Components of CET

1. Components of CET

2. Components of CET Sole purpose for or against autism Independent Team One Report Trans-disciplinary approach Concise meeting time 4 Squares (Domains) Not Standardized Score Based Report Shared with the parents ahead of time Qualitative Sensory not assumed Three person team Objective – don’t know kids All doing Observations in all settings Home visits (all three go) Showing deficit does not have to be academic Report follows MET criteria

3. CET Components • Components that can be immediately implemented • Components that can be implemented in a reasonable amount of time but that need some planning. • Components that have major barriers for our district / ISD.

4. Beyond CETCustomizing Implementation Kelly Dunlap, Psy.S. Stephanie Dyer, Ed. S.

5. Implementation = Herding Cats

6. CET = Standardize the ProcessBeyond CET = Customize the Implementation • Factors in Customization • Players • ISD / District Structure • Competency of Staff in ASD Evaluation • Political / Cultural Variables • Buy In / Support

7. Acronym Deciphering Tool • SE = Special Education • ASD = Autism Spectrum Disorder • MARSE = Michigan Administrative Rules for Special Education • REED = Review of Existing Evaluation Data • MET = Multidisciplinary Evaluation Team • IFSP = Individual Family Service Plan • IEP = Individualized Educational Program • SAS = Supplementary Aids and Services • P&S = Programs & Services • FAPE = Free and Appropriate Public Education • LRE = Least Restrictive Environment • AIB = Autism Insurance Benefit • DSM = Diagnostic and Statistical Manual of Mental Disorders • PDD-NOS = Pervasive Developmental Disorder – Not Otherwise Specified • ADOS = Autism Diagnostic Observation Schedule • ADI = Autism Diagnostic Interview • CMHP = Child Mental Health Professional • PCP = Person-Centered Plan • IPOS = Individual Plan of Service • ABA = Applied Behavioral Analysis • EIBI = Early Intensive Behavioral Intervention • ABI = Applied Behavioral Intervention • ABLLS = Assessment of Basic Language and Learning Skills • VB-MAPP = Verbal Behavioral Milestones Assessment and Placement Program

8. Current Players at the Table

9. Referral / Evaluation Considerations • Context of Referral: • Request for Initial Evaluation, or • Already eligible, but not ASD (e.g. ECDD/SLI) • Potential Challenges • Pressure to accept outside diagnosis and proceed to an IEP with ASD eligibility • IDEA/MMSEA Considerations to Remember: • Always consider information provided by parent (REED) • AIB diagnosis • Not typically done by a team • Possibly using different tools • Using different criteria • Special Ed evaluation done for dual purposes of eligibility and IEP development

10. Autism Council SUBCOMITTEES Adult Services Early Intervention Education Workgroups Screening and Assessment / ASD Eligibility Determination

11. START’s Centralized Evaluation Team (CET) Training (CET): (M. Ziegler, D. Schoemer) “Exemplars” (e.g. Kent, Ottawa, Char Em Evaluation Guidelines) CDC ACT (Autism Case Training) http://www.cdc.gov/ncbddd/actearly/ACT/class.html CCRESA Progression & Feedback “Beyond CET” Training: S. Dyer Collaborative Conversations: • C. Lord, B. Ingersoll, S. Pastyrnak, OAISD AIM (Autism Internet Modules) http://www.autisminternetmodules.org National Association of School Psychologists National Research Council Resources

12. “There is no single behavior that is always typical of Autism and no behavior that would automatically exclude an individual child from a diagnosis of Autism.” National Research Council

13. 3 Steps: • Ensure high quality special education eligibility evaluations…. (Clean up our own backyard!) • Utilize “Gap Analysis”: What additional information do schools need, when given an outside evaluation, to address special education ASD eligibility? • Move toward true collaborative evaluation So, where do we start?

14. Improve Quality of ASD Evaluations

16. Improving School Processes • All staff need to be competent at ASD screening / evaluation • Current Issues: • Not recognizing there are THREE required eligibility areas • Not recognizing that “educational impact” can be in one of THREE areas (e.g. academic, behavior, social) • Use of tools with no observational data • Not understanding terms: • Pervasive • Marked • Qualitative • Adverse Impact

17. ASD Evaluation Process • Key Components • Evaluation Methods & Tools ASD Eligibility Criteria • Rule 340.1715 • Deep Understanding Other Considerations / Individual Challenges High Quality Evaluation

18. TEAM TEAMTEAMTEAM Evaluations are conducted as a team! Collaboration One voice One contact One report Minimum: Psych, SSW, SLP…

19. Collaborative Team Approach

20. CET Components Selected

21. 4 Critical Components Evaluation Checklist Meeting Evaluation Components Results Review Meetings Team Report

22. Evaluation Checklist Meeting Attended by MET members (Psych, SSW, SLP) Critical for coordination of scheduling (ie. IEP, RRM, observations…) Discussion and assignments of evaluation components (evaluation checklist) Allows time for training, questions, case study, problem solving KEY COMPONENT #1

24. Evaluation Checklist Teacher interview Parent interview / home visit Observations CA-60 review ADOS Diagnostic Testing Report Writing Results Review Mtg Need / Impact Determination Schedule IEP Feedback to building team/coach/sped rep Parent interp IEP attendees

25. Evaluation Components Parent/Family Interview(s) and Home Visit Teacher/Service Provider Interview(s) Observations (Multiple Times/Settings by all team members) ADOS (Viewed/scored by TEAM) Other Information as Determined by Evaluation Team KEY COMPONENT #2

26. Evaluation Methods/Tools Predominantly OBSERVATION and INTERVIEW Not YES/NO, Black/White…Qualitative Evaluation Autism Diagnostic Observation Schedule (ADOS): Not score, but observation opportunity Specific diagnostic tests (communication, cognitive, social, sensory, adaptive) Caution: Questionnaires? CARS?

27. Sample Reliability Validity EXAMPLE: ADOS-2: • Test / Re-test Reliability—2 Weeks: • Classification changed for 9 of the 39 children (23%) Technical Adequacy

28. Assessment ToolsCentral Assessment Lending Library (CALL) https://www.cmich.edu/colleges/chsbs/Psychology/call/pages/default.aspx/ • ASIEP-3: Autism Screening Instrument for Educational Planning • ADOS-2 (Autism Diagnostic Observation Schedule) • ADI-R: Autism Diagnostic Interview • CARS-2: Childhood Autism Rating Scale • GARS-2: Gilliam Autism Rating Scale • GADS: Gilliam Asperger Disorder Scale • KADI: Krug Asperger Disorder Index • PEP-3: Psycho-Educational Profile • ABLLS-R: Assessment of Basic Language and Learning Skills • VB-MAPP: Verbal Behavior – Milestones Assessment and Placement Program

29. Parent Interview • During home visit • At least two evaluation team members • Guided interview • Biggest concern • Describe interview process • Birth, developmental, medical history • Go through questions • Visit to child’s room if possible

30. Teacher Interview • Allow at least 45 minutes • Preferably two evaluation team members • Guided interview • Biggest concern • Describe interview process • Go through “teacher interview” questions • Academics • Explain rating scale if using one & set up return process

31. Observations All team members need to conduct observations Make sure all settings, times of day, contexts are covered Allow room in schedule for additional observations Powerful…allows for considering function of behavior (“eyes on kid, eyes on kid…”) Dig down below the surface

32. Understanding BehaviorPositive Behavior Intervention Support Perspective Behavior serves a FUNCTION Behavior is influenced by: internal events such as physiological condition (e.g., earache) emotional state (e.g., anxious, scared) factors outside the immediate context, including relationships, activity patterns, and lifestyle issues. Behavior is related to and governed by its CONTEXT: ENVIRONMENT Horner, R., 2000

33. Possible Function? When peers try to talk to her, Mariah turns away, does not respond verbally, and pulls her sweater over her head; peers move away. When the teacher gives her corrective feedback about her work, Mariah turns away, does not respond verbally, and pulls her sweater over head; the teacher sits next to her, rubs her shoulders and says comforting words.

34. Marci was observed grabbing toys and objects from othersand appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure. Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

35. Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure. Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

36. Marci was observed grabbing toys and objects from others, while yelling, “I had it first!” and pushing peers away. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci kept saying, “Am I bugging you yet?” and “Isn’t this so funny?” Marci was observed pulling at girls’ ponytails and accessories; she will say, “I don’t like your hair like that-it looks stupid.” Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” while being redirected from an argument with a peer. Marci has previously shoved, kicked and poked this girl when she doesn’t do what Marci wants her to do.

38. Results Review Meeting Only Eval Team present (Psy, SSW, SLP) List all 12 criteria on board Color code information (teacher, parent, eval team) Ask BIG question in each area: Is there a qualitative impairment in socialization?... Discuss each criterion; check criterion that has been reached Report writer (on computer) KEY COMPONENT #3

39. Data Analysis?

40. Determining Eligibility Start with the child, not the characteristics Integrate quantitative & qualitative information Within qualitative assessment, discover whether student meets criteria for Autism Spectrum Disorder “Preponderance of the evidence”

42. Results Review Meeting cont… Process All data sources Determine eligibility / DECISION If eligible as ASD, determine how the ASD is impacting progress in gen ed in the areas of socialization, independence, communication, transition, self-regulation… Feedback/recommendations provided to building team, parents, coach, sped rep

43. Of primary concern is Johnny’s level of independence. Due to difficulties in pragmatic language and communication, sensory modulation, and socialization, Johnny’s independence is limited. In order to participate with the routines and activities of the classroom, Johnny currently requires considerable physical and verbal prompting from adults. His independence is significantly impacted in the following areas: • Transition (task to task and place to place) • Group participation • Direction following • Self care • Interactions with peers • Outside play • Inside play with free choice time • Spontaneous conversation

44. Report Writing Process Use template! (Follows the MET criteria) Information from RRM provided basis for report; recommendations and consistent message developed at the RRM Report writer determined when assigning tasks from the evaluation checklist Very defendable; easy to understand; excellent feedback from staff, parents, special ed reps; creates consistency; eliminates redundancy! KEY COMPONENT #4

45. Critical Report Considerations • Build a case for your conclusion (e.g. you shouldn’t get to end and question eligibility recommendation) • Avoid “cut and paste” process (makes it challenging to cohesively build a case) • Use Persuasive Writing Skills • Customize to MET form • Explain what does NOT align (e.g. standardized scores, parent reports of behaviors, etc.)

46. EXAMPLE SOCIAL: Based on survey information and observations,       demonstrates a range of nonverbal behaviors such as smiling when happy, frowning when sad, pointing to orient another to something, and looking nervous when he does something wrong. For example, on one occasion during direct observation,   . On another occasion,       On yet another occasion,       These are a just a few examples of the good use of nonverbal behavior       uses to communicate in social situations. During direct assessment,       was able to describe an event using a full range of facial expressions, body postures, and gestures including pointing, shrugging his shoulders, and nodding. Although reports indicate that      struggles with matching facial expressions with mood (e.g.       face will be straight when he is actually happy) and using a full range of non-verbal, in school observations and direct assessment, these behaviors were not noted to be qualitatively (DEFINE) impaired compared to peers.       

47. EXAMPLE SOCIAL:       also is attentive and responsive to the social environment and engages in the give and take of social interactions that define reciprocity.       is reported to have two good friends in the general education classroom and a number of friends in the special education classroom.       was observed during recess to play soccer with a group of about six other students and despite some disagreement among them around rules, they sustained the game for the majority of the recess time.       is also reported and observed to initiate and even seek out peers to engage with and likes to show toys and school work to both peers and adults.      , however, indicates that       does not show or share at home unless it is in an interest areas, although in school,       is reported and observed to share a full range of information including sharing about events outside of school like vacations. During direction observation,       showed and shared on a number of occasions. For example,

48. ASD is characterized by: qualitative impairments in _____________________,qualitative impairments in ____________________,and ____________________. QUICK CHECK:

49. TheTriadof ASD:QualitativePervasive Characteristics of ASDDEEP UNDERSTANDING Social Skills -- Reciprocity Communication Restrictive, Repetitive, and Stereotyped behaviors: Insistence on Sameness Idiosyncratic Behavior Imposition on Environment

50. Eval Team Practice