Collecting Information

Informed Decisions are Right DecisionsManisha Verma

Purpose of Gathering Information

• To see if the child is a “child needs special intervention.”

• To gather information that will help determine the child’s educational/ therapeutic needs

• To guide decision making about appropriate educational programming for the child.

Identifying Children for Evaluation

• Parents may request that their child be evaluated. 

• The school system may ask to evaluate the child

Procedural guidelines:Notify parents in writing Before the school may proceed with the

evaluation, parents must give their informed written consent.

The Scope of Evaluation

• A child’s initial evaluation must be full and individual, focused on that child and only that child. 

• The evaluation must use a variety of assessment tools and strategies

• Reports from other therapists, counselors, and Special Educators reports and evaluation data must be referred to.

Techniques of Assessment

• Interview Parents Primary Source

• Records previous/professional reports –Must be able to interpret Be careful of predisposition bias

• Observe the child It starts from the first moment of interaction

The art of history taking

• Basis of a true history is good communication • Important to acquire good consultation skills

which go beyond prescriptive history taking•  A good history is one which reveals the client’s

ideas, concerns, and expectations as well as any accompanying diagnosis. 

• Listening is at the heart of good history taking. • It takes practice, patience, understanding and

concentration

Interview skills

• Clinical Settingallowing for good eye contact, enabling easy

access to computers or notes and avoiding 'distance' 

Take care with the opening greeting, as this can set the scene for what follows. It may assist or inhibit rapport. 

Take care not to let the gadgets intrude on the consultation. 

Interview skills• Clinician Skills

Aim to Create an AllianceEmpathy, Genuineness, respect , warmth,

immediacy, tolerance, transparency, skillful validation, patience, Paraphrasing

Do not deal from authoritative position .Gain understanding of Client’s Focus of

Treatment (FOT)Time Management Avoid:

AssumptionsPreconceived ideasBiases

Interview skills

• Listen first and listen second Let the client tell you the story they have been

storing up for you Important to be able to ask discriminating,

delineating questions  go back to this overall picture and break down any aspects of the history that you need to from there.

Listening does not just involve using your ears. Also use facial expression, body language and verbal fluency

 To use questioning and clarification of details to 'draw out' the history. 

What questions?• Open questions•  They do not suggest a 'right' answer to the

patient and give them a chance to express what is on their mind. 

• Questions with options• This technique must be used with care as there

is a danger of getting the answer you wanted rather than what the client meant

• Leading questions• These are best avoided if at all possible. They

tend to lead the client down an avenue that is framed by your own assumptions.

Sensitive Questions Guidelines

• Respect patient privacy

• Be direct and firm

• Avoid confrontation

• Be nonjudgmental

• Use appropriate language

• Document carefully Use patient’s words as much as possible

Interview Do’s and Don’t s• Inquire if you can help with any immediate requirement/

needs

• Good Eye Contact

• Posture Matching/ Cross Matching

• Avoid Second Guessing

• Listen more Talk less - but keep the flow goal oriented

• Do not Lecture or Educate

• No personal Experiences to be discussed

• Do not take the bait - Become aggressive or sarcastic

• Identify inconsistencies

• No Technical Jargon

• Clarify Responses - Do not move on too quickly

A smart mother makes often a better diagnosis

than a poor doctor.

August Bier (1861–1949)

Initial Contact Interview Structure

• Personal /Demographic Data Age, Name , Sex, Education, Economic status

• Informant Information Name , Relationship, Age , Occupation, Income Your impression of the reliability of information

• Reason for referral The immediate reason for being referred to you.

• Presenting complaints and Duration Brief and verbatim History of presenting complaints

Initial Contact Interview • History of presenting complaints

A description of the symptoms and their duration, including:

how the symptoms began, and how the symptoms changed with time (e.g. Increasing

gradually or stepwise /remained the same/episodic in nature)

Changes in biological functions (e.g. Sleep, appetite, weight)

Affect of symptoms on patient’s relationships, day to day activity and work

Association between symptoms and any stressors or events

Any other relevant information

Initial Contact Interview

• Family history: age and occupations of parents and the parent’s

relationship with one another general information about siblings the patient’s relationship with his parents and

siblings social standing of the family history of psychiatric illness, suicide or disability

or substance misuse in the family Any other relevant information

Initial Contact Interview • Personal history:

Antenatal and birth history Mother’s general health during pregnancy

• Early developmental history Cover major milestones like sitting, crawling,

standing, walking, babbling, first words, eating by self

• Health in childhood Any major illnesses, fits, febrile convulsions Potential for hereditary diseases Was the illness episodic? Or was the child

continuously unwell? Nature of treatment received, and response to treatment? why ?

Initial Contact Interview

• Social Communication Assessment: Eye contact Time place space orientation Conflicts with peers Low interpersonal engagement Implied social rules Frequently switches subjects Incomprehensible speech/language

Initial Contact Interview

• Functional Assessment• Appearance and behavior:

General appearance Posture and movement Eye Hand co-ordination Gross motor/ Fine Motor skills Attitude towards examiner/environment

• Caution Denial of opportunity Socio-economic background

Initial Contact Interview

• Behavioral History Aggressive/calm Unpredictable Temper tantrums Eating habits Does not like to be touched Withdrawn/shy Overly sensitive

• Cognitive Assessment Attention and concentration Memory – short term and long term Intelligence

Initial Contact Interview

• Educational History Previous consultations/Teacher’s opinion Previous IEP Any BIP Academic/ Pre-Academic Activities Difficulties in classroom Detailed Antecedents and precedents

Initial Contact Interview

• Identify Strengths and Weaknesses of the child• Identify Likes and Dislikes (Rewards)• Note down any other points you would like to

discuss further.• Psycho education

Observation• Identify patterns to a student’s behavior• Patterns help us predict future occurrences of an

identified behavior. • In turn, this helps us implement more effective and

efficient interventions (eg. time of day, time of week, type of class or setting, etc…). RTI - Response to Intervention BIP - When a BIP is written for a student, must be

able to Quantitatively describe the identified target behavior Before, During, and After an intervention has been utilized.

• Descriptions :Quantitative (encouraged) vs. Qualitative (discouraged)

Points to Remember•  Who is ____________?

 Describe child, including such information as place in the family, personality, likes and dislikes.

• 2. What are __________’s strengths?  Highlight all areas where child does well, including

school, home, community, and social settings.

• 3. What are ________’s successes?  List all successes, no matter how small.

• 4. What are ________’s greatest challenges?  List the areas where child has the greatest difficulties.

• 5. What are _________’s needs?  List the skills child needs to work on and the

supports he or she needs.

Points to Remember• 6. What are parents dreams for ? 

Describe parent’s vision for child’s future, including short-term and long-term goals.

• 7. Other helpful information.  List all relevant information, including health care

needs, that has not already been described above.

• Brainstorm with people  General teacher, Family members, Tutor, Therapist,

consultant) to get ideas before the meeting. Write down things you feel must be included in the IEP. Decide how you want to share this information with the other members of the IEP team.

• Ask other team members  if they can share their ideas about child’s program

What can I do if PARENT’S don’t agree?

•  Sometimes, the following words can help to resolve an issue. “What will it take for us to reach an agreement on

this issue?” “Why don’t we just try this for 6 weeks and see how

it works?” “We can all agree that this is not an easy issue. But

we need to find a solution that will work for child. that we can all live with.”

“I just don’t see this as being appropriate for child. There have to be other options we haven’t looked at.”

• Communicate this in a reasonable and calm way.

Appropriate Reaction Techniques

• Simple Reflection It’s okay if you think child does not have a problem at

present. We can work on why others find it difficult to work with him

• Shifting Focus A teacher described a child as obstinate I see him to be a persistent child

Appropriate Reaction Techniques

• Reframing How many times do you think he disturbs the

class? Which particular class? It does not look like it is all the time. It is in this

particular period or time frame?

Conclusion Try to let clients tell you their story freely. When you use questions, try to keep them as

open as possible. Use all your senses to ‘Listen'. Check that what you think is wrong is what your

patient thinks is wrong. Keep an open mind and always ask yourself if

you're making assumptions. Be prepared to reconsider the causes of

symptoms that you or a colleague have decided upon.

Conclusion

• Summarise give the client a run-down of what they've told

you as you understand it. Sharing understanding a good idea to ask the client if there's anything

they want to ask you at the end of a interview.  Fix a date and time for follow up.

Thank You