Chapter 7

A Team Approach to Assessment and Planning

7.1 Myths and Misconceptions
7.2 Working with Other Professionals
7.3 Personnel Available at School and School Board Level
7.4 Other Related Professionals
7.5 Things to Remember When Accessing Help
7.6 A Team Approach to Assessment and Planning

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7.1 - Myths and Misconceptions

Myth:	Most professionals given their training will be effective collaborators.
Fact:	While being consultative/collaborative may be a strength for some, utilizing these skills in a school team setting may often require a certain amount of training and or practice. Coming to a consensus, dealing with resistance, and maintaining focus in a group setting can be complex skills and often require that individuals explore and practice effective consultation techniques.

Myth:

If team members are agreeing with you then the meeting is successful.

Fact:

While it may be true that agreement is just what it seems, it is also just as likely that agreement can be a form of resistance. Agreeing with a suggestion or a statement without further discussion can be an indication that the person agreeing is in fact trying to end the meeting. Resistance comes in many forms, such as humour, silence, confrontation, as well as consensus. Recognizing and dealing with resistance is a crucial skill in successful consultation/collaboration.

Myth:	The medical community will be able to provide information on how to implement a program.
Fact:	The medical community may be able to assist with a description of the impairments experienced by a student with an ABI. In some rehabilitation centres, specially trained resource teachers will be available to assist, but for the most part, it will be left to educators and the school team to discover the strategies that will be needed to cope with those impairments.

Myth:	Serious physical impairments are always noted in the Ontario Student Record.
Fact:	While most serious physical impairments are noted on the Health Record found in the OSR, ABI is often the exception, either because it is never medically diagnosed or because the impairments connected with an ABI are not immediately apparent.

7.2 - Working With Other Professionals

The Team Approach

The team approach in special education is by far the most common and effective way of dealing with the diverse needs of students with exceptionalities. In the case of students with acquired brain injury, the members of the team may include a number of personnel not normally utilized in a school setting. In those cases where a student has required intervention at the hospital and rehabilitation level, those professionals generally associated with a medical model of service delivery will be involved in developing a plan for the student.

Within the Ministry of Education guidelines for the development of an individual educational plan, the utilization of a team approach in addressing the concerns of a student with an exceptionality is clearly delineated. It is essential that professionals, parents, and where appropriate, the students themselves be given an opportunity to share information and work together in formulating a plan. It is not always possible or perhaps even preferable to have all those involved in the same room for each team meeting. Involvement in a team meeting may, for some, take the form of a written report submitted ahead of time or information passed on at another time. Because of this, it is important that one person take on the role of coordinating the report and informing all parties of pertinent information. This role is generally, at the school level, performed by a special education teacher and overseen by the principal.

As is often the case, members of any team come to the table with a variety of views, differing amounts of information, and perhaps, differing opinions on what the end goal of the meeting might be. While it is very common that all members share the goal of improving the school life of a student, how to reach this goal may be a basis for some lively discussion. Health professionals may focus on the physical rehabilitation aspects of treatment, educators may be more concerned with curricular concerns, and parents or the students themselves may be more concerned with effect in terms of reestablishing friendships and feeling comfortable in school.

For team meetings to be successful a relationship of trust must be established that allows all the participants to voice their concerns and suggestions for programming. It is essential that team members decide on goals that are mutually acceptable to each other, communicate those goals, and share responsibility in attaining them.

Perhaps the most important element of a successful team is the commitment of the school administrator to ensure that the team process proceeds smoothly. Professionals agree that for an in-school team to be successful, the following considerations must be addressed.

In-school teams must:

• Meet regularly
• Have and follow an agenda
• Have a meeting place that is not open to constant interruption (such as the staff room)
• Have regular members, which includes an administrator
• Review documentation and information prior to the meeting
• Keep appropriate documentation
• Have a focus on problem-solving
• Recognize the personal and professional assets of team members.

7.3 - Personnel Available at School and School Board Level

Professional	Role	How to access
Learning resource teacher	Individualized support for students Liaison between team members Resource support for classroom teachers	Available in most schools Can see students informally Is required to oversee any identified students with exceptionalities
Psychologist	Cognitive assessment Behavioural assessment Recommendations for programming	Generally referred through learning resource teacher and central office staff
Educational assistants	Implementation of program in coordination with educator Individualized support for student	Additional funding through special education budget Can be tied directly to IEP claim
Counsellors	Varies from school to school and school board to school board Generally responsible for providing individual counselling to students Career counselling to older students	Referral though school or can be accessed through parent referral
Speech and language pathologists	Language and speech assessment and programming Augmentative/alternative communication services Goal is the development of effective communication system	Referral from school or physician Can continue from preschool
Physiotherapist	Assessment and program planning Provision of specialized equipment Consultation on exercises, sitting postures, muscle control Goal is motoric independence	Referral from physician or specialized setting
Occupational therapist	Assessment and program planning Development of a range of fine/gross motor skills with a focus on independence (e.g., drinking from a cup) Recommendations for activities at school and at home Goal is to enhance student's independence	Referral from physician or specialized setting
Outreach teacher from ABI rehabilitation facility	Provides ABI specific knowledge on strategies specific to a particular student Will act as ongoing resource to school team	Parents may make referral Teachers may contact with permission of parents
Local community brain injury associations	Offers excellent background information on needs of students with ABI	Anyone may call

7.4 - Other Related Professionals

Professional	Role	How to access
Neuropsychologist	Follow-up Cognitive, psychological, neuropsychological, behavioural assessment Collaborative programming	Referral from family physican, school, insurer, or self.
Neurologist	Neuropsychological assessment	Referral from family physician
Pediatrician	Developmental and medical assessment	Referral from family physician
Psychiatrist	Medical management of neuroleptics and psychiatric presentations	Referral from family physician
Insurance people	Access to funding support	Depends on relevant policy (automobile, health)
Case Manager	Manage and coordinate services	Depends on severity classification
Public Health Nurse	Dealing with public health concerns of development, safety, and general medical nature	Through local regional services

7.5 - Things to Remember When Accessing Help

• It is essential that one person coordinate the efforts of the team.
• There will be varying levels of knowledge among parents and professionals.
• Different stages of recovery/rehabilitation will require the involvement of different members of the team.
• The process will be more complex because of the possibility of dealing with varying ministries (health) as well as private organizations (insurance).

7.6 - A Team Approach to Assessment

An effective assessment incorporates a variety of sources to build a complete picture of a student’s capabilities. It is only when this complete picture is examined, that members of a team can begin to program effectively for students with ABI.

Assessment information should come from a variety of sources including:

• Parents
• Educators
• Medical personnel
• Other related professionals
• And, where appropriate, the students themselves.

Information collected from only one source will reveal only a partial understanding of the nature of the student’s capabilities and thus prove ineffective for programming.

The importance of teacher observation

In special education in general, and certainly in the case of ABI where terminology and medical overtones may serve to intimidate, there may tend to be an overreliance on standardized assessment measures. It is because of the complexity of the condition that something as seemingly simple as “teacher observation” may appear unimportant in the overall assessment process. Nothing could be further from the truth. Frontline educators have a unique opportunity to observe students over prolonged periods of time both as individuals and within a group setting. In the case of ABI it is likely that an educator may be the best source of information with regard to pre-injury performance and thus be in a position to make some comparisons. Working collaboratively with the in-school team and the parents, important data that can lead to effective programming can be collected just through watching!

Tips for good observation

• Keep notes
• Observe within a variety of settings (working independently, within a group)
• Observe across subject areas
• Do not forget the social aspects of education
• Be aware of time (is the student more fatigued in the morning?)
• Be aware of any bias you may have in observing
• Enlist the viewpoints of others.

Why is a neurological assessment necessary?

Neuropsychological information measured, utilizing standardized types of formal assessment, can be extremely useful in the development of an effective program only if combined with additional information provided by educators. Information provided by educators may consist of observational data, samples of the student’s work, information about pre-injury performance as well as information about classroom structure, the availability of differentiated learning environments, and personnel. No information is useful in isolation. If, for example, an assessment yields the result that auditory memory is severely impaired, then a team approach can establish first whether this information is compatible with the observations of the educators involved, and secondly, how to best accommodate the learning needs given the constraints of the student’s educational environment.

Brain injury can affect a student’s performance along a large spectrum of functioning. Because the brain is multidepartmental the location of injury is very important in terms if how it affects functioning. Cognitive/ neuropsychological assessment can assist in differentiating areas of deficit that may affect performance and thus provide valuable information for programming.

While traditional achievement tests and intelligence tests play a role in assessing a student with an ABI, it must be remembered that they will, by and large, be measuring pre-injury learning and not the post-injury ability to learn. Therefore, it is most important that specialized tests to measure current specific cognitive function be used.

Why is a neurological assessment important?

For students with an ABI, an assessment which focuses solely on an examination of their academic and social achievement in comparison to their peers or curriculum expectations alone will not provide the necessary information to develop an effective program. For these students, assessment must focus on their current cognitive (memory, problem-solving ability, spatial awareness, etc.) functioning as it relates to academic and social settings. When assessment fails to take into account “how the student thinks” there can be a continued decline in the student’s performance postinjury. This decline may appear to be a continued effect of the student’s injury, while in reality, continued decline presents in a very small percentage of individuals who have sustained an ABI. It is far more likely that a student with an ABI, who is failing to learn, may be doing so as a result of a mismatch between factors such as the learning environment, pace of instruction, mode of delivery, and the underlying cognitive limitations and strengths of the student. For example, a child who, as a result of the injury, needs to be presented with new material in a visual way, will fail to learn in a class that relies heavily on auditory instruction.

Understanding that some cognitive skills (e.g., flexible attention-shifting, organization, modality of learning, processing speed) have been altered or diminished, can assist the educator in developing a program that will allow the student to avoid academic frustration and learn more effectively. With an awareness of cognitive strengths, programming can be adjusted to meet the needs of students with ABI. Accommodations as simple as providing information through the student’s modality strength (e.g., auditory), providing the student with explicit stepwise organization to a task and slowing down can dramatically affect the student’s ability to learn new material successfully.

Who initiates a neurological assessment?

A neurological assessment may be initiated by a medical doctor, an insurance company, a lawyer, or a case manager at a rehabilitation facility. Within a school setting, if an assessment has not been done upon return to school, a special education teacher may initiate testing through contact with the school board special education staff. Often, only a portion of the testing needed can be done at the school level. In many cases tests such as those that measure intellectual functioning in terms of IQ as well as achievement assessments may be administered through school board personnel. Where more sophisticated testing is required, a neuropsychologist will be required.

When is a neurological assessment done?

In the case of ABI, there may not be any preexisting information other than that which is normally acquired throughout a student’s schooling. Copies of report cards, group-administered assessments, and screenings at the preschool level are generally accumulated throughout a student’s school career. While these types of information will be helpful in developing a complete picture of the student’s past functioning it should be noted that a student’s ability to acquire, retain, and utilize new learning may be dramatically altered as a result of the brain injury.

In the case of a student who has experienced an ABI, assessment is not recommended for students immediately following the injury. Often physical complications, along with a rapid recovery period may render assessment results unreliable. Students may also be restless, agitated, fatigued, and confused during this time. Only when a student has stabilized and is able to focus for periods of time is an assessment recommended. This is generally around the 6-month mark. As recovery can last for up to 2 years, follow-up assessments at regular intervals are essential to fine-tune and adapt instruction to meet the student’s changing needs.

Types of tests used in neuropsychological testing

In addition to traditional testing tools such as IQ testing (e.g., WISC-III) and tests of academic achievement (e.g., WIAT), assessment in the case of a student with ABI will most likely include tests of:

• individual cognitive skills such as memory (CMS),
• verbal learning (CVLT-C),
• executive/organization, and planning skills (CCT),
• overall neuropsychological development function (e.g., visual attention, planning, problem-solving, phonological processing, processing speed, comprehension, visuomotor precision, and auditory memory [NEPSY]).
  
  
  (See Appendix 9-2 for information on specific tests.)

Who is responsible for assessing a student with ABI?

When a student returns to school having sustained an ABI, assuming that the child had not been identified as exceptional in another capacity, there may be very little testing done beyond that which is normally completed on students at a particular grade level.

Psychological testing, such as the establishment of an IQ score, as well as examinations of other types of cognitive functioning will be completed by a psychologist.

A good neuropsychological assessment should clearly define a student’s cognitive strengths and weaknesses. Using this information, combined with the ongoing observations by the educators, the special education personnel, in cooperation with the neuropsychologist (and perhaps special education personnel from an ABI rehabilitation facility) team members, will be able to develop and implement effective programming strategies. It should be expected that the developmenet of effective learning strategies will require ongoing observations and modifications of the student’s success. This is particularly true for a student with an ABI due to the changes that occur as a result of recovery.

What to do with the results of an assessment

The intent of a good assessment is to provide information about the child’s current level of cognitive functioning. It should provide a clear profile of the student’s strengths and weaknesses across a number of cognitive skills. It should also provide examples of how the student presents with his/her apparent strengths and weaknesses in the context of his/her learning environment. With this information, educators should be able to articulate specific strategies and accommodations in teaching style and material exposure that will enhance the child’s abilities and de-emphasize and/or compensate for the inabilities.

What can the teacher do to assess the possibility that s/he has a child with an ABI in the classroom?

You may have a child who has sustained an ABI if s/he experiences any, but typically combinations, of the following:

• Attention Difficulties: Students experience trouble sustaining attention for prolonged periods of time; or they cannot perform two tasks at once (take notes and listen to the teacher). Often they are better with visual and written material than with oral and auditory material since they can review and re-attend to the written material at their own leisure, but once the auditory information has been given, it is gone.
• Slowed Rate of Processing: Students will almost invariably be slower to intake and process information, and will be slower to respond (verbally, physically) than their cohorts.
• Memory Failure: Students will have long-term, substantial learning and memory difficulties in terms of encoding the information, storing it for permanent later access, and retrieving the information at a later time. They are more successful at recognizing previously experienced material than they are at recollecting it.
• Executive Function: Students typically will have difficulty with the skills that allow one to monitor and manage one’s knowledge base (e.g., organize information, sequence and prioritize information, plan ahead, anticipate outcomes, shift topics/ thoughts, think abstractly, make sound, informed judgments). These difficulties become more obvious in older children since the demands for these sophisticated skills are more apparent as one progresses through the academic system.

So, ask yourself:
Is the student able to:

• Concentrate? How long?
• Mentally manipulate information (e.g., do math in his/her head?)
• Do two things at once (e.g., write notes, and listen to instruction simultaneously?)
• Concentrate on visual versus oral information?

Is the student:

• Accurate, but slow to respond or complete things?
• Accurate when there are no time limitations (e.g., times versus untimed test?)

Does the student:

• Have difficulty in retaining new information?
• Improve with context information for learning?
• Increase learning with repetition?

Does the student:

• Have problems prioritizing, organizing, and/or sequencing information and are these corrected when an organization plan is provided to him/her?
• Have difficulty in following through a commitment?
• Have difficulty shifting “cognitive set”/thoughts/ approach when the task demands, environment, or situations have changed?

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