Abstract
Students with low-incidence disabilities frequently receive less than optimal psychoeducational services because the specialized tests and instructional materials required to meet their idiosyncratic needs often are unavailable due to budget constraints, inadequate training of school personnel, and the difficulty school personnel have keeping current on low-incidence disabilities. To enhance the services provided for these students, a centralized statewide lending library for school personnel serving students with low-incidence disabilities was implemented. The development of this project, its impact, and the needs of school personnel in the area of low-incidence disabilities are described.
Despite the federal mandate to schools to provide a free, appropriate public education for students with disabilities (Individuals With Disabilities Education Improvement Act [IDEA], 2004), students with low-incidence disabilities often receive limited services, particularly in rural school districts where resources are fewer than in larger districts (Bowen & Ferrell, 2003). Students with a vision, hearing, or motor impairment; a severe cognitive impairment (CI); autism spectrum disorder (ASD); or multiple disabilities have unique needs. If their instructional programs are based on individualized assessment results specifying their particular strengths and areas of difficulty, instruction is more likely to be effective. Obtaining a realistic profile of a student’s performance is critical to documenting change as a function of instruction (Campbell, Reilly, & Henley, 2008). Most traditional assessment measures are inappropriate for these populations (Simeonsson & Scarborough, 2001). For example, administering a standard test to a student with visual impairments puts this student at a disadvantage. Thus, specialized tests are necessary, many of which are very costly. Some test kits cost as much as US$2,000 and some test record books are US$35 each. Typically, more expensive record books can be used several times with one student to monitor progress and plan future instruction, yet the initial cost is substantial. Because of the expense and the low-incidence of such referrals, such specialized resources are frequently unavailable in many school districts.
As Cole and Shapiro (2005) noted, some of the greatest challenges school psychologists face involve serving students with low-incidence disabilities. These students require the most specialized type of assessment and instruction to learn even basic skills. Many with severe sensory, motor, or CIs are likely to have multiple disabilities, including behavioral difficulties, which further complicate the provision of appropriate instruction. These students present complicated problems requiring the most sophisticated psychoeducational assessment. Unfortunately their assessments are too often the least thorough, least appropriate, and least useful in terms of planning instruction. Unfortunately too often in assessment reports these students are described as untestable. A more accurate statement may be that examiners were ill equipped and unprepared for assessing these students.
Besides the lack of specialized tests and instructional materials, another complication is that the curriculum in school psychology training programs rarely addresses low-incidence disabilities. Because of the infrequent occurrence of these disabilities, this area is not a priority in most training programs. In two national surveys of trainers and practitioners in the United States, Cole and Shapiro (2005) found very few school psychology programs provide the opportunity for concentrated study in low-incidence disabilities. Consequently, a shortage of school psychologists with the skills required to meet the unique needs of students with low-incidence disabilities exists. Furthermore, because of the low rate of such referrals, school psychologists who have received training in this area may have difficulty maintaining their skills and keeping up with advances in research concerning low-incidence disabilities.
In response to these concerns, we conducted a needs assessment with all directors of special education in intermediate school districts in a Midwestern state. The focus of the mail survey was on areas where directors felt assistance was necessary in meeting the needs of students with low-incidence disabilities. The Tailored Design Method (Dillman, 2006) was used for the survey resulting in a return rate of 61%. Eighty-five percent of respondents indicated they needed the most help in psychoeducational assessment, augmentative or alternative communication systems, and physical therapy. Directors of special education in urban areas with major medical centers indicated little need for assistance. However, directors in smaller districts, particularly rural areas, indicated that considerable help was needed.
Based on the survey results, we developed a proposal for a statewide lending library and consultation center for students with low-incidence disabilities. The project was sanctioned by the state legislature and funded through the state department of education. The lending library supplements current psychoeducational services in the state by providing assessment and instructional materials designed specifically for students with low-incidence disabilities, as well as consultation, to school district personnel to assist them in better meeting the needs of these students.
Program Description
The Central Assessment Lending Library (CALL) provides services for students from birth through adolescence with low-incidence disabilities. CALL is located in the psychology department of a state university and is currently open on Monday and Wednesday from 8:30 a.m. to 4:00 p.m. during the school year. The staff includes three faculty members and one doctoral student in the school psychology program. Since its inception, CALL has been staffed by one to four doctoral students per school year. Graduate students in school psychology and industrial/organizational psychology programs have worked in the library. CALL’s major functions include clinical services, training, and scholarship. Each of the program’s major functions is described below.
Clinical Services
School personnel throughout the state contact CALL staff by phone or email to consult on a case. Staff discuss appropriate assessment and instructional options with them and send needed materials, including record books, to the school district. Multiple copies of more than 90 different tests and 90 instructional materials are available and are listed on our website by category along with a brief description. Materials address the following areas: adaptive behavior, autism, behavior/emotional development, cognitive development, developmental inventories, academics, family assessment, hearing impairment, motor impairment, nonvocal cognitive development, screening, severe cognitive/multiple impairments, visual impairment, and sleep disorders. Many materials are available in Spanish. Materials arrive for school personnel within 2 to 4 days of a request and can be kept up to 3 weeks. If needed for a longer period, school personnel are asked to contact library staff to request an extension. The only cost to school districts is the return postage or shipping. Once materials are returned, they are cleaned and restocked if necessary, and then they can be sent to other districts. Additional consultation on interpretation of results and assistance with instructional planning is provided by CALL staff as well.
When the project began in 2006, the emphasis was on assessment. Although the services aid school personnel in verifying eligibility, assessments linked to planning instruction are a top priority. Recently, we added numerous instructional materials appropriate for students with low-incidence disabilities, for example, flash cards of sight words and math facts in Braille, the Edmark Reading Program (Pro-Ed, 2002), a program for children with CIs, the Perkins Panda Program (Perkins School for the Blind, 2002) for teaching early literacy skills to children from birth through age 8 who are visually impaired or blind, and Early Literacy Skills Builder (Browder, Gibbs, Ahlgrim-Delzell, Courtade, & Lee, 2007), the only phonics-based reading program for teaching reading to children with moderate to severe disabilities.
Another reason for borrowing materials from the lending library is to enable school personnel to review and try assessment or instructional materials before purchasing them. By doing so, they can determine whether the materials will be useful for their district. Thus, the services help school personnel avoid spending money on expensive materials that may sit unused if they are not found to be helpful. This aspect of CALL aids school personnel in spending their budgets wisely.
For each test lent to a school district, a detailed written review is provided similar to test reviews found in journals. Each review presents an overview of the test, issues related to the test’s use, a detailed evaluation of the technical adequacy, and a summary of recent research on the test. Reviews are prepared by CALL staff. Often school personnel request the reviews alone because they are considering updating their assessment options or considering which materials they would like to borrow from the library. The reviews help update school personnel on assessment options available for these students.
To help school personnel understand various low-incidence disabilities, many CDs, DVDs, and books are available through CALL as well. Examples of topics include how to read to children who are visually impaired, book sharing with children who are deaf, and educational and medical issues involved in Tourette syndrome. Any published DVD or videotape describing how to administer a test available through CALL is sent along with the corresponding test kit, if needed. Test protocols available in Spanish are also available through the library. These protocols save districts the expense of purchasing an entire package of protocols that may rarely be needed. To aid school personnel in planning comprehensive and useful assessments, in gathering sufficient background information on a student, as well as in understanding complex information in school and medical records of students with low-incidence disabilities, information-organizing checklists (Bradley-Johnson & Johnson, 2006) are often sent when a case involves students with visual impairments, hearing impairments, severe CIs, and motor impairments.
CALL maintains a website providing additional access to, and information about, our services. CALL’s website includes descriptions of our various services and staff members, lists tests and instructional materials available by disability category, and includes a brief overview of training seminars available. The descriptions of resources by disability category helps school personnel consider options and make informed requests for materials. This information is updated as new materials are added.
Training
To help school personnel keep up-to-date on advances in different areas of low-incidence assessment and intervention, CALL staff also provide professional development training seminars on topics for which we receive the most frequent requests. Each seminar is approximately 2 hr in length and additional follow-up is provided to school personnel on individual cases through their contact with the library. The training seminars are provided at no cost to the schools.
School psychology doctoral students, who work in the library under supervision of faculty, gain considerable experience in consulting with school personnel on difficult cases. Typically fourth-year, third-year, and second-year graduate students are involved so that upper level students assist in supervising students who are less advanced. This arrangement provides supervision, in addition to that provided by faculty, for the less advanced graduate students.
Scholarship
Although not a primary goal of the lending library, numerous test reviews completed by staff have subsequently been published in peer-reviewed outlets. Several staff also developed and published a model for assessing ASD. A number of students have utilized the library’s materials in conducting their theses and dissertations.
Program Outcomes
Clinical Services
In the approximately 8 years since CALL began, more than 2,000 tests or instructional materials were borrowed by school personnel. In addition, there were more than 200 requests for consultation only and more than 100 requests for copies of test reviews only. On average, the lending library has received about 224 requests for services per academic year. The mean age for students served was 7.1 (SD = 4.1 years, range = 1 month to 26 years).
School psychologists made the majority (69%) of requests. Remaining requests were from graduate students (12%), school social workers (5%), speech-language pathologists (3%), teachers (2%), teacher consultants (2%), faculty (2%), and occupational therapists (1%). Information regarding the profession of the person making the request was not available for the remaining 4% of cases.
Table 1 provides the means and standard deviations for items on evaluation forms sent to school personnel who requested materials. Since CALL began, 508 evaluation forms were returned for a return rate of 34%. Although 12% of requests were from graduate students, they were not asked to complete an evaluation form. Many school personnel borrowed materials repeatedly and did not complete an evaluation form each time they borrowed the item. These two factors necessarily lowered the return rate. Respondents generally agreed information provided by borrowed materials helped with a case, and they indicated that the materials would not have been available without CALL services. Furthermore, respondents generally agreed that, as a result of consultation with CALL staff, they were able to better document a diagnosis and make more useful recommendations.
Means and Standard Deviations of Library Evaluation Data.
Note. Ratings are on a 5-point scale ranging from strongly disagree (1) to strongly agree (5). CALL = Central Assessment Lending Library.
The most frequent requests for materials and consultation involved ASD and CI. Although visual impairment occurs in only about 0.04% of the student population (Office of Special Education Programs, 28th Annual Report to Congress, 2006), about 6% of the requests to CALL were for assistance with these cases.
Examples of cases for which consultation, materials, or both were requested follow:
What options are there for assessing various aspects of adaptive behavior and planning instruction for a 7-year-old, who has no speech, cortical visual impairment, and because of severe cerebral palsy, cannot use his hands?
What are the options for cognitive assessment for two brothers, aged 8 and 14, who were adopted 3 months ago from Russia, and who use Russian sign language?
This 6-year-old girl with Down’s syndrome has few words and attends to tasks no more than 10 s at a time. She will not point to indicate responses and would not attempt beginning items on the Leiter-Revised (Roid & Miller, 1997). What should we use to assess cognitive development?
This 5-year-old boy has cerebral palsy and is in a regular kindergarten classroom. An assessment of his receptive and expressive language skills resulted in average to high performance. However, several subtests from other measures indicate memory problems. Are there any norm-referenced measures that assess memory on various tasks?
What early literacy materials are available for preschoolers who are seriously visually impaired?
Of the more than 90 different tests available through CALL, the 10 most frequently requested are described in Table 2. Results indicate the most frequently requested materials are norm-referenced measures primarily used to verify ASD or CI eligibility.
Most Frequently Requested Library Materials.
Training
Since its inception, CALL staff have presented training seminars to more than 1,900 school personnel on topics for which we received requests. The most frequently requested training seminars were a comprehensive model for assessing ASDs, addressing children’s sleep problems, and assessment of children with severe impairments to aid instructional planning. Several new professional development seminars have been added that address visual impairment, hearing impairment, and educationally useful cognitive assessment and intervention for infants and toddlers.
Since its inception, CALL monies have funded 14 half-time assistantships for doctoral students in school psychology and the industrial-organizational psychology programs. The industrial-organizational students helped with development and maintenance of the website.
Scholarship
Five test reviews have been published in Journal of Psychoeducational Assessment based on the work of the CALL doctoral students (Bruni, 2014; Drevon, 2011; Sevecke, 2014; Swartzmiller, 2014; Vladescu, 2007), and three others are in press. Library staff also published a comprehensive model for assessing children with suspected ASD (Bradley-Johnson, Johnson, & Vladescu, 2008). Graduate students affiliated with the project have used lending library materials in conducting their theses and dissertations, several of which have resulted in publications in peer-reviewed journals (e.g., Cook, Bradley-Johnson, & Johnson, 2014; Knight & Johnson, 2014).
Conclusion
CALL is a centralized statewide lending library established to improve services provided by school personnel for students from birth through adolescence with low-incidence disabilities. CALL staff work toward this goal by providing access to resources (i.e., psychoeducational tests and instructional materials) as well as sharing knowledge and expertise in the area of low-incidence disabilities. Although the services are available only to school districts in one state, the library has received several out-of-state and international requests for services. Because the project is funded by the state legislature, for out-of-state and international requests, we only provide consultation and email test reviews. Nearly all counties within the state, both rural and large urban school districts, have requested services. Despite the responses to our needs assessment by directors of special education from large urban areas with major medical facilities indicating they probably would not need services of the proposed library, their school personnel are some of the most frequent users of CALL’s services. For rural areas, CALL has often provided resources and access to knowledge and expertise in the area of low-incidence disabilities that may have otherwise been unavailable. This serves to enhance the competence of school personnel which, in turn, allows them to more effectively support children with low-incidence disabilities. Thus, both rural and urban districts use the library’s services. Both the available data on evaluation forms returned to CALL and the continued and frequent use of the library by school personnel attests to its impact in schools, particularly for school psychologists.
Working in the library provides an excellent training opportunity for doctoral students in school psychology. Working on the project keeps them up-to-date on assessment and instructional options, makes them aware of concerns school personnel have regarding these students, enhances their consultation skills, and expands their knowledge of various low-incidence conditions. The graduate students assist in writing reviews of the materials, receive supervised experience in consulting with a variety of school personnel, and assist in preparing and presenting professional development seminars.
In addition to providing the assessment and instructional tools needed to meet the unique needs of students with low-incidence disabilities, CALL also provides school personnel with consultation on individual cases, written test reviews, materials describing various disabling conditions, and training seminars to enhance their knowledge.
Besides improving services, the project reduces costs to schools by sharing available resources through a centralized library and enabling school personnel to try materials before purchase to ensure their usefulness. After hearing about the project, one state senator noted, “With the current economic situation, support for this project is a no-brainer.” School personnel benefit from having up-to-date information and appropriate resources to enable them to provide the best services they can to students with low-incidence disabilities.
Footnotes
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The first author is co-author on two tests included in their library and the second author is co-author on one of the tests.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.