Thurfriday

So yeah, I flaked.  It was a long week and I've been exhausted and recovering from illness.

On Thursday, I had several meetings to plan re-evaluations.  No parents showed up but I managed to obtain participation by phone for both of them.  The rest of Thursday was uneventful except for an extremely generous and unexpected gift to me and my family from everyone in the department.  While I have alluded to dealing with some personal problems in my life, I may as well say it here now: my wife was diagnosed with stage four cancer in April of this year and it has been progressing rapidly despite treatment.  That is who I was with at the hospital last Friday.

My coworkers have been extremely kind and supportive of me and my family.  Even I am anonymous on this blog, I do want to say that I really appreciate the kindness and sensitivity that they have shown me.

Friday began with my getting lost on the way to an out of district meeting.  It is really amazing just how rural some parts of New Jersey can be.  I finally found my way, after a phone call.  No parents.  No one answered when we called home.  We spoke about the student who had an incident the day before.  The student backed down from another student and lost face and, oddly, wasn't in school today, either.

When I got back to my office, there was a message from the parent saying that their child was refusing to go back to the school ever again and that the parent was in agreement with this, even though they had only gotten the story from their child without talking to the school.  Before I called the parent, I wanted to speak to the school to see if they had spoken to the parent.  I left a message and didn't hear from them until late afternoon.  I was informed that they had spoken to the parent and had an appointment to see the student on Monday at their home because the other parent didn't want the student to leave the school.

This OOD really seems to go the extra mile considering they are willing to make home visits.

That is where my day ended.

Feelin' like a new man

Today was the first day that I woke up and didn't feel like something the cat dragged in...and with three cats, that's saying something.

Even so, I had my work cut out for me since I had four meetings to attend at three different locations, all in district.  My first meeting was an initial referral conference for a student that I had done a risk assessment on at the beginning of December.  The parent wasn't able to attend in person and participated over the phone.  When I introduced myself, I said, "You may not remember me but we spoke a couple of weeks ago."  The parent said they remembered my name and would never forget it.  I joked that could either be good or bad but from the tone I sensed a certain amount of appreciation.  I learned during the meeting that the student had been admitted to an inpatient unit.  On the one hand, I'm glad the student is finally getting services.  On the other hand, this student has now started their contact with mental health professional and I don't foresee this ending anytime in the near future.  The student really struck me as having borderline traits and personality disorders are particularly difficult to treat.

My second initial referral meeting at the second school of the day was another complicated matter.  The student is in a foster home.  The child has a very complicated and sad background.  It is a shame.  The one thing that bothered me during the meeting was the teacher who was talking beyond her area of expertise.  The teacher said that perhaps the student is blocking memories.  I don't mind people playing armchair psychologist (hell, I make a living at it) but don't talk about it in a meeting with a parent.

The third meeting was a change of pace: an eligibility conference.  Just prior to this meeting, a downed a breakfast drink for lunch.  The meeting went well and was the simplest of them all.  While the parent didn't want the level of service that was initially recommended, which would have required a complete change of school for the child, the student has been making progress.  With the addition of accommodations and modification, the student should be alright.

My last meeting of the day was back at the second school and was my very own initial referral conference.  This one was the most technically screwed up of the all.  The student had been referred at the end of last school year, just about a year after they had been evaluated by the child study team and found ineligible.  So at the time of the second referral, it was determined that the reports could be accepted since it was within a year and an additional neurological would be done.  Then the summer came and we do not have a permanent team during the summer so there was no one to keep tabs on this.  Add this to the fact that the board didn't approve the neurological evaluation until September and this leads to the current problems.

So at some point during the current school year, someone asks, "Whatever happened with X?"  X being the student in question.  I do some digging and find out that nothing ever happened with X.  I speak to my supervisor because now the old psych and ed are out of date.  I'm advised to treat it as a new referral and do a new psych and ed.  So this is what I do.

During the meeting, I own up to the district's failure to get this done and inform the parent that the evaluations will be expedited.  The parents certainly seem trusting enough and I hope that my manner put them at ease.  We all part on amicable terms.

This brings me to the end of any significant activities for the day.

Is arsenic a good day time cold remedy?

I woke up feeling like crap this morning.  I wasn't feeling so hot last night either.  But I had two eligibility conferences to attend and it would have been more of a pain to find someone to cover for me than just sucking it up and going to work.  Otherwise I would have just crawled back into bed.

I swallowed two DayQuil and went to work.

I put together some paperwork and got ready to leave for my first meeting which was at an out of district placement.  About 30 minutes before it was time to leave, I got word that the mother had called to cancel.  I told the case manager who was also the case manager for the student in the afternoon, that if she could just arrange for that meeting to be canceled, I could go home and get some rest.

Since that wasn't in the cards, I decided to do some actual work.  I went to my assigned school to do an observation on a 5th grader.  So after 40 minutes, 15 of which involved watching the student attempt to put led into multiple mechanical pencils, I was done with that.

I also stopped off at the middle school to see the IT department supervisor and asked whether the district owns a copy of Adobe Acrobat so that I could convert the new Special Education Medicaid Initiative service logs into form-fillable documents.  I got my wish and I'm scheduled for the installation sometime later this week.  Yipee!!

After lunch, I wrote up my classroom observation and then prepared for my afternoon meeting.  The meeting went off without a hitch and I returned to my office and finished out the day.

Missing Friday and the New Week

So I wasn't at work on Friday due to an unforeseen trip to the ER which resulted in a two day hospital stay.  Not for me.

So I was definitely not rested when I returned to work on Monday.  There wasn't a whole lot to do today which was good since I was still exhausted and sore from sleeping on furniture that isn't meant to be slept on.

I finished paperwork for my meetings that are coming up in the next two weeks.  I also finished an IEP and got it ready to be put in the mail.  I wrestled with a photocopier that was determined to eat any piece of paper that passed through it.

I also did some counseling which was the most interesting portion of my day but nothing out of the ordinary enough to report.

Tomorrow and the rest of the week should prove more eventful.  I just hope that my aches and pains go away soon.

Thursday Interrupted

So while I was typing up a risk assessment report I was called to do another risk assessment.  The student I went to see was one that I had assessed twice last school year.  It was a fairly easy evaluation because of my knowledge of the student.  In the end, the student wasn't sent out.  In fact, when I looked at how things were going this year in comparison to last year, things had improved greatly.  Now if the student could learn not to run their mouth when angry.

At lunch time, I was talking with some of my coworkers.  We have a position on our team that is currently vacant.  Two months ago, we interviewed folks for the position but then nothing.  I floated the theory at the lunch table that the position was not going to be filled.  That since we were functioning fine without the position being filled that it was saving the district money.  I think I'm write, considering we were just asked to consider plans that would allow us to bring back more out of district students.

I looked at my out of district caseload, all two of them, and chuckled.

Initial or Re-eval?

The small stuff that I did today involved "inviting" general education teachers to a series of initial and re-evaluation planning meetings as well as doing paperwork for the meetings that I have coming in the next two weeks.

Then I attended a re-evaluation planning meeting at one of my out-of district placements.  The meeting was so fast that it took me longer to travel to the location than the meeting itself.  By way of explanation, I did get lost on the way there and the parent participated by phone.

In the afternoon I attended a coworkers meeting.  This was actually the second meeting for this student since the first time around the parent didn't show.  Here is the situation: the student had been eligible in another district under preschool disabled.  Due to family problems, the family had to move.  They moved in the middle of the re-evaluation that would have moved them from preschool to Part B (everything above preschool) in the previous district and moved around a lot.  So the time line is completely thrown off and when the family moved into our district, the parent requested an evaluation as though it were an initial.  So it was processed through our department as an initial.  Following that logic, we need written consent before we can start testing.  This makes the parent's absence from the initial referral conferences problematic.

So during this meeting, as we were awaiting the parent's arrival (they never showed) I brought up the idea that the kid is actually still in special education because they were previously eligible.  The problem is that the family moved before the paperwork was completed and the time lines are thrown off.  So by treating this as an initial we may be denying the student of a Free and Appropriate Public Education.  In addition, we can start the evaluation because, since the student is still in special education, we have implied consent since we only need written parental consent in an initial.  The assigned caseworker was going to speak with our director about this way of thinking and see if it holds water.

Eligibility Tuesdays

My day consisted of attending two eligibility conferences.  One was an initial eligibility conference in which we did not find the student eligible.  The parent was pleased that their child wasn't eligible.  I wasn't sure how the parent was going to react considering they were the source of the referral.

The second one of the day was a re-evalaution.  This one resulted in a change in classification.  The student had been found eligible under the emotionally disturbed classification several years ago...for one incident...that, when taken in context, seemed understandable and not a reason to base that classification.  Following our evaluations, we changed the classification to a more reasonable communication impairment.

The rest of my day was spend doing paperwork.

Tomorrow I get to go out of district for a planning meeting.  A meeting for which I already know the outcome.  All these meetings before the break are playing havoc with counseling.

A Case of the Mondays

So now that my counseling is limited to the afternoons due to the students' schedules, I stayed in the office until after lunch.  I spent my time by doing some work for my PLC and completing a psych report.  I also contacted a parent and arrange an early initial planning meeting.  Usually I have to give 15 days notice before a meeting unless you get consent from the parent before hand.  This parent gave his consent although my initial date needed to be changed to accommodate their schedule.

In the afternoon I was able to counsel two kids.  Only two because when I tried to get a third, every kid I attempted to get was getting tutoring from one of their in-class support teachers.  Ah well.

The session that I did have with these students were much better than my previous ones.  I finally got a chance to use the Aquarius card game.  It was amazing how much their defenses dropped during the game.  Or the opportunity to relate their behaviors in game to their behaviors out of game.

Following the counseling, I fielded a few more phone calls from parents and went home for the day.

The Winter NJASP Conference

Well today was the day.  Not only didn't I win any of the raffles (none of my tickets even came close) but I didn't even get a good pen.  The one pen I got was stolen by someone.

Beyond that, it was a good day.  I got to see a couple of good friends and former coworkers (both of which are the same people).  One was the director of my school psych program, who was running a workshop on supervising school psych interns.  The other was actually someone that I met working for psychiatric emergency services.  Last year, he was nominated for NJ School Psychologist of the Year.  Both of these people have been big influences on my professional development and it was great to see them again.

My morning workshop was on executive functioning.  The presenter was the creator of the Behavior Rating Inventory of Executive Functioning.  I thought it was a very good presentation.  He was entertaining and informative.  Some of the people that I shared a lunch table with felt that he was a bit condescending.  While I think he may have been flippant, I didn't think him mean-spirited.  Just that he didn't know much about New Jersey certification and license requirements.  The presentation did make me want to get several instruments, not just the BRIEF.

I attended the workshop on supervising school psychology interns in the afternoon.  You really need to think about being ready to be an intern supervisor because, while it may look like you get to foist work off on someone else, you are ultimately responsible for the work that the supervisee turns in.  Still, I am curious about the experience.

All in all, it was a good day.  I'm dreading what may be awaiting me at work on Monday but I'll deal with that then.

NJASP Conference Eve

Today was my last day of work for the week.  So I managed to get some stuff done that needed to get done before I left for the week.  I made arrangements for a student schedule change, harassed a teacher to get a behavior inventory back; called the parent from Monday's meeting.  It is funny how long ago Monday feels now.  It feels really far away.

But for everything I accomplished, more work came my way.  I assigned to several new initial referrals.  Most of them had me signed on as the school psych but one of them is for a student in my grade so I'm the case manager of record for that one.  So, before I left, I also had to get my other coworkers to commit to a date for the initial referral conference.  So I can sleep tonight without that hanging over my head.

The interesting bit of conversation that I had today was with my coworker and office mate.  We were discussing risk assessments.  The part of this conversation that I wanted to talk about was how to make the assignment of risk assessments seem fair.

In any organization, there may be perceptions that some people get all the work while others don't.  The people that feel "dumped on" may have this perception.  Sometimes all it is is a perception.  At other times, there is a bias at the level of distribution for whatever reason.  At that level, it may be a perception of whose job it should be or of competence or capriciousness.  And sometimes it is just a matter of being in the wrong place at the right time.  Or the right place at the wrong time.  Or...well you get my meaning and that is also a matter of perception.  Some people, like me, love risk assessment (love is too strong of a word, but as I noted yesterday I have been finding them intellectually stimulating recently).  Or at least just take it in stride as part of the job.  Some folk are uncomfortable with them either because of lack of training or experience or both.  Let's face it, being comfortable talking with a complete stranger about whether they have plans to kill themselves or someone else may not necessarily be "normal."  And some people may just find the emergent nature of risk assessments disruptive to their daily routine.  I'm sure that if you drew a ven diagram of these "factions" there would be a lot of overlap.

So back to the question of making the distribution of risk assessments fair.  My first thought was to have a list of all the staff responsible for risk assessments and each time a person completes a risk assessment, they get a check next to their name with the goal of trying to make the check marks even out.  Upon further examination of this idea, it has its flaws, such as actually relying on a person to keep such a list.  It may also increase the feeling of being dumped on or the feeling that "I do more than you and I have the check marks to prove it."

My coworker brought up a better idea, hearkening back to our days in non-profit behavioral healthcare: the rotating on-call system.  Assigning one person to be the primary and one person to be the back-up on-call for the week.  I think it is a really good idea because it would free people from having to worry about having their week disrupted because people would know when they are on-call (thanks to a schedule) and could plan accordingly.  It also takes the feeling of being dumped on away because everyone gets their time in the barrel and it becomes luck of the draw.  On one rotation, you may have none while on another rotation, you may have one every day.  Another benefit is response time: there is no wait to assign a staff member to the risk assessment because it is already decided.

This method might not work in all districts.  The districts that I can see this being difficult for are the ones where staff is assigned and located in a particular school.  This isn't an issue in my district because we all work out of a central office.

Well that is it for today.  Tomorrow is conference day.  I'll have to remember to bring my camera and take a few pictures.  I also have to remember to bring some cash for the raffle.  There are several interesting test kits up for raffle.  Also I have to get some new pens...hopefully they have ones with black ink...can't stand blue ink...

Tis the Season

With the return from the Thanksgiving weekend, we already seen an increase in the number of risk assessments.  Four of them in three days.  I wonder if the trend is going to continue.

So with this as a preface, I had a risk assessment, the fourth of the week so far.  A middle school student with reports of suicidal ideation.  I spent quite a long time on this one and didn't really come to a conclusion until I obtained collateral information from family members.  In the end, it was what the student didn't tell me and their family did that led to my decision.

So I was thinking about the role of a school psychologists and how it relates to the risk assessment.  During the assessment the thought crossed my mind, "I should just send the student out and be done with it."  Within the confines of the school, it seems to me that the general feeling is that we are to decide whether another mental health professional needs to assess the student rather actual determining whether the student is at risk.

Part of this feeling may come from the fact that we don't actually have any power outside the school.  We are only able to say that the student can't return to the school until they have been cleared by someone with the authority and license to do so.  So does that absolve us from investigating further?  Does it mean that we should just CYA (or COA)?

I don't think so.  In my district, we have a relationship with the local screening center where we complete a report (a much briefer report than my actual in-district write up) and fax it to the center, as well as giving them a heads up call.  So by digging deeper and asking more questions and seeking further information, we may end up getting information that won't be given to the professionals at the hospital.  Either because the student/family may change their story on the way there or just refuse to discuss certain issues that may have been discussed in the school.

I'll also reiterate another piece of advice that I have picked up from the people that really trained me in risk assessment.  Some excellent people indeed.  That advice is: take your time.  Don't let anyone rush you.  Not the student; not the guidance counselor; not the principal.  If you have questions, make sure you ask them.  Don't feel like you have to fill the silence.  You can take your time and think of your next question.  And don't feel silly for asking the same question again, particularly if you something is bothering you about the first answer.

Like I said, it was what the student didn't tell me and their evasiveness that led me to ask further questions and seek out other sources of information that ultimately led to my decision.