Components of CET
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
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.
Beyond CET
Customizing Implementation
Kelly Dunlap, Psy.S.
Stephanie Dyer, Ed. S.
Implementation = Herding Cats
CET = Standardize the Process
Beyond CET = Customize the Implementation
• Factors in Customization
– Players
– ISD / District Structure
– Competency of Staff in ASD Evaluation
– Political / Cultural Variables
– Buy In / Support
Acronym Deciphering Tool
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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
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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
Current Players at the Table
Special Education
AIB
Private Insurance
Medicaid / MIChild
Criteria
ASD / MARSE
ASD =DSM disorders of
autistic disorder,
Asperger’s or PDD-NOS
ASD =DSM disorders of
autistic disorder,
Asperger’s or PDD-NOS
Plan for Evaluation
REED/30-day timeline
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Who Evaluates
MET
Licensed psych or physician
CMHP
Using What Tools
Prescriptive for Child
/ Purpose
“autism diagnostic
observation schedule”
(e.g. ADOS-2)
Must include ADOS-2
Developmental Family
History (e.g. ADI-R)
Determination of
Impairment /
Diagnosis
IFSP / IEP Team
Determines
Impairment
Diagnosis of Condition
Diagnosis of Condition
Eligibility for
Services
IFSP / IEP Team
Treatment prescribed or
ordered by evaluator
CMHP + Medicaid Agency
final approval
Service Plan
IFSP / IEP
Treatment Plan developed by
board certified or licensed
provider
IPOS developed through
PCP process
Types of Services
IFSP=Early
Intervention services;
IEP=SE, RS, and SAS
Behavioral Health, Pharmacy,
Psychiatric, Psychological,
Therapeutic
ABA
(EIBI and ABI)
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
Autism Council
SUBCOMITTEES
Early
Intervention
Adult
Services
Workgroups
Screening and
Assessment /
ASD Eligibility
Determination
Education
Resources
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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
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CCRESA Progression & Feedback
“Beyond CET” Training: S. Dyer
Collaborative Conversations:
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C. Lord, B. Ingersoll, S. Pastyrnak, OAISD
AIM (Autism Internet Modules)
http://www.autisminternetmodules.org
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National Association of School Psychologists
National Research Council
National Research Council
“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.”
So, where do we start?
3 Steps:
1. Ensure high quality special education
eligibility evaluations….
(Clean up our own backyard!)
2. Utilize “Gap Analysis”: What additional
information do schools need, when given
an outside evaluation, to address special
education ASD eligibility?
3. Move toward true collaborative evaluation
Improve Quality
of ASD Evaluations
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:
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Pervasive
Marked
Qualitative
Adverse Impact
High Quality Evaluation
• ASD Evaluation Process
 Key Components
 Evaluation Methods & Tools
• ASD Eligibility Criteria
 Rule 340.1715
 Deep Understanding
• Other Considerations /
Individual Challenges
TEAM TEAM
TEAM TEAM
Evaluations are
conducted as a
team!
☺ Collaboration
☺ One voice
☺ One contact
☺ One report
Minimum:
Psych, SSW, SLP…
Collaborative Team Approach
CET
Components
Selected
4 Critical Components
1. Evaluation Checklist Meeting
2. Evaluation Components
3. Results Review Meetings
4. Team Report
KEY COMPONENT #1
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
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
KEY COMPONENT #2
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
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?
Technical Adequacy
• Sample
• Reliability
• Validity
• EXAMPLE: ADOS-2:
• Test / Re-test Reliability—2 Weeks:
• Classification changed for 9 of the 39
children (23%)
Assessment Tools
Central 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
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
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
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
Understanding Behavior
Positive 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
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.
• 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.
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.
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.
KEY COMPONENT #3
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)
Data Analysis?
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”
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
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:
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Transition (task to task and place to place)
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Group participation
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Direction following
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Self care
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Interactions with peers
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Outside play
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Inside play with free choice time
•
Spontaneous conversation
KEY COMPONENT #4
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!
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.)
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.
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,
QUICK CHECK:
ASD is characterized by:
qualitative impairments in
_____________________,
qualitative impairments in
____________________,
and
____________________.
The Triad of ASD:
Qualitative Pervasive Characteristics of ASD
DEEP UNDERSTANDING
• Social Skills -- Reciprocity
• Communication
• Restrictive, Repetitive, and
Stereotyped behaviors:
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–
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Insistence on Sameness
Idiosyncratic Behavior
Imposition on Environment
Eval Team Practice
Other Considerations
• Eligibility before age 8
• Re-evaluations
• Others
Gap Analysis
What needs to be done when an outside
evaluation is provided?
Considerations
• We still have obligation to address MARSE
eligibility criteria (ex: ADHD)
• What do we know from what they provided?
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Diagnostic information/rating scale scores
Developmental history
ADOS score
• What do we still need to know?

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What does child look like across settings?
Impact on social, behavioral, academic
Additional parent/teacher info specific to triad
Communicate with evaluator
Proceed with Process
• Checklist Meeting
• Evaluation Components (completion
of identified “what we still need to
know” items)
• Results Review Meeting
• Team Report
What if there is disagreement?
(e.g. one says “yes” and one says “no”)
• Remember, different purposes (diagnosis
versus special education eligibility and IEP
development)
• Adherence to strong evaluation process, report
is defendable
• Commitment to communication
• Make sure to meet student needs
 Implementation of Universal Supports
 Use of SW-PBIS practices
ONCE ELIGIBILITY IS DETERMINED—
IMPACT OF NEW PLAYERS
ON THE IEP PROCESS
CHALLENGES & SOLUTIONS
Challenges & Solutions
• Expect Requests for School Observation
– Context of the Request:
• Part of AIB evaluation to develop a treatment plan / IPOS
• To identify potential generalization opportunities
• To monitor progress
• Potential Challenges:
– Moves from observer to participant (e.g. intrusion into the instructional
process for the individual child or the whole classroom)
– Liability Issues
• Administrative Considerations to Remember:
– Requests should be processed per the school visitation policy
– Observers need to be cognizant of privacy rights of other children and
remember that this is an observation of the child, not the teacher!
– Observers are non-participants
IEP Challenges & Solutions
• Expect more input on PLAAFP & Goals:
– Remember---PURPOSE of the IEP: Determine impact
of ASD on access and progress in general education
– Behavioral Health Treatment Plan / IPOS may focus
on developing discrete skills identified from an
alternative curriculum or ABLLS-R / VB-MAPP
– COLLABORATE; COLLABORATE; COLLABORATE
• Where there is agreement, embed in the IEP
• Where these is disagreement, focus on the PURPOSE of the
IEP
What is FAPE?
IDEA 2004
An educational program that is individualized to a specific
child, designed to meet that child's unique needs,
provides access to the general curriculum, meets the
grade-level standards established by the state, and
from which the child receives educational benefit. 20
U.S.C. §1401(9).
Ed Benefit = progress over time (IEP goals, curriculum,
social, communication, behavior, etc.)
To provide FAPE, schools must provide students with an
education that prepares the child for further education,
employment, and independent living. 20 U.S.C.
§1400(c)(5)(A)(i)
Defining LRE: Fed Language
“To the maximum extent appropriate,
children with disabilities…. are educated
in the general education classroom with
children who are not disabled…”
….and that special classes, separate
schooling, or other removal of children
with disabilities from regular education
environment occurs only if the nature or
severity of the disability is such that
education in regular classes with the
use of supplementary aides and services
cannot be achieved satisfactorily.”
IEP Challenges & Solutions
• Expect more input on Programs / Services:
– The IEP must always offer FAPE in the LRE
– Methodology Request
• All requests MUST be “considered”
• Generally, methodology is at the discretion of the special
education service provider
• Determine if the methodology is needed for the child to
receive FAPE
– AIB services may supplement but not supplant FAPE
• MSA: “These supports may serve to reinforce skills or lessons
taught in school, therapy or other settings, but are not intended to
supplant services provided in the school or other settings or to be
provided when the child would typically be in school but for the
parent’s choice to home-school the child.”
--MSA Bulletin 13-09
Request for Push-in AIB Services
Parent / Therapists’
Reasons
Special/General Education
Issues Raised
•
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•
•
Parent’s inability to get
the child to the outside
therapist’s location;
Desire on the part of the
therapist to generalize
skills learned in 1:1
treatment / intervention;
Push in therapist could
build capacity of school
staff and save $ on 1:1
parapro
•
IDEA / MMSEA/Gen Ed
Considerations
1:1 Therapy (EIBI) = defacto
request for a reduced school
day (geography issue:
classroom is therapist’s office)
•
District’s obligation is to provide
FAPE in the LRE (can’t bargain
away FAPE or LRE);
•
Reduced school day would rarely
constitute FAPE;
ABI—supporting
generalization of skills /
capacity-building:
•
Services included IN the IEP
should be limited to those needed
for FAPE.
•
Liability issues / Who monitors
implementation of the portions of
the IEP provided by individuals
the district does not supervise?
•
Including AIB
treatment/intervention during
school day risks insurance co.
challenge that district should be
payor. What happens when child
no longer eligible for AIB service
OR state funding of AIB
reimbursement ends?
•
•
Potential labor law
issues (e.g. supervision,
subcontracting of union
work)
Potential FAPE issue
(consider if should be in
the IEP as SAS and if so,
must be provided at no
cost to the parent)
Requests for Pull-Out AIB Services
Parent / Therapists’
Reasons / Request
• Therapist does not
offer after school or
evening hours;
Special / General Education
Issues Raised
• Developing a reduced
day IEP;
• Refusal to develop a
• Request IEP team to
reduced day IEP or write
develop a reduced
the therapy in the IEP
day IEP or write the
may result in potential
AIB therapy in the IEP
truancy issues
so the child will not be
marked absent
• Temptation is to write the
service in the IEP to
avoid truancy issues
IDEA / MMSEA / Gen Ed
Considerations
•
Same as for Push-In AIB
Services
•
IEP Team must offer FAPE: Is
the therapy (e.g. ABA) needed
for FAPE? Or methodology that
is generally left to the discretion
of the district if the student is
progressing?
•
Legal Alternatives that parents
may want to explore:
• Home-school
• Register as home-school;
parents provide core
instruction and Ss receive
auxiliary services (ISP),
but not FAPE;
• Register as home school &
explore shared-time for
non-core classes
• Online classes
Move Toward
Collaborative
Evaluations
Purpose of a Collaborative Approach
• Current Changes (e.g. AIB, Autism State Plan)
• Eliminate Redundancy
• Ensure Families are Provided Resources /
Contacts
• Treatments
• Services
Challenges
• Ethical Issues
– Report sign-off and letterhead
– Quality/ethical guidelines
• “Turf Issues”
 Who’s the lead?
 Private vs. public issues
• In-house Team Issues
– MET teams
• Limited guidance in literature
• TIME
Conversations with
Collaborative Partners
1. What are those common pieces that both
groups need?
2. What about mutual releases of
information?
3. Invitation of collaborative partner to
REED or evaluation checklist meeting?
How can different players be at each
other’s meetings?
4. Respecting professional expertise
5. How many different people does the child
see during the evaluation process?
6. What happens when parents get
conflicting information?
7. What pieces are sensitive?
•
•
•
Cognitive information
Reporting only ADOS score
Recommendations out of context
SUMMARY
1. “Clean up our own backyard”: Improve
quality of ASD evaluations
2. Understand “Gap Analysis”: What is it that
schools need to address ASD eligibility when
given an outside evaluation?
3. Move toward a true collaborative evaluation
Don’t let the barriers paralyze you…
Next Steps
• Brainstorming with team
• Brainstorming with other ISD teams
• Talk with neighboring ISD/Districts or your
Regional Collaborative Network (RCN)
• Email Dave, Kelly, Maureen, or Stephanie
• Access START’s formal Technical
Assistance Process (in development)