Module 1: Navigating Assessments for Students with Complex Needs

Synthesizing Assessment Information

This section describes how to synthesize the information from various assessments into a collaborative, transdisciplinary approach. Inclusion Outreach (IO) also conducts assessments on school visits and provides reports to the educational team at the end of the visit. IO develops collaborative transdisciplinary reports to provide recommendations for creating inclusive and meaningful learning opportunities embedded in general classroom activities. These recommendations are reflective of the perspectives of multiple disciplines.

Synthesizing the information is made easier by asking questions. These are examples of some of the questions to ask to facilitate the synthesis of information:

What do the reports tell us about the student’s strengths and needs?
How can a therapy goal or recommendation be reinforced in a classroom activity?
How can therapy goals reinforce IEP objectives and vice versa?
How can a therapy goal or recommendation create opportunities for meaningful learning and inclusion?
How can the classroom activities and environments be modified to support the student?
What is the type and level of support the student will need to be successful at an activity or skill building task?
Who can you collaborate with to improve the success of identifying, developing, and implementing activities?

Note: When reading the assessments, it is vital to keep the perspective that your student is a learner and remember to presume their competence. Focus on what the student CAN do, and how they CAN learn.

Case Example
Opportunity for Practice

Case Example: Synthesis Strategies

Read through the sample neuropsychologist’s report and synthesis strategies table to view how using the questions and report information can be synthesized. This is not an exhaustive list of synthesis opportunities from the neuropsychologist’s report but does provide a glimpse at how to put all the information together.

Note: This sample report has been edited for brevity

Neuropsychological Assessment Report (Sample)
Name	Joshua Tree	Dates of Assessment	April 8 and May 15, 2020
Age at Assessment	9 years old	Date of Report	June 20, 2020
1. Reason for Referral
The student is 9 years old with a history of an early brain injury, global developmental delay, epilepsy, cerebral palsy, and bilateral hearing loss. The student was referred for an updated neuropsychological evaluation to clarify current cognitive functioning and to assist with educational programming.
2. Sources of Information
This report is based on: (1) an interview with parents (2) approximately 2.5 hours of testing (3) a follow-up interview with parents (4) a review of questionnaires completed by the parents and the school (5) a review of available school and medical records.
3. Relevant Background History
Secondary to brain injury, the student has a movement disorder (cerebral palsy with choreoathetoid movements), global developmental delay, epilepsy with a predisposition for generalized and focal onset seizures treated with valproic acid, and a moderate to severe bilateral hearing loss. The student started walking at about six years of age. The student primarily uses a wheelchair, and at times a walker, to ambulate at school. The student demonstrates ongoing difficulties with fine motor skills and does not have bowel and bladder control. The student uses American Sign Language (ASL) as their primary means of communication but will sometimes vocalize sounds or words. The parents reported that the student has a vocabulary of approximately 500 signs, which many are approximations of ASL due to difficulties with fine motor control. At the time of the assessment, the student was in Grade 4. An Individual Education Plan (IEP) is in place with a special education service designation of Physically Dependent. The student receives full-time support from educational assistants at school and has access to physiotherapy and speech-language therapy, as well as consultation services with occupational therapy, and a hearing resource teacher. The IEP noted various accommodations, including individual and small group instruction with academics, simplification and repetition of information, and use of visual cues. The student has used an iPad for communication but struggled due to motor difficulties. Language, processing speed, attention, memory, and flexibility were rated to be significant problems in school. The teacher reported that the student is starting to recognize the ability gap with peers. The student demonstrates difficulties with emotional and behavioural regulation such as crying, hyperactivity, impulsive behaviours, and becomes easily frustrated. The student struggles with transitions, changes in routine, and avoids unfavourable activities. They may slide out of the wheelchair, scream, throw hearing aids, pinch, scratch or hit others, and hit themselves in the head.
4. Behavioural Observations
The student’s attention span was very brief during testing. They were co-operative and attentive for short periods of time on simple tasks and after breaks, but inattentive, easily distracted, and fidgety throughout testing. The student would shut down as the level of difficulty increased. They seemed to respond well to encouragement, praise, and enthusiasm.
5. Cognitive Abilities
The student is able to understand simple requests and one-step instructions. They performed well below average on tasks of receptive language, comprehension, and expressive language. They have a short attention span, are easily distracted, have difficulty organizing tasks, and avoids tasks that require sustained mental effort (e.g., school work). Attention problems, hyperactivity, and impulsive behaviours have a significant impact on academic performance, behaviour, and relationships.
6. Academic Skills
Performed well below age-level expectations.
7. Emotional and Behavioural Functioning
Marked concerns regarding emotional dysregulation and aggressive behaviour. The student is often irritable, and moods change quickly.
8. Adaptive Functioning
Overall adaptive functioning was rated to be well below average with deficits in conceptual and practical skills. Social skills were rated to be an area of relative strength, albeit far below age-level expectations.
9. Impressions
Test results are felt to be a reasonable estimate of the student’s current abilities. The student was unable to complete a full measure of intelligence. Based on these findings, the student’s current level of functioning is consistent with a diagnosis of Intellectual Disability, Moderate to Severe, according to the DSM-5. The student will continue to be significantly delayed developmentally compared to other individuals of similar age, requiring high levels of supervision, support, and life-long services.
10. Recommendations
This report should be shared with the school to assist with educational programming. The student would benefit from ongoing consultation from occupational therapy, physiotherapy, speech and language therapy, and a hearing specialist to determine the need for accommodations and assistive technology at school. The student would benefit from an augmentative communication (AAC) device to supplement signing, taking into consideration motor limitations and cognitive deficits in consultation with Special Education Technology-British Columbia (SET-BC). Speak in clear, short sentences and use simple words. Keep activities brief and offer frequent breaks. Ask one question at a time and give only one-step instructions. In addition to verbal instructions, information should be presented visually with pictures, colourful illustrations, and demonstrations (e.g., modelling of skills). Academic material should be presented in a meaningful context using practical hands-on activities. Identify times when the student is alert, focused, and interested and use these “windows of opportunity for teaching.” Use “first-then” statements and offer two choices at a time. Consultation with a psychologist or behavioural consultant would be helpful to develop a behaviour support plan. The student’s responsiveness to verbal praise and connection to familiar people are strengths that can be used to promote development of functional skills.

Synthesis Strategies Table
Topic	Information	Synthesis
Current Status	Uses ASL—a primary form of communication (approximations of 500 signs) Primarily uses a wheelchair (at times a walker) at school Fine motor difficulties (hence the approximations in ASL) Background information: movement disorder—CP, global development delay, epilepsy (generalized and focal seizures), and moderate to severe bilateral hearing loss	It is important to remember that a student’s whole is greater than the sum of their parts Reports offer a wealth of information but do not fully reflect who the student is as a whole These diagnoses provide bits of information that are useful for designation (Physically Dependent) and what specialists to collaborate with (teacher for the deaf and hard of hearing), but don’t tell us who the student is, what activities they like, or what their favourite tv show is for example
Recommendations	Would benefit from ongoing support and consultation with PT, SLP, OT, and hearing specialist Ongoing accommodations and assistive technology to facilitate engagement Would benefit from an augmentative communication device Speak in clear, short sentences, use simple words, keep activities brief with frequent breaks, use verbal and visual presentation of information Academic material presented in meaningful context using hands-on activities when the student is alert, focused and interested	Gathering information from the recommendations and goals section of reports provides educators with the WHAT—what can the student educational goals be? What goals and recommendations can be pulled from the reports to weave with educational opportunities and curriculum to create meaningful learning opportunities for the student? Improve fine motor skills and hand-eye coordination by using manipulatives in a math lesson (curriculum-based, classroom activity) This is a current opportunity that has the capacity to improve future functioning—improved fine motor skills could mean easier use of AAC and improved communication with others
Goals	Neuropsychology reports generally don’t have goals, but provide information on the student’s strengths and needs Strengths—social skills, understands simple requests, and one-step instructions, responds well to encouragement and praise Needs—emotional regulation, brief attention span, transitions and change are difficult, shuts down when level of difficulty is increased, language processing speed, attention, memory, and flexibility impacted	Gathering information regarding strength and needs provides educators with the HOW—how do you achieve success in the learning activities? Learning opportunities should utilize the student’s strengths to improve or increase skills in areas of need Give simple verbal and visual information/prompting regarding a change or transition, and use praise and encouragement throughout Collaborate with specialists (such as OT, PT) to identify accommodations to maximize learning
Support	Receives full-time support from an EA Access to PT and SLP OT consultation services Consultation services from hearing resource teacher Accommodations—individual/small group instructions, simplification, and repetition of information, visual cues	Gathering information regarding support gives educators the WHO—provides the support to assist the student to achieve success and combined with the HOW gives educators the type and level of support that is most useful
Collaboration	Information is gathered from parents and school SLP, PT, OT, hearing resource teacher involved	Identifying who to collaborate with adds to the WHO—who is needed to help the student achieve success Collaboration is key for ensuring that learning opportunities are meaningful, functional, and are fully supported for success Is there a need for role release?

Opportunity for Practice: Synthesis

Using the synthesizing questions, read the sample occupational therapist’s report and identify synthesis strategies that match the topics and information provided. After you’ve matched the synthesis strategies, you can reveal the answers to see how yours compare.

Occupational Therapy Progress Update (Sample)
Student	Joshua Tree	Today's Date	December 1, 2020
Name of Professional	P.T. Barnum	Type of Service	Occupational Therapy
Overview of Therapy Goals and Progress
This OT met with the PT to review and collaborate on the student’s care plan for therapies. The student underwent bilateral hip surgery and has been recovering at home since. He has resumed some physiotherapy services and joint OT and PT pool therapy sessions have been recommended by his Vancouver Children’s Hospital rehabilitation team.
Goal 1: Through swimming and other fine motor activities and sports, the student’s hand-eye co-ordination will show signs of improvement by correctly tapping targets in the water in 90% of trials when supported by June 2022.
Goal Partially Met: The student has made great progress in hitting targets since starting swimming sessions—with approximately 60% accuracy.
Goal 2: Through swimming and other sensory processing activities, the student will use 2-3 self-regulation strategies to maintain a calm-focused-alert state for a 30-minute duration during OT sessions, with adult support by June 2022.
Goal Met: The student’s swim session was reduced to 60 minutes (from 75 minutes) which appears to have helped the student’s ability to self-regulate through the OT session. Ongoing practice is recommended to help the student maintain strategies and skills to self-regulate to a calm-focused-alert state.
Conclusion
At this time, it is recommended that the student continue with OT services next school year to continue to work towards their goals including motor skill development, mobility safety, and self-regulation.

Topic	Information	Synthesis
Current Status	Recovering from bilateral hip surgeries Pool therapy recommended for recovery	How can the classroom and activities be modified to include a student from bilateral hip surgeries? How can pool therapy be part of a class-based activity
Recommendations	Continued OT support for the coming school year Continue working on motor skill development, mobility safety, and self-regulation	What therapy goals align with IEP objectives? How can motor skill development, mobility safety, and self-regulation be strengthened by activities in the classroom? (e.g., playing catch with a classmate in gym)
Goals	Improve hand-eye co-ordination: goal partially met Improved self-regulation strategies (sessions were reduced to aid in the success of the goal): goal met	What classroom activities, tasks, or routines could reinforce hand-eye co-ordination? (e.g., using manipulatives in a math lesson) What classroom activities, tasks, or routines could reinforce self-regulation? (e.g., movement breaks Give simple verbal and visual information/prompting regarding a change or transition, and use praise and encouragement throughout Collaborate with specialists (such as OT, PT) to identify accommodations to maximize learning
Support	Adult support noted as well as OT involvement	What is the type and level of support required to support the student to success? (e.g., EA provides verbal prompting and hand under hand support for hand-eye co-ordination task Is role release required to provide the support?
Collaboration	Met with PT to collaborate on care plan for therapies Continued collaboration with PT for mobility safety	For activities that support mobility safety, collaboration with a PT who can provide guidance for safety and success

Course 4: Program Planning