Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psychology Assessment Center: Future Directions And Focus

Journal of Multicultural Affairs, Nov 2017

School Psychology Assessment Centers (SPAC) developed at the University-level are crucial in developing competent school psychologists. While many models on how to develop mental health centers are in existence, a new model exists for creating a SPAC on a University campus that is specifically designed to serve the diverse surrounding community and postsecondary students (see Ellis-Hervey et al., 2016). The community’s needs were reviewed, including missing service links in the region, and identification of potential clients who would benefit most from services provided. Senior students who work with clients in the SPAC gain assessment skills and build supervision skills through close interactions and consultation with junior students. New goals of the SPAC is to develop and implement academic, behavioral, social skills and therapy/counseling services.

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Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psychology Assessment Center: Future Directions And Focus

Journal of Multicultural Affairs Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psycholog y Assessment Center: Future Directions And Focus Nina M. Ellis-Hervey Ph.D. 0 1 2 N.C.S.P. 0 1 2 L.S.S.P. 0 1 2 P.L.P. Stephen F Austin State University 0 1 2 0 1 2 Ashley Doss B.S. 0 1 2 MAIO-Cert Stephen F. Austin State University 0 1 2 dossan 0 1 2 @titan.sfasu.edu 0 1 2 DeShae Davis-Gatti M.A. 0 1 2 0 Part of the Child Psychology Commons, Clinical Psychology Commons, Developmental Psychology Commons, Education Commons, and the School Psychology Commons Tell us how this article helped you 1 Juliet Aura BS/P Stephen F. Austin State University 2 Stephen F. Austin State University Follow this and additional works at: http://scholarworks.sfasu.edu/jma Diversity of Diagnoses and Student Learning Experiences in an On-Campus School Psychology Assessment Center: Future Directions and Focus Nina M. Ellis-Hervey, Ashley Doss, DeShae Davis-Gatti, and Juliet Aura Stephen F. Austin State University School Psychology Assessment Centers developed at the University-level are crucial in developing competent school psychologists, as they advance from graduate training into ethical practitioners. Training at the graduate level provides students with the opportunity to engage in understanding the needs of the surrounding communities in which they are located. The National Association of School Psychologist (NASP) Ethical Principles (2010), state that school psychologists present an “ongoing responsibility and support the development of healthy schools, families, and communities while also contributing to the knowledge and research base, mentoring, teaching, and supervision of future psychologists” (Ellis-Hervey, Doss, Davis, & Bradford, 2016, p. 1) . While many models on how to develop mental health centers in general are in existence (see: IDCFS, Utah State, Oklahoma State, etc.), a new model exists for creating a School Psychology Assessment Center on a University campus that is specifically designed to serve the surrounding community and postsecondary students by providing services such as assessments, diagnoses, and recommendations for interventions (see Ellis-Hervey et al., 2016) . This paper will identify, discuss, and examine how a School Psychology Assessment Center at a University may present the opportunity to reduce barriers common in poverty-stricken and ethnic majority communities. The School Psychology Assessment Center (SPAC) at Stephen F. Austin State University (SFASU) was developed in 2013 by Dr. Nina Ellis-Hervey. Currently, the SPAC has been in operation for two and a half years, serving an average of 15 to 20 clients per year, shared between two to three graduate students supervised by faculty and staff during the final stages of their program (SFASU School Psychology Doctoral Program). The mission of the SPAC is to provide “affordable, quality mental health assessment and care to the campus, community and area residents” (School Psychology Assessment Center, 2016, para. 1) . These services are provided through assessments, measuring psychological, emotional, behavioral, social, academic, and occupational functioning of clients. The SPAC was originally developed to address potential links missing in the training process of school psychologists at SFASU (Ellis-Hervey et al., 2016) . Established within the School Psychology program, the SPAC offers clients within the community a service open to the public as well as providing graduate students with the opportunity to practice and refine skills under direct supervision licensed psychologists. A primary component to development of the SPAC at SFASU was identifying needs within the community, school, and environment in which the Clinic would be housed (Ellis-Hervey et al., 2016) . Overall, the community’s needs were reviewed, including missing links in the region, and identifying potential clients who would benefit the most from services provided. Understanding the services that are already available within the community is a key component to recognizing outreach services as it provides clinicians with a way to make partnerships to existing services, provide additional supports, and fill in gaps that may be identified by what is available within the community. Partnerships were created through the SPAC at SFASU that included the Department Chair of Human Services, the Dean of the College of Education, Director of Disability Services, Dean of Student Affair, the University Medical Center Director, and the Director of Counseling Services, examining how to provide services through the program that provided opportunities of rigorous training for graduate students as well as comprehensive and quality-ensured services to the greater community (Ellis-Hervey et al., 2016) . The SPAC at SFASU was designed to assist students in the acquisition and application of services rendered to the public while also benefiting the surrounding community’s population. The primary population(s) anticipated to serve include: students who attend SFASU as a graduate or undergraduate students, children within the community, and students referred from schools and private practices. To reach these anticipated populations, the Director of the SPAC, with assistance from graduate assistants, developed informational meetings, packets describing services available for handouts, and wrote formal letters to distribute to private practices within the community, school districts, and campus officials (Ellis-Hervey et al., 2016) . By laying a foundation of approachability and creating a reputation of providing competent services, the School Psychology Assessment Center at Stephen F. Austin State University has provided students and community members a location to acquire services that include the opportunity for assessments, diagnoses, and recommendations for potential effective interventions. Creation of this Center on campus has provided a safe place for students seeking assistance with academic and emotional difficulties that are prevalent within the university and community. Multicultural Education Among educators and the field of education, a major topic of research and conversation consists of identification and potential remedies of the achievement gap. Defined as the gap in standardized test results between Blacks and Whites, Latinx and Whites, and recent immigrants and Whites, the opportunity gap is a constant concern in the field of education ( LadsonBillings, 2013 ). A potential remedy within this small community that focuses on addressing and reducing the achievement gap within society may be found in this School Psychology Assessment Center. Providing the opportunity to examine, identify, and potentially reduce gaps seen in education. The area of focus on multicultural education seeks to reduce the disparity often identified between the majority culture and ethnic majority culture. Programs such as Affirmative Action, Women, Infants, and Children (WIC), and the availability of government assistance have been developed by policymakers to assist in the economic disparity often seen in families from multiple ethnic backgrounds (Gorski, 2013; National Conference of State Legislatures, 2016) . Originally designed to provide assistance with the basics, these programs help families to become more integrated in society and allow them to focus on attaining higher education, instead of worrying about food and shelter, a more primary need. Identification of Students with Disabilities State and public agencies must identify, locate, and evaluate all children with disabilities in the state who need special education and related services, as mandated by the Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004) . However, some children and adolescents with special needs do not receive services under IDEA, but are served under Section 504 of the Rehabilitation Act of 1973. Section 504 is a civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of the non-disabled are met. According to data reported by the IDEA (2011) , 9.3% of students in the state of Texas are served under IDEA. The disability categories include Autism, Deaf-blindness, Emotional Disturbance, Hearing impairment, Intellectual Disability, Multiple Disabilities, Orthopedic Impairment, Other Health Impairment, Specific Learning Disabilities, Speech or Language Impairment, Traumatic Brain Injury, and Visual Impairment. Federal mandate dictates that to determine if a student has a disability, a referral or request for evaluation may be made by a school professional or the student’s parents (IDEA, 2004) . Parental consent is mandatory before the student may be evaluated. The evaluation must assess the student in all areas related to the student’s suspected disability. The evaluation results are then used to decide the student’s eligibility for special education and related services and to make decisions about an appropriate educational program for the student. If the student is found to be a "student with a disability," as defined by IDEA, he or she is eligible for special education and related services. Within 30 calendar days after a student is determined eligible, the Individual Education Plan (IEP) team must meet to write an Individualized Education Plan for the student. Specific Populations served at SFASU School Psychology Assessment Center Similar to the process of identifying and evaluating students for disabilities in the school environment, SFASU SPAC has a referral or request for evaluation process. Once referrals are delivered to the SFASU SPAC, the director of the Center and supervisor, determines which studentclinician will work with the new client. Referral forms containing a short behavior checklist are included for the potential client’s aid in identifying some of the difficulties a client may be encountering. During the initial meeting, a permission and consent for assessment form is signed. A ‘Consent to Obtain Information’ form is also signed if the client has previous assessment and psychoeducational records. Background information is collected using developmental history interview forms. From this point, appointments are set to gather ratings of social, emotional and behavioral functioning, adaptive functioning, cognitive and achievement assessments, curriculum-based assessments, and if the opportunity is available, observation data is also collected. Studentclinicians (assessment and practicum students) collaborate with their supervisors to provide a concise and clear assessment report, guided by a combination of the background information, behavioral observation, and assessment data results of the client. A feedback meeting is attended by the parents/caregivers, client, studentclinician, and supervisor in which feedback and directive recommendations are provided. The parent/caregiver and/or client (based on age) receives the signed assessment report and is provided with a permission to release information form, should they want to deliver the report to other agencies. SFASU SPAC has completed comprehensive assessments for 38 clients. The SFASU SPAC has served an average of 19 clients annually. SPAC clients consisted of 17 female and 21 males, ranging from ages of six years through 57 years, with a mean client age of 18 years. SPAC clients served include 36.8% in elementary school, 2.6% in secondary school, 55.3% postsecondary school, while 5.3% already held a Bachelor’s degree. In addition, 71.1% of SPAC clients were White, 10.5% Black or African American, 5.3% Latinx/Hispanic American, 2.6% Bi/Multiracial, 2.6% Asian American/Pacific Islander, and 7.9% Unreported. The SFASU SPAC typically receives referrals for academic, attentional, and concentration difficulties. Of those referred to the SFASU SPAC, 26.3% of clients are referred by educators, 21.1% are selfreferrals, 18.4% by the University Disability Services, 18.4% by mental health professionals (including Physicians, Licensed Professional Counselors, Psychologists, and Psychiatrists), and 15.8% by parents or caregivers. Common diagnoses within the SFASU SPAC include Attention Deficit Hyperactivity Disorder (34%), Specific Learning Disability (34%), Generalized Anxiety Disorder (16%), and Major Depressive Disorder (5%), with 11% other diagnoses, including Autism Spectrum Disorder, Post-Traumatic Stress Disorder, Adjustment Disorder, Gifted/Talented, No Diagnosis, Mild Neurocognitive Disorder, and Persistent Depressive Disorder. See Table 1 for a breakdown of diagnoses. It is important to note that although n=38 for total number of clients, the number of diagnoses given totals 51, as some clients received comorbid diagnoses (more than one diagnosis). Diversity Within The Community The ethnic makeup within the community of Nacogdoches, Texas consists of the following: 51.2% White, 28.4% African American, 0.5% Native American, 1.8% Asian American, 0.1% Pacific Islander, 0.1% other, 2.3% Bi/Multiracial, and 16.8% Latinx/Hispanic American (U. S. Census, 2010) . Further, the ethnic makeup within the university the School Psychology Assessment Center is housed at is as follows: 56.8% White, 21.2% African American, 15.2% Latinx/Hispanic American, 2.7% Bi/Multiracial, 1.9% unknown, 1% Asian American, 0.7% nonresident, and .5% American Indian or Alaska Native. SFASU is also ranked 661 nationwide in ethnic diversity (College Factual, n.d.). To date, the SPAC has served 8% of Hispanic origin, 4% of Asian origin, 11% African American, 51% White, 19% Bi/Multiracial, and 6% not reported. Overall, the SPAC serves a similar ethnic makeup consistent with the community and university. Referrals are most often made by teachers (28%), with the next highest percentage made by the self (21%). An increase in awareness of services available by the SPAC have proven functional to members within the community, as the number of referrals have increase each year. Diversity Within SPAC Clients Served. Referrals to the School Psychology Assessment Center at SFASU are most often from educators within the community at 26.3%. 21.1% are self-referrals, 18.4% are referred by the University Disability Services, 18.4% by mental health professionals (including Physicians, Licensed Professional Counselors, Psychologists, and Psychiatrists), and 15.8% by parents or caregivers. As of late, there has been an increase in referrals directly from concerned professionals within the Office of Multicultural Affairs. This growth has occurred as relationships have been developed and nurtured between the Office of Multicultural Affairs and the Department of Human Services where the center is housed. Much information has been exchanged between the two departments, particularly with growing concerns expressed about the mental health of some of the multicultural students on campus. Of note, of those served, 8% are of Hispanic origin, 4% of Asian origin, 11% African American and 19% Bi/Multiracial. This is over 40% of the overall referrals and clients seen within the center. This is of great significance because students serving clients are not only being merely exposed to diversity, but they are all experiencing work with clients of various ethnicities and backgrounds. In a city the majority demographic is nearly 57% White, it is clear there is a need to ensure service providers are prepared and effective in exchanges and work with diverse populations. Improving Access In order to ensure that services may be extended to those of all backgrounds and particularly multicultural students in great need, reduced pricing and payment plans have been and are offered. With these implementations, the SPAC continues to have more opportunities to serve underprivileged populations and those who wouldn't otherwise have the privilege of access to quality and thorough psychoeducational assessments. Though these options have been implemented, the center director desires to continue to find ways to increase awareness by developing action plans such as participation in community outreach, the annual Diversity Conference, psychological programming, community service and constant contact with professionals in the Office of Multicultural Affairs and Student Services. Measuring Success Beyond basic and typical solidification of referrals, the SPAC will continue to be vocal about the psychoeducational assessment needs within the community and college campus. There is a need for educators and professionals within the community to know the services offered for those in need the center. Professionals working within the SPAC want to continue to build community and campus investment in the center by getting “in the trenches”, meeting the community where they are, providing information on various difficulties that may warrant assessment and creating a safe space where those of multicultural background especially, are not intimidated by stigma. Future Direction and Role of SPAC within the Community As the SFASU SPAC continues to grow and extend more services, careful consideration must be given to the most effective assessment practices for the populations in which it serves. Beyond assessment practices, it is also important that those identified as individuals with disabilities (across the developmental life span) receive the most effective academic and behavioral interventions for continued positive growth beyond simple recommendations. For this reason, supervisors and licensed professionals at SFASU are seeking collaborations with outside mental health professionals to extend training of future School Psychologists (within the SPAC), beyond assessment to include more experiences in academic, behavioral, social skills and therapy/counseling (individual and group) intervention services. Innovative collaborations and continued progression of experiences for clients and students are essential for an efficient SPAC (EllisHervey et al., 2016). Early Introduction of Experience To introduce students to the assessment process early in the graduate curriculum, the SFASU SPAC Director and Psychoeducational Assessment and Individual Intelligence Testing instructor Dr. Nina Ellis-Hervey, created a 20-hour practicum experience in which junior students collaborate with a senior student, on doctoral internship, on a psychoeducational assessment experience. Further, these junior students also shadow a senior student in the SPAC to learn the process of assessment, the Center procedures, how to complete intake of a client (with client permission), how to select appropriate assessments, how to complete an integrative report, and observe a client feedback meeting. Students are also educated on the various reported difficulties clients present within the Center and are prompted to research these concerns, consult with their assigned senior student about how to conceptualize cases and recommendations, and report their experiences to their instructor. Extension of Experiences of Senior Students Senior students gaining practicum experience who work with clients in the SPAC are not limited to assessment skill building; students also build their supervision skills through close interactions and consultation with junior students. Upon gaining experience in the SPAC, senior students have successfully completed introductory psychoeducational assessment courses, Multicultural Counseling, and a Child and Family Assessment course. Within each of these courses, students learn about the limitless diversity in assessment, not only in choice of evaluation tools, but in the populations they will assess. These students have also completed practicum experiences within a school setting, have completed the Consultation and Supervision course, and have strengthened their skills in case conceptualization and consultation. The goal is to ensure these students not only feel proficient but learn to impart that knowledge to more junior students. According to Falender et al., (2004 ), a final aspect of the developmental progression (of a future practitioner in training) should be the provision of guided opportunities to supervise less advanced trainees or school staff involved in specific projects. For this reason, a great emphasis is placed on senior students and early development of their supervision skills. Since this is a new experience for them, budding supervisors work closely with the SPAC Director, collaborating mental health professionals, and faculty to develop these skills. Senior students working in the SPAC report to their supervisor concerning goals of experiences shared with junior students who shadow them, challenges they encounter while developing a supervisor identity, and the direction of their personal growth. Senior students working in the SPAC also collaborate with one another and their supervisors in gaining professional development opportunities. These include, but are not limited to, traveling and presenting at local, state, national, and international mental health conferences and engagements, planning local mental health conferences and awareness programs, and taking part in local in-services and trainings. Some trainings include Health Insurance Portability and Accountability Act (HIPAA), Crisis Prevention and Intervention (CPI), Question-Persuade-Refer (suicide risk assessment training), receipts and monetary handling training, security awareness training, and general Center policies and procedures training. Students also engage in research teams and work with clients in various school districts. Further, since the SPAC is a newer center, students are instrumental in evaluating the progress of the Center, helping to develop and fine-tune policies and procedures, increasing awareness within the community of the services available and advocating for the Center’s growth and longevity. With all these opportunities, practicum students acquire a tailored experience spanning various developmental continuums. Such practices will continue and as the needs of the community continue to grow, more inservice trainings and skill building presentations will be added for students, faculty, and the greater community. In the future, the focus of supervisors and faculty in the SPAC will be to continue to provide practicum students (both Specialist and Doctoral levels) the opportunity to improve targeted skills by use and close review of formative and summative evaluations. Supervision practices will consistently be assessed to ensure students receive the best benefits and preparation as future practitioners. According to Simon, Cruise, Huber, Swerdlik and Newman (2014) supervision should be a developmental process which allows training of various students to start where their assessed functioning levels are in each competency domain. Students will have more frequent opportunities to voice their input on the goals of their individualized supervision experience. Developing SPAC Beyond Practicum and into Pre-Doctoral Internship The need for more comprehensive psychoeducational assessments and related services, in the East Texas area, are vast. Referrals are made often and come from various campuses and community agencies. Developmental levels of new practicum students and the limited number of students working in SPAC at a given time can impact wait lists for services and they may often become extensive. To ameliorate longer waiting periods for clients, faculty and supervisors working in the SPAC are collaborating to make the SPAC a rotation within the existing internship experience at the SFASU Charter School. Another focus is to create a consortium with neighboring public schools so students may have supervised diverse experiences in community public schools as well as a more clinical setting. Requests from the Campus and Community Beyond the scope of psychoeducational assessments, many campus and community agencies have asked the SPAC director to extend services to include academic, behavioral, social skills, and therapy/counseling (individual and group) intervention services. This has been expressed as a need because clients referred to the Center build a strong rapport with those with whom they work. Clients seem more inclined to complete recommendations for services when they are offered services by those who know their needs best. Students training in the SPAC have also asked to serve in this capacity and are excited for the possibility. In the future, the SPAC will focus on development of such services that faculty, supervisors, and students are able to engage in to further develop and remain current in their intervention skills while fulfilling the more direct needs of the clients. Creating Liaisons and Collaborations with Neighborhood Mental Health Professionals Since its inception, the SFASU SPAC has garnered the attention and respect of many mental health professionals in the area and beyond. Some professionals have decided to become a direct contact and send all patients and clients in need of psychoeducational assessments to the Center. Some neighboring School Psychologists and Licensed Psychologists have consulted with the Center Director and have provided invaluable consultation and supervision to students. The Director and students in the SPAC have continued to work with the primary mental health center in the area on their planning committee for the annual state mental health conference. This has allowed students the opportunity of working on a multidisciplinary team to achieve pertinent goals for the community and plan conferences for fellow mental health professionals from around the state. This conference planning provides students with multiple opportunities that extend beyond the SPAC. Students are involved in the coordination of professional development workshops, selecting conference presentation topics, reaching out to potential keynote and session speakers, preparing conference materials, and more. Students also present with faculty at the conference on trending School Psychology topics and best practices for service delivery for children and families. Final Remarks Training of future School Psychologists at the Specialist and Doctoral level often includes multiple training opportunities. It is the hope that these experiences are infused with exposure to diverse clients with many presenting difficulties. Over the past two and a half years, faculty and students at SFASU have maintained the SPAC, which assists in such goals. Though the Center has been successful in providing training opportunities and tailored experiences for student learning, while providing needed services to the university campus and the community, there is still much work to be done. As students grow to learn their own strengths and weaknesses they desire to “fill in the gaps” with more specialized work including development and implementation of academic, behavioral, social skills and therapy/counseling (individual and group) intervention services. These are also the needs of the growing community, according to neighboring mental health professionals and clients in the area. There is particularly a need for services, specifically for the increasingly diverse community, and further, the growing multicultural college population. For this reason, greater emphasis will be placed on in-service trainings for students and faculty in working with diverse populations. Formative and summative evaluations will be carefully studied to determine where an increase in training may be needed and how clients feel they might be better serviced. Students will also be supported in consulting with their supervisors on their training needs and desired experiences. There will be a greater emphasis on providing even higher quality services to multicultural clients in efforts to support them more and provide the services that will allow them to achieve their goals, become aware of any weaknesses and build on their strengths. With these methods, it is believed that the SPAC will continue to grow and offer the greater community, students, and faculty what they need to work together to improve the assessment and treatment outcomes for all. Diagnosis (type) Attention Deficit/Hyperactivity Disorder Generalized Anxiety Disorder Specific Learning Disability Major Depressive Disorder Autism Spectrum Disorder Persistent Depressive Disorder Mild Neurocognitive Disorder Adjustment Disorder Post-Traumatic Stress Disorder Gifted/Talented No Diagnosis Opposition Defiance Disorder Social Anxiety Disorder Total number of clients Total number of diagnoses *These numbers represent those who also have comorbid diagnoses Ellis-Hervey , N. , Doss , A. N. , Davis , D. , & Bradford , A. ( 2016 ). The development of school psychology assessment centers as training, service delivery, and research site . Journal of Human Services , Training, Research, and Practice, 1 ( 1 ), Article 4. [Active link: http://scholarworks.sfasu.edu/cgi/vie wcontent.cgi?article=1000&context= jhstrhp] Falender , C. A. , Cornish , J. , Goodyear , R. , Hatcher , R. , Kaslow , N. J. , Leventhal , G. , Sigmon , S. T. ( 2004 ). 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Nina M P.L.P. L.S.S.P. N.C.S.P. Ellis-Hervey Ph.D., Ashley MAIO-Cert Doss B.S., DeShae Davis-Gatti M.A., Juliet Aura BS/P. Diversity Of Diagnoses And Student Learning Experiences In An On-Campus School Psychology Assessment Center: Future Directions And Focus, Journal of Multicultural Affairs, 2017,