Clin and School Psych Exam 1

historic struggles between psychiatry and psychology

-Psychiatry on top; psychology fighting for a place at the table
- The First World War gave a big push to psychology as the military turned to them to develop tests to help manage the huge influx of recruits who needed to be assessed for mental fitness and best assignment of duties.
- The VA's demand for psychologists to meet the needs of returning veterans led to great growth in the field.
-Fighting the battle to be allowed to provide psychotherapy
-Psychologists limited almost exclusively to testing roles in the clinical treatment of patients

boulder model

Traditional Ph.D. model established in 1949 at Boulder Conference; scientist-practitioner model

difference between phd and psyd

phd:

• producing clinical scientist

• for those who want to do empirical research & add to the knowledge base

  • products: scientific research & knowledge

psyd:

• for those who want to practice psychology

• emphasis on being informed consumers of research rather than producers of research

roles of clinical psychologists; what they do that is distinct

-They must display congruence, must be genuine and transparent
-Must have unconditional positive regard, show respect to the client as a human being
- Must have empathy, to understand the inner world of the of the individual, see it through their eyes

who does psychological testing?

psychologists

who can do psychotherapy?

psychiatrists, psychologists, and social workers

who can prescribe psychotropic medication?

psychiatrists

carl rogers and the interview model (empathy)

nondirective listening skills

• attending behaviors/minimal encrouagers

• therapeutic silence

• paraphrase

• clarification

• reflection of feeling

• summary

directive listening skills

• feeling validation

• interpretive reflection of feeling

• interpretation

• confrontation

• immediacy

• questions

achievements of DSM

drawbacks of DSM

-It represent political compromise as much as it does "truth."
-It is based on a medical model that overly medicalizes human nature.
-The pharmaceutical industry is increasingly involved in psychiatric research.
-It lacks cultural sensitivity.
-It is based on a categorical rather than dimensional model of diagnosis

key importance of DSM III

-To increase reliability of diagnosis:
-Psychiatry embarrassed by its lack of precision and scientific respectability.
-Impossible to do many kinds of research without valid diagnosis.
-To create a diagnostic system that was atheoretical.
-Given the many different theories used by clinicians, DSM aimed to stay with what was observable and describable by anyone, regardless of theoretical orientation.
-To match up better to insurance companies and their demand to be paying only for diagnosed illnesses.
-To make diagnosis an objective, descriptive, rule-governed process.
-To match treatment to diagnosis. If there are no valid treatments, diagnosis is less important. Once there are, diagnosis is critical

taxonomy

-The process or system of describing the way in which different living things are related by putting them in groups
-The study of the general principles of scientific classification

differential diagnosis

We also check to see if there are other diagnoses we should consider as a better fit

categorical diagnosis

A disorder is either present or absent. You are in the category or not based on whether you "meet criteria."

dimensional diagnosis

There is a continuum between normal and abnormal behavior, and a person can be anywhere along it

Bowlby and how the model affects adults

-The secure base relationship with the therapist aids the patient in tolerating, modulating, and communicating difficult feelings and complex mental states.
-The therapist empowers the patient to think, experience feelings, and consider actions that were previously forbidden
-The therapist is can become a new (and real!) attachment figure in relation to whom the patient can develop fresh patterns of attachment (the secure base)

general principles vs. ethical standards in the current code

• The General Principles are the guiding

aspirational ideals of the profession:

Beneficence, Fidelity, Integrity, Justice

and Respect for People’s Dignity

• The “enforceable” Ethical Standards give

guidance on specific do’s and don’ts,

specifying things like confidentiality,

record keeping, maintaining competence

boundaries of competence

• Psychologists have an obligation to

develop and maintain competence in

their field.

• They should practice within the

boundaries of that competence.

• They should be aware of personal issues

that may interfere with their ability to

work and address them

informed consent

• In all their services (therapy, research,

assessment), psychologists obtain the

informed consent of those whom they

serve in language that is

understandable.

• In situations where this is not legally a

requirement (children, forensic

settings), psychologists attempt at least

to gain assent.

maintaining confidentiality

• Confidentiality is the cornerstone of the therapist/client relationship

• Without assurance of confidentiality, many clients would never seek help

• There are certain exceptions, mandated by law, where society has decided that other goods outweigh that of confidentiality, e.g. child abuse, suicidal or homicidal risk

dual or multiple relationships

• Any situation where there are multiples roles between therapist and client, i.e., that in addition to the therapist/client relationship, another relationship also exists

• These could be social, sexual, business, professional, forensic, online (Facebook)

• Not always unethical, sometimes unavoidable

• Burden is on the therapist to minimize harm

basic history of school psych

school psychologists: what they do, where they work, when students/teachers see them

• type of psychologist

• have graduate training (coursework and relevant practical experiences, specialist-level degree program or doctoral degree)

• hold certificate to practice school psych, credentialed in state/nationally certified

• assessment

• consultation

• prevention

• intervention

• staff/parent/student education

• research program development

• mental health care advocacy

• systems change

demographics of the school psych field

-most are between the ages of 45-64
- most are female
-most have a doctorates (41%)
-majority are state certified
-Most make around $75,000
-contracts vary from 180-220 days
-mean salary between $330-$409
- make more in the north east

Bronfenbrenner’s ecological model

●This model provides an organizing framework from which to view individuals
●Allows us to consider variables inside and outside of the individual
○Can help prevent the fundamental attribution error and self-serving bias

distinguishing factors of school psychologist job in schools

history of IQ testing

● R.M. Yerkes persuaded US army to test 1.75 million men

during WWI

● 1918: 1,726,966 men enlisted in the Army were tested in

groups

● More than 83,500 enlisted men were given individualized

tests

● Differences in performance between black and white

males were attributed to genetics, not environment

types of testing used in schools

● Cognitive/Intelligence/Aptitude

● Educational/Achievement

● Personality

● Social/Emotional

● Behavior

● Adaptive

assessment versus testing

Assessment:

● Identify students with disabilities that need support

● Federal/state law requires assessment before formalized

support is provided

Goal of testing: identify in order to remediate through

education, not to stigmatize/ segregate through

removal

▣Intelligence: The global capacity to profit from experience and to go beyond given information about the environment. (APA, 2016)
* Intelligence = IQ = Aptitude = Cognitive Ability = Ability to Learn *
●Intelligence is measured through responses to questions and tasks
●We measure intelligence using items on subtests
○Subtests are comprised of individual test items/questions
○Each subtest consists of a number of items that are similar, but get increasingly difficult from beginning to end
●Subtests vary based on domain
●Scores on subtests are taken together and represented as one score - the Full Scale IQ
●A combination of all of the indices and the best estimate of overall cognitive functioning
●Individual's scores are compared to individuals' of the same age (normed)
-Critics suggest that IQ tests have been used to support racial inequalities and subsequent inadequate educational opportunities for minorities

-Assessment: planning, collection & evaluation of information relevant to a psychoeducational concern
-Testing: a tool used in the assessment process

interpretation of scores—what it means to be normed vs. standardized

● Average: 90-110

● Mean: 100, SD: 15

● Scored in range

normed: individual’s scores are compared to

individuals’ of the same age

standardized: is a method of assessment built on the principle of consistency: all test takers are required to answer the same questions and all answers are graded in the same, predetermined way & provides better reliability of answers

who refers students?

Referral by instructional,

administrative and other

professional staff of the local

school district, parents and state

agencies, including the New Jersey

Department of Education and

agencies concerned with the welfare

of students

● Parents, teachers, I&RS,

doctors, speech, OT,

psychologists

● Within school- typically from

I&RS (Intervention and

Referral Services)

are all students tested for special education?

no

who is a part of the child study team?

● New Jersey specific

● Multi-disciplinary team mandated in every public school

● Members:

○ School Psychologist

○ Social Worker

○ Learning Disabilities Teacher Consultant (LDTC)

● Primarily responsible for Special Education eligibility

determination and case management

Section 504 of the Americans with Disabilities Act

GENERAL EDUCATION

a student must be

determined to: (1) have a physical or mental impairment

that substantially limits one or more major life activities; or

(2) have a record of such an impairment; or (3) be

regarded as having such an impairment. Section 504

requires that school districts provide a free appropriate

public education (FAPE) to qualified students in their

jurisdictions who have a physical or mental impairment

that substantially limits one or more major life activities

IDEIA & 14 eligibility categories in NJ

SPECIAL EDUCATION

Provides…

○ Free Appropriate Public Education (FAPE)

○ Least Restrictive Environment (LRE)

○ Guidelines and criteria for special

education (accommodations/modifications)

and related services

● Documented in an Individualized Education

Plan (IEP)

(1) student has one or more of the disabilities defined in (c)1 through 14 below; the

(2) disability adversely affects the student's educational performance and the

(3) student is in need of special education and related services

eligibility categories:

● Auditory Impairment

● Autism

● Intellectual Disability

● Communication

Impairment

● Emotional Regulation

Impairment

● Multiple Disabilities

● Deaf/Blindness

● Orthopedic Impairment

● Other Health Impairment

● Preschool Child with a

Disability

● Social Maladjustment

● Specific Learning Disability

● Traumatic Brain Injury

● Visual Impairment

SLD – models of identification

Conditions of special education eligibility

• Interventions in the general education setting shall be provided to students exhibiting academic difficulties and shall be utilized, as appropriate, prior to referring a student for an evaluation of eligibility for special education and related services.

• The staff of the general education program shall maintain written documentation, including data setting forth the type of interventions utilized, the frequency and duration of each intervention, and the effectiveness of each intervention.

• When it is determined through analysis of relevant documentation and data concerning each intervention utilized that interventions in the general education program have not adequately addressed the educational difficulties, and it is believed that the student may have a disability, the student shall be referred for evaluation to determine eligibility for special education programs and services under this chapter.

Attachment styles and how they are understood in the school context

advantages of the child interview (and special considerations)

● Understand how the child views their world

● Observe child’s behavior

○ Both verbal content & non-verbal behaviors are data

○ Interaction between child & parent including separation from

parent

○ Child’s response to the structure of interview

● May give us information we can’t obtain any other way (i.e.,

feelings & cognitions can’t be observed)

● Adults are less accurate in reporting a child’s subjective and

internal feelings

disadvantages of the child interview (and special considerations)

● Time consuming

● Lack of standardization lowers reliability

● Bias can enter (and subjectivity)

● Different levels of information from different children

special considerations for child interview

Interview must be adapted based on
child's reaction
• Language----key developmental issue
- Child's verbal expression & understanding
increase w/age
- Below 8y/o, child attends more to context
cues than words, especially if they differ
- Use play materials & pictures to enhance
understanding (ex: anger "thermometer")

Confidentiality: discuss at outset
• Cultural issues
• Both verbal content and non-verbal
behaviors are data
• Interaction between child and parent
including separation from parent
• Child's response to the structure of
interview