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- Best Practices in the Assessment and Identification of ED
The federal definition of emotional disturbance (ED) provides limited guidance to educational professionals charged with making Individuals with Disabilities in Education Improvement Act eligibility determinations. Despite calls to revise the definition, the ED category remains largely unchanged nearly four decades after being codified into federal law. To navigate the vague, ambiguous, and outdated eligibility criteria, school psychologists must adhere to comprehensive assessment strategies whenever an ED placement is considered. In this study, we examined the ED assessment practices of 214 school psychologists. The results indicated that respondents all too frequently relied on only select sources of data (e.g., behavior rating scales), rather than taking a multimethod, multisource approach, when evaluating children referred for emotional and behavioral concerns. Implications for both the practice and preparation of school psychologists are discussed.
The Education for All Handicapped Children Act of 1975 (Pub. L. 94–142) guaranteed access to public education for children with a range of disabilities, including those with emotional and/or behavioral disorders. In writing the federal definition for the category intended to include children diagnosed with various forms of psychopathology, the U.S. Congress adopted a modified version of a definition originally developed by Eli Bower in the 1950s and 1960s (Merrell & Walker, 2004). Bower's definition of what is now designated emotional disturbance (ED) was largely based on his late 1950s study of 207 children identified as “emotionally disturbed.” According to Bower (1982), the definition was derived from an analysis of teacher-reported data on each of these previously diagnosed children. Essentially, his original definition summarized the “major differences” between the children identified as having ED and their typically developing classmates (Bower, 1982). The recommendations from this research were codified into Pub. L. 94–142 as the official definition of ED, and they remain relatively unchanged almost four decades later.
Borrowing directly from Bower's original conceptualization, the current definition that appears in the Individuals with Disabilities in Education Improvement Act of 2004 (IDEA) delineates children with ED as those demonstrating at least one of the following:
- An inability to learn, which 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;
- A general, pervasive mood of unhappiness or depression, and;
- A tendency to develop physical symptoms, pains, or fears, associated with personal or school problems.
Other elements of the current federal definition that are rooted in the original Bower conceptualization of ED include the requirements that these symptoms be exhibited to a “marked degree” and “over a long period of time.” Also, consistent with other IDEA eligibility categories, the federal ED definition stipulates evidence must exist confirming that the student's disability “adversely affects” his/her educational performance (IDEA, 2004 [§300.8 (C)(4)(ii)]).
The addition of a “social maladjustment clause” marks the federal law's only significant deviation from Bower's definition. IDEA's explicit exclusion of children who are deemed socially maladjusted has been controversial since its initial incorporation into the law (Skiba, Grizzle, & Minke, 1994). Basically, without further explanation or guidance, the federal definition requires school districts to exclude children who are socially maladjusted and do not otherwise meet the criteria for ED. The problems associated with the implementation of this clause, which has no basis in the scientific literature and no explicated rationale, have been the focus of several articles critical of the federal definition of ED (Bower, 1982; Kehle, Bray, Theodore, Zhou, & McCoach, 2004; Skiba & Grizzle, 1991). Despite serious concerns raised by critics, the social maladjustment clause has been retained through every reauthorization of IDEA.
Beyond the problems inherent in the social maladjustment clause, several other serious concerns and deficiencies associated with the federal definition are evident, and these have been enumerated and discussed in detail over the years since Pub. L. 94–142 was enacted (Becker et al., 2011; Clarizio, 1987; Forness & Kavale, 2000; Hanchon & Allen, in press; Merrell & Walker, 2004; Skiba & Grizzle, 1992). The major criticisms have focused on the lack of empirical support for the eligibility criteria; the vague, ambiguous, and outdated language included in the definition; and the failure to successfully lobby for changes to the law. More recently, ethical concerns have been raised regarding the utilization of a definition so fraught with questions of validity and fairness (Hanchon & Allen, in press).
One of the most pressing ED-related issues for practicing school psychologists, and those charged with preparing future generations of school psychologists, is the school-based implementation of a problematic and vague federal definition. This, coupled with research indicating that most states’ ED definitions deviate only minimally from the federal law (Becker et al., 2011), makes it imperative that school psychologists consider additional resources (e.g., practice standards, diagnostic codes external to IDEA, empirical research) when identifying and intervening with children suffering from emotional problems. Given the lack of direction and clarity provided within the federal definition, supplemented with only limited guidance offered through state laws and regulations, school psychologists must be thoughtful and diligent in adhering to various “best practice” recommendations as applied to the identification of children within the ED classification.
Best Practices in the Assessment and Identification of ED
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- Best Practices in the Assessment and Identification of ED
An appropriate school-based evaluation of a child's social, emotional, and behavioral functioning begins with a school psychologist who is properly trained in assessment, child psychopathology, intervention planning, and applicable legal and ethical codes. The National Association of School Psychologists (NASP, 2010) Standards for the Graduate Preparation of School Psychologists require training programs to provide evidence of preparation in each of these four domains as part of a comprehensive program curriculum. Although evidence of meeting relevant NASP professional training standards is necessary, it is not sufficient for ensuring that preservice school psychologists are adequately prepared to navigate the vague and ambiguous language of the federal definition. In fact, considering the longstanding concerns associated with the federal guidelines, it is quite likely that trainers also experience difficulty when preparing to teach school psychology students the best practices of ED identification.
To be on sound footing when making assessment-related decisions regarding the identification of a child who may qualify under the ED category, a school psychologist must first have expertise and knowledge of the broader domain of child psychopathology. Clearly, the federal definition and its five primary criteria are not intended to serve as diagnostic criteria for specific types of emotional disorders (e.g., major depressive disorder, generalized anxiety disorder). Only through graduate preparation and ongoing professional development can school psychologists develop the skills necessary to identify childhood disorders. On the completion of academic training, school psychologists have the additional professional and ethical obligation to keep abreast of developments in ED research. This sentiment is underscored by recent surveys suggesting that school psychologists often feel underprepared to work with many emotional disorders and issues (Miller & Jome, 2008). A strong foundation in child psychopathology not only includes knowledge of the relevant state and federal eligibility guidelines, but also familiarity with established diagnostic codes for various emotional, behavioral, and mental disorders (e.g., Diagnostic and Statistical Manual of Mental Disorders [4th ed.; DSM-IV]; International Statistical Classification of Diseases and Related Health Problems [10th revision; ICD-10]). These additional resources provide valuable information and guidance to aide in operationally defining what are otherwise ambiguous concepts within the federal definition of ED (e.g., “pervasive mood of unhappiness,” “long period of time”) (IDEA, 2004 [§300.8 (C)(4)(ii)]).
The planning of an appropriate ED evaluation can only be accomplished by professionals adequately trained in psychopathology, which includes appropriate treatment options for these types of disorders. It is insufficient to simply understand topographical features, such as common symptoms, clinical features, and diagnostic criteria for the various forms of psychopathology (Heathfield & Clark, 2004). Although this information facilitates eligibility determinations and diagnosis, to best meet the needs of the children they serve, school psychologists must collect data that can be used to plan interventions designed to promote the positive functioning and well-being of each child. Obviously, treatment planning is informed by knowledge of a child's specific condition (e.g., obsessive compulsive disorder, bipolar disorder; Theodore, Akin-Little, & Little, 2004). However, knowing the salient symptoms or features of a child's specific emotional disorder does not provide adequate information for individualized treatment planning. The evaluation of a broad range of factors that may be influencing the child's behavior is necessary to promote positive functioning in both the school and home environments.
To ensure that enough data are collected to accurately determine ED eligibility and to plan an effective course of treatment, school psychologists must utilize a comprehensive approach to assessment. Although assessment planning should always be guided by referral information and other considerations that are specific to the individual child, following general guidelines for a comprehensive multimethod, multisource approach that utilizes multiple measures, settings, and informants is strongly recommended (Merrell & Walker, 2004; Reddy, 2001). Given the context of a vague, ambiguous, and perhaps professionally indefensible set of federal criteria that continue to serve as the basis for ED eligibility determination (Skiba et al., 1994), school psychologists are advised to follow established models of appropriate and comprehensive psychoeducational assessment.
Professional training guidelines (NASP, 2010) and ethical practice standards (Jacob, Decker, & Hartshorne, 2011) emphasize the need for a comprehensive approach to assessment without regard to the disability category. Likewise, popular assessment textbooks, whether focused on general psychopathology or specific mental disorders, advocate for comprehensive and multifaceted assessment methods to facilitate disability identification and intervention planning (Mash & Barkley, 2007; Merrell, 2008; Sattler, 2008). As a result, one can assume that most school psychology graduate students are regularly exposed to these principles as part of their didactic and field-based experiences. Nevertheless, even with a general consensus within the profession regarding the need to adhere to best practice assessment strategies, recent findings related to school psychologists’ ED assessment practices raise concerns as to whether or not these recommendations are being carried over into actual practice in the schools (Hanchon & Allen, in press).
In determining what constitutes a comprehensive school-based evaluation of ED, school psychologists and trainers can draw from several well-respected and established resources (e.g., Frick, Barry, & Kamphaus, 2010; Mash & Barkley, 2007; Merrell, 2008). One text, in particular, provides an excellent overview and explanation of the various components of a multimethod, multisource, multisetting assessment (Merrell, 2008). These components are divided into three general areas: methods (e.g., interviews, observations, behavior rating scales), sources (e.g., parent, teacher, child), and settings (e.g., home, school, community). Other training resources (Frick et al., 2010; Mash & Barkley, 2007; Sattler, 2008) describe similar techniques and sources of data, but we find Merrell's (2008) model to be particularly useful in providing a sound overview of the comprehensive assessment of ED. For specific emotional disorders, school psychologists would benefit from access to more extensive compendiums (e.g., Mash & Barkley, 2007).
Building on our previous research (Hanchon & Allen, in press) indicating that school psychologists often rely too heavily on only selected components from various comprehensive assessment models (e.g., behavior rating scales), seemingly at the expense of others (e.g., parent and child interviews), our current study sought to examine more directly the frequency with which practicing school psychologists utilize comprehensive assessment strategies in the identification and treatment planning of children referred for ED evaluations. These data may be useful in bridging the gap between recommended best practice and the actual school-based delivery of services to children with emotional and behavioral disorders. Only through comprehensive approaches to assessment can we effectively design interventions to meet the needs of these students. Furthermore, the data may be of interest to trainers as they seek to identify areas in need of further coverage within programs’ coursework and field-based experiences.
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- Best Practices in the Assessment and Identification of ED
Among all the disability categories for which school psychologists and other educational personnel are charged with determining eligibility, perhaps none present more challenges than ED. School psychologists are required to utilize a vague, ambiguous, and controversial set of criteria with limited guidance from either federal regulations or state law. Over the four decades since Pub. L. 94–142 was enacted, the problems associated with an antiquated definition have been the subject of numerous articles, the focus of special issues of prominent journals (Hughes & Bray, 2004), and the motivation behind efforts to revise the federal criteria and essentially redefine ED (Forness & Knitzer, 1992). Still, the ED definition remains unchanged, with few signs of substantial revision in the foreseeable future. Despite longstanding research citing our educational system's failure to meet the needs of ED children (Knitzer & Olson, 1982; Wagner, Kutash, Duchnowski, Epstein, & Sumi, 2005), school psychologists remain tasked with serving these students under problematic, at best, and unethical, at worst, conditions.
Given the weaknesses of the federal conceptualization of ED, school psychologists are under greater pressure than normal to adhere to recommended best practices in identification and assessment. Fortunately, there are numerous resources available to facilitate responsible and comprehensive evaluations designed to ensure accurate identification and to inform the development and implementation of effective interventions. In addition to established and respected diagnostic systems (e.g., DSM-IV, ICD-10), which can be used to confirm the existence of widely accepted forms of child psychopathology, the field of school psychology is replete with academic resources to guide professionals as they navigate the murky waters of ED assessment (Frick et al., 2010; Mash & Barkley, 2007; Merrell, 2008). In each case, the recommendations are clear. The assessment of children suspected of ED must exemplify a multimethod, multisource approach, which utilizes multiple measures, settings, and informants.
The results of our study are consistent with those published previously (Hanchon & Allen, in press). Although NASP training guidelines, standards of ethical practice (Jacob et al., 2011), and respected assessment texts recommend comprehensive assessment strategies for determining eligibility and formulating effective treatment plans, the actual practices of school psychologists often fall short. On a positive note, our results demonstrated that just over half of the respondents consistently included at least four of the five components we termed “critical” for an ED evaluation focused on eligibility determination and intervention planning. In many cases, these school psychologists also utilized other valuable sources of data (e.g., FBAs, observations in multiple settings). However, in contrast to these school psychologists who meet various best practice recommendations, an unacceptably high number of respondents (just over 25%) consistently included only two or fewer of these critical components (i.e., parent interview, teacher interview, child interview, observation, behavior rating scale) in their initial ED evaluations.
These results raise concerns regarding both the practice and preparation of school psychologists. Practicing school psychologists and trainers alike have an ethical responsibility to ensure that appropriate assessment techniques are used with all children being considered for a potential ED placement. The identification of a student with ED can yield great benefits for the child in terms of treatment, support, and supplemental educational programming. However, when the label is misapplied as the result of a problematic definition and inappropriate evaluation, the classification of a student as ED can lead to stigmatization, failure, and other negative long-term consequences. An ambiguous federal definition, further complicated by poor assessment practices, could be a contributing factor in the overrepresentation of minority, low socioeconomic status, and single-parent children in ED programs (Losen & Orfield, 2002; Wagner et al., 2005). Only through the maintenance of high standards in preparation and practice can the field of school psychology effectively meet the needs of ED children being served under an outdated and problematic disability category.
The data and results presented in this article extend the work of Hanchon and Allen's (in press) examination of school psychology assessment practices and, as such, share a similar set of limitations. First, the study includes data from only 214 school psychologists practicing in relatively restricted geographic regions. Further study of ED assessment practices incorporating a broader and more representative sample is necessary. Second, the results were based on retrospective estimates made by school psychologists regarding their assessment practices. An examination of the actual assessment techniques included in these evaluations would result in a more accurate accounting of current practices. This could occur through an examination of district, state, and national data pools.