Assessments that Get Services

Mitchel Perlman, PhD is a clinical forensic psychologist who will be speaking at our upcoming two-day Empowering Autism conference in Orange County, CA on June 27-28, 2014.

by Mitchel Perlman, PhD

Tired of receiving denials for services? Care to shift in a positive direction at least some of the odds toward service/funding approvals? Of course you are!

Quite often, the fault lies with the assessment itself: even, in fact, with a good (if not great) assessment. How can that be? For many reasons, but below are three of the biggest contributors.

Each agency has a different set of qualifying criteria.

If the examiner is not familiar with that agency’s criteria, the evaluation will not target what the agency needs to be addressed. Thus, while the evaluation may cover a number of pertinent issues for your child, and it may cover those issues quite well, it may at the same time entirely miss addressing the very issues that are relevant to qualifying your child for that agency’s funding/services/accommodations.

Failing to relate the Disorder to the Functional/Educational Limitation.

Having a qualifying Disorder is only a piece of what is required. One must also have very specific functional (SSI, Regional Center) or educational (School District) limitations. Even still, there is the additional requirement for the qualifying Disorder to be causal to those functional/educational limitations.

Assessment tools are quite circumscribed.

Our assessment tools are remarkably limited, and those tools are used in highly fixed ways/conditions. The examiner, then, must rely on you (the parent) to provide the information that testing cannot capture. Unfortunately, the examiner will not necessarily solicit that information from you. Therefore, parents must proactively provide the examiner with information critical to qualifying under an agency’s specific criteria (via documentation, via narrative, via video clips), and that information must be organized in a format that is both intuitive and usable to the examiner.

Each agency has a different set of qualifying criteria

Theoretically, testing is part of an investigation: i.e., an investigation that addresses very specific issues, questions, and/or concerns. As each funding/service agency has a very different set of qualifying criteria, the same report should not be generated for those different agencies. Instead, the examiner must understand the qualifying criteria for that particular agency, the data collected must address that qualifying criteria, and the report’s content must be written in the agency’s unique language (i.e., using that agency’s lingo). So, while the actual testing and the information gathered for each agency may be similar (if not virtually identical), the assessments may differ considerably in how that data/information is ultimately synthesized and reported.

Notably, examiners (and parents) are often led astray by the fact that the same or similar words are used across the agencies, but those words are not similarly defined by those agencies. A qualification of Autism using the DSM-IV (Autistic Disorder) or DSM 5 (Autism Spectrum Disorder), for example, may meet Regional Center’s definition of Autism, but may not meet the federal definition of Autistic Disorder for Supplemental Security Income (SSI), and it may not meet California’s special education definition of Autistic-like Behaviors. That confusion exists also between what SSI considers to be “Marked & Severe Functional Limitations” and what Regional Center considers to be “Significant Functional Limitations:” similar words applied dissimilarly.

Failing to relate the Disorder to the Functional/Educational Limitation

Whether seeking to qualify for Supplemental Security Income, for Regional Center funding, or for special education services, there must be impairment-related functional/educational restrictions. That is, there must be a causal relationship between the Diagnosis/Disorder and the functional/educational limitation. It is not sufficient, for example, to meet the criteria for Autism, even if the student has functional/educational limitations as well. Through data collection and information gathering, the examiner must show how the student’s symptoms of Autism directly cause (or sufficiently exacerbate) the specific functional limitations (SSI, Regional Center) or the student’s ability to be educated in general education (School District). Similarly, it isn’t sufficient to document a Processing Disorder and an ability-skill discrepancy. Instead, the examiner must document how that specific processing deficit is sufficiently responsible for that discrepant skill. For example, a clear/known causal relationship exists between Orthography (process) and Reading (academic skill), but there is little to no causal relationship between Orthography and Math. The former combination may lead to a qualification of special education under the Specific Learning Disability (SLD) handicapping condition, but the latter combination would not.

Assessment tools are quite circumscribed

Not only are assessment tools themselves limited as to what they assess and how they assess, but many students’ issues cannot be assessed by any tool: at least not under standardized conditions. The information parents can provide to the examiner, then, may be central (not supplemental) to the assessment investigation. Behaviors related to ADHD, for example, are rarely seen during the controlled environment of one-on-one testing. Instead, those behaviors are seen during group activities, and especially during less structured and/or emotionally-charged events. A ten second video clip of the student at a friend’s birthday party, then, may be infinitely more telling (and more valuable) than a four hour assessment office visit. Similarly, children with Bipolar Disorder typically thrive on the focused adult attention afforded by an assessment setting. At the examiner’s office, in fact, children with Bipolar Disorder may be quite engaging and charming. The negative side of their egocentric posture and their sense of entitlement instead surfaces when they are told, “No” by a parent, so an audio clip of their rage reaction to being denied may be one of the best forms of documentation that can be provided.

Given the above, then, it is imperative for BOTH the evaluator and the parent to have a working knowledge of what the most salient issues are that need to be addressed for the type of funding/services a parent is hoping to secure for their child. In so doing, the parent would have a better understanding of what he/she may provide to the examiner, to improve their child’s odds of getting those needed services.