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Alan Cashmore Centre Team Approach to Assessment

Alan Cashmore Centre Team Approach to Assessment. Alan Cashmore Centre Team Approach to Assessment. Looking at the Whole Child. COLLABORATION TO GAIN UNDERSTANDING. General Principals of Assessment. In the context of Therapeutic Observation

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Alan Cashmore Centre Team Approach to Assessment

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  1. Alan Cashmore Centre Team Approach to Assessment

  2. Alan Cashmore Centre Team Approach to Assessment

  3. Looking at the Whole Child COLLABORATION TO GAIN UNDERSTANDING

  4. General Principals of Assessment • In the context of Therapeutic Observation Finding out what the problem is from all perspectives ( parent, child, professionals involved) This ongoing process guides what we do in the interactions called therapy.

  5. Team Approach to Assessment Our unit works as a team I.e: a flattened pyramid of multidisciplined professionals Shared information Intervention must fit the therapist and the family. The decisions are team determined. We form a “mini- team.”

  6. Assessment to Goal Setting with the Family Involves the family and mini-team getting to know one another and the issues. Evolves with time and degree of success. Goals are like “wishes for the family” Goals are reviewed in meetings, conferences several times a year.

  7. Advocacy into Community and School System Children come from the community and go on to the community. We help to bridge understanding to the community of the whole child. Knowledge of resources and advocacy skills are needed to ensure family is supported as they move on from our service. Follow up outreach within the age of 7 often required.

  8. CASE STUDY “N” • 3.4 year old boy • Aggression toward brother • Parents concerned with lack of empathy • Hyper- lexic • Referred by Speech Pathologist in community

  9. The Morning Therapeutic Group

  10. OBSERVATION • Observing child is an ongoing process. ADAPTIVE FUNCTIONING At home ( initial visit with CCC) fit? In program: how they organize themselves in tasks, do they stay on task? response to limits ( testing, ignoring, or negotiating?) transitions, routines ( N. would fall apart)

  11. EMOTIONAL • Development of relationship is key • Response to stress (i.e: Leaving parent) • Reactions to changes in environment ( easily overwhelmed) PHYSICAL • Gross motor, fine motor (anxiety during art) • Sensory Integration needs

  12. COGNITIVE Exploration of materials School readiness Understanding other’s perspective • SOCIAL Chooses play partners Problem solving skills Sharing needs and ideas

  13. SPEECH/ LANGUAGE • Expressive • Receptive i.e: • Question asking • Processing difficulties • Pragmatics and social communication

  14. COLLABORATION • Meet with Mini Team to discuss observations. • Child Care Counselor, Psychiatrist,Therapist, Speech/ Language Pathologist. Plan, strategize, discuss, wonder… Day Program team meetings and Daily Debrief Example: Mitigated Echolalia with N. dramatic decrease within weeks.

  15. INTERVENTION • On going process of observing and collaborating to find what works. Example: Daily plan to organize ( transitions; attending) Social stories (bedtime; going home; empathy) Visuals for home use “How to Play” booklets In the moment drawing it out Visuals brought meaning to N.’s day, opened opportunities to develop play skills, make sense of social situations, reduced anxiety.

  16. DAILY PLAN

  17. Limit setting. He was looking for limits and boundaries- they were unclear and fuzzy. • Offering 2 choices when he reverted to clock dials and thermostats- reflecting his feelings of being overwhelmed, and then moving him on. • Modeling social interactions- providing scripts, visual “instructions” for how to play with others. The visuals and the social interaction work all helped to increase social opportunities- to be part of a group.

  18. PARENT COMMUNICATION • Bridging MTG to home- Ongoing. • Parent Observations of Child in MTG • Ongoing report of challenges at home- what to do, what may work? ( Home program) • Daily check in with parent (In center) • How is parent handling difficult behaviors? ( Too much talking, explaining. Hanging on to Intelligence- part of grieving) Major decrease in anxiety ( less outbursts, more settled) once visuals put into place and parent style became more clear.

  19. BRIDGE TO COMMUNITY • Preschool • Occupational Therapy (we look for at earlier age) • School readiness- Screening • Consult to Kindergarten- up to one year.

  20. Alan Cashmore Centre: Speech, Language and Communication Assessment As an Ongoing Process In the Team Context.

  21. Basic Facts: • LANGUAGE DEFICITS in children with emotional and behavioural disorders: 71% had clinically significant language deficits. (18 research studies reviewed data)

  22. EMOTIONAL AND BEHAVIOURAL DISORDERS in children with language disorders: 57% had Emotional/Behavioural Disorders *Literature Review published: Journal of Emotional and Behavioural Disorders, Spring, 2002 by Benner, Nelson and Epstein.

  23. Speech, Language and Communication Assessment in the Team Context. • Progression of assessment from program entry to therapy sessions. • What a Speech-Language Pathologist is looking for – what you might notice too. • How the S-LP integrates her work with the team.

  24. Overview of the Assessment Process • N. enters Morning Therapeutic Group • Observation and informal sessions in the group • Informal information gathering • Structured information gathering • Hearing Screening • Goal selection with parents • Regular, bi-weekly “therapy” sessions begin • Continuing observations, consultations with team

  25. Observation and Informal Sessions in the Group • 4-6 weeks • Observe N. at free play, snack time, circle and gym: • interactions with adults and children, style and level of play, language sampling • enter his play, read books together, try out early ideas on strategies • Mitigated echolalia – N. asking many questions, what was communicative function of this behavior?

  26. Informal information gathering • Written reports from e.g. previous S-LP • Verbal reports/history/concerns of parents • Verbal reports from Child Care Counselor and other staff and discussion of initial impressions • CCC already beginning work at home and helping parents with bedtime routine; discussion/feedback on Social Story she’s written for N.

  27. Structured Information Gathering for Functional/social Assessment • Assessment of Social and Communication Skills for Children with Autism – Kathleen Quill • Communicative Means-Function Questionnaire – Finnerty and Quill • Westby Symbolic Play Scale • Pragmatics Observation guide • [Formal speech-language assessment using standardized tests]

  28. Goal Selection with Parents • Some of N.’s behavior goals: • N. will increase his positive social interactions with adults and peers. Objectives: • Look toward speaker when name called • Imitate actions and words at circle time • N. will help to organize tasks and make transitions (plan) • Stay with group in community settings

  29. Some of N.’s communication goals • N. will ask and answer meaningful question Objectives: • Answer and ask yes/no questions about his actions; about pictures of others’ actions • Answer and ask “wh”-questions appropriately • N. will maintain a topic for 2-3 turns Objectives: • Will stay with a topic when reminded “we’re talking about _______ right now” • Will listen and look at his communication partner to understand their part in the conversation and their needs

  30. Regular Bi-weekly “Therapy” Sessions • Parent involved in session • Observing S-LP model for listening/language/communication skill development • Joining in interactions with N. guided by S-LP • Parent feedback on how it’s going, need to change/adapt goals

  31. Ongoing team consultation • Work closely with CCC to develop visual supports • Continue to observe, connect with N. in playroom (social) setting • Brainstorm, feedback, suggestions between team members as issues arise with emotions, behavior and communication

  32. Alan Cashmore Centre Team Approach to Assessment

  33. Looking at the Whole Child COLLABORATION TO GAIN UNDERSTANDING

  34. General Principals of Assessment • In the context of Therapeutic Observation Finding out what the problem is from all perspectives ( parent, child, professionals involved) This ongoing process guides what we do in the interactions called therapy.

  35. Team Approach to Assessment Our unit works as a team I.e: a flattened pyramid of multidisciplined professionals Shared information Intervention must fit the therapist and the family. The decisions are team determined. We form a “mini- team.”

  36. Assessment to Goal Setting with the Family Involves the family and mini-team getting to know one another and the issues. Evolves with time and degree of success. Goals are like “wishes for the family” Goals are reviewed in meetings, conferences several times a year.

  37. Advocacy into Community and School System Children come from the community and go on to the community. We help to bridge understanding to the community of the whole child. Knowledge of resources and advocacy skills are needed to ensure family is supported as they move on from our service. Follow up outreach within the age of 7 often required.

  38. CASE STUDY “N” • 3.4 year old boy • Aggression toward brother • Parents concerned with lack of empathy • Hyper- lexic • Referred by Speech Pathologist in community

  39. The Morning Therapeutic Group

  40. OBSERVATION • Observing child is an ongoing process. ADAPTIVE FUNCTIONING At home ( initial visit with CCC) fit? In program: how they organize themselves in tasks, do they stay on task? response to limits ( testing, ignoring, or negotiating?) transitions, routines ( N. would fall apart)

  41. EMOTIONAL • Development of relationship is key • Response to stress (i.e: Leaving parent) • Reactions to changes in environment ( easily overwhelmed) PHYSICAL • Gross motor, fine motor (anxiety during art) • Sensory Integration needs

  42. COGNITIVE Exploration of materials School readiness Understanding other’s perspective • SOCIAL Choses play partners Problem solving skills Sharing needs and ideas

  43. SPEECH/ LANGUAGE • Expressive • Receptive i.e: • Question asking • Processing difficulties • Pragmatics and social communication

  44. COLLABORATION • Meet with Mini Team to discuss observations. • Child Care Counselor, Psychiatrist,Therapist, Speech/ Language Pathologist. Plan, strategize, discuss, wonder… Day Program team meetings and Daily Debrief Example: Mitigated Echolalia with N. dramatic decrease within weeks.

  45. INTERVENTION • On going process of observing and collaborating to find what works. Example: Daily plan to organize ( transitions; attending) Social stories (bedtime; going home; empathy) Visuals for home use “How to Play” booklets In the moment drawing it out Visuals brought meaning to N.’s day, opened opportunities to develop play skills, make sense of social situations, reduced anxiety.

  46. DAILY PLAN

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