Contracting for School Psychological Services in New York State

New York state school psychologists continue to misunderstand the issues related to contracting for services.  This is problematic, because other who are in a position of authority tend to misrepresent what is old news. 

To begin with, districts have unique systems that allow them to subcontract other agencies or individuals to provide services when schools cannot do so (typically through BOCES although private contractors are used in some LEA's such as the NYC DOE).  For example, a district can seek an outside contractor if there is a student who is deaf or hard of hearing and if they can demonstrate that they do not employ school psychologists with the expertise to evaluate a student with those needs (and if there are no interpreters within the district). 

Somehow, people in the field have begun to worry that this practice can eliminate the employment of school psychologists by districts.  

Nothing could be farther than the truth.

The issue of a district eliminating school psychologists and contracting for their services has already been challenged at the state level and the New York State Educational Department (NYSED) has consistently ruled that a district has no authority to eliminate a position and contract for the same services provided by these professionals.

My goal is to disseminate some of the rulings by the Education Commissioner which highlight that this practice runs counter to Education Law.  I'll begin with one ruling and will continue onwards.

On particular ruling (Maxine Davis v. Westport School District http://www.counsel.nysed.gov/Decisions/volume39/d14234.htm)

involves a school psychologist who was employed full time by the district for five years and then .6 for the year after that.  After that year, the position was eliminated. 

At that time, the district also contracted with an agency that provided substance abuse prevention services who placed one of their employees in the school to provide services to children. 

While the district maintained that the services that the agency staff provided (on school grounds) were different than those that were provided by the school psychologist, attorneys for Maxine Davis disagreed.  They stated that the services that the agency person provided included:

Counseling services to students with existing alcohol, tobacco, or other drug abuse concerns. Additional services are provided in the areas of individual counseling, student assessment, family contacts, recommendations for referrals to other needed services in the community, student support groups such as Banana Splits and Students Against Drunk Drivers (SADD), peer mediation or related training, faculty, staff, parent training, and assistance with planning and carrying out positive alternative activities.

The Education Commissioner, of course, ruled that the school psychologist needed to be reinstated immediately and paid back-pay.

In ruling on this case, the Commissioner cited a few cases that are important for all school psychologists to keep in mind.

• Mairs v. Board of Education - Affirmed NYS Education Law which states that if a district eliminates a position and creates another position whose duties are similar to those performed by the person whose position was eliminated, then the person holding such position at the time of its abolition shall be appointed to the newly created position.

• Matter of Friedman - This is the first ruling that indicated that a school board has no authority to eliminate a position and contract out for the same services. It further provides a strong rationale for having a school psychologist as an integrated member of the school team, as opposed to a contracted professional that is not integrated into the school.   It goes on to indicate that the duties of a school psychologist are pedagogical in nature and since a board of education has no general authorization to contract for instructional services then all school districts must continue to employ certified school psychologists to perform those duties which are truly instructional in nature, including serving on the CSE and providing psychological evaluations and counseling. This decision continues to be referenced whenever there is even a hint of using independent contractors to provide school psychological services. 

• Appeal of Spataro - Affirmed that a district may not ignore the tenure rights of its employees by attempting to contract with an independent contractor to perform the same services previously performed by its tenured staff.

I strongly suggest that all school psychologists who are employed in New York state familiarize themselves with this case and reference the document located at: http://nyasp.org/pdf/cutting_sps.pdf  which offers some more information contracting for services.

I'd encourage you to share this information widely with your colleagues, peers and administrators, as well as other individuals in positions of authority.

Mental Health is the Issue

This shooting in Connecticut has affected us all.  And in the rush to deal with this tragedy, invariably the public will focus on guns and gun control.

Doing so, I feel, will probably sidetrack the issue as to how we can deliver mental health services to more people (and especially children) in a better and more efficient way.

The gun issue is nuanced.  Some countries actually have more guns per capita than the United States.  That's true, but there are major conditions placed on the citizens in those countries , both before and after guns are purchased.  It's true that gun related violence is not prevalent in those countries, but, at least in Israel, the rates of gun related suicide are quite high.

But, violence occurs at high rates in other countries where it is nearly impossible to obtain a gun.  Remarkably, on the same day that we witnessed the horror at Sandy Hook elementary in Newton, the residents of the Guangshan county in the city of Xinyang also dealt with a tragedy that defied logic.  Twenty-two children were attacked by a knife-wielding individual outside the gates of the Chenpeng Village Primary School.

Just to be clear, I do agree that gun laws need to be stricter.  But we should not let the conversation move away from mental health.

In many ways, we may be very similar to China.  Our lives are stressful.  There is a wide gulf between the rich and poor, and workers in all countries are not treated fairly, leading to high rates of poverty. We move a lot within our country's borders, which erodes our social support.  "Back in the day", when we didn't move all that much, children found support in extended family.  That extended family is not always so close in today's day.  And there is a lack of psychological support in the schools and in the community at large.

In addition (while I can't speak for China), I know that we are, as a people very mean to one another.  We get angry way too easily.  We value winning an argument, at any cost, than coming to a realistic resolution.   This narrative dominates our political discourse, but it also has trickled into our daily lives.  Along with the environmental stressors that we are all experiencing, we are just not nice to one another.  And if we are all experiencing this distress, the effects should be more intense for children and adults with mental illness.

This isn't an argument for excusing the actions of what these attackers committed in Connecticut and in Xinyang.   But, if these people had been able to access the psychological support in their schools, communities and clinics in their area, perhaps we would not have had these tragedies.   Chilling statistics on the National Alliance on Mental Illness website remind us that:

Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment. An untreated mental disorder can lead to a more severe, more difficult to treat illness and to the development of co-occurring mental illnesses.

and:

In any given year, only 20 percent of children with mental disorders are identified and receive mental health services.

Organizations such as New York Association of School Psychologists (NYASP) and the National Association of School Psychologists (NASP) have worked hard to help school professionals and families deal with these disparities.  They were some of the first groups to post helpful resources to help the families, friends and children that were dealing with the aftermath of the Sandy Hook massacre.  And they continue to advocate for legislative solutions to close this mental health gap.

The real conversation here is how we can have more people access more mental health services in our attempt to prevent these types of tragedies from occurring again in the future.

Functional Communication Training for Children with Autism Spectrum Disorders

Children with autism struggle with communication issues.  While these children often evidence social skills deficits and repetitive/stereotypical behaviors, many of these problem areas can be remediated if the child is taught how to use language functionally.

A functional use of language is something that is difficult to teach in the classroom, but it can be managed through appropriate procedures and strategies. We often “measure” language by asking parents and staff to identify how many words a particular child may speak; programs are then developed to increase the number of words which children on the spectrum speak.

However, this measure of assessing language in children on the spectrum (i.e., a total amount of vocabulary) gives an incomplete picture of the nature of the child’s strengths and weaknesses – it is a good start to teach vocabulary, but we need to go beyond that.

Our studies of evolutionary psychology indicate that humans are a species that uses tools; it is this tool use that sets us apart from other mammals and other species.  Language is another tool that we use to obtain what we want from the environment.

While some children speak too little and others too much, what all these children on the spectrum share is the inability to use language effectively as a tool to actualize their goals.  Some children do not have enough words to express themselves – these students need to be taught more words and when these words should be used.  Others have so many words that they do not know which ones to choose to express themselves – these students need assistance in choosing their words and using them at appropriate times.

In the absence of efficient methods of communication, many children on the spectrum resort to other means to actualize their goals.  These means are often interpreted by many of us in the schools to be destructive, rude or disrespectful.  But, using words as tools to actualize their goals is a concept that is difficult for them to understand.  So, they often perform other actions to obtain their goals.  In the most severe cases, they will injure themselves in horrific ways.  In other cases, they may yell, scream, throw things or perform any other set of actions that would be considered a “meltdown” or “tantrum”.

Fortunately there are many guides out there that are easily written and can help the practicing school psychologist.  Mark Durand’s Severe Behavior Problems: A Functional Communication Training Approach is an excellent book that has helped me tremendously when implementing Functional communication training (FCT).

FCT is a set of procedures that teach communication skills to the child as a replacement to the inappropriate actions with which he is engaging.  Central to FCT is the idea that child perform challenging responses to the environment when they: 1) lack the communication skills to convey their intent or 2) do not know which specific communication patterns should be used to convey their intent.

For example, one of the children with which our team is currently working had a goal of using the word “no” to stop activities which he did not enjoy.  While this goal may appear to be counter-intuitive, we wanted the word “no” to replace what his current response at the time was: biting staff members until their skin broke.  Conceptually, it was important for us to understand that while his reaction was extreme, his biting was the tool he used to stop activities .  Our goal was to teach him how to use another tool, which would actualize the same goal (stopping activities) better and more efficiently.

Typically, when this student was presented with a task that he usually avoided (i.e., math), he often bit staff.  What we had done initially is as he would lean in to bite, we gave him the command “Say no”.
At first any sound was rewarded with a cessation of the activity and a loud proclamation from the staff member indicating “OK, all done!”.  We walked away quickly and gave him a break for 2 – 3 minutes.  After he learned to just make a sound and not bite, we required that he approximate the sound “n”.  Soon after we ratcheted up the demands and required he say “no”, which lead to “no more” and then “no more, please”.

Our next step was to identify what aspects of the activity (math, in this instance) was so aversive, and we worked to teach him the component skills that he lacked so that he may perform the activity in the future.

Visual strategies can be used in addition to FCT or instead of FCT.  For example,  with another child, our team has developed a visual strip of common phrases that one particular child can use (e.g., “No thank you”, “Yes, please”, etc.).  When the targeted child is asked a question, he is pointed to the particular menu of phrases that he can use.  The student then can scan the phrases and can select the one he can use.  Our team does require that he use the words; failure to do so would have him too dependent on the strip.  Two very useful resources for these sets of procedures are A Picture's Worth: PECS and Other Visual Communication Strategies in Autism by Andy Bondy and Lori Frost and Visual Strategies for Improving Communication: Practical Supports for School & Home by Linda A. Hodgdon.

Overall, teaching children with autism better alternatives for communication can greatly enhance their social skills, advocacy and overall life satisfaction.

Don't be Afraid of the New Autism Diagnosis

Cathy Lord, in a piece that she wrote for the Huffington Post, said:

In the DSM-5, we propose a new way of looking at these disorders, merging them into a single diagnosis of autism spectrum disorder. We believe this will create more accurate diagnoses and improved access to services. It should also improve research into ASD, because there will be less diagnostic confusion

And I agree.  I feel that there has be undue anxiety regarding a variety of issues.  There are a host of reasons why these changes are being implemented.  For example:

1. Research suggested that there was considerable confusion among researchers, doctors, psychologists and psychiatrists regarding the criteria of PDD-NOS, Autistic Disorder, and Asperger Disorder.  Often we saw "graduations" of one disorder into the other, which tended to be problematic, often leaving people with the complex task of attempting to identify a label instead of looking to begin interventions and help the children and adults in need.
2. Emergent research suggests that Asperger Disorder and Autistic Disorder, as currently defined in the DSM-IV differ only in levels of language and/or IQ (one may argue that IQ as a construct is heavily influences by language, but that is a debate that I would leave for some of my other colleagues).  The Neurodevelopmental group of the DSM-5 argued that they did not want  diagnostic decisions to be based on IQ or language. One can argue that there is a paucity of studies that have looked at this difference (Relying on memory, I can recall roughly 15 articles in the period from 1994 - 2012), and I would argue that the reason more research is not being published in peer-review publications is that these studies are finding no difference except in language and IQ.  
3. Others have bemoaned the fact that there the DSM is dropping Childhood Disintegrative Disorder (CDD).  While there isn't a good base of experimental data to support this difference, we see that emergent case study research suggests that CDD is probably the norm.  That is to say, the group hypothesized that autism is an auto-immune disorder which kicks in within the first few months of a child's life, similar to MS which kicks in in the fourth decade of someone's life.  This might explain parents' descriptions of the disorder.  A fascinating hypothesis, which may be the key to explaining such parental reports.

I agree with Cathy Lord and the work that her Neurodevelopmental group has engaged in.

School Psychologist

"What is a school psychologist?" people often ask me  - this great piece is a nice succinct description of what school psychologists do!  Check it out!

The development of mands

Over the last few weeks, I have been thinking about the development of the mand reptetoire in all children.  Typically we discuss how the mand develops in children on the spectrum, but it appears that we need to look at other issues as well.

For example, how does the mand develop in response to motor development - for example, does the development of the ambulation repetoire affect the mand repetoire in any discernable manner?  If I can walk, and experience more of the environment, will I not want more of it?  And will I not ask for more?  So if the motor skills of a child are impaired, then these children will not necessarily see as much of the world and by consequence, not mand for it.

Just some Sunday evening thoughts...

Autism Caught On Tape -- Computer Scientists Use Technology To Help Children With Autism

ScienceDaily -- Computer scientists have devised two tools to help people interact with autistic children. Videotaping interactions allows teachers or parents to replay situations and evaluate the cause of particularly good or bad behavior. Cataloging actual data, rather relying on memory or interpretation, proves to be a more accurate measure of a situation.

How Schools, Parents Can Work Together For Successful Kids

ScienceDaily (2009-08-18) -- It is widely understood that, ideally, schools and parents should work together to ensure that children can succeed as students and citizens. But what is the right balance? And how much do teachers want parents involved in the classroom? A new study identifies ways that schools and communities can work with parents to give children the greatest chance of success.

Overt and covert behavior

The term "behavior" has been misrepresented and misinterpreted by many in the school psychology field, including proponents as well as opponents of behavior analysis. Proponents have used the term too loosely, while opponents have used a bit of a warped definition to attack the field.

Furthermore, school psychologists as well as behavior analysts have also taken a very narrow view of the definition of behavior.

According to Cooper, Heron, and Heward (2007), in order for a phenomenon to be considered a behavior, we need to have several conditions:

1. there must be a part of the organism which is moving.
2. there must be a change in the environment as a result of this movement.

With this, it is easy to see that throwing a desk or completion of homework are behaviors. However, some individuals in the field develop behavior plans based on the lack of a behavior, such as "not doing homework" and "not throwing a desk as targets or goals of behavior plans.

That is not going to work.

You need to target behaviors constantly. You may want to reduce certain behaviors or increase other ones, but you want to target behaviors or to set behaviors as goals - not non-behaviors.

Let's look at reading, something that is often not considered to be a behavior. While reading, there is movement of the lips, tongue, and vocal chords. After the behavior is done, there is a transformation of the sound waves in the environment, which informs us that we have had a behavior occur.

Ahh, someone would say - that only counts if the person is reading out loud. What if the person is reading silently.

Yes, it is sticky, but not unmanageable. If one is reading silently, thinking, feeling mad, or examining a beautiful painting, there are neurotransmitters which are being released and activating neurons. After the neurosynaptic reaction the brain is different than what it was prior to starting the behavior. Therefore, these activities qualify as a behavior.

Overt behaviors are those that anyone can observe, while covert behaviors are those that only the organism can examine.

More on this after a bit....

Rehab

There was an interesting article on the CNN website that lamented that Lohan and Spears were making a "mockery" of the entire rehab process.

Did it really take a strung out actress and a singer past her prime to do that?

Not that I feel bad for them, but really - how much of this is the fact that two good-looking girls are going all out and crazy as opposed to two guys?

There is hardly a tree in the New York suburb of Suffolk that has not been crashed into by a car owned by Bily Joel. And hardly a drug that Robert Downing Jr. has not used to excess.

I wonder about rehab. Does it really work? Are there studies out there that allow us to examine the efficacy and effectiveness of the most commonly used procedures in drug and alcohol treatment? Alcoholics Anonymous does not allow for independent research to examine these aspects of their treatment.

Furthermore, any individual who does question AA is often sent for re-training (at least here in New York). These re-training sessions are similar to the re-education camps that Mao Zedong sent those who opposed the Communist party.

At its core, rehab attempts to stop behaviors, and gives very few skills to replace behaviors. I mean, seriously, does playing squash really take the place of a good drink? (see the ads of TV and in our schools: "Do sports, don't drink").

Rehab is in essence a bunch of DRA procedures- a differential reinforcement of alternative behaviors. People are reinforced for playing ping pong as opposed to drinking or smoking pot.

The problem is that you can do both at the same time. Hey - just look at Sunday softball games - they are designed so you can drink and play at the same time. And Keith Hernandez, legendary baseball player of the 80's used to pop into the dugout between innings to down a cold and snort a line or two.

The issue which people in the rehab treatment community don't really get is that there is really nothing out there which is as reinforcing as drugs or alcohol. There is nothing really that can replace it.

Maybe it might be better to help these people change their environment, permanently. Rehab is a place that these people use which (to borrow a word from the field) "enables" these people. It changes their environment temporarily, allows people to feel falsely secure in this new environment, and discourages people from actually making changes.

It does, however, allow these people to talk about the changes that they want to make. But talking isnt doing.

So, when we blame Brittney Spears or Lindsay Lohan for "making a mockery" of rehab, consider that maybe the intervention of rehab is flawed. Where is the evidence?