Download Identification and Management of Children at Risk

Identification & Management of
Children at Risk
Presented by:
Dr. Nanolla Yazdani, School Psychologist
A. Goal
B. Understanding of emotionally
disturbed child
C. Identification of Emotional
Disability
D. Management of emotionally disturbed
child
E. Treatment
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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In-depth understanding, identifying, and
managing, Children with Emotional
Disabilities
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1. Reports from Bazelon Center for Mental
Health, Washington DC.
2. Comparison of identification rate, IDEA, 2004
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Students with mental and emotional disorders have been
cited as among the most under-identified and
underserved students with a disability.
• Lack of resources and concern about costs that the
district might incur, lack of access to mental health
services for identified children, stigma concerning the
label of emotional disturbance and desire to remove
troublesome children perceived as not having a “real
disability” may all contribute to overall low identification
rates for children with mental and emotional disorders.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Effective prevention of school failure depends crucially
on early recognition and provision of services for
troubled children. Delaying identification results in
children requiring more intensive IDEA services once
they are identified.
• State education agencies and local schools should
collaborate with mental health agencies to design
coordinated systems of care that use resources from
both systems to meet the comprehensive needs of
children with mental and emotional disorders, including
those identified as emotionally disturbed under IDEA.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• National IDEA identification of children with
emotional disturbance - 0.74%
• National IDEA identification of children with other
health impairments - 0.4%
• U.S. Surgeon General's identification of children with
mental disorder + extreme functional impairment 5%
• U.S. Surgeon General's identification of children with
mental disorder + significant functional impairment 11%
• Highest state rate (Minnesota, Vermont) - 1.92%
• Lowest state rate (Arkansas) - 0.10%
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1. State Policies Regarding Individuals with
Disabilities Education Act Amendments of
2004 (what is EmD?)
2. Pattern that can serve as a cue
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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“A condition exhibiting one or more of
the following characteristics over a long
period of time and to marked degree that
adversely affects a child’s educational
performance.”
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• An inability to learn that
cannot be explained by
intellectual, sensory, or
health factors
• An inability to build or
maintain satisfactory
interpersonal relationships
with peers or teachers
• Inappropriate types of
behavior or feelings under
normal circumstances
• A general pervasive mood of
unhappiness or depression
and/or
• A tendency to develop
physical symptoms or fear
associated with personal or
school problems
IDEA, 2004
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Emotional disturbance includes
schizophrenia. The term does not apply to
children who are socially maladjusted,
unless it is determined that they have an
emotional disturbance.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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DSM-IV-TR: Mental disorder is conceptualized as
clinically significant behaviors or psychological
syndromes or patterns that occur in an individual and
are associated with present distress, disability or with
significantly increased risk of suffering death, pain,
disability, or important loss of freedom.
(Diagnostic and Statistical Manual for Mental Disorders, 2000)
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Withdrawal, avoidant,
insecure behaviors, selfconscious
• Anxiety, excessive worries,
preoccupation
• Excessive motor movement
• Problem with relationship
• Attention-problems, poor
comprehension
• Lack of empathy,
manipulation
• Attention seeking behaviors
• Perception of reality
• Rituals, obsessivecompulsive
December 2012
• Problems with authority
figures
• Persistent complaint of
being ill
• Blaming others
• Regressive and acts like
younger child
• Self-distractive, risk-taking
behaviors
• Depressive mood, lack of
interest or pleasure,
irritability
• Physical change (weight,
grooming, sleep, interaction,
appetite)
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Preoccupation with details of certain thoughts
Hopelessness
Poor coping mechanism to stressors
Impulsivity
Unrealistic sense of power
Deceitfulness/bullying
Difficulties with relationships
Anxiety and aggression/Poor resistance to anger impulse
Pattern of disruptive behaviors
Possible delusion or hallucination
Aggressiveness expressed is grossly out of proportion
Suicidal or homicidal ideation
Deliberate engagement with distraction of properties
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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What is the most
popular
unacceptable and
dangerous
symptom in
American Schools?
December 2012
Different Forms of
VIOLENCE
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1.
Mood Disorders
2.
Substance-Related Disorders
3.
Personality Disorders
4.
Adjustment Disorders; Disruptive Behavior Disorder
5.
Impulse Control Disorders
6.
Schizophrenia or other Psychotic Disorders
7.
ADHD, CD,ODD; Educational Problems
8.
Sexual and Gender Identity Disorders
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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•
•
•
•
Retention
Absences
Summer school
Change in schools,
number of schools
• Suspensions
• Bus suspensions
• Leaving school early,
attending partial day
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Syndrome vs. Symptom (establishing
diagnosis)
• Diagnostic Criteria
• Provisional Approach
• Behavioral Problems vs. Pathological
Symptoms
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1.
Functional Behavioral Assessment (FBA)/Identification
2.
Planning
3.
Intervention
4.
Referral
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Behavioral Problems (may have a
symptom)
• Pathological symptoms (criteria for clinical
impression has met)
• Impact on learning (mild, moderate, and
severe)
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1.
Implementation of Functional Behavioral Assessment
(FBA). This problem-solving process identifies the
student’s problem behavior and its function.
2.
Teacher, counselor and school psychologist,
collaboratively identify, isolate, and assess the impact
of the problem behavior on the student’s learning
process.
3.
The school psychologist or counselor identifies
underlying causes and functions of problem behavior.
4.
Problem behavior will be analyzed based on its
function, location, frequency, duration, and intensity
(degree of its impact on the learning process).
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Management plan (intervention) will be
drawn based on FBA.
• Management plan (intervention) will be
utilized in Tier 1 and Tier 2.
• Progress of management plan
(intervention) will be monitored.
• Individual and group therapy will be
conducted to facilitate Tier 1 and Tier 2.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Clinical Interview will be conducted with child, teacher,
counselor, and parent.
• Formal Assessment (Behavioral and Emotional Rating
Scale 2nd Edition) will be administered to draw initial
phase for establishment of base line for problem
behavior.
• The Problem Documentation will be provided to
complete the final phase of base line establishment.
• Develop the FBA and communicate with the team
members.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Problem Documentation:
Describe the problem
Behavior(s) in each location
below.
Frequency:
Indicate the
frequency of the
problem behavior.
Hourly/daily/weekl
y
Duration: How
long
Impact on
Learning: List
below
1. High Impact
(Disruptive or
dangerous)
2.Moderate
(disrupts own
learning process)
3. Mild (annoying)
School: Indicate source
Home: Indicate source
Community: Indicate source
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Testing!!!!!!!!!!!!!!!!!!!!!
What is missing?
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Problem Behavior
Concrete definition
Carlos is aggressive.
Report by teacher
He hits other students during
recess when he doesn’t get his
way.
Trish is disruptive.
Report by teacher
She makes irrelevant and
inappropriate comments during
class session.
John is hyperactive.
Report by teacher and mother
1.He completes only small portion
of his work at home.
2.He blurts out answers in the
class.
3.He leaves his assigned seat.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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1. Frequency
2. Duration
3. Intensity (Educational Impact)
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Intervention should be research based.
• Intervention should be based on Bio-Psycho-SocialEnvironmental Mode.
• Intervention should deal with the function and the
cause of behavior.
• The modified behavior should be overt, measurable,
and objective.
• Intervention should rectify skill deficit, desire deficit,
and performance deficit problems.
• Interventions should deal with the problem behavior.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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A graphical display of
baseline and
intervention modalities
should be available in
the student’s file.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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In TST process, if Tier 1, Tier 2, and Tier 3
did not rectify the problem behavior(s), the
student should be referred for initial
evaluation for EmD.
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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• Treatment should be viewed in a systemic
fashion that involves prevention and
intervention.
• Treatment should be multifaceted and
comprehensive.
• Intervention and prevention should be
planned by a team (educators, parents,
children, and counselors).
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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Questions
and
Discussions
Thanks for being
here
December 2012
Office of Instructional Enhancement and Internal
Operations/Office of Special Education
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