UPDATE ON PSYCHOLOGICAL SERVICES AT TCDSB

Select Public/Private If Private select Ed. Act. Section. REPORT TO SPECIAL EDUCATION ADVISORY COMMITTEE UPDATE ON PSYCHOLOGICAL SERVICES AT TCDSB Peace is the work of justice indirectly, in so far as justice removes the obstacles to peace; but it is the work of charity (love) directly, since charity, according to its very notion, causes peace. St. Thomas Aquinas Created, Draft First Tabling Review November 3, 2014 November 19, 2014 Click here to enter a date. M. Kokai, Chief Psychologist F. Piddisi, Superintendent of Student Achievement and Well Being Special Services INFORMATION REPORT Vision: At Toronto Catholic we transform the world through witness, faith, innovation and action. Mission: The Toronto Catholic District School Board is an inclusive learning community rooted in the love of Christ. We educate students to grow in grace and knowledge and to lead lives of faith, hope and charity G. Poole Associate Director of Academic Affairs A. Sangiorgio Associate Director of Planning and Facilities S. Pessione Associate Director of Business Services, Chief Financial Officer and Treasurer Angela Gauthier Director of Education Page 26 of 34

A. EXECUTIVE SUMMARY 1. This report is an update on TCDSB Psychological Services, describing the range of services provided by the TCDSB Psychology Department within a tiered model. It also indicates next steps to effectively respond to evolving needs. B. PURPOSE 1. Over the years the provision of school psychological services has changed from a one-tier, gatekeeping model to a pyramidal, three-tiered model. The purpose of this report is to provide SEAC, school administrators and other stakeholders an update on what these changes are in the role of school psychology. Specifically, psychological assessments and associated wait times need to be considered in the broader context of school psychology services, which include services at the level of all three tiers. C. BACKGROUND 1. Just as practices in education have been constantly evolving and changing in the last 10 years and, following Ministry directions, becoming more student focused and emphasizing support for ALL students, so have practices in school psychology been changing to align with these evolving needs. The guiding principles and the practical implications of Learning for All, Growing Success, Caring and Safe Schools, Open Minds - Healthy Minds - Mental Health Strategy, Creating Pathways to Success, etc. have all had an impact on expectations with regards to psychological services within the board. 2. Historically, in response to the needs and expectations of the education system at the time, school psychology operated as a one-tier service, by providing assessment services to fulfil the role of a gatekeeper for special education services. Although over time the education system started to rely on a broader range of school psychology services, this one-tier, assessment focused model was brought back and reinforced by the introduction of the Intensive Support Amount (ISA) funding model by the government of the time. 3. As described in Learning for All, and in order to align with education practices, the provision of psychological services is currently based on a pyramidal, multi-tiered prevention/intervention model. In this model the levels of interventions and the intensity of supports are provided based on need. Below are some examples of the growing need for Tier1, Tier 2 and Tier 3 services in psychology: a. By implementing the School Based Support Learning Team (SBSLT) model in TCDSB schools, there has been an increasing need for Tier 1 and Tier 2 services, including classroom level consultation and early intervention. b. By supporting the TCDSB Mental Health Strategy, psychology services have been required within all three tiers: i. Tier 1: Mental Health awareness/literacy via professional development for teachers, administrators, and support staff; parent/student Page 27 of 34 Page 2 of 9

workshops; classroom based universal prevention/early intervention programs, ii. Tier 2: consultations and targeted early interventions; threat assessment; crisis response, iii. Tier 3: supporting students with mental health problems and mental illness, including self-harm and suicide risk. 4. Through the Accountability Framework for Special Education Program Review Committees there have been increasing requests for psychology staff involvement in investigating, providing input, evaluating and tracking the implementation of evidence based programs within Special Education and Mental Health. D. EVIDENCE/RESEARCH/ANALYSIS 1. The Ontario Psychological Association (OPA) 1, Canadian Psychological Association (CPA) 2 and the National Association of School Psychologists (NASP) 3 practice guidelines for school psychology indicate a clear expectation for psychological services in schools across all three tiers as best practice. 2. Consistent with the description of the types and levels of service by school psychologists in the OPA and CPA documents, the TCDSB Psychology Department provides: a. student focused indirect and direct service; b. whole class/whole school intervention/service; and c. system level services. 3. Student Focused Psychology Services: Formal Referrals/Requests: Student focused psychology services are initiated in the context of the interdisciplinary team (SBSLT) at the school level. A formal request ( Request for Psychology Services ) is generated and signed consent is given by the parent (or the student as appropriate). Such services include: a. Tier 2 level: small group intervention for students; b. Tier 3 level: assessments/diagnosis (cognitive, academic, social-emotional, behavioural, mental health); counselling (individual or group); behaviour management/programming reviewing/interpreting outside reports (e.g. for IPRC presentation). 4. Statistical data indicate that for a number of years (2006-2010) there was a stable balance between the number of incoming and completed requests (around 2800/year). However, the shift in demand for a broader range of service, and a continued steady flow of incoming new requests for assessments resulted in an increase in referrals waiting to be addressed. In addition, the growing awareness and literacy in mental health issues are anticipated to result in a higher incidence of psychology referrals to 1 Professional Practice Guidelines for School Psychologists in Ontario, Ontario Psychological Association, 2013 2 School Psychology: An Essential Public Service in Canada, Canadian Psychological Association, 2014 3 National Association of School Psychologists, USA Page 28 of 34 Page 3 of 9

address mental health concerns. (In 2013-14, the number completed referrals for individual counselling was 302, the number of suicide risk assessments was about 40.) 5. Statistical Data regarding Formal Referrals (assessments; counselling; file reviews): Year Formal requests completed/ year Formal requests received/ year % of total student population referred/ year 2013-14 2528 2182 2% 1632 2012-13 2214 2147 2% 1978 2011-12 2626 3077 3.4% 2045 2010-11 2624 4 2869 3.2% 1594 2009-10 2008-09 2007-08 2006-07 Stable at about 2800 Stable at about 2800 Stable about 3.2% at The number of referrals waiting at the end of June Stable at about 1350-1400 6. Psychological Services Supporting All Students: Whole Class/ Whole School Services - In these Tier 1- Tier 2 services direct work with or indirect support of students may be involved, such as: a. consultations/ meetings about students with teachers, administrators, support staff; b. trauma/crisis intervention with groups of students; and c. classroom based or school based prevention/intervention (e.g., resiliency, selfregulation, anxiety prevention, etc.) (For these services, a formal referral ( Request for Psychology Services ) is not required. These requests are considered Informal Requests.) 7. As well, psychology service providers as members of the school s Mental Health Response Team participate in crisis intervention in their schools. 8. Year 9. Crisis intervention 10. 2013-14 11. 76 12. 2012-13 13. 51 14. 2011-12 15. 50 8. Through the combination of formal and informal referrals, the total number of TCDSB students receiving psychological services each year has been around 4000 since 2010 (about 4% of the total population). 4 61 summer assessments not included Page 29 of 34 Page 4 of 9

9. Psychological Services Supporting the System: Board-Wide Services - As members of the multi-disciplinary Special Services Program Review Committees (Accountability Framework), psychology service providers have been involved in investigating, facilitating, evaluating and tracking the implementation of evidence based programs within Special Education (e.g. Empower Reading, JUMP Math, Skillstreaming) and Mental Health (e.g. ASIST, Safe Talk, FRIENDS For Life, etc.) 10. Psychology staff contributed to capacity building and professional development by providing presentations and in-services to teachers, support staff, parents and students. Year #of days: Program review, design, improvement #of professional presentations 2013-14 About 225 days 240 2012-13 About 225 days 64 2011-12 About 180 107 11. Based on the guiding principles and strategies described in Learning for All, the SBSLT model aims to provide supportive consultation and early intervention as soon as students start to experience difficulties, as opposed to waiting to fail. Psychology staff are involved in ongoing consultation via SBSLT meetings, individual consultations with teachers, with other SBSLT members and with parents. 12. Student-focused meetings: The total number of days spent in SBSLT and IPRC review meetings by psychology staff: Year #of days: #of days: IPRC SBSLT review 2013-14 960 days 419 days (2x194 (4.9x194 days) 5 days) 6 2012-13 1030 days 380 days (1.9x194 (5x194 days) days) 2011-12 1029 days 392 days (2x194 (5x194 days) days) Total 1380 days 1410 days 1421 days 13. Next Steps: Responding to Changing Needs 5 One school year is 194 days; This time is equivalent to completing about 240 formal assessments (1 assessment: about 30 hours, i.e., 4 days) 6 This time is equivalent to completing about 104 formal assessments Page 30 of 34 Page 5 of 9

a. Re-conceptualizing Psychological Assessments - In order to respond to the demand for services including the full scope of school psychology, best practice requires us to increase our precision and be more selective in using our resources: to ensure that services are provided to those students who require them. In this context, psychological assessments are considered Tier 3 services, and precision and specificity is needed to ensure that those students who require an assessment can receive it in a timely manner. The management of outstanding referrals is an ethical responsibility of the professionals/service providers who consider and balance the responsibility for both the individual student and all students on the waitlist. Clear, transparent criteria/guidelines are provided to guide the process of accepting new referrals, prioritizing existing referrals and to ensure equitable and consistent access to service across the system. i. Precision and specificity: Existing referrals 1. Existing referrals are being reviewed regularly by the school administration and psychology service provider for the purpose of triaging them based on the severity of the problem, and urgency of the need for intervention. 2. Concerns around safety, as well as urgent need for intervention are considered high priorities, and are addressed as soon as possible. 3. Request for service for students who receive effective intervention and doing well are considered low priorities and typically wait longer. 4. Requests that are 2 years old or older must be addressed as high priority or cancelled ii. Precision and specificity: New referrals 1. New referrals are screened based on existing criteria 7 (Appendix 1). Psychology staff must be consulted and agree to the referral. Documentation on the student s needs as well as on the student s response to early intervention strategies is required. (This requirement is consistent with PPM 8.) b. Streamlining consultation services - Historically, the role of school psychology was to support the formalized identification process for students with special education needs, therefore performing a gate-keeper role in schools. In this role, the majority of referrals were for formal assessments. With these changes and especially through the introduction of the SBSLT model of response and support students needs are identified by teachers, psychology staff is engaged in consultation on an ongoing basis as needed. c. Effective communication with schools - Psychology service providers constitute an integral part of the school team; therefore, there is a need to inform school staff about the role and how psychology can help. On the other hand, psychology service 7 This is necessary, as, similarly to other types of services such as health care and social services in the community, the potential demand for psychological services is practically unlimited. Page 31 of 34 Page 6 of 9

providers need to know what schools (administrators, teachers, parents, students) need to be better supported in achieving their goals. This requires effective, ongoing communication between the local schools and service providers, as well as at the management level, between administrators and the Chief Psychologist. A mechanism for systematic, effective communication between school administrators and the Chief Psychologist is being explored. d. Psychology staff recruitment - In order to address the province-wide chronic and ongoing challenge of shortage in qualified school psychology professionals, psychology staff is getting support in providing internship and practicum placements to graduate students to help recruitment. E. METRICS AND ACCOUNTABILITY 1. Regular collection and monitoring of statistical data regarding psychology services will continue to be provided as a part of the Special Education Plan submitted to the Ministry annually through SEAC. F. CONCLUDING STATEMENT This report is for the information of the Special Education Advisory Committee. Page 32 of 34 Page 7 of 9

Appendix 1 TCDSB Psychology Referral Criteria (October 2014) NEW REFERRALS 1. Psychology staff was consulted and agreed to the new referral 2. Specific student criteria, supported by documentation (i.e. Student Profile, IEP, report card, DIP data, etc.) a. significant academic delay of 2 years or more, AND b. suspected significant psychological processing weaknesses (along with strengths that suggest average cognitive abilities); OR c. suspected significant cognitive delay, adaptive behaviour deficits, OR d. mental health concerns, or significant social-emotional or behavioural difficulty that interferes with learning. 3. Specific instruction related criteria, supported by documentation (i.e. Student Profile, IEP, report card, DIP data, etc.) a. classroom or school based intervention has been implemented to address the need, AND b. more information on student s learning is needed for programming to improve progress Note: In case a student already had a psychological assessment in the past, only proceed with a referral, if prior assessment results are not consistent with the student s current functioning. When prior screening or assessment results need to be reviewed for IPRC or IEP, consult with psychology staff regarding a need for referral. Recommendations for assessment by outside practitioners (e.g. medical practitioners, psychologists, etc. in the community) will be only considered by SBSLTs based on the above criteria. Page 33 of 34 Page 8 of 9

TCDSB PSYCHOLOGY PRIORITIZING EXISTING REFERRALS: Outstanding referrals are prioritized based on triaging the severity and urgency of needs into 3 categories: 1. high priority: a. student s behaviour puts own and others safety at risk; immediate attention required (serious behaviour and/or mental health problems) b. student with significant needs requires assessment in order to access ISP (or other specific program) or transitioning support within TCDSB c. outside report to be reviewed for programming recommendation and/or IPRC d. referral that is 2 years old or older - it must be addressed or cancelled 2. medium priority: a. student struggles academically, classroom and school based interventions have not been sufficient in addressing student achievement and well-being 3. low priority: a. student presents with challenges, but current intervention strategies are working at this time. Page 34 of 34 Page 9 of 9