academic difficulties in multiple content areas; and display chronic behavior problems including noncompliance, aggression, and disrespect toward authority figures (Coleman & Webber, 2002).
According to the 25th Annual Report to Congress on the Implementation of the Individuals With Disabilities Educa- tion Act (U.S. Department of Education, 2003), children with ED earn lower grades than any other group of children with disabilities. They also fail more courses and minimum com- petency examinations and are retained at the same grade level more frequently than children who have other types of dis- abilities. The average grade point average of children identified with ED is 1.7, compared with 2.3 for all students receiving special education services, and 2.6 for students in regular education. Children identified with ED also miss an average of 18 to 20 days of school per year, which is significantly higher
than any other group of children. Eighteen percent of children identified with ED are educated outside of their home school, and of those children who do attend their home school, less than 17% are educated in regular classrooms.
In addition to experiencing problems with academic per- formance and attendance, children identified with ED are less likely to graduate and are at a greater risk for delinquency as well as other problems. Sixty-five percent of youth with ED withdraw from school during Grades 9 through12, as compared with 41% of all children with disabilities and 24% of all high school students. Only 28% of youth with ED earn a high school diploma, compared with 47% of all youth re- ceiving special education services and more than 80% of all high school students. Twenty-eight percent of youth with ED are arrested at least once before they leave school, and 58% are arrested within 5 years of leaving school. Seventy-three percent of those students with ED who withdraw from school are arrested within 5 years of leaving school. Moreover, there is a general overrepresentation of African Americans and children from lower socioeconomic backgrounds in emotional support programs as compared with their representations in the general population. Also, girls remain underrepresented in such programs. Finally, families of children with ED are more likely to be blamed for the children’s disabilities, and teachers and aides who work with children identified with ED are more likely to seek reassignment or leave their position.
Legal Issues and Definition IDEA Definition
Currently, the federal definition of ED is as follows:
(i) The term means a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems. (ii) 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. (IDEIA, 2004; 34 C.F.R. 300.8)
Recently, the federal definition of ED has been the target of much criticism and discussion (Coleman & Webber, 2002; Kauffman, 1997). The primary issues involve this definition’s exclusion of children who are socially maladjusted from emo- tional support services and the meaning and measurement of terms such as “long period of time,” “marked degree,” and “adversely affects educational performance” (IDEIA,
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2004; 34 C.F.R. 300.8). Professionals and advocacy groups have also criticized the current IDEIA definition of ED as being overly restrictive and not supported by legal precedent or educational and clinical research. Recently, there have been many efforts to develop alternative definitions of ED; however, Congress has chosen to continue to use the current IDEIA definition (McConaughy & Ritter, 2002).
Social Maladjustment (SM)
Given that SM has never been defined in the federal law, the explanation of this concept has often been left to individuals and organizations in the field of education, as well as to the state and local education agencies responsible for implement- ing special education services. Some formal attempts have been made over the past few decades to create an operational definition of SM, but there has never been a single descrip- tion of SM that has been universally recognized and accepted (Clarizio, 1992; Forness, Kavale, & Lopez, 1993).
In the absence of a standard definition of SM, speculation remains as to what this term actually means. Most researchers and practitioners have concluded that SM can be conceptualized as a pattern of engagement in purposive antisocial, destructive, and delinquent behaviors. Generally, SM has been equated with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev. [DSM-IV-TR]; American Psychiatric Associa- tion, 2000) criteria for Conduct Disorder and, in some cases, Oppositional-Defiant Disorder, whereby socially maladjusted children are thought to understand but choose not to conform to societal rules and norms. Instead, socially maladjusted chil- dren are considered to be motivated by self-gain. These youth often display behavior that may be highly valued in their peer group but may not be within the range of socially acceptable behaviors. Overall, intentionality is believed to be the distin- guishing feature between children demonstrating ED and those demonstrating social maladjustment (Clarizio, 1992).
Taken as a whole, the overlap between behaviors outlined in IDEIA for the criteria of ED and those typically considered to represent characteristics of SM and the frequent comorbid- ity of various emotional and behavioral disorders suggest that attempting to interpret and use the SM exclusionary clause contained within the definition of ED may be almost impos- sible, and perhaps unnecessary. More specifically, if a child meets the criteria for an ED, the maladjustment exclusionary clause is irrelevant because, although children with ED can also be socially maladjusted, children with SM must also be identified as having an ED to receive special education services under IDEIA.
Section 504
Section 504 of the Rehabilitation Act of 1973 protects the rights of preschool, school-age, and adult students with dis- abilities to fully participate in school activities unless the education of these students cannot be achieved in this way. The students’ schools are also required to take all necessary steps to
make sure that the students are receiving an appropriate educa- tion, including making accommodations within the classroom. Determining eligibility for emotional support services under IDEIA or accommodations through Section 504 requires multidisciplinary evaluations of children’s behavioral and emotional problems. Furthermore, Section 504 regulations are broader than those of IDEIA in that many students not meeting requirements for educational disabilities under IDEIA may meet such requirements under Section 504. Consequently, these children would be entitled to receive accommodations in the regular education setting, such as formulation of behavior plans, preferential seating, and modifications to their daily schedule. These accommodations can help children succeed both academically and socially without lowering academic standards and expectations for them.
Best Practices in Assessment The formulation of an assessment plan for children suspected of having an ED is influenced by two factors: the perspective taken by team members relative to the nature and/or cause of the disorder and the purpose of the assessment.
Perspectives on EDs
According to McConaughy and Ritter (2002), there are four general perspectives on the nature of EDs. One perspective views child psychopathology as the basis for the children’s difficulties and suggests that both genetic and environmental factors contribute to the individuals’ psychopathology and to the emotional, behavioral, and social difficulties that the students experience. The second perspective suggests that behavioral–environmental interactions form the basis for the children’s disorder. Instead of assessing psychopathology, this perspective assesses reciprocal interactions between the individuals’ behaviors and their environments; within a school context, the focus is on the school environment and the children’s interaction patterns with peers, teachers, and administrators. A third perspective seeks to identify the functional relationships between environmental events and problem behaviors and assumes that all behavior serves some function for the children. In an attempt to change behaviors, assessment from this perspective focuses on antecedent events that might precipitate behaviors; consequences that may reinforce behaviors; and interventions that alter antecedents, consequences; or both. A fourth perspective emphasizes the effectiveness of interventions and defines disorders by the extent to which the students’ behaviors prove resistant to interventions. The extent to which the multidisciplinary assessment team emphasizes each of these four perspectives will be influenced by the purpose of the assessment.
Purposes of Assessment
School-based assessment of EDs might have several purposes. First, assessment can be designed to help teachers cope with
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behavior problems that are manifested in regular education classroom settings. Should this be the purpose of the assess- ment, the team should adopt either the behavioral–environmental interaction or the intervention-focused perspective because these perspectives are likely to offer the most effective strate- gies for teachers to use in their classrooms. A second purpose of assessment is to help children reduce their problem behavior and improve their competencies and skills. If this is the pur- pose of assessment, the behavioral–environmental interaction or intervention-focused perspectives might again be the most effective perspectives to adopt. A third purpose of assessment is to determine whether a child is eligible for special educa- tion services. If this is the purpose of assessment, the team should adopt the child psychopathology perspective as a basis for the assessment because this assessment will lend itself to making classifications and eligibility decisions. A fourth purpose of assessment is to determine whether children and their families need to be referred for mental health services outside of the school setting. Again, the team might consider adopting a psychopathology perspective of ED if this is the purpose of assessment. In particular, the last two purposes of assessment discussed often require the team to classify, categorize, or label children. Several different approaches exist regarding such classification.
Approaches to Classification
Currently, classifying children’s emotional and behavioral problems typically falls under one of two approaches: categori- cal classification and empirically based taxonomies.
Categorical. Categorical classifications provide a list of specific criteria to describe symptoms of a disorder. Prob- lems are organized in a present versus absent manner. If all of the specified symptoms are met, or present, the individual is considered to have the disorder. Otherwise, the individual is believed not to have the disorder. The DSM-IV-TR (APA, 2000) and current special education classification systems are two examples of this approach.
Empirically based taxonomies. Empirically based assess- ments refer to procedures that are based on observation and ex- perience. In empirically based taxonomies, statistical methods are used to identify patterns of co-occurring problems. Using this approach, problems are rated quantitatively according to dimensions such as frequency, duration, and intensity. The em- pirically based approach yields standard scores and percentiles for judging children’s behaviors relative to peers and delineates clinical cutoff points for discriminating between criterion groups selected to represent typical versus clinical ranges of functioning. Consequently, quantitative taxonomies provide a more differentiated method for assessing the severity and patterning of problems. However, it is important to remember that empirically based measures are not without limitations. For example, these measures do not provide information regarding the cause of children’s problems, and the results do not directly translate into choices for interventions. Consequently, school-
based and community-based counselors must obtain additional information using other assessment procedures. Several stan- dardized behavior rating scales such as the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach, 1991a, 1991b, 1991c, 1991d) and the Behavior Assessment System for Children 2 (BASC-2; C. Reynolds & Kamphaus, 2006), are examples of empirically based taxonomies.
Assessment
Currently, best practice when conducting multidisciplinary evaluations of children with emotional or behavioral problems requires that information be gained from the children’s parents and teacher(s) and from the direct assessment of the children (McConaughy & Ritter, 2002). Examples of assessment methods that can be used to gather information from parents and teachers include standardized rating scales, interviews, and questionnaires and forms. Furthermore, children’s parents can provide specific information regarding the history of the presenting problem, other possible problem areas, feasibility of interventions and family resources, and stressors. Examples of methods that can be used in direct assessment of the child include self-report rating scales, child clinical interviews, and direct observations. Each of these evaluation techniques is discussed in more detail in the following sections.
A critical factor for school-based and community-based counselors to consider when working with children with emotional or behavioral problems is that the students are often referred for such evaluations by adults who perceive their behaviors as problematic. Consequently, in multidimensional assessment, counselors should compare scores from children’s self-reports to similar scores obtained from the parent and the teacher rating scales. However, it is important to remember that none of the informants observe all aspects of children’s behavior. More specifically, each informant’s reports can be limited by factors such as the contexts in which they typically see the children and their relationships and interactions with the children. Furthermore, each informant’s perceptions and standards for rating children’s behavior are likely to vary, as is their own influence on that behavior. Given the many factors influencing ratings of children’s behaviors, it is not surprising that research has shown only moderate levels of agreement across different informants.
Assessment Methods Although there is still no standard battery of assessment procedures to be used when evaluating children for the presence of ED (as there are for evaluating children for learning disabilities or mental retardation), research does offer some guidance regarding several different types of assessments that may be used when evaluating children for ED. Examples of such assessments include empirically based assessments, standardized rating scales, interviews, direct observations, functional behavioral assessments (FBA),
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social skills and social competence, and achievement and academic functioning.
Empirically Based Assessments
To take into account the variations among diverse informants and in the kinds of data they are able to provide, the empiri- cally based approach uses a variety of standardized behavior rating forms specifically designed for the different types of informants. For example, some items are similar across differ- ent versions of a family of rating scales, whereas other items may be specifically targeted for various settings (behavior in home, school, etc.). Overall, information provided by multiple informants can be valuable for identifying consistencies and inconsistencies in how adults perceive children’s behaviors in different settings and in deriving cross-informant syndrome scores to reflect children’s behavior patterns across different settings.
Standardized Rating Scales
Numerous rating scales have been developed to provide efficient methods to gain teacher and parent reports of children’s adap- tive and problem behaviors. Broad-band scales measure a wide range of potential problems and include instruments such as the Child Behavior Checklist (CBCL; Achenbach, 1991b), Teach- er’s Report Form (TRF; Achenbach, 1991c), and the BASC-2 (C. Reynolds & Kamphaus, 2006). Narrow-band scales focus on particular types of behaviors and include scales such as the Reynolds Child Depression Scale (W. M. Reynolds, 1989) and the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996). Narrow-band instruments are often used in conjunction with broad-band scales to assess particular problems. In addition, it is important for counselors to assess children’s competencies as well as their problem behaviors so that goals and interventions can be built around skills the children already possess. The Behavioral and Emotional Rating Scale (Epstein & Sharma, 1998), School Social Behavior Scales (SSBS; Merrell, 1993), CBCL, TRF, and BASC-2 are examples of broad-band instru- ments for assessing both behavioral and emotional strengths and problems areas. According to current best practice in the assessment of EDs, a broad-band standardized rating scale should be obtained from at least one parent and one teacher. If possible, it is useful to obtain ratings on both broad-band and narrow-band scales, from both of the children’s parents, and from more than one teacher (if the students have multiple teach- ers) to compare the ratings assigned to the children’s behaviors across different environments and from different informants’ perspectives of the problems. Standardized self-report rating scales can also be used to obtain information directly from older children. In standardized self-reports, respondents are typically asked to rate lists of feelings or behaviors on dichotomous or multipoint scales. Finally, the results of the standardized rat- ing scales should be integrated with information gained from other assessment methods, such as interviews (McConaughy & Achenbach, 1990).
Interviews
Interviews have played a prominent role in the assessment of children’s behavioral and emotional problems in both clini- cal and school settings (Busse & Beaver, 2000). Interview formats can vary from highly structured to unstructured and semistructured approaches.
Structured interviews. Structured interviews are being used more frequently during assessments of children’s emotional and behavioral difficulties to improve the reliability and the validity of the information provided during the interview. Structured diagnostic interviews are typically used with multiple informants (e.g., parents, children, and sometimes teachers) and are designed to broadly assess symptoms and behaviors. However, some struc- tured diagnostic interviews tend to be rather time-consuming and may feel unnatural to both the counselors and the interviewees because of their rigid patterns of questioning. An example is the NIMH Diagnostic Interview Schedule for Children, Version 4 (Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000). In con- trast, some types of structured diagnostic interviews use standard question formats but allow for more flexibility to create a more conversational style during the interview. Examples of such in- struments are the Child Assessment Schedule (Hodges, Gordon, & Lennon, 1990) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Ambrosini, 2000).
Unstructured interviews. Unstructured interviews do not follow a standard format and can be individually designed to assess specific areas of problematic functioning. However, if not designed properly, unstructured interviews may not ad- dress separate relevant issues such as other problem areas, the children’s strengths that interventions can build on, interven- tions previously attempted, and the types of interventions most likely to succeed given environmental variables and the unique characteristics of the child. Unstructured interviews can also make it difficult to compare information received from parents, teachers, and children (McConaughy & Ritter, 2002).
Semistructured interviews. Overall, semistructured interview formats seem best suited for use by counselors because they al- low for some flexibility in format, yet provide at least a minimal amount of structure to the interview. In addition, these interviews can be used to compare data obtained from the same informants through behavior rating scales and from other assessment data. Typically, semistructured interviews begin with general questions about the presenting problem, antecedents and consequences that may be related to the child’s behaviors, adults’ perceptions of and typical reactions to the behavior, and expectations regarding appropriate behavior. Although the main focus of the interview should remain on the child’s current behaviors, it is also important to inquire about historical information and environmental factors that may be contributing to current difficulties.
Interviews with children provide counselors with an op- portunity to observe behavioral tendencies and interaction styles, impulsivity and distractibility, displays of anxious or nervous behaviors, and range of emotions displayed during
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the course of the interview. The information yielded from these informal behavioral observations can then be compared with information provided by other informants and from other assessment data. Semistructured interviews are usually the most appropriate for interviews with children (McConaughy & Achenbach, 1990).
With very young children (5 years old or younger), in- dividual interviews are usually not beneficial, at least with respect to content. More specifically, children under the age of 10 years are typically unreliable reporters of their own behavioral and emotional symptoms (Edelbrock, Costello, Dulcan, Kalas, & Conover, 1985). However, spending even a few minutes alone with younger children can provide counselors with information regarding the child’s emotional and behavioral characteristics and their perceptions of the problems (Bierman, 1983). By beginning the interview with simple rapport building, counselors can begin to gain the child’s support and the cooperation necessary for subsequent assessment and intervention activities. Counselors can then begin to ask the child about various situations in which the problems typically occur to learn the child’s perspectives about problem situations. Other questions to ask the child focus on family, school, social, and personal factors (Breen & Altepeter, 1990). Upon completion of the interview, data should be compared with other assessment data, such as rat- ing scales and direct observations, to assess the consistency of the information obtained.
Direct Observations
Direct behavioral observations have been used extensively to as- sess children’s behaviors and are an essential component of FBAs. As a general rule, observations should be conducted throughout the course of the multidisciplinary evaluation and in different settings (both where the behavior is likely to occur and in less problematic settings). Observations should also be conducted in short-duration sessions on different days. The observer should randomly select one or two children in the same setting who can represent controls to provide a comparison with peers in the same environment (McConaughy & Ritter, 2002). There are two broad categories of observation recording systems: empirical and narrative recording (Breen & Altepeter, 1990).
Empirically based observations. Empirical observations require operationally and predefined behaviors that can be recorded during the observation interval. There are various methods for recording empirical observation data, such as time sampling, continuous event recording, and interval recording (momentary time sampling). Time sampling involves record- ing behaviors only during prespecified intervals. For example, the observation period may be divided into 90 ten-second intervals, and the observer only records whether or not the behavior was present during every other 10-second observa- tion interval. Time sampling techniques are typically most useful for recording multiple behaviors during one observation or for recording behavior patterns across different settings.
Continuous event recording involves recording each time a behavior occurs during the observation period (or the duration of time the behavior lasted) and is typically most useful when the behaviors occur relatively infrequently, have a definite beginning and end to them, and are of short duration. As with time sampling, interval recording requires the observer to designate predetermined observation intervals and monitor whether or not the target behavior was displayed either at the beginning or end of each prespecified observation interval. Interval recording is typically used when recording relatively high frequency behaviors, behaviors in short duration, and multiple behaviors or behaviors across multiple settings.
Narrative recordings. In contrast to empirically based obser- vation techniques, narrative recordings require the observer to transcribe students’ behaviors throughout designated observa- tion periods. For example, the observer records the target child’s behaviors, antecedents, consequences, and others’ reactions to the child’s behaviors. Specific examples of techniques for implementing narrative recordings include descriptive time sampling, daily logs, and antecedent-behavior-consequence (A-B-C) analysis (McConaughy & Ritter, 2002).
FBA
FBA is a problem-solving process that is designed to identify the function of problem behaviors for the child, which then leads to interventions. FBA involves the assessment and link- ing of external environmental conditions (antecedents and consequences) to specific behaviors so that these behaviors can be predicted and controlled (Ervin, Ehrhardt, & Poling, 2001). Once behavioral function is determined, this information can be used to design interventions to reduce the occurrence of problem behaviors and to increase the frequency of socially appropriate behaviors. Currently, IDEIA only requires an FBA to be completed when a child with a disability becomes involved with school discipline proceedings. However, FBA is a viable assessment process and is based on the require- ments for comprehensive and individualized multidisciplinary evaluations of students for special education services. More specifically, the evaluation team, in conducting an FBA as part of the comprehensive individual evaluation, provides evidence regarding whether the student demonstrates an ED and is in need of special education and related services.
When conducting FBA in schools, counselors and other members of multidisciplinary or prereferral intervention teams may choose from among three general assessment methods to meet the varied demands of particular situations. The first is informant methods, which refer to indirect measures of behavior, including behavior rating scales, checklists, and interviews. The second assessment method involves direct observational methods. The third assessment method, experi- mental or functional analysis, is a process that involves the systematic manipulation of environmental variables, under controlled conditions, to determine the variable’s effect on the problem behavior (Knoster & McCurdy, 2002).
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Social Skills and Social Competence
Children with emotional or behavioral difficulties often expe- rience significant social difficulties. As a result, assessment of social skills and social competence are critical components of a multidisciplinary evaluation for students experiencing emo- tional or behavioral difficulties. Methods often used to collect data about children’s social functioning include sociometric techniques, observation, self-reports, rating scales, and peer nominations. Examples of specific assessment instruments to assess social skills include the Social Skills Rating System (Gresham & Elliott, 1990) and the SSBS (Merrell, 1993).
Achievement and Academic Functioning
All multidisciplinary evaluations require some type of assess- ment of children’s current level of academic performance to establish the need for special education services. Consequent- ly, when functioning as a member of a multidisciplinary team, counselors must help determine the extent to which children’s emotional disorders adversely affect educational performance. Group or individually administered standardized achievement tests, curriculum-based assessment, review of grades, and portfolio assessments are all examples of assessment meth- ods appropriate for measuring educational performance. In addition, standardized teacher-completed rating scales, such as the BASC-2 (C. Reynolds & Kamphaus, 2006) and the TRF (Achenbach, 1991c), can yield information concerning students’ academic achievement and adaptive behaviors.
Instruments
Achenbach and McConaughy’s model. Achenbach and McCo- naughy’s model of multiaxial, empirically based assessment emphasizes the different types and sources of information that may be relevant when assessing children’s emotional and behavioral difficulties and competencies (Achenbach, 1991a; Achenbach & McConaughy, 1987; McConaughy, 1993; Mc- Conaughy & Achenbach, 1988). The model incorporates six ASEBA rating forms, in addition to interviews, review of records, and information from outside professionals and standardized psycho-educational assessment instruments. Five assessment axes represent different types and sources of information to be included in the assessment, depending on the age of the child. Axis I, Parent Reports, includes the CBCL for ages 2 to 3 years (CBCL/2-3; Achenbach, 1992; Achenbach, Edelbrock, & Howell, 1987) and the CBCL for ages 4 to 18 years (CBCL/4-18; Achenbach, 1991b), as well as a review of relevant records and parent interviews. Axis II, Teacher Reports, includes the TRF (Achenbach, 1991c), review of relevant school information, educational history, and teacher interviews. Axis III, Cognitive Assessment, includes standard- ized cognitive ability tests and measures of perceptual–motor skills, language functioning, and academic achievement. Axis IV, Physical Assessment, includes height, weight, physical development, and medical and neurological exams. Axis V,
Direct Assessment of the Child, includes the Youth Self-Re- port (YSR; Achenbach, 1991d), the Direct Observation Form (DOF; Achenbach, 1991b; McConaughy, Achenbach, & Gent, 1988), and the Semistructured Clinical Interview for Children and Adolescents (SCICA; McConaughy & Achenbach, 2001). Axis V also includes self-concept measures, personality tests, and other relevant forms of psychological assessment. The CBCL/2-3, CBCL/4-18, TRF, and YSR have well-established reliability and validity, as detailed in the manuals of each instrument (Achenbach, 1991b, 1991c, 1991d, 1992). Finally, several studies have affirmed the reliability and validity of the DOF (Achenbach, 1991b; Achenbach & Edelbrock, 1983; McConaughy et al., 1988; Reed & Edelbrock, 1983).
The Scale for Assessing Emotional Disturbance (SAED). The SAED (Epstein & Cullinan, 1998) is designed to operationalize the federal definition of ED. The SAED’s five scales (Inabil- ity to Learn, Relationship Problems, Inappropriate Behavior, Unhappiness or Depression, and Physical Symptoms or Fears) are based on the five characteristics outlined in the federal definition of ED, and it includes two subscales for measuring Social Maladjustment and Overall Competence. The SAED underwent extensive development and field-testing, which resulted in good content validity and instrument reliability (for details, see Epstein & Cullinan, 1998). Two concurrent valid- ity studies were also conducted with the TRF and the Revised Behavior Problem Checklist, and all correlations were found to be statistically significant (Epstein, Cullinan, Harniss, & Ryser, 1999). In determining if children’s emotional and behavioral problems adversely affect educational performance, consider- able weight is allotted to just one item, and, given that different raters will provide ratings according to their own perspectives, extreme caution should be exercised with interpreting the re- sults of this single item. Two sets of norms are provided: one based on a sample of children not identified as ED (NonED) and the other from a sample of students of the same age who were currently receiving emotional support services (ED). The authors recommend using the NonED norms for screening and eligibility decisions and the ED norms for intervention planning and evaluating progress. However, the norms are problematic in some ways. The authors state that the rater is usually a teacher but may also be a parent, counselor, social worker, close relative, and so forth. Because only school personnel completed the scale in the normative sample, it is not appropriate to use the same norms for ratings from both teachers and parents because of their differing perspectives and experiences with the student.
SCICA. An example of a semistructured child interview is the SCICA (McConaughy & Achenbach, 2001). The SCICA is designed to be administered to youth between the ages of 6 and 18 years and uses a protocol of open-ended questions to as- sess a wide variety of areas, such as family and peer relations, functioning at home and school, and children’s perspectives of the problems. This instrument yields broad scores for Internal- izing, Externalizing, Total Observation, and Total Self-Reports
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scales and contains two separate sets of syndromes based on 120 observation items and 114 self-report items. Dimensional scores similar to those obtained from various versions of the CBCL family of instruments (Achenbach, 1993) can also be derived from these items, but only for children ages 6 through 12 years. Overall, the syndrome and broad scales show high test–retest reliability. Adequate content and criterion-related validity are also provided in the instrument’s manual (Mc- Conaughy & Achenbach, 2001).
DOF. The DOF (Achenbach, 1991b) is designed for rating and recording direct observations of children’s behaviors dur- ing 10-minute time intervals in a classroom or in other group- oriented situations. The DOF is composed of 96 items, 72 of which have complements on the CBCL/4-18 and 85 of which have equivalents on the TRF. Using this method, the observer writes a narrative description of the observed behavior and then rates the children on each item at the end of the observation interval. The observer also rates children’s on-task behavior at the end of each 1-minute interval. Information about the instrument’s reliability and validity is available in Achenbach (1991b). Overall, interobserver reliability is reported to be high for the behavior problem score and the on-task score. In terms of validity, DOF scores have been found to correlate significantly and in the expected directions with teacher-reported problem behaviors, school performance, and adaptive functioning. In addition, boys who had been referred for counseling by their teachers because of problem behaviors obtained significantly higher behavior problem scores and significantly lower on-task scores than a matched sample of boys observed in the same classrooms (Reed & Edlebrock, 1983).
SSBS. The SSBS is a 65-item, norm-referenced rating scale designed specifically for use in schools. Responses are provided on a 5-point Likert-type scale and make up two major scales: Social Competence (Scale A) and Antisocial Behavior (Scale B). Both of these scales consist of three subscales (1 = Interpersonal Skills, Self-Management, and Academic Skills; 2 = Hostile-Irritable, Antisocial-Aggressive; and 3 = Disruptive-Demanding). The manual presents raw scores, standard scores (M = 100, SD = 15 for total scale scores), per- centile ranks, and social functioning levels. Social functioning levels indicate the general level of social–behavioral compe- tence displayed by children. Two social functioning levels that indicate the need for further evaluation are “moderate” and “significant problem.” Evidence provided in the manual indicates that the SSBS has adequate to excellent reliability; a solid factor structure; and adequate content, construct, and discriminant validity. More detailed psychometric properties of the SSBS are presented in the manual (Merrell, 1993).
Implications for School-Based and Community-Based Counselors
Today, school personnel face the daunting challenge of providing an appropriate education to growing populations
of children who are at risk of school failure. For example, today’s school children are at a higher risk for depression than any previous generation. As many as 9% of children will experience a major depressive episode by the time they are 14 years old, and 20% will experience a major depres- sive episode before graduating from high school (American Psychological Association, 2003). Consequently, if schools are to realize their educational purpose with children whose emotional or behavioral difficulties place them at high risk of school failure, new roles for school counselors are neces- sary. National school counselor certification examinations and state credentialing standards require knowledge of and skill development in assessment (American Counseling As- sociation, 2005; National Board for Certified Counselors, 2005), and professional associations have specified assessment competencies (ASCA, 2003; Association for Assessment in Counseling and Education, n.d.; Council for Accreditation of Counseling and Related Educational Programs, 2001). However, despite the training that school counselors receive in their graduate training programs and the links between educational testing and counseling indicated by research, it is not clear from a review of the literature whether professional school counselors use the assessment skills they possess, are confident in their selection of assessment instruments, and feel competent in using assessment procedures. Increasingly, counselors are being called on to administer, score, and inter- pret various types of standardized tests. Additional assessment procedures that school counselors may be asked to use during a multidisciplinary evaluation include rating scales and self- reports; parent, child, and teacher interviews; observations of the student; FBA; review of relevant records; and assessment of social skills and academic performance of children.
Multidimensional, multifaceted, and multisourced evaluations are essential in the assessment of children suspected of having an ED (Rudolph & Epstein, 2000), and school counselors are in- creasingly being asked to contribute to these evaluations. Ideally, multidisciplinary evaluations should be conducted in a systematic manner and by a team of professionals, including school coun- selors, parents, administrators, teachers, school psychologists, the students themselves, and outside medical and mental health agencies such as community-based counselors.
Although school-based and community-based counselors use many of the same assessment tools when evaluating a child for ED, they may base the identification of ED on different cri- teria. For example, under IDEA, a student cannot be identified as having an ED until after the school’s multidisciplinary team has determined that the student is eligible for services (Merrell, 2003, p. 34). Therefore, a diagnosis of ED by an outside mental health agency will not mean that the child will be eligible for services at school. In addition, community counselors may use the DSM-IV-TR (American Psychiatric Association, 2000) to determine the presence of ED, whereas school counselors de- termine eligibility for services on the basis of the laws outlined in IDEA (Epanchin, 1991, pp. 311, 313).
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These differences highlight the need for communication between school-based and community-based counselors during the assessment process and when determining whether or not a child is eligible for services. Although school-based counselors and community-based counselors may use different criteria to determine the presence of ED, it is important for both to have an awareness of the DSM-IV-TR (American Psychiatric Association, 2000) criteria. Children may benefit when school counselors are knowledgeable about the DSM-IV-TR criteria because it may assist school counselors in knowing when children should be referred to outside mental health agencies. This understanding of the DSM-IV-TR criteria can also be beneficial to both school counselors and community counselors because it allows for increased communication between the two groups of profes- sionals (Hohenshil, 1996). Collaboration between the school and outside mental health agencies can provide a more comprehensive evaluation of the child, which can assist the school in determin- ing eligibility for services and can allow for the development of more effective interventions.
Currently, multiple levels of assessment, including early identification and screening of children who are beginning to demonstrate behavior or emotional difficulties, may rep- resent a best practice approach for multidisciplinary teams. Research, which we have summarized in this article, offers guidance for counselors in working with children undergo- ing a multidisciplinary evaluation for ED. First, research indicates that assessment procedures should be ongoing throughout the course of an evaluation and should be con- ducted by various members of the multidisciplinary team in a variety of settings. Second, it is important to use multiple assessment methods to increase the reliability and validity of the information obtained. Use of multiple assessment meth- ods, along with multiple assessors, reduces the likelihood of bias resulting from the assessor, the assessment method, or the informant. The goals of the assessment of children with EDs are to obtain relevant information about the child in unstructured and instructional environments, to assimilate the data to create comprehensive pictures of concerns and strengths, and to develop short- and long-term goals and strategies for intervention. The assessment must identify both the strengths and the needs of the child and identify the people and systems with whom the child interacts. It is important to select appropriate assessment methods so that they not only assist in the identification of children with emotional and/or behavior disorders but also assist in the development of interventions.
In conclusion, multidisciplinary assessment of children with EDs is receiving national attention as educators and policy makers are becoming more aware of the long-term negative outcomes for students who receive insufficient evalu- ations and/or emotional support services that do not meet their needs (U.S. Department of Education, 2003). Furthermore, appropriate interventions for children with ED can only be determined from well-conducted, comprehensive multidisci-
plinary team evaluations. Consequently, it is imperative that members of multidisciplinary teams become familiar with current best practice approaches. We have outlined many of the methods and procedures considered to be best practice in the assessment of ED, and these can be used by counselors when serving on multidisciplinary teams. Although more research is necessary regarding instrumentation, there are currently a sufficient number of assessment methods to allow school- based and community-based counselors to select techniques that match the purposes of the evaluations and the individual characteristics of the students with whom they are working. In doing so, counselors can improve the overall assessment process and, in turn, improve the services that students with ED receive.
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