The psychological referral: A procedural approach

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<ul><li><p>224 LEONARD J. MC DANIEL AND A. EDWARD AHR </p><p>done in a subtle attempt to reflect positive teacher attitudes to the group. Emphasis was also placed on stimulating a research attitude among the group. Both sessions were teacher-centered inasmuch as the teacher chose the topics for discussion and also the topics for the prepared presentation and participated in the actual dis- cussions. Frequently, questions would arise in the unstructured sessions that would be carried over to the structured sessions. The psychologist then acting as a re- source person, prepared a presentation from the professional literature. Teachers also volunteered to do library research on particular issues. General references, such as, Handbook of Education on Teaching, journals, etc., were made available to the group. </p><p>In-service teacher education as specified above, involved all three forms of communication which were interrelated as a total process. </p><p>REFERENCE QUAY, LORENE C., SHOWALTER, MIRIAM, &amp; MCDANIEL, L. A plan for school psychological services. </p><p>Unpublished paper, 1962. </p><p>THE PSYCHOLOGICAL REFERRAL: A PROCEDURAL APPROACH A. EDWARD AHR </p><p>Niles Township Department of Special Education, Linwlnwood, Illinois </p><p>Clinical assessment remains an important function in the modern school psy- chological services program but it is secondary to those areas which allow for the more efficient use of the psychologists time. These areas would include consultation services, the in-service education of teachers, research, and mental health programs for pupils and parents. Individual evaluation primarily on the basis of testing ceases to be the most important function of the school psychologist when his role is considered to be that of helping schools and teachers to become more effective in their efforts to meet the educational, social, and personal needs of all children. </p><p>In order to have the time to implement his new and expanded role, the school psychologist must make a series of decisions as to how he will deal with individual referrals. If the psychologist responds as his predecessors did, he will quickly find himself caught in the referral-testing cycle since past experience suggests that re- ferrals generally exceed available manpower. The psychologist in the schools must partially extinguish this testing response which has been conditioned with con- tinuous reinforcement if he is to significantly reduce or change the referral expecta- tions of school personnel. </p><p>He must begin by communicating in both word and action the understanding that referral does not automatically lead to testing. If it does, the psychologist has forfeited his obligation to exercise clinical judgment, resulting in a mechanical, time- consuming reaction which obviates the initiation of a total school psychology pro- gram. The discretion of the psychologist should determine if and when individual testing will make an educational difference or if it is necessary a t all. Other pro- cedures may be available to collect sufficient information which will result in as </p></li><li><p>THE PSYCHOLOGICAL REFERRAL : A PROCEDURAL APPROACH 225 </p><p>much, if not more, functional data with which to handle the present situation and its antecedent aspects. </p><p>The school psychologist must assert himself a t the administrative level on key issues which affect his program. Table 1 depicts an outline of procedures cooperative- ly developed by a school district and its psychologist which has proven invaluable in responding to referrals for psychological services. This outline serves as a guide in obtaining essential information prior to or in lieu of an individual examination. In addition, it breaks the rigid referral-testing cycle, allowing the psychologist adequate freedom to engage in undertakings which could have a broader impact on the school policy, organization, curriculum, teaching methods, and classroom management. </p><p>TABLE 1. PROCEDURES PRIOR M OR IN LIEU OF INDIVIDUAL EVALUATION </p><p>Level Step Procedure </p><p>1. 2. </p><p>I </p><p>3. 4. 5. </p><p>I1 6. 7. 8. 9. </p><p>111 10. 11. 12. </p><p>IV 13. </p><p>Review written referral by teacher Discuss cme with special service personnel Review school record Observe student and work samples Confer with school personnel Hold parent interview Secure previous medical or psychological reporta Obtain health history Obtain social history Refer to school psychometrist Refer to Special Education psychologist Refer to community agency or private practitioner Assume responsibility for individual evaluation </p><p>Note.-Regardless the level at which the sequence of procedures is terminated, the following eteps are mandatory: </p><p>(-4) school staffing; (B) parent conference; and (C) follow-up. </p><p>It should be noted that the procedures are listed in a specific order representing various levels where the collection of data may be terminated. Should the problem persist, although recommendations and subsequent modifications were attempted for a reasonable amount of time, the next level of procedures would be activated. In discussing these procedures it must be recognized that flexibility is implicit if the psychologist is to function in a professional manner. His procedure may vary from child to child or from teacher to teacher. The psychologist selects from a reservoir of specialized knowledge, skills, and techniques that which appears most appropriate. Thus, he does not do the same thing in every situation, i. e., individual testing. </p><p>Initially, school personnel regarded this procedural approach as overly-cautious and as leading to a lag in psychological services of the type to which they had been accustomed. Previous psychologists had functioned primarily as psychometrists with the customary automatic referral-testing habit. However, once the personnel of the school had witnessed the way in which the psychologist was able to con- tribute to the school as a whole, care had to be taken to avoid the complete and total deemphasis of individual evaluation. </p><p>Level I consists of five activities which can be accomplished within the realm of normal school functioning without unduly alarming parents during this initial phase. It is mainly a data-gathering or screening process but it insures the use of </p></li><li><p>226 A . EDWARD AHR </p><p>several sources of information. Furthermore, the psychologist is less likely to un- wittingly deny himself behavioral information if he screens cases more thoroughly a t their outset. </p><p>LEVEL I A well designed referral form assists the teacher in reflecting upon the </p><p>many aspects of a childs behavior rather than limiting him to one area of concern. It enlarges his perspective, and the written responses tend to reduce exaggerated statements and to tone down otherwise cmotioiially laden verbal statements which are associated with some incidents. </p><p>Consultation with other special service personnel serves a twofold purpose. If the pupil is receiving some type of assistance, an attempt must be made to avoid duplication of service, while allowing for a complementary function if advisable. Should no other service be involved, the psychologist may later wish to make such a referral within the school setting. </p><p>A review of the cumulative record affords the psychologist an op- portunity to make an objective, longitudinal appraisal of the childs school history. It may serve as a check on the current teachers evaluation and may delineate certain patterns of behavior which are more meaningful than the isolated incidents or re- marks submitted by one teacher. </p><p>The child is first seen in the classroom to witness his hehavior in a group setting and to observe varied school work samples. Cognizant of the reason for referral, prior school information, and extra services and modifications currently being employed, the psychologist is now in a position to bring to bear his specialized training on the stated problem. </p><p>At this point a teacher and principal conference is essential for eff ective feedback in terms of consolidation and summarization of present information. A discussion a t this point can lead to the elimination of certain factors as inoperative on the basis of preliminary information, and the identification of the most probable hypotheses to account for the students problem. Tentative recommendations can be offered and implemented in lieu of an individual evaluation. I n such a case the next three levels (11-IV) would be bypassed and the following final three steps com- pleted. </p><p>A school stufing involving all school personnel who have contact with the student during the current year would discuss the child, his identified prob- lem, and how to implement the recommendations. This is an example of in- creasing the psychologists effectiveness through indirectly helping children by direct influence upon the teachers that they will come in contact with. </p><p>The staffing is followed by a parent conference (preferably with both parents), where the child, his apparent school problem, and the current recom- mendations are discussed. It is made clear, however, that should the present situation fail t o change, the parents will be asked to take a more active part in assisting the school to remedy the students problem. </p><p>Follow-up procedures are then initiated by the psychologist so that a determination may later be made by school personnel to determine the effective- ness of the present recommendations. </p><p>Step 1 . </p><p>Step 2. </p><p>Step 3. </p><p>Step 4. </p><p>Step 5 . </p><p>(A) </p><p>(B) </p><p>(C) </p></li><li><p>THE PSYCHOLOGICAL REFERRAL: A PROCEDURAL APPROACH 227 </p><p>LEVEL I1 If the decision made at the end of the Level I activities subsequently </p><p>does not appear to deal adequately with the case, or if it is decided that an individual evaluation might make an educational difference, then parental permission should be obtained for such a psychological examination. There are many reasons why parental permission for a psychological evaluation should be requested but three should suffice. First, it is a matter of courtesy to keep parents informed of school action pertaining to their child. Second, the parents cooperation and additional information may be secured. Third, written permission can serve as a precautionary measure, if needed, for the protection of the psychologist and school. </p><p>To avoid duplication of community effort the psychologist inquires to determine whether or not any previous medical or psychological reports are avail- able. If so, the parents are asked to sign a release form so that such information may be secured and the school may cooperate with the agency or private prac- titioner. </p><p>Although the school nurses records will contain some medical informa- tion regarding the child, this material usually consists of a general statement based on a cursory examination by a physician to comply with the states requirement for a physicians examination at various intervals. Therefore, it is necessary for the nurse to obtain a detailed health history from the parents to gain adequate referral information. A second contribution is made by the nurse when she indicates whether she thinks the elicited information is reliable and valid. </p><p>If a social worker is employed in the school district and there is general agreement that a social history will contribute to the total picture, such data should be obtained. </p><p>Based upon the information gleaned from the procedures in Level I1 enough data may be available to initiate the final three steps mentioned previously. If not, the plan continues. Depending on the reason for the referral or felt need for an in- dividual evaluation, the local school psychologist may consider the following alternatives. </p><p>Step 6. </p><p>Step 7 . </p><p>Step 8. </p><p>Step 9. </p><p>LEVEL I11 If the nature of the problem seems limited, the child could be referred </p><p>to the school psychometrist, if one is employed. If the youngster appears to be a likely candidate for some service or </p><p>class offered through the Department of Special Education, referral could be made to that department if this were a large district or joint agreement. </p><p>The parents should be given the opportunity to go to a private practitioner if they so desire. Or, in the case of younger children with emotional problems, it may be advisable to refer the parents directly to a community agency or a variety of private practitioners if it appears likely it will eventually be necessary for them to be involved in a therapeutic setting. </p><p>If the request was accepted by one of these individuals or agencies, (steps 10-12), the final three steps (i.e., staffing, parent conference, and follow-up) would follow as usual after receipt of reports and discussions with such individuals. Through the </p><p>Step 10. </p><p>Step 1 1 . </p><p>Step 12. </p></li><li><p>228 A . EDWARD AHR </p><p>utilization of other school and community resources, the school psychologist is able to emphasize and play a broader role in the schools, stressing positive mental health and the prevention of more serious problems. </p><p>LEVEL IV </p><p>Should the parents not wish to go to an outside source or if a referral was refused for any reason, then the local school psychologist would assume re- sponsibility for the individual evaluation. </p><p>The school psychologist functions in a setting wherein the provision of a positive mental health program could potentially have far reaching effects on the youth of our nation. Such a program cannot be achieved, much less initiated, until psychol- ogists come to the realization that the one-to-one paradigm involved in the referral- testing cycle does not provide a sound model for a school mental health program. </p><p>Step I S . </p><p>DISCRIMINANT ANALYSIS OF ACHIEVEMENT PROFILES OF SOCIALLY MALADJUSTED PUPILS </p><p>DONALD A. LETON AND MARGARET HOLZ' </p><p>University of Hawaii Los Angeles City Schools </p><p>Criteria for grouping students in classes for socially maladjusted and emotion- ally disturbed are not clearly formulated nor experimentally validated at the present time. Various professional personnel, e.g., principals, teachers, social workers, counselors and psychologists, are all instrumetal in effecting the placement of such pupils. In referring pupils for social adjustment classes, teachers tend to consider classroom behavior and academic deficiencies as major factors in defining social maladjustment. Other specialists tend to consider such factors as relationship inadequacies, withdrawal and aggressive behavior, emotional immaturity, defective superegos, and sociopathic disturbances, as criteria for such classification. This situation has led to inconsistent standards of eligibility, and to heterogeneous groups of students in adjustment classes. </p><p>The socio-emotional criteria used by guidance specialists tend to be qualitative and subjective, whereas the classroom behavior and achievement criteria can be quantified. If the socio-emotional criteria were independent of achievement and classroom performance then two distinct bases of selection would exist. Since they are confounded in the child's personality, however, they cannot be considered separately. In a normal classroom situation...</p></li></ul>

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