Multidisciplinary Evaluation

A comprehensive multidisciplinary evaluation assesses the physical, mental, emotional, academic, communicative, functional, and social status of an individual suspected of having a disability. This paper will provide an overview of the definition, trends, purpose, process, team composition, assessment instruments, pros and cons, and federal mandates of multidisciplinary evaluations. Federal and state eligibility criteria for special education services mandate that a child undergo a multidisciplinary evaluation if a learning difference is suspected.

Keywords Due Process; Dynamic Assessment; Educational Diagnostician; Hearing Officer; Independent Educational Evaluation (IEE); Individualized Educational Program (IEP); Individuals with Disabilities Education Act of 2004 (IDEA 2004); Interdisciplinary Evaluation; Multidisciplinary Evaluation; Parental Notice; Referral Source; Related Services; Response to Intervention (RTI); Transdisciplinary Evaluation; Zone of Proximal Development

Overview

Many individuals are able to able to attend school without any special accommodations. However, some experience learning difficulties that require intensive educational and related services in order to be successful. For these individuals, teachers, parents, therapists, and other school personnel provide assistance and support by modifying the learning environment.

Prior to making major modifications (i.e., smaller class size, therapeutic services) in the educational environment, individuals are referred for a multidisciplinary evaluation. A multidisciplinary evaluation determines if an individual is eligible or remains eligible for special education services. Should the individual be eligible for special education services, the multidisciplinary evaluation determines the types of services and support systems the individual should receive.

A comprehensive multidisciplinary evaluation assesses the physical, mental, emotional, academic, communicative, functional, and social status of an individual suspected of having a disability. The composition of a multidisciplinary evaluation team will vary depending on the needs of the individual being assessed (Haynes & Pindozola, 1998; Meyer, 2007; Paul, 2007; Tomblin, 2000). Team members can include professionals such as:

• Medical personnel (i.e., physicians, nurses, or pharmacists),

• Psychologists,

• Educational diagnosticians,

• Therapists (i.e., physical, occupational, speech-language pathologists),

• Social workers, and/or

• Nutritionists.

While team composition will vary based on the needs of the individual, core multidisciplinary evaluation teams typically consist of the parent, the individual (if appropriate) and a diagnostician (i.e., educational teacher or psychologist).

Assessing individuals with disabilities is a necessary and fundamental activity for teachers (regular and special education), therapists (occupational, physical, speech) caregivers/parents, and other stakeholders (medical, social services). Federal and state eligibility criteria for special education services mandate that a child undergo a multidisciplinary evaluation if a learning difference is suspected.

Definition of Multidisciplinary Evaluation

The term multidisciplinary is often used to describe a team composed of different disciplines. However, interdisciplinary and transdisciplinary are other terms used to describe teams composed of different disciplines. The primary difference between the three types of multidisciplinary teams is how the team functions and conducts assessment.

A multidisciplinary evaluation can be defined as an evaluation conducted by individuals from different disciplines with each individual conducting an independent evaluation in his or her content area. For instance, the multidisciplinary team for a child with cerebral palsy would include teachers, therapists, parents, and other personnel. Each team member provides an independent evaluation and recommendations for the individual. In other words, each team member assesses the child in discipline specific individual parts versus viewing the child as a whole. For example, the physical therapist only assesses the motor aspects and does not address how the motor deficits may affect academic performance.

As a result of the independent assessment, the multidisciplinary evaluation leads to independent goal setting and treatment by each team member. The multidisciplinary evaluation team may communicate with each other but often are autonomous and lack common goal setting which can impede the decision making process and cause conflict over priorities (Bailey & Wolery, 1989; Paul, 2007; Tomblin, 20).

The process of multidisciplinary evaluation requires team members from a variety of disciplines who have expertise in child development. Each discipline is responsible for independently evaluating the individual to determine strengths and needs. As stated earlier, evaluation teams can be multidisciplinary, interdisciplinary, or transdisciplinary. While each team is composed of different disciplines, it is important to restate that the difference in each type of team is how the team members interact with one another.

Trends in Team Evaluation

As stated, the multidisciplinary team collects information independently, develops recommendations based on the independent evaluations, and reports findings to the team and family. While multidisciplinary evaluation is the most frequently used type of evaluation for individuals with disabilities, new concepts of team evaluation continue to develop. As stated earlier, interdisciplinary and transdisciplinary teams are emerging as the teams of choice in identifying individuals with disabilities (Bailey & Wolery, 1989; Paul, 2007; Tomblin, 2000).

The interdisciplinary team is composed of team members who collaborate, relay, or share information across disciplines (Bailey & Wolery, 1989; Paul, 2007). Evaluation teams that adopt the interdisciplinary concept emphasize the integration of activities through sharing goal setting. Instructional and/or academic goals are jointly developed and communicated. Thus, evaluation data is synthesized to identify strengths and needs of the individual as a whole.

Another team concept is the transdisciplinary evaluation team. This type of evaluation team is highly collaborative and role boundaries are often indistinct across professional boundaries (Bailey & Wolery, 1989; Paul, 2007; Tomblin, 2000). The transdisciplinary team is composed of team members from different disciplines, however services are provided by one or two team members who are trained by individuals with expertise in specific areas of child development (Bailey & Wolery, 1989; Paul, 2007).

The hallmark of the transdisciplinary team is "role release." Role release means that team members perform activities across disciplines (Bailey & Wolery, 1989; Paul, 2007). For example, a speech-language pathologist may collect the motor development history or the physical therapist may record communication attempts.

Transdisciplinary evaluation is considered the best practice for service delivery; however, it is difficult to obtain due to professional territorial issues (Bailey & Wolery, 1989; Paul, 2007). Territorial issues are related to how much information to give an individual outside of the area of expertise. An interdisciplinary team requires preparation and education on team processes. In other words, for this type of team to be effective the team members must agree on priorities, leadership, and ways to resolve conflicts.

Overall, evaluation teams composed of various disciplines must provide a comprehensive evaluation to individuals with disabilities. Each type of the evaluation team discussed assesses the developmental areas of communication, motor, behavior, cognition, emotional, and social skills. Regardless of how the team functions, each team member in the evaluation process should be accountable for the achievement of identified goals.

Defining Teamwork

In the field of special education, it should be recognized that an effective multidisciplinary team is a group of professionals who understand the principles of team work. While the focus of this paper is not to define the development of a team, it is important that the reader understand that in the true spirit of Individuals with Disabilities Education Act of 2004 (IDEA 2004) professionals must work as teams to advance the educational performance of individuals with disabilities. Therefore, this paper will provide a brief summary of team development.

Initially, the team must establish its identity and purpose for being a team. Next, the team must understand the role of each team member and establish common goals in order to be effective. Team members must be committed to the task of evaluation and establish open communication lines. As team membership changes, new team members should be educated as to the roles, purpose, and communication channels used by the team. The cohesive team will find that understanding the member roles, being committed to the team, and having open communication lines allow the team to achieve the identified goals to complete the assessment process. In summary, effective multidisciplinary evaluation teams utilize the resources available in each member to achieve optimal results for the individual being assessed.

The Evolution of Multidisciplinary Evaluation

In the past, many individuals with disabilities were assessed in various settings by independent specialists. This type of thinking led to competitive behaviors which highlighted the roles and boundaries of each individual discipline. With the passage of IDEA, the multidisciplinary evaluation evolved into a team based model versus an independent model.

IDEA recognizes that individuals with disabilities are complex and are best served when various disciplines share their knowledge and skills. Multidisciplinary evaluation is an effective way to plan, coordinate, and implement educational strategies for individuals with disabilities. However, it should be stated that parents/caregivers and the individual, if applicable, should be active participants in this process.

Current best practice and perhaps the most profound change in multidisciplinary evaluation is the inclusion of the family and individual as active participants on the evaluation team. The inclusion of the family and individual has allowed insight into the identification and selection of strategies that are priorities of the family and/or individual. By having the families identify the strategies; acceptable outcomes for the individual in the school and home environment are identified and most likely integrated into all environments.

Purpose of Multidisciplinary Evaluation

The purpose of the multidisciplinary evaluation is to gather information from a variety of sources to determine if a disability interferes with learning and to develop an intervention program. Once a child has had a multidisciplinary evaluation, IDEA 2004 requires a re-evaluation to be conducted every three years to determine if the individual remains eligible for special education services. The re-evaluation must note reasonable progress in the intervention program and changes, if any, that need to be implemented.

According to the Individual with Disabilities Education Act of 2004 (IDEA, 2004), a multidisciplinary evaluation must be conducted by a team and provided at no cost. A multidisciplinary team must determine that a child is eligible for special education. Therefore, special education services can not be determined on the basis of one test or one person.

Applications

The Multidisciplinary Evaluation Process

A multidisciplinary evaluation team is established to gather information about an individual. In terms of special education, evaluation is the gateway to services. The goal of the multidisciplinary evaluation is to identify needs, strengths, and differences in learning styles in order to provide recommendations and develop an intervention program.

According to Meyer (2007), school based multidisciplinary assessment has three phases. The first phase is to determine if a disability exists by gathering information from reliable sources and/or observing the individual in different environments. The next phase is the determination that the disability adversely affects educational performance (Meyer, 2007). Finally, the multidisciplinary assessment makes the determination for the need of special education and related services that allows the individual to participate in the school curriculum (Meyer, 2007).

Tomblin (2000) described the clinical problem solving process which can be applied to the multidisciplinary evaluation process. The evaluation process requires the team to establish the clinical question; determine what information is needed in order to answer the clinical question; determine how the information will be obtained; gather the information; interpret the clinical standards; and, answer the question (p. 6). These principles can guide the multidisciplinary evaluation team in the determining if an individual has a disability.

The first step in a multidisciplinary evaluation is the screening process. Prior to screening, a referral must be made by the school, parents, or others; and, parental consent must be obtained. In the screening process, the evaluation team is minimally defined as the referral source and an assessor. The referral source is the individual who identifies a possible concern. Doctors, parents, teachers, and/or the individual can be the referral source. The assessor is the individual who screens the individual to determine if the individual is having difficulty in comparison to peers. The assessor can be the teacher, medical personnel, and/or therapist. The goal of the multidisciplinary team at this stage is to identify if an individual is at risk for a disability. If the individual fails the screening, he or she is referred for a multidisciplinary evaluation to determine eligibility for services. Should the individual not be identified as being at risk, the evaluation process stops and obtained information is discussed with all stakeholders.

Next, the multidisciplinary team must assess the individual in all areas of the suspected disability. The evaluation determines if the individual is eligible for special education and related services. According to IDEA 2004, the family can request an Independent Educational Evaluation (IEE) or due process should they disagree with the findings. The parents can also request for the IEE to be paid by the school system.

Once the evaluation is completed, the multidisciplinary evaluation team in conjunction with the family develops the Individualized Educational Program (IEP). According to IDEA 2004, the IEP must be reviewed, at minimum, annually and a multidisciplinary re-evaluation is conducted every three years. Parental notice must be given in writing for the annual IEP meeting and for the re-evaluation. In terms of the re-evaluation, the notice must include why the re-evaluation is being conducted; inform the parents of the right to his or her child's records; the procedures and tests to be used; and when the tests will be conducted. As with the initial evaluation, the parents must provide written consent.

In closing it should be made clear that should a parent refuse consent for either the initial or re-evaluation, the school district can request due process and ask a hearing officer to allow the multidisciplinary evaluation. Parental consent is not required prior to a child taking a state or local school district test that is administered to all children or should school personnel need to review existing student testing data or information.

Multidisciplinary Evaluation Assessment Instruments

The multidisciplinary evaluation team has an obligation to use a variety of sources and test data in order to gain an understanding of the individual's performance by conducting a comprehensive assessment. However, specific tests are not required to be given to the individual as part of the multidisciplinary evaluation.

Evaluation instruments can be either formal (standardized) or informal (nonstandardized) or a combination of the two (Meyer, 2007). A formal or standardized test is described as a test that has some type of normative data in which to compare the child's performance to his or her peers. Standardized tests can be either norm-referenced or criterion-referenced. A norm-referenced test allows a comparison of the individual's performance with peers' performance. One example is the Peabody Picture Vocabulary Test III by Dunn and Dunn (1997). A criterion-referenced test measures the individual's mastery of information. In contrast to norm-referenced testing, criterion-referenced emphasizes individual performance versus group performance (Haynes & Pindozola, 1998). Criterioin-referenced assessment is considered to be informal assessment measure. Classroom based tests and/or observation are examples of criterion-referenced tests (Meyer, 2007).

Evaluation information should be provided by parents, classroom-based assessment and observations, and information obtained from therapists. For example, the multidisciplinary team should address questions such as:

• What areas does the child have problems?

• What areas does the child succeed or have strengths?

• What are the goals and priorities for the child?

• What types of services or modifications are necessary in order for the child to be successful in the academic environment?

The multidisciplinary team must determine that the information obtained represents the individual's present levels of performance, describes the modifications and services needed in the educational program, and establishes measurable goals.

Viewpoints

Pros & Cons of Multidisciplinary Evaluations

There are several rationales for using multiple disciplines in assessing individuals with disabilities. Proponents of multidisciplinary evaluations often cite that no one discipline can have the expertise to competently assess all areas of development (Bailey & Wolery, 1989; Haynes & Pindozola, 1998; IDEA, 2004; Meyer, 2007; Paul, 2007; Tomblin, 1998). For example, a child with cerebral palsy could not be appropriately assessed by one discipline. The assessor would need to have expertise in the developmental areas of motor, cognitive, and language development as well as academic skills.

Opponents of multidisciplinary evaluations are not opposed to the concept of multiple disciplines being involved in identifying disabilities (Bailey & Wolery, 1989; Meyer, 2007; Tomblin, 1998). The opposition tends to focus on the how the team functions (i.e., multi-, inter-, or transdisciplinary) and how the assessment data is obtained (i.e., dynamic, RTI, etc.).

Federal Law & Multidisciplinary Evaluation

IDEA 2004 stipulates that any child suspected of having a disability must have a multidisciplinary assessment to determine eligibility for special education services. Federal law stipulates that parents have the right to initiate a request for a multidisciplinary assessment; however, the school district can deny the request, if allowed by state law (IDEA, 2004; Zirkel, 2007). In denying the request, the school district must provide written notice of the denial.

IDEA 2004 stipulates timelines in which a multidisciplinary evaluation must be conducted. Once parental request or parental consent is obtained for a multidisciplinary evaluation the school district has 60 days in which to complete the evaluation. At the end of the 60 days, eligibility and needs must be determined. This determination leads to the development and implementation of an Individualized Educational Program (IEP).

Alternative Assessment Approaches in Multidisciplinary Evaluation

Traditionally assessment approaches have focused on administering and interpreting standardized tests given by the multidisciplinary team. Changes in the idea of what an assessment should do as well as assessment procedures are challenging professionals to adapt alternative assessment approaches. One of the biggest reasons for the changes is the slow realization by professionals that standardized testing procedures do little in assisting the intervention process (Meyer, 2007).

According to Meyer, new models of multidisciplinary assessment include dynamic, observational, ecological, or Response to Intervention (p. 108). As such each of these models moves away from static assessment procedures toward dynamic assessment procedures. Static assessment procedures consist of giving a standardized assessment and basing all decisions on the individual's performance at the moment of test administration (Haynes & Pindozola, 1998; Tomblin, 1998). In contrast, dynamic assessment procedures require the individual and examiner to participate in the assessment process by asking and giving information. The majority of the new models of multidisciplinary assessment is based on Vygotsky's "zone of proximal development" and considered to be dynamic assessment procedures (Haynes & Pindozola, 1998; Meyer, 2007).

Ecological assessment is another new model in multidisciplinary evaluation. According to Meyer (2007), ecological assessment was described by Westby et al. as reviewing the different contexts (physical, social, and psychological) and their effects on educational performance. As with dynamic assessment, ecological assessment is grounded in Vygotsky's theory of child development (Meyer, 2007).

Reponse to Intervention (RTI) is an additional model that is gaining momentum in assessment practices. However, the primary difference between RTI and other types of assessment procedures is the focus on prevention (Meyer, 2007). Students are identified as being at risk and interventions are provided support services while remaining in regular educational services. Should the intervention fail, the individual is then referred for special instruction in other types of educational settings.

In this paper, the reader has been introduced to the process, procedures, and trends in multidisciplinary evaluation. The evaluation process is a dynamic and ever changing process in the diagnosis of individuals with disabilities. However, multidisciplinary evaluation is required for individuals with disabilities to receive special education or related services in the school environment.

Terms & Concepts

Due Process: Due process is a legal proceeding that follows the established rules in the enforcement and protection of an individual's rights.

Dynamic Assessment: Dynamic assessment is a type of assessment in which the participant and the evaluator are actively involved in the assessment proceedings.

Ecological Assessment: Ecological assessment reviews the different contexts (physical, social, and psychological) and their effects on the educational performance of an individual.

Educational Diagnostician: Educational diagnostician is a specialist who assesses and diagnoses learning problems of students.

Hearing Officer: Hearing officer is a impartial mediator appointed by the state or local education agency to preside over a due process hearing.

Independent Educational Evaluation (IEE): An IEE is an evaluation conducted by any qualified examiner who is not employed by the school district.

Individualized Educational Program (IEP): IEP is a written plan of the special education and related services to be provided by a school district. Each child identified as having a disability as determined by a multidisciplinary evaluation and who receives services must have an IEP.

Individuals with Disabilities Education Act of 2004 (IDEA 2004): IDEA 2004 is a federally mandated program which outlines state and local special education and related services for children with disabilities.

Interdisciplinary Evaluation: Interdisciplinary evaluation is a type of evaluation team composed of team members who collaborate, relay, or share information across disciplines (Bailey & Wolery, 19; Paul, 2007). Evaluation teams that adopt the interdisciplinary concept strongly focus on integrating activities and sharing goal setting.

Multidisciplinary Evaluation: Multidisciplinary evaluation must be completed prior to an individual receiving special education and related services under IDEA.

Parental Notice: Parental notice is written information provided to parents outlining their rights and the procedures used in the multidisciplinary evaluation process.

Referral Source: Referral source is the individual who initiates the referral for a multidisciplinary evaluation. The referral source can be made by anyone with a vested interest in the child.

Related Services: Related services are those services a child with a disability needs in order to benefit from special education. Related services can include speech-language, occupational, or physical therapy, transportation services, and/or medical services.

Response to Intervention (RTI): RTI is a an evaluation method that targets intervention designed to prevent academic difficulties.

Transdisciplinary Evaluation: Transdisciplinary evaluation is an evaluation method where collaborative and role boundaries are often indistinct across professional boundaries (Bailey & Wolery, 19; Paul, 2007; Tomblin, 2000).

Vygotsky's "zone of proximal development": The Zone of Proximal Development was proposed by Vygotsky. The underlying principle of this theory is the comparison of what an individual can learn without help and what a child can learn with assistance.

Written Consent: Written consent is provided by the parent or caregiver stating in writing that he or she agrees with having the multidisciplinary evaluation conducted.

Bibliography

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Bevan-Brown, J., Bevan-Brown, R., Carroll-Lind, J., Kearney, A., Edwards, T., & Hayes, D. (2011). The evaluation of a multidisciplinary approach to training people who work with students with severe and challenging behaviours. International Journal of Learning, 18, 359-369. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=83814082&site=ehost-live

Dunn, L.& Dunn, L.M. (1997). Peabody picture vocabulary test (3rd ed.). MN: American Guidance Systems.

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Individuals with Disabilities Education Act (IDEA), Amendments 20 U.S.C. § 1400 et seq. (2004).

Meyer, J. (2007). Assessment. In E. Gravani & J. Meyer (Eds). Speech, language and hearing programs in schools: A guide for students and Practitioners (pp. 53- 1998). Texas: Pro-Ed Publishers.

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Suggested Reading

Benard, B. (1989). Working together: Principles of effective collaboration. Prevention Forum, 10 , 4-9.

Dykeman, B. (2006). Alternative strategies in assessing special education needs. Education, 127 , 265-273. Retrieved November 29, 2007 from Academic Search Premier http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=23761151&site=ehost-live

Glaun, D. Cole, K. & Reddihough, D. (1998). Six month follow-up: The crucial test of multidisciplinary developmental assessment. Child: Care, Health, & Development, 24 , 457-472. Retrieved November 26, 2007 from Academic Search Premier http://search.ebscohost.com/login.spx?direct=true&db=aph&AN=6130491&site=ehost-live

Huebner, E. & Gould, K. (1991). Multidisciplinary teams revisited: Current perceptions of school psychologists regarding team functioning. School Psychology Review, 20 , 428-434.

Lewis, A, Lindsay, G., & Phillips, E. (2003). Assessment in special schools: National early assessment procedures and pupils attending special schools in England. European Journal of Special Needs Education, 18 , 141-153. Retreived November 29, 2007 from Academic Search Premier http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=10307948&site=ehost-live

Pierangelo, R. & Giukiani, G. (2002). Assessment in special education: A practical approach. MA: Allyn & Bacon Publishers.

Preece, P. & Mott, J. (2006). Multidisciplinary assessment at a child development centre:

Do we conform to recommended standards? Child: Care, Health, & Development,32 , 559-563. Retrieved November 26, 2007 from Academic Search Premier http://search.ebschohost.com/login.spx?direct=true&db=aph&AN=21870155&site=ehost-live

Sabers, D. (1996). By their tests we will know them. Language, Speech, and Hearing gServices in Schools, 27, 102-108.

Vygotsky, L. (1978). Mind in society: The development of higher psychological processes. Cambridge MA: Harvard University Press