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Evaluating the Educational Needs of
Children with Mental Health Conditions
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When Might an Educational Evaluation Be Necessary?
For a number of reasons, students with mental health conditions are more
likely than their peers to encounter academic, social, or emotional problems
at school. Mental health conditions that affect mood, thinking, interactions
with peers, and physical and emotional arousal levels may also interfere
with a student’s ability to focus on learning. A range of other
factors can interfere with learning and behavior as well, including co-existing
vulnerabilities (such as hypersensitivity to noise), learning disabilities,
stresses in the student’s life, or side effects from medications.
In some cases teachers can fairly easily help a student
who is struggling in class, by changing seating assignments,
providing pointers on effective study skills, offering
alternative ways to carry out projects, or using a variety
of instructional approaches to engage the many types of
learners in the classroom. Strategies such as these are
outlined by each school district in a document known as a
District Service Plan (DSP) or District
Curriculum Accommodation Plan (DCAP). Teachers
are encouraged to try these approaches for any student
and to consult designated specialists within the district
who may be able to offer assistance. No formal process
is required, nor does a student need to have a specific
disability to “qualify” for these accommodations.
If a classroom teacher finds effective ways to help a
student, it may not be necessary to investigate further.
However, if a student experiences significant academic,
social, or emotional difficulties that interfere with learning
and that the classroom teacher has not been able to resolve,
it is usually a good idea (although not required) for the
family and school to meet for preliminary (“pre-referral”)
discussions. This meeting may be the first step toward
an educational evaluation, which entails a carefully defined
process for schools, parents, and clinicians to work together
to identify and address students’ educational needs. top
Why Have a Pre-Referral Meeting?
Before any official evaluation begins, either the family
or the school can initiate a pre-referral meeting to share
observations and ideas.
A pre-referral meeting offers a number of possible benefits:
- It is important for the family to understand what the
school is observing about the child’s difficulties
in school. Likewise, it is important for the school to
understand what the family is observing at home and to
hear how, or if, the student describes these difficulties
to family members. A shared understanding of the child’s
overall situation helps frame the issues to be looked
at during the educational evaluation process.
- Because teachers work with many students, they may
have encountered and successfully handled similar problems
before. They can be helpful allies in managing a student’s
difficulties, and may be able to provide some simple,
rapid interventions that make an immediate difference
for the student.
- Parents can be helpful allies to teachers by recommending
strategies and approaches that are effective at home
and that may also prove helpful in the classroom.
- The early establishment of effective communication
and mutual understanding between the family and the school
serves the long-term best interests of the student, the
family, and the school. If the student does have a disability,
the family and school may need to work together over
many years.
- After an evaluation is performed, meetings involve
many participants and analysis of complex data. However,
pre-referral meetings often have a less formal and less
technical quality, involving fewer people than meetings
that occur later in the process. The more relaxed atmosphere
of a pre-referral meeting may be more conducive to building
trust and a collaborative relationship between family
and school.
If the student’s challenges continue to interfere
with learning after the parents and school have met, an
Initial Educational Evaluation to determine eligibility
for special education is recommended. Schools cannot deliver
special education services without first going through
this formal assessment, which requires schools to apprise
and involve the family. top
What Is an Initial Educational
Evaluation?
An Initial Educational Evaluation provides comprehensive
data (from standardized testing, observation and teacher
input) to help pinpoint what the student’s problem
areas are and identify ways to help the student. An Initial
Educational Evaluation may (but does not necessarily need
to) include any of the following components:
- Report of classroom functioning (usually by the student’s
teacher)
- Classroom observations by other teachers or special
education staff
- Evaluations by specific school service providers,
such as speech therapists, occupational therapists,
and/or reading specialists
- Academic (also called “achievement”)
testing usually done by a special educator or school
psychologist
- Psychological testing
- Medical evaluations (providing diagnoses and/or treatment
recommendations)
- Student interviews and/or home visits/developmental
history by school social worker or mental health staff
Depending on the number and type of tests required,
the student’s tolerance for testing, and schedules
of the specialists involved, an Initial Educational Evaluation
may take several months to complete. (This may complicate
efforts to meet stipulated timetables for the evaluation
process.) The results are written up in reports that
are discussed in a team meeting by the student’s
family, school staff (educators, special educators, school
psychologists or social workers), and other participants
invited by the family. The tests need to be repeated
at least once every three years in order to determine
a student’s current performance. top
How Does an Initial Educational
Evaluation Get Underway?
The steps required for an educational evaluation are set
out in federal and state laws and regulations. Federal
law establishes the right of all students, including those
with disabilities, to receive a free and appropriate public
education (FAPE). It places the responsibility on the states
for identifying all children with disabilities who would
qualify for special education services. The process is
designed to encourage families, schools, and clinicians
to work together on behalf of the student while protecting
the interests of all parties.
After clarification of any efforts already made by the
school, any parent, teacher, or other school professional
who is concerned about a student’s performance
in school can formally request an Initial Educational
Evaluation for special education eligibility.
Before proceeding with the evaluation, many school districts
require a letter documenting the request for an educational
evaluation. The letter should be brief, should include
the date and the sender’s contact information,
and should convey a collaborative tone. It may include
brief mention of areas of concern.
A sample request letter is provided below:
[date]
Dear [name of Principal or Special Education
Director]:
I am writing to request an Initial Educational
Evaluation to determine whether [name of student,
date of birth], who attends [name of school,
grade level] has a disability, and to determine
whether educational interventions or special
education services may be appropriate. I am
concerned in particular about [student’s
skills in a particular subject or student’s
behavior in certain settings]. Please let me
know how I can best support the educational
evaluation process. I would be happy to provide
any relevant information to help the school
complete this evaluation.
Please call me at [phone number] to respond
to this request, and forward to me at [address]
any documents I need to sign to help the school
begin this process.
Thank you in advance for your attention.
Sincerely,
[name of family member, clinician, or concerned
other] |
To ensure a timely response, it is a good idea to follow
up (by phone or in person) in approximately a week to
10 days to clarify the status of the request.
Since school staff (or other clinicians hired by the
school) will be performing the assessment and delivering
any needed interventions, the school recommends which
specific areas of the student’s functioning need
to be examined. Parents may suggest particular skill
areas for testing and have the right to accept the school’s
recommendations, request additional testing, or reject
the proposal for recommended testing.
Once the request for evaluation is received, a school
district has 10 school days to begin the evaluation process.
No evaluations can be performed without the written permission
of a parent or guardian. Even if the evaluation request
was made in writing by a parent, a consent form for the
evaluation must be signed by a parent or guardian before
any testing can be done as part of this evaluation. top
How Do Clinicians Participate
in the Educational Evaluation Process?
In preparation for a team meeting, and often as part of
the educational evaluation, clinicians may provide a letter
to the school outlining:
- The student’s diagnosis, based on recognized
diagnostic criteria such as the DSM. It is preferable
to omit mention of suspected or rule-out diagnoses,
because including them makes school disability determinations
more difficult.
- The primary symptoms supporting the diagnosis
- How the illness interferes with the student’s
educational progress (including social-emotional development)
- Recommended educational interventions, special services
(such as occupational therapy, speech therapy, etc.),
or specialized instruction (such as specialized reading
instruction for students with dyslexia, or check-ins
with therapeutic staff for students whose anxiety interferes
with educational progress). Recommendations for specific
alternative schools or placements are usually not helpful)
- Side effects from current medications that may interfere
with the student’s normal functioning in school top
What Happens at the Team
Meeting?
Within 45 school days of the request for an evaluation,
the student’s evaluating team should meet to review
the Initial Educational Evaluation assessment reports and
outline next steps. The team includes school staff, the
family, and anyone invited by the family to accompany them.
Because the process can be confusing and overwhelming to
family members, many families find it useful to invite
a trusted clinician, family member, or friend to join the
team meeting. All of the attendees can participate in decisions
about the student’s education.
The team will make one of the following recommendations.
- The student does not have a disability that would require
special education or educational interventions.
- The student has a learning style that requires some
educational interventions to allow the student to succeed
with the school’s curriculum. In such cases, the
school may draw upon strategies and expertise outlined
in its District Service Plan (DSP), or District
Curriculum Accommodation Plan (DCAP), which
is designed to accommodate diverse learning styles within
the regular classroom.
- The student has a disability or handicapping condition
that requires specific interventions or accommodations that
will provide the student with the same access to the
curriculum as non-disabled students. Accommodations often
address physiological challenges (such as vision or hearing
deficits, the need for a wheelchair, etc.) that can interfere
with participation in all the opportunities for learning
offered to other students. The Americans with
Disabilities Act (ADA) protects students with
disabilities against discrimination. A set of accommodations
known as a 504 Plan (because it is derived
from Section 504 of ADA) is drawn up by the team to document
the specific accommodations.
- The student has a disability and is not making effective
progress in school, and requires specialized
instruction or related services from specially
trained staff (such as speech therapists, occupational
therapists, special education teachers, specialized reading
teachers, or counselors). In such cases, the school develops,
with the family, an IEP or Individualized
Educational Program. Students who need specialized
instruction are protected by the Individuals
with Disabilities Education Act (IDEA), which
stipulates the process for developing the IEP. The
IEP should include goals and objectives for the student,
to be achieved through the use of specified accommodations
and modifications (interventions that
either alter the ordinary curriculum expectations, or
require specialized instruction).
If the student is found eligible for accommodations or
special education services, the team will write an official
plan that documents the student’s needs and how the
school will support them. In complex situations that require
many school-related services, a subsequent meeting may
be scheduled to develop or finalize the student’s
IEP. Once a plan is signed by the parent or guardian, it
can be implemented by the school. top
What are the Follow-up Procedures?
If parents do not agree with the team’s findings, they
can request an Independent Educational Assessment, an evaluation
performed by personnel outside of the school system. They
can request that it be done at the school system’s
expense, although conditions may apply.
Parents may ask the evaluation team to reconvene at
any time to discuss their child’s progress. Students
with IEPs receive IEP progress reports at the same frequency
that report cards are received by all students. In most
cases, this occurs approximately every 3 months (quarterly).
IEPs are rewritten on an annual basis (called Annual
Reviews) and re-evaluated (with new testing in the area
of disability) every three years. Typically, schools
will assess the effectiveness of Section 504 plans yearly. top |
Important Points for Families
Many parents may feel intense pressure to “do whatever it takes” to
overcome any perceived obstacles to success in school. It may feel particularly
stressful if your child has shared with you any unhappiness about some
aspect of school, leading you to feel that satisfactory resolution of any
problems in the classroom is essential to your child’s well-being.
Discussing your child’s social, emotional, and learning
problems with a group of people is not easy for most parents,
no matter how supportive the other participants in the
group may be. You may also feel uncomfortable with the
specialized vocabulary, procedures, and regulations that
surround the process of getting a plan in place for your
child.
While it is important to resolve specific challenges facing
your child, the establishment of strong and trusting relationships
with the people working with your child is critical. It
is likely that your child will derive more benefit over
the long term if you work toward fostering a positive relationship
with the school. There are some things you can do to foster
long-term, collaborative alliances with the staff with
your child’s school.
- Try to keep an open mind when approaching
teachers. If your child has told you about
a troubling incident, try to reserve judgment until
you hear what the teacher says about what happened
and how it was handled. You may learn information from
teachers that significantly changes your perception
of the situation.
- Try to find something positive you can share
during the discussion, such as feedback about
a successful school intervention or a positive comment
from your child about a project that was fun.
- Try not to criticize teachers and other school
personnel when talking with your child. As
much as possible, try to offer support to your child
without undermining the adults your child spends time
with every day at school. It is likely that after differences
between your child and any teachers are resolved, you
will want all parties to move on with a positive attitude.
- Become involved in the school community via
committees, volunteering for special events, etc. as
a way to get to know school staff in a more personal
way--as individuals rather than officials or potential
adversaries.
- Be punctual to any school meetings so
that you show respect for teachers’ schedules.
Schools run on very precise schedules because students
need to be supervised at all times.
- Bring a spouse or trusted friend with you to
a school meeting for companionship and comfort, whether
or not he or she actively participates. Just knowing
you have someone at your side who supports you can help “ground” you
and increase the chances you can be composed and at your
best.
- Don’t assume that pre-referral efforts
are a “stalling” strategy. A pre-referral
plan is not an effort for schools to avoid doing appropriate
educational evaluations; its purpose is to allow schools
to respond rapidly with reasonable educational interventions
that can be implemented right away.
- If the Initial Educational Evaluation leads
to recommendations for accommodations derived from
a school’s District Service Plan or District
Curriculum Accommodation Plan, don’t assume such
interventions are inferior to individualized plans. If
the formal assessment does not find the student has
a disability, a 504 Plan or an IEP cannot be developed.
However, even without a formal individualized plan
to accommodate a specific disability, teachers can
in fact make many useful accommodations within a regular
classroom.
- Don’t assume that a 504 Plan is inferior
to (“a runner up prize” for) an IEP. Schools
are required to provide a basic floor of educational
opportunity for each student in the “least restrictive
environment” for a student. A 504 plan may be
the most appropriate way to meet one child’s
needs, whereas another child might benefit more from
an IEP.
- Consider allowing the school to start with
interventions that have been successfully implemented
by school staff in other cases. Familiarity
with the interventions will help the staff to implement
them successfully, and accurately measure their impact.
If a child’s disability is new to the school,
the staff will need to be educated to understand the
disability and to successfully implement appropriate
interventions, provide at least one copy of concise materials
that explain the nature of the disability.
- Don’t measure your success in team meetings
by the number of services or interventions you obtain
from the school. A few services or interventions
effectively implemented may benefit the student more
than many interventions poorly implemented.
- Consider notifying and meeting individually
with the Special Education Director if you do not feel
the team process is working effectively. This
step may expedite the process.
- Consider hiring a professional, such as an
educational consultant or an advocate, if
you feel the educational evaluation process and its
complex rules and procedures are too overwhelming,
or if meeting with the Special Education Director is
not productive. Another reason to bring in professional
assistance from outside the school system is that if
there is disagreement with the school, that professional
will take the lead in presenting your position—leaving
you with a less adversarial role.
- Once you have reached agreement on a plan,
don’t hold up required paperwork. Families
sometimes fear signing an IEP or any other school documents,
believing that the unsigned document provides them
additional leverage. An IEP, 504 Plan, or other educational
plan can be amended at any time at the request of the
family (or the school).
Despite a family’s best efforts to work with the
school, sometimes a child does not benefit from the services
provided by the school. Families are not required to “settle” for
whatever the school decides is appropriate. If a family
disagrees with the findings of the educational team, or
if a child does not progress, a family may request an independent
evaluation, or contact the State Department of Education
to identify legal options. Schools are required to provide
families with documentation that explains parental rights. top |
Important Points for School Staff
Families whose children are struggling with mental health issues are profoundly
affected by their children’s troubles and may want schools to do
whatever might possibly help their children. Parents are commonly coping
not only with the child’s problems at school, but with the impact
of the child’s behavior on siblings and family relationships.
Further, families are rarely equipped to navigate the
process of obtaining modified classroom instruction for
their children. In addition to coping with the daily stresses
of raising a child experiencing problems in school, they
are usually not familiar with the process of evaluation
or the learning strategies teachers typically use. However,
they may be extremely helpful partners with school staff
by supplying insights about the child, key information
about the child’s condition and interventions that
are effective at home, and by reinforcing strategies at
home that are effective at school.
There are some things you can do to foster long-term,
collaborative alliances with the family:
- Keep in mind that children may behave very
differently (worse or better) at home than at school.
Parents may have a very different perception and understanding
of the child’s situation than the school staff.
Remarks such as, “but he has no problem with
that here,” may be perceived by parents
as judgmental, since it is not uncommon for children
to conduct themselves differently in different settings.
- Don’t assume that a student’s difficulties
in the classroom are caused by a mental health condition
or by the medications used to treat it. A
mental health condition, particularly if it is severe,
may mask other problems, such as learning disorders.
A student who becomes upset in class may be overwhelmed
because of an undiagnosed learning problem that makes
it hard to do the required work. In students with mental
health conditions, the stress caused by an untreated
learning disorder may exacerbate the mental health
condition.
- Be willing to consider interventions that the
family proposes, even if the interventions
are not commonly used in the school district. Aware
of schools’ resource constraints, families often
are skeptical that schools will make the necessary
efforts on behalf of a child identified as “disabled.” The
family may be consulting books or web sites to identify “cutting
edge” or alternative interventions for their
child’s disability. While these interventions
may not be customary for the school district, the school’s
willingness to consider them fosters trust and can
improve collaboration with the family.
- Be willing to make changes if the agreed-upon
interventions do not achieve the desired results within
a reasonable period of time. The bottom line
on any intervention is whether it works. Measurement
of the effectiveness of interventions can ally families,
clinicians, and schools. If proposed interventions
fail, “cherishing the defect” to clarify
how the intervention should be modified (or even replaced)
further diminishes conflicts and encourages collaboration.
- Involve the student’s clinician in the
work of the team at school, or incorporate the clinician’s
findings and recommendations into the plan for the
student’s education. When a school minimizes
the magnitude of a student’s disability, this
can conflict with the way physicians recognize and
treat patients, and may impede collaboration. Efforts
to identify how certain interventions can be enacted
at the school, and how the interventions will be modified
or augmented if the student’s condition does
not improve, are more likely to enhance partnering
with clinicians.
- Ask the family for advice on the most effective
method of contacting the student’s clinicians.
Clinicians are often extremely busy with patients,
and must “triage” interactions with all
others. They may be extremely difficult for you to
reach. Suggest that the family alert clinicians that
their child’s school will be attempting to be
in contact. Even “unilateral” efforts to
send information to a clinician (rating scales, classroom
observations, etc.) often benefit students. Clinicians
vary in their familiarity with educating students with
disabilities.
- Be aware that team meetings can be overwhelming
to families, both because of the unfamiliar
language, procedures and regulations, and because the
family is usually outnumbered by the school staff.
This experience for families can be distressing, and
parents or guardians may not always be at their best
during team meetings. An empathic smile, an acknowledgment
of how difficult the process is for families (“I
know this process can be overwhelming”), or a
kind word (“this may be difficult, but we’ll
work together to get through it; we all want what’s
best for your child”) can go a long way toward
building mutual trust with the family.
- When talking with a student’s family,
don’t make comparisons between the services that
student receives and the services provided to other
students with similar needs. While you may
have been through the educational evaluation process
a number of times on behalf of many different students,
a family may be going through it for the first time,
and their focus is on a single student – their
child. A family who feels their child’s needs
are not being met is unlikely to welcome comparisons
to other students. top
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Important Points for Clinicians
Clinicians can significantly influence the way a student’s needs
are perceived and accommodated by school staff. Although clinician recommendations
are an important part of the educational evaluation, the school is not
required to accept or implement any recommendations or suggestions from
clinicians. The school does not have to accept findings from an independent
evaluation, either, even if the evaluation is paid for by the school. To
maximize the impact of your input to the team, consider the following points:
- Identify school staff who understand the student’s
difficulties, who are receptive to attempting different strategies,
and who work effectively with other school staff. The identification
of helpful school staff and, conversely, staff unlikely to recognize,
implement, and monitor appropriate interventions, often allows a
clinician to determine the probability that an existing school placement
will succeed. The most effective way for a clinician to gather this
information is to attend the school’s team meetings. Since
this is not always feasible, phone contacts with staff, or observations
from family members can be very helpful.
- Allow the student’s family to review a report prior
to submitting it to the school, to ensure that information
relevant to clinicians but not to the school is omitted (for example,
family history of mental illness). However, school staffs dislikes
receiving reports with information “blacked out” since
it suggests they are receiving an incomplete description of the student.
An abbreviated report or letter is preferable to a report with information
marked out.
- Inform the school staff of any significant clinical changes
in the student. When appropriate permission is granted by
the family, clinicians’ input to the school on a student’s
clinical changes enhances team collaboration and is usually appreciated
by school staff.
- Avoid recommending a specific alternative school or particular
place where services should be delivered, since
schools often already have arrangements or contracts with alternative
schools or programs. If the clinician thinks a certain school would
be a good fit for a particular child, a description of the services
that make that school attractive should be provided.
- Clinicians can recommend that a parent seek an independent
evaluation if they perceive that the school educational
evaluation is inaccurate or incomplete.
- With permission of the family, contact the case manager or
lead teacher to discern whether the team is making reasonable efforts
to implement the child’s education plan. If it appears the
team is not implementing the plan devised, it may be useful to contact
the Special Education Director in writing. Indicate
how the student’s disability is not being addressed in a satisfactory
way by the school. Such letters also document the good faith efforts
of clinicians to collaborate with a school system should the appeal
process become necessary.
- Encourage the family to contact their State Department of
Education to identify legal options, if the student is not
being adequately served by the school district, and if interactions
with the school (by letters or phone) do not suggest a satisfactory
resolution. top
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