Va-LEND: Collaborating with Rural School Divisions to Train Interdisciplinary Autism Assessment Teams

1
Va-LEND Collaborating with Rural School
Divisions to Train Interdisciplinary Autism
Assessment Teams Donald Oswald,1 Joann Bodurtha,1
Donna Gilles,1 Judy Sorrell,2 Jessica Philips,3
John Prickett3 1Virginia Leadership Education
in Neurodevelopmental Disabilities (Va-LEND), 2
Shenandoah Valley Regional Program (SVRP), 3
Commonwealth Autism Service (CAS)
Results Evaluation data indicated that trainees
achieved the identified objectives and were
satisfied with the training provided (see Table
2.). The project yielded a functioning Regional
Autism Assessment team that has, over the period
of 10 months, contributed to the eligibility
determination and intervention planning / IEP
development of 10 children (see Figure 2.).
Assessments routinely included Administration
of the ADOS and ADI-R Classroom
observation Informal assessment by
Speech/Language Pathologist and Occupational
Therapists The assessments yielded a report
which was submitted to the childs eligibility
team and a member of the RAAT routinely
participated in the eligibility meeting to
discuss assessment results. Clinic evaluation
data indicated that most parents were satisfied
with the assessment process and the resulting
report. Eleven physicians and one allied health
professional participated in the dinner meeting.
In addition to an introduction to the RAAT,
participants received copies of the American
Academy of Pediatrics Toolkit, Caring for
Children With Autism Spectrum Disorders A
Resource Toolkit for Clinicians, and information
about the Autism Treatment Network and the Autism
Intervention Research Network on Physical
Health
Introduction There is general agreement that
children with Autism Spectrum Disorders (ASDs)
who receive early diagnosis and intervention
experience better outcomes (Zwaigenbaum, 2010).
Interdisciplinary diagnostic assessment is the
accepted state of the art for diagnostic
evaluation of young children. Rural school
divisions face particular challenges in providing
interdisciplinary assessment and intervention.
There is evidence that local teams can be
successfully trained to provide high-quality
assessments of children with ASDs (McClure,
MacKay, Mamdani, McCaughey, 2010) The goal of
the project was to identify children with ASDs at
an earlier age by training a school-based
Interdisciplinary team to administer
gold-standard, autism-specific assessments in
order to achieve reliable diagnostic decisions to
be used by Local Education Agencies (LEAs) for
the purposes of eligibility and IEP
development. Va-LEND, CAS, and SVRP, a regional
special education program, collaborated in
planning and developing a school-based
interdisciplinary assessment service, the
Regional Autism Assessment Team (RAAT). The
objectives of the collaboration were to train
assessment team members in (a) the use of
reliable, gold-standard diagnostic assessment
instruments (b) interdisciplinary team
functioning and family centered practice (c)
integrating disciplinary perspectives and
disciplinary contributions to the diagnostic
assessment process. The project also sought to
clarify the role of local primary care providers
in the screening and interdisciplinary assessment
process, emphasizing primary care as the starting
point. Local primary care physicians are a
critical link in the process and project staff
worked to integrate them into the process.
Figure 2.

• Table 2. Training evaluation data
• Before session questions about how well informed
  individuals were about the topic(s) included in
  the training ranged from not at all to somewhat.
  After session responses to the same questions
  ranged from somewhat to well informed about
  specific training topic(s), with nearly all
  participants showing increased information/knowled
  ge about the training topic(s).
• 100 of training participants (n27) Agreed or
  Strongly Agreed that the information presented
  in the training was useful, clear and
  understandable, and would change their
  practice/behavior.
• 100 of training participants Agreed or
  Strongly Agreed that they were satisfied with
  the overall training and that effective training
  tools were used

• Methods
• A school-based interdisciplinary regional autism
  assessment team was formed at the SVRP the team
  included school psychologists, speech and
  language therapists, occupational therapists,
  school social workers and behavior analysts from
  six rural school divisions.
• School-based assessment team members were
  enrolled as medium-term Va-LEND trainees and
  received formal training in the following areas
• Autism Diagnostic Observation Schedule (ADOS)
  administration and coding
• Autism Diagnostic Interview Revised (ADI-R)
  administration and coding
• Interdisciplinary team functioning (see Table 1.)
• Family-Centered Practice
• Interdisciplinary Assessment Role of the
  Occupational Therapist
• ADOS - Consensus coding
• Evidence-Based Practice
• To provide support and mentoring for trainees,
  school-based assessment team trainees observed an
  evaluation at the VCU Developmental Disorders
  Assessment Clinic and Va-LEND training team
  members observed two evaluations at the
  Shenandoah Valley Regional Program site.
• SVRP and CAS staff worked with local school
  division personnel to devise an administrative
  process for referral to the assessment team and
  for feedback of assessment results to the childs
  eligibility team (See Figure 1.)
• A dinner meeting was held for primary care
  physicians in the region to provide information
  about screening for ASDs and to introduce them to
  the RAAT.

• Discussion
• Barriers to effective early identification are
  significant, but smooth and accessible processes
  can improve transitions from evaluation to
  school-based intervention. The project sought to
  address the following barriers
• There is typically a long wait for external
  evaluations.
• The results of external evaluations may not
  translate easily into educational plans.
• External evaluations may foster an adversarial
  relationship between parents and school
  personnel.
• Single-discipline evaluations may not capture the
  complexity of the childs ability / disability
  profile.
• We chose to develop a modification of the school
  evaluation process as the means to address these
  barriers.
• Issues encountered in the implementation of the
  project including
• administrative concerns of participating school
  divisions about the quality of the reports from
  outside assessments, delays, etc.
• distinguishing a clinical evaluation from an
  educational assessment
• advertisement / marketing of the service
• advantages of ongoing contact with the children
  and families through school services
• possibility of further comprehensive
  single-discipline evaluations (e.g., in-depth OT
  and Speech/ Language evaluations if needed).
• The vision of the collaborators is to extend the
  project to other parts of the state.

Figure 1.
References Guralnick, M.J. (2000).
Interdisciplinary clinical assessment of young
children with developmental disabilities.
Baltimor,e MD Paul H. Brookes Publishing
Co. McClure, I., MacKay, T., Mamdani, H.,
McCaughey, R. (2010). A comparison of a
specialist autism spectrum disorder assessment
team with local assessment teams. Autism, 14,
115. Zwaigenbaum, L. (2010). Advances in the
early detection of autism. Current Opinion in
Neurology, 23, 97-102.

• Table 1. Principles of interdisciplinary team
  assessment
• Ecological validity of assessments
• Recognizing uncertainty
• Coordination and nonredundant testing
• Dynamic nature of the assessment
• Respect for contributions of other disciplines
• Cultural competence
• Role of the family
• Role of community providers
• Inclusion and support