The Development and Model of Therapeutic Assessment with Children: Application to School-Based Assessment
Abstract and Keywords
Therapeutic Assessment (TA) is a relatively new model of psychological assessment that, in addition to offering the benefits of a traditional assessment, also serves as a collaborative, short-term intervention. With variations, TA has been utilized with adults, adolescents, and children; research evidence on efficacy is encouraging. This chapter serves to introduce the model of TA with children to a wider audience, specifically school psychologists, as the use TA with children in schools stands to be a compelling and potent child–family–school intervention. In this chapter we review the development of TA, the rationale for and application of each step of the comprehensive model, and provide guidance to design meaningful feedback plans for parents, teachers and children. We also illustrate its use, with several examples of school-based special education assessment cases to demonstrate how including comprehensive or selected components of TA in school-based assessment of children can result in positive therapeutic change.
Fortunately, in recent years much progress has been made in recognizing the large number of children who struggle with moderate to serious mental health and learning concerns. These children are in need of assessment, identification, and individual and systemic interventions to ameliorate the impact of their challenges. Given the number of children needing identification, and the shortage of resources to provide for assessment and treatment, we must make the best use of our available resources. Whenever possible, we need to utilize methods of assessment and intervention that are responsive to consumers and have proven efficacious. With these concerns at the forefront, this chapter raises the following questions: Can the psychological assessment of children offer more than identification/diagnosis and recommendations, and actually be an intervention in and of itself? And, if so, can this intervention involve and impact the child, as well as the child’s support systems such as his or her family and school? And further, can the efficacy of such efforts be documented? In this chapter, we suggest that the answer to all three of these questions is yes, and encourage assessment professionals to incorporate collaborative and therapeutic methods in their assessment practices with children and their parents. We also propose that these methods can be applied fruitfully in school-based assessment, and with diverse clients. Although the integration of these methods into assessment practice is perhaps most exciting for what it can offer the consumers of psychological services, it also stands to offer psychologists a satisfying experience and hopefully a renewed interest in assessment practice.
The psychological assessment of children has a long history (Kamphaus, 2001). Practices are well established for the assessment of children’s functioning in cognitive/intellectual, academic, behavioral, and social/emotional/personality arenas. Psychological assessments of children take place primarily in (1) schools, where educational achievement and factors that may be hindering a child’s learning are (p. 225) the focus, along with recommendations for educational and behavioral interventions; and (2) in clinics, hospitals, residential settings and juvenile justice facilities, where mental health/illness, its impact on behavior and development, and recommendations for psychotherapeutic interventions are the predominant focus. Regardless of setting, most assessments provide a diagnostic formulation and recommend educational and/or therapeutic interventions, but are not seen as interventions in and of themselves. However, the intervention or therapeutic potential of assessment has been noted by a number of clinicians who have advanced a new perspective on assessment, referred to generically as collaborative or therapeutic assessment.
A model that is gaining in prominence is Therapeutic Assessment (TA). TA, as developed by Finn and colleagues (Finn, 1996, 2007; Finn & Tonsager, 1997), is a relatively new application of psychological assessment that, in addition to offering almost all of the benefits of a traditional assessment, also serves as a collaborative, short-term intervention. TA is a semi-structured hybrid of assessment and intervention techniques, and requires assessors to possess and integrate competencies in both assessment and intervention. Fortunately, most psychologists are prepared with this foundation and, with additional training, can readily add TA to their repertoire. With variations in the model, TA has been utilized with adults, couples, adolescents, and children. Furthermore, TA has shown great promise clinically, and research studies and case studies have demonstrated its efficacy with adults and adolescents (Finn & Tonsager, 1992; Hilsenroth, Ackerman, Clemence, Strassle, & Handler, 2002; Hilsenroth, Peters, & Ackerman, 2004; Michel, 2002; Newman & Greenway, 1997). Recent research has also found TA with children (TA-C) to be an efficacious intervention (Tharinger, Finn, Gentry et al., (2009).
In TA-C, the assessor strives to provide the child with multiple opportunities and modalities to express his or her thoughts, feelings and behavior. The assessor also assists the parents in coming to a new understanding of their child, through active observation and collaboration. To accomplish these goals, the assessor uses an array of assessment and intervention tools. These include interviews with parents and children to co-construct and explore assessment questions (Tharinger, Finn, Wilkinson, & Schaber, 2007), along with parental observation and assisted processing of their child’s testing sessions (for an example see Hamilton et al., 2009), selected nomothetic and idiographic testing instruments (Finn, 2007), extended inquiry methods (Finn, 2007; Handler, 2008), features of play, playfulness and play therapy (Tharinger, Christopher & Matson, in press), family sessions (Tharinger, Finn, Austin, et al., 2008), oral and written consumer-friendly feedback for both the child and parents (Tharinger, Finn, Wilkinson, et al., 2008; Tharinger, Finn, Hersh, et al., 2008), and, finally, follow-up sessions.
The primary goal of TA-C is to help parents understand their child in new ways, become more empathic towards their child, and shift their interactions with their child to foster positive development in the child and the family. TA-C is designed to answer specific questions parents and children pose for the assessment, to form working alliances with parents and children, and to collaboratively engage children and their parents in the assessment process. As introduced above, in most instances parents are encouraged to observe their child’s testing sessions and process the findings with the assessor along the way. In addition, parents and children receive interactive feedback that addresses their assessment questions and explores steps for change. Thus, TA-C is seen as a short-term family systems intervention (Finn, 2007). TA-C is particularly appropriate for challenging, multi-problem situations, with children who are difficult to understand, when previous interventions have failed, and with parents whose own projections or psychological difficulties keep them from being able to accurately perceive and appropriately respond to their children (Tharinger et al., 2007). TA-C also has the potential to be a child–family–school intervention, or child–school intervention, as will be addressed and illustrated later in this chapter.
The goal of this chapter is twofold. The first goal is to introduce TA-C to a wider audience, specifically school psychologists and psychologists who work with children in schools, and encourage them to consider how the model of comprehensive TA-C may be useful to their assessment practice. To accomplish this goal, we first briefly review the literature on the psychological assessment of children. We then proceed to describe the history and development of collaborative assessment and TA, including the philosophical and theoretical underpinnings and recent efficacy research. Following, we depict the rationale for, and application of, each step of the comprehensive model of TA-C, and refer to case studies where TA-C has been utilized. We also include a discussion of an underdeveloped aspect of (p. 226) training in child assessment: how to work with the information obtained, to reach a case conceptualization, organize the findings sensitively, and design a meaningful feedback plan for both the parents and the child.
We acknowledge the reality that using the comprehensive TA-C model will not be feasible in many practice settings, including schools. Thus, the second goal of this chapter is to propose a strategy for adopting selected components of TA-C, given the needs and constraints of a particular case and specific setting. To accomplish this goal, we highlight a sequential process for selecting and adapting components of TA-C for school-based assessment purposes. We discuss the major components of TA-C that appear to have the most value and transportability to assessment practice in the schools. We have organized these components into categories that can be conceptualized as four stages: (1) adopting a new foundational base, which includes embracing a collaborative stance toward assessment; (2) utilizing innovative assessment practices, which include constructing assessment questions with the child, parent and teachers; (3) integrating innovative practices of case conceptualization; and (4) planning and delivering feedback to parents, children, and teachers in meaningful and collaborative ways. We also propose the use of intervention sessions within the assessment as a potentially very useful component. Lastly, we illustrate a variety of protocols that adopt features of TA-C, using, as examples, school-based special education assessment cases conducted by graduate students under the instruction and supervision of the first author. Our intent is to demonstrate how including selected components of TA-C in school-based assessment can result in therapeutic change.
Psychological Assessment of Children
As introduced above, psychological assessment of children is usually used for diagnostic and intervention planning purposes. An assessment typically: (1) addresses a combination of cognitive, academic, social, emotional, behavioral and personality concerns; (2) determines if a psychiatric diagnosis or handicapping condition/disability is present that is impacting the child’s functioning; (3) assists (if applicable) in school or other placement decisions; and (4) establishes the need for educational, psychosocial and/or psychiatric intervention/treatment. In addition, many assessments aim to understand the strengths and resources of the child’s supportive systems, as these often impact access and response to treatment. And finally, assessment is sometimes used to evaluate whether an intervention has been successful. Thus, psychological assessment has usually been conceived of and recognized as a preamble to change, or as a way to document change, but not as a change agent in and of itself.
The traditional assessment model historically followed by psychologists has been labeled the “information gathering” model by Finn and Tonsager (1997). The goal of assessment from this model is to describe and diagnose individuals in order to make decisions and communicate about them among professionals. Also called the “medical model” (Mutchnick & Handler, 2002), this approach is characterized by a unidirectional flow of information in which the individual assessed (and, in the case of a child, his or her parents) typically has minimal input into the process of the evaluation. Moreover, depending on the particular evaluation circumstances, the individual being assessed may or may not understand the reasons for assessment, and may or may not be given the results. This may be particularly true if the individual being assessed is a child. In this model, the assessor follows the necessary standardized testing protocols, compares the data with appropriate norms, and determines relevant diagnostic categories, all with little collaboration with the client. In summary, in this approach, which has dominated assessment practice for decades, the “expert” assessor evaluates and diagnoses the patient or client, and then recommends a treatment to the patient or a referral source in order to “repair the problem” (Mutchnick & Handler, p. 75).
This information gathering, or medical model approach to psychological assessment, has been strongly associated with the area of personality assessment. Traditionally, personality assessment has been identified with psychodynamic theory and other depth psychology theories that seek to understand the underlying causes and mechanisms of an individual’s patterns of behavior. The goal of this type of assessment has been to discover mechanisms that may account for, or influence, current behavior and patterns of the individual being assessed. This tradition of assessment has included a strong emphasis on using history, background information, responses to standardized tests, and responses to projective tests (also referred to more recently as performance based tests) to construct a formulation of how the individual may have come to develop his or her particular challenges, and how they are (p. 227) being maintained. This tradition has looked at the impact of early events and processes, as well as current concerns and themes (often not fully conscious or in awareness in the person being assessed) that may be affecting current emotional states, disordered behaviors and impaired relationships.
In personality assessment, projective tests have been viewed as useful in that they can offer alternative, less structured stimuli for clients to respond to (e.g., drawings, pictures, sentence stems, inkblots). These less structured stimuli are thought to allow many individuals, including children, to forego or lessen their protective layers or defenses, resulting in a less censored response. Thus, concerns and preoccupations that are useful to understanding the person and planning interventions may be revealed. More contemporary personality assessment utilizing projective measures has embraced an “experience-near” approach (Handler, 2008). As will become apparent in a later section, TA embraces and even heightens many of the experience-near features of personality assessment. This occurs through the use of process assessment techniques, as well as methods of interactive, collaborative discussion of findings.
Psychological assessment has also been influenced by the behavioral tradition (see chapter in this volume on behavioral assessment). Behavioral assessment, often referred to as functional behavioral assessment or functional behavioral analysis, has as its goal to determine the cause or function of a given behavior before an intervention is attempted. In this tradition, the resulting recommended intervention is based on the hypothesized cause of the behavior. Interviews, rating scales completed by multiple informants, naturalistic observations, and response to environmental manipulations are major tools of behavioral assessment. The scope of behavioral assessment typically is more circumscribed than that of personality assessment, as it focuses on specific behavior and patterns of behavior, in contrast to the more comprehensive focus of personality assessment. Furthermore, the behavioral assessment tradition has always been intervention focused. As will become evident, aspects of behavioral assessment are integrated into TA, and are perhaps most apparent in the use of intervention techniques within a testing session, or the inclusion of a complete session where intervention is the major focus.
Thus, as will be seen, TA-C utilizes aspects of contemporary personality and behavioral assessment, and also aims to gather accurate and useful information per traditional assessment models. TA-C is very compatible with the integrated perspective that is emerging in the literature, with its blending of personality and behavioral approaches, informed by multi-modal, multi-informant, multi-method techniques, and guided by an openness to understanding the findings from a multi-theoretical orientation. Contemporary assessment calls for the integration of the nomothetic and idiographic traditions, with clinical judgment valued along with statistic or actuarial judgment (Riccio & Rodriquez, 2007). This is all very encouraging.
However, from the point of view collaborative assessment and TA, psychological assessment still falls short of being optimally useful to the consumers of the assessments. Psychological assessment, particularly of children, has much more to offer than diagnoses, recommendations, and communication among professionals. It has been noted that the way in which assessment is typically practiced “profoundly undermines the usefulness of this potentially powerful diagnostic and therapeutic intervention” (Cohen, 1997, p. 254). In actual, day-to-day practice, assessments are often conducted quickly, without taking time to gather and integrate the perspectives of multiple individuals, including the child, parent, teachers, and others centrally involved in the child’s life. Information from multiple informants, and the use of multiple methods, is essential if the assessor is to make sense of test data, which is not definitive alone (Cohen, 1997). Additionally, if parents, children, and teachers are not encouraged and given time to formulate the questions they hope the assessment might address, the assessment’s meaning and utility are seriously limited. Furthermore, if the child, parents, and others involved are not helped to understand how the findings relate to the child’s everyday life and their relationship and work with the child, an intervention opportunity is missed. The skills needed to provide meaningful feedback to stakeholders, including children themselves, have been underdeveloped, under-taught and under-practiced, in spite of ethical guidelines requiring or encouraging such practice (Tharinger, Finn, Hersh, et al., 2008; Tharinger, Finn, Wilkinson, et al., 2008).
As introduced earlier, the central question becomes: How can we maximize, or at least enhance, the usefulness and transparency of psychological assessments for consumers—in our case, children, parents and, in many cases, involved educators? Additionally, in this era of the call for evidence based practice in medicine and psychology, (p. 228) can we provide empirical evidence for the efficacy and effectiveness of psychological assessment and assessment as an intervention? We now endeavor to address these questions.
Development of Collaborative and Therapeutic Assessment Models
In the 1960s and 1970s, many psychologists with interpersonal and humanistic theoretical perspectives called for a reevaluation of the purposes and practices of psychological assessment (Fischer, 1985/1994). Some psychologists, disenchanted by the traditional and medical models, rejected the practice of assessment altogether. Others independently began to adjust the ways they interacted with individuals they were assessing, including both adults (Fischer, 1985/1994; Mosak & Gushurst, 1972; Richman, 1967) and children (Colley, 1973; Fischer, 1970, 1985/1994), after incidentally noticing benefits from more humanistic and interpersonal techniques. For example, Mosak and Gushurst discovered that simply the act of giving clients their assessment results signified that the clinician had “a genuine belief in the patients’ strength” and in their ability to handle undesirable information (p. 542), which then had a noticeable effect on clients’ mood and engagement in treatment. Richman noted similar improvements in difficult inpatient populations, concluding that a “skillful sharing of test results with the patient is often beneficial, especially for the very disturbed, when conducted by a psychologist trained in both testing and psychotherapy” (p. 63). Fischer explained the advantages of collaborating with children in her assessments, and described a successful collaborative assessment approach in which she observed a child in the context of his family’s home environment, and also processed portions of the testing that were difficult for him at the time they occurred.
Paralleling these movements in the field of psychology, the medical research literature has reflected a shift in the medical model of diagnosis, and in the traditional attitudes toward the doctor–patient relationship. Approaches such as shared decision-making (Quill & Brody, 1996) and patient-centered medicine (Laine & Davidoff, 1996) emphasize the importance of medical providers collaborating with patients by projecting an empathic, attentive attitude, in order to facilitate disclosure of concerns, increase participation in treatment planning, and improve compliance with recommendations (Pegg, Auerbach, Seel, et al., 2005). Indeed, engaging clients in a relationship and giving them information tailored to their personality and life can convey “respect and consideration for their autonomy and capability,” and indicate that the clinician sees them “as an integral component in their own treatment” (Pegg et al., p. 373). Thus, a more collaborative approach to client–provider interaction, influenced by a common desire to make the experience more “humane, respectful, and understandable” to consumers (Finn, 2007, p. 5), has emerged in both the medical and psychological fields.
In psychology, these collaborative approaches aim to help clients directly, and to provide transformative experiences during the assessment process itself, rather than waiting until testing is complete to indirectly help clients by drawing up treatment recommendations (Finn, 2007). Numerous therapeutic and collaborative models and techniques have been developed. Although all share the goals of helping clients have a positive experience of the assessment, and experience positive change (Finn), and many techniques overlap, there are some important differences between the approaches. We review two prominent models: Fischer’s model of collaborative, individualized assessment, and Finn’s semi-structured Therapeutic Assessment model.
Fischer’s Model of Collaborative Assessment
Collaborative assessment embraces the belief that clients and their families are the experts on their own lives, and brings that knowledge to the assessment process, while assessors are the experts on psychology and on the assessment instruments (Fischer, 2000). Thus, clients and assessors must work together, drawing on their different areas of expertise, in order to fully understand the client’s challenges and develop ideas about the kinds of intervention needed. The goal of Fischer’s approach is to describe the client as an individual—that is, his or her “particular situation” and “life comportment”—and to provide individualized recommendations that have already been tested, to some extent, during the assessment process (Fischer, 1985/1994). In this model, testing methods and responses, rather than reflecting an absolute truth, are viewed as tools that may help illuminate the client’s life and challenges; the client’s life experiences themselves are regarded as the primary data (Fischer, 2000). For Fischer, the value of tests lies not necessarily in their normative data or resulting scores based on client responses, but in their ability to produce experiences that bear similarities to situations the client likely faces in everyday life. For example, taking a reading achievement test may (p. 229) evoke behaviors and emotions that the client regularly demonstrates when reading in school. For this reason, in some cases tests may be used in idiographic ways, or standardized procedures may be deviated from when opportunities arise to explore experiences in greater depth. Tests are tools that are “used by” the assessor and client as they work together to learn about the client’s situation; they are not simply “administered to” the client (Fischer, 1985/1994).
In Fischer’s model, collaborative dialogue between the client and assessor is essential to understanding how test findings and experiential information fit together. Reports are written in very accessible language, in the first person, and include detailed narrative descriptions of the client’s behavior and the assessor’s impressions of the client. Fischer discusses with the client what will be included in the report, and notes in the report itself any disagreements between herself and the client about the picture presented. She also invites clients to write annotations on the actual copies of reports to be sent to other professionals, expressing their evaluation of, and reactions to, what she has written (Fischer, 1985/1994). Outlined in her groundbreaking book, Individualizing Psychological Assessment, this “human-science” model follows six guiding principles: (1) primary emphasis is on life events, rather than on test scores and theoretical constructs; (2) events that occur in session are processed as they occur, and are considered as important data; (3) collaboration occurs with the client; (4) it is expected that clients will react in different ways, and these reactions are processed with the client; (5) assessors consider all data as behavior in context; and (6) the goal is to practice “authentically,” which means to strive for what is possible, while acknowledging the necessary limits and requirements of clinical reality (Fischer, pp. 46-48). Fischer’s work has provided an excellent foundation for conducting psychological assessment from a collaborative stance.
Finn’s Model of Therapeutic Assessment (TA)
Therapeutic Assessment (TA), a form of collaborative assessment developed by Finn and colleagues (Finn, 1996, 2007; Finn & Tonsager, 1997), is a brief, semi-structured therapeutic intervention informed by psychological testing. It is based on the premise that psychological assessment, when practiced in a collaborative and interpersonal manner, can produce benefits beyond its typical information gathering purposes. It can serve as a kind of short-term intervention in and of itself (Finn & Tonsager). In contrast to traditional assessment (discussed earlier), which focuses on collecting accurate information about the client that can be used to make placement or treatment decisions, the goal of TA is not only to collect accurate information, but to use that data to help the client (or child client and parents) learn new ways of understanding and addressing the client’s current challenges in living (Finn & Tonsager). According to Finn (1996), the traditional approach to psychological assessment “ignores the interpersonal context of clients’ test responses and promotes a mechanistic, de-humanized approach to psychological testing” that is possibly “harmful to clients and at best benefits them only indirectly” (p. 83). Moreover, the traditional approach has been described as imparting stress, anxiety, anger, and confusion to clients (Handler, 2007), especially children. In contrast with this traditional, “information gathering,” model of assessment, Finn (2007) describes “therapeutic assessment” as an attitude and respect about the relationship with the client, where:
[T]he goal of the assessor is more than collecting information that will be useful in understanding and treating the patient. In therapeutic assessment, in addition, assessors hope to make the assessment experience a positive one and to help create positive changes in clients and in those individuals who have a stake in their lives. (p. 4)
Whereas traditional assessment’s intent is to help clients indirectly through the recommendations that follow, therapeutic assessment’s intent is to help directly (Finn, 2007). The process of TA itself is intended to be transformative (Handler, 2007) and to leave clients “positively changed at the end of an assessment” (Tharinger et al., 2007, p. 297). Although aspects of TA are likely practiced by many gifted clinicians without their even knowing it (Finn, 2007), this idea that psychological assessment can be a therapeutic intervention is a “major paradigm shift in how assessment is typically viewed” (Finn & Tonsager, 1992, p. 286). However, it is important to clarify and emphasize that collaborative/therapeutic techniques in TA do not replace standardized testing; rather, they augment the diagnostic process by engaging clients more honestly and respectfully. Simply by making “minor changes” in evaluation procedures, “assessors can enhance the therapeutic effects of an assessment without (p. 230) compromising in any way the valid and reliable test information that is collected” (Finn & Tonsager, 1997, p. 382).
TA originally differed from other forms of collaborative assessment in its explicit goal of leaving clients positively changed at the end of an assessment, although other collaborative assessment techniques have now adopted this goal as well. This goal is achieved through an ongoing focused dialogue between the client and assessor, which can lead to the “co-authoring” of a “new story” about the client and his or her strengths, significant relationships, and problems in living. By providing an experience of empathic attunement and accurate mirroring, assessors help support clients in grasping and assimilating these new conceptualizations, and in trying out next steps in their growth process (Finn & Tonsager, 1997, 2002). Although the techniques used in TA are drawn from a number of different interventional approaches, one strong underpinning is collaborative empiricism as practiced in cognitive-behavioral therapy. In this approach, the clinician and client work together to set up different “experiments” to test mutually generated theories about why the client experiences certain problems in living, and what will ameliorate them (Beck, 1995). In TA, as contrasted with cognitive therapy, these “experiments” often make use of results from psychological tests.
Theoretical Underpinnings Of TA
Like other forms of collaborative assessment, the principles of TA are rooted in intersubjective, phenomenological, and interpersonal theories of human behavior (Finn, 2007). TA also incorporates concepts and techniques from a variety of other psychological orientations, including behavioral, social learning theory, cognitive-behavioral, object relations, attachment, narrative, humanistic, and family systems. Interpretation and inference involve an integration of nomothetic and idiographic methods. Data is interpreted in the context of the reason for the assessment, and the client’s relationship with the assessor. The tests and methods used are an opportunity for the client to communicate with the assessor, and responses reflect the quality of the developing relationship. Assessors use clients’ test responses and descriptions of their test experiences to “get in their shoes” and empathically comprehend their experiences and perspectives. This is the philosophical foundation of the collaboration and working alliance established with the child and parents. In addition, the assessor’s experience, affect, and counter-transference reactions are essential pieces of information that are understood to illuminate potentially important case dynamics, but are also considered as potential sources of bias in interpretation and communication about the findings (Fowler, 1998; Handler & Meyer, 1998; Smith, 1998). Thus, the assessor’s active self-awareness is a key tool in TA. It is our experience that assessors who also have training and expertise in therapy models that involve the use of the self (such as interpersonal and attachment-based models) easily transfer these abilities to their work with TA.
Three characteristics of personal motivation are thought to account for the therapeutic value of a collaborative/therapeutic assessment: (a) self-verification; (b) self-enhancement; and (c) self-efficacy/self-discovery (Finn & Tonsager, 1997). Self-verification theory posits that a person aspires to have his or her self-concept and reality affirmed by others, regardless of whether that self-concept is positive or negative (Swann, 1990). TA specifically attends to clients’ self-verification needs through a deliberate organization of feedback findings, in which the first testing results revealed are always those that are consistent with, and thus reaffirm, the client’s self views (Finn, 2007; Finn & Tonsager). Self-enhancement can be conceived of as the desire to be appreciated and loved by others, and to feel good about oneself (Finn & Tonsager). This construct is reflected in TA by the collaborative, interpersonal nature of the process in which assessors strive to be respectful, open, and humane with their clients (Finn). The third variable proposed by Finn and Tonsager is self-efficacy/self-discovery, which refers to the need to feel in control over one’s environment, in addition to an individual desire for knowledge and personal growth. The collaborative nature of therapeutic assessment addresses this construct by including the client in all phases of the process, as well as by the practices of soliciting clients’ assessment questions, and asking clients to confirm or deny assessment results. It is theorized that when the assessor acknowledges and attends to these three constructs during the course of an assessment, clients become positively changed and experience more beneficial effects than they would from an assessment conducted following the “information gathering” model (Finn).
Research On TA
A number of case studies attest to the success of collaborative and therapeutic assessment methods with adults and adolescents (Finn, 1994, 1998, 2003; Finn & Kamphuis, 2006; Michel, 2002). Additionally, controlled studies of TA and collaborative assessment with adults have found positive effects including decreased symptomatic distress, increased self-esteem, and greater hopefulness (Finn & Tonsager, 1992; Newman & Greenway, 1997). A study comparing traditional and collaborative assessment also found that adults who received a therapeutic assessment felt a stronger alliance with their assessor, and were less likely to terminate follow-up treatment against medical advice, than those who received a traditional assessment (Ackerman, Hilsenroth, Baity, & Blagys, 2000).
Findings also are accumulating for the efficacy of TA-C and collaborative assessment with children. Numerous supportive clinical case studies have been published (Fischer, 1985/1994; Hamilton et al., 2009; Handler, 2007; Mutchnick & Handler, 2002; Purves, 2002), as well as empirical case studies (Smith & Handler, 2009; Smith, Nicholas, Handler & Nash, 2009; In these case studies, parents report gaining a better understanding of their children’s problems, feeling more effective in their parenting and being more motivated to pursue appropriate services. Parents also indicate decreased behavioral problems, and improved mood and social functioning in their children.
Furthermore, the Therapeutic Assessment Project (TAP) conducted a study of the efficacy of TA-C with 14 children and their parents (Tharinger, Finn, Gentry, et al., 2009. They found high treatment acceptability, significantly decreased child symptomatology, and enhanced family functioning as reported by children and mothers following a TA-C. In addition, mothers demonstrated a significant increase in positive emotion, and a significant decrease in negative emotion, pertaining to their children’s challenges and future. These findings support assertions from published single case studies that TA-C is likely an efficacious child and family intervention. Tharinger and students also have several new research studies underway in child populations that are investigating the comparative efficacy of assessment practice as usual, versus assessment infused with selected components of TA-C. These studies, being conducted in schools and independent assessment practice sites, are addressing the impact of enhanced parent collaboration and feedback in two studies—child feedback in one study, and child collaboration in another. Findings from these studies will inform the transportability of TA-C components into real world practice.
Steps Of TA
Finn (1996, 2007) has proposed a semi-structured, six-step generic model for TA. There is variation in the phases as applied to children, adolescents, adults, and couples. Each of the steps of TA, according to Finn, is important in its own right; and yet, in our experience, the whole is greater than the sum of the parts. In TA-C the steps include: (1) the assessment question gathering phase, typically an initial interview with the parents and a brief interview with the child and parents together; (2) the standardized testing phase, ranging from two to eight sessions, where the child is tested while the parents observe and discuss the ongoing process and findings; (3) the family intervention phase, where the child and parents are engaged together to test out both typical and new ways of relating; (4) the summary/discussion phase, where the assessor and parents meet to collaboratively discuss the feedback and plans for the future, and a subsequent session where the child is presented with feedback (verbally and in written form), usually with parents present; (5) the written communication phase, where individualized written feedback for parents and standardized reports for referral sources, if required, are prepared; and (6) a follow-up phase, where the child and parents return for a final discussion of progress, one to three months later. Finn acknowledges the reality of client, setting, assessor, and resource variables that may preclude adopting all six phases, and encourages assessors to adapt the model to their particular needs and circumstances. We discuss adopting components of TA, short of a comprehensive TA, in a later section. We now provide the comprehensive TA-C model.
Comprehensive TA-C Model
The comprehensive TA-C model as used in TAP (see Tharinger, Finn, Gentry, et al., 2009; Tharinger et al., 2007) is now described, session by session, and a rationale is provided for many of the methods, particularly the construction of assessment questions, collaboration, the use of tests, and communication of findings (feedback) in both oral and written forms. Case studies that have used this model can be found in Hamilton et al. (2009), Tharinger et al. (2007), Tharinger, Finn, Austin, et al. (2008), and Tharinger, Christopher, and Matson (in press).
TA-C typically involves 8 to 10 weekly sessions that take place over a 3-month period (although these sessions can be condensed over a much shorter time period). We have found that weekly sessions (p. 232) allow parents, in particular, time between sessions to process what they are learning and begin to construct a new story about their child. The weekly schedule also allows assessors time to absorb the findings and plan the next session. In this way, the typical pacing of TA-C is more like a therapy or counseling schedule than a traditional assessment. Weekly sessions of an hour and a half each are usually sufficient.
Although TA-C can be provided by a single assessor (discussed below), in TAP the TA-C is conducted by a team of two assessors (referred to as the assessment team). When there are two assessors, they work together with the child and parents at the initial and final sessions of the assessment (interviews, family session and feedback). However, during the testing phase, one assessor administers the testing and creative procedures with the child, while the other supports the parents in their observation of their child’s testing. The following description of comprehensive TA-C assumes a two-person assessment team.
Initial Phone Contact with Parents to Discuss Referral
In the initial conversation with parents to explore contracting for a TA-C, the assessor explicitly expresses to parents the intention that the assessment be a collaborative process and the conviction that parents’ input is essential to the success of the TA-C. This assertion is then put into practice by asking parents to start thinking about their questions for the assessment, in preparation for their first session. This process lets the parents know from the beginning that they have the opportunity to direct where the assessment will go.
First Session with Parents: Interview to Generate Assessment Questions/Related Background
TA-C assumes that parents’ concerns and questions about their children can be best addressed if the assessors are able to elicit specific assessment questions at the beginning of the assessment process (Finn, 2007). This exemplifies the collaborative stance in action. It is sometimes difficult for parents to translate their concerns into questions, and many parents are surprised even to be asked what they would like to learn. The assessment team helps parents understand the purpose of asking questions, and actively helps them generate useful assessment questions. While gathering background information, the assessment team remains alert to any implicit questions, confusions, or concerns in the parents’ narrative, and asks if these are areas they would like the assessment to focus on and be able to answer. Assessment questions are most useful when they are phrased in colloquial rather than technical language. Inquiring about the events or circumstances that led up to the referral often leads to a more complete description of what it is the parents (or referring person, through the parents) are wondering about the child, and why. Asking parents what decisions they need to make about their child further contextualizes the referral concern, and provides information as to what parents really want to learn from the assessment (Fischer, 1985/1994). For instance, parents asking if their child has ADHD may be wondering how to manage the child’s oppositional behavior at home, wondering whether the child would benefit from a different school environment, or wondering why the child’s academic performance has recently declined. Each of these concerns would call for a different kind of recommendation, and perhaps even a different selection of tests. Choosing tests based on clients’ assessment questions is more efficient than administering a standard battery, increases diagnostic accuracy, and leads to more useful answers to the clients’ concerns (Brenner, 2003).
An additional benefit of gathering specific assessment questions is that it provides an opportunity for assessors to learn parents’ expectations for the assessment, and to provide information to parents about what the assessment may or may not realistically be able to address. Gauging parental expectations prior to the assessment is important, in light of studies that have shown relatively low parent satisfaction with the degree to which assessments met their expectations for providing help (Bodin, Beetar, Yeates, et al., 2007). Well-formulated assessment questions can serve as a “contract” of what parents can expect from the assessment. Parents typically formulate questions about a broad range of topics including etiology, diagnosis, causes of specific behaviors, parent or family influences on the child’s problem, how to help, prognosis, what the child thinks and feels, and triggers or contributing factors. In addition, the content and phrasing of assessment questions may provide illuminating information about the parents’ existing “story” about their child, the parent–child relationship, the parents’ openness to certain kinds of feedback or recommendations, and the parents’ fears and hopes for their child (Finn, 2007). This information can later be used to inform decision-making about how (p. 233) best to organize and frame feedback to parents about the assessment findings.
Thus, in the initial meeting with the parents, the assessment team verbally reviews the procedures of the assessment, and answers parents’ questions about the process. The team explores the parents’ goals for the assessment, and co-constructs individualized assessment questions that capture the concerns, puzzlements, and challenges the parents have about their child and family. Initial background information is obtained to inform the context for each assessment question (often, an additional interview is conducted later in the assessment process to further flesh out relevant history, background, etc.). The obtained questions (e.g., “Why is my child having a hard time getting along with other kids?”…“What is the source of my son’s stress and sadness?”) guide the assessment from this point on. Finally, the assessment team coaches the parents on preparing their child for his or her upcoming first session.
First Session with Parents and Child Together: Beginning Testing with the Child and Parent Observation
The second session, typically a week following the initial meeting with the parents, begins with a brief check-in between the assessment team and the parents, after which the child is invited to join. These steps again underscore the foundation of active collaboration. The parents are asked to introduce the child to the assessment team, explain a bit about their understanding of the process of the assessment, and verify that the child understands the reasons for the assessment, and is willing to participate. The parents and assessment team work together to address any questions and concerns raised by the child, and the parents share with their child one or two of their assessment questions (the parents have been coached on this, in the previous session). The parents are encouraged to share a question that is systemic in nature (e.g., “How can we all learn to control our anger and talk together about what bothers us?”), so as not to single out the child. The child also is invited to contribute his or her own assessment questions, at this time or at any time during the assessment. In our experience, it is hard for most children to generate their own questions at this time. They may feel overly self-conscious during this first meeting with the assessment team, as so much attention is being focused on them. However, we have found that more outspoken or parentified children are sometimes able to construct initial questions. Examples from recent cases in TAP include, “Why do I get blamed every time something goes missing at home?” from one child, and “Why won’t my parents help me more?” from another.
After this joint introduction, the session continues with the parents leaving the room with one member of the assessment team, and going to an observation room—either behind a one-way mirror, or in an adjacent room with a live video feed—to observe as the other member of the assessment team begins to engage the child in the assessment process. The child is aware that the parents will be observing, and that there is a video camera and/or one way mirror in the testing room. The opportunity for the parents to observe the child assessment sessions with the support of an assessment team member is a variation on the practice originally proposed by Finn (2007). Finn described inviting parents to observe assessment sessions from the corner of his office, and then talking with the parents after each session to ascertain their reactions, respond to their questions, and make small interventions in relation to the way they perceive their child. This method can be used successfully when TA-C is conducted by a single assessor. However, in TAP, the use of an assessment team allows one assessor to conduct these conversations “in the moment” rather than at the conclusion of the session. In our experience, this practice significantly advances the collaborative experience of the parents, and also helps them to digest the information their child is providing through the tests and creative methods.
It is important to acknowledge that inviting parents to observe all or some of their child’s testing sessions is a controversial feature of TA-C. The practice of inviting parents to observe testing may raise significant concerns for some assessment professionals, as test security may be compromised to some extent. However, parents only view the testing materials briefly, and they do not take the tests themselves. Inviting the parents to observe is done in the spirit of collaborative empiricism as practiced in cognitive-behavioral therapy (Beck, 1995). The opportunity for parents to observe and discuss their reactions is thought to affect the process and outcome of the therapeutic assessment in significant ways (Tharinger et al., 2007). For example, when parents are given the opportunity to watch their child’s testing, it can foster their curiosity about their child, engage them as active participants, demystify psychological assessment, and educate them about psychological tests and the assessment process.
(p. 234) Furthermore, by discussing parents’ perceptions of the testing sessions, the assessor can help them discover answers to their questions about their child, and can help them begin to shift their “story” about why their child has problems. The assessor emotionally supports the parents as they reach new understandings, or confirm their existing beliefs, about their child. This process also allows the assessor to ascertain parental readiness and resources for change, thus informing the subsequent sessions involving the parents, including the upcoming family intervention session and feedback sessions. In working with the observing parents, the assessor maintains a collaborative stance by adopting the terms the parents use, actively and empathically listening to their concerns, and encouraging the parents’ questions and comments about the process. In our experience with the parents in TAP, many indicated that the observation piece was one of the most central aspects of their coming to a new understanding of their child.
It is also important to acknowledge that some assessors may be concerned about the willingness of children to disclose with their parents observing. As discussed in Tharinger et al., (2007), we have found in TAP that most pre-adolescent children not only willingly accept their parents observing the assessment, but with the support of their strong collaborative alliance with the assessor, use this setup as an opportunity to communicate to their parents either directly or indirectly through some of the tests and methods. However, there are likely children who would not be comfortable or feel safe with this setup. In this case, it may be that TA-C is not indicated, or that the assessor will instead need to work more intensely with the parents outside of the observational context. In fact, when using TA with adolescents, the parents do not observe any of the adolescents’ sessions. This differentiation is based on adolescents’ developmental need for privacy and some individuation from their parents.
It is also important to note that there are cases and circumstances when parental observation of their child’s testing sessions is not helpful, and can even be overwhelming and possibly detrimental. We are aware of cases where parents with backgrounds of severe trauma have been overwhelmed and traumatized while watching their children, even with good support from the assessor. In these cases, it might be best to videotape the child sessions and show excerpts to the parents later, carefully choosing what might be useful for the parent to view.
With the parents situated behind the mirror or watching the video feed with one assessor, the child and the other assessor begin to form their unique relationship. The assessor and the child typically talk more about the process, and discuss any further questions the child may have. Depending upon the child, this discussion may be lengthy or short. Next, it is common practice to invite the child to do a series of drawings (Tharinger & Roberts, in press). Standard instructions are used, and questions follow each drawing, with selective “extended inquiry” (Finn, 2007; Handler, 2008) that may include asking the child to tell a story about one of the drawings. This initial child session often ends with free play, to provide the child with the opportunity to engage in unstructured activity that may reveal aspects of his or her personality and life themes (Tharinger, Christopher, & Matson, in press), as well as to allow the child a chance to express reactions to the experience of the session.
Child Testing Sessions and Continued Parent Observation
The subsequent two to six (or more) sessions consist of child testing activities, with parents continuing to observe. Again, the number of sessions is determined by the nature and extent of the questions guiding the assessment. Test selection in TA-C is individualized for each case. Tests may include standardized psycho-educational and neuropsychological measures; behavior rating scales completed by parents and teachers; self-report personality and psychopathology measures; and performance-based personality and psychopathology measures, including individually crafted sentence completion tests, stories told to apperception cards, and the Rorschach, typically using extended inquiry methods after the standard inquiry portion is completed.
In collaborative and therapeutic assessment models, tests are approached as tools that can provide access to clients’ typical real-world experiences (Fischer, 2000). Handler (1998) asserts that even seemingly objective, straightforward tests such as the Wechsler intelligence tests provide data far beyond what they purport to measure. By observing the child’s response to the assessment situation, the assessor can develop a sense of the child’s reactions to success and failure, reactions to interpersonal stress, regulation of affect, thought processes, tendencies toward perfectionism, level of anxiety, and defensive and coping strategies. It is important to keep in mind that standard psychological assessment can be an uncomfortable and confusing (p. 235) process for children. The standardized administration procedures for many tests inherently involve “failure experiences,” as the assessor is required to continue administering a subtest until the child has answered a string of questions incorrectly, in order to establish a ceiling (Handler, 2007). The assessor generally cannot provide immediate feedback about the child’s performance, and this, as well as the assessor’s often detached, impersonal stance may arouse anxiety for children. Although it is essential to follow standard procedures so that tests can be properly scored and norm-referenced, in TA the assessor is encouraged to ask about the client’s experience of the test, once standardized administration is complete (Finn, 2007).
While this may not be appropriate in all cases, the assessor may also use a “testing of the limits” or “extended inquiry” approach (Handler, 2008), following standardized administration of intelligence and achievement tests, to determine what assistance or modifications are needed for the child to succeed on items that were previously failed. For instance, the assessor may encourage the child to take guesses, walk the child through a problem-solving strategy, or provide small hints (Handler, 2007). Different types of extended inquiry may be used with other tests (Finn, 2007). For example, the child may be invited to make up a story about a character from a Rorschach or TAT response, or asked follow-up questions to contextualize responses to a self-report measure. These procedures can give greater depth and meaning to the understandings construed from test scores, and also provide opportunities for different, more supportive interpersonal interactions with the child. These techniques also assure the “experience-near” level of inference, as responses are explored and associated meanings determined. And these techniques may also inform recommendations for subsequent interventions.
In addition, further opportunities for play, unstructured and structured, may also be incorporated into testing sessions with the child (Tharinger, Christopher & Matson, in press). While this adds to the total time the assessment requires, providing free-play opportunities may be beneficial in several respects. The assessor’s invitations to play may contribute to a positive child–assessor alliance, with the possible benefit of increasing the child’s comfort during, and cooperation with, the testing. It is likely that the more comfortable and cooperative the child is, the more confident the assessor can be that the child’s performance is representative of his or her true abilities and typical behavior. Furthermore, observing the content and style of the child’s play may provide more information and hypotheses about the child’s world. In addition, themes and characters that might inform the development of an individualized fable as feedback for the child (discussed later) may arise through play.
In this series of testing sessions, as the child engages in the testing activities, the parents continue to observe from behind the mirror or through the video feed. Parents are encouraged to share comments and ask questions of the assessor who observes with them. As mentioned earlier, this is an extended and active collaborative process with the parents. As appropriate, if a team approach is used, the parents may also meet with both assessors at the end of the session, without the child, for further clarification of their observations. These “check-outs” can be very useful to enhance the parents’ understanding of developing answers to their assessment questions.
Development of Initial Case Formulation and Informing the Assessment Questions
During the process of the assessment sessions, and following their completion, the assessment team works to integrate the information that has been gathered, determine if additional data gathering is needed (through tests, interviews, or contacting collateral sources), and starts to put together the case conceptualization. In addition, the assessors reflect on the preliminary feedback that will be given, typically in relation to the assessment questions. In TA-C, this analysis informs the plan for the family intervention session, the next step in the process. Following the family intervention session, the assessment team integrates information learned from this session to arrive at the final case conceptualization, and organizes the feedback to be presented to parents.
Planning and Conducting a Family Intervention Session
Following the completion of the formal testing sessions and tentative case conceptualization, a family intervention session is usually planned and held (Tharinger, Finn, Austin, et al., 2008). The plan and format of this session is individually designed to meet the needs of each family. Typically, the parents and child are guided to interact in a structured or semi-structured family activity. The goals include allowing the assessors to see the child’s behavior in the family context, testing systemic hypotheses, and providing parents with the (p. 236) opportunity to experience success in applying new techniques in which they may have been coached by the assessors. Additional goals involve providing the child with a new experience of the parents, assisting the family in gaining insight into how the family contributes to the child’s problems (and thus preparing parents to accept systemic feedback), inspiring the family, and imparting new hope.
One of the most creative tasks when planning a family session is deciding on the method or technique to use. When planning a family session, the assessor can choose from a variety of techniques that help move the focus from the child to the family, yet still maintain a common purpose with the assessment process as a whole—to continue to assess factors involved in the child’s problems. There are a wide variety of possible methods and activities available for use in a family session; for descriptions and illustrations of parent coaching, semi-structured parent–child play, family drawing, family sculpture, family psychodrama, consensus TAT, and consensus Rorschach methods, see Tharinger, Finn, Austin, et al. (2008). In-depth examples of family intervention sessions also are provided in Hamilton et al. (2009), Tharinger et al. (2007), and Tharinger, Christopher, and Matson (in press). Whatever method is chosen, its implementation must be carefully planned. Special attention is paid to the questions that have guided the assessment, the family’s history and patterns of interaction, and the assessors’ resulting systemic hypotheses, as well as the assessors’ sense of the family’s readiness for various levels of intensity that may potentially be evoked during the family session. Of utmost importance is that the activities in the family session be mindfully and uniquely tailored to meet each family’s needs, such that the targeted behavior or experience can be invoked “in vivo” and at an appropriate level of intensity considering the family’s resources.
Planning Parent Feedback/Summary-Discussion Session: Principles of Case Conceptualization, Organizing Findings by Level of Discrepancy, and Feedback Plan
Throughout all sessions with the parents and the child, and most thoroughly before the feedback sessions, much work is put into an analysis of all information gathered through the interviews, testing sessions, and parental observations and consultations. The analysis of this information is an iterative process that guides and impacts the progression of the assessment from beginning to end. Hypotheses evolve throughout the process until the assessors arrive at the case conceptualization and organization for feedback.
Principles Of Case Conceptualization
In traditional psychological assessment of children, as well as in TA-C, the interpretive task is to make sense of complex information. This includes the child’s observed overt behavior, report of conscious experiences and perceptions about self and other, portrayal of unconscious or less conscious dynamics and concerns, and the interpersonal relationship between the child and the assessor (Fowler, 1998; Smith, 1998). As assessment data are usually rich, complex, and often inconsistent, theoretically based interpretations can serve a useful organizing function. Higher-order conceptual constructs often are needed to help “explain” apparent inconsistencies in the findings. Thus, data needs to be understood within the child’s cultural context, and examined from multiple theoretical and empirical perspectives, as well as from the assessor’s clinical experience and the assessor’s experience of the child. The task is to look for meaningful patterns that capture the complexity in the child’s thoughts, emotion, behavior, and interpersonal functioning; to understand how the child developed to this point in time; and to figure out what influences help to maintain behavior that is not healthy for the child or the family. In TA-C, these principles are embraced, as well as others discussed below.
In TA-C, it is acknowledged that the information obtained from the child has been given in the present moment, and in the context of the child’s interpersonal relationship with the assessor, and thus must be interpreted in that light. In addition, information gathered from the child likely has been influenced by the child’s perception of the relationship the assessor has established with the child’s parents, so this also needs to be taken into account. Furthermore, if the child’s parents have observed the testing sessions, it is safe to assume that the child was consciously or unconsciously communicating to his or her parents, likely making the child’s responses more “experience near” and relevant. And finally, it is understood that the assessor is a, if not the, central tool in the assessment. The assessor’s experience, affect, and counter-transference reactions are essential pieces of information. These must be understood to illuminate potentially important case dynamics and bias in interpretation and communication of the findings. In TA-C, the culminating (p. 237) goal for the assessors is to provide a coherent, individualized portrait of the child, in context, that leads to enhanced understanding and motivation for change for the child, and, perhaps even more importantly, for the parents.
Organization Of Assessment Findings
In TA-C, after interpreting the assessment data and arriving at a case conceptualization, Finn (2007) suggests organizing the findings into three levels, referred to simply as Level 1, Level 2, and Level 3. Level 1 findings are those that are highly consistent with how clients already think about themselves, and that they are likely to agree with and accept easily. These findings should not be surprising to clients. In feedback to parents, of course, the relevant consideration is consistency with how parents view their child, and how they view themselves in relation to their child. Level 2 findings are those that are mildly discrepant from the clients’ usual ways of thinking about themselves or their child. Level 2 findings may be reframes of how parents typically see their child. Although parents may be somewhat surprised by Level 2 feedback, they should not be upset by it, or likely to challenge it outright; although they may not immediately accept it without question, they should be able to integrate it into their views of their child fairly easily. Ideally, it is recommended that the majority of information presented during the feedback session be Level 2 information (Tharinger, Finn, Hersh, et al., 2008), as this is the information that parents are most likely to learn from or be changed by.
Level 3 findings are highly discrepant from clients’ existing self-views or parents’ views of their child. Parents are likely to become anxious upon hearing Level 3 information, and they may challenge or reject these findings. Their views of their child, and in many cases also their related views of themselves, may be threatened by this information. Things that parents suspect but fear may also fall into this category, as they will likely be difficult and anxiety-provoking to hear, even if they are not fully “unknown.” Although parents’ immediate reaction may be to deny these findings, over a long period of time (e.g., weeks or months after the assessment is completed) they may come to understand and integrate these findings into the way they see themselves. It is important to note that whether the assessors consider a finding to be “positive” or “negative” is not a factor in deciding what level it falls under. What is important are the parents’ perceptions and existing views of their child. If these are negative, then “negative” findings that fit with these existing views are the most likely to be easily accepted by the client—and, thus, are Level 1 feedback. It is equally important to be aware of the idiosyncratic significance some findings may hold for particular parents and families.
These levels determine the order in which findings should be presented to parents during the feedback meeting. Level 1 findings are presented first, followed by Level 2 and then Level 3. Thus, the most self-verifying information is presented first, and then the discussion moves into progressively more discrepant information. Presenting the most self-verifying information first makes parents comfortable, and supports the expectation that the assessment findings will be valid and useful. In contrast, presenting information that parents have trouble grasping is likely to mobilize the clients’ defenses, arouse anxiety, and create the expectation that the assessor has not understood or seen them or the child correctly, and will not be able to provide helpful information or suggestions that are connected to their real life challenges. They are then likely to be less engaged and invested in the remainder of the feedback session, and may not optimally benefit even from feedback on other, more self-consistent findings, because they will have already adopted a defensive position and “checked out” to some extent. Or, they may simply remain anxiously preoccupied with the upsetting Level 3 findings, and be unable to focus fully on the remaining feedback.
The assessors’ goal in feedback is to help the parents accept and integrate as many of the assessment results as possible. However, in some cases it may not be beneficial to present every single item of information that the assessor believes the assessment reveals about the child. Discussing too much new information at once may be overwhelming for the parents. Furthermore, some Level 3 feedback may be so threatening to the parents that it would not benefit them to hear it at the present time. For example, hearing that their child has a serious depression may be overwhelming for parents to hear, if they have not been somewhat prepared. However, in our experience, if the sequencing of findings is well thought-out, and the discussion of findings is conducted in a collaborative and supportive way, parents may, by the end of the session, be ready to hear Level 3 findings that they may otherwise not have been able to absorb. For example, when parents have been assisted to note their child’s depressive affect and irritability, as well as lack of (p. 238) interest in previously enjoyed activities, they are more able to hear the findings related to depression, and be ready to move into ways to help their child.
In addition to careful sequencing, the practice of organizing feedback around parents’ assessment questions also increases the likelihood that Level 3 findings will be accepted by the parents. If the information can be framed as an answer to a confounding question, or an explanation for something the parents have long wondered about, the parents may be more motivated to process and consider the information rather than defensively reject it (Finn, 2007). For example, if one of the parents’ assessment questions was, “Is my child really sad like her teacher thinks?” feedback addressing depression will likely be easier to hear and respond to. An additional strategy for increasing acceptance of Level 3 information is to give careful consideration to the language used. For instance, if the assessors know that the parents are especially fearful of “depression,” it is likely that using this word would immediately arouse significant anxiety. If alternative terms like “lots of sadness” or “feeling down most of the time” can be used instead, the parents may be more able to take in the information and evaluate it against their own self-perceptions and perceptions of their child. In addition to the careful planning and wording of feedback organized around the parents’ assessment questions, the entire process of the assessment—particularly the parent observation of the testing sessions, extended inquiries, and family session—is also designed to take potential Level 3 information and make it Level 2. That is, when parents have had the experience along the way of taking in surprising or discrepant information about their child, hearing this information from the assessor at feedback is likely to be much easier.
Preparing To Provide Feedback To Parents: Guides, Rationale, And Resistance
The literature offers direction for providing oral and written feedback to parents following the assessment of their child (Braaten, 2007). These guides represent a significant advance, as historically psychologists maintained that assessment results were too complex or threatening for clients (Groth-Marnat, 2003) and, as a result, feedback was often withheld or minimized with adults and adolescents, and rarely, if ever, given to children. Fortunately, as ethical codes have evolved, the client’s “right to know” has become paramount, requiring assessors to take reasonable steps to provide assessment results to clients, or to persons acting on the clients’ behalf. Many experts have offered guidance for the parent feedback session that occurs at the conclusion of a psychological assessment of a child (for a summary, see Tharinger Finn, Hersh, et al., 2008).
Furthermore, a convincing rationale has developed for the importance of providing feedback to parents and children (Tharinger, Finn, Hersh, et al., 2008). The rationale includes adhering to ethical guidelines (APA, 2002; NASP, 2000); enhancing the involvement of the child and parents; increasing the likelihood that parents will follow through with recommendations (Finn, 2007); and further motivating assessors to clearly conceptualize, understand, integrate, and effectively organize their findings (Finn, 2005). In addition, providing feedback is one of the major ways for the assessment to have a therapeutic impact. Studies have demonstrated that well-formulated feedback with adults leads to a decrease in symptomatology, an increase in self-esteem and hope (Finn & Tonsager, 1997; Newman & Greenway, 1997), enhanced self-related processes such as self-understanding and positive self-regard (Allen et al., 2003), willingness to engage in recommended therapy (Ackerman et al., 2000), and positive alliance to a future psychotherapist (Cromer & Hilsenroth, 2006; Hilsenroth, Ackerman, Clemence, Strassle, & Handler, 2002; Hilsenroth, Peters, & Ackerman, 2004; Weil & Hilsenroth, 2006). Although much less attention has been devoted to investigating the effects of psychological assessment feedback with parents and children, Human and Teglasi (1993) found that parents reported positive changes resulting from feedback from psycho-educational evaluations, such as improved understanding of their child, a better parent–child relationship, and an increase in the child’s self-esteem.
Although the rationale for providing feedback is compelling, and the benefits significant, historically there has been and continues to be much professional resistance to providing feedback. Pope (1992) posits that when the fundamental aspects of feedback are carefully considered, the process of feedback can “provide a context of clear communication within which the purpose of an assessment can be achieved;” when neglected, however, it tends to “limit, and sometimes destroy entirely, the usefulness of an assessment” (p. 268). There are a multitude of factors that may explain why, historically, assessment professionals may have regarded the revelation of diagnostic impressions to the client as a “minefield that must be approached with wary caution” (Berg, 1985, p. 55). One contributing (p. 239) factor may be that assessors are often not adequately trained in the task (Butcher, 1992; Pollak, 1988). Standardized assessment is straightforward, manualized, thoroughly taught in training programs, and becomes effectively mastered with practice; the feedback meeting, however, can be a delicate process that requires sensitivity and interpersonal, even therapeutic, skills (Pollak). Perhaps a lack of graduate and professional training contributes to a lack of confidence for some assessors in their ability to translate a psychological conceptualization of a client’s performance into words that the client can understand (Pollak, 1998; Lillie, 2007). Theoretically, providing feedback challenges assessors to “build a bridge” between the testing instrument and its clinical utility. Clinical utility can mean anything from pathological diagnoses to “empathic overtures that can bolster self-understanding and self-acceptance” (Quirk, Strosahl, Kreilkamp, & Erdberg, 1995, p. 28).
Resistance to providing feedback may also be fueled by economics. Consistent with many current concerns about resources, “the bureaucratic allocation of time” allows little opportunity to engage in an assessment feedback session in order to address questions and concerns with the client; the clinician may have to donate their free time in order to provide adequate feedback (Pope, 1992, p. 268). Pollak (1988) posits that a clinician with a heavy testing load may view feedback as an imposition, after testing and report writing have been completed. In conclusion, psychologists and psychological training programs have traditionally not given the assessment feedback process much attention. This is unfortunate, considering that “the value of even the most comprehensive and expertly conducted psychological assessment is significantly diminished if findings are misunderstood and recommendations go unheeded” (Pollak, p. 145).
Summary/Discussion (Feedback) Session with Parents in TA-C
A general organization for discussing findings with parents following a TA-C has been offered by Tharinger, Finn, Hersh, et al., (2008) and is summarized here. The assessors begin by acknowledging that parents are often anxious about attending feedback sessions, and check in with the parents about their initial emotional state at the beginning of the session. The assessors then review the plan for the entire session, explaining what will happen and encouraging questions and collaboration. Before beginning the discussion of findings, the assessors thank the parents for participating in the assessment, and particularly acknowledge any factors that may have been especially difficult for the parents. The assessors then move into answering the parents’ assessment questions, following Finn’s (2007) level-based organization of feedback from least to most self-discrepant, as described above. Because it is likely that the assessors will not have been able to accurately predict all of the parents’ reactions, their responses are closely monitored, and if the parents appear to be becoming too overwhelmed, the assessors modify their plan for the session and stop to provide support whenever necessary.
The assessors avoid arguing with parents about assessment findings, and instead encourage them to share their own perspective and how they would explain or make sense of their child’s test responses. Although recommendations may have been offered throughout the session, all recommendations are summarized at the end of the session. The parents are encouraged to discuss how feasible the recommendations may be, and whether they have any questions or concerns about how to implement them. Before ending the session, it is recommended that the assessors discuss with the parents how feedback will be communicated to the child. The assessors also thank the parents again, and share genuine statements about what each assessor learned or gained from being involved with the family. See Hamilton, et al. (2009) for a case example.
Preparing to Provide Assessment Feedback to Children
Providing assessment results to children in a way that they can understand, appreciate, and relate to, is not an easy or straightforward process. Tharinger, Finn, Wilkinson, et al., (2008) offer that providing feedback to children is “equally if not more difficult” than providing it to parents or teachers. Additionally, assessors who have attempted to deliver a summary of the findings to a child, perhaps as straightforward as strengths and weaknesses, have likely encountered blank stares and a sense of the child being overwhelmed, or just tuning out. Assessors may then, understandably, feel “ineffective and vulnerable in their relationship with the child,” and decide to focus their efforts only on feedback to the parents (Tharinger, Finn, Wilkinson, et al.). However, for practitioners of collaborative and therapeutic assessment with children (Finn, 2007; Fischer, 1985/1994; Handler, 2007; Purves, 2002; Tharinger, Finn, Wilkinson, et al.), it would be considered a rare exception not to provide the (p. 240) child with individualized information about his or her assessment performance. These professionals are committed to engaging children in a process that is “respectful and responsive” to their experience, and sharing the results in a child-friendly manner. Indeed, helping children understand the purpose and process of an assessment, inviting their participation in determining the goals of the assessment, and providing an explanation of the results, are important aims of collaborative and therapeutic assessment of children.
Thus, in TA-C it is important to find effective ways to present children with some feedback. As discussed in Tharinger, Finn, Wilkinson, et al. (2008), feedback needs to be given to the child using language as close as possible to that which the child would use. It is a good idea to use images or words the child actually used during the assessment. The tone should be supportive and hopeful, and the assessor should carefully select which findings to share with the child. Although the prior preparation the assessor has completed for the parent feedback is foundational, the child is given much less direct information, perhaps just a single piece or two of the “new story.” Typically, appreciations are shared, strengths emphasized, and Level 1 and 2 information included. In almost all cases, providing Level 3 information to the child would be considered only if the parents have indicated strong support for the child in beginning to address these issues. In most instances, it is better for Level 3 information to be addressed over time through ongoing interventions, perhaps by a therapist or teacher.
However, even with this level of awareness and preparation on the part of the assessor, upon reflection it is hardly surprising that many children’s ability to absorb highly self-relevant and emotion-laden material during a feedback session is extremely limited. It is our experience that children often tune out when findings from the assessment are presented to them in a direct manner, even when adjusted for level of language and complexity. Fortunately, many assessors (Finn, 2007; Purves, 2002; Tharinger, Finn, Wilkinson, et al., 2008) have successfully overcome the challenge of direct feedback by developing more indirect and engaging methods of explaining assessment findings to children. Drawing from Fischer’s (1985/1994) example as well the classic work of Winnicott (1953), these practitioners routinely create individualized fictional or metaphorical stories or fables that incorporate assessment findings into a child-friendly format.
Tharinger, Finn, Wilkinson, et al. (2008) outline the rationale and benefits of providing children with their assessment results through individualized fables. First, the format of a fable presents a more digestible form of information for a child, and gives the child a vehicle to try out new conceptions of the self without becoming overwhelmed. Second, using fables can help children feel validated and understood, and can provide them with an intense experience of positive, accurate mirroring. And, in addition, sharing the fable with the child’s parents present enhances their ability to empathize with and construct, or accept, a new story about the difficulties their child is having, how those difficulties might be affected by the systemic functioning of the family, and how the family may be able to intervene.
We have found that children who receive a fable created especially for them, a fable that portrays their functioning and family in an understandable way, often experience a sense of finally being really understood for the first time. Furthermore, fables can diminish children’s shame and negative self-conceptions, in that the stories can help reframe the child, for instance, from “bad” to sad, or from “dumb” to dyslexic. The fable also serves as a “transitional object” that can be kept, illustrated, and referred to by the child and the parents long after the assessment is over. The child may read the fable numerous times, allowing the child to better internalize the story and be soothed by it over time. Finally, in our experience, parents also find the fable to be a lasting, positive product from the assessment. The child may request that the parent read the story to them again and again, thus promoting the parent and child working together. We have also found that parents are grateful to have the story to refer to themselves, as it serves as a hopeful reminder of the changes to which they have committed.
For the assessor, constructing a fable is both a clinical and a creative undertaking. The following steps have been offered for constructing fables (Tharinger, Finn, Wilkinson, et al., 2008).
(1) Create the individualized storyboard. The beginning of a fable typically incorporates elements of the child’s and family’s development and culture. The goal is to bring the story alive with details the child will recognize and be drawn to, thus engaging the child’s attention and imagination. This is accomplished through creating a somewhat veiled connection with the child’s everyday reality. The child is the main character in the fable, often represented as an animal or a mythical creature that the (p. 241) child has identified as being his or her favorite, or one he or she wishes to be. Important family members are included as additional characters. In addition, the assessor typically is included in the fable and represented as a figure of wisdom and kindness; for example, as a wise owl, sage, or respected tree in the forest. The parent characters usually have sought assistance from this wise character (as occurred during the assessment).
(2) Introduce and address the challenge(s). Following the introduction that sets up the scenario, the child’s character is typically confronted with a challenge or conflict that is quite similar to one in the child’s past or recent experience, and that in real life has been somewhat overwhelming. The focus of the challenge is based on one of the presenting concerns for the assessment, on the obtained findings, and on the level of change the family appears to be ready for at the time. The goal of a fable is to model a successful step toward constructive change. The steps may be suggested by the wise character in the story, but typically are carried out by the parental characters, representing the parents’ commitment to helping the child.
(3) Be realistic. It is important to emphasize that if parents are not capable of or willing to implement a certain solution, it should not be incorporated into a fable for the child. In cases where the next steps are unclear at the time the child receives feedback, the fable should indicate that the next steps and solutions are to be worked out, and (if it is true) that the parents have committed to work toward change. Examples of fables from TAP are provided in Hamilton, et al. (2009), Tharinger et al. (2007), Tharinger, Finn, Wilkinson, et al. (2008), and Tharinger, Christopher, and Matson (in press).
Providing Child Feedback
We advise that feedback to the child follow the oral feedback to the parents and, if possible, take place in an entirely separate session, possibly a few days or a week later. This sequence allows the parents time to discuss and absorb the feedback presented to them about their child. This timing also allows the assessors to reflect on how the parents responded to the feedback they received, and what growth steps they have committed to undertaking. As discussed above, this understanding helps the assessors decide what steps to represent in the fable. The child and parents attend this session together, and the assessors start the session by thanking the child for participating in the assessment. Following, it is time to introduce the fable and emphasize how special it is. The child is told that the assessors, together with the parents’ input (if that is the case; parents are often invited to collaborate), wrote the fable particularly for the child. The child is then invited to choose who will read the fable: one of the assessors, a parent, or the child. After the fable has been read and reactions expressed, we suggest that the assessor invite the child to modify it if he or she wishes. This gives the child an active role with the fable, and a chance to impart his or her own sense of what is needed. Many children like the story just the way it was written, but others may choose to change some details such as the name of a character, or the color of an animal’s fur. We suggest always asking if the child likes the “ending” (i.e., the resolution) of the story. In our experience it is unusual for a child to ask for major changes, but if that occurs it is very instructive. (The few times this has happened, a child had a different idea of how the fable should end.) The presentation of the fable typically concludes the assessment process with the child and the parents (although in many cases we suggest a follow-up check-in three months later, discussed in an upcoming section). Because the fable may serve as a transitional object, the assessors may wish to remind the child that he or she can read it, or ask the parents to read it, whenever he or she wishes.
Written Feedback for Parents
Most child assessments culminate in the production of a written report, usually intended for the use of other professionals, treatment facilities, or the child’s school. The report serves as an enduring, transportable record of the assessment to facilitate communication of the findings. Because reports have historically been used primarily by other professionals for intervention planning purposes, relatively little attention has been given to the usefulness and comprehensibility of written reports to parents. In TA-C, Finn (2007) suggests organizing written feedback for parents to correspond to the assessment questions they generated at the beginning of the process. The format of written feedback in TA-C is typically very similar to the organization of oral feedback, and thus the preparation time put into the oral feedback pays off greatly when it comes to producing a written letter. Findings are organized by assessment question, and presented in the same order as during the feedback session. The written communication typically takes the form of a letter to parents, rather than a traditionally organized psychological report (Finn, 2007), although a formal report may also be provided if needed for other (p. 242) purposes, such as documenting a diagnosis or disability for school accommodations.
In the parent letter, the assessors use first person, colloquial language and active voice, and incorporate comments, examples, or even disagreements that the parents offered during the feedback session. Fischer’s (1985/1994) collaborative assessment reports take a similar approach to written feedback. Information about the child is presented in the form of characteristic behaviors, rather than labels or categorizations, and the child and parents are described as having been active participants in the process. The narrative style and tone of the letter communicate that it provides the assessors’ subjective impressions rather than some “absolute truth” about the client, but the clear descriptions and examples explain how the assessors arrived at these impressions. Examples of partial parent feedback letters from TAP cases of TA-C can be found in Tharinger et al. (2007) and Tharinger, Christopher, and Matson (in press).
If possible, it is highly recommended that an in-person follow-up session occur one to three months after the TA-C has been completed. The assessor(s) typically meet with the parents and the child to discuss progress the child and family have made. This is also a time to explore factors that may be promoting or hindering progress, answer any additional questions the parents and child may have, and problem-solve any difficulties that may be interfering with implementation of the recommendations. New events in the life of the family, both positive and negative, may also be explored as to their impact on the child and the family. In our experience, it is often most useful to use part of the session to check in with the parents, and then invite the child to join at the end. In some cases we have found it useful to reintroduce the fable to the parents and child, and ask them to add the next steps to the fable; that is, the child and family story.
Application of TA-C to School-Based Assessment
Up to this point in the chapter, we have provided a description of the development of collaborative assessment and TA, and reviewed evidence for the efficacy of these assessment approaches and models. We have also presented an in-depth view of the comprehensive model of TA-C used in TAP, as well as the rationale for many of the steps, particularly the importance of obtaining assessment questions, actively collaborating with parents, and providing meaningful feedback to the parents and the child. As indicated in the introduction, we are well aware that comprehensive TA-C, especially the extensive involvement of parents in observing their child and participating in family intervention sessions, is not readily transportable to school-based assessment practice. In addition, TA-C in its comprehensive form is unlikely to be feasible in most educational settings due to limited time, personnel, and economic resources. Furthermore, the focus of assessments of children in schools is not typically the child in the context of the family, but rather the child in the context of the school, with emphasis on the areas of learning and achievement. However, we are confident that many of the components of TA-C can be adapted successfully into school-based assessments with many benefits for children, teachers, and parents.
We now discuss the components of TA-C that appear to offer the most value and transportability to assessment practice in the schools. We have organized these components into four stages (see Figure 11.1): (1) adopting a new foundational base, which includes embracing a collaborative stance to assessment; (2) utilizing innovative assessment practices, which include constructing assessment questions with the child, parent, and teachers; utilizing process testing techniques, including testing the limits and extended inquiry processes; and being actively collaborative with the child, parents, and teachers throughout the assessment; (3) integrating innovative practices of case conceptualization; and (4) feedback planning and delivery, including an analysis and organization of the findings by assessment questions, and levels of feedback to guide discussions with parents and teachers; developing a fable or other creative method for providing child feedback; and communicating feedback to the parents, child, and teachers in meaningful and collaborative ways. These four stages are sequential, and build on and inform one another. There can be no progression to Stage 2 without Stage 1, no progression to Stage 3 without Stage 2, etc. We also give some consideration to the development of intervention sessions with the assessor and the child, and possibly with the teacher. These sessions have some resemblance to, and may coincide with, Response to Intervention (RTI) strategies or dynamic assessment (Palinscar, Brown & Campione, 1994)
We follow the discussion of the four stages with four case examples to illustrate the application of (p. 243) components of TA-C in school based assessment. The examples are drawn from cases that were completed by graduate students in school psychology, who were taking an assessment course (covering social/emotional assessment and TA-C components) under Tharinger in the fall semester of 2006, 2007, or 2008. The students were placed in a number of public school districts for this assessment practicum. The cases involved children referred for assessment due to suspected emotional disturbance (ED), or for reevaluation for an existing ED handicapping condition. All cases included here, with one exception, involved children in elementary and middle school. One, however, completed by the second author, involves an older adolescent, and is included due to its exceptional ability to illustrate the effectiveness of the components of TA in a complex case.
Foundational Base—Embracing a Collaborative Stance and Orientation to Assessment
The use of a collaborative stance by the assessor has the potential to provide a richer assessment experience for children, parents, and teachers than may typically occur in the school setting. By utilizing a collaborative approach, an assessment is done with the child, not to the child. This collaborative stance generally yields active participation and a positive experience for the child, parents, and teachers involved in the assessment. Generating a collaborative atmosphere includes consistently portraying genuine concern and interest in the input of the child, parents, and teachers. The assessor explicitly conveys the collaborative nature of the assessment, and emphasizes the importance of the perspectives and opinions of those participating in the assessment. Incorporating a collaborative stance into all aspects of the assessment process is a relatively easy way to for an assessor to enhance the assessment process in schools.
The task of establishing a collaborative orientation overlaps with that of establishing a strong working alliance. A strong working alliance involves a sense of connectedness between assessor and child while working towards common goals. Fostering a strong working alliance is highly beneficial, for it can increase a child’s investment in the assessment process. This heightened investment can, in turn, result in the collection of a rich sample of the child’s emotional, behavioral, cognitive, and academic capabilities. To establish rapport and engender a strong working alliance, the assessor spends time exploring the child’s interests and using play and playfulness. The assessor also exhibits respect towards the child based on cultural knowledge, and enhances his/her understanding of the child’s cultural context and accompanying cultural beliefs, values, and worldview. These assessor behaviors should occur in an interpersonal climate marked by warmth, acceptance, unconditional positive regard, and appropriate limits.
Innovative Assessment Techniques
Construction Of Assessment Questions
The construction of assessment questions with children, parents, and teachers, is a component of TA-C that can be readily incorporated into school based assessment practice. Most school based assessments are guided by questions about special education eligibility and programming, and how to best meet the needs of children in the school (p. 244) context. In addition, assessors can allow additional questions from those involved, to help direct the assessment. The inclusion of this TA-C component is an early demonstration of the assessor’s authentic commitment to collaboration, and later facilitates the process of heightening the relevance of the feedback to invested parties. Furthermore, creating assessment questions fosters enhanced motivation to contribute to the assessment by allowing the child, parents, and teachers to take some ownership of the assessment process, and to know that they will receive feedback that is important and meaningful to them.
Assessors can request assessment questions during interviews with children, parents, and teachers. If these individuals have difficulty generating questions, offering examples of assessment questions is beneficial. During interviews, the assessor also listens for other potential underlying questions. The assessor then poses any suspected questions, to discuss whether the questions are of interest to the parent/teacher/child. The co-construction of assessment questions is intended as a collaborative effort, requiring active involvement from both the assessor and those interviewed.
Use Of Process Assessment Methods
Process assessment also is easily transported to school based assessments. Although a standard battery may be required in school settings, it can be supplemented with additional assessment instruments that are chosen on an individual basis to address specific assessment questions. Furthermore, rather than administering assessment tools in a way that only seeks answers to each question, the recommendation from TA-C is to intermittently process the testing experience with the child. The assessor is also encouraged to use him- or herself as a key assessment tool, by remaining highly attuned to the child’s emotional and behavioral responses throughout administration of the assessment instruments. Recognition and identification of the child’s responses to the testing situation are invaluable to gaining a more comprehensive understanding of the child’s functioning. The assessor maintains cognizance of counter-transference reactions to the child, as a means of gaining an appreciation for others’ experience with the child. For example, if, during testing, a child is easily distracted by external stimuli in the room, has difficulty staying in his seat, and consistently needs redirection, the assessor will experientially understand the energy required to manage his behavior. The assessor will then be able to gain appreciation for the teacher’s dilemma, and subsequent frustration related to managing that child’s behavior while simultaneously trying to attend to the needs of the other students in the classroom.
Processing testing is also useful in that it can contribute to the child’s expanded awareness of personal strengths and weaknesses, which in itself is an intervention. Of noteworthy importance, the assessor uses creativity and flexibility without compromising standardization, which is required for valid interpretation of test results. To conduct process testing with the child, the assessor intersperses brief breaks within the testing protocols to “check in” with the child and to better understand his or her current thoughts and feelings. The assessor also makes reflective statements about the child’s verbal and nonverbal responses to various aspects of testing. The assessor asks the child for ideas about what would make particularly challenging aspects of testing easier. The assessor inquires about situations in school and at home that elicit similar negative responses from the child, in order to start making broader connections about the child’s interaction with the environment. Including the technique of processing testing with the child is relatively simple and, as an added benefit, can help demystify the assessment process for children in schools.
A form of active collaboration with parents is also highly recommended and transportable. Parent collaboration is vital to the therapeutic nature of the process and the systemic change that is possible with TA-C. It is important for parents to feel like part of a team, helping the assessor explore ideas about their child, and thus gaining a level of investment beyond that typically seen in assessment practice as usual. This may be especially important given that parents begin the assessment with their own background and history of school experiences. Navigating the school system may be intimidating for some parents, and so active collaboration can foster greater parental involvement in the assessment process.
Increased collaboration with parents not only has the potential to ease the parent–school relationship, but can also provide important information and produce change both inside and outside of the school context. Collaboration begins by focusing on what the parents would like to learn from the assessment and constructing assessment questions, as detailed earlier. The collaboration continues with check-in phone calls, which help keep parents (p. 245) informed about the progress of the assessment, and also key the assessor in to any major family events or changes outside of school. By providing parents with updates on the assessment, assessors also can begin to connect testing observations to the child’s real world, in school and at home. For example, the assessor may share an observation such as, “I know one of the concerns for Johnny is his ability to pay attention and stay on task in the classroom. I noticed that after spending only 1 to 2 minutes on a series of drawings, Johnny became very involved in the last one, taking over 30 minutes. He was highly focused and paid great attention to detail for this last drawing. Have you ever noticed anything similar? Are there some things that Johnny will really get involved in?” These follow-up questions provide the assessor with more information and can help parents start to connect the assessment to their own experiences. Not only does this build the assessor–parent relationship, but it also lays the groundwork for feedback. Based on how the parents are able to integrate some of the assessor’s observations, the assessor begins to determine what information may be Level 1, 2, or 3, for feedback.
In translating TA-C components to the school setting, collaboration with teachers is a significantly larger area of focus than in comprehensive TA-C. In comprehensive TA-C, the systemic process generally focuses on the parents’ views of the child, whereas in schools both the parents’ and teacher’s views are important. Especially if the referral concern is more academic in nature, the teacher is likely to be the primary focus of TA methodology. Thus, teacher questions should be gathered, and the collaborative stance should be extended to include the teacher. Teachers will most likely be a major source of information regarding the child, and so helping them invest in the assessment process can impact the teachers’ openness to feedback. Often, recommendations at the end of a school assessment will ask teachers to make additional modifications or accommodations for a student. An “expert” approach by a school psychologist, where the teacher’s views and the realities of the classroom have not been explored, can lead to more resistance in following through with recommendations. However, if the teacher has been involved in the assessment and supported by the assessor, then the recommendations can be tailored to the realities of the teacher’s resources; subsequently, he or she is more likely to incorporate suggestions and to reinvest in the student. The collaboration process with teachers should be similar to that with parents, including constructing assessment questions, doing check-ins about the student and the progress of testing, and beginning to collaboratively hypothesize about test results. Checking to see if the testing confirms the teacher’s experiences with the student can provide a means of testing the teacher’s openness to systemic feedback. Parallel to the parent process, teacher collaboration will heighten the depth and long-term intervention potential of the assessment. Teachers often face the challenging task of managing multiple children with emotional and behavioral difficulties, in addition to the rest of the students in the classroom. Minimal support or advice may be offered to these teachers to assist with this demanding task. The level of parental support may differ for each child, which can be frustrating. Furthermore, teachers may not receive sufficient validation for their hard work and taxing experiences. Therefore, the collaboration, support, and advice from an assessor can be highly valuable to teachers, and has the potential to greatly benefit children because of the significant portion of time children spend with their teachers in school.
The approach used in TA-C to integrating assessment data and developing a case formulation (detailed earlier) can be applied in the school setting. In the TA-C model, information gathered through interviews, testing sessions, and observations, is analyzed in an iterative fashion with appreciation for and awareness of the child’s cultural context, and is used to support and refute hypotheses about the child. The data is considered from multiple theoretical perspectives. For example, children are part of multiple systems; therefore, a child’s functioning will need to be examined in the family, school, interpersonal, and intrapersonal contexts. A behavioral approach may explain how a behavior is reinforced via attention at school, yet understanding how those needs for attention either are or are not being met at home can help an assessor understand the child more holistically. And although the assessment focuses on the child, it is extremely important to gauge the needs and resources of the major adults—namely, teachers and parents—who may be frustrated or overwhelmed by a child, and thus will need support themselves, in order to create a supportive environment for the child.
The objective for an assessor employing this component of TA-C in a school setting is to integrate the data about the child into a coherent, individualized case conceptualization that is organized (p. 246) by the needs of the school, as well as by the parents’, child’s, and teacher’s assessment questions. A tentative case formulation provides hypotheses that can be addressed in an intervention session, if applicable, which then allows for further refinement of the case conceptualization. Most important, the case formulation is critical in determining how to organize parent, child, and teacher feedback, and how to deliver feedback in such a way that the results can be heard and internalized.
Consideration of an Intervention Session
As discussed earlier, including family intervention sessions in TA-C allows the assessor to test hypotheses, determine the systemic level of change possible, and promote positive solutions/skills before the final feedback meeting (see Tharinger, Finn, Austin, et al., 2008). In TA-C, not only is the assessment itself considered an intervention, but there also is room for the incorporation of an explicit intervention session, which may be extremely beneficial in the school setting. Although intervention sessions in TA-C typically involve parent(s) and child, an assessor in a school setting could potentially create a child–teacher intervention session instead, or even an intervention session with the child alone. Intervention sessions can provide unparalleled information about how the child might respond to new and different ideas, and can allow the testing of these ideas before implementing a fully formalized intervention. Intervention sessions in the schools could help find a “best fit” of intervention practices within the RTI model.
However, it is important to recognize that school resources are limited, and full intervention sessions with parents or teachers may not be feasible for every assessment. Therefore, it is beneficial for the assessor to fully adopt the perspective that the entire assessment is an intervention, and to realize he or she has the potential to do mini-interventions with the child throughout the assessment process. This concept is similar to testing the limits in a standardized test protocol. After administering a standardized test, assessors can return to test the limits to gain more information about the child’s strengths and weaknesses. Assessors use their judgment about whether testing the limits could provide new or revealing information. This idea can be translated to the social/emotional components of assessments as well. For example, after administering a Rorschach with very low Human and Popular content, going back through the cards to determine whether or not the child can see the popular responses (after being told what they are) can illuminate important distinctions in the case conceptualization (see Hamilton et al., 2009). For academic assessment, providing the child with additional math problems and a calculator could determine whether the calculator will be helpful, or whether the child will need assistance in learning to use the calculator effectively. Testing how a child responds to positive reinforcement, or to a token system, can also be diagnostic and help inform specific recommendations.
If the assessor is able to create the opportunity for a teacher–child intervention session, this could be an important time to foster a more positive relationship, or to test out new routines and behavior techniques for the teacher–child dyad. For example, in planning and creating family intervention sessions, a variety of activities can be used to foster positive interactions and to help parents feel as though they can become part of the solution. Similarly, a school intervention session could help the teacher gain more empathy and understanding for why a child reacts the way she does, and help the teacher reframe seeing the child as “the problem” in the classroom. A successful intervention session could help a teacher reinvest in a child who may need significant support and understanding. Ideas for the session can be drawn from family therapy exercises, play therapy, or behavioral interventions. In summary, intervention sessions are a component of TA-C that can often be a turning point in creating a new “story” for the child, and for helping adults understand their role in maintaining, and opportunities for changing, problem behaviors. As mentioned above, the intervention session is also a piece of TA-C that fits particularly well within the RTI model, and facilitates the use of RTI to address social/emotional as well as academic issues. Years ago, we even did an intervention session with a teacher in which she tried a different instructional method with a kid—with the assessor present as a coach/observer/consultant. It was very helpful to everyone.
Integrating Innovative Practices of Feedback Planning and Delivery
Levels Of Feedback
In order to help assessors provide feedback to parents and teachers in a way that allows for them to understand and integrate as much information as possible, TA-C advocates the use of three levels, as described previously. Organizing feedback by levels can be especially important when determining what “official” feedback will be given to the school as part (p. 247) of the assessment report, and what feedback can be given to individual parents and teachers. The use of the parents’ and teachers’ assessment questions to provide an organizational scheme for feedback also furthers the collaborative relationship, provides real-world relevance, and promotes investment in hearing the results.
Level 1 feedback is often what parents or teachers may already know, and therefore functions as confirmation or validation of that information. If the assessor has been able to create a collaborative relationship with the parents, pieces of Level 1 feedback have likely already been shared during check-ins. This can allow for the quick assimilation of Level 1 information during the formal feedback session, and can thus allow assessors to focus on addressing deeper levels of feedback. Level 2 feedback may not be as obvious for parents, or may begin to incorporate systemic feedback that does not focus solely on the child. Ideally, the assessor has already planted the seeds of Level 2 feedback during check-ins and the co-construction of assessment questions. This makes the Level 2 feedback more accessible to the parent or teacher, and can help the long-term intervention potential of the assessment. Lastly, Level 3 feedback is the most difficult for parents to hear, and in some cases may or may not be shared, based on how the parent is able to respond to the previous Levels. It does not help the child when a parent, who may already be low on emotional resources, is overwhelmed by feedback results. Thus, Level 3 feedback that does not bear directly on the child’s eligibility for services may not always be appropriate given the family’s current situation, including level of emotional or financial stressors. However, the collaborative relationship often helps parents pick up on themes and systemic involvement on their own, which can create a bridge to Level 3 conversations.
It should be noted that levels of feedback may vary by feedback recipient. For example, something that might already be strongly suspected by a teacher (and thus Level 1 or 2 feedback for the teacher) might be highly surprising and upsetting information for the parents (and thus Level 3 for them). If parent and teacher feedback will occur in separate meetings (as is advisable), the assessor may need to plan different organizations of the findings for each party.
Parent feedback is typically a standard part of a psychological assessment of a child. In the school setting, parent feedback for an assessment often happens at the time of a formal special education meeting, where eligibility and services are determined. In this scenario, parents are asked to hear, understand, and then make decisions about services for their child, without much time to truly process the information. Although some assessments may be relatively straightforward, and the results aligned with parent expectations, more complicated cases, especially those surrounding SED qualifications, may require more in-depth parent feedback. Best practice is to provide parents with a separate feedback session, prior to the eligibility meeting, to address their questions and to provide them the space to integrate feedback that may be difficult to hear.
Not only should feedback be provided to parents in a way where they are free to ask questions and process the information, it should also be communicated in a way that is more accessible than a typical school report. We have found the use of parent-friendly letters summarizing the assessment findings to be extremely effective in helping parents return to the themes of the assessment in their own time. These are sent following the parent feedback meeting. A letter also provides a tangible result that can make the assessment seem worthwhile to the parent, especially when it addresses their concerns and assessment questions (see Tharinger et al., 2007).
Providing teachers with appropriate and useful feedback is essential in a school-based assessment. As it is the teacher who will be implementing recommendations in the classroom, addressing the teacher’s questions and concerns is a top priority. Teachers are often understandably concerned about their ability to provide extra services to one child, while also maintaining responsibility for the other students in their class. Thus, feedback should be informed by real world constraints of the teacher and school system, including time and energy. It is also the case that, as with parents, teachers sometimes have inaccurate and distorted “stories” about a child. This is where an intervention session, to test the reality potential of an intervention in the classroom and the teacher’s perceptions, could be of great use in generating teacher investment. The collaborative relationship fostered by TA principles enhances the teacher’s ability to hear and process feedback. Just as parents may be resistant to more systemic levels of feedback, teachers may also need (p. 248) support in hearing their own role in maintaining a student’s behavior. If the collaboration with the teacher(s) has been successful, then feedback according to Levels 1 and 2 should be readily absorbed by teachers. Just as parents should be given time to digest assessment results, teachers should also receive feedback prior to being asked to make significant changes in the classroom for interventions or new services.
Child feedback, especially for elementary-aged children, is often overlooked in the long and detailed process of initiating more specialized services in schools. However, best practice includes providing developmentally appropriate feedback to children as part of an assessment. If the process of the assessment has been collaborative with the child (as explained in previous sections), then the feedback can be an extension of the assessor helping the child process the assessment and what will happen next. Just as we recommend a personalized format for parents, TA-C also uses a personalized format for child feedback, such as a story or fable, as discussed earlier. One of the most creative and rewarding parts of TA with children can be the use of fables to communicate assessment results (Tharinger, Finn, Wilkinson, et al., 2008). Fables provide children with a metaphor they can relate to, and help the assessor communicate results in an interpersonally safe and developmentally appropriate manner. Child feedback does not need to be limited to fables; any medium that the child can relate to would be appropriate (e.g., card, poem, rap song, co-constructed cartoon).
Case Examples of Components of TA-C Applied to School-Based Assessment
As just described, the various components of TA-C work in tandem to create the therapeutic impact of assessment. Although we have delineated the different components of TA that are applicable in schools, case examples that embed components of TA-C applied within the school context can serve as useful illustrative tools. The following four examples show the integration of TA-C techniques across diverse clients and assessment goals. Names have been altered to protect the students’ privacy. The case vignettes are arranged from least to most complex, in terms of the extent to which TA components were incorporated into the assessments.
Daniel’s case highlights the importance of fostering an ongoing collaborative relationship with the parent that can then help shift the parent’s “story” of his/her child. Daniel is an 8-year-old, Hispanic second-grader in a primarily Hispanic school district in a large southwestern state. He repeated first grade due to reading difficulties, and has a history of externalizing behaviors, including tearing/crumpling work, refusing to do work, shutting down, crying, throwing chairs, yelling, and leaving the classroom. At the time of referral, Daniel was in a supplemental behavior program and receiving RTI reading services. However, his behavior remained a significant concern, so he was referred for a comprehensive evaluation.
As is typical in a large system such as a school, there was already information about Daniel and his family that other adults thought the assessor should know before beginning the assessment. The main concerns expressed were that Daniel reported that his father said Daniel did not have to listen to a female teacher, and that the father was sexist. This information could have damaged the collaborative potential of the assessment before it began. However, the female assessor was encouraged to form her own opinions and embrace a collaborative stance, gather the father’s assessment questions, and check in with him throughout the assessment.
The assessment revealed that Daniel was dealing with an irritable form of depression due to changes in his family system. His mother and father had divorced two years prior, and Daniel had lived with his mother, two half-siblings, and his mother’s boyfriend. Daniel’s behavior problems and repetition of first grade happened around the time of the divorce. Approximately four months before the evaluation, his mother and the rest of the family moved, leaving Daniel in his father and grandmother’s care. Responses to projective measures indicated that Daniel was dealing with conflicting feelings towards his mother (love and abandonment), while his feelings towards his father indicated a lack of emotional availability on his father’s part. Cognitive results and academics were average, with reading slightly below average; thus, Daniel did not meet criteria for an LD in reading. Rather, it was determined that his academics were being hindered by his depression.
(p. 249) planning and providing feedback
One of the most therapeutic outcomes of the assessment was helping the father change his view of Daniel from “mad” to “sad.” This idea was introduced over the course of the assessment, so that during parental feedback, the father was able to accept his son’s depression, rather than solely focusing on Daniel’s anger and misbehavior. The father was able to begin understanding what triggered Daniel’s outbursts, and why he was better behaved at home, where his father’s presence provided a sense of security. In planning the child feedback, the assessor noted how Daniel had communicated especially well via his drawings, in which he created a tree with broken hearts that needed to be planted, and “Dino-Man,” a boy who would turn into a dinosaur when he got sad or angry. Daniel’s drawings served as the basis for constructing a personalized fable as his feedback. At the end of the process, Daniel was moved to a more structured behavior program for the next school semester. In addition, his father was willing to initiate family therapy to help Daniel with the family changes, and remained committed to attending the sessions.
Overall, in this case, components of TA-C were used to enhance the depth and improve intervention outcomes of Daniel’s assessment. It would have been easy for the assessor to have minimized the father’s input, or to have been too intimidated by rumors of his sexism to work collaboratively with him. However, collaboration with the father was essential in helping him learn that his son was depressed. Not only was the father able to make this shift; he was also subsequently open to family therapy services. The mismatch between the father’s expectations for how Daniel should handle his problems, and Daniel’s sensitivity/depression, was a fruitful area for family work, enabled by the collaborative nature of the assessment.
Christina’s case particularly highlights the TA components of collaborative stance of the assessor, the co-construction of assessment questions, working closely with a teacher, the process of sensitively delivering feedback, and the importance of the alliance established between Christina and the assessor. Christina is a 13-year-old White female of low SES in seventh grade, referred for a reevaluation to determine continued eligibility for special education services. She was previously classified as a student with an Other Health Impairment (OHI) due to ADHD, ED, and an LD in math reasoning. She began receiving special education services in fifth grade. At the time of the assessment, she was in a resource math class and was receiving counseling.
The assessor developed a strong working alliance with Christina by exploring her interests, particularly in the areas of Anime and Harry Potter. The assessor also sought to understand Christina’s strengths, which Christina described as her creativity and imagination. In addition, the assessor was successful in working together with the mother and teacher throughout the assessment. Through collaboration with all these individuals, the assessor was trying to understand Christina and the contexts in which she was developing. Christina’s mother explained that the family was under increased stress since the father had lost his job a year ago, and was only able to find another job recently. She mentioned multiple concerns about Christina, including being late to class and social isolation. The mother also reported that Christina’s silliness “turns off” other kids, and that she is regularly teased. The teacher expressed various concerns about Christina’s behavior. The teacher reported that Christina is often late to class and disorganized, and exhibits odd social behavior, such as laughing for no apparent reason. The teacher described Christina as socially unaware because she was not tuned in to others’ feelings or to social cues. The teacher also stated that students consider Christina “weird” and sometimes refuse to work with her in groups.
innovative assessment techniques
The assessor worked with the mother, teacher and Christina to formulate assessment questions. The mother’s assessment questions included: (1) “What are your general impressions of Christina?” and (2) “Why has she started being late to classes?” The teacher’s assessment questions were: (1) “What are her academic strengths and weaknesses?” and (2) “How much of what she says is real and how much is for attention?” Christina’s assessment questions were: (1) “How can I learn more about Anime?” and (2) “How can I do better in front of people?” Answers to these questions were sought during the assessment, along with determination of Christina’s eligibility for special education services. Those involved in the assessment seemed to appreciate posing questions that would later be answered during feedback.
Christina was cooperative and friendly during testing, and seemed to be putting forth adequate effort. (p. 250) The child interview was informative, as Christina explained that she sometimes likes to go into her own fantasy world in her mind. Throughout the interview, she went off on tangents about her interests. The assessor let her do this to learn more about her interests, as well as her thought process. Christina acknowledged that she has a few friends but that most people think she is “weird.” She relayed that although she occasionally becomes upset and cries, she uses her imagination to cheer herself up. During testing, Christina sporadically began telling stories about fantasy characters. Occasionally, she would start performing a task correctly and then forget what she was supposed to be doing.
Testing revealed that Christina’s overall intellectual functioning was in the average range. She displayed a weakness in processing speed, the ability to perform simple tasks rapidly, mainly due to inattention. As found previously, she had a weakness in math reasoning, while her other academic achievement areas were commensurate with her overall cognitive functioning. The assessor also learned that Christina’s imagination is a coping strategy she has developed to help regulate her negative emotions. Her depressive and anxious symptoms had dramatically decreased since her last evaluation, and Christina indicated that she had learned through counseling to employ her imagination to better manage these symptoms. Although her imagination was an adaptive tool for emotion regulation, it also appeared to function as an impediment to her academic progress and social relationships. The testing showed continued attentional difficulties as well, which, along with her imagination, often worked together to distract her from class work. At the time of this assessment, Christina no longer met the criteria for ED, but qualified for OHI based on her history of ADHD, and for LD in math reasoning. It was recommended that she continue to receive counseling services to help her more effectively use her imagination, as well as other coping strategies, and to improve her social skills. It was also recommended that she continue in a resource math class to improve her math reasoning skills.
planning and conducting feedback
Feedback was organized into levels and delivered to the mother, teacher, and Christina to address their assessment questions, and to provide the other findings from the assessment. Feedback for the mother first involved answering her question about the assessor’s general impressions of Christina. For Level 1 feedback, the assessor explained that Christina is very imaginative and likes attention. For Level 2 feedback, the assessor described that Christina talked about wanting more friendships and how, although her imagination has helped with her depression and anxiety, her imagination seems to be affecting her peer relationships. Addressing the mother’s second question about why Christina has been late to class was also seen as Level 2 feedback. The assessor connected Christina’s increased tardiness to when she stopped taking medication for ADHD. Christina had ceased taking medication because the family was unable to pay for it. The tardiness seemed to be related to Christina’s tendency to “wander off” into her imagination, and to the attention she receives from her teachers when she is late to class. The assessor also described the cognitive and achievement findings, Christina’s eligibility for special education services, and her recommendations for Christina. The assessor checked in often with the mother during the feedback session to inquire about what she thought of the information provided. Because the feedback was provided gently and in a collaborative manner, the mother was receptive to and appreciative of the feedback.
Feedback for the teacher was organized according to her questions, first starting with a discussion of Christina’s academic strengths and weaknesses. This was Level 1 feedback and involved an explanation of Christina’s difficulty with math reasoning. An explanation of Christina’s processing speed deficit due to ADHD, and her subsequent trouble focusing, was also provided, highlighting how this affects her performance in school. The teacher’s second question about what portion of Christina’s behavior is real and what part is for attention was answered through Level 1 and Level 2 feedback. The Level 1 feedback for this question was that Christina’s behavior is a combination of these. She seeks attention, but also has some difficulty with social skills. For Level 2 feedback, a description of the ways in which Christina’s imagination has helped her manage her depressive and anxious symptoms was given. Then, the assessor talked with the teacher about how Christina sometimes overly uses her imagination, which may appear strange to others. The assessor gave the example that Christina might think about something funny in her imagination and then start laughing out loud, which seems odd to others who are not aware of her imaginative thoughts. The teacher had also expressed concern (p. 251) about Christina’s tardiness to class. The assessor explained that this was partly related to ADHD and her difficulty planning and organizing, but also due to her desire for attention. The assessor carefully explained that Christina even tried to gain negative attention. She preferred being noticed and scolded for being late, to no attention at all. The assessor checked in with the teacher intermittently throughout the feedback session to remain attuned to how the teacher was receiving the feedback. The teacher thanked the assessor for the feedback, and appreciated the way the feedback answered her assessment questions. Although she was slightly shocked to learn that Christina was enjoying negative attention, she said that this made sense. The teacher agreed to work with the assessor through consultation to try to reduce Christina’s tardy behavior. The teacher was grateful for this additional support from the assessor. The teacher reported that she felt more compassionate towards Christina as she began to better understand Christina’s social skills deficit from the assessor’s feedback.
Feedback was provided to Christina by first giving her some direct feedback from the assessment (i.e., general feedback, and then answers to her assessment questions), and then sharing a fable the assessor had written for Christina. For general Level 1 feedback, the assessor stressed Christina’s strengths, specifically her creativity and her imagination. For Level 2 feedback, the assessor suggested that she wonders if Christina is starting to use her imagination a little too much at times (e.g., she started writing a story in the middle of a class). The assessor also explained that it is easier for Christina to get distracted than other kids her age because of her ADHD. The assessor then addressed Christina’s assessment questions, with an answer to her question about how to learn more about Anime as Level 1 feedback. The Level 2 feedback encompassed a discussion of Christina’s other assessment question about talking in front of others. The assessor said that she wonders if it is sometimes easier for Christina to retreat to her imagination rather than to talk with other kids in school. The assessor stressed that Christina’s imagination helps her greatly when she is feeling nervous or sad, but that she might be more comfortable talking in front of others if she gets to know her classmates better. The assessor checked in with Christina as she was providing feedback to find out how she was thinking and feeling about the findings.
The assessor then shared the fable, which was about an Anime character, Kittyama, who loved to dance. Kittyama wanted to show the other Anime kids at school her dance moves, but was worried that they might laugh at her or tease her. Another special thing about Kittyama was that she could transport herself to another world called Imaginoku. When she was there, she could dance as much as she liked. She had many friends in Imaginoku and never worried about being teased. Kittyama enjoyed being in Imaginoku so much that sometimes she would transport herself there when she was supposed to be somewhere else. Kittyama wanted more friends at school, and desired to show them her dance moves. One day, Kittyama met a wise tree who she told about her dilemma with those at school, and how she wanted to demonstrate her dance moves. The wise tree asked if maybe others at school did not get to know her, because she would often go to Imaginoku. The wise tree suggested that she try to stay in school more and talk with other kids, rather than transport herself to Imaginoku so often. Kittyama tried this, and found that she was able to talk with others a little more easily. Although she was not ready to dance for them yet, she thought that she probably would be able to, once she spent more time with them and got to know them better.
Christina appreciated the Level 1 feedback, but was not receptive to the Level 2 feedback or the message of the fable. Instead of considering the fable’s message, she focused on the illustration of the Anime character on the cover of the fable. As the assessor was observing Christina’s reaction to feedback, she realized that what she anticipated to be Level 2 feedback was, in fact, Level 3 feedback. The assessor understood that Christina was not able to integrate all of the feedback she provided. Therefore, she remained flexible and met Christina at her level without pushing her to process more than she was able to. The assessor had been in close contact with Christina’s counselor throughout the assessment process, so she was able to ensure that he would provide Christina with extra support and additional coping strategies that would not negatively affect her social relationships as her imagination had.
During school based collaborative assessments, certain components of TA-C may have more pronounced, positive effects on outcome than others. The most significant TA-C components illustrated through Christina’s assessment were the collaborative stance of the assessor, the co-construction of assessment questions, working closely with a teacher, the gentleness of providing feedback, and (p. 252) the alliance established with Christina. Christina had previously suffered from depression and anxiety. She created an imaginative world to soothe herself, which was highly effective. Yet, this world had become a pervasive part of her life that was interfering with her ability to function well in school and in social relationships. The assessor needed to connect with Christina and show acceptance and appreciation for the world she had created, in order to facilitate a disequilibrium that would motivate her openness to trying other coping strategies. Causing such a dramatic change for Christina was understandably going to be a difficult process, requiring a supportive environment beyond the assessment. The assessor’s collaboration with the mother, teacher, and counselor helped these people better understand Christina, and enhanced their willingness to support Christina as needed in the future.
Many TA-C components were applied during Michael’s assessment, mainly because of the complexity of the case and the high stakes of needing to determine how to help him progress in the school context. Thus, Michael’s story portrays the utility of incorporating a collaborative stance, a strong working alliance, the collection of assessment questions, processing testing, a case formulation, and the delivery of feedback into a school-based evaluation. Michael is a 17-year-old Caucasian male from a family with minimal financial resources. He should have been a twelfth-grader, but was a tenth-grader according to course credits, due to failing multiple classes. The families in the school district where Michael was enrolled were culturally diverse and ranged from middle to low socioeconomic status. Michael had a history of disciplinary problems in school stemming from verbal and physical aggression towards students and teachers. He had previously been sent to alternative educational placements eight times, and had been summoned to court six times. Most recently, Michael was sent to an alternative educational placement for “making a terroristic threat” towards a teacher at his high school. Following this placement, Michael was referred for a comprehensive reevaluation to assess his continued eligibility for special education programming and to determine an appropriate educational setting for him. Michael qualified for special education in the past as a student with ED, and an LD in reading comprehension.
The development of a strong working alliance was critical to this evaluation, as Michael had previously undergone numerous unfavorable experiences with assessors and was therefore resistant to cooperating and putting forth effort. Michael initially tried to shock the assessor by interspersing strange, fantastical comments into their conversations so that she would view him negatively and avoid delving deeper. He had successfully elicited this response from others throughout his life. However, the assessor maintained a collaborative, therapeutic stance, as she displayed unconditional positive regard and an unwavering interest in learning more about him. The assessor explored his interests in video games and in writing stories, as they established rapport. Michael slowly became more invested in the assessment process as he realized that the assessor genuinely valued his input and was dedicated to helping him, his mother, and his teachers better understand him.
By collaborating with Michael’s teachers, the assessor discovered that Michael failed numerous classes due to a lack of effort, rather than due to insufficient ability. In fact, the teachers explained that Michael was one of the brightest students in their classes. Michael’s mother was surprised to find out that he had qualified for a learning disability in reading comprehension in the past, because she reported that he loves to read. This highlighted the importance of providing the mother with accessible feedback from the assessment.
The collaboration with teachers and Michael’s mother was also highly beneficial to investigating his behavior. Because of his history of failing classes, Michael was not enrolled in any advanced coursework and, subsequently, was not adequately challenged in his current classes. Teachers informed the assessor that he typically displayed problematic behavior when he finished independent schoolwork before others in the class, and was therefore bored. In those situations, he would try to make others think he was “weird” and “crazy.” For example, during one class, after he finished his work he bit into a pen and let the ink drip down his face. His teachers explained that he had no friends in school, and had often been ridiculed by peers. Michael’s mother also helped the assessor understand the etiology of Michael’s behavioral issues, as she explained that she and Michael had been physically and verbally abused by her husband throughout Michael’s life. The husband had recently moved out of the home, which both the mother and Michael (p. 253) reported had a positive impact on them. The mother also described the danger of their neighborhood, as they lived in a trailer home without any security features.
innovative assessment techniques
The assessor co-constructed assessment questions with the teacher and mother, which further increased investment in the assessment process and heightened their interest in the findings. The assessment questions from both the mother and teacher inquired about Michael’s peer relationships, and why he constantly exhibited shocking behaviors such as biting the pen. Michael did not generate any assessment questions, as he stated that he already knew everything about himself. The assessor respected Michael’s perceived self-awareness, and did not force him to provide assessment questions. Instead, she relayed appreciation for the opportunity to learn about him. With a strong working alliance, the assessor was able to obtain an accurate representation of his current functioning. Extended inquiry was used with the social/emotional assessment tools to gain a more comprehensive understanding of his emotional and behavioral functioning. For example, he quickly completed a standard version of sentence completion items. Yet, he spent significantly more time attempting to complete idiographic sentence completion items. When asked about the difference in completion time, he was aware of the stark contrast. He attributed this discrepancy to the individualized, personal nature of the idiographic items and stated that it was far more difficult for him to complete these than the other items.
Through integrating the information from teachers and the mother with the testing data, the assessor formulated a case conceptualization. According to test results, Michael’s overall cognitive functioning was in the high average range, and all of his academic abilities, including reading comprehension, were commensurate with his cognitive functioning. In addition, Michael shared with the assessor a fictional book he was writing, which provided further evidence of his proficiency in reading comprehension. The test results indicated that he did not qualify for an LD in reading comprehension.
However, Michael was not progressing in obtaining course credits in high school, possibly due to the mismatch between his academic prowess and the level of instruction. The alternative educational placement where he was located during the assessment was a self-paced learning environment that allowed him to earn course credits at an accelerated rate. Michael preferred this environment, and desired to complete the credits required for graduation from high school at the alternative school. Michael’s verbally and physically aggressive behavior seemed to be his way of protecting himself by preemptively striking out against those he viewed as threatening. In support of this finding, one of Michael’s stories from the Thematic Apperception Test featured a lonely dragon that chomped humans and stole their armor, as it thought that if it could not have friends, it would cover it up with treasure. Michael’s constant hypervigilance and defensive stance were also understandable, considering the lack of safety and security present in his neighborhood, and in his home during his formative years, due to his father’s abusiveness.
planning and conducting feedback
Feedback was delivered to Michael primarily to shed light on his behavior, and also to examine his willingness to participate in counseling. His openness to receiving feedback and engaging in a counseling intervention was facilitated by the strong working alliance. He appreciated the relationship forged between himself and the assessor. The assessor’s persistence in wanting to learn more about him, and her refusal to negatively evaluate him, provided a corrective emotional experience that gradually resulted in the shedding of armor and the subsequent exposure of a lonely boy. While Michael may not have shifted his view of himself, he was struck by the fact that someone had taken the time to know and understand him in a nonjudgmental, caring way, rather than being repulsed by his shocking behavior.
The feedback for the mother and teachers was individualized to address their concerns. The assessor helped these people shift their view of Michael from “bad” to “lonely and scared.” This new understanding of Michael was therapeutic, in that it enhanced their sympathy towards him and ultimately altered the way his mother and teachers related to him. During the course of the assessment, Michael began to quickly earn course credits. The assessor and teachers determined that he could complete high school at the alternative school. Over the next few months following the assessment, he completed all credits required for graduation, and graduated on time with the other twelfth-graders.
(p. 254) Damien
Damien’s assessment case demonstrates commitment to a collaborative orientation, collection of assessment questions, building a strong alliance with the child, an integrative case conceptualization, organizing feedback according to levels, and the use of a child fable as a successful feedback medium. This case also used an intervention session between the child and assessor that provided a mini-intervention in the area of academics, and informed subsequent recommendations. Damien is a 12-year-old African American boy in the seventh grade. He was originally assessed for ED while in fourth grade, due to depressive symptoms that had been present for over a year. At the time of the assessment, Damien was living with his mother and 17-year-old stepbrother. The reevaluation was conducted to determine Damien’s continued eligibility in special education, and the suitability of his current services.
Damien is from a low SES family facing serious economic hardship. Damien’s father passed away eight months before the assessment, and Damien’s depression and irritability had subsequently increased. His mother did not have a car, so a face-to-face interview at the school was not feasible. In TA-C, meeting with parents in person is part of building the collaborative relationship. However, this may not always be possible in a school setting, and phone interviews have been used if needed. In this case, the assessor was able to schedule a home visit to meet with Damien’s mother. The assessor’s willingness to make a special effort to meet with the mother laid the foundation for a collaborative relationship and strong working alliance with her. The assessor’s efforts clearly demonstrated that she valued the mother’s input as an important part of the assessment.
During the home visit, the assessor was able to gauge Damien’s mother’s emotional resources. It became clear that she and the rest of the family were still grieving the loss of her husband, and that the resultant economic hardship was a constant stressor. Her priorities were trying to provide for her boys’ basic needs, and helping keep them out of trouble. She reported that she and Damien would argue over chores, and sometimes Damien would become irritable and yell, while at other times he would start crying. Damien’s mother was clearly overwhelmed by her circumstances, and in her comments kept focusing on her own struggles to support her family. Although Damien’s depressive symptoms began years ago, it was essential for the assessor to understand the family’s coping around the death of his father, and the limited available emotional support at home. By meeting with the mother, the assessor was able to gain important information about her resources and her inability to handle any difficult assessment results that might constitute Level 3 feedback.
innovative assessment techniques
Although Damien was invited to include his own assessment questions, he did not contribute any. When asked about previous assessment experiences, he said, “They just had me fill out a lot of different forms that I didn’t really care about…. I feel like I work with so many people I don’t even know.” Thus, in order to gain Damien’s active participation, the assessor had to focus on building rapport and demonstrating to Damien that this assessment could be a different experience. Damien’s mother contributed two assessment questions: (1) “Why does Damien argue about chores so much?” and (2) “Why does he lie and make me look like a bad parent?” Although these questions were not as systemically oriented as we often seek in a comprehensive TA-C, they were realistic and genuine questions that could enrich feedback with the mom.
Damien’s teacher also contributed assessment questions, and the following is a good summary of her perspective: “I want to learn how to help him understand that it is okay that something is difficult, and that it is okay if he doesn’t understand it right away the first time. He’s almost afraid to believe in himself. I want to know how to help him realize that he can do a lot of things he says he can’t. I also want to understand why he puts so much stress on himself to make things better at home—to make his mom happy.” Damien’s teacher provided important information about his daily experiences and emotional reactions. Thus, by actively collaborating and seeking questions from Damien’s mother and teacher, the primary adults in Damien’s network were more personally invested in the assessment. Instead of Damien’s reevaluation simply focusing on whether he continued to meet criteria for ED, the assessment process could also be tailored to address the mother’s and teacher’s concerns.
Damien’s cognitive testing showed average to low average cognitive abilities, with weaknesses in (p. 255) short-term and long-term memory. Damien’s achievement results were in the low average range, with an LD in mathematical calculation based on a discrepancy model. Damien was known as a gifted artist, and thus the projective drawings were a good medium for him to express himself. Damien’s Draw-a-Person featured an elf warrior woman, who was a character from an online game. He described her as someone who had been hurt emotionally, due to her forest being burned down, but whom he respected because she was strong and loyal. Damien had more difficulty attempting the Kinetic Family Drawing, in that it was harder for him to draw “real” people, especially his family. Damien’s illustration showed his mother sleeping in bed with his father’s pillow, while Damien played on his computer and his stepbrother playfully did chores. Thus, the assessor was given more support for her conceptualization of his mother as emotionally unavailable and preoccupied with grief about her deceased husband. Damien appeared to be meeting his own needs by seeking out the support and stability of the online game, which he often played for over six hours per day.
The Draw-a-Tree projective provided insight into Damien’s functioning. He drew a small oak tree in the desert that only survives by having roots that can get water from deep within the ground. However, behind the small tree was a spirit tree to help the smaller tree grow. When asked what the [smaller] tree needed most, Damien replied unequivocally, “A protector” to keep it safe from wind, storms, and debris. Similar to the elf protecting her forest, Damien appeared to be seeking support and protection, but also relying on himself to be strong.
The case conceptualization indicated three major areas contributing to Damien’s depression. First, his frustration and sense of failure in school had resulted in a low sense of self-efficacy. Damien’s weaknesses in short- and long-term memory seemed to contribute significantly to his frustration, because he had a difficult time learning and retaining new information. He felt doomed to do poorly, no matter what his effort. Secondly, the grief surrounding the death of his father was a recent and profound stressor that would tax the resources of any child, and most certainly was affecting Damien. And lastly, although his mother was working very hard to provide for Damien and his stepbrother, Damien did not seem to be receiving the emotional support he needed at home, resulting in Damien seeking out other areas in which to feel supported and competent, namely the online game.
Damien had numerous strengths, particularly his solid social skills and average cognitive abilities. Damien also possessed a good sense of humor and was well liked by both teachers and peers. Although Damien was easily frustrated in school and would shut down and withdraw from work, he did not have any acting-out behaviors or discipline concerns. Damien also had a great desire to succeed in school, as he felt this might “make his mom happy.” Understanding both Damien’s abilities, and his attitudes toward school and himself, were important components of the case conceptualization because they helped explain the underlying mechanisms maintaining his depression.
Observation and teacher report had indicated that one of Damien’s biggest struggles in the classroom was avoiding work he felt was difficult. Once Damien began to shut down, the teacher had little success in re-engaging him in an activity or assignment. It was hypothesized that Damien’s weaknesses in short- and long-term memory made learning and retaining information challenging. This was especially clear in math, which involves remembering basic math facts and working through multi-step problems. However, the assessor noticed in Damien’s achievement testing that although he struggled with basic calculation, his performance in applied reasoning of math concepts was commensurate with his other cognitive abilities. Because the assessor had not been able to give Damien feedback about his performance during standardized administration, Damien was unaware that he did better in math reasoning, including problems with money, time, and fractions, than in calculation.
Thus, the assessor designed a mini-intervention session to determine whether Damien could accept positive feedback about an area of academics, and learn to discriminate his strengths and weaknesses. The assessor prepared for the intervention session and decided to use the math achievement section from a different achievement test than the one previously used. Damien was asked to complete a few calculation problems while being timed. Then, he and the assessor discussed how difficult Damien found those problems. However, the assessor was able to praise Damien’s effort and stress that, although he struggled, he was able to do about half of the problems correctly. The assessor was very careful not to push Damien to the point where he would shut down before experiencing success.
(p. 256) The assessor then asked Damien if he would be willing to try a different type of problem, one that the assessor had noticed Damien did not seem to mind as much during prior testing. Damien agreed, and the assessor was able to tell Damien each time he got a question correct on the applied math problems. After getting five in a row correct, the assessor mentioned to Damien how well he seemed to be doing; however, Damien replied that those had been easy questions, so his performance was not a big deal. Damien and the assessor continued and as the questions became harder and Damien continued to do well (getting about 80% correct), the assessor again paused and noted how well Damien was doing. The assessor also reflected that it seemed like Damien truly comprehended the questions that were being asked. Damien gave a shy smile and said that these questions were not as “mathy” as the others, that they were more “common sense.” The assessor and Damien engaged in a conversation in which the assessor emphasized that the commonsense problems could actually be harder than the straightforward calculations, for some people.
The assessor then tried to connect his experience in the mini-intervention session to the classroom by asking Damien what it is like for him when he is doing math in class. Damien indicated that normally he just started “tuning out” when math class started. The assessor wondered aloud whether there were parts of math that were hard, but other parts that were easier for him. Damien replied that he just seemed to have it backwards, that he could not complete the “easy” questions, but could sometimes understand the longer word problems. Damien and the assessor ended the session by discussing how Damien and his teacher could work on not letting the basic calculations interfere when trying to do more complex problems.
Although at first Damien defended against his ability to do well in math, the consistent positive feedback during the intervention session allowed the assessor and Damien to better understand Damien’s strengths and weaknesses in math. His overgeneralization of negative thoughts, and low frustration tolerance, seemed to be some of the hallmark thoughts and behaviors maintaining his depression around academics. After the intervention session, Damien seemed to have a better sense of his strengths and weaknesses, and how he could start trying to work around them instead of giving up.
planning and conducting feedback
In planning the parent feedback, the assessor was initially concerned that the idea that Damien was not receiving enough positive emotional support at home would be overwhelming, and hence Level 3 feedback for his mother, who was already stressed and needing support of her own. However, after reviewing his mother’s questions, the assessor was able to tie the questions to Damien’s depression and how he was expressing it at home and school. Her first question of, “Why does he argue with me so much over chores?” was answered by reminding Damien’s mother about his depression, and then informing her that especially for adolescents and children, depression may not always be expressed through sadness. The assessor planned to use the “arguing over chores” as an example of irritability, and explain why sometimes Damien would cry and at other times yell when he was upset.
The mother’s second question was, “Why does he lie and tell people I am a bad parent?” This question referred to incidents in which Damien would say he did not have a coat, or his mom did not give him lunch money, when in fact she had provided both of those things. The assessor answered this question first by validating how important the mother was to Damien, and that throughout the assessment he spoke of her as his biggest supporter and the person he needs the most. The assessor then wanted to frame Damien’s lying as an “acting-out behavior,” similar to the irritability just discussed around chores. The assessor planned to do more brief parent education about how adolescents, especially boys, may not know how to deal with uncomfortable feelings, and will often either seek support or act out in ways that elicit negative attention. By bringing up Damien’s need for attention, the assessor was able broach the idea that Damien desires positive attention from his mother, and that this can help him deal with some of his negative feelings. Thus, the assessor was able to incorporate into feedback the notion that Damien needed positive attention from his mother, in a way that answered her questions and explained his behavior and needs in terms of his depression, which she already knew about from a previous assessment.
By the end of the assessment, the assessor had a solid conceptualization about what was contributing to Damien’s depression, and how that was impacting his home and school life. Thus, the assessor felt that besides the academic feedback, Damien should and could hear that he is capable, and that there are teachers at school who want to help him. Because of Damien’s affinity for the online game, the assessor decided to create a fable using some of the characters, skills, and names from the game.
(p. 257) During the student feedback, Damien seemed somewhat blasé as the assessor talked about the actual testing results. Then the assessor told Damien she had written a story using what she had learned about him and some of the characters from the online game. Damien immediately sat up and looked the assessor in the eye as she read the story to him. The fable told the story of a young Orc who struggled with learning the different skills for battleax during school, but who loved alchemy and would often study different potions at home. The Orc story paralleled the events in Damien’s life, such as losing his father, having difficulty in academics (battleax skills), and arguing with his mother. The story ends with the Orc meeting a wise elf who helped him begin to understand his feelings of sadness, as well as how to deal with those feelings. The story does not promise a “happily ever after” ending, but rather honors the reality that the young Orc is dealing with some very sad and difficult issues, while providing hope that there are others ready to support the young Orc and help him with those feelings.
After the assessor finished the fable, Damien simply asked her to read it again. Following the second read through, Damien paused, looked at the assessor, and said, “I got it.” He clearly realized the Orc story was based on him, and then he and the assessor were able to talk about the different kinds of counseling services he could receive at school, and how they could help him manage his sad feelings. Damien was clearly more engaged with the assessor after the fable and, by the time the feedback session occurred, their collaborative relationship had grown so that Damien was able to be more open about his thoughts and responses than in the first few sessions, where the assessor had still been gaining his trust. The extra time and creativity the assessor put into creating the fable for Damien showed that she really understood him and wanted to communicate in a way that would work for him. The feedback experience was positive for both Damien and the assessor, as they were able to communicate via the fable and feel connected around the assessment experience.
Damien’s case demonstrates that an early commitment to collaboration with parent, teacher, and student led to a rich case conceptualization and feedback that was relevant and helpful to the participants. Once in special education, students receive reevaluations every three years; thus, Damien came into the assessment with a typical “let’s get this over with” attitude. However, the assessor took the time to understand Damien, his concerns, his strengths, and what his daily life was like for him, which resulted in a different type of assessment experience. The multi-theoretical case conceptualization went beyond just identifying Damien’s continued depression, to understanding the interplay between home and school experiences that were maintaining his symptoms, and appreciating his strengths. He was a student in need of positive attention, and the meetings with the assessor started to provide some of this basic support and led to Damien’s receptiveness to feedback. Damien’s positive experience with child feedback demonstrates the power of communicating with students in a way that is personalized and relevant to them. The application and integration of TA-C components in this school assessment helped create an enriching and positive experience for all involved.
Summary and Conclusions
TA-C is a relatively new form of psychological assessment that can serve as a collaborative, short-term family intervention. It is designed to engage children and their parents collaboratively in the assessment process, address their questions of interest, provide meaningful and sensitively ordered feedback, and facilitate meaningful change (both during and subsequent to the assessment). In this chapter we have described the development of collaborative assessment and TA, reviewed the extant research addressing their efficacy and effectiveness, and presented the comprehensive model for using TA with children. Initial research findings are encouraging, and offer a beginning evidence base for the use of TA and TA-C. In addition, noting that the implementation of comprehensive TA-C is unlikely in most cases of school based assessment, we have proposed components of TA-C that we see as most likely to transfer well to the school setting and have a significant impact. We also provided four case illustrations of using components of TA-C in school based assessment of children and adolescents, including teacher involvement. We hope these cases have created excitement about the possibilities and benefits of using components of TA-C. As introduced early on, one of the main principles of TA-C is that the assessment in and of itself can be an important intervention for children and parents. Our hope is that incorporating aspects of TA-C into school based assessment will prove to be an important intervention for children, teachers, parents, and schools. We plan to continue our research efforts to test out this possibility.
We also are aware that in contemporary school psychology assessment practice, assessment is viewed as the last step in a series of referral processes. And, in (p. 258) models based on RTI, assessment is seen as a fallback to be used only after all other standard or empirically based interventions have been tested. The principles of TA-C suggest that assessment is not the last step, but rather another potential intervention that can provide an even greater level of detailed, individualized information about the child. Components of TA-C can be incorporated into school assessments to help maximize the information gathering and intervention potential of an assessment. While some of the previously discussed components of TA-C are easier to implement than others, each of the components stands to be highly beneficial, and certain components may be more or less applicable depending on the particular school based case. Thus, we encourage assessors in schools to individually tailor the incorporation of these components into their assessments with children, in order to maximize the potential for new understanding and change for all involved parties.
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