Centralized Evaluation Centralized Evaluation TeamTeam

Reviewing the C.E.T. ProcessReviewing the C.E.T. Process

Kelly Dunlap, psy.s.Kelly Dunlap, psy.s.

School psychologistSchool psychologist

Autism education and intervention specialistAutism education and intervention specialist

High Quality High Quality School-Based ASD Evaluation School-Based ASD Evaluation

NO OPINIONSNO OPINIONS

ALL DECISIONS INFORMED BY….ALL DECISIONS INFORMED BY…. THE LAWTHE LAW THE RESEARCHTHE RESEARCH THE DATATHE DATA

Today’s Guiding Principle

Purpose / AGENDAPurpose / AGENDA

PURPOSEPURPOSE

Not compliance on Not compliance on evaluation (e.g. REED)evaluation (e.g. REED)

Not intended to cover Not intended to cover ALL issues related to ALL issues related to evaluation evaluation

Not intended to cover Not intended to cover issues related to other issues related to other disabilitiesdisabilities

Focus on core issues and Focus on core issues and components of components of evaluationevaluation

Components of Components of High Quality High Quality EvaluationsEvaluations CriteriaCriteria ToolsTools ProcessProcess ReportReport

AGENDA

HISD Compared to StateHISD Compared to State

START Primary ComponentsSTART Primary Components

Acronym Deciphering ToolAcronym Deciphering Tool

SESE = Special Education = Special Education ASDASD = Autism Spectrum Disorder = Autism Spectrum Disorder MARSEMARSE = Michigan Administrative = Michigan Administrative

Rules for Special EducationRules for Special Education REEDREED = Review of Existing = Review of Existing

Evaluation DataEvaluation Data METMET = Multidisciplinary Evaluation = Multidisciplinary Evaluation

TeamTeam IFSPIFSP = Individual Family Service = Individual Family Service

PlanPlan IEPIEP = Individualized Educational = Individualized Educational

ProgramProgram SASSAS = Supplementary Aids and = Supplementary Aids and

ServicesServices P&SP&S = Programs & Services = Programs & Services FAPEFAPE = Free and Appropriate = Free and Appropriate

Public EducationPublic Education LRELRE = Least Restrictive = Least Restrictive

EnvironmentEnvironment

AIBAIB = Autism Insurance Benefit = Autism Insurance Benefit DSMDSM = Diagnostic and Statistical = Diagnostic and Statistical

Manual of Mental DisordersManual of Mental Disorders PDD-NOSPDD-NOS = Pervasive Developmental = Pervasive Developmental

Disorder – Not Otherwise SpecifiedDisorder – Not Otherwise Specified ADOSADOS = Autism Diagnostic = Autism Diagnostic

Observation ScheduleObservation Schedule ADI ADI = Autism Diagnostic Interview= Autism Diagnostic Interview CMHPCMHP = Child Mental Health = Child Mental Health

ProfessionalProfessional PCPPCP = Person-Centered Plan = Person-Centered Plan IPOSIPOS = Individual Plan of Service = Individual Plan of Service ABAABA = Applied Behavioral Analysis = Applied Behavioral Analysis EIBIEIBI = Early Intensive Behavioral = Early Intensive Behavioral

InterventionIntervention ABIABI = Applied Behavioral Intervention = Applied Behavioral Intervention ABLLSABLLS = Assessment of Basic = Assessment of Basic

Language and Learning SkillsLanguage and Learning Skills VB-MAPPVB-MAPP = Verbal Behavioral = Verbal Behavioral

Milestones Assessment and Milestones Assessment and Placement ProgramPlacement Program

Referral / Evaluation Referral / Evaluation ConsiderationsConsiderations

Expect an Increase in Evaluation Requests:Expect an Increase in Evaluation Requests: Initial Evaluation orInitial Evaluation or Already eligible, but not ASD (e.g. ECDD/SLI) Already eligible, but not ASD (e.g. ECDD/SLI)

Potential ChallengesPotential Challenges Pressure to accept outside diagnosis and proceed to an Pressure to accept outside diagnosis and proceed to an

IEP with ASD eligibilityIEP with ASD eligibility

IDEA/MMSEA Considerations to Remember:IDEA/MMSEA Considerations to Remember: Always consider information provided by parent (REED) Always consider information provided by parent (REED) AIB diagnosis AIB diagnosis

Not typically done by a teamNot typically done by a team Possibly using different toolsPossibly using different tools Using different criteriaUsing different criteria

Special Ed evaluation done for dual purposes of Special Ed evaluation done for dual purposes of eligibility (TWO PRONGED TEST) AND IEP developmenteligibility (TWO PRONGED TEST) AND IEP development

Ensure high quality Ensure high quality evaluationsevaluations

Current Issues in State:Current Issues in State:– Not recognizing there are THREE required Not recognizing there are THREE required

eligibility areaseligibility areas– Not recognizing that “educational impact” can be Not recognizing that “educational impact” can be

in one of THREE areas (e.g. academic, behavior, in one of THREE areas (e.g. academic, behavior, social)social)

– Use of tools with no observational dataUse of tools with no observational data– Not understanding terms:Not understanding terms:

MarkedMarked QualitativeQualitative Adverse ImpactAdverse Impact

“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.”

NationalNational ResearchResearch CouncilCouncil

• 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

• CCRESA Progression & Feedback• “Beyond CET” Training: S. Dyer• Collaborative Conversations:

• C. Lord, B. Ingersoll, S. Pastyrnak, OAISDC. Lord, B. Ingersoll, S. Pastyrnak, OAISD• AIM (Autism Internet Modules) http://

www.autisminternetmodules.org • National Association of School Psychologists• National Research Council

ResourcesResources

Components of Components of high quality evaluationshigh quality evaluations

CriteriaCriteria

ToolsTools

ProcessProcess

ReportReport

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

1. Considered a lifelong developmental 1. Considered a lifelong developmental disability that adversely affects a student’s disability that adversely affects a student’s educational performance in 1 or more of the educational performance in 1 or more of the following areas: (following areas: (IMPACTIMPACT--prong 2)--prong 2)

a) Academic (e.g. ability to meaningfully participate and progress in the a) Academic (e.g. ability to meaningfully participate and progress in the general curriculum including lack of initiation, impaired quality of general curriculum including lack of initiation, impaired quality of participation, low grades, etc.)participation, low grades, etc.)

(b) Behavioral (e.g. disruption, aggression, lack of appropriate (b) Behavioral (e.g. disruption, aggression, lack of appropriate engagement, eloping, tantrums, etc.)engagement, eloping, tantrums, etc.)

(c) Social (e.g. ability to develop and maintain relationships/friendships, (c) Social (e.g. ability to develop and maintain relationships/friendships, responses to social situations that alienates others and diminishes responses to social situations that alienates others and diminishes acceptance, etc.)acceptance, etc.)

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

1. Considered a lifelong developmental 1. Considered a lifelong developmental disability that adversely affects a student’s disability that adversely affects a student’s educational performance (Prong 2)educational performance (Prong 2)

2. Characterized by qualitative impairments in 2. Characterized by qualitative impairments in (Prong 1):(Prong 1):

a. Reciprocal Social Interactions,a. Reciprocal Social Interactions,

b. Communicationb. Communication

c. Restricted Range of Interests / Repetitive c. Restricted Range of Interests / Repetitive BehaviorBehavior

Autism Spectrum Disorder Autism Spectrum Disorder TriadTriad

Qualitative Impairments

In CommunicationQualita

tive Impairm

ents

in Reciprocal

Social Interaction

Restrictive, Repetitive & Stereotyped

Behavior

ASD

DSM V (May 2013)

Autism Spectrum Disorder

Autistic Disorder

CDDRett’s

Disorder

PDD-NOSAsperger

DSM IV (1994-2013)PERVASIVE DEVELOPMENTAL DISORDERS

Continuum of Skills for Individuals with Autism

Severe MR Gifted Aloof Passive Active/Odd Non-verbal Verbal Awkward Agile Hyposensitive Hypersensitive

The Advocate (2003)

Measured IQ

Social Interaction

Communication

Motor Skills Fine & Gross

Sensory

Early Diagnosis?Early Diagnosis?(AIM Module—Recognizing (AIM Module—Recognizing

ASD)ASD) Retrospective studies (e.g., looking at home videos)Retrospective studies (e.g., looking at home videos) Prospective studies (following the development of Prospective studies (following the development of

children at low and high risk for autism) children at low and high risk for autism) Signs of autism are often present in the first year of Signs of autism are often present in the first year of

life, and especially by the first birthday life, and especially by the first birthday

(Landa, Holman, & Garrett-Mayer, 2007).(Landa, Holman, & Garrett-Mayer, 2007). If families and professionals pay close attention to If families and professionals pay close attention to

red flags, experts suggest that many children could red flags, experts suggest that many children could be diagnosed by age 2 be diagnosed by age 2 (Plauché Johnson, 2008), (Plauché Johnson, 2008), and perhaps and perhaps up to 50% of children with autism could be diagnosed up to 50% of children with autism could be diagnosed reliably as early as 14 months of age reliably as early as 14 months of age (Landa, 2007).(Landa, 2007).

Key Early Indicators of ASDKey Early Indicators of ASDhttp://www.cdc.gov/ncbddd/autism/index.htmlhttp://www.cdc.gov/ncbddd/autism/index.html

Lack of:Lack of: Reciprocal social smiling by 6 monthsReciprocal social smiling by 6 months Response/Orientation to name by 12 monthsResponse/Orientation to name by 12 months Reciprocal gestures by 14 months (showing objects, Reciprocal gestures by 14 months (showing objects,

pointing, reaching, waving)pointing, reaching, waving) Avoids eye contact / wants to be or play aloneAvoids eye contact / wants to be or play alone No words by 16 months (and meaningful 2-word No words by 16 months (and meaningful 2-word

phrases by 24 months)phrases by 24 months) Not play “pretend” games (feed a doll) by 18 monthsNot play “pretend” games (feed a doll) by 18 months Plays with parts of objects (e.g. wheels)Plays with parts of objects (e.g. wheels)

More Info at: (www.autisminternetmodules.org) Dashboard: Recognizing ASD—What Early Interventionists Should Know (What are some of the red flags you might see during the first three years of the child's life?)

MCHATMCHAT

Failed Screening = 2 or more failed critical items OR failed three items or more.(Yes/No converted to Pass/Fail)

Bold capitalized are CRITICAL

1. No 2. NO 3. No 4. No 5. No 6. No 7. NO 8. No 9. NO 10. No 11. Yes 12. No13. NO 14. NO 15. NO 16. No 17. No 18. Yes 19. No 20. Yes 21. No22. Yes 23. No

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

1. Considered a lifelong developmental 1. Considered a lifelong developmental disability that adversely affects a disability that adversely affects a student’s education performance.student’s education performance.

2. Characterized by 2. Characterized by qualitativequalitative impairments in:impairments in:

a. Reciprocal Social Interactions,a. Reciprocal Social Interactions,b. Communicationb. Communicationc. Restricted Range of Interests / c. Restricted Range of Interests / Repetitive BehaviorRepetitive Behavior

““Qualitative”Qualitative”

AtypicalAtypical Significantly different from other students Significantly different from other students

at the same age and developmental levelat the same age and developmental level Outside the typical sequence of Outside the typical sequence of

developmentdevelopment Across all environments.Across all environments. Presence and AbsencePresence and Absence Unique to each StudentUnique to each Student

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

Characterized by Characterized by qualitativequalitative impairments in: impairments in:

Reciprocal Social InteractionsReciprocal Social Interactions

CommunicationCommunication

Restricted Range of Interests / Restricted Range of Interests / Repetitive BehaviorRepetitive Behavior

ReciprocalReciprocal Social Interaction Social Interaction

A mutual exchange A mutual exchange (e.g. of words, actions, or (e.g. of words, actions, or

feelings).feelings).

Theory of MindTheory of Mind

(ToM) means the ability to (ToM) means the ability to recognize and understand recognize and understand thoughts, beliefs, desires thoughts, beliefs, desires and intentions of other and intentions of other people in order to make people in order to make sense of their behavior and sense of their behavior and predict what they are going predict what they are going to doto do.(Atwood, 2007).(Atwood, 2007)

TOM—ability to understand the TOM—ability to understand the feelings, intentions and feelings, intentions and perspectives of others and perspectives of others and recognize that they are recognize that they are different from our own.different from our own.

Reciprocal Social InteractionReciprocal Social InteractionAt least 2 of the following 4At least 2 of the following 4

(i) (i) MarkedMarked impairment in the use of multiple impairment in the use of multiple nonverbal behaviors such as eye-to-eye nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gaze, facial expression, body postures, and gestures to regulate social interaction.gestures to regulate social interaction.

MarkedMarked = Clearly evident; Behaviors are distinctive and = Clearly evident; Behaviors are distinctive and noticeably different from same-aged peersnoticeably different from same-aged peers

PURPOSE of Nonverbal BehaviorPURPOSE of Nonverbal Behavior

(ii) Failure to develop peer relationships (ii) Failure to develop peer relationships appropriate to developmental level.appropriate to developmental level.

Impaired perspective taking: viewing situations from Impaired perspective taking: viewing situations from another’s point of view and predicting other’s behavioranother’s point of view and predicting other’s behavior

Reciprocal Social Interaction Reciprocal Social Interaction

(iii) (iii) MarkedMarked impairment in spontaneous impairment in spontaneous seeking to share enjoyment, interests, or seeking to share enjoyment, interests, or achievements with other people, for achievements with other people, for example, by a lack of showing, bringing, or example, by a lack of showing, bringing, or pointing out objects of interest.pointing out objects of interest. Joint / Shared AttentionJoint / Shared Attention

(iv) (iv) MarkedMarked impairment in the areas of social impairment in the areas of social or emotional reciprocity.or emotional reciprocity. Identifying and responding appropriately to other’s Identifying and responding appropriately to other’s

emotional states (e.g., comfort a crying person)emotional states (e.g., comfort a crying person)

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

Characterized by Characterized by qualitativequalitative impairments in: impairments in:

Reciprocal Social InteractionsReciprocal Social Interactions

CommunicationCommunication

Restricted Range of Interests / Restricted Range of Interests / Repetitive BehaviorRepetitive Behavior

CommunicationCommunicationAt least 1 of the following 4At least 1 of the following 4

(i) Delay in, or total lack of, the (i) Delay in, or total lack of, the development of spoken development of spoken language language not accompaniednot accompanied by by an attempt to compensatean attempt to compensate

About 40% of children with an About 40% of children with an ASD do not talk at all.ASD do not talk at all.

About 25%–30% of children with About 25%–30% of children with an ASD have some words at 12 an ASD have some words at 12 to 18 months of age and then to 18 months of age and then lose them.lose them.

Remaining children speak, but Remaining children speak, but sometimes not until later in sometimes not until later in childhood and/or non-functional childhood and/or non-functional speech.speech.

http://www.cdc.gov/ncbddd/autism/signs.html

CommunicationCommunication

(ii) Impairment in Pragmatics: (ii) Impairment in Pragmatics:

The ability to initiate, sustain, or engage in The ability to initiate, sustain, or engage in reciprocal conversation with othersreciprocal conversation with others

a. Using language for varying purposes (e.g. a. Using language for varying purposes (e.g. greeting, informing, promising, requesting, greeting, informing, promising, requesting, etc.)etc.)

b. Changing language according to the needs of b. Changing language according to the needs of the listener or situation (e.g., giving the listener or situation (e.g., giving background information to an unfamiliar background information to an unfamiliar listener, speaking differently in a classroom listener, speaking differently in a classroom than on a playground)than on a playground)

c. Following rules of conversations and c. Following rules of conversations and storytelling (e.g., taking turns in conversation, storytelling (e.g., taking turns in conversation, staying on topic, rephrasing when staying on topic, rephrasing when misunderstood, proximity, use of eye contactmisunderstood, proximity, use of eye contact

RECEPTIVE & EXPRESSIVE RECEPTIVE & EXPRESSIVE LANGUAGE are not equalLANGUAGE are not equal

II didn’t say she stole my money.didn’t say she stole my money. I I didn’tdidn’t say she stole my money. say she stole my money. I didn’t I didn’t saysay she stole my money. she stole my money. I didn’t say I didn’t say sheshe stole my money. stole my money. I didn’t say she I didn’t say she stolestole my money. my money. I didn’t say she stole I didn’t say she stole mymy money. money. I didn’t say she stole my I didn’t say she stole my moneymoney..

CommunicationCommunication

(iii) Stereotyped / repetitive use of language / (iii) Stereotyped / repetitive use of language / idiosyncraticidiosyncratic

Idiosyncratic Idiosyncratic = contextually irrelevant or not understandable to = contextually irrelevant or not understandable to the listener; may have private meaning / be understood by the the listener; may have private meaning / be understood by the speaker or to those familiar to the situation (e.g. movie lines)speaker or to those familiar to the situation (e.g. movie lines)

Can include:Can include: EcholaliaEcholalia Repeat videos / scriptsRepeat videos / scripts Nonsense languageNonsense language Verbal FascinationsVerbal Fascinations

CommunicationCommunicationAt least 1 of the following 4At least 1 of the following 4

(i) Delay in, or total lack of, the (i) Delay in, or total lack of, the development of spoken language development of spoken language not not accompaniedaccompanied by an attempt to compensate by an attempt to compensate

(ii) Impairment in Pragmatics:(ii) Impairment in Pragmatics:

(iii) Stereotyped / repetitive use of (iii) Stereotyped / repetitive use of language / idiosyncraticlanguage / idiosyncratic

(iv) Lack of varied / spontaneous make-(iv) Lack of varied / spontaneous make-believe play or social imitative playbelieve play or social imitative play

Precursor to symbol development needed in Precursor to symbol development needed in languagelanguage

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

Characterized by Characterized by qualitativequalitative impairments in: impairments in:

Reciprocal Social InteractionsReciprocal Social Interactions

CommunicationCommunication

Restricted Range of Interests / Restricted Range of Interests / Repetitive BehaviorRepetitive Behavior

Restrictive, Repetitive, Stereotyped Behaviors Restrictive, Repetitive, Stereotyped Behaviors

At least 1 of the following 4 At least 1 of the following 4

(i) Encompassing (i) Encompassing preoccupationpreoccupation with 1 or more with 1 or more stereotyped and restricted patterns of interest stereotyped and restricted patterns of interest that is that is abnormalabnormal either in either in intensityintensity or or focusfocus..

DISTRESS OVER DISRUPTIONDISTRESS OVER DISRUPTION

(ii) Apparently inflexible adherence to specific, (ii) Apparently inflexible adherence to specific, nonfunctionalnonfunctional (e.g. no purpose) routines or rituals. (e.g. no purpose) routines or rituals.

(iii) Stereotyped and repetitive motor (iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements.or twisting, or complex whole-body movements.

(iv) (iv) Persistent preoccupation Persistent preoccupation with parts of objects.with parts of objects.

Michigan Definition of Michigan Definition of Autism Spectrum DisorderAutism Spectrum Disorder

1. Considered a lifelong developmental disability that adversely 1. Considered a lifelong developmental disability that adversely affects a student’s educational performance.affects a student’s educational performance.

2. Characterized by qualitative impairments in:2. Characterized by qualitative impairments in:a. Reciprocal Social Interactions,a. Reciprocal Social Interactions,b. Communicationb. Communicationc. Restricted, Repetitive, & Stereotyped Behaviorsc. Restricted, Repetitive, & Stereotyped Behaviors

3. Determination may include unusual or inconsistent 3. Determination may include unusual or inconsistent response to sensory stimuli in combination with a, b, and response to sensory stimuli in combination with a, b, and c, above.c, above.

4. There shall not be a primary diagnosis of schizophrenia 4. There shall not be a primary diagnosis of schizophrenia or emotional impairment.or emotional impairment.

5. Determination shall be based on up a full and individual 5. Determination shall be based on up a full and individual evaluation by a MET including a psychologist (or evaluation by a MET including a psychologist (or psychiatrist), authorized provider of speech and language, psychiatrist), authorized provider of speech and language, and a school social worker.and a school social worker.

What about the What about the EXPERTEXPERT team?team?

CET: Centralized Evaluation TeamCET: Centralized Evaluation TeamIndividualize the processIndividualize the process

Objective 3-person TeamObjective 3-person Team Sole purpose is ASD eligibilitySole purpose is ASD eligibility Start with the child, not the characteristics (e.g. does the ASD Start with the child, not the characteristics (e.g. does the ASD

dominate the child’s thinking?)dominate the child’s thinking?) Use the quadrants for observation and organizing informationUse the quadrants for observation and organizing information Conduct a Home visit with all 3 membersConduct a Home visit with all 3 members MET meeting to determine eligibility (Meeting Mechanics)MET meeting to determine eligibility (Meeting Mechanics) Preponderance of evidencePreponderance of evidence One combined reportOne combined report Report follows the MARSE criteriaReport follows the MARSE criteria Meet with parents BEFORE the IEP meetingMeet with parents BEFORE the IEP meeting

CRITICAL COMPONENTSCRITICAL COMPONENTS

Components of Components of high quality evaluationshigh quality evaluations

CriteriaCriteria

Tools:Tools: Developmental HxDevelopmental Hx ObservationsObservations Direct Interaction / AssessmentDirect Interaction / Assessment

ProcessProcess

ReportReport

Evaluation Evaluation methods / Toolsmethods / Tools

Use predominately Use predominately OBSERVATIONSOBSERVATIONS and interviews and interviews Evidence of presence / absence of behaviors across settingsEvidence of presence / absence of behaviors across settings

Is the ASD dominating the child’s interaction with the environment?Is the ASD dominating the child’s interaction with the environment?

““JUST THE FACTS”— examples / non-examples but NOT JUST THE FACTS”— examples / non-examples but NOT interpretation!!! <that meeting is coming!!>interpretation!!! <that meeting is coming!!>

What about standardized tests (supporting What about standardized tests (supporting documentation)?: “documentation)?: “No test or rating scale should be used as the sole criterion... Instead, No test or rating scale should be used as the sole criterion... Instead, consideration should be given to the student’s developmental history, systematic direct observation…, and consideration should be given to the student’s developmental history, systematic direct observation…, and interview information with various individuals who know the student well. interview information with various individuals who know the student well. “ (CALL)“ (CALL)

What question is the tool/test going to answer for you?What question is the tool/test going to answer for you? Most tools don’t match MARSE rulesMost tools don’t match MARSE rules Impact (2Impact (2ndnd prong): NO tool can provide information on the prong): NO tool can provide information on the

impactimpact

Direct ObservationsDirect Observations“Eyes on Kid”“Eyes on Kid”

ALL team membersALL team members

All settings, times of day, and contextsAll settings, times of day, and contextsCET----HOME VISIT w/ at least 2 observersCET----HOME VISIT w/ at least 2 observers

Allow room in schedule for additional Allow room in schedule for additional observationsobservations

Use CET Quadrant formUse CET Quadrant form

Consider contextConsider context

Direct ObservationDirect Observation“EYES ON KID”“EYES ON KID”

Qualitative Impairment in Communication

Qualitative Impairment in Reciprocal Social

Interaction

Restrictive, Repetitive and Stereotyped

Behaviors

Sensory

Other Supporting EvidenceOther Supporting Evidence

ChecklistsChecklists

Interview FormsInterview Forms

Direct Assessment ToolsDirect Assessment Tools

C.E.T. Interview StepsC.E.T. Interview Steps

Meet in a room with a dry erase or Meet in a room with a dry erase or chalkboardchalkboard

Assign a facilitatorAssign a facilitator Write four MET Categories on boardWrite four MET Categories on board Use Meeting Mechanics principlesUse Meeting Mechanics principles Facilitator interpretation of autism Facilitator interpretation of autism

characteristics characteristics

Standardized ToolsStandardized Tools

Determine what, if any, standardized Determine what, if any, standardized assessments are needed and complete assessments are needed and complete prior to team review of information:prior to team review of information: Determine what you are trying to answer Determine what you are trying to answer

using this tool – is it appropriate?using this tool – is it appropriate? Is this tool reliable? Ex. ADOS-2 Is this tool reliable? Ex. ADOS-2 (Required for Medicaid/MIChild/Private Insurance)(Required for Medicaid/MIChild/Private Insurance) 2 wk Test-Retest Reliability – 9 of 39 students changed 2 wk Test-Retest Reliability – 9 of 39 students changed

classification – that’s 23%!classification – that’s 23%!

Assessment ToolsAssessment ToolsCentral Assessment Lending Library Central Assessment Lending Library

(CALL) (CALL) https://www.cmich.edu/colleges/chsbs/Psychology/call/pages/default.https://www.cmich.edu/colleges/chsbs/Psychology/call/pages/default.

aspx/ aspx/ ASIEP-3: Autism ASIEP-3: Autism

Screening Instrument Screening Instrument for Educational for Educational PlanningPlanning

ADOS-2 (Autism ADOS-2 (Autism Diagnostic Observation Diagnostic Observation Schedule)Schedule)

ADI-R: Autism ADI-R: Autism Diagnostic Interview Diagnostic Interview

CARS-2: Childhood CARS-2: Childhood Autism Rating ScaleAutism Rating Scale

GARS-2: Gilliam Autism GARS-2: Gilliam Autism Rating ScaleRating Scale

GADS: Gilliam GADS: Gilliam Asperger Disorder Asperger Disorder ScaleScale

KADI: Krug Asperger KADI: Krug Asperger Disorder IndexDisorder Index

PEP-3: Psycho-PEP-3: Psycho-Educational ProfileEducational Profile

ABLLS-R: Assessment ABLLS-R: Assessment of Basic Language and of Basic Language and Learning SkillsLearning Skills

VB-MAPP: Verbal VB-MAPP: Verbal Behavior – Milestones Behavior – Milestones Assessment and Assessment and Placement ProgramPlacement Program

Components of Components of high quality evaluationshigh quality evaluations

CriteriaCriteria

ToolsTools

ProcessProcess: REED (Compliance): REED (Compliance) Gathering InformationGathering Information Integrate Qualitative and Quantitative InformationIntegrate Qualitative and Quantitative Information Differential EligibilityDifferential Eligibility Team-based Decision-MakingTeam-based Decision-Making

ReportReport

C.E.T. Basic PremisesC.E.T. Basic Premises

C.E.T. Team C.E.T. Team IndependentIndependent of the of the Referring TeamReferring Team

Primary and Only Primary and Only ResponsibilityResponsibility of of the C.E.T. is to find whether the the C.E.T. is to find whether the student meets eligibility criteria of student meets eligibility criteria of ASD.ASD.

The Centralized Evaluation The Centralized Evaluation TeamTeam

Team members include: Team members include: psychologist, social worker and psychologist, social worker and speech therapistspeech therapist

Others (parents, teachers, OT/PT, TC, Others (parents, teachers, OT/PT, TC, etc.) provide valuable information etc.) provide valuable information but are but are notnot part of the formal part of the formal recommendation of eligibilityrecommendation of eligibility

Benefits of C.E.T.Benefits of C.E.T.

Truly a Comprehensive Evaluation Truly a Comprehensive Evaluation Consolidates Three Separate Consolidates Three Separate

Evaluation Reports into One for ParentsEvaluation Reports into One for Parents Allows for Individual Opinion but Allows for Individual Opinion but

Focuses on the Overall PerspectiveFocuses on the Overall Perspective Focuses On Autism, NOT Service or Focuses On Autism, NOT Service or

Program IssuesProgram Issues Reduces Dissenting Opinions at IEPReduces Dissenting Opinions at IEP

The Centralized The Centralized Evaluation ProcessEvaluation Process

The C.E.T. Process must have enough The C.E.T. Process must have enough formform to focus on the disability of to focus on the disability of autism and autism and openopen enough to discover enough to discover the childthe child

Selection of C.E.T. TeamSelection of C.E.T. Team

At minimum of one experienced support At minimum of one experienced support staff on each C.E.T.staff on each C.E.T.

Strength areas are recognizedStrength areas are recognized Developmental considerationsDevelopmental considerations Team combinationsTeam combinations

Identify Team, Designate a Team Identify Team, Designate a Team CoordinatorCoordinator

C.E.T. Steps and SequenceC.E.T. Steps and Sequence

Social Worker schedules home visit: Social Worker schedules home visit: obtain permission for evaluation obtain permission for evaluation biggest concern(s)biggest concern(s) complete social, developmental historycomplete social, developmental history describe evaluation processdescribe evaluation process observations of child in home setting observations of child in home setting

including child’s room if possibleincluding child’s room if possible ideally all three members participate in ideally all three members participate in

home visit, minimally two visithome visit, minimally two visit

C.E.T. Steps and SequenceC.E.T. Steps and Sequence

Coordinator contacts team members:Coordinator contacts team members: schedule initial team schedule initial team

meeting/interviews meeting/interviews with referring with referring team/individuals team/individuals

arrange observation times in various arrange observation times in various settings beyond home settings beyond home

visitvisit

Teacher and Provider Teacher and Provider InterviewsInterviews

Allow 45 minutesAllow 45 minutes Preferably two evaluation team membersPreferably two evaluation team members Guided Interview:Guided Interview:

Biggest concern(s)Biggest concern(s) Describe interview processDescribe interview process Address each interview question, including Address each interview question, including

academicsacademics Explain rating scale if using oneExplain rating scale if using one

C.E.T. observations in all C.E.T. observations in all relevant settings are relevant settings are

completedcompleted Transition ObservationsTransition Observations Home ObservationsHome Observations Classroom ObservationsClassroom Observations Unstructured Areas Observation – Unstructured Areas Observation –

RecessRecess Interaction with Other StudentsInteraction with Other Students Observations of Others in Response to Observations of Others in Response to

the Studentthe Student

Marci was observed grabbing toys and objects Marci was observed grabbing toys and objects from othersfrom others and appeared unaware that the and appeared unaware that the other child was using or playing with the other child was using or playing with the object. object. Marci was observed tickling peers Marci was observed tickling peers under the chin while giggling, moving from one under the chin while giggling, moving from one peer to the next. None of the children peer to the next. None of the children appeared to be enjoying thisappeared to be enjoying this, but Marci did not , but Marci did not seem to recognize their displeasure.seem to recognize their displeasure.

Marci was observed pulling at girls’ ponytails Marci was observed pulling at girls’ ponytails and accessories;and accessories; Marci has not been noted to Marci has not been noted to pull hair other than in pony/pigtails or when pull hair other than in pony/pigtails or when there are accessories present. there are accessories present. Marci was noted Marci was noted to state, “I want to poke her in the eye” and “I to state, “I want to poke her in the eye” and “I want to kick herwant to kick her” in a very unemotional manner ” in a very unemotional manner not directed at anyone. Despite her statement, not directed at anyone. Despite her statement, Marci has not attempted to do the things that Marci has not attempted to do the things that she says. she says.

Marci was observed grabbing toys and objects Marci was observed grabbing toys and objects from othersfrom others, while yelling, “I had it first!” and , while yelling, “I had it first!” and pushing peers away. pushing peers away. Marci was observed Marci was observed tickling peers under the chin while giggling, tickling peers under the chin while giggling, moving from one peer to the next. None of moving from one peer to the next. None of the children appeared to be enjoying thisthe children appeared to be enjoying this, but , but Marci kept saying, “Am I bugging you yet?” Marci kept saying, “Am I bugging you yet?” and “Isn’t this so funny?”and “Isn’t this so funny?”

Marci was observed pulling at girls’ ponytails Marci was observed pulling at girls’ ponytails and accessories;and accessories; she will say, “I don’t like your she will say, “I don’t like your hair like that-it looks stupid.” hair like that-it looks stupid.” Marci was noted Marci was noted to state, “I want to poke her in the eye” and “I to state, “I want to poke her in the eye” and “I want to kick herwant to kick her” while being redirected from ” while being redirected from an argument with a peer. Marci has an argument with a peer. Marci has previously shoved, kicked and poked this girl previously shoved, kicked and poked this girl when she doesn’t do what Marci wants her to when she doesn’t do what Marci wants her to do. do.

C.E.T. Decision MakingC.E.T. Decision Making

C.E.T. members share all relevant C.E.T. members share all relevant informationinformation

Utilize all relevant checklist, Utilize all relevant checklist, characteristics, materials to organize characteristics, materials to organize information complete relevant rating information complete relevant rating scales scales

Determine if additional information is Determine if additional information is needed before completing MET needed before completing MET

Six C.E.T. Decision Making ErrorsSix C.E.T. Decision Making Errors

Summarizing Each QuadrantSummarizing Each Quadrant

Reviewing the MET CriteriaReviewing the MET Criteria

Differential eligibilityDifferential eligibility

Don’t you think its Don’t you think its ___________________?___________________?

What do we ask?What do we ask?

EI CI

Criteria; Criteria; Function / Attribution; Function / Attribution; Quadrant extras;Quadrant extras;Preponderance of evidence Preponderance of evidence

ASDASD

Qualitative impairments Qualitative impairments in:in:

Reciprocal social Reciprocal social interactioninteraction

CommunicationCommunication

Restricted Range of Restricted Range of Interests / Repetitive Interests / Repetitive Behavior Behavior

EIEI

(a) Inability to build or maintain (a) Inability to build or maintain satisfactory interpersonal satisfactory interpersonal relationships within the school relationships within the school environment.environment.

(b) Inappropriate types of (b) Inappropriate types of behavior or feelings under behavior or feelings under normal circumstances. normal circumstances.

(c) General pervasive mood of (c) General pervasive mood of unhappiness or depression. unhappiness or depression.

(d) Tendency to develop physical (d) Tendency to develop physical symptoms or fears associated symptoms or fears associated with personal or school problem with personal or school problem

C.E.T. Steps and Sequence C.E.T. Steps and Sequence ContinuedContinued

Write C.E.T. report, share report with Write C.E.T. report, share report with referring teamreferring team

Contact parents and share report Contact parents and share report prior to MET Meetingprior to MET Meeting

Referring team schedules MET and Referring team schedules MET and I.E.P. meeting with parents. At least I.E.P. meeting with parents. At least one C.E.T member must be present one C.E.T member must be present at the MET and I.E.P. at the MET and I.E.P.

CET ReportCET Report

EXAMPLE SOCIAL: EXAMPLE SOCIAL:

Based on survey information and observations,       demonstrates Based on survey information and observations,       demonstrates a range of nonverbal behaviors such as smiling when happy, a range of nonverbal behaviors such as smiling when happy, frowning when sad, pointing to orient another to something, and frowning when sad, pointing to orient another to something, and looking nervous when he does something wrong. For example, looking nervous when he does something wrong. For example, on one occasion during direct observation,   . On another on one occasion during direct observation,   . On another occasion,       On yet another occasion,       These are a just a few occasion,       On yet another occasion,       These are a just a few examples of the good use of nonverbal behavior       uses to examples of the good use of nonverbal behavior       uses to communicate in social situations.communicate in social situations.

  

During direct assessment,       was able to describe an event During direct assessment,       was able to describe an event using a full range of facial expressions, body postures, and using a full range of facial expressions, body postures, and gestures including pointing, shrugging his shoulders, and gestures including pointing, shrugging his shoulders, and nodding. Although reports indicate that      struggles with nodding. Although reports indicate that      struggles with matching facial expressions with mood (e.g.       face will be matching facial expressions with mood (e.g.       face will be straight when he is actually happy) and using a full range of non-straight when he is actually happy) and using a full range of non-verbal, in school observations and direct assessment, these verbal, in school observations and direct assessment, these behaviors were not noted to be qualitatively impaired compared behaviors were not noted to be qualitatively impaired compared to peers. to peers.             

          

Organization of C.E.T. Organization of C.E.T. ReportReport

Use ASD M.E.T. Form to write reportUse ASD M.E.T. Form to write report The report must reflect the findings of the The report must reflect the findings of the

C.E.T.C.E.T. Integrate the information from all three support Integrate the information from all three support

staff into one reportstaff into one report Details are important – Define characteristics Details are important – Define characteristics

that either support the eligibility of autism or do that either support the eligibility of autism or do not support the eligibility of autismnot support the eligibility of autism

Consistency of MET Form Answers either For or Consistency of MET Form Answers either For or Against the Eligibility of AutismAgainst the Eligibility of Autism

Contact parents and share Contact parents and share report prior to MET Meetingreport prior to MET Meeting

Which C.E.T. Member Contacts Which C.E.T. Member Contacts Parent?Parent?

The importance of contacting parent The importance of contacting parent prior to the M.E.T. meetingprior to the M.E.T. meeting

Role of other team membersRole of other team members

C.E.T Steps and Sequence C.E.T Steps and Sequence ContinuedContinued

C.E.T. determines C.E.T. determines student eligible for student eligible for services with an services with an Autism Spectrum Autism Spectrum Disorder Disorder

C.E.T. Steps and Sequence C.E.T. Steps and Sequence ContinuedContinued

C.E.T. determines C.E.T. determines student is not student is not eligible for services eligible for services under Autism under Autism Spectrum DisorderSpectrum Disorder

• Remember, different purposes (diagnosis versus special education eligibility and IEP development)

• Adherence to strong evaluation process, report is defendable

• Commitment to communication

What if there is disagreement?What if there is disagreement?

(e.g. one says “yes” and one says “no”)(e.g. one says “yes” and one says “no”)

• Regardless of outcome, determine what the student’s educational needs are and how they can be met.

• IEP Programs and ServicesIEP Programs and Services• 504 Plan504 Plan• General AccommodationsGeneral Accommodations• Tier II SupportsTier II Supports• Universal Supports, SW-PBISUniversal Supports, SW-PBIS• Counseling, Coaching, Peer SupportsCounseling, Coaching, Peer Supports

After the CET ProcessAfter the CET Process

Overall quality of our CET Process?

Areas we could improve upon?

Follow up tasks?

DiscussionDiscussion