Unit 2: Assessment of high support needs

2.1.  Formal and informal assessments medical, therapeutic, psychological assessments

2.2.  Assessment of family resources and family support system

2.3.  Assessment of current level of functioning personal care, communication and social skills, mobilit


2.4.  Assessment of need for assistive devices

2.5.  Interpreting assessment results to plan the support programme


















2.1    Formal and informal assessments medical, therapeutic, psychological assessments



Assessment is entering every phase of professional development. Assessment and evaluation are crucial steps in educational process. Before making a choice of assessment method, some important questions must be asked: what should be assessed?, why assess? For an assessment instrument one must also ask: is it valid? Is it reliable?, is it feasible? What is assessed and which methods are used will play a significant part in what is learnt. A wide range of assessment methods currently available include essay questions, patient management problems, modified essay questions (MEQs) checklists, OSCE, student projects, Constructed Response Questions (CRQs), MCQs, Critical reading papers, rating scales, extended matching items, tutor reports, portfolios, short case assessment and long case assessment, log book, trainer’s report, audit, simulated patient surgeries, video assessment, simulators, self assessment, peer assessment and standardized patients.

Medical assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases or disability early in people that may look and feel well

Mini-Clinical Evaluation Exercise (Mini-CEX) is a rating scale developed by American Board of Internal Medicine to assess six core competencies of residents: medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization and efficiency.

Test of clinical competence, which allows decisions to be made about medical qualification and fitness to practice, must be designed with respect to key issues including blueprinting, validity, reliability, and standard setting, as well as clarity about their formative or summative function. MCQs, essays, and oral examinations could be used to test factual recall and applied knowledge, but more sophisticated methods are needed to assess clinical performance, including directly observed long and short cases, objective structure clinical examinations, and the use of standardized patients.

Therapeutic Assessment is a short-term intervention in which traditional psychological tests are used collaboratively with clients to help them understand themselves better and find solutions to their persistent problems.

In its underlying philosophy, Therapeutic Assessment is related to humanistic and human-science psychology, to narrative, interpersonal, and systemic models of psychotherapy, and to intersubjectivity theory. However, Therapeutic Assessment also uses techniques from many schools of psychotherapy, including cognitive therapy, behavior therapy, psychodynamic therapy, interpersonal therapy, and Gestalt therapy.

Therapeutic Assessment is a paradigm in which psychological testing is used to help people understand themselves better and find solutions to their persistent problems. Therapeutic Assessment differs from traditional psychological assessment, whose main goal is to diagnose disorders, plan treatments, and evaluate the effectiveness of interventions; Therapeutic Assessment can serve all these purposes as well, but its primary goal is to facilitate positive changes in clients.

Psychological assessment is a process of testing that uses a combination of techniques to help arrive at some hypotheses about a person and their behavior, personality and capabilities. Psychological assessment is also referred to as psychological testing, or performing a psychological battery on a person.

Psychological assessment may come in two forms: formal and informal. Formal assessment involves the use of tools such as tests, questionnaires, checklists and rating scales, while in informal assessment the interview/evaluation usually lacks such structure or organization. In either case, the psychologist will typically start by asking questions.


Formal assessment, often referred to as psychological evaluation, is generally performed by a licensed psychologist when a problem, that does not have a physical origin, is noticed and the cause needs to be determined. This problem can exist in several realms, for example: (1) inappropriate behavior (2) inappropriate mood states (3) failure to perform up to expected standards (as in schoolwork).


The purpose of evaluation is to determine what is happening in the individual's psychological life that may be blocking their ability to behave (or feel) in a more appropriate and constructive manner. Testing cannot necessarily pinpoint the precise cause of the disturbance, especially if it is a complex emotional issue, but it will give a number of clues that can help the individual, parent and/or professional go in the right direction. In some cases that are more specific, such as dyslexia or other learning disability, testing will let the parent and teacher know exactly what steps need to be taken to help the child/adolescent learn.


Generally, a full battery of psychological tests can take several hours to administer (often administered to a child in several one to two hour time periods to avoid fatigue). It takes several more hours for the professional to score and interpret the test results and to write a report suitable for school personnel or a psychotherapist to use in developing a curriculum or treatment plan. Occasionally, a psychologist will determine that only a few tests from the full battery need to be administered to pinpoint or rule out a particular problem and thus avoid an unnecessarily lengthy and expensive procedure. Whichever you and the professional determine is necessary, the results should yield a wealth of information useful to the individual, parents, educational institution or other professionals to make one’s emotional, educational and/or vocational life more healthy, satisfying and successful.




2.2           Assessment of family resources and family support system


Severe illness or disability can disrupt family life, cause family dysfunction, strain resources, and cause caregiver burden. The family's ability to cope with crises depends on their resources. Caregiver strain measures stress or burden due to the physical, personal, emotional and financial stress incurred by a caregiver as a result of, or in relation to, his/her caregiving role/s.


Family resources - means that can be used by the family to cope with difficult situations; include the following resources:

·      social resources - strong social support network which may include spouse, children, parents, siblings, neighbors, co-workers and others

·      cultural resources - cultural values which can influence an individual or family's ability to care for the sick and cope with stress e.g. optimism, familialism, approach vs avoidance style, etc.

·      religious resources - spiritual beliefs, practices and support services

·      economic resources - family's income and savings

·      educational resources - level of formal education attained by an individual which allows him to understand the patient's condition and give him appropriate care

·      medical resources - acessibility to medical facilities and adequacy of help from healthcare providers

Family Assessment Tools

There are many tools that can be used to conduct family assessment. Each collects specific information about family systems, functioning, culture, and experiences. Regardless of the tool selected, several key ideas to consider when selecting a tool for each specific family include:

·      Timing (before or at the beginning of service delivery to design strategies, during intervention to assess effectiveness)

·      Method (conversation, checklist, or questionnaire)

·      Data collected (family interests, priorities, concerns, routines, traditions, resources and activities)

·      Developmental framework (child development)

·      Reporting method (method information is shared with family/practitioners to inform IEP/IFSP development and EBP)

·      Requirements for early intervention or early childhood providers (active listening, feedback and sharing information)

·      Comfortable for family (confidentiality of information and tone of the tool)

Through active listening, feedback, and sharing information, a family assessment is able to capture the life of a family in a way that feeds directly into service delivery. It should engage family members (not just parents) in conversations with each other or with the professional to consider the present, the future, successes, and challenges.

The benefits of Family Based Assessment include:

·      It facilitates family participation

·      It helps providers understand the family’s strengths, goals, and priorities

·      It helps identify the family system and resources

·      It helps to reflect the voices and choices of the family

·      It reflects the families’ needs so that intervention can be tailored to address those needs


What is Family Support?

Families want the best for their children, to nurture their growth and development. Families with children who have special needs want the same for their children, but often face additional challenges, including great stress, social isolation, and financial strain. Families may become overwhelmed, and find it difficult navigating the service system for their child, and to find social and emotional support for themselves. "Family Support" helps families access a broad array of supports and services, including formal supports (such as paid respite care) and informal supports (such as parent-to-parent connections) and a community system of services that promote the well-being of families and their children with special needs.

Family support aims to:

The Family Support Program works with families, communities, and service providers to promote and provide support for families with children who have special needs – which includes special health care needs, developmental and learning disabilities, and behavioral/mental health diagnoses.<--break->

Family Support includes:

How do Families and Children Benefit from Family Support?

Families find information and emotional support, and learn about enhancing their child’s development and well-being – all of which promotes improved outcomes for families and children.


When do Families Seek Support?

Families with children ages birth to young adulthood seek family support for lots of reasons. Here are just some:




2.3           Assessment of current level of functioning personal care, communication and social skills, mobility



Assessing levels of functioning

Functional assessments help identify the level of support, supervision and resources a person needs. They can be used to determine eligibility, care planning and assessing outcomes.


What functional assessment covers

Functional assessment practices consider differences in cognition, communication, sensory abilities (sight, hearing) and mobility.

Rather than simply asking people questions about their educational history or contact with disability-related support services, or whether they can perform a specific skill related to cognitive functioning, it's better to ask them to demonstrate a particular skill. In other words, you assess what a person 'does do', rather than what they 'can do'.

Functional assessment shifts the focus from the cause of disability or cognitive impairment to the impact of the condition. It's important to distinguish between capacity limitations that result directly from a person's health status and those limitations in which a person's participation is restricted due to environmental factors, including their physical environment and social.

The World Health Organization lists a number of activity and participation domains in its Checklist for International Classification of Functioning, Disability and Health (World Health Organization 2003) that should be considered in functional assessments.


Functional assessment domains




Learning and applying knowledge

Solving problems


Receiving and producing spoken message
Receiving or producing non-verbal messages

Domestic life and mobility

Preparing meals
Using transport
Simple exercise (taking stairs, walking short distances)

Interpersonal interactions and relationships

Forming and maintaining intimate relationships
Forming and maintaining social relationships with family and friends
Relating to strangers

A person's functioning in the context of their environment also needs to be considered, including available supports such as family, health and support services, medication, and aids for communication and memory.




2.4           Assessment of need for assistive devices



Assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability.

Assisstive devices and technologies are those whose primary purpose is to maintain or improve an individual’s functioning and independence to facilitate participation and to enhance overall well-being. Examples of assistive devices and technologies include wheelchairs, prostheses, hearings aids, visual aids, and specialised computer software and hardware that increase mobility, hearing, vision, or communication capacities.

The International Classification of Functioning, Disability and Health (ICF) defines assistive products and technology as any product, instrument, equipment or technology adapted or specially designed for improving the functioning of a person with a disability. 

An Assistive Technology Evaluation assesses an individual’s or student’s need for assistive technology use and support, and is a critical component of determining the most efficient Assistive Technology options available. Assistive Technology options may include high or low/light tech devices such as hardware, software, apps on the computer or a mobile device, specialized equipment, modifications or adaptations to current equipment or furniture, and services which will assist an individual to accomplish something that is difficult or challenging.  For some individuals, AT (assistive technology) may support an individual to accomplish a task that is otherwise impossible to do without the support of AT. Whether it is an assessment for access to education, communication, employment, transition to post-secondary education, Activities of Daily Living, or access in their home or community, an assistive technology assessment will provide a thorough determination of AT options available, using a feature matching process to meet the individual needs of the client. Without an AT assessment, individuals and/ or students are often given Assistive Technology that is not efficient or appropriate for the specific, individual needs. This causes frustration and ultimately leads to abandonment of the technology.  Research shows that half and possibly as much as 80% of assistive technology is abandoned by the prospective user.  Too many times this is the result of an unqualified individual or team implementing AT without a proper assessment. The assistive technology needs to be appropriate and recommended specifically considering the  individual’s abilities, challenges, needs, preferred learning style, the task to be accomplished, and the environment in which the AT will be used.  The first and  most important step in the process  is to analyze and determine the right assistive technology via an Assistive Technology Assessment. Having a certified professional assist with this step is critical.

AT assessment process consists of gathering information about what, and how, a student is using AT in order to find ways to meet the needs of the learners by matching the strengths and weaknesses of the learner to the device.

There are three outcomes of the AT assessment process:

Rothstein and Everson (1995) suggest several guidelines for decision making regarding assistive technology that are still applicable even with today’s rapidly changing technology, including:




2.5           Interpreting assessment results to plan the support programme



diagram of assessment cycle

Effective Use of Assessment Results

·      Using assessment results to inform program changes or improvements is perhaps the most challenging final step in the assessment cycle – commonly referred to as ‘closing the loop’.  Linda Suskie (2009) provides invaluable reminders to ensure that assessment results are used effectively and appropriately:

·      Assessment reports that end up briefly perused and then filed without any resulting action are a waste of time.

·      Assessment results should never dictate the decisions; we should always use our professional judgment to interpret the results to help make appropriate decisions.

·      Actively discourage inappropriate interpretations or use of assessment results.  How results have been used in the past has been shown to have a significant effect on people’s willingness to participate in gathering and using assessment information.

·      Prevent problems with closing the loop by carefully planning your assessment.

·      While positive assessment results should be celebrated, even more recognition and reward should go to exemplary assessment efforts.

·      Promote the use of multiple sources of information when making any major decision.

·      Communicate assessment information widely and transparently.


The effective use of assessment results starts with thoughtful planning.  With the collaborative effort of faculty, assessment plans can be designed to produce actionable results.  Sometimes, the use of assessment results can be a challenge, especially when they are perceived as not being relevant, valid or credible.  They may be incomplete or not actionable.  There may have been limited resources or overly heavy faculty workloads that made the task untenable.

So, a great way to start the planning process is:

·      Begin with the mindset that the assessment effort is for discovery, hypothesis testing, and ultimately for enhancing student learning and overall program improvement.

·      Begin with a clear, compelling question(s) about student learning ~ ones that faculty really care about.

·      Discuss and choose the most effective “method” that will answer this question

·      Focus on the fact that the method to collect and analyze the data will affect how the results will ultimately be used.

·      Do a mock-up of the results for discussion.  Discuss these hypothetical results with faculty to improvement the methods to be used.  Interpret what conclusions might be drawn and anticipate what the program would do if the results fall short of expectations.

It is critical that the entire faculty be involved in the discussion of assessment findings and the recommended actions for making program improvements based upon the findings. There are myriad examples of effective uses of assessment results as they relate to the program’s curriculum, budget and resources, academic processes, and promotion and marketing of the program.


Examples of Effective Use of Assessment Results

Curriculum examples might include:

·      Modifying the frequency and schedule of course offerings

·      Adding or removing course from the curriculum

·      Pedagogical models or approaches to be shared among faculty and students

·      Revision of course content or assignments

Budget and resource examples might include:

·      Increasing classroom space

·      Adding lab resources

·      Hiring or re-assigning faculty or staff

Academic process examples might include:

·      Revising course prerequisites

·      Revising criteria for admission to the program

·      Revising advising processes or protocols

Promotion and marketing examples might include:

·      Communicating and celebrating student performance and success

·      Communicating student voices and perceptions to stakeholders

·      Industry feedback from external assessments

·      Including student work on the program website, recruiting materials, fundraising materials or in the self-study